98 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



is also a considerable amount of fresh blood. The uterine 

 end of the tube seems to have a normal lumen, but the 

 muscular coat is unusually pronounced. The distended 

 tube contains numerous pockets around its circumference, 

 which have been formed by adhesions between the different- 

 folds. The wall has been also somewhat invaded by active 

 trophoblast. The chorion and its villi are largely necrotic 

 and the villi at some pomts are being invaded by their 

 own trophoblast. The chorionic wall is undergoing acute 

 degeneration and at some points there are indications of 

 an adherent amnion. Hanging in the amniotic cavity 

 is a small process, about 1 mm. long and 0.5 mm. in diame- 

 ter. This contains a small vesicle and represents in all 

 probability the degenerated cord of the embryo. Other- 

 wise there is no remnant of an embryo. Sections stained 

 with iron hematoxylin show the stratification of the 

 fibrin unstained as in a fresh blood clot. Most of the red 

 blood corpuscles remain unstained, which shows that, as 

 the ovum was strangulated, there was a gradual addition 

 of fresh blood, which made the tumor larger and larger. 

 The fibrin bands which permeate the clot often avoid indi- 

 vidual villi, indicating that they have a tendency to pre- 

 vent coagulation. 



No. 908. 



(Dr. Paul Wegefarth, Baltimore, Maryland.) 

 Both tubes and a clot measuring 60X50X35 mm. Our 

 records state that the specimen is from an operation by 

 Dr. Cullen and was brought into the laboratory by Dr. 

 Leonard. There is some correspondence regarding it with 

 Dr. Wegefarth, who was then one of the resident physicians 

 of the Church Home. The specimen consists of both tubes, 

 one ovary, in which there are two corpora lutea, and the 

 large clot containing remnants of the villi; also a cavity, 

 which appears to be that of the amnion. The small tube 

 appears to be normal and the large tube is hemorrhagic and 

 unruptured. As the fimbriated end is greatly distended, 

 undoubtedly the clot was aborted from it. The clot is of 

 a uniform consistency and has leucocytes scattered through 

 it. At some points they have accumulated in large masses 

 in the neighborhood of fibrous villi, which are found scat- 

 tered through it. 



A section through the wall of the cavity with the clot 

 shows that it is composed of an atrophic chorion with de- 

 generated villi attached to it. No embryo is found. The 

 uterine end of the larger tube shows active inflammation 

 in its hypertrophic folds and also an exudate, but the folds 

 are not adherent. Around the distended portion of the 

 tube are numerous pockets, but the tips of the folds are 

 not adherent, although very edematous. The uterine 

 end of the small tube has in it very hypertrophic folds and 

 similar outpocketings, showing that this process, which 

 causes the arrest of the ovum, was no doubt present in the 

 uterine end of the pregnant tube. 



No. 910. 



(Dr. G. L. Hunner, Baltimore, Maryland.) 

 Unruptured tube, 24 mm. in diameter. From a white 

 woman, 39 years old, this being her sixth pregnancy; four 

 of the previous five having been normal. In the fifth she 

 miscarried at 6 weeks. The last menstrual period began 

 May 9, 1914, and the operation took place on June 10. 

 There was no indication of infection. At the time of the 

 operation it was found that she had chronic pelvic inflam- 

 matory disease and there was distention of the left tube, 

 which was also tied down by adhesions. The specimen 

 was brought to the laboratory and fixed in Carney's fluid 

 by Dr. Sabin. The specimen is a tube distended by a 



spherical mass, 24 mm. in diameter, which consists chiefly 

 of organized clot. A cross-section of the mass shows an 

 irregular chorionic lumen, about 7 mm. in diameter, sur- 

 rounded by firm, bloody walls. The choriou is filled with a 

 dense "magma" and no remnants of an embryo can be seen. 

 Sections were made through three portions of the tube. 

 Those through the uterine end show marked outpocketings 

 from the lumen, there being six in each section. The free 

 end of the tube is filled with hypertrophic folds, which 

 almost completely obliterate the tube lumen. Possibly 

 there are also some outpocketings. Sections through the 

 distended portion pass through the chorionic cavity, 

 which is 7 mm. in diameter. It shows the usual picture 

 of destruction of the villi and the invasion of leucocytes in 

 large masses forming small abscesses; there is some active 

 trophoblnst at its periphery, also much nbrinoid substance. 

 Practically the entire muscular wall has been destroyed by 

 the trophoblast and clot within. 



No. 911. 



(Dr. Wegefarth, Baltimore, Maryland.) 



Unruptured tube, 65 X33 mm., brought to the laboratory 

 perfectly fresh and was fixed in Bouin's fluid by Dr. Evans. 

 The specimen consists of the right Fallopian tube, and the 

 ovary of the same side, approximately 20 mm. in diameter. 

 The tube is covered with a rather rough but unbroken 

 peritoneum. Cross-sections show a sausage-shaped blood- 

 clot about 17 mm. in diameter, in which are appar- 

 ently large, feeble chorionic vestiges. Sections through the 

 uterine end of the tube show a single lumen into which 

 project several small folds. Apparently it is normal. 

 Sections through the distended portion show that the 

 entire tube contains a large clot. Within are embedded 

 numerous necrotic villi. Aside from a slight infiltration 

 with leucocytes the tube wall appears to be normal. 



No. 919. 



(Dr. V. N. Leonard, Baltimore, Maryland.) 

 Tubal mass, 65X40X25 mm. The specimen consists 

 of an unruptured tube, one ovary, and a piece of the 

 uterus. Sections were cut through the middle of the 

 tubal mass. The wall was markedly inflamed and a 

 similar condition prevailed in the folds, which were very 

 edematous and infiltrated. In the tube wall were certain 

 outpocketings, also an extensive formation of fibrinoid 

 substance. Within was a circumscribed mass composed 

 largely of fibrous villi and necrotic trophoblast, in the 

 center of which was a mass composed largely of hyaline 

 degeneration and a marked infiltration with polymorpho- 

 nuclear leucocytes. At one point these were so numerous 

 as to form a large abscess. The specimen came from a 

 colored woman, 28 years old, who had been married 4 

 weeks. She is the mother of one child, 10 years old. 

 Her last period began on January 3, 1914, and the opera- 

 tion was performed on April 27. She had been bleeding 

 3 weeks before the operation. At the time of the opera- 

 tion the pelvis was found filled with clotted blood. 



No. 927. 



(Dr. Leon H. Watkins, Baltimore, Maryland.) 

 Unruptured tubal mass, 50X20X20 mm. The patient, 

 a well-nourished colored woman (age unknown), had had 

 one child and no miscarriages. The last menstrual period 

 had occurred July 7, 1914, the one preceding having been 

 in April. At the hospital a diagnosis of extra-uterine 

 pregnancy and chronic appendicitis was made. The uterus 



