ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



77 



evidently from a peritonitis. Menses regular. Four 

 months ago there was a recurrence of pain, but no irregu- 

 larity of menses. The uterus is retroflexed and adherent. 

 There is tenderness up to the left, where a cystic movable 

 mass is felt, anterior to the uterus. Abdominal section 

 April 2, 1911. There was free blood in the abdominal 

 cavity and signs of an old pelvic peritonitis. On the left 

 side was a thin-walled tube on the point of rupture. This 

 ruptured and an organized clot was extruded, in the 

 middle of which a set of membranes were found attached. 

 The right tube was closed and filled with altered blood and 

 adherent. Mass 40X30X30. Within there is a deep 

 cavity containing a vesicle and a folded amnion, both 

 attached to the chorion at the same point. The cord is 

 broken and appears normal; no embryo found. Sections 

 show a granular mass in the vesicle. The chorion and 

 amnion appear normal, the former containing blood-vessels. 

 The villi and trophoblast show marked changes, hyaline 

 degeneration of the syncytium with destruction of its 

 nuclei often appearing as a mass of bacteria (?). From the 

 appearance one would say that normal development had 

 gone on until a short time before the operation, when the 

 specimen became 'detached' or 'strangulated.' " 



No. .519. 



(Dr. Hunner, Baltimore.) 



(Plate 6, fig. 7.) 



Unruptured. The kinked unopened tube with one 

 ovary was sent to the laboratory. An organized clot 

 found in the tube measured 25X20 mm. There was an 

 open cavity in the ovary. Sections show only a few scat- 

 tered fibrous villi in the organized clot. At some points 

 large masses of leucocytes occur; at others these few tro- 

 phoblast cells are invading the clot. 



No. 520. 



(Dr. Harvey, Troy, New York.) 



Unruptured. The tube was distended with a large 

 clot, which peeled out easily. It measures 60X35X30 

 mm. On the outside of the clot is a gelatinous mass 

 5X3X3 mm., which in sections appears to be the rem- 

 nant of the ovum. From this a long fibrous process, a 

 villus, enters the clot. Other fibrous villi are present: 

 the leucocytes segregate in the middle of the clot. 



No. 524. 



(Dr. E. Cullen.) 



The mass measures 70X60X50 mm.; within it has a 

 cavity, 25 mm. in diameter, lined with a smooth mem- 

 brane, to which is attached a hemorrhagic mass. This is 

 14 mm. long and continuous with a gelatinous cord, 15 

 mm. long and 2 mm. in diameter. The wall of the chorion 

 is well denned. It is lined with the amnion, and the umbil- 

 ical cord ends in a membrane which may represent the body 

 wall of the embryo. There are definite blood-vessels in 

 the cord and in the chorion. It appears as if the embryo 

 hail reached an advanced stage of development, and then 

 had been destroyed by trauma or otherwise. The villi 

 of the chorion are all in a partly organized clot with many 

 leucocytes and trophoblast cells scattered through it. At 

 some points long streams of trophoblast run from the villi 

 through the clot into the wall of the tube, where they linn 

 a blood sinus. The villi are very irregular in form, often 

 denuded of trophoblast and invaded by leucocytes. At 

 other points are beds of syncytium. Follicular salpingitis. 



No. 535. 



(Dr. R. B. Slocum, Wilmington, N. C.) 

 Embryo CR 11 mm. The tubal mass measures 60X 

 55X50 mm. and is Unruptured. It is lined with a smooth 

 membrane, both chorion and amnion, and contains a dis- 

 torted, but apparently normal, embryo. There an- no 

 j external branchial arches, the ribs are easily seen and the 

 | eye measures 0.6 mm. The tube wall and the rhorion is 

 one thick organized clot with villi in all stages of degener- 

 ation. The inflammatory process has invaded the entire 

 tube wall that is, the villi are almost destroyed. They 

 are irregular and have but little trophoblast over them. 

 No blood-vessels are in the villi, although numerous free 

 blood-cells are in the meshes of the mesenchyme. Much 

 of the trophoblast is necrotic. 



No. 539. 



(Dr. Mayo, Baltimore.) 



A multipara, 27 years old, came complaining of pains 

 in the left side. The period was one day overdue, but has 

 always been irregular. The specimen has been somewhat 

 injured. The tube is 40 mm. long and 8 in diameter. At 

 certain points a blood clot is protruding from the lumen. 

 Sections show a well-organized clot with much fibrin and 

 many leucocytes. In the clot are scattered degenerated 

 villi of irregular size, some distended and decidely mucoid 

 in nature, others fibrous. There is very little trophoblast 

 present, and many of the villi are being invaded by leuco- 

 cytes. 



No. 540. 



(Dr. Mayo, Baltimore.) 



(Plate 6, fig. 6.) 



The patient is 35 years old and has had one child, 10 

 years old. A year ago she had acute pelvic inflammatory 

 disease, and since that time has had continuous bleeding. 

 An operation for chornic pelvic inflammatory disease 

 was instituted, and a tubal pregnancy was found. The 

 unruptured tube, measuring 50X16X16 mm., was hard- 

 ened in loto. It was filled with a blood clot, 14 mm. 

 in diameter. The blood clot fills the lumen of the tube 

 and with it is a small collapsed ovum. Irregular villi 

 ramify from it throughout the clot. Within the clot they 

 are fibrous, but at its periphery they have an extensive 

 and active trophoblast, which encircles the tube wall as 

 well as the clot. The tube wall also contains masses of 

 leucocytes, and is being destroyed rapidly. Outpocketings 

 in uterine end of tube. 



No. 553. 



(Dr. Roeder, Grand Island, Nebraska.) 



A Syrian, age 26, nursing her first child, which is now 

 13 months old. Started menstruating four months ago. 

 Had two periods and then missed two. Operated on No- 

 vember 8, 1911, for pain in left lower abdomen. Blood 

 clots were found in the peritoneal cavity. The left tube of 

 a pregnancy of about 2 months was removed. It measured 

 50X23X23 mm. and contained a clot 30X15 mm.; this 

 appears to contain a collapsed ovum. Sections show 

 that the ovum is collapsed; in one section it is hourglass- 

 shaped. Irregular villi with a scanty trophoblast are 

 scattered through the organized clot. There is some tro- 

 phoblast in the tube wall. This ovum had failed to remain 

 implanted. There were no embryo blood-vessels in the 

 chorion. Mucous membrane of fimbriated end normal. 



