ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



91 



edly inflamed and contains abcesses. Its epithelial lining 

 has disappeared entirely. The chorion is star-shaped; 

 the tips of the processes are encircled by a mass of fresh 

 blood. Between these processes are older hemorrhages 

 in which the corpuscles are no longer well defined. Within 

 the second area are numerous necrotie villi. Those within 

 the first area, which still communicate with the chorion, 

 take the stain well and are covered with an active tropho- 

 blast. It appears as though the fresh hemorrhage in these 

 specimens is favored by the presence of live villi, and that 

 in turn this hemorrhage causes the trophoblast to be more 

 active. 



FIG. 19. Outline of specimen No. 815. 



No. 825. 



(Dr. Vest, Baltimore.) 



(Plate 9, figs. 4. 5.) 



Specimen, 90X40X25 mm. 



Unmarried colored woman, age 29 years. Last men- 

 strual period, January 2, 1914. Bloody discharge, January 

 26. Abdominal discomfort, especially in iliac fossa, for 3 

 weeks. She probably has a mild chronic gonorrhea. 



At the tune of the operation it was found that the 

 ovaries, tube, and uterus were covered with adhesions 

 and were very vascular. A small corpus luteurn was found 

 in the right ovary. The fimbriated extremities of both 

 tubes were open. The uterus is normal in size and con- 

 sistency, and the ovaries appear to be normal, except for 

 the adhesions. About 50 c.c. of fresh blood, including 

 fresh clots, were found in the abdominal cavity. 



The specimen consists of the entire tube with the ovum 

 lodged in its outer half. It is unruptured and bound 

 together with numerous fibrin bands, as shown in the 

 figure. The wall is very vascular. The whole specimen 

 measures 90X40X25 mm. On the distal or abdominal 

 end two openings are seen; the lower one appears to be 

 normal, whereas the upper one may possibly be due to a 

 mechanical injury, which has allowed the folds to protrude, 

 this simulating a second opening. The specimen was cut 

 through the point of its greatest distention, and the sec- 

 tion seems to include the chorion in its greatest diameters. 

 It is covered with a well-formed membrane, which encircles 

 the whole ovum, but the wall is somewhat thin at the point 

 at which it is destined to rupture. What is especially 

 remarkable is that the ovum contains two sharply defined 

 cavities, separated from each other by a transverse mem- 

 brane. This septum is composed of two layers, the space 

 between them being encircled by a wreath of invading villi. 

 Both cavities appear to be amniotic, but contain no trace 

 of an embryo; however, under the membrane lining the 

 outer cavity there is a small club-shaped nodule, about 

 2.5 mm. long, which may be the embryo. Sections will be 

 required to determine this point. Projecting from the 

 outer cavity is an extension, which is shown in the figure. 

 This extension protrudes from the ostium, which is de- 

 scribed above as possibly an artefact. The real ostium does 



not seem to contain a lumen. This must be determined 

 by sections. 



The specimen was cut in the middle, revealing the double 

 ovum described above. On one side of one of the cavities 

 was a small white body, which was cut into serial seel ions 

 It was found to be composed of a neerotic mass of tro|ih<i- 

 blast infiltrated with leucocytes and lying on the outside 

 of the chorion; otherwise, no embryo could be found. 

 Sections through the uterine end of the tube show that the 

 mucosa is made up of marked folds which are much infil- 

 trated with polymorphonuclear leucocytes. There is a 

 fibrinous exudate within the lumen. Sections through the 

 fimbriated end of the tube reveal quite a normal mucosa 

 with some fibrinous exudate. A section through the 

 middle of the tube, as indicated in the figure, discloses a 

 double ovum with a membrane separating two cavities. 

 Each ovum is lined with its own mesoderm, from which 

 strands pass into the ccelom. No trace of an amnion in 

 either cavity. In the larger coelom is a rich tuft of magma 

 arising from a small nodule, which may represent the rem- 

 nant of the embryo. This is somewhat encircled with 

 strands of mesodermic tissue and contains several epithe- 

 lial-like cells. The membrane separating the two ova is 

 double and composed only of the chorionic wall with but 

 little trophoblast between the two layers. The villi have a 

 tendency to separate this membrane, as shown in the 

 figure. The villi are well covered with trophoblast and 

 there is an outer shell of fibrinoid tissue, which takes on 

 an intense eosin stain. Beyond this is the tube wall, which 

 is more or less infiltrated. The spaces between the villi 

 are mostly empty, partly rilled with trophoblast inter- 

 mixed with a scanty amount of blood and partly filled 

 with small organized clots containing many leucocytes. 



No. 835. 



(Dr. Harvie, Troy, New York.) 



Unruptured tube, 40X30X30 mm. From a white 

 woman, 35 years of age, this being her fourth pregnancy. 

 She had had two children, 9 and 6 years old respectively, 

 and had had an abortion 3 years previously at the end of 

 the second month. The periods had occurred on Novem- 

 ber 1 to 4, 1913; December 8 to 19; and January 12 to the 

 time of operation. (Specimen received February 9.) At 

 the time of the operation the uterus was found to be 

 normal as to location and mobility; there was no indication 

 of venereal disease, nor of tubal or ovarian trouble. The 

 specimen consists of a tube which is very much distended 

 by an oval mass measuring 40X30X30 mm. A cross- 

 section of it shows that it is composed chiefly of a compact 

 red clot, in the center of which a dark area, 12 mm. in 

 diameter, is seen. Throughout the clot are scattered white 

 pieces of chorionic villi. 



Sections through the uterine end of the tube show that it 

 is normal in appearance. The folds, however, are quite 

 pronounced and seem to be hypertrophied. The same is 

 true of the abdominal end of the tube; here also is no indi- 

 cation of inflammation. Sections through the enlarge- 

 ment of the tube show that it is mottled and is composed 

 of two zones: an inner, fibrous and organized, and an outer, 

 composed of fresh blood. The mass has implicated com- 

 pletely hau" of the tube wall, while in the other half the 

 lumen is present. In it the folds also seem to be normal. 

 A few scattered villi are present, and several long fibrous 

 villi permeate the clot. The trophoblast is scanty, except- 

 ing on one side, where it shows activity at the point of 

 juncture of the clot with the tube wall. There is sniin j 

 inflammatory reaction in the tube wall. 



