ON THE FATE OF THE HUMAN EMBKYO IN TUBAL PREGNANCY. 



95 



conscious, with a rapid pulse and colorless face. The oper- 

 ation was performed as soon as the instruments could be 

 sterilized. 



Operation: The abdomen contained a large quantity 

 of blood and clots. The left tube was clamped and 

 removed. The patient made a good recovery with primary 

 union of the wound. Ten days after the operation patient 

 had an acute attack of what seemed to be gallstone colic, 

 which lasted a day. The decidual cast (sent with speci- 

 men) was passed a few days after the operation." 



The specimen consists of numerous large blood clots 

 about 30 mm. in diameter. The flattened decidua meas- 

 ures 50X30 mm. and the brownish unruptured tube, 

 somewhat bent upon itself, measures 50X25X25 mm. 



Sections of the decidua show that it is unusually well 

 developed. Very large decidua cells line the cavity of the 

 uterus, and through the decidua are seen very large venous 

 sinuses and also numerous degenerated uterine glands. 

 Sections through the uterine end of the tube show that it 

 is lined with small villi and filled with a clot, extending 

 from the main hemorrhagic mass of the. tube. The folds 

 are filled with leucocytes. The main mass of the tube con- 

 tains a fairly well-organized clot, around which is a com- 

 plete tube, well covered with a continuous layer of epithe- 

 lium. Some of the folds are very hemorrhagic and the 

 tube wall in general is inflamed. In a cleft within the clot 

 is a mass of active trophoblast about 2 mm. in diameter. 

 The syncytium is pronounced and often vacuolated, 

 containing fresh blood-corpuscles. The tips of the villi 

 reach into this mass, but the connection with the tube wall 

 is not shown in the section. On the outside of the tube a 

 large clot of typical granular magma is seen. It is about 

 3 mm. in diameter and is composed of small granules 

 encircled by a variety of streaks which take on the char- 

 acteristic hematoxylin stain. 



No. 891. 



(Dr. Leonard, Baltimore.) 



Tubal mass, 60X30X30 mm. The specimen is from a 

 white woman, aged 30 years, who has been married 13 

 years and has two children, aged 12 and 10 years. She has 

 had two miscarriages, one at 5 months and one at 6 weeks. 

 No history of venereal disease. The menses began at 

 13 years and were regular every 4 weeks with a moderate 

 flow lasting 4 to 5 days. There has been only a slight flow 

 since an operation (6 years ago), occurring regularly once a 

 month. Two weeks before an operation for dilatation and 

 curettement she had constant vaginal bleeding, varying 

 in amount, often containing large clots. A few days 

 before operation she had an attack of severe cramping 

 in the abdomen, without vomiting, which lasted 3 or 4 

 hours. After being discharged from the hospital she was 

 readmitted on May 10, complaining of same pain in the 

 lower abdomen and continuous bleeding. She was 

 operated upon May 12, when an unruptured right extra- 

 uterine pregnancy was found. Unruptured tubal mass, 

 60X30X30 mm. It was incised and found to contain a 

 solid clot. It was then fixed without further manipulation. 

 One day later (May 13) new sections were made and a col- 

 lapsed ovum was found about 5X10 mm., which was 

 entirely surrounded by fresh hemorrhages. 



The uterine and fimbriated ends are distended with an 

 exudatc which is rich in leucocytes. The wall of the 

 tube is infiltrated with polymorphonuclear leucocytes The 

 distended portion of the tube contains a collapsed ovum 

 and the villi are largely necrotic. The blood clot is not 

 well organized, but contains many leucocytes. The wall 



of the necrotic ovum is one mass of llicm. There is no 

 active trophoblast. In this specimen tin 1 tube has rup- 

 tured opposite its greatest distentinn, and Hie opening 

 has been plugged by clots of blond )>ri Hiding into it. 

 The ends of the ruptured tube are "healed" into the clot. 

 There is a good deal of granular magma on the outside of 

 the tube. 



No. 892. 



(Dr. Leonard, Baltimore.) 



Unruptured tube, 90X45X4") mm. From a white 

 woman, aged 39, who has been married 21 years and has 

 7 children, the oldest 20 and the youngest 7 years old; 

 no miscarriages. The second and fourth deliveries were 

 instrumental, but uncomplicated. The menses began at 

 13 years and were regular every 4 weeks. Duration, 6 

 to 7 days, with a profuse flow but not especially painful. 

 Last period, February 25; preceding period, January 24 or 

 25. About April 23 patient had sharp bearing-down pain 

 in the lower abdomen. About a week later she began to 

 have a slight show of blood and passed a large clot. She has 

 had a constant slight bloody discharge ever since. Oper- 

 ated upon at the Johns Hopkins Hospital, May 14, 1914. 



The unruptured tube was cut into blocks; the section 

 was mottled and well organized. No embryo was found. 



In the uterine end of the tube numerous large outpocket- 

 ings reach far into the muscularis to end blindly. In the 

 middle of the distended portion the section struck the 

 ovum, which is collapsed and contains no lumen. From 

 the chorion long fibrous villi extend, a few of which reach 

 to the tube wall. The latter is markedly infiltrated with 

 leucocytes and trophoblast cells, indicating that there was 

 a good early implantation as well as an infection. At 

 some points there are abscesses. The tube lumen extends 

 about one-fourth around the wall and is lined with adherent 

 folds, which form pockets; in other words, a localized 

 folhcular salpingitis is present. 



No. 898. 



(Dr. Hunner, Baltimore.) 



Tubal mass containing embryo 15 mm. long. The 

 woman, aged 27 and married 8 years, had never been preg- 

 nant before. She has had regular periods lasting 3 or 5 

 days. The last period began 28 days before the operation. 

 During the intervening time there has been some irregular 

 black discharge. She had a peritonitis-like attack 5 days 

 before the operation. At the time of the operation there 

 were free clots of blood found in the peritoneal cavity. 

 The left tube, containing the pregnancy mass, w-as re- 

 moved. There were some adhesions about the right ovary. 

 The clot, 60 mm. in diameter, is attached to the tube, which 

 measures 50X25X25 mm. After separation it was found 

 that at the point at which the fimbriated end was embedded 

 in the clot there was a cavity containing a macerated 

 embryo, 15 mm. in length. The embryo was still inclosed 

 in the amnion, which in turn was encircled by coagulated 

 blood. 



The uterine end of the tube contains marked hypertro- 

 phied folds and some exudate. At a point 25 mm. from 

 this end, and midway between it and the distended tube, 

 is a very active inflammatory process, the folds being 

 adherent a follicular salpingitis. There are many finger- 

 like processes from the folds, whieh extend into the lumen 

 of the tube as well as into the follicles. The mucosa of the 

 distended portion is interesting from the fact that the 

 changes, which took place after the abortion of the normal 

 embryo, are shown. In this region a follicular salpingitis 

 is also pronounced. There is much fibrinous degeneration 



