78 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



No. 554. 



(Dr. W. B. Hetfield, Brooklyn, New York.) 

 50X20X20 mm. nodular embryo, 1 mm. long. Un- 

 opened tube sent fresh. It was placed in formalin at once 

 and later cut into blocks. The clot within is closely 

 adherent to the tube wall, and contains a cavity 20X10 

 mm. At one point in the ccelom is a flattened nodule, 

 composed mostly of round cells, and undoubtedly the rem- 

 nant of the embryo. The villi are irregular, fibrous, and 

 degenerating; some are necrotic. The chorion contains 

 blood vessels. There is not much trophoblast and the 

 leucocytes are very numerous, often invading the villi. 



No. 561. 



(Dr. Sperry, Baltimore.) 



Operation January 8, 1912. Menses regular until 

 October 17; then the period was missed until November 

 27. Profuse bleeding for the last few days. No decidua 

 found in the uterine scraping. There was a tubal preg- 

 nancy near the uterine end. The tube measured 28X22 

 X22 mm. It was cut into blocks after it had been hard- 

 ened in Zenker formalin solution. Within was a collapsed 

 ovum. Part of the villi had degenerated and blood had 

 entered the coelom. There were no blood-vessels in the 

 chorion. The villi were partly fibrous and partly mucoid; 

 where they reached the tube wall some were well formed 

 and covered with trophoblast. The chorion was well 

 implanted in the tube wall, but most of it lay in its lumen. 

 There were, however, cyst-like spaces in the wall lined with 

 epithelium, which were possibly pockets from the lumen of 

 the tube. A curious granular mass stained intensely with 

 hemotoxylin was present among the villi. Similar masses 

 were seen in other specimens. Strands of fibrous mesen- 

 chyme extended into the ctt'lom. These possibly rep- 

 resent the remnants of the embryo. Multiple lumina in 

 uterine end of the tube. 



No. 567. 



(Dr. T. Cullen, Baltimore.) 



(Plate 2, fig. 5; plate 7, fig. 1.) 



Embryo 5 mm. long. 



"Admitted to the Church Home, January 31. The 

 periods began at 14 and have always been regular, coming 

 at intervals of 21 days and lasting about 5 days. There has 

 been no history of intermenstrual bleeding, nor other 

 disturbances with menstruation. Her periods have been 

 at times associated with some backache. Present illness: 

 About 2 weeks ago the patient began to menstruate, the 

 previous period having been 3 weeks before, no longer time 

 than this having ever elapsed between periods. This time 

 bhe commenced to suffer with abdominal pain, which grad- 

 ually decreased with cessation of the menstrual flow. 

 A week later, one week before admission, she began to 

 bleed again and to suffer severe abdominal pain which 

 she described as cramps. The bleeding has become worse 

 each day during the past week until her admission to the 

 hospital." 



Tube 55X30X25 mm., filled with blood and contain- 

 ing a cavity 15X10 mm. lined with a smooth wall. After 

 a long search the embryo was found. As it was markedly 

 dissociated and macerated, only the main features could 

 be made out. The embryo and villi show remarkable 

 changes. The villi are partly necrotic, fibrous, and 

 mucoid. Some have large vesicles, making them appear 

 much like fatty tissue. The trophoblast is extensive and 

 invades the tube wall. The mesenchyme of the main wall 



of the chorion is very thin, having dissolved itself into the 

 ccelom. Pockets in middle of the tube (?). 



No. 570. 



(Dr. Hunner, Baltimore, Maryland). 



(Plate 3, fig. 1.) 



Patient aged 24, married lo months. In March 1911, 

 after missing two periods and after heavy lifting, she had 

 a miscarriage at about 6 weeks and curettagefor secundines. 

 She has felt well since the miscarriage in March 1911 and 

 has had regular periods, the last period beginning Decem- 

 ber 26. On January 9 she began to bleed, only a small 

 quantity of thick, dark blood. This has continued ever 

 since up to the day of operation, February 9. When the 

 period was due, January 24, there was an apparently normal 

 bleeding for a few days. On January 13, on coming home 

 from theater, she complained of a heavy feeling in the lower 

 abdomen, which was almost more than she could bear. 

 On January 15 she had a similar pain. After this she had 

 no pain or ache until February 3, when, before getting out 

 of bed, she was seized with a sudden pain beginning in the 

 lower right side and continuing for 2 or 3 hours. This 

 was relieved after coming downstairs and taking some hot 

 coffee. 



She was examined on February 8. The abdominal 

 walls were rather tense; there was slightly more resistance 

 and tenderness in the right pelvis. No attempt was 

 made to outline a mass for fear of rupture. On February 

 9, a vaginal exploratory incision was made posterior to 

 the cervix, and a small amount of bloody fluid was found 

 in Douglas's pouch. The right tube was delivered and 

 excised. The right ovary was normal. The left ovary 

 and tube were not seen but seemed to be normal. No 

 recent Graafian follicle was found in the right ovary. 

 Tube, 30 mm. long, opened by Prof. Brodel, who probed 

 out a clot, measuring 25X14X8 mm. This was hardened 

 in corrosive acetic mixture. 



A collapsed irregular ovum, embedded in a curious 

 fibrous mass, was found. The chorion consists of a rami- 

 fying mass of tissue without blood-vessels or typical villi. 

 There is very little trophoblast. 



No. 575. 



(Dr. Hunner, Baltimore.) 



(Plate 2, fig. 4, and plate 7, figs. 2, 3.) 



Tube, 50X30X25 mm. The tube came unopened 

 and was hardened in formalin. Later it was cut longitu- 

 dinally and found to contain a blood clot 40X23X18 mm. 

 Sections through the clot show a collapsed ovum with a 

 coelom about 5 mm. in diameter. The clot is well organ- 

 ized and ramifying through it are fibrin bands, among 

 which are many leucocytes. The villi show all stages of 

 degeneration, fibrous and mucoid. Many are necrotic. 



No. 576. 



(Dr. Sperry, Baltimore.) 



Embryo, CR 17, AR 16 mm, Normal ovum kept in 

 normal salt solution for 8 hours, then placed in formalin. 

 The tube measures 60X40 mm., the cavity 30X30X25 

 mm. Within the wall of the tube is a layer of blood 

 into which the ovum has implanted itself. The villi 

 enter the clot as tufts and look quite normal. At their 

 tips the trophoblast enters the blood clot, and along fibrin 

 strands leucocytes radiate. Numerous atrophic villi are in 

 the clot. The ovum as a whole peeled out easily. It is 

 completely covered with beautiful villi. 



