94 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



reaction is present. The fimbriated end has a small 

 lumen and the folds are more or less adherent. The thicker 

 folds are invaded with gland-like invaginations and there 

 are also numerous villus-like processes. In this region 

 there is a marked fibrinous exudate. The distended 

 portion of the tube is filled with a partly organized clot, 

 within which are numerous leucocytes. Throughout the 

 clot are a few scattered villi, which have undergone marked 

 fibrinous degeneration; many of them are encircled with 

 hordes of leucocytes. The epithelial wall of the tube is 

 intact around the entire clot. The embryo, which is 

 located in a small cavity, is greatly deformed and its 

 tissues are almost completely dissociated. The central 

 nervous system can still be made out and the heart is a 

 mass of round cells. Two lenses are still adherent to the 

 epidermis upon the sides of the head. The sections 

 through the chorion show that its walls are degenerating 

 and that the villi are becoming fibrous. The trophoblast 

 is scanty. The tubal wall is somewhat inflamed, and at 

 the point of implantation is invaded by trophoblast cells. 



FIG. 21. Section through FIG. 22. Sketch of embryo 

 tube to show the extent of from No. 881. X 8. 



the blood clot within a 

 cavity containing the em- 

 bryo (No. 881). X 2. 



In this region the inflammation is more marked than 

 elsewhere. Within the clot the leucocytes are accumu- 

 lating in masses, especially around the dead villi. 



No. 882. 



(Dr. Sexton, Baltimore.) 



Tubal mass containing a pathological embryo 8 mm. 

 long. The patient was a white woman, 34 years old, with 

 3 children under 7 years of age. She had had two abor- 

 tions, one at the end of the second month and the other at 

 the end of the third month. D and C 10 years before; 

 inguinal glands excised 9 years before. Operation May 1. 

 Normal menstruation 3 months before; 2 months before 

 she began to have a little staining of dark blood, which 

 continued for 7 weeks; she then suddenly passed a large 

 amount of blood. After that she had a small amount of 

 bleeding daily, but very little pain. Sharp pain one week 

 before operation, lasting about '2 hours, and subsequently 

 three other attacks. 



Left tube and ovary sent to laboratory. Chronic salpiu- 

 tutis, gonorrheal on the right side. Uterus normal. 

 Appendix chronically inflamed, atrophic. The unruptured 



tube was brought to the laboratory fresh. On the outer 

 surface were several indications of rupture, although in 

 reality it had not ruptured anywhere. The fresh tube 

 (60X45X40 mm.) was opened in saline solution. In 

 thickness the wall ranges from 10 to 15 mm. and is per- 

 meated with villi and bands of fibrin with numerous spots 

 of fresh hemorrhage. The cavity within is 20X15X12 

 mm. ; it is lined with a smooth membrane and has within it 

 a large clot of blood. With difficulty the membrane 

 surrounding this cavity was torn and after it was dissected 

 away the embryo came into view. The embryo is very 

 white and opaque and has a knob-like head and no extremi- 

 ties. Although the dissection may have distorted the 

 specimen, it looks as though the embryo had been dead for 

 some time. From all appearances it seems as though the 

 blood clot had entered the amniotic cavity and that the 

 amnion had been torn before the clot could pull off the 

 embryo. The clot was thoroughly coagulated and only 

 with difficulty could be peeled from the embryo. 



Sections of the embryo show very decided changes, as 

 the tissue is completely dissociated. Nevertheless, the 

 external form of the embryo is well retained. The uterine 

 end of the tube has hypertrophied folds, with numerous 

 outpocketings of epithelial cells; also villus-like processes, 

 a few of the folds adherent. The lumen contains an 

 inflammatory exudate. At the point of distention the 

 wall is markedly inflamed and the clot is more or less ad- 

 herent. Where the epithelial lining is intact, the folds are 

 united, forming pockets; that is, there is a localized fol- 

 licular salpingitis. The chorionic wall and villi are fibrous 

 and covered with a scanty amount of trophoblast. The 

 encircling blood clot is not well organized and many of 

 the villi are necrotic and have been invaded by leucocytes. 



No. 889. 



(Dr. Logan, Changteh, Hunan, China.) 



Pathological ovum in tubal mass, 50X25X15 mm. 

 On March 28, 1914, Dr. Logan writes the following history: 



"Extra-uterine (tubular) pregnancy. No. 89-14, 

 Changteh Hospital. Aged 32; occupation, trained nurse. 

 Race, Chinese. Menstruation began at 14, was regular 

 until 19. During her nineteenth year the patient been me 

 much emaciated and had a cough. During this time she 

 missed four periods. Amount of flow moderate, painful 

 during the first day only. Was married January 18, 1913. 

 After marriage she did not menstruate, becoming pregnant 

 at once. The child was born at term, but died during a 

 difficult breech delivery. After the child was born the 

 patient was in bed for 20-odd days. The lochial discharge 

 did not cease for over 30 days after delivery. About 40 

 days after the lochial discharge stopped, she menstruated. 

 The flow was greater than usual, but otherwise was not 

 abnormal. It lasted 4^ days. 



"Extra-uterine pregnancy flow. From the time the 

 above last menstrual flow began until the 'show' of the 

 extra-uterine pregnancy, was 33 days. Patient remembers 

 distinctly (it is remarkable how the Chinese remember the 

 exact day any particular illness began). On the first day 

 the flow was very slight; the second day it was very little 

 more, but the pain in the back was intense. From the 

 third to the eighth day of the flow the pain was intense in 

 the back and suprapubic regions, also in the left leg. The 

 show was increasingly abundant, but never copious up to 

 the eighth day after it began. On the eighth day after the 

 flow began (41 days after the beginning of the last normal 

 menstruation) the patient fell unconscious. She was seen 

 5 minutes later by the operator, who found her semi- 



