ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PKKCN \ \('Y. 



81 



(ion; has dyspmca. Diagnosis: Ruptured ectopic preg- 

 nancy. Operation, May 18. When the abdomen was 

 opened, about a quart of free blood was found, some fresh 

 with many dark clots of blood. In the left tube, partly 

 extruded, was the specimen contained in the jar. The 

 specimen was placed in 4 per cent formalin and not 

 handled or disturbed. No history could be obtained as 

 to the probable length of time of gestation. The bleeding , 

 of May 7 occurred 2 weeks after her last menstrual period 

 in April." 



The pear-shaped mass, which appears to be a clot peeled 

 out from tube, was cut inlo blocks and microscopic sections 

 were made, one of these being from the middle of the mass. 

 The section passed through the embryo, the amniotic 

 cavity, and the degenerated hemorrhagic chorion. There 

 are but few villi scattered throughout the organized clot 

 of which the mass is composed. It has also within it 

 numerous fibrous strands, often accompanied by many 

 leucocytes. Throughout the clot are scattered degener- 

 ated villi, with but little trophoblast, but occasionally with 

 buds of syncytium. The villi show all stages of degenera- 

 tion, some being necrotic, others infiltrated with leucocytes. 

 The amniotic cavity is encircled with a thin amnion and 

 a degenerated chorion. The embryo stains fairly well and 

 is macerated and disintegrated and appears to be patho- 

 logical. 



No. 686. 



(Dr. Cecil Vest, Baltimore.) 



Tubal mass, 70X50X40 mm. A colored woman, 29 

 years of age, has menstruated regularly every 28 days 

 since her twelfth year. Has one child 11 years old. The 

 patient has been menstruating 3 weeks before entering 

 the hospital. Diagnosis: pelvic abscess, peritonitis, and 

 extrauterine pregnancy. 



The specimen was taken immediately to the laboratory. 

 It consisted of the major portion of one Fallopian tube, 

 much distended and with large tortuous vessels on its sur- 

 face, so that the appearance of a placental site was given. 

 A normal embryo being expected, the muscular wall was 

 carefully opened and much clotted blood was met with. 

 The smooth opening at one end revealed the same picture, 

 so that it was decided to open the entire mass boldly by a 

 transverse razor cut. This procedure showed that an 

 exceedingly large and rather firm clot was responsible for 

 the main mass and that through it villi occurred, so that 

 the degenerating ovum was unquestionably inclosed by the 

 clot. The tubal mass was laid into slabs from 3 to 5 mm. 

 thick, none of the sections revealing the embryo. The 

 material was placed in a sat. aq. sol. of HgCl 2 , to which 

 5 per cent glacial acetic acid was added and fixed 10 hours. 

 While the specimen was in 60 per cent alcohol measure- 

 ments of the entire mass were 70X50X40 mm. The 

 slabs were separated for dehydration. Three sections were 

 cut from different portions of the mass, one of which in- 

 cludes the outer end of the free tube, as the mass has bur- 

 rowed into the tube wall, making a large pocket which 

 communicates with the tube. 



The mucosa of the free tube wall is markedly inflamed, 

 indicating that the tube was inflamed before the ovum 

 lodged in it. The blood clot is well organized and well 

 adherent to the tube wall, which is inflamed and invaded 

 with trophoblast cells. Scattered through the clot are 

 many individual villi in process of degeneration and de- 

 struction. Some are necrotic, but most of them are 

 surrounded with leucocytes. The trophoblast is not 

 extensive and is degenerating, often forming masses of 

 nuclear matter. In one of the sections is a remnant of the 



collapsed ovum, fibrous and practirally without i i 

 phoblast. The ovum is detached and is disint>n "it mi; 

 with a clot in an unruptured tube. 



No. 694. 



(Dr. Tobie, Portland, Maine.) 



(Plate 2, fig. 1.) 



Protruding clot, 30X20X20 mm. in diameter, with a 

 cavity inside. The specimen came out with the ovary 

 attached. This contained a number of follicles, 4 mm. 

 in diameter, and a small corpus luteum t>X7 mm. In 

 the ovary there is also a second cavity (~Xl- r > mm 

 filled with blood and encircled by a corpus lilirosutn. The 

 tube is 40 mm. long and 10 mm. in diameter, except where 

 the clot protrudes. The latter measures 30X20X20 

 mm. and contains a cavity (the en-lorn) 13X7X7 mm. 

 This cavity is a closed one; it is lined throughout with 

 mesenchyme and contains two small white nodules, 1 mm. 

 in diameter, attached to the chorion. Sections through 

 the chorion show the mesenchyme well developed, but the 

 villi are degenerating. Many of them are necrotic and 

 at some places there are large masses of nuclear mallei', 

 remnants of the syncytium. At other points the trophoblast 

 is very active, especially where it comes in contact with 

 the tube wall. Here it is invading the tissues and encir- 

 cling the blood-vessels. Within the blood clot strands of 

 trophoblast run in all directions after being encircled with 

 lymphocytes. 



No. 697. 



(Dr. G. K. Dickinson, Jersey City, New Jersey.) 

 (Plate 7, fig. 5.) 



Tubal mass, 55X30X30 mm. The specimen is from 

 a German woman, 36 years old, this being the sixth 

 pregnancy. The first two were normal; in the third an 

 abortion took place at the fourth month; the fourth 

 ended in a still birth; the fifth was normal. The last 

 child was born on October 10, 1911. Menstruation 

 began in December 1912 and continued until March 

 1913. The uterine hemorrhage, which relates to the 

 present case, started on May 7, 1913. The operation for 

 tubal pregnancy was on June 1, 1913, when the left tube 

 was removed. There was no history suggestive of any 

 pathological process in the uterus; no history whatever uf 

 venereal disease. The specimen was hardened in '2 per 

 cent formalin and sent to the laboratory in this solution; 

 when it came to the laboratory it was found to consist of 

 a rigid tube, the outer half of which measured 55X30X 

 30 mm. It had been cut open by the operator before the 

 specimen was fixed. The incision made in the tube passed 

 through the mass of a clot which was about 20 mm. in 

 diameter. The clot appeared to be well fixed, and within 

 was a cavity lined with membrane, folded in places, which 

 probably represented the amnion. Within this cavity 

 was soft granular tube about 3 mm., probably the embryo 

 The specimen was cut through the outer third and the 

 inner third of the tubal mass. The second cut passed 

 through the embryonic "remnant." Sections through 

 this show what appears to be a degenerate embryonic 

 head, much resembling the lymph follicle, in which then- 

 is a faint outline of the dissociated central nervous system. 

 The inner mass is surrounded with a delicate membrane 

 covered with a single layer of flattened epithelium. The 

 cavity containing the embryo is lined throughout with a 

 degenerated chorion, to which the amnion is attached 

 more or less freely. The chorionic wall and villi show 

 marked fibrous, as well as mucoid, degeneration. Many 



