ON THE FATE OP THE HUMAN EMBRYO IN TTIBAL PREGNANCY. 



mi 



Her last period began on July 16, 1914, and she was oper- 

 ated upon on September 29. Otherwise the history 

 contains nothing of importance. We received only the 

 embryo, and therefore could make no examination of the 

 tube wall. 



No. 953. 



(Dr. M. Y. Dabney, Cleveland, Ohio.) 



Ruptured tubal pregnancy, 3.5X20X20 mm. The tube 

 was moderately distended and sections were taken through 

 three portions of the wall. The folds of the mucous 

 membrane of the uterine and fimbriated ends were normal 

 in form, but were somewhat infiltrated with leucocytes. 

 No outpocketings nor adhesions could be detected. Sec- 

 tions through the distent ion showed that it was composed 

 of mottled blood with the fresher corpuscles taking on 

 iron hematoxylin stain; the rest failing to do so. Scat- 

 tered through the clot were a few fibrous villi, in the last 

 stages of disintegration, being outlined mainly by an 

 accumulation of leucocytes. Sections struck the point 

 of implantation, where the tube wall was quite inflamed. 

 The crescent-shaped lumen which surrounded the clot had 

 hanging into it a few atrophic folds; otherwise it was lined 

 with a single layer of epithelium. 



No. 967a. 



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

 Unruptured mass, 50X40X30 mm. From a Malay 

 woman, 27 years of age, who had been married 10 years and 

 was the mother of two children; there was no history of 

 previous abortions. The last period began on April 20, 

 1914, and lasted for 10 days; after this there was irregular 

 bleeding until the operation, which took place May 19, 

 1914. She had had a uterine discharge since 1906 and her 

 husband was suffering from gonorrhea. The specimen 

 consists of a piece of tube, a distended portion which has 

 been cut into, and numerous large blood clots. No 

 embryo is found. Sections through the uterine end of 

 the tube show that it is quite normal in form. A section 

 made from the distal side of the distended portion shows 

 the tube to be filled with very large folds and at the 

 periphery is a pronounced follicular salpingitis with pockets 

 forming between the tube folds, which are filled with 

 numerous epithelial-like cells. The wall of the distended 

 portion is very thick and composed of mottled blood, in 

 which are numerous necrotic and fibrous villi. Large 

 masses of nuclear dust often accompany the necrotic villi. 

 Sections stained with iron hematoxylin show that only 

 the fresh blood masses take on the fresh stain. 



No. 9676. 



(Dr. R. \V. Hammack, Manila, Philippine Islands.) 

 Unruptured tubal mass, 60X35X30 mm. The patient 

 was a Malay woman, 33 years old, the mother of two chil- 

 dren; there was no history of abortion. The last period 

 began the last part of May, and was followed by profuse 

 hemorrhage, which was more or less continuous until the 

 time of the operation, August 1. At the operation the un- 

 ruptured tube was found to be bound down with adhesions. 

 The tubal mass is considerably contorted and measures 

 60X35X30 mm. (It had been opened before it was sent 

 to us.) It contains a blood clot 25X15X15 mm. but no 

 embryo is to be found. The mucous membrane of the 

 tube wall is markedly inflamed and surrounded by an 

 extensive follicular salpingitis. It has been invaded by 

 several outpocketings. The tissue of the folds has been 

 almost entirely destroyed by numerous leucocytes which 



have invaded it. The cavities ol' (he spaces :uv filled with 

 exfoliated epithelial cells. The blood clot within is of 

 uniform density, ami on one side of it is a necrotic ovum 

 with many attached villi. 



No. 967c. 



(Dr. R. VV. Hammack, Manila, Philippine Islands.! 



Tubal mass, 05X50X30 mm. The patient was a Malay 

 woman, 40 years of age, who had been married for 20 years. 

 She had been pregnant three times, with no abortions. 

 The last period took place in March 1914, after which 

 there was continuous bleeding for about a month before 

 the operation (June 18, 1914). There was no discharge 

 from the uterus. At the operation it was found that the 

 uterus was bound down by adhesions. The specimen 

 consists of a tubal mass, 65X50X30 mm. Its distal 

 end contains the cavity, 20 X 15 mm. In addition there are 

 four other masses, together weighing about 80 grams. 

 No embryo is to be found. 



Sections through the uterine end of the tube show that 

 the folds are markedly hypertrophied and from them ex- 

 tend numerous villus-like processes. There are also 

 several outpocketings. The mucous membrane is edema- 

 tous and somewhat infiltrated with leucocytes. The 

 section through the cavity into the specimen is lined with 

 a very thick layer of fibrinoid substance, and some of the 

 large sinuses within the muscular wall have in them tro- 

 phoblast cells. The section also strikes a portion of the 

 tube lumen which is marked by pronounced follicular 

 salpingitis as well as outpocketings. Although no trace 

 of an embryo was found in the sections, I am inclined to 

 believe that a normal embryo had been present and was 

 peeled out entirely at the time of the operation. The 

 extensive amount of fibrinoid substance and the pro- 

 nounced trophoblast cells within the venous sinuses sup- 

 port this idea. 



No. 974. 



(Dr. A. W. Elting, Albany, New York.) 



Unruptured tube, 40X20X20 mm. From a patient 

 34 years of age, who had been married 11 years. She 

 began to menstruate at the age of 16 and had always been 

 regular. A few months after her marriage she had her 

 first abortion, which was an artificial one. She stated 

 that since that time she had had nine or ten pregnancies, 

 some of which aborted spontaneously, others being artifi- 

 cially induced. She had had only one child, at full term, 

 now 13 months old. Menstruation was regular after the last 

 childbirth. The last menstruation began October 3, 1914, 

 was normal, and lasted 3 days. On October 16 she had 

 severe pain in the abdomen, chiefly on the left side, with 

 nausea and vomiting and a slight flow. The pain con- 

 tinued with more or less nausea and slight Mowing until 

 she was operated upon on October 22. At the operation 

 evidences of an attempted tubal abortion were found. 

 There was considerable amount of blood in the abdominal 

 cavity, but no evidence of actual rupture of the sac or of 

 an extrusion of the fetus. 



The specimen consists of an Unruptured tube measuring 

 40 X20 X20 mm., to which is attached an ovary, containing 

 a cyst, 35 mm. in diameter. A section of the tube shows 

 that it is filled with blood of a uniform black hue. The 

 clot protrudes through the fimbriated opening. Sect inns 

 through the uterine end of the tube show small folds, slightly 

 inflamed, with several very small outpocketings. The dis- 

 tended portion of the tube has a very thin muscular wall 

 with scattered folds, many of which are adherent. There 



