ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



99 



was enlarged and in the left side could he felt a movable 

 mass somewhat larger than the left ovary and separate 

 from it. The right side seemed clear. At the operation, on 

 July 13, the mass in the left side was found to be an extra- 

 uterine pregnancy, about 3 cm. in diameter, in the middle 

 portion of the left tube. The uterine portion of the tube 

 \v:is removed. The right tube and ovary were normal. 



The specimen consists of the left Fallopian tube, which 

 forms an S-shaped spiral. At the uterine end the specimen 

 undergoes an egg-shaped dilatation, becoming about 20 

 mm. in diameter. From the segment of the tube next 

 adjoining this, projects a tumor-like swelling, 25X15X 

 15 mm., over the surface of which chorionic villi may be 

 seen exposed in some places. Sections through the swelling 

 of the uterine end show the tube with its periphery infil- 

 trated with blood. A slit-like chorionic cavity, 6X2 mm. 

 is found near the beginning of the dilatation. 



Sections were taken through the uterine end of the tube, 

 through the middle of the swelling, and the fimbriated end, 

 which contains a very small opening. The folds in the 

 uterine end of the tube are unusually well pronounced; 

 none of them are adherent. At the fimbriated end the 

 lumen is almost closed and is lined with two concentric 

 layers of mucous membrane with numerous epithelial 

 pockets between them. The condition of the mucous 

 membrane in the uterine and fimbriated ends of the tube 

 appears to be the reverse of. what is usually found in these 

 cases, but careful inspection proves definitely that the two 

 ends were not mixed at the time the sections were taken. 

 Sections through the middle of the tube struck the point of 

 implantation, which seems to encircle the entire wall, and 

 not the faintest trace of the tube lumen can be made out. 

 The blood within the tube lumen is mostly fresh and partly 

 organized; within are seen many villi and the collapsed 

 ovum. Some of the villi are necrotic and some of them 

 have undergone fibrous degeneration. The tube wall has 

 been invaded at its largest diameter by very active tro- 

 phoblast. No trace of an embryo is found. 



No. 928. 



(Dr. W. Morriss, Baltimore, Maryland.) 



Unruptured tube, 75 X28 X28 mm. The history of this 

 case is somewhat meager. The patient was 20 years old. 

 There were pelvic symptoms three weeks before the opera- 

 tion. The last period is said to have begun 6 days before 

 the operation and appeared to be normal. At the time of 

 operation no adhesions were found, but there was a retro- 

 flexion of the uterus. 



This fine specimen measures 75 mm. in length. Near 

 its fimbriated extremity the tube has swelled into an egg- 

 shaped dilatation, 28 mm. in circumference and about 28 

 mm. in length. The end of the tube has three distinct 

 fimbriated areas, the largest of which measures 24X15 

 mm., the second 8X7 mm., and the third 14X6 mm. 

 The free-hand section shows that the tube is occupied by 

 a firm hemorrhagic nodule which separates itself easily 

 from the tube wall. Sections through the tube at the 

 uterine end show that the form is normal, but the sur- 

 rounding tissue is somewhat infiltrated with round cells. 

 The second block, which was cut at a point about 1 cm. 

 from the first near the point of distention, shows large and 

 acutely inflamed folds, more or less adherent, owing to the 

 presence of an inflammatory exudate. Sections through the 

 fimbriated end show that the folds are edematous, but nor- 

 mal in form and not adherent. There are several small out- 

 pocketings in the muscular wall. Sections through the 

 distended portion passed through the point of implanta- 



tion, leaving a crescent-shaped slit, encircling the blood 

 clot one-half way around the tube. Into this project a 

 few villi, apparently normal. The blood clot is largely 

 fresh, partly organized, and permeated by strands and 

 colonies of leucocytes. The villi are mostly necrotic and 

 many of them have been invaded by leucocytes. Where 

 the trophoblast comes in contact with fresh blond it is 

 vacuolated and active. 



No. 932. 



(Dr. R. W. Hammack, Manila, Philippine Islands.) 

 Unruptured tube, 40X30X25 mm. From a Malay 

 woman, 20 years old, who had been married a short time 

 before the operation, this being her first pregnancy. On 

 March 30, 1914, she had had bleeding for one day. The 

 last menstrual period had occurred on April 6, 1914. The 

 operation was performed on May 19. There was no his- 

 tory of infection nor of any discharge from the uterus. 

 At the time of the operation large irregular blood clots 

 were found encircling the tube. The specimen consists of 

 many large blood clots and a portion of the right Fallopian 

 tube and ovary. A slab shows that the tube is occupied 

 by a hemorrhagic chorion. A section through the ovary 

 shows a beautiful convoluted corpus luteum, measuring 

 17X10 mm. 



Sections through the uterine end of the tube show that 

 it is filled with large folds, which are for the most part 

 adherent, and form numerous pockets within the tube 

 lumen. There are also several deep pockets which reach 

 far into the muscular layer. Sections through the dis- 

 tended portion take in the point of implantation as well 

 as the crescent-shaped tube lumen on the opposite side. 

 The folds of the tube lumen are insignificant and there are 

 no outpocketings. The tube lumen is composed of much 

 fibrinoid substance, together with leucocytes, organized 

 and fresh blood clot, as well as many villi, which are capped 

 by necrotic masses of trophoblast. A section, which passed 

 through the mam chorionic wall, shows that it is entirely 

 collapsed. 



No. 934. 



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

 Pathological embryo, 6 mm. long. From a negro 

 woman, aged 35, who had been married 10 years. She 

 was the mother of 3 children, the oldest 10 years old and 





FTC;. 24. Pathological embryo from specimen No. 934. 



