ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PRECXAXVY. 



whole clot is permeated with hands of fibrinoid substance, 

 between which are scattered necrotic villi. In the center 

 of the block is an irregular cavity about 1 cm. in diameter, 

 containing a dense mass of cells which take the hema- 

 toxylin stain well, and presenting every appearance of a 

 section through an embryo; however, none of the more 

 solid portions of the embryo can be seen. It appears as 

 if the cells had broken up, forming a "stew" in which the 

 largest particles are individual cells. A section through 

 the middle of the enlargement also shows strands of 

 fibrin and scattered villi. Upon the tips of some of these 

 villi are some trophoblast cells. On one side of the tube 

 wall is a single gland-like structure bin-rowing into the 

 muscle. Section through the outer end of the tube shows 

 that the lumen is filled with well-formed folds, some of 

 which are adherent. It appears, however, to be normal. 



No. 808. 



(Dr. J. M. Hundley, Baltimore.) 



(Plate 1, fig. 4, and plate 11, figs. 3, 4.) 



Normal embryo, 4 mm. long. Operation, December 11. 

 No infection, no venereal disease, and at time of operation 

 the uterus and ovaries appeared to be normal. Patient 

 aged 23; married; has one child, '2 years old; no miscar- 

 riages. Menstruated the third month after the birth of 

 the baby and without pain. Menstruated each month 

 normally and at the proper time up to November 1913. 

 Did not skip a period and they were not delayed. On 

 November '25 the menstruation began and lasted for a day. 

 On November 29 she had a hemorrhage, which lasted for 

 a few minutes and then ceased, but recurred December 3. 

 She suffered severe pain from November 25 to December 

 11, the day of operation. 



The specimen consists of a distended tube, measuring 

 70X25X25 mm. It is attached and lying in the broad 

 ligament with an adjacent spherical tumor, 50 mm. in diame- 

 ter, which appears to be a cystic ovary, on one side of which 

 is a crescent-shaped corpus luteum. The tube was cut 

 through the middle and found to contain a blood clot 

 separated by about 1 mm. from the tube wall. The first 

 section went directly through the embryo, cutting it into 

 3 parts. The cavity containing the embryo measured 

 3 mm. in diameter and extended a considerable distance 

 down the center of the tube. As the specimen had been 

 hardened in loto in formalin, the parts of the embryo were 

 not injured, so that they could be easily drawn and each 

 cut into serial sections. The form of the embryo was 

 sharply defined, with beautiful arm buds. 



The form of the tube and its adjacent cyst is well shown in 

 the drawing. Sections were cut from many parts of the 

 tube, permitting a careful reconstruction of the specimen. 

 The section through the uterine end of the tube shows a 

 small lumen with delicate folds and no sign of inflammat ii in. 

 Within the lumen of the tube is a clump of cells which 

 appear to belong to the ovum. At the beginning of the 

 distended portion the folds are very pronounced and con- 

 tain very large spaces lined with endothelium and filled 

 with clear fluid. Some of these spaces extend through the 

 bases of the folds into the tube wall. They look very 

 much like lymphatics. At this point the contents of the 

 tube are composed mostly of an organized blood clot. The 

 folds are not adherent, nor are there any outgrowths of 

 the epithelial cells into the muscular wall. A little nearer 

 to the embryo the section contains many active villi, with 

 a very extensive trophoblast adherent to the tube wall all 

 around. The lumen of the tube is sharply defined on one 

 side of the clot. It contains an organized mass, but other- 



wise- appears to be normal. The proper interpretation of 

 this specimen is that the ovum has implanted itself in the 

 tube wall between the lumen and (he broad ligament. 

 Section through the middle of the ovum shows the same 

 relation as given above, but the tissue between I he lumen 

 of the tube and the chorion is composed partly of a thick 

 layer of trophoblast, although mainly of a large nerroiic 

 plug into which there have wandered a number of leuco- 

 cytes. This section is through the part of the chorion con- 

 taining the embryo, but in tins as well as in all the resl there 

 is no remnant of an amnion. Possibly the entire aiimion 

 was removed with the embryo. The ccelom is filled partly 

 with a delicate magma and partly with granular magma, 

 which takes the hematoxylin stain. These nnicin-like 

 particles are often stratified and a few of them have layers 

 which encroach on central ground. Apparently we have 

 here a substance which I have frequently described as 

 granular magma. Large patches of flakes like these are 

 often seen in specimens of tubal pregnancy. The cavity 

 of the chorion continues within the tube wall for about 1 cm. 

 and suddenly reappears within the lumen itself. In other 

 words, we have here an interstitial implantation of the 

 ovum which has ruptured in the tube wall in both direc- 



FIG. lf>. Outline of tube attached to ovary which contains a 

 large cyst (No. 808). The dimensions of the pregnancy 

 and of the tube lumen are indicated by the clotted lines. 

 The lumen itself is long-drawn-out and lies iu the center 

 of the clot. X 0.75. 



tions, extending outward to the h'mbriated end of the tube. 

 The chorionie mass extending outward has in it an irregu- 

 lar ccelom. Where the embryo is located, the space is 

 5 mm. in diameter. It is reduced to 2 mm. at the point 

 of the entrance of the clot into the tube lumen. Further 

 on it is smaller, but then becomes larger again. In other 

 words, the ovum is elongated and constricted. The outer 

 dilatation contains a very small vesicle, which does not 

 communicate with the embryo. As it is not an extension 

 of the umbilical vesicle, it appears to be a detached portion 

 of it. Further downward the umbilical vesicle disappears 

 and here the ccelom is completely filled with a dense retic- 

 ular magma. In this region the mesoderm of the chorion 

 is of very irregular thickness. Some of the cells ramify 

 through the magma and at other points there seems to be a 

 complete rupture. At any rate, numerous groups of 

 maternal red blood corpuscles are scattered through the 

 magma fibers. As the specimen was hardened in lulu 

 and as the sections were cut in celloidin, these corpu-di -, 

 must have entered the culom before the operation. Be- 

 yond the clot the folds of the tube are again well pro- 



