ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



83 



serum and pus, indicating that there had been an extensive 

 salpingitis with pocket formation of the mucosa. 

 fimbriated end shows a similar inflammation, but no 

 pocket formation. The main mass consists mostly of a 

 clot, partly organized, throughout which is seen much 

 nuclear material representing degenerated syncytium, and 

 i few villi on the loft, most of which show a mUCOld degen- 

 eration of their mesenchyme. The tube wall is somewhat 

 inflamed; its epithelial lining is for the most part wanting. 

 There is no trophoblast in any of the sections. 



No. 728. 



(Dr. Branham, Baltimore.) 

 Tubal mass, 60X40X30 mm. 



Ruptured collapsed tubal wall with several blood clots, 

 some of which are about 5 cm. in diameter. Embryo 

 15 mm (?) The specimen was brought to the laboratory 

 fresh and put in a finger bowl. Among the floating frag- 

 ments were found the tail and legs of an apparently normal 

 embryo about 15 mm. long. All were preserved in f< 

 malin. _ n 



The specimen came from a white American woman, .31 

 years of age, this being her second pregnancy, the first 

 iviving ended at full term. Her last menstrual period 

 began May 8 and continued to May 15. On May 29 she 

 began to bleed. When she consulted Dr. Branham, he 

 found that the uterus was markedly enlarged, and on 

 July 17 she was operated on for tubal pregnancy. At the 

 time of the operation, it was found that the left tube had 

 ruptured near its distal end. No history of venereal 

 disease The specimen consists of two large blood clots, 

 a collapsed tube, which has been opened throughout its 

 length, and one ovary, to which a piece of the tube is 

 attached. This piece is apparently the fimbriated end. 

 Within the ovary is a cavity filled with gelatinous fluid, but 

 there is no hemorrhage. The lower part of the embryo 

 which accompanies this specimen appears to be normal, 

 as the legs are well formed. 



Sections were made through the middle of the cavity 

 which contains the embryo and through the large vesicle 

 of the ovary. The section through the thick wall of the 

 ovum shows that the chorion is well infiltrated with leuco- 

 cytes and the villi are matted together with bloody 

 syncytium and an organized clot. The epithelium cover- 

 ing many of the villi is necrotie, and at these points are 

 large accumulations of leucocytes, showing that there was 

 a very active inflammatory process before the tube was 

 ruptured. At some points on the surface of the clot there 

 is considerable activity of the trophoblasts. Elsewhere the 

 cores of the villi show various kinds of degeneration, both 

 fibroid and mucoid. Sections through the vesicle of the 

 ovary show that it is completely surrounded with a well- 

 formed corpus luteum. Outpocketings are present in mid- 

 dle portion of the tube. 



No. 729. 



(Dr. H. G. Sloan, Cleveland, Ohio.) 



(Plate 10, figs. 3, 4, 5,) 



Ruptured tube 20X10 mm., embryo 8 mm. 1-rom 

 a white woman, aged 25, who was married in 1907. 

 She has had four pregnancies. In the first two abortion 

 took place at 6 weeks; the third ended in the birt 

 of a healthy child at term, and the fourth is this tubal 

 pregnancy. ' The last period was from June 22 to 25, 1913. 

 The operation for tubal pregnancy, following rupture 

 of the tube, was performed on July 16. At the time of the 

 operation it was found that the right tube had ruptured 



at a point 1 cm. from the uterus, and the fimbriated end 

 of the left tube was inverted and closed by adhesions. 

 The patient acquired syphilis in 1905, and she had a 

 doubtful history of gonorrhea. She came from a large 



family. 



The specimen, which was fixed in formalin, was received 

 at the laboratory on July 19, 1913, and immediately 

 placed in fresh 10 per cent formalin. It consisted of a 

 small piece of tube, which is about 20 mm. long and 10 mm. 

 in diameter. It is distended with a blood clot and on one 

 side a rupture has occurred which has allowed the ovum to 

 protrude. The ovum is covered with so extensive a mass 

 of villi that it seems to be composed almost exclusively of 

 them. The entire embryonic mass is 8 mm. long; the indi- 

 vidual villi are 4 mm. long and branch two or three times. 

 Sections were cut in celloidin through the uterine end of the 

 tube and through the middle of the rupture. The ovum 

 was embedded in paraffin and cut into serial sections. 

 The general appearance of the specimen and some of the 

 villi are shown in the figure. The sections through the 

 uterine end of the tube show that the mucosa is thrown into 

 folds, but there is no indication that they are adherent. 

 At one point there is a marked diverticulum of the epithelial 

 layer of the mucosa, producing a distinct glandular appear- 

 ance. Sections through the point of rupture are inter- 

 esting. They show that the trophoblast is eating into 

 the tube with great force, and at the point of rupture it 

 has naturally destroyed the whole muscular coat. In the 

 vicinity the tube wall is hemorrhagic and inflamed. On 

 the broad-ligament side the process is extremely active. 

 The syncytium is active and vascular and is being invaded 

 by tissue's which are destroying the sides of the large 

 arteries. The hemorrhages thus produced are barred off 

 by the extended wall from which the trophoblast has pro- 

 truded. There is very little hemorrhage between the villi, 

 and at points where they are engulfed with blood they are 

 necrotie and invaded by the leucocytes. 



The ovum is covered with irregular villi, which indicates 

 that it is pathological. The serial sections show that the 

 villi are somewhat fibrous, but most of them contain well- 

 defined blood-vessels, indicating that a recent but normal 

 embryo must have been present. The wall of the chorion is 

 torn, thickened, and collapsed, and contains a small amount 

 of free blood. The ccelom is well filled with many folds of 

 the amnion, and through the opening in the chorion the 

 umbilical cord protrudes. The structure of the amnion 

 appears to be quite normal, but the chorion and cord are 

 somewhat fibrous. Toward the free end of the cord it is easy 

 to make out two arteries, while at its'tip there is an irregular 

 ragged mass of cells, indicating that the cord has been torn 

 from the body of the embryo. The examination of the 

 specimen indicates that we are dealing with an ovum 

 which contained a normal embryo at the time of the rup- 

 ture and that shortly before the operation the embryo 

 escaped from the ovum; however, enough time must have 

 elapsed to allow for the secondary changes, as indicated by 

 the fibrous end of the cord and the irregular form of the 

 piece of the embryo which remains attached to the cord. 

 Sufficient time elapsed to allow the injured cord to fall 

 apart. The uterine end of the tube consists of multiple 

 lumina. 



No. 734. 



(Dr. Vest, Baltimore.) 



(Plate 9, figs. 1, 2.) 



Unruptured tube, 50X25X25 mm. The specimen is 

 from a colored woman, 33 years old. She has had two 

 full-term children, but no miscarriages. No evidence of 



