86 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



No. 772. 



(Dr. Lowsley, New York.) 

 Unruptured tubal mass, 30X20X15 mm. 

 The last period began June 23, 1913, and the bleeding 

 continued for 15 days. Operation, July 9. The specimen, 

 preserved in formalin, came with the ovary attached. 

 The tube is kinked upon itself and shows a disteution in 

 its middle portion, which is filled with a clot of blood, 

 12 mm. in diameter. There is a second specimen in the 

 bottle which appears to be a portion of the other ovary 

 with a corpus hemorrhagicum in it. Sections were made 

 through both ovaries, through the middle of the enlarge- 

 ment and the distal and proximal ends of the tube. The 

 uterine end of the tube appears to be normal; the lumen 

 is well denned and folds of the mucosa are covered with a 

 beautiful epithelium. The fimbriated end also appears 

 to be normal. Between the folds there is some blood and 

 possibly a little exudate. The clot within is well organized, 

 is fully detached from the tube wall, and shows strands of 

 fibrin running through it. 

 Along these strands are many 

 leucocytes and also rows of 

 trophoblast cells. The scat- 

 tered villi show all stages of 



4/ ^%^ *'?^|jt/ degeneration, but near the 



surface of the clot a small 

 group of these is covered with 

 an active mass of tropho- 

 blasts. Here there is a pro- 

 nounced syncytium. The 

 clot as a whole peels out of 

 the tube wall very readily, 

 showing that the chorion did 

 not attach itself to any por- 

 tion of its wall. 



Fio. 13. Outline of tube 

 with ovary attached (No. 

 772). X \. 



No. 773. 



(Dr. Lowsley, New York.) 



Unruptured tube, 55X20X15 mm. The specimen, 

 without any history, was given me, hardened in formalin. 

 It is spiral-shaped, as the figure shows. Sections were 

 cut from parts of the tube, which were found filled with an 

 organized clot. At some points the strands of "fibrin" 

 seemed to represent a disintegrating ovum. The uterine 

 end of the tube seems quite normal; the fimbriated end is 

 somewhat hyperemic. The intermediate portion of the 



FIG. 14. Outline of kinked tube before it was opened (No 

 773). X . 



tube contains a well-organized clot, which is reticulated; 

 in the meshes are fresh hemorrhages. In the middle of 

 each area of fresh blood there is usually a villus, indicating 

 that the fresh blood entered the clot along the hues of the 

 villi. There is quite an extensive leucocytic infiltration 

 around the clot and along the fibrin bands. The clot is 

 attached to the tube wall at one point only in a pocket; the 

 epithelial lining and folds are intact. 



No. 775. 



(Dr. Lowsley, New York.) 



(Plate 10, fig. 1.) 



Unruptured tubal pregnancy, 70X40X35 nun. The 

 tube is filled with an organized clot, within which lies a 

 collapsed ovum radiating from the center to the periphery 

 of the clot. The walls of the chorion have collapsed to 

 form a plexifrom structure with occasional cavities in the 

 chorion. It is entirely uecrotic. On the periphery is a 

 zone of leucocytes. On one side the tube wall is intact; 

 it is markedly infiltrated and gradually merges on the 

 other side with the clot. 



No. 777. 



(Dr. Tobie, Portland, Maine.) 



Unruptured tubal pregnancy, 75X55X55 mm. From 

 un American woman, 28 years of age, married twice within 

 five years. She was never pregnant before, although her 

 first husband was the father of children by another wife. 

 The first husband probably had gonorrhea. The patient 

 conies from a fertile family. She has been treated for 

 tenderness over the left ovary, probably a pyosalpinx. 

 Her last period was from July 4 to 8, the flow continuing 

 until the time of the operation for tubal pregnancy, Sep- 

 tember 30, 1913. The left tube and ovary were found 

 matted together with a large amount of blood. This tube 

 was removed. 



Upon examination of the specimen a very large oval, 

 unruptured tubal pregnancy is found, which is quite vas- 

 cular. The dimensions are 75X55X55 mm. It is com- 

 pletely filled with large, partly organized blood clots, 

 in the center of which is a stellate cavity about 5 mm. in 

 diameter, which probably represents the cavity of the 

 ovum. The clot is mottled with fresh masses of blood, 

 showing that the hemorrhage in the tube has been continu- 

 ous. The clot is not attached to the tube wall, which is 

 lined with folds more or less matted together. The tube is 

 inflamed and is encircled by a thick inflammatory deposit. 

 Within the clot are a few necrotic villi, but very few signs 

 of nuclear dust. Nor have the leucocytes permeated the 

 clot to any marked extent. A few detached tubal folds in 

 the clot are surrounded with leucocytes. 



No. 784. 



(Dr. Iseman, Chicago.) 



Ruptured tubal mass, 75X35X35 mm., dumbbell- 

 shaped. Pathological embryo, 5 mm. long. The speci- 

 men is from an American woman, 41 years old, who was 

 married 14 weeks before the operation. She had not been 

 pregnant before. No history of venereal disease. She 

 had suffered from chronic catarrhal and interestitial 

 inflammation of both tubes and chronic pelvic peritonitis. 

 She came from a very fertile family. The last period 

 began August 2 and continued until August 6, 1913. 

 On September 2 the patient began flowing in the usual 

 way, but the flow did not stop at the end of 4 days, con- 

 tinuing until the time of the operation, October 2. On 

 September 20 the patient had severe pains and all of the 

 symptoms of rupture of the tube. At the time of the 

 operation the uterus was found to be somewhat enlarged 

 and soft; the cervix was very soft. There was no infection. 



The entire mass consists of a tube apparently ruptured, 

 which has also been cut into. One of the enlargements 

 contains a cavity from which a very delicate membrane 

 protrudes. At the bottom of this cavity is an elongated 

 embryo, showing arm and leg buds. The straightened 

 embryo measures S mm. On account of its smoothness, 

 the shape of the head and extremities, it may be normal; 



