90 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



nounced, but show no signs of inflammation. Here, as 

 throughout the tube lumen, the "large lymphatic spaces" 

 within its folds are greatly distended. 



In general the form of the embryo and its tissues and 

 organs seem to be normal. The lens is just beginning to 

 form. The spinal cord, however, shows marked histolysis 

 in the dorsal region. The change begins on the ventral 

 side of the upper cervical cord and reaches its maximum in 

 the middle of the back, where the ventral two-thirds of the 

 cord has broken down. In the neighborhood of the leg 

 the cross-section of the cord is hourglass-shaped, with a 

 lumen in each half. Although the destructive changes in 

 the ventral side of the cord are so very severe, numerous 

 cell divisions are present in the dorsal side, an evidence 

 that it is continuing to grow. 



No. 809b. 



(Dr. Lowsley, New York.) 



Ruptured tube from which a large clot protrudes. The 

 entire mass measures 60 X40 X30 mm. The clot, which is 

 peeled out with great ease, is solid and appears to be unor- 

 ganized. It measures 45X25X20 mm. Sections were 

 cut through the distal and proximal ends of the tube and 

 through the clot. Section through the proximal end shows 

 that the tube lumen is normal in form, but the folds seem 

 somewhat thin and dovetail together. They are markedly 

 infiltrated with leucocytes. The section through the 

 distal end, however, shows no folds in the lumen. The 

 tube wall is matted together and hyperemic with muscle 

 bundles running in all directions. Instead of single large 

 folds, we have a few hyperemic folds, markedly inflamed, 

 with outgrowing pockets of epithelial cells into the tube 

 wall. Somewhat nearer to the uterus the tube wall has in it 

 a great many pockets, less than a millimeter in diameter, 

 each of which has its own accompanying muscle-wall. 

 It seems like an active effort towards regeneration of the 

 tube lumen. In this region there are at least 50 of these 

 lumiua. The clot, which is protruding from the rupture, 

 appears to be quite fresh, but it is more or less cut up by 

 thin bands of fibrin, which are associated with myriads of 

 leucocytes. A few necrotic villi are present. 



No. 809c. 



(Dr. Lowsley, New York.) 



Tubal mass, 80X45X35 mm. Operation in Bellevue 

 Hospital, July 25, 1913. Last regular menstrual period, 

 July 15. The specimen came to the laboratory unruptured, 

 with an artificial constriction in the center, due to a band 

 which had been tied around it. Practically the entire tube 

 is distended; in its proximal portion the pregnancy is 

 contained within the tube wall, but protrudes from it into 

 the lumen more distally. Sections were cut from four 

 portions of the tube. In the outer third, the collapsed 

 ovum was found. Section through the uterine end shows 

 that the mucosa is practically normal. Possibly the folds 

 are hyperemic. Sections between the uterine end and the 

 ovum show that the clot has invaded the tube wall 

 throughout the greater part of the circumference, leaving 

 a small space on one side which may represent the lumen 

 of the tube. Into this space a few tubal folds protrude. 

 The clot is well organized and permeated with an irregular 

 mass of villi, many of which are necrotic. The tropho- 

 blast is quite active and invades the tube wall; in some 

 places it has intermingled with it large masses of leuco- 

 cytes. Toward the outer end of the tube, near the ovum, 

 the clot has become entirely separated from the tube wall. 

 It appears as though we have a more advanced stage in 



this specimen than that shown in an early stage in speci- 

 men No. 808. The wall of the collapsed ovum appears to 

 be necrotic and at many points is being invaded by leuco- 

 cytes. The villi are long and slender; many of them reach 

 the tube wall. The periphery of the clot is encircled by 

 one mass of leucocytes. Between the clot and the tube 

 wall is a curious granular mass which takes the hematoxy- 

 1m stain and is especially well marked with the Van Gie- 

 son stain. Possibly this may be a rnucoid secretion, or it 

 may be granular magma; it is occasionally seen in other 

 specimens. The mucosa of the tube wall is of about 

 normal thickness and is hyperemic; in places the adjacent 

 folds are united. This condition is much more pronounced 

 in the outer end of the tube. Here there is a very marked 

 inflammation of the tube folds, which are agglutinated. 

 We have here a marked salpingitis. In this specimen the 

 inflammatory process is pronounced in the distal, but not 

 in the proximal, end of the tube. 



No. 815. 



(Dr. Leonard, Baltimore.) 



Tubal mass, 50X30X25 mm. 



The specimen came from a colored woman, 39 years 

 old, who had been married 10 years and had had one child, 

 9 years old, but no miscarriages. The last period began 

 December 1, 1913. Operation, January 7, 1914. Her 

 periods had been irregular for some time and there were 

 indications of chronic inflammatory disease; probably 

 gonorrhea. At the time of the operation (January 7, 

 1914), it was found that the tube and the uterus were in- 

 volved in extensive adhesions. 



The specimen consists of the left Fallopian tube (from 

 which the ovary has been dissected away), measuring 8 

 cm. in length. Extending to within 2 cm. of the fimbriated 

 extremity and beginning 1 cm. from the uterine end, the 

 tube consists of a large oval mass, 5X3X3.5 cm. The 

 top and posterior surface of this mass is deeply blotched 

 by what appears to be a large and rather firm subjacent 

 clot of blood, making up most of the tumor. An abundance 

 of small tortuous venules run over the surface of the tumor. 

 The fimbriated extremity of the tube is open, as deter- 

 mined by a blunt probe (1 mm. in diameter). Cut ad- 

 hesions are abundantly evident from many points of the 

 surface of the tube. With a razor two complete trail- 

 sections of the mass were made, one near the outer pole, 

 the second at the mid-portion of it. The latter disclosed 

 distinct, small chorionic cavity, in which no embryo was 

 visible. The specimen was immediately fixed in 10 per 

 cent formalin at 40 C. 



Sections were cut through the distal and proximal ends 

 of the tube, and two sets through the middle of the dis- 

 tention. Sections through the uterine end of the tube 

 show that the muscle wall is well formed and apparently 

 normal, but practically all of the epithelial lining of the 

 lumen has been exfoliated. Some new flattened cells are 

 still adherent, but more are found free in the tube lumen. 

 Sections through the outer end of the tube show that the 

 lumen is quite small ; the folds are hypertrophic and more or 

 less matted together by a muco-purulent exudate. In 

 fact, the stroma of the folds is also much infiltrated with 

 leucocytes. At the bottom of the folds are numerous 

 villus-like processes. All these findings indicate the pres- 

 ence of a follicular salpingitis. 



Sections through the cavity of the ovum show that the 

 chorlon is mostly fibrous and contains no blood vessels. 

 The trophoblast forms occasional nests upon the chorionic 

 wall and in places is invading it. The tube wall is mark- 



