Paper - A study of the causes underlying the origin of human monsters 17
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Mall FP. A study of the causes underlying the origin of human monsters. (1908) Jour, of Morphol., 19:
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A Study Of The Causes Underlying The Origin Of Human Monsters
Embryos of the Fifth
The changes in the beginning of the ﬁfth week are quite similar to those at the end of the fourth week, for the normal development has advanced but very little. However, toward the end of the ﬁfth week, when the anlages of the ribs appear and there is further differentiation in the mesenchyme, we also ﬁnd modiﬁed pathological processes, which are quite characteristic, and are not seen in earlier stages. The first specimens, then, which are -about to be described could also with propriety have been considered with those at the end of the fourth week. In these we ﬁnd again the dilated and dissociated central nervous system, dissociation of the tissues and the organs, infiltration of the liver with round cells, and a dilated and gorged vascular system. All these changes are well marked in Nos. 97 and in 251. In No. 251, however, the pathological changes are so marked that it merits a special description. The chorion is well enveloped in pus, showing that an active endometritis encircled it. The head of the embryo is rounded, solid and ﬁlled with a dissociated brain. The face is practically destroyed and the brain is protruding on the dorsal side of the head. Following the sections in order down the spinal cord, it is found that in this the central canal is distended and the walls partly dissociated.
TABLE X. NORMAL Emmvos or rm; FIFTH Wnnx. '3 E . Specimen. Embryo. Chorion. ‘£3; é’ mm. mm. days His (17) ........ .. 8.5 20}: 12 No.163 . . . . . . . . .. 9 35x35x2o 5w-ks,
No. 388 . . . . . . . .. 9 52
No. 258 . . . . . . . . .. IO 35x3ox25
Ecker . . . . . . . . .. I0 60
No.88 . . . . . . . . .. IO 3ox28x15
No. 389 . . . . . . . .. I0 3°
His (98) . . . . . . . .. 10.3 35x25
N. 11 30x30 54 11 40 x 35 x 30 11 30:; 27 61 11 30:: 25
His (ﬁg) . . . . . . .. 11.5 3ox27
No.156......... 12 35x35
His (S1) . . . . . . .. 12.5 3ox27
ARRESTED DEVELOPMENT or THE EMBRYO. (Fifth Week.)
h . . No. Erbfzzneo. 12£‘;‘°&5“§;;(5):_f Mexgerf-13-I Changes in the Chorion. mm. mm. days
97 9 30 x 30 x :5 ‘ 61 Fibrous.
3 5 9 :05 x 65 x 65 Atrophic. Inﬁltrated by leucocytes. 25: 9 30:: 25 x 25 77 Fibrous. Abscesses. 366 9 Fibrous or hyaline. 16: IO 50x 25 x 25 S3 Pus between villi. 54 I I 133 :1 32 x 32 x 32 65 Normal in shape but ﬁbrous. 288a. 1 I 85 x 35 x 3 5 5 or 6 Fibrous. Invaded by 1eucoweeks cytes and syncytium
343 :2 45 x35~x 25 Fibrous. 1 7 7 1 2 3302. 1 2 6o x 55 x 50 1 28 Inﬁltrated by leucocytes. 3 30b 1 2 5 5 x 50 x 45 1 2 8 Inﬁltrated by leucocytes.
348 1 2 50 x 30 x 2 5 Fibrous degeneration. No. 1.] ORIGIN OF HUMAN MONSTERS. 115
The usual changes are again seen in the vascular system, and the dissociation of the tissues and organs is well marked. The mesodermal tissues, including the precartilages and peripheral nerves, are more or less ﬁlled with round cells, which, as the epidermis is wanting, have also wandered to the exterior of the body.
Specimen No. 161 is especially interesting, for the inﬂammatory changes around it are no doubt due to the repeated attempts at abortion by the mother. The woman was already suffering with leucorrhoea, and it was easy for her to extend this purulent inﬂammatory matter into the uterus with the rubber catheter she had used. VVhile this experiment was followed by great activity in the leucoytes and syncytium on the outside of the chorion, an equally active reaction took place within the embryo. The head end of the embryo is almost completely dissociated, but the process is less intense in the lower part of the body. In general, the changes are similar to those in the embryos described above.
More intense changes are found in embryo No. 135, in which the duration of the pathological process must have been long, judging by the changes in the embryo and the chorion. The chorion, to which we look for the primary lesions, is smooth and devoid of villi. The large amnion within is ﬁlled with a jelly-like mass which became ﬁrm after ithad been treated with formalin. The atrophic embryo contains a dissociated central nervous system without a brain, the head being very small and converted entirely into a mucoid mass. The eyes have sunk deep into the tissue of the head and contain hard lenses, composed of lens ﬁbers. The anterior end of the chorda dorsalis is much enlarged and forms a mucoid tumor, on either side of which may be seen a large cartilaginous mass of tissue. Heart and vascular system are ﬁlled with blood, which extends through their dissociated walls into the surrounding tissue, obscuring the outlines of the organs and peritoneal cavity. All this shows that development ceased a long time before the abortion took place, and that the tissues simply grew onward in an irregular fashion. thatsis, they dissociated. II6 MALL. [VOL XIX.
The remaining nine embryos of the ﬁfth week may be considered together, for in many respects they are alike. In all of them the bodies of the vertebrae are well outlined and the precartilages of some of the ribs are laid down. They may be compared with the normal embryos, Nos. 109 and 16'’. whose skeletons have been studied with great care by Bardeen. It may be that the ﬁrst four embryos of this group belong to the fourth week, for it is certain that their development is not as far advanced as No. 163, but they are fully as large. The slight difference may be due to errors in measure-ments or to the possibility that pathological embryos of younger stages may simply “swell” but not develop. However, the opposite is usually observed.
Specimens Nos. 54, I 33, 348, 2883, 343 and 177 show much the same changes in them. The tissues are well dissociated, with a variety of other changes in the body. In Nos. 54 and 343 the front end of the brain is missing and the ventricle communicates with the exterior of the body, as if the neuropore were open. In these two specimens, in which the cerebral vesicles have been fully destroyed, there are but few pathological changes in the rest of the body. They may be compared with No. 256 (Fig. 8, Plate III), in which the fore-brain was removed by mechanical means, that is, through rough handling, and is in every respect an anencephalic monster.
No. 133 is well dissociated, but in it, as in the rest of this group, the liver is more like the normal, showing that in later stages the liver is more resistant than it is in younger ones. No. 348 shows about the same changes, only that in addition the embryo as a whole is disintegrating. The deformed embryo from specimen No. 288a is from a mole in which the chorion was found to be collapsed. The position of the embryo is in the upper right hand corner. In No. I 77 the process of dissociation has outlined the ribs into two zones. an outer and an inner, although no true cartilage is present. Back of the eyes, in the occipital region, there are two cartilaginous masses, much too well developed for an embryo of this stage, and similar to those found in No. I 35. These changes are given as examples of further development of some of the tissues after the general growth of the embryo has come to an end. In No. 343 the fore-brain is destroyed entirely and the medulla is distended. The outlines of the organs and tissues are well deﬁned, and they are fairly well inﬁltrated with migrating blood cells.
The structure and form of the organs in No. 343 resemble in many respects the state of things found in N05. 330a and 33ob. These two specimens came from twin ova which were aborted 128 days after the beginning of the last menstrual period, thus making the duration of the pathological process fully nine weeks. The chorions are both ﬁbrous, are enveloped in pus and inﬁltrated with leucocytes. Both embryos show practically the same changes in them as are found in several other sets of twins, which seems to me to be strong evidence in favor of the theory that the deformed embryos are due to endometritis. The changes in both embryos are very much alike and can be described together. The epidermis is intact, but the true skin is hypertrophied, and in front of the head, in the region of the deformed mouth, the epidermis shows peculiar thickenings. Both spinal cords are dilated and their walls are dissociated. The cerebral vesicles and mid-brain are nearly destroyed, the main portion of the head being taken up by the hind-brain. The large bloodvessels and the heart are ﬁlled with blood; in 33ob the wall of the ventricle is inﬁltrated with blood cells and in 3303. it is nearly destroyed by them. The tissues and organs of the embryos are well dissociated and more or less ﬁlled with round cells. Some of the liver tissue is necrotic.
In reviewing the most marked peculiarities of the pathological changes in embryos of the ﬁfth week, it may be noted that the differentiation of the tissues has made some of them more resistant than others; the more central tissues show the least amount of change, and the extremities, head and face the most, these giving way ﬁrst. The spinal cord and medulla show more resistance than the brain and do not disI18 MALL. [VoL. XIX.
integrate as easily. The vascular system seems to suffer more than the nervous system does, but this may be due to the character of the primary trouble in the chorion, which probably ﬁrst made itself felt in the heart. It is clear that when the heart is aﬁected and stops that the embryo is then deprived of its nutrition, and under these circumstances the brain suffers before the spinal cord. Among the tissues the precartilages and cartilages suffer least of all.