100 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



the youngest 5. Her last period had begun July 21, 1914, 

 previous periods having been irregular. The operation 

 was performed August 10. The patient was probably 

 suffering from chronic gonorrhea, and at the time of the 

 operation numerous adhesions were encountered. The 

 fresh specimen was placed in Brouin's fluid. After it was 

 partly fixed it was cut into slabs with a razor. The speci- 

 men consists of a Fallopian tube, 92 mm. long, and an 

 ovary, 32X20 mm. The tube is swollen, forming two 

 large irregularly spherical masses, which adjoin the outer 

 and inner (uterine) ends respectively, and measure 50 X 

 55X40 mm. and 50X32X36 mm. When the mass at 

 the isthmic end is cut open, a firm, bloody, chorionic mass 

 with a lumen, 21X12 mm., is seen. The chorionic cavity 

 has smooth walls and contains an adherent young mon- 

 strous embryo with a greatest length of about 6 mm. This 

 is best described as an opaque white mass, in which head 

 and body are barely distinguished as nodules. Between 

 the two tubal swellings and lying directly over the ovary 

 are numerous greatly hypertrophied folds of musoca. 

 This fimbriated area extends in an irregular sickle-shaped 

 area, 38X13 mm. 



A section through the largest part of the tube, which 

 strikes the middle part of the chorionic cavity, shows that 

 the ovum is surrounded by mottled blood clots, some 

 organized, others fresh. The chorionic wall is fibrous, 

 and the villi are fibrous and atrophic. The muscular wall 

 of the tube is markedly inflamed and closely adherent to 

 the inclosed clot. There are also several out pocket ings in 

 the muscular wall from the epithelial lining of the tube. 

 The embryo, which looks like a grain of wheat, was cut 

 into serial sections, but only the central nervous system 

 can be recognized in them. The rest of the viscera are 

 completely dissociated; none of them can be located with 

 certainty. The enveloping sheath, that is, the skin, 

 is markedly hypertrophied, showing that this portion of 

 the embryo was growing while the rest was undergoing 

 destruction. 



No. 938. 



(Dr. Gilbert M. Elliot, Brunswick, Maine.) 

 Ruptured tube, 45X20X20 mm. From a French- 

 Canadian woman, married June 30, 1914, this being her 

 first pregnancy. Her last period began on June 16 and 

 the operation was performed on August 16, on account of 

 a sudden collapse, probably due to the rupture of the tube. 

 The patient had been very healthy anil there were no indi- 

 cations of venereal disease. Aside from the tubal infection, 

 the rest of the organs appeared normal at the time of the 

 operation. The specimen consists of a Fallopian tube, 

 about 45 mm. in length, and distended near the uterine 

 end by a spherical enlargement, 20mm. in diameter, which 

 has ruptured spontaneously, the fissure being about 16 mm. 

 in length. The mass, when cut into slabs, shows the 

 chorion densely infiltrated with blood. In its middle por- 

 tion is an irregular chorionic cavity, 7 mm. in diameter, 

 near which the blood is bright red. In the fimbriated 

 extremity of the tube, which is extensive, the ovary, 

 measuring 30X17X15 mm., has been implanted. A well- 

 developed corpus luteum can not be found, but a small, 

 dense yellow body, about 4 mm. long, is seen at one pole. 

 Sections from the uterine and fimbriated ends of the 

 tube appear to be quite normal; the folds are not excessive 

 nor adherent. There are no out pocket ings. There is a 

 slight exudate within the tube lumen. Sections through the 

 distended portion do not include the wall of the chorion. 

 The clot is well organized and ramified with strands of 

 leucocytes and a few necrotic and degenerate villi. At some 



points the leucocytes are so numerous as to form small 

 abscesses. The tube lumen, which is very small, is almost 

 entirely denuded of its epithelial layer. Aside from the 

 pregnancy the tissue seems to be normal throughout. 



No. 939. 



(Dr. W. G. Sexton, Baltimore, Maryland.) 

 Unruptured tube, 75X25X20 mm. From a Hebrew 

 woman, 36 years old, who was the mother of 3 children 

 and had had no previous abortions. The last menstrual 

 period occurred 4 5 months before the operation, which took 

 place on August 17, 1914. There was no history of vener- 

 eal disease, but at the time of the operation adhesions were 

 found around both tubes. The specimen consists of two 

 Fallopian tubes. The larger (the right) measures 75 mm. 

 in length and is distended by two enlargements about 

 20 mm. in diameter and 25 mm. in length. Sections 

 through the distended portion nearest the fimbriated 

 extremity show an enormous hypertrophy of the tubal 

 mucosa, the tube lumen measuring 13 mm. This is also 

 true for the other enlargement in its outer half; but in 

 sections through the inner half the walls are more fibrous 

 in character and inclose on one side a blood clot, 3 mm. in 

 diameter. The other tube measures 56 mm. in length 

 and shows three enlarged portions, the outermost enlarge- 

 ment which adjoins the fimbriated extremity, is 14 mm. 

 in diameter and about 18 mm. long. It shows an extensive 

 lumen completely occupied by folds of mucosa. The 

 second enlargement, which adjoins the first, is about 11 

 mm. in diameter. A section shows that some change has 

 taken place in the tube. The third enlarged portion, 

 which is smaller, measures 9 mm. 



Sections through the uterine and fimbriated ends of the 

 pregnant tube seem to be quite normal as to form, but there 

 is a marked inflammation. The clot, encircling a few villi 

 present within it, lies in a pocket away from the main 

 tube lumen, and in this pocket, which is entirely surrounded 

 by mucous membrane, is a very pronounced peripheral fol- 

 licular salpingitis. The main part of the lumen, like the 

 rest of tube, is normal as to form. The tube from the oppo- 

 site sideshows in its course three distinct enlargements, the 

 whole tube measuring 56X15X12 mm. Sections were 

 cut through these enlargements in four portions of the 

 tube and it was found that in general the form of the folds 

 is normal, although a considerable amount of inflammatory 

 reaction is present. The uterine end of the tube appears 

 very much like the corresponding end of the opposite side, 

 with the possible difference that it is somewhat more 

 inflamed. The sections through the fimbriated end arc 

 much like those from the other side, with the possible 

 exception that there are some outpocketings in the thickened 

 folds as well as in the muscular wall of the tube. The 

 distended portion within the fimbriated end is markedly 

 inflamed and some of the folds here are adherent that is, 

 there is a beginning follicular salpingitis. The enlarge- 

 ment near the uterine end shows a more pronounced fol- 

 licular salpingitis. The case is especially valuable, as it 

 shows the diseased condition in the tube, opposite the one 

 which is pregnant, whereas that in which the pregnancy is 

 located has a large divertieulum off the lumen of the main 

 tube. 



No. 945. 



(Dr. G. E. Crawford, Cedar Rapids, Iowa.) 

 Normal embryo, CR 37.5 mm. From a German woman, 

 aged 37, married in 1S99. She was the mother of thnv 

 children and had had one abortion in 1904 at 2 months. 



