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ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



No. 838. 



(Dr. Kittridge, Nashua, New Hampshire.) 



(Plate 11, fig. 2.) 



Clot, 25 mm. in diameter, contains a pathological 

 embryo, 6 mm. long. 



The woman, a patient of Dr. A. K. Wallace, did not sus- 

 pect pregnancy, but was sent to the hospital with the usual 

 abdominal symptoms. She was immediately operated 

 upon and a rupture of the tube was found near the uterus 

 with the inclosed specimen protruding. The specimen 

 consists of a dark chestnut-shaped mass, 27X23X29 mm. 

 From the middle of one of the flattened sides white chori- 

 onic villi protrude. A cut through the specimen disclosed 

 a spherical smooth-lined cavity, about 9 mm. in diameter, 

 into which projected a nodular opaque white embryonic 

 rudiment, measuring about mm. 



"The clot" consists of the choriun, which is hemorrhagic; 

 from one side a tuft of white villi protrudes. The cavity 

 within contains a very much deformed embryo. The 

 wall of "the clot" is well organized and permeated with 

 strands of mucus leucocytes, which in turn are being in- 

 vaded by long lines of trophoblast cells. The villi show all 

 grades of degeneration, mucoid and fibrous. Some are 

 necrotic and others appear to be very active. Upon the tuft 

 of protruding villi the trophoblast is as well defined as in the 

 normal chorion. The tissues of the embryo are thoroughly 

 dissociated, but the central nervous system can still be made 

 out. This is all of the anatomy which can be determined 

 with certainty. On the external surface, as the illustration 

 shows, are prominences which may represent the extremi- 

 ties. 



No. 840. 



(Dr. Elting, Albany, New York.) 



Ruptured tube, 85X40X30 mm., contains a patho- 

 logical embryo, 8 mm. long. The specimen comes from a 

 white woman, 45 years of age, who has had four previous 

 pregnancies, the first 20 years ago, the last 10 years ago. 

 On January 7, 1914, she had pains low down in the abdo- 

 men. On January 10 she passed what was thought to be 

 an embryo and membrane [decidua]. On January 13 

 the flow began, and continued for 6 days. On February 

 2, at 2 p. m., there was some pain in the lower abdomen, 

 with hemorrhage. She was brought to St. Peter's Hos- 

 pital late the same night. At the operation on the next 

 day the uterus was found moderately enlarged. The left 



FIG. 20. Outline of specimen No. S40, before it was cut into 

 sections. The cavity within is indicated by the clotted 

 line. X 3- 



tube was distended and there had been an extensive hemor- 

 rhage from it into the abdominal cavity. There was no 

 evidence of any infection or venereal disease. The right 

 tube and ovary were normal. The uterus was 1.5 times its 

 normal size. The specimen consists of an unruptured 

 tube, 85X40X30 mm. It is quite evenly distended 

 (fig. 20). On section, it is found to be composed of a well- 

 organized clot, containing within it a cavity 15X10X 

 5 mm. Part of this is filled with a dense reticular magma, 



probably the cavity of the amnion. The tube wall is 

 covered with a dense layer of well-developed blood-vessels. 

 This finding illustrates again the fact that the vascularity 

 of the tube does not indicate that it contains a normal 

 embryo. 



Sections were made of the tube through its largest, 

 diameter, and also through the uterine and fimbriated 

 ends. The uterine end appears to be perfectly normal, 

 showing delicate folds of mucous membrane and fully 

 developed circular muscles. At the fimbriated end the 

 folds are somewhat adherent, and into the lumen protrudes 

 one very large fold with immense blood-vessels. This, and 

 the wall surrounding the tube, are infiltrated with many 

 leucocytes, showing that an active inflammation is present. 

 The section through the distended part shows that the 

 tube wall has been almost entirely destroyed, but its side 

 is occupied by large accumulations of leucocytes. The 

 clot is mottled, showing that fresh hemorrhages are taking 

 place. The chorionic wall is partly necrotic and has been 

 invaded by numerous trophoblast cells, which in some 

 places form small mounds. The villi ramify through the 

 organized clot, some of them reaching its surface. At 

 some points the trophoblast is active, especially where 

 it comes in contact with the invading leucocytes. What 

 appears to the naked eye to be magma proved to be a dis- 

 sociated embryo. The central nervous system can still 

 be made out sufficiently to determine its size. Sections 

 were not serial, so it is impossible to obtain a complete 

 description of the specimen. Although there is no history 

 of infection, the inflammatory reaction of the tube wall is 

 too severe to be accounted for simply by the presence of 

 the ovum. 



No. 851. 



(Dr. Sexton, Baltimore.) 



Ruptured normal embryo, CR 52 mm. The specimen 

 came from a white woman, aged 36 years, this being her 

 third pregnancy. There was no history of any venereal 

 disease. She was married in 1904 and has two living 

 children. Her last period began December 23, 1913. 

 Her physician, Dr. Seldner, sent her to the Hebrew Hos- 

 pital, where an operation was performed by Dr. Ney on 

 March 9. Dr. Sexton described the fetus as being free 

 from the tube, but still attached by its cord and apparently 

 living at the time of the operation. 



The specimen consists of a collapsed ruptured tube 

 about 50 mm. in diameter, from which protrudes what 

 appears to be a normal ovum covered with rich villi. The 

 collapsed ovum is about 40 mm. in diameter. Transverse 

 sections show that it is for the most part detached from the 

 tube wall, but is well implanted on the side. A section was 

 taken from the middle of the attachment of the chorion to 

 the tube wall. The chorionic wall, as well as the tube, is 

 quite fibrous, but apparently normal for this stage. The 

 villi are long and slender and covered with small tufts of 

 trophoblast, showing a slight amount of blood between the 

 tips. There are active necrotic masses of trophoblast 

 between them. The zone between the tips of the villi and 

 the tube wall is composed mostly of fibrinoid tissue, which 

 grades over into the tube wall. This zone has in it also a 

 large accumulation of leucocytes, which at some points 

 seem to be forming small abscesses. The fibrinoid tissue 

 has been invaded by trophoblast cells and often suggests 

 the appearance of cartilage. At one point in the specimen 

 the fibrinoid tissue has been penetrated by the trophoblast 

 cells which are puncturing the blood vessels, from which a 

 small amount of blood streams into the intervillous spaces. 

 Wherever flow comes in contact with the trophoblast a 

 syncytium seems to form which is more or less vacuolated. 



