102 



ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



are no outpocketings. The tube wall is markedly inflamed. 

 The clot within is quite uniform, consisting of concentric 

 rings of fibrous tissue, on the periphery of which are embed- 

 ded a few small necrotic villi, most of them having been 

 invaded by leucocytes. 



No. 977. 



(Dr. G. N. J. Soinmer, Trenton, New Jersey.) 



Partly ruptured tube, 45X25X20 mm. From a 

 woman 27 years of age, who had been married 4 years, 

 this being her first pregnancy. After the period beginning 

 September 3, 1914, the next period, on October 17, was 

 accompanied by pain in the left side. Bleeding continued 

 off and on until the time of the operation, November 4, 

 1914. She had three attacks of pain at intervals of 6 

 days. The left tube was removed at the operation and 

 found to be ruptured about its middle. There was no 

 evidence of pelvic inflammation. The right tube and 

 ovary were normal; the uterus was somewhat enlarged and 

 soft; there were no signs of leucorrhea or venereal disease. 

 The members of the mother's family had been fertile. 



The specimen is a tube, measuring 45X25X20 mm., 

 which came to us partly ruptured and distended at several 

 points. At one point there is a rupture about 5 mm. in 

 diameter, through which protrude numerous white villi. 

 A section through this portion shows that the ovum is 

 directed towards it, most of the villi having accumulated 

 under the point of rupture. More towards the center of 

 the tube is a cavity which contains a granular mass, prob- 

 ably the disintegrated embryo within the cavity of the 

 chorion. 



Sections through the uterine end of the tube show that 

 it is filled with numerous very large folds, many of which 

 are adherent to one another; but there are several small 

 outpocketings in the muscular layer. The section through 

 the fimbriated end of the tube is quite similar to that 

 through the uterine end. The wall of the tube near the 

 rupture is markedly infiltrated with trophoblast on one 

 side. Within are numerous villi which, although some- 

 what fibrous, are quite normal in appearance. They 

 are covered with a large amount of trophoblast, which 

 would seem to indicate that the embryo had been normal 

 a short time before the rupture. The clot is somewhat per- 

 meated with bands of fibrin and the delicate folds of the 

 tube are all independent. Most of the villi have blood 

 within them, showing blood-corpuscles of the embryo. 



No. 990. 



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



Unruptured tube, 64X37X33 mm. From a white 

 woman who has been married 8 years, this being her first 

 pregnancy. The last period began on October 30 at the 

 regular trine and continued until the time of operation, No- 

 vember 23. She has been suffering from pain in the pelvic 

 region for the past month, with occasional severe pains in 

 the abdomen, accompanied with great difficulty in breath- 

 ing. There is no evidence of venereal disease. 



At the time of operation the uterus was found to be 

 normal and well embedded in large blood clots, over a pint 

 of blood and serum being removed. There were old adhe- 

 sions about the right tube and both ovaries. The left tube 

 contained the pregnancy. Both ovaries were cystic and 

 degenerated; the corpus luteum of pregnancy could not be 

 found. 



Sections through the uterine end of the tube show the 

 folds greatly enlarged with epithelial pockets growing into 

 them as well as into the tube wall. Some of these pockets 



are unusually large, measuring about 1 mm. in diameter. 

 The clot is mottled and contains an ovum which is partly 

 collapsed and filled with fresh blood. There are several 

 very large accumulations of leucocytes in this specimen, 

 many necrotic and a few fibrous ones. A section strikes 

 the point of implantation, which is relatively small, the 

 crescent-shaped tube lumen being lined with a few small 

 folds, which are almost filled with leucocytes. Another 

 section through the blood clot, but nearer the fimbriated 

 end, gives the same picture. 



No. 992. 



(Dr. Edward J. O'Brien, Detroit, Michigan.) 

 Ruptured tube, 51X42X36 mm., with an embryonic 

 mass 2 mm. long. From a woman who first married 

 5 years ago. She had a miscarriage at 7 months which 

 was followed by pneumonia, which kept her in bed 4 weeks. 

 The menses have always been normal. There is no history 

 of excessive leucorrhea. She is strong and well nourished. 

 A year ago she married a second time and menstruation 

 was regular until 3 weeks before operation. This period 

 lasted 3 days longer than usual and was very profuse and 

 painful. Examination showed marked tenderness on the 

 right side and a mass to the right of the uterus. The 

 uterus was not perceptibly enlarged. 



The specimen consists of an irregularly compressed tube, 

 which has been ruptured or cut open, and shows a cavity 

 lined with a smooth membrane, measuring 20 mm. in 

 diameter. No embryo was found. Sections through the 

 uterine end of the tube show a lumen quite large and 

 filled with hypertrophied folds, which form large pockets 

 ramifying clear across the tube lumen. There are also very 

 pronounced pockets at the bottoms of the folds that is, 

 there is a pronounced follicular salpingitis with the usual 

 villus-hke processes extending into the follicles. A section 

 through the hemorrhage did not include the tube wall. 

 It is mottled with blood, which is partly organized and 

 partly fresh. The latter takes on an intense stain with iron 

 hematoxylin. The chorionic wall is not much altered 

 and is lined with a very thin amnion. The section passes 

 through the cord, the free end of which is partly round, 

 but at one place it runs out into a sharp point. The cord, 

 which is about 2 mm. long, contains the remnants of its 

 blood vessels and a rounded tube, which strongly suggests 

 the allantois. The hemorrhagic mass is permeated with 

 numerous villi, most of which are fibrous and many of 

 them necrotic. The trophoblast is not very active and at 

 some points there are necrotic masses of trophoblast, 

 showing that the ovum was strangulated some time before 

 the operation. 



No. 995. 



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

 Unruptured tubal mass, 85 X 65 X 40 mm . From a white 

 woman 38 years old, this being her fifth pregnancy, she 

 having given birth to three children and having had one 

 other abortion. The last period began September 28, 

 1914, and on October 8 bleeding began and continued until 

 November 26, when the operation was performed. There 

 was no evidence of venereal disease. She came from a very 

 fertile family, being one of 13 children and one of 144 grand- 

 children and great-grandchildren. At the time of the 

 operation the uterus was somewhat enlarged. The right 

 tube and ovary, although normal, were bound down by 

 adhesions. 



The specimen consists of a well-organized clot, the 

 measurements of the tubal mass being given above. Sec- 

 tions were taken through the clot as well as through the 



