ON THE FATE OP THE HUMAN EMBRYO IN TUBAL, PREGNANCY. 



87 



the fact, however, that the amniotic sac measures 15 mm. 

 in diameter speaks against it. Upon further study it 

 appears as though the specimen had not been ruptured, 

 but opened by the operator. Also, in moving the embryo 

 around slowly in formalin, it naturally rolls upon itself, 

 taking a normal form, the greatest length of which is 

 5 mm. 



Sections through the tube wall show that the chorionic 

 membrane, villi, and tube form a continuous mass, being 

 tied together by an inflammatory hemorrhagic mass. 

 There are some degenerate villi attached to the peritoneal 

 side of the wall, showing that the tube had ruptured before 

 the operation. Many of the villi are well formed, being 

 covered also with an active trophoblast. This often ex- 

 tends away from the villi in long streams, which are lost in 

 the blood clot or which are extended to the peritoneal side 

 of the tube by means of fibrin bands. Much of the syncy- 

 tium is necrotic, some is vaeuolated, and some shows 

 nuclear fragmentation. The mesenehyme of the villi 

 shows a variety of forms of degeneration and some of 

 them contain blood-vessels. The chorionic wall is quite 

 thin and apparently normal. Serial sections of the em- 

 bryo show that it is markedly deformed, the tissues are 

 dissociated, and the individual organs can not be outlined. 



No. 787. 



(Dr. Sanderson, Canandaigua, New York.) 

 Unrupturc-' tube, 40X11X11 mm. From an Ameri- 

 can woman, 28 yrnrs old. She had been married 7 years 

 and this is her first pivgnancy. Last period from Septem- 

 ber 15 to 20; operation, October 26, 1913. Periods had 

 been normal and regular. No history of venereal diseases. 

 At the operation it was found that the uterus was small, 

 but in normal position. The ovaries and other tubes were 

 apparently normal. There is a tendency towards sterility 

 in the family. 



The specimen consists of 4 blood clots, the largest of 

 which is 2 cm. in diameter, and an unruptured tube 40 

 mm. long and 11 mm. in diameter. The distention is near 

 the fimbriated end. A number of blood clots have been 

 formed from the blood which has leaked into the peritoneal 

 cavity. Sections were taken from the tube in three places. 

 At the uterine end the folds were matted together, almost 

 obliterating the tube lumen. A number of gland-like 

 ducts extend into the muscle wall. At the fimbriated 

 end a similar condition exists. In the center of the tube 

 the folds of the mucosa form a dense plexus all around the 

 tube and the clot in the center is well organized. There 

 are numerous fresh hemorrhages. At one point is a small 

 group of fibrous villi between the clot and the mueosa. 

 In the neighborhood of these the mucosa is infiltrated with 

 fresh blood, showing the source of the hemorrhage. In 

 some of the sections is a group of peculiar cells, which line 

 part of the tube wall. They may be trophoblast cells. 



No. 790. 



(Dr. Darling, Milwaukee.) 



Tubal mass, 75X45X40 mm. Embryo, 20 mm. long. 



"The specimen was removed by Dr. F. Munkivity and 

 myself and submitted to Dr. Bunting for diagnosis, ;is it 

 appeared to be one of true implantation of the phu-rnta. 

 At the lower angle of the opening incision in the specimen 

 the fetal cord was attached to the cavity wall or rather to 

 the placenta, which in turn was here implanted. To us the 



FIQ. 15. Outline of small tube containing a remnant of an 

 embryo (No. 7S7). X 5. 



FIG. 16. Tubal pregnancy which has broken into the broad 

 ligament (No. 790). X f. 



tissue beneath this appeared to be ovarian. When fresh 

 the yellow lutein tissue at this point was very distinct." 



Patient, a German American, 28 years old, this being 

 her first pregnancy. Married in 1906. Last period 

 January 20-26, 1913; missed February 20; nausea, with 

 abnormal appetite. Operation, April 21. In 1906, the 

 year of marriage, the patient bled every 2 weeks for 2 or 

 3 days; no pain. A surgeon removed two cervical polypi. 

 Bleeding ceased for a year, when the same thing again 

 occurred. Polypi were then removed. In 1909 polypi 

 were again removed. No other previous history bearing 

 on condition. In 1913 intermittent bleeding from Febru- 

 ary 23 until April 21. Pain in side April 20. Uterus 

 enlarged to size of two months' pregnancy. No venereal 

 disease discoverable, nor is there a history of it; no dis- 

 charge. The husband denies gonorrhea. Left adue.xa 

 normal. Very little blood in abdominal cavity. Tube 

 unruptured, but distention threatened. Peritoneum vel- 

 vety and slightly torn by distention. 



This specimen is said to be an ovarian pregnancy. The 

 entire mass measures 75X45X40 mm. At one end the 

 specimen has been opened and contains a cavity, 28 mm. 

 in diameter, which is lined with a smooth membrane and 

 contains a distorted and much injured embryo, apparently 

 normal in form, but adherent at the back of its neck to the 

 wall of the ehorion. This anomaly is due to a stitch. 

 The adhesion is composed of delicate fibers. The speci- 

 men was cut into slabs, 4 mm. in thickness, and was found 

 to be the hemorrhagic wall of the ovum, that is, the ehorion 

 lined with a shell of tough tissue, which may or may not 

 be the ovarian tissue. This is to be determined after the 

 sections have been cut. 



Sections were cut from four of the blocks, as indicated 

 in figure 16. Those through the uterine end of the tube 

 show a lumen, 2 mm. in diameter. The mucosa is hyper- 

 trophied and the folds are matted together. The section 

 through the enlargement, as indicated in the figure, shows 

 that it contains a cavity which communicates with the 

 cavity containing the ovum and a cross-section of the tube 

 which has a lumen, 8 mm. in diameter. It has very large 



