80 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



well eaten up by the trophoblast, and some of them lie in 

 the clot. The ovaries are very fibrous, being filled with 

 corpora fibrosa. No small Graafian vesicles are present 

 in any of the sections. There is one large one, but the 

 section is not through the ovum. The uterine mucosa 

 seem normal. Mucosa of uterine end of tube inflamed. 



No. 659. 



( Dr. Vest, Johns Hopkins Hospital, Baltimore.) 

 The specimen, secured fresh from an operation upon a 

 white woman by Dr. Russell, consists of a tube with the 

 ovary. Fixed at 9 h 45 m a. m. in hot (40 C.) sat. aq. 

 HgCl 2 and 5 per cent glacial acetic in thermostat at 37 C. for 

 3 hours, then room temperature for 3 hours, then 60 per cent 

 alcohol. March 28, 70 per cent; March 29, 74 per cent. 

 The tube measures 30X15X10 mm. and contains a clot 

 9 mm. in diameter. The ovary contains two large cavi- 

 ties, each fully 15 mm. in diameter; one communicates 

 with the surface through a small opening and the other 

 through a large opening. Both are lined with a narrow 

 layer of lutein cells. The clot lies in the tube, which is 

 almost completely lined with a layer of epithelial cells. 

 It contains a few degenerate fibrous villi. At one point the 

 clot is adherent to the tube wall. Here there is an exten- 

 sive inflammatory reaction, there being many leucocytes at 

 this point. What must be regarded as a few trophoblast 

 cells are also present. 



No. 667. 



(Dr. Swint, Baltimore.) 



Normal (?) embryo. Woman, 24 years old, first preg- 

 nancy. Hemorrhage from March 10 to date of operation, 

 April 5. The tube was found ruptured; the ovum, 20 X 

 12 mm., was protruding from it. The whole tube measures 

 40X30X30 mm. The villi of the ovum are ragged and 

 long, and upon careful inspection it is clear that the ovum 

 has ruptured and turned inside out. The stalk of the 

 umbilical cord is 3 mm. in diameter and 15 mm. long. 

 Undoubtedly the embryo has escaped. Sections of the 

 villi show they are normal in appearance, with a transparent 

 mesenchyme containing blood vessels filled with blood. 

 The trophoblast is quite extensive. Apparently most of it 

 has fallen off. 



No. 670. 



(Dr. Smink, Baltimore.) 



(Plate 2, figs. 3, 7.) 



Normal embryo, CR 12.5, All 9.5 rain. Tube very 

 vascular, just ruptured, and the embryo in its amnion is 

 hanging out. The implanted chorion was cut in position 

 and found to be a beautiful specimen. The chorion seems 

 normal; the epithelial lining of the tube is mostly intact 

 and in many places the extensive trophoblast comes in 

 contact with it. There are beautiful instances of the 

 trophoblast penetrating the maternal blood-vessels and the 

 epithelial lining of the tube, burrowing with gland-like 

 processes into the rmiscle of the tube wall. The chorion 

 and its villi appear normal, but there is much degeneration 

 of the villi where they come in contact with a blood clot, 

 as shown on plate 2. The trophoblast is most active after 

 being piled up in large reticular masses. There are two 

 large hemorrhages between the villi, but in general the 

 intervillous spaces are filled with a clear fluid. In some of 

 the villi there are deep invaginations of the epithelial 

 covering, as shown in the figure. The mesenchyme of most 

 of the villi is very rich in large flat cells which may be 

 resting wandering cells. Pronounced follicular salpingitis. 



FIG. 10. Outline of villas, showing group of cells growing into 

 its mpsonuhyme (No. 670). X 60. The part within the 

 square is enlarged on plate 2. 



No. 673. 



(Dr. Wells, Hartford, Conn.) 



"A day or two ago I sent you a fairly early human 

 ovum. It was from a tubal pregnancy in the fimbriated 

 extremity of the left Fallopian tube, just aborting through 

 the end or possibly the side of the tube. The woman was 

 due to menstruate on February 15, but failed to do so. 

 On March 11 she began to flow, but without pain. This 

 continued for 2 weeks and stopped. Early on April 5 she 

 was seized with a sinking spell, which quickly became 

 severe shock. I was then called. She was kept under 

 morphine until she rallied, and on April 7 I operated on 

 her and removed the specimen which I sent you. It was 

 put immediately into formalin and I hope reached you in 

 good condition. The woman is doing well." 



The unruptured tube measures 16X16X16 mm. It 

 was cut into blocks and inside was found a collapsed ovum. 

 Sections were taken from three parts of the tube. In one 

 of the blocks the ccelom was still present with very thin 

 walls. It must have been ruptured, as it contained blood. 

 In fact there is an indication of the obliteration of the 

 coelom through adhesion of the adjacent walls of the 

 chorion. No blood-vessels are present. The villi show 

 degeneration changes, mostly of the mucoid type. The 

 trophoblast is often extensive, especially when it comes in 

 contact with the tube wall, also elsewhere in the blood clot. 

 This is a fine specimen of the destruction of the ovum in the 

 early stages of development. 



No. 685. 



(Dr. Hundley, Baltimore.) 



A pear-shaped tubal mole, 70X60X50 mm., contain- 

 ing an amniotic cavity 15X10 mm., in which are remnants 

 of a pathological embryo about 12 mm. long. 



German woman, aged 30 years, married 7 years, no 

 children or miscarriages. Menstruated regularly every 

 month until last month, April, when the flow was profuse 

 and painful. May 7 noticed a slight show of blood. 

 Since that date has been bleeding in small amounts to 

 present time. Was taken seriously ill on the morning 

 of May 18 with severe abdominal pain and great prostra- 



