84 



ON THE FATE OP THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



venereal disease. The last period began July 15, 1913, 

 and the previous one 4 weeks earlier. Pain came on 5 

 weeks before the operation, which took place on July 26. 

 A few old adhesions were found ; otherwise, with the excep- 

 tion of the distended tube, everything was normal. The 

 right tube was removed. The unruptured specimen \v;is 

 brought to the laboratory and fixed in formalin. The 

 uterine end is apparently normal and the clot protrudes 

 from the fimbriated end. .Sections were cut from four por- 

 tions of the tube. Those through the uterine end show 

 that the muscle wall is hypertrophied and the tube lumina 

 multiply, about 20 being present in a single section. Some 

 of the lumina end in blind pockets. The fimbriated end 

 appears edematous, possibly a post-operative change, 

 as the specimen is covered with a fungus. However, the 

 blood-vessels are gorged with blood. The two sections 

 through the clot show that it is well organized and contains 

 a collapsed ovum and swollen, degenerated, and necrotic 

 villi. The trophoblast is absent ; the clot is not adherent to 

 the tube wall, but the latter shows some inflammatory 

 reaction. 



No. 741. 



(Dr. Watkins, Baltimore.) 



(Plate 8, figs. 2, 3, 4.) 



Pus tube, 30 mm. in diameter, on the left side, and un- 

 ruptured tubal pregnancy, 70X50X40, on the right side. 



The specimen is from a white woman, 28 years old, mar- 

 ried 2j years ago. No previous pregnancies. No appar- 

 ent venereal disease. Low grade of chronic pelvic inflam- 

 mation, possibly gonorrhea!. Last normal period March 

 16, 1913. Regular and normal till then. Missed three 

 periods and then bled for 10 days. Operation, August 

 14, 1913. Specimen placed in 10 per cent formalin at 



FIG. 11. Outline of tube with ovary attached (No. 741). 



4 p. m. and slabs cut with a Gillette blade at 6 h 15 m p. m. 

 Fresh formalin. The. blade laid bare the ehorion sur- 

 rounded by a large blood clot. The pus tube, which was 

 not opened at this time, is pear-shaped, with the stem 

 kinked upon the body. The larger part, that is, the distal 

 end, measures 30 mm. in diameter and has a very thin wall 

 which is about to rupture. It extends up to the inner 

 opening of the tube. When opened, it is found to be filled 

 with a watery fluid containing some flakes. The middle 

 third of the specimen is also distended, being 15 mm. in 

 diameter, while the inner or uterine end seems to be normal. 



The fimbriated end is closed completely. The unruptured 

 tube is a large, solid mass 70X50X45 mm., to which an 

 ovary is attached. Sections of the specimen show that it 

 is for the most part filled with blood, the ehorion being in 

 the center, triangular in shape, and lined with a smooth 

 membrane. Its greatest diameter is 10 mm. The pus 

 tube on the left side shows marked folding of the mucous 

 membrane. At its uterine end some of the folds resemble 

 the villi of the intestine. There are only a few folds in the 

 tube where it is moderately distended, and very few where 

 it is distended to the maximum. The wall shows no active 

 inflammation. The right tube contains the pregnancy. 

 The uterine end of the muscular wall of this tube is mark- 

 edly thickened, and the mucosa is likewise thrown into 

 folds; possibly there are several lumina instead of one. 

 The fimbria are congested. The distended tube wall was 

 cut through at the site of the ovum, which in section is 5 

 by 15 mm. The ovum is entirely detached from the tube 

 wall. The villi are atrophic and necrotic, forming delicate 

 threads which radiate from the ovum and are extended by 

 means of fibrous bands to the wall of the tube. The clot 

 is partly organized and partly fresh and the tube wall is 

 more or less infiltrated with leucocytes, which in some 

 places form abscesses. The cavity of the ovum is crossed by 

 strands of mesenchyme, and on one side there is a small 

 nodule which possibly is the embryo. 



No. 754. 



(Dr. Kolb, Baltimore.) 



(Plate 3, fig. 2, and plate 9, fig. 3.) 



Ruptured tube, 70X25X15 mm. Ovum 1X2 mm. 



"Jewess, 27 years old, married 6 years; one previous 

 pregnancy, which ended in a normal birth 5 years ago. 

 Last period August 26 to 29, 1913. Operation for ruptured 

 tubal pregnancy, August 30, 1913. No history of venereal 

 disease. The uterus was found slightly enlarged, ovaries 

 and left tube normal in appearance. Right tube and ovary 

 removed." 



The specimen consists of a tube presenting a small rup- 

 ture and a clot protruding from the fimbriated end. It 

 was cut into blocks and sections were taken from three 

 parts of the tube. Those from the uterine end show that 

 it contains a single small lumen. The other sections show 

 a clot with the remnant of the ovum, the clot implicating 

 the wall of the tube more or less in an inflammatory 

 process. Sections show that the muscle is markedly infil- 

 trated with round cells. The blood-vessels of the fimbria 

 are engorged with blood and the folds are matted together 

 with an exudate. Within the tube wall and on its peri- 

 toneal surface are two circumscribed solid masses of 

 epithelial cells. Near the fimbriated end of the tube the 

 sections struck the ovum, which measures about 1X2 mm. 

 It lies detached upon the folds of the tube and some of the 

 villi protrude into an adjacent clot. The villi show all 

 stages of degeneration and necrosis, and the chorionic 

 membrane is almost destroj'ed. At some points it is 

 represented only by necrotic hyaline syncytium. The 

 cwlom is filled with a mottled magma. There are no blood 

 vessels in the ehorion. At no point has the ehorion 

 remained attached to the tube wall. Repeated examina- 

 tions of the blocks and the sections make it impossible to 

 find the point of rupture in the tube. As the tube wall is 

 much infiltrated and as the clot is protruding through the 

 opening of the fimbriated end. it may be that we are not 

 dealing with a case of rupture. In any case the rupture, 

 if any, must have been very small. 



