76 



ON THE FATE OF THE HUMAN EMBRYO IN TTJBAL, PREGNANCY. 



No. 495. 



(Dr. C. F. Davidson, Easton, Maryland.) 



(Plate 6, fig. 3.) 



The specimen, which has been cut open, measures 30 X 

 25X25 mm. The cavity within, which has been cut into, 

 was about 6 mm. in diameter. On one side of the cavity is 

 a small nodule which, when sectioned, is found to be a clot 

 of blood. No embryo is found. The cavity is lined with 

 a smooth, fibrous membrane, the chorion; there is no 

 amnion. The villi are also very fibrous, being covered with 

 a scanty trophoblast. Between the chorion and the wall 

 of the tube, which is very thin, is an organizing clot of 

 blood. Scattered through it there are groups of chromatin 

 granules from syncytium and also of leucocytes. At 

 points the syncytium is invading the mesoderm of the 

 chorion. 



No. 490. 



(Dr. Lee, New London, Conn.) 



Normal embryo, CR 18 mm. Patient 37 years of age, 7 

 years previously had been delivered of a normal child. 

 The present illness was believed to be due to a tubal preg- 

 nancy of about 6 weeks duration. A ruptured tube was 

 found on the left side and an embryo 18 mm. long. One 

 ovary was removed. The chorion was free and appeared 

 to be normal. It was not cut. Sections of the tube wall 

 show that very few fibrous villi were present. 



No. 497. 



(Dr. Walter Tobie, Portland, Maine.) 

 Embryo, normal, CR 43 mm. Ruptured. The tube 

 wall was sent to me. 



No. 503. 



(Dr. Hunner, Baltimore.) 



Normal embryo, CR 13 mm., AR 11 mm. 



"Mrs. D., age 28 years, admitted to the Johns Hop- 

 kins Hospital May 9, 1911. Clinical diagnosis, ectopic 

 pregnancy right side. Has two children, youngest 3^ 

 years old. She last had her menses normally on February 

 6. The following week, three weeks ago, she began to 

 bleed and has been bleeding ever since. Has passed no 

 clots, but the blood manifests itself as a stain and is not 

 much in quantity. Since the onset of this bleeding the 

 patient has had intermittent cramp-like pains in the 

 lower abdomen, of from five to ten minutes' duration. 

 On account of these she has been in bed for the last two 

 weeks. Her stomach is intolerant of medicines. Before 

 the peritoneum was opened through a median-line incision 

 a blood clot was made out beneath. The right tube was 

 large and distended with blood clot. The tube was re- 

 moved and opened, the blood clot was exposed, and in it 

 a fetus was found. The appendix was then exposed; 

 it was long, thickened, bulbous at the end, and bound up 

 in adhesions. 



The mass measured 50X40X30 mm. The specimen 

 had been in salt solution all night in a cool place. Next 

 morning it was fixed in formalin. The tube was well 

 ruptured, and the chorion, which was hemorrhagic, was 

 exposed. Amnion about 15 mm. in diameter. Head of 

 embryo crushed, but specimen appeared normal. The 

 sections are hard to interpret. The folds of the tube are 

 very large; in them may be seen great blood sinuses. The 

 organized blood as well as the tube wall is being invaded 

 by trophoblast. Villi irregular, with extensive trophoblast 

 and syncytium. Some villi degenerating and invaded by 

 leucocytes. Main wall of chorion thiu and covered with 

 syncytium. 



No. 507. 



Ruptured tubal pregnancy brought from the Johns 

 Hopkins Hospital by Dr. Evans. Specimen 50X35X30 

 mm., its cavity lined with a smooth membrane. No 

 embryo found. Tissues quite hard, and do not stain well; 

 apparently necrotic. History and specimen unsatisfac- 

 tory. No follicular salpingitis on fimbriated side of ovum. 



No. 513. 



(Dr. T. Cullen.) 



Unruptured. Placed immediately in strong formalin. 

 It measures 70X30X30 mm. Later it was cut into slabs 

 and in one of them was found a collapsed ovum. At one 

 point some of the villi of the chorion were quite free. The 

 coelom was filled with granular magma, and within it there 

 was a sac, about 6 mm. in diameter (the amnion). No 

 embryo found. The clot was well organized, being also 

 encircled with a wall of leucocytes. Ovum collapsed, the 

 villi irregular and fibrous, some long and slender and end- 

 ing as a club. Trophoblast scanty; at some points it had 

 degenerated completely, leaving a hyaline mass with gran- 

 ules of chromatin. Some showed a mucoid degeneration. 

 Others had been invaded by trophoblast or by leucocytes. 

 All kinds and stages of degeneration were apparent. 

 There were blood-vessels in the chorion. Outpocketings 

 in middle portion of tube. 



No. 514. 



(Dr. Harvie, Troy, New York.) 



The tube measures 15X8X8 mm. and contains a 

 small clot. Hardened in formalin. Sections show a few 

 degenerate villi, some only as shadows, others hyaline, and 

 a few with a number of buds of syncytium. Trophoblast 

 scanty, often missing entirely. 



No. 515. 



(Dr. Ernest Cullen.) 



Ovum 17X14X11 mm. Operated upon by Dr. Cullen, 

 April 13, 1911. Patient colored, age 33 years; was in col- 

 lapse; hemoglobin 20 per cent. Ruptured ectopic preg- 

 nancy was suspected. The peritoneum was full of blood; 

 the tube was found ruptured near the isthmus. Many 

 clots and apparent placental fragments were floating free. 

 The left (?) tube and ovary were removed. Among the 

 free fragments an ovum (about 12X15 mm.) was discov- 

 ered; it showed many branched, rounded villi, averaging 1.5 

 to 3.5 mm. in length. An apparently normal yolk-sac, 

 3X5 mm. (?), with vessels. No trace of embryo. Speci- 

 men in bichloride acetic. (Beautifully fixed material.) 



The specimen shows villi normal in shape. It had been 

 split open by Dr. Evans. Repeated examinations revealed 

 only a smooth internal surface without amnion or embryo. 

 It was stained in lolo and cut into serial sections. There 

 are blood vessels in the chorion but no amnion; possibly 

 there are some remnants of an embryo. The villi appear 

 to be fibrous, the trophoblast is scanty, and some of the 

 syncytium has undergone hyaline degeneration. Corpus 

 luteum apparently not normal; infiltrated with round cells 

 which often look like the follicles of the lymph gland. Sec- 

 tions of tube normal. 



No. 517. 



(Dr. Sommer, Trenton, New Jersey.) 



"The history is indefinite, as the patient does not speak 

 English and the data were only imperfectly obtained 

 through an interpreter. Age 34, Italian, multipura, 

 married 5 years. One year ago she had pelvic pain, 



