Paper - A study of the causes underlying the origin of human monsters 21
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Mall FP. A study of the causes underlying the origin of human monsters. (1908) J Morphol. 19: 3-368.
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A Study Of The Causes Underlying The Origin Of Human Monsters
Description of the Specimens and the figures
The description of each specimen is complete in itself, giving its main data, which were obtained from my notebooks as well as from the specimens and their sections. Their numbers correspond with those in my catalogue.
The measurements of the embryo are as follows: C.R., crown-rump or sitting height; C.H., crown—hee1 or standing height; and A.R., neck rump or length of the spinal column.
These specimens, with others which I am collecting, will be deposited in the Wistar Institute, where they may be studied by investigators interested in teratology.
Embryo No. 6
Carnegie Embryo No. 6
Ovum, 40 mm. in diameter; embryo, C. R., 24 mm.
From Dr. C. 0. Miller, Baltimore, October 27, 1892.
This specimen was obtained through the kindness of Dr. C. 0. Miller, from whom the excellent specimen, No. 2, was secured some time before. (See JOURNAL OF MORPHOLOGY, Vol. 5, p. 459.) Both specimens were removed from the uterus by self-inflicted mechanical abortions, which the woman was in the habit of performing upon herself and which finally caused her death. Dr. Miller informs me that when he was called to visit his patient she was bleeding profusely and he had considerable difficulty in removing this embryo and its membranes. In so doing the ovum was ruptured, but it still retained a suflicient quantity of fluid to protect the embryo. The time of the abortion was 77 days after the beginning of the last menstrual period. The entire membrane and embryo were placed in 95 per cent alcohol one and one-half hours after the abortion.
The above history makes it highly probable that the embryo is normal, as does also its reconstruction. However, at the tip of the tail there is a small vesicle which cannot be considered normal. It is lined with a single layer of cylindrical cells, much like that of the central canal, is covered in part with round cells identical with those of the cord, and has on either side of it a spinal nerve, as shown in the diagram and the drawings.
Embryo No. 10
Carnegie Embryo No. 10
Embryo, C. R., 20 mm.
From Dr. W. S. Miller, Worcester, Mass.
At first I believed the embryo to be normal, but after it had been cut into sections 20 microns thick, and the entire body reconstructed from them, it was found that the abdominal viscera were clumsy in shape and that the liver protruded into the umbilical cord. A comparison of the picture of the reconstruction of the body of this embryo with those of both older and younger specimens will show that the body of the embryo is markedly distorted and that there is hernia of the liver.
Fig. 10. — Reconstruction of the embryo. X 8 times. L, liver; S, stomach; W, Wolffian body; SC, suprarenal body.
Embryo No. 11
Ovum, I0 x 7 mm.; umbilical vesicle, 1.5 x I mm.; “embryo,’-’ .8 mm.
From Dr. Kittridge, Nashua, N. H., March 16, 1893.
This specimen was sent me by mail in an ordinary 4._-oz. bottle filled completely with alcohol. Dr. Kittriclge has procured for me the following history: “The woman, from whom the specimen was obtained, is twenty-five years old, menstruates regularly every four weeks, the periods lasting from four to five days. She gave birth to a child September 19, 1892, and had the first recurrence of menstruation December 19. The second period followed on January 25, and was very profuse; it lasted until February I. The next period should have begun about February 22, but on account of its lapsing the patient concluded that she was pregnant, and called at my officei a few days later. I did not examine her, but asked her to remain quiet and await developments, as I thought possibly that she might be pregnant; On the evening of March I she fell and sprained herself, and during the same night had a scanty flow. The flow recurred each day, and on the 7th of March she passed the ovum. It was kept in a cool, moist cloth for twenty hours, and when it came into my hands was at once placed in a large quantity of 60 per cent alcohol.”
Fig. 11a. — Photograph of the entire ovum. Natural size.
Fig. 11b. — Diagrammatic section of half the ovum with the embryonic mass attac ed. X 10 times. The villi are drawing only upon the upper quartet of the chorion. Ec, ectoderm; en, entoderm; um, umbilical vesicle; mes, mesodern; cae, ccelom; all, allantois; a, amnion.
The ovum is very large for its age, having a long diameter of IO mm. and a short diameter of 7 mm. It is covered with villi only around its greatest circumference, having two spots without villi, as was the case with Rei«:hert’s ovum. The villi of the chorion are from 0.5 to 0.7 mm. long, are branched and are somewhat fibrous in structure.
Upon opening the chorion it was found that the embryonic vesicle is situated just opposite the edge of the zone of villi.
Fig. 11c. - Section through the umbilical vesicle and its invagination of specimen. X 50 times. The three layers correspond with the ectoderm, mesoderm and entoderm. The invagination marks the cavity of the amnion.
About it there is a considerable quantity of magma reticulé, which I did not remove, and therefore could not obtain good camera drawings. The portion of the chorion to which the vesicle is attached was cut out and stained with alum cochineal and cleared in oil, but even after this treatment it was impossible to obtain any clear picture. The specimen was next imbedded in paraffin and cut into sections IO microns thick. The series proved to be perfect. From the sections a reconstruction was made in wax.
The dimensions of the different portions of the vesicle are as follows:
|Diameter of stem||0.4 mm.|
|Length of stem||0.4|
|Length of vesicle||1.5|
|Width of vesicle||10 ?|
|Length of invagination||0.8|
|Width of invagination||0.5|
|Diameter of opening of invagination||0.03|
The sections and reconstruction show that the embryonic vesicle is attached to the chorion by means of a stem. The greater part of the vesicle itself is composed of two layers. ectoderm and mesoderm. In the neighborhood of the embryonic stem there is a third outer layer which shows all of the characteristics of the ectoderm. Just beside the attachment of the vesicle to the stem there is a sharp, deep and narrow invagination of all three embryonic membranes. Within the stem there is a sharply defined allantois which communicates with the cavity of the vesicle just below the cavity of the ectoderm. The ectodermal plate of the invagination is very broad but not of equal thickness throughout its whole extent. It extends to the outside of the vesicle and ends quite abruptly in tl1e neighborhood of the stem. The hloo<l—vessels of the mesoilermal layer extend to the stem but do not enter it, nor are there any blood-vessels in the chorion.
Fig. 11d. — Section through the stem uniting the umbilical vesicle with the chorion. X 50 times. The cavity within the stem lined with epithelium is the allantois.
Since the first publication of this specimen, embryos both normal and pathological have been studied, all of which indicate more and more that this specimen must belong to the pathological class. The other pathological specimens in my collection as well as the perfect normal specimen described recently by Peters all speak for this conclusion. Yet the presence of all three blastodermic membranes in it, with blood islands in the mesoderm, and an allantois in the embryonic stem, indicate that this specimen cannot be far from the normal, but represents the earliest changes in the blastodermic membranes in a specimen of the Peters’ stage under pathological conditions.
Embryo No. 12
Ovum, 20 x 20 mm.; embryo, C. R., 2.1 mm.
From Dr. Ellis, Elkton, Md.
“The patient from whom the ovum was obtained is twentythree years old, menstruated first in her fourteenth and married in her twentieth year. Some time after her marriage she became pregnant and aborted July 6, 1893, having passed two periods at that time. The next time she became pregnant she aborted this specimen. She was last unwell November 7, the flow lasting five days, and she aborted on the 18th of December, that is, I found the ovum in the discharges of that day, although the waiting began the day before. The patient says it has always been her habit to go more than twenty—eight days, her periods recurring on the thirtieth day usually, but frequently the intervals are longer, thus: She was unwell on October 5 and on November 7 and in September she went 21 week over her time. The patient is an intelligent and truthful person and you can rely on her statements.”
The ovum appears to be perfect and normal, being covered with the normal number of villi. The embryo within appearecl normal and of the two weeks’ stage. In reflecting over the specimen, I have concluded that its brain is too small, the central canal too wide open, and the optic vesicles too atrophic to be normal. The spinal cord is also too wide open behind. The embryo could be viewed as normal with the exception of the spina bifida in the lower part of the cord and the anencephaly in the anterior.
Fig. 12a. — Photograph of the entire ovum. Natural size.
Fig. 12b. — Diagrammatic reconstruction of half the ovum with the embryo attached. X 10 times. The villi are drawn upon the upper half of the diagram only. Coe, coelom; uv, umbilical vesicle; all, allantois; mp," medullary plate.
Fig. 12c. — From a reconstruction in wax. X 40 times. Cs, eighth cervical myotome; OV, optic vesicle; AV, auditory vesicle; H, heart; VOM, yolk vein; P, coelom; UV, umbilical vesicle; 03, third occipital myotome; All, allantoisg Am, amnion.
Fig. 12d. — View of the embryo to show the open spinal cord below and the atrophic head with large neuropore.
Sections of the chorion indicate also that it is practically normal with the exception of some fibrinous masses between the villi. Otherwise there is no indication of a change in the structures of the villi nor in the syncytium.
It is certainly possible that all of these slight changes took place during the twenty-four hours before the abortion, while the uterus was making ready to expel the ovum.
Embryo No. 13
Ovum, 8 x 7 111111.; vesicle within, 1.4 x .85 111111.
From Professor His, Leipzig.
This embryo is the well—known specimen No. 44 of the His collection. (See Anatomic mensch. Embryonen, II, pp. 32 and 87.) The ovum is not completely covered with villi.
Fig. 13a. — Section through the umbilical vesicle and chorion of specimen No. 13, H_1s’s No. 44. Blood corpuscles are seen within the cavity of the vesicle. X 30 times.
Within there is a small double vesicle which appears to be the amnion lying upon the umbilical vesicle. Attached to the denser (umbilical) vesicle there are numerous fibrils which extend throughout the entire coelom.
This specimen promised to be, at the time Professor His described it, the valuable early stage sought for by all embryologists, but unfortunately the sections prove it ‘to be pathological. The great quantity of fibrils, magma reticulé, within the coelom already indicated that the embryo is not normal.
Fig. 13b. — Section through the amnion, jugular veins, umbilical vesicle and cliorion. X 30 times.
Fig. 13c. - Section through the umbilical vesicle as it joins the chorion. X _3o times. The largeirregtilar space in the chorion is a blood space which communicates with the veins of the embryo.
Fig. I3d.——Embryonic vesicle attached to the cliorion. X 20 times. After His.
The sections show that there is a double embryonic vesicle composed of the amnion and umbilical vesicle, the walls of which are thickened and fibrous, with the embryonic layers but poorly defined. The tissues of the vesicle and its cavity are well filled with migrating cells. The chorion is also fibrous, with blood-vessels and migrating cells extending into the villi. The syncytial layer is not extensive.
Embryo No. 14
Chorion, 30 mm. in diameter; within them is a small double vesicle with a short pedicle 1.5 mm. in diameter. From Dr. Friedenwald, Baltimore, I893.
Figs. 14a. and I4b. — Sections through the nodule (vesicle) of the specimen. X 25 times. A few blood islands as well as an enclosed mass of syncytium are within the stem.
The mesodermal layer of the chorion is thin and decidedly fibrous with but few cells scattered through it. There are no villi. There are groups of cells in the chorion, at the base of the embryonic vesicle, which are probably islands of syncytium inclosed within it.
The walls of the vesicle are thick and fibrous with no blood island within them. It is covered with a single layer of epithelial cells which have fallen off at points. Scattered throughout the mesoderm there are numerous migrating cells. At the base of the vesicles there are a few blood spaces with blood cells within them. The vesicle is lined with a single layer of epithelial cells.
At the base of the larger vesicle there is a large closed space lined with spindle cells. A similar space lies immediately below the smaller vesicle. ’
Embryo No. 20
Chorion, 20 x 14.6 mm.
From Dr. J. W. Williams, Baltimore, February 14, 1894.
From the exterior, the ovum appears to be normal with well developed villi of the chorion. Within the coelom, however, there is a great quantity of magma, within which were buried several nodules. These were removed and sectioned.
Fig. zoa. Fig. zob.
Fig. 2oa.—Exterior of ovum, showing long irregular villi. Natural size. Fig. 2ob.—Ins1de V1C\V of chorion, showing strands of magma rcticule.
Sections show that there is no amnion lining the chorion and that the small nodules are only small masses of magma which contain no cells. The villi are normal in form with the usual quantity of syncytium upon them. At isolated points between the villi there are small masses of a granular substance which look like coagulated albumin.
No. 21. Chorion, 12 x 9 x 5 mm. ; vesicle within, 5.5 x 3.5 mm. From Dr. Cullen, London, Canada, January, 1896. The fresh specimen, still inclosed within the decidua, was
hardened in a large quantity of formalin and sent by express in the same fluid.
Fig. 2Ia.—()vum covered with long irregular villi. Slightly enlarged.
From the external appearance, the ovum is apparently normal, with well—developed villi branching a number of times. Upon opening the specimen it was found that the coelom is filled with a small quantity of magma reticulé, within which is 6llli)6(l(le(l a very large trasparent vesicle.
Fig. 2Ib.——lnterior of chorion, showing magma and vesicle. X 5 times.
This, with its attachment to the chorion, was removed and cut into serial sections 20 microns thick.
The main vesicle is brought in contact with the chorion by means of a small secondary vesicle; both are inclosed with a layer of mesoderm within which are numerous blood islands.
The smaller vesicle is lined w-ith a layer of large spindleshaped cells. Migrating cells are within the cavities of both vesicles, and are also scattered throughout the surrounding magma.
There are no bloo(l—vessels in the chorion. The syncytial layer is diminished, but is well formed upon the tips of the villi. Here it often accumulates in layers, forming peculiar strata.
Fxc. 2Ic.—Section through the vesicle and chorion. X 25 times. The second vesicle between the larger one and the chorion appears to be the stem with a dilated allantois, although it is not attached to the chorion.
Embryo No. 24
Chorion, 21 x 16 x 5 mm.
From Dr. C. 0. Miller, Baltimore.
The ovum was covered completely with villi which branch a number of times. Upon opening the specimen it was found that the coelom was filled completely with magma reticulé of moderate density. No trace of an embryo could be found. From time to time I made renewed search and finally decided to cut the entire specimen into sections. After staining it with cochineal a small nodule became visible when the specimen was placed in direct sunlight. This. with a piece of chorion upon which it lay, was cut into serial sections 20 microns thick.
The walls of the vesicle are composed of three layers, the outer being greatly thickened at points, but retains sharp borders. The mesoderm is hypertrophic. The inner layer is irregular, thick and thin, with a tubular branching process which extends to the stem of the vesicle. There are blood islands in the vesicle and stalk, and the vessels extend to the villi of the chorion. There are migrating cells in the tissue of the pedicle.
flu. 24a.——Section through the vesicle attached to the chorion. 25 times. There is 21 multiple allantois and multiple amnion with a thick layer of epithelium over the vesicle.
Fig. 24c.——A still deeper section of the vesicle, showing the irregular thickening of the ectodcrm and entoderm.
The syncytial layer is very extensive, forming large buds upon the chorion as well as upon the villi. At points these buds coalesce to form islands, the centers of which are composed of necrotic mass filled with fragmented nuclei.
Embryo No. 25
Chorion, 25 mm. in diameter, with a pedicle within 6 mm. long and 2 mm. in diameter.
Dr. J. W. Lord, Baltimore.
The ovum is covered entirely with long villi, and has a hemorrhage on one side of it. The pedicle within has all of the characteristics of the umbilical cord of an embryo five weeks old. There is no trace of an embryo, but there are a
Fig. 25.—Section through the umbilical cord and amnion at their attachment to the chorion. X I0 times.
number of cells at the free end of the pedicle, which also has a ragged edge. The amnion lines the entire coelom and is reflected over the pedicle just as it would be over the normal cord
Sections show that the club-shaped cylindrical body is in fact the cord with its blood-vessels and amnion. The free end of the cord is rich in round cells, appearing much like the granulation tissue of healing wounds. At this point the end of the cord is infiltrated with cells, in addition to the nucleated cells of the cord, and it has very ragged edges. It appears as if the embryo had gradually fallen off, piece by piece, leaving the ragged stump of a cord. The blood-vessels of the cord are but sparsely filled with blood. At the base of the cord there is a remnant of the umbilical duct. Apparently the chorion is normal.
Embryo No. 29
Chorion, 30 mm. in diameter.
Dr. W. D. Booker, Baltimore.
The ovum is covered with but few atrophic villi, and within no trace of an embryo can be found. The coelom is filled with a cheesy mass or granular magma, like that usually found within the amnion of pathological embryos. After the magma had been searched through most completely, the portions of the chorion which might have a remnant of an embryo at tached were stained and cut into serial sections, but nothing whatever could be found.
Sections of the chorion show that its walls and villi are fibrous and thickened. There is no amnion present. The syncytial layer is very extensive over the villi and chorion, invading them at points. Immediately over the syncytium of the villi, and occasionally between them, there is a gelatinous envelope, which at times appears fibrinous. Within this envelope there are many leucocytes with fragmented nuclei.
Embryo No. 30
Embryo, C. R., 60 mm.
From Dr. Snively, Waynesboro, Pa."
The woman from whom it was obtained is colored, and menstruated last from April 5 to 12. On June 19 she had her first pains, which continued until the 21st, when the abortion occurred, i. e.., 77 days after the beginning of the last period.
The specimen is apparently normal with the exception of a hernia. of the liver into the umbilical cord. The communication between the coelom of the cord and the peritoneal cavity is much too large for this stage and the liver protrudes into the cord fully 5 mm.
Embryo No. 32
Ovum, 30 mm. in diameter, within a pedicle 9 x 2 mm.
From Dr. W. D. Booker, Baltimore.
“Mrs. N ., colored. Last menstruation began December 26, 1893, and lasted 4 days, the usual duration being from 4 to 5 days. Cohabitation with husband December 12 and January
Fig. 32a.—Section through the cord and the amnion at its attachment to the chorion. X IO times.
9. Hemorrhage began March I4 and continued until the 18th, when the abortion took place. The entire ovum was placed in 80 per cent alcohol one hour_after the abortion." The time between the beginning of the last period and the abortion is 82 days.
Fig. 32b.—Section through‘ the attachment of the umbilical cord to the chorion. X 10 times.
Upon opening the ovum I found within it a large pedicle, 9 x 2 mm., which had every appearance of the normal umbilical cord of an embryo, 25 mm. long. The age of this ovum when estimated by the menstrual history calls for a cord of this size, but the chorion is undersized. At any rate, we have a cord without an embryo. At the point at which the cord should be attached to the body there is a mass of cells, making it appear as if the embryo ulcerated away. At this point the blood—vessels are greatly distended with embryo’s blood, which also permeates the surrounding tissues. \Vithin the cord there is a large space, the coelom, as well as a reticular space, as is shown in figs 32a and b. The mesoderm of the chorion and villi is fibrous.
Embryo No. 37
Chorion, 25 x 18 x 15 mm., within a small nodule 2 mm. in diameter.
From Dr. G. M. Gould, Philadelphia.
The entire ovum is covered with villi which appear normal in form, both to the naked eye and under the microscope.
The specimen was macerated considerably, but the thick sections I made of it are extremely instructive. The embryonic mass within proved to be an atrophic cord, embryo and umbilical vesicle, as shown in figs. 37b, c and d. The cord with its blood—vessels passes directly over into the head end of the embryo, which contains but a rudimentary nervous system. The mesodermal tissues are characteristic and the form of the pharynx and lower jaw is recognizable. From this region the two branchial arteries pass into the cord, as the figures show. A single vein, however, passes from the cord directly into the center of the body and ends just below the lower jaw. There is no heart, liver, myotomes, nor lower end of the body, these being replaced by the cord. The arteries are empty and the vein is distended with blood.
Fig. 37a.—-Photograph of the entire ovum. Natural size.
Fig. 37b.—Section through the head, umbilical vesicle and chorion. The pharynx and first aortic arches are cut across in the head. X 10 times.
Fig. 37c.—iScction 1hrmIp;h the umbilical cord, vesicle and the chorion. X 10 times.
Fig. 37d.-—Section through the attachment of the umbilical cord and vesicle to the chorion. X lo times. No. 1.] ORIGIN O17 HUMAN MONSTERS.
Embryo No. 54
Embryo, C. R., 11 mm.
From Dr. McMorris, Belle Plaine, Iowa.
The embryo alone was given me. It shows an atrophic head, but otherwise appears like a normal embryo of 4% weeks.
In the sections it is seen that the central nervous system is solid with the exception of the mid-brain, whose ventricle still communicates with the exterior of the body through an open neuropore. The head is atrophic. The vertebrae are well developed. The liver is large; the heart, other organs and coelom are difficult to outline.
Embryo No. 55
Ovum, 35 x 20 x 14 mm.
From Dr.- Watson, Baltimore.
Last period January 18 to 22, abortion March I 3, I894. The specimen is a very solid fleshy mass, which contains a sharply defined spherical cavity, 15 mm. in diameter, with smooth walls. Absolutely no trace of an embryo found within this cavity.
Blocks of the tissue were imbedded in celloidin and some sections were cut. The sharply defined cavity proved to be the coelom, as its walls were formed by the chorion. The thick fleshy mass proved to be villi of the chorion, syncytium, blood, fibrin and pus. The walls of the chorion contain remnants of blood-vessels, are partly invaded by leucocytes and are fibrous. The main bulk of the villi and syncytium stains poorly and appears necrotic. The mesoderm is fibrous, more or less invaded by leucocytes and covered in part with a very active syncytium. The cavity of the coelom is partly filled with :1 granular magma, in which are imbedded some cells.
Embryo No. 58
Ovum, 20 x 18 x I2.
From Dr. Howard, Cleveland, Ohio.
“The specimen is from the first pregnancy of a woman who has been married for one year. The duration of the menstrual periods is usually from 3 to 4 (lays, the last one having ended July 25. The August and September periods were passed, and September 30 she had a hemorrhage which she believed to be the usual menstruation; this ended October r
Fig. 58a. — Photograph of the ovum with the piece to which the vesicle IS attached cut out and turned over.
with the abortion of the ovum. The time between the beginning of the last period and the abortion is 71 days. Cohabitation july 25 to August 5 and again on August I 5, or several days before the first lapsed period.”
The ovum is only partly covered with villi and is filled with a jelly-like mass of magma. floating within this mass there is a large vesicle, 6 mm. in diameter, with transparent walls.
This vesicle in turn is partly filled with a granular deposit. The syncytium is excessive. The mesoderm of chorion and inclosed vesicle is very fibrous. There are blood islands and a cavity lined with epithelium in the stem of the vesicle. The main portion of the vesicle is composed of two layers, but near the stem there are three layers present. The mesoderm of the villi is hyaline and oeclematous, and between them there is a stringy mass of mucus or fibrin rich in leucocytes.
Fig. 58b. — Sections through the vesicle at its attachment on the chorion. X 10 times. Within the stem there is 21 sharply defined cavity lined with epithelium and an hour-glass-like space filled. with blood. On one side the stem is covered with epithelium.
Fig. 58c. — The cavity of the stem, shown in Fig. 581), enlarged 50 times.
Embryo No. 60
Embryo, C. R., 8 mm. Dr. Dobbin, Baltimore. The body and extremities of the embryo appear normal in form. The tissues are considerably macerated and may be normal. The spinal cord is solid. There are large islands of blood cells in the liver.
Embryo No. 69
Ovum, 70 x 40 x 30 mm; embryo, C. R., I 3. Dr. Chabot, Baltimore. The chorion is smooth, not being covered with villi. The head of the embryo is atrophic and club-shaped and the body is fairly plump. The arms are well developed, of the fiveweeks stage, and appear normal.
The central nervous system is distended and the brain is maeerated. The outline of the organs and of the peritoneal
Fig. 69.— Photograph of the embryo attached to the chorion. Natural S126.
cavity is not distinct, and the entire body is filled with migrating cells. The main bundles of nerves are filled with spindleshaped cells, making them look like the nerves of amphibian embryos. The epidermis is hypertrophied and at many points forms papillae. The embryo end of the umbilical cord is atrophic, invaded by migrating cells, and its blood-vessels are greatly distended. The whole chorion and part of the cord have undergone fibrous degeneration.
Embryo No. 70
Mole, 45 x 30 x 28.
Dr. Ellis, Elkton, Md.
“The specimen is from a woman whose periods were regular until July 28, 1896, when she passed her period. In October she had a profuse hemorrhage, and on the 20th, aborted, the time between the beginning of the last period and the abortion being II 3 days.”
Fig. 70.——Photograph of the cut surface of the mole. Reduced one-half.
The specimen, as the figure shows, is very solid, and sections proved it to be composed of a mass of distended chorionic villi, forming an hydatidiform mole. Between the villi there is a large quantity of blood with an extensive syncytium which forms a large solid mass on one side of the specimen. Within the center of the specimen there is a small collapsed chorion with poorly defined walls. The specimen was not cut into serial sections, so it is impossible to state definitely whether or not the embryo has been destroyed entirely.
Embryo No. 71
Ovum, ID x 9 x 5 mm.
Dr. G. H. Whitcomb, Greenwich, N. Y.
Dr. Whitcomb writes me: “The specimen is from a woman twenty-three years old who had been married three months before the abortion occurred. She had been troubled with chronic cystitis and endometritis but menstruated regularly. After marriage she had two menstrual periods, but the third failing to appear she concluded that she was pregnant. Seven days after the lapsed period she slipped while descending the stairs, and this was followed with some tenesmus. Four days later I examined her and found a free flow of unstained mucus from the uterus, with tenderness, hyperaemia of the pelvic organs and irregular pains. I requested a specimen of urine. which was given me on the following day. It was found loaded with pus and blood, and also contained the ovum. Two days later the decidua was discharged. The .specimen was preserved in 50 per cent alcohol. Shortly after this the. woman became pregnant again, which went on to full term."
The abortion from the above data took place 40 days after the beginning of the last menstrual period. When the ovum came into my hands, three years later, it was well preserved and had not been opened. The villi are well developed and even, but slightly deficient on one side. I cut the specimen inhalf around its greatest circumference and then stained the two halves. Within there was a small amount of magma reticulé and at the bottom of one of the shells of chorion there was found a very small nodule. Otherwise there is nothing within the ovum. The nodule was imbedded and cut into sections 20 microns thick.
Fig. 71. — Photograph of the ovum. Enlarged 2 diameters.
The syncytium and the chorion appear normal. There are no blood-vessels. The nodule within the chorion is a solid
mass which appears in structure like dried red blood corpuscles of the frog.
Embryo No. 77
Ovum, 70 x 40 x 30 mm. Dr. Horn, Baltimore.
The fresh specimen was sent to the laboratory and it was immediately preserved in strong alcohol. After it was hardened it was found to be of firm consistency and of a very red color, indicating that it must be pathological. Later, when it was cut in half, there was found within it a spherical cavity, 20 mm. in diameter, lined with a smooth, fibrous membrane and filled with a clear fluid which permitted of a careful inspection of its interior. On one side of the cavity there was a small elevation, one millimeter in diameter and one-fourth of a millimeter high.
Fig. 77a. — Photograph of the specimen cut open. One—half natural size.
Fig. 77b. — Section of one of the villi. Enlzu'g'e(l 160 times. B, blood; S, syncytmm, small cells of which are scattered throughout the mesoderm.
Sections were made of the walls of the specimen through the elevation which proved to be a fibrous thickening of the amnion at its junction with the chorion. There are no bloodvessels in any portion of the chorion. Between the villi there is a great quantity of syncytium, fresh blood and fragmented leucocytes. At many points the syncytium and leucocytes invade the chorion and the villi with the apparent intention of destroying them. VVhere fresh blood and syncytium come in contact there are many fragmented leucocytes present.
Embryo No. 78
Ovum, 36 x 33 x I 3 mm. ; nodule within, 14.6 mm.
Dr. A. P. Stoner, Harlan, Iowa.
“The woman from whom the specimen was obtained menstruated last on December 1, 1896, and the abortion took place on February 26, I897. The sac was perfectly smooth when it was passed, and, without opening, it was placed in 50 per cent alcohol. After the abortion two or three pieces of decidua and placenta were passed, weighing together about 30 grams, the right quantity, it seemed, for a ten-weeks ovum. The woman’s husband has been absent for over ten weeks, thus making the specimen at least that old. It appears as if there had been an arrest of development of the embryo and that the membranes continued to grow.”
Fig. 78a.—Photograph of ovum with piece of chorion and nodule lying on top of it. Natural size.
figs. 78b, 78c, and 78d.——The sections through the vesicle and chorion. X 10 times. Blood is within the cavity of the vesicle. The stem is partly covered with epithelium and there is a double amnion, shown in Fig. 78b.
When the specimen came into my hands the walls of the chorion were perfectly smooth without any villi whatever. It was filled with a clear fluid and within there is attached a small double vesicle, measuring I x .6 mm. This was imbedded and cut into serial sections.
The chorion is atrophic and has no villi upon it. The nodule within is covered with a single layer of epithelial cells which becomes thickened over the pedicle. At one point the thickening is greatly increased and immediately below it there are two small vesicles lined with epithelial cells. The main cavity of the vesicle is lined with a layer of cubical cells, and is filled with a considerable quantity of round cells. This cavity is hour-glass shaped and extends to the walls of the chorion, as the figures show. The mesoderm of the vesicle is increased in quantity and is filled with wandering cells. At the base of the vesicle there are several blood spaces filled with blood.
Embryo No. 79
Ovum, 50 x 50 x 50 mm.; embryo, C. R., 32 mm.
Dr. Briggs, Blackville, S. C.
Dr. Briggs writes that the abortion took place 91 (lays after the beginning of the last menstrual period.
The specimen came into my hands well hardened in strong alcohol with all of the membranes intact. When opened it was found that the inner walls of the amnion and the embryo were entirely covered with a layer of firmly coagulated granular substance or granular magma.
Fig. 79. — Photograph of ovum cut open, showing the embryo encrusted in granular magma. Natural size.
The chorion is very hemorrhagic and thick on one side, while on the other it is very thin. The sections show apparently normal structures in the thick portion, while in the thin portion there is an extensive leucocytic infiltration. At this latter point the walls of the chorion are markedly changed, being invaded by the syncytium as well as by leucocytes.
Serial sections of the embryo show that it must have been strangulated before the abortion took» place. The central nervous system is greatly macerated, the liver has disintegrated and the aorta is greatly distended. The rest of the embryo appears normal. The intestine is almost entirely within the peritoneal cavity; a single loop of it still remains in the opening communicating with the coelom of the cord.
The embryo is completely covered with a layer of magma which contains but few cells in it. Below this the epidermis is wanting at many points, while at other points it appears normal. At the edge of the epidermis there is every appearance of an attempted regeneration, as its border is thickened and has rounded and not ragged edges.
Embryo No. 80
Carnegie Embryo No. 80
Ovum, 24 x 18 x 18 mm.; embryo, C. R., 4 mm.
Dr. Branham, Baltimore.
Embryo and ovum are apparently normal, with the exception of a mass attached to the ovum, which proved to be diverticulum, its cavity communicating with the main coelom. The lower part of the embryo is bent upon itself. The whole ovum had been preserved without opening it. Some magma reticu1é is within the coelom.
As far as it is possible to determine, the sections indicate that the embryo, cord and yolk sac are normal. The villi of the chorion, however, which are well developed, have a considerable quantity of a fibrinous mass between them which is rich in leucocytes. The syncytium is well developed and at the tips of a number of villi it is decidedly necrotic. It may be that these changes are of sufficient importance to account. for the abortion.
Embryo No. 81
Ovum, 65 x 55 x 35 mm; embryo, C. R., 15 mm.
Dr. Branham, Baltimore.
“The abortion took place just three months after the beginning of the last menstrual period.”
The unopened ovum had been placed in a large quantity of alcohol, and when it reached the laboratory I cut a window into it to allow the alcohol to enter its cavity. Within an embryo was found, which appears macerated and is broken
Fig. 8xa.—-Photograph of the whole ovum. Slightly reduced.
in its middle. The crest of necrotic tissue on the head of the embryo, the stumpy leg, the distended cord and atrophic chorion, all indicate that it is pathological.
Two parts of the embryo were cut into serial sections and different portions of the chorion were also examined.
Macroscopic as well as microscopic examination of the chorion shows that it has undergone extensive degeneration. Its walls are filled with large islands of blood and at points there is leucocytic infiltration, showing that an inflammatory process had also invaded it. Accompanying the inflammatory process the syncytial layer of cells has invaded the walls of the chorion, thus helping along its destruction. The mesoderm of the chorion has undergone fibrous degeneration and within its walls there are numerous cysts, some lined with flat epithelial cells and some with cylindrical. The amnion appears normal and lines the entire coelom.
Fig. 8Ib.—-—Photograph of the embryo within the chorion.
The embryo is somewhat atrophic. Its central nervous system is macerated and there is a marked cyst-like dilatation at the tip end of the spinal cord. All the tissues, including the cartilages, show more or less dissociation. The necrotic crest covering the top of the head gives all the appearance of an ulcer; the ectoderm is destroyed and the mesoderm covering the brain is greatly thickened and pigmented with round cell infiltration of the surrounding tissue. The marked dilatation in the cord encloses double cavities filled with a mucoid reticulum, much as in embryo No. 32. This tissue is similar in appearance to the normal notochord in amphibian embryos. No. 1.] ORIGIN O17 IIUMAN MONSTERS. [77
Embryo No. 82
Solid mole, 75 x 60 x 40 mm.
Dr. Cassidy, Baltimore.
“Last period began June 3, I896, and this tumor was passed March 8, 1897, about 40 weeks later.”
The specimen was brought to the laboratory fresh and was hardened in formalin. It is pear-shaped, ulcerated on the
pointed end and the interior appears to be composed of fresh blood clots.
Fig. 82a. - External surface of the mole, slightly reduced.
Sections of the large solid mass show that within it there is a collapsed ovum with folds of the chorion extending throughout the specimen. On one side of the specimen there are long slender villi. Most of the layers of the collapsed chorion are composed of double walls, usually in apposition and occasionally completely blended. There is no amnion lining the chorion. Along the main central body of the collapsed chorion there are large quantities of fresh blood. The rest of the tumor is composed of old blood clots and nests of leucocytes and of syncytium. The syncytial nests are located in great part along the chorion, show active growth when 178 [VOL XTX.
Fig. 82b.——Cut surface of the tumor, showing large masses of blood between the distorted chorion. Reduced one-third.
they come in contact with fresh blood and are necrotic elsewhere. At no point does the syncytium invade the walls of the chorion.
It is impossible to interpret this specimen without admitting that the chorion continued to grow after the ovum had collapsed.
Embryo No. 87
Ovum, 24 x 16 x 9 mm.; embryo, C. R., 4. mm.
Dr. Cole, Peru, Ill.
“The last period took place April I 5, 1896. On May I5 the woman -had a slight flow which repeated itself every few days until the 27th, when the abortion took place. The day before the abortion the woman worked very hard.”
The lower end of the embryo looks atrophic and on the
opposite side of the ovum there is a vesicle 2.5 mm. in diameter.
Both the embryo and vesicle with pieces of the adjacent chorion were cut into serial sections.
The embryo proved to be a normal specimen about 21 days old, with normal umbilical vesicle and so on. The vesicle on the opposite side of the coelom appears to be anything but an umbilical vesicle. It lies free in the cavity of the coelom imbedded within the magma, and is in no way torn. It is composed of three distinct layers: a thick middle layer, in which are numerous blood islands, an epithelial lining layer, and an outside layer, which does not completely cover the specimen. On one sideiof the vesicle there is a sharp invagination of all three layers, which projects well into the vesicle. The mesoderm of this invagination has also within it several blood islands.
Fig. 87a.—-Additional vesicle on the side of the ovum opposite the embryo. Enlarged 2 times.
The chorion is normal in appearance, with blood-vessels entering it from the normal embryo.
Fro. 87b. Fig. 87c.
Fms. 87b and 87c.—Sections through the vesicle and chorion. X 25 times. The deeper portion of the invagination in Fig. 87b is shown cut in cross-section in Fig. 87c. Blood islands may be seen in the mesoderm.
Embryo No. 93
Solid mass, 40 x 20 mm.
Dr. Cassidy, Baltimore.
The specimen was sent to the laboratory fresh and was hardened in formalin. Upon opening it, it was found that within there is a cavity into which projected a large tongue of fleshy tissue. VVithin this tongue there is a clot of blood as well as a sharply defined cavity.
Sections, through different portions of the specimen, showed that the outer sac is the decidua and that the tongue of tissue is the chorion. \.-Vithin the central cavity of the tongue (coelom) lies the amnion. I cannot state definitely whether or not the remnants of an embryo were present, for the specimen was not cut into serial sections. The walls of the chorion are thickened and irregular, and around it are packed hypertrophied villi with great quantities of syncytium and blood between them. Covering the villi and syncytium there is a layer of blood and fibrin separating them all from the decidua. \Vithin the mesodermal tissue of the chorionic walls there are occasional islands of syncytium.
Embryo No. 94
Ovum, 50 x 40 x 30 mm.; embryo, C. R., 20 mm.
Dr. Knill, Detroit, Mich.
Ovum is smooth with villi on one side of it only. The amnion does not fill the chorion completely; it measures 30 x 20 mm. Within the amnion there is much coagulated matter which envelops the embryo completely. This granular magma can be picked ofi easily in large flakes. The embryo thus exposed is bent upon itself more than usual and appears macerated, as if it had been dead for a number of days. The features are not clear, the tips of the hands and feet not being well defined. The lower part of the embryo is necrotic and the spinal cord is protruding. The entire ovum has been hardened in alcohol.
The sections show that the villi of the chorion are somewhat atrophied, with occasional nests of leucocytes within them. The mesoderm of the chorion and amnion show clearly marked fibrous degeneration. The embryo itself is normal in shape, but the brain is greatly dissociated and the liver is cloudy and projects into the cord.
Fig. 94.——Embryo partly imbedded in granular magma within the chorion. Natural size.
All of the epidermis is exfoliated with great masses of migrating cells lying between the embryo and the envelope of magma.
Embryo No. 97
Ovum, 33 x 30 x 15 mm.; embryo, C. R., 7; A. R., 9 mm.
Dr. Goldman, Baltimore.
“Beginning of last menstrual period, March 8, I897. Abortion, May 8. The entire ovum was hardened in 95 per cent alcohol.”
The ovum appears normal with the villi distributed equally over it. Upon opening, it was found filled with dense magma reticulé, in which could be discerned the faint outline of a four-weeks embryo. A block of the chorion, including magma and embryo, was cut into serial sections.
The form of the embryo, amnion and umbilical vesicle is normal. On one side of the embryo the epidermis is wanting and the amnion is filled with cells. The umbilical vesicle is filled with migrating cells, but its blood islands and its entoderm appear normal. The chorion is fibrous. The outer covering of the vesicle is composed of a short layer of columnar epithelial cells. The magma of the coelom is filled with wandering cells.
Fig. 97.—-External surface of the chorion. Natural size.
The nervous system is greatly dilated and dissociated. The liver tissue is obscured and filled with migrating cells. The contour of the abdominal viscera is obliterated and they are likewise filled with migrating cells. Pharynx, heart, large veins and aorta are greatly dilated.
Embryo No. 104
Ovum, 3 5 x 3 5 x I 5 mm; embryo elongated, 12 mm. long. If curled upon itself it would measure, C. R., about 7 mm.
Dr. J. P. West, Bellaire, Ohio.
“The beginning of the last menstrual period was on May 7, and the abortion took place on June II, 1897. The entire ovum was preserved in strong alcohol.”
The villi of the chorion appear atrophic, being wanting on one side of the ovum. After the ovum was carefully cut in half it was found filled with magma partly reticular and partly granular. On one side is a snake-like embryo with straightened head and atrophic extremities. The embryo, with a piece of chorion to which it is attached, was cut into serial sections.
Fig. I04.-Photograph of the embryo within the chorion surrounded by magma. Natural size.
The main walls of the chorion are fibrous. The amnion is intact. The brain and spinal cord of the embryo are dilated and dissociated,——probably macerated also. The outlines of the organs and body cavity are obliterated. The boundaries of the liver can no longer be determined. The tissues of the body are generally dissociated and they, with the umbilical cord and magma, are infiltrated with migrating cells. The heart, large veins and aorta are greatly distended with blood. The head is atrophic.
Embryo No. 110
Ovum, 46 x 30 x 30 mm.; embryo, C. R., 8 mm.
Dr. VVest, Bellaire, Ohio.
“The last period of the woman began September 22, 1897, and lasted five days. On December 8 there was a slight flow which continued until the I 3th, when the abortion took place. Hardened in alcohol.”
The shape of the ovum is oblong and its walls are fleshy, the villi having all disappeared. Within there is a clear fluid with a granular deposit covering the embryo. The embryo is greatly macerated and is but slightly attached to the chorion. At the point of attachment there is an elevated mound of necrotic tissue, to which the embryo is stuck. There is no distinct cord and the amnion is wanting. Evidently both chorion and embryo have been dead for a long time.
Fig. 110. — Photograph of the embryo within the chorion. Natural size.
The chorion is atrophic and the deciclua is infiltrated with leucocytes. The amnion, umbilical vesicle and the attachment of the umbilical cord to the chorion are completely destroyed. The embryo is atrophic, the face not being developed at all. The central nervous system is swollen; the outlines of the viscera and body cavity obliterated and filled with migrating cells. The liver is small. The heart and large blood—vessels are greatly distended.
Embryo No. 115
Ovum, 30 x 27 x 22 mm.; amnion, IO x 5 x 5 mm.; embryo, C. R., 3 mm.
Dr. A. S. Atkinson, Baltimore.
The abortion took place two months after the beginning of the last period. During the second month of pregnancy there was continuous bleeding.
The ovum was brought to the laboratory fresh immediately after the abortion and placed in strong formalin. It was opened at once in formalin and found filled with a gelatinous, transparent mass, which became fibrous after the formalin had acted upon it. Later on alcohol made it opaque. The chorion is practically free of villi and looks necrotic. The embryo is well in the middle of the ovum and is apparently separated from the chorion. The head as well as the tail is atrophic.
Sections show that the villi of the chorion are atrophic, with but a small quantity of syncytium attached to them. The entire chorion is surrounded with a mass of decidua filled with leucocytes.
The magma of the coelom is very dense and has within it but few migrating cells. Within the greatly distended amnion lies the embryo, looking much like a chick of the third day. The peritoneal cavity communicates freely with the exocoelom, in which hangs an atrophic umbilical vesicle. The lumen of the umibilical vesicle is filled completely with entodermal cells, its blood spaces are greatly distended but nearly empty, and its solid stem ends abruptly after it enters the body of the embryo. There is no trace of either alimentary canal or liver left. Rudimentary Wolffian bodies and ducts are present. The central nervous system is solid. The heart and large veins are simple in form and greatly distended with blood.
Fig. 1I5a.-—Embryo imbedded within the magma reticulé of the coelom. Natural size.
Fig. II5b.—Embryo attached to the chorion. X 3 times.
The mesodermal layer of the chorion and its villi appear normal, with the exception of the tip ends of the villi, which are enveloped in a mass of leucocytes.
Embryo No. 122
Ovum, 20 x 16 x 6 mm.; embryo, C. R., 5 mm. Dr. W. Williams, Baltimore. “Last period began April 19, 1898, and the abortion took place on June 23. Continuous bleeding for eight days before the abortion.”
The transparent and fibrous chorion is covered with a few scattered villi of irregular length. The embryo is atrophic with a club head, large heart, stump tail and no limb buds.
fiGS. I22a_ and b.——Two halves of the ovum, showing coelom and embryo. X 2 times.
The nervous system is greatly distended and dissociated. The front of the head and the branchial arches are atrophic. The liver is small, the Wolffian body well marked and the body cavity sharply defined. The large veins of the body and of the liver are greatly distended with blood, the aorta being much enlarged and empty. The tissues of the entire embryo
are partly filled with loose round cells. The chorion is thin and fibrous.
Embryo No. 123
Ovum, 17 x I4 mm.; vesicle within, 1.8 x 1.5 x I mm.
Dr. H. J. Boldt, New York.
“The last menstrual period prior to the abortion occurred August I4 or I 5, 1898. Abortion, September IO. The whole ovum was placed in 95 per cent alcohol within 10 minutes after the abortion.”
The entire ovum was covered with villi, apparentlynormal, but surrounded by a layer of pus and blood. After opening it I found the coelom filled with a mass of coagulated fibrinous albumin, the magma reticulé, within which no embryo could be seen. The two halves of the ovum were then stained, which brought out prominently a small vesicle imbedded in the magma. This vesicle had a rounded opening upon one side (Fig. a), with a long pedicle upon the other, which extended towards but was not attached to a small mound on the inside of the chorion. Vesicle and chorion were both cut into serial sections.
The sections of the vesicle appear as those of the normal umbilical vesicle. The opening on the side is undoubtedly due to a tear, judging by its broken edges.
Fig. I23d.——Section through the vesicle. X 25 times. Entoderm, mesoderm and blood islands are shown.
Embryo No. 124
Ovum, 90 x 75 x 50 mm.; embryo, C. R., 35 mm. Abortion 18 weeks after the beginning of the last menstrual period.
Dr. Cassidy, Baltimore.
The ovum was brought to the laboratory fresh and then hardened in a strong solution of formalin. It appears as :1 transparent cyst with a crescent—shaped placenta on one end, measuring 60 x 50 mm. Upon opening it I found within :1 second sac measuring 50 x 37 x 35 mm., which had tough
Fig. 124a.—Whole ovum. with placenta attached to one side of it. Reduced one-half.
fibrous walls and proved to be the amnion. Within this was the embryo, with club hands and feet, pointed ears and a very thin, twisted, umbilical cord.
Sections of the placenta show that the villi are matted together and are covered with a thick layer of decidua cells. The entire thickness of villi is infiltrated with leucocytes, which at points are accumulated sufficiently to form small abscesses. The walls of the chorion are considerably thickened immediately below the placenta and are fibrous in structure. Between the villi at their bases there is a quantity of fresh blood, and between their distal ends there is a great quantity of syncytium, which does not stain well and appears to be necrotic. Masses of fine granules are seen which stain intensely with haematoxylin, and on account of their uniform size they are probably bacteria.
Fig. I24b.--——Ovum cut open, showing amnion. Reduced one-half.
fiGS. I24c, d, e.—-Three vxews of the embryo.
Fig. 124f. — Section through the hand showing well-formed bone and cellular infiltration of the surrounding structure. Enlarged 17 times.
Fig. 124g.— Section through the foot with the phalanges numbered. Enlarged I7 diameters.
Sections of this interesting specimen do not reveal very much, for the tissues do not stain well. The form of the organs and skeleton, with the exception of that of the extremities, appears to be normal. However, the skin appears more fibrous than usual, being somewhat infiltrated with round cells. In the deformed extremities this infiltration is very pronounced and involves all of the structures of the hands and feet with the exception of the cartilages, forming syndactyly.
Embryo No. 128
Carnegie Embryo No. 128
Ovum, 50 x 43 mm.; embryo, C. R., 20 mm.
Dr. Lupton, Baltimore.
The woman from whom this specimen was obtained is eighteen years old and has one child. The first recurring period after the birth of the child was on July 4, 1898; the second period, August 5; and the abortion on October 20.
After the abortion the entire ovum was placed in water, and 18 hours later was brought to the laboratory. It was a beautiful white specimen and I immediately placed it in formalin, in which it was opened at once. The water did not seem to have penetrated the ovum, as the embryo was not at all swollen and appeared perfectly normal. The formalin, however, at once caused the coagulation of a delicate network of fibrils which enveloped most of the embryo. The sections show a delicate reticulum of fibrils within the amnion.
Fig. 128. — Embryo within the amnion and chorion covered with a delicate mass of fibrils and granules. Natural size.
Embryo No. 130
Ovum, I5 x IO x 6 mm.; vesicle within, 4 x 3 x 1.5 mm.
Dr. De Saussure. Charleston, S. C.
“The specimen was passed by the patient while urinating, I4-days after the beginning of the last menstrual period. She had no idea that she was pregnant and thought that the specimen was a piece of mucous membrane from the bladder. It was hardened entirely in 50 per cent alcohol.”
When the specimen came into my hands it was only half covered with villi, the other half apparently having had them stripped off. There was also a tear in the chorion through which a vesicle was protruding. Upon lifting the ovum this vesicle fell out. The ovum was then carefully cut open and
Fig. 130a. — Ovum with extruded vesicle. Natural size.
was found to contain a considerable quantity of magma reticulé. Within this there was a long pedicle, measuring 7 x 2 mm. There was also a space in the magma large enough to hold the vesicle which had escaped. Both ovum and vesicle were cut into serial sections.
The serial sections of the ovum show that the amnion is still unbroken, as shown in figs. 1), c, cl. Its greatest measurements are I0 x 4 mm., into which extends the umbilical cord. At the end of the cord there is a mass of tissue mostly broken down, the remains of the embryo. This mass is ragged, without any form corresponding to an embryo, and had the amnion been torn no doubt it would have fallen out. The blood-vessels of the cord are gorged with nucleated blood cells, but they do not extend into the embryo. The chorion is normal in appearance.
Fig. I3ob.-—Section through the amnion, cord and remnant of the cmbryo. X 10 times.
Fig. 13oc.—Section through the amnion, cord and chorion. X 10 times.
Fig. I3od.—Section through the :1ttac11mcnt of the amnion and cord to the chorion. X 10 times.
The umbilical vesicle (Fig. 130a) is pear-shaped and completely closed. At no place is there a break to show its attachment to the cord. Although considerably macerated, the
sections showed the characteristic structure of an umbilical vesicle.
Embryo No. 132
Ovum, 42 x 30 mm.; embryo, C. R., 15 mm.
Dr. Munson, Washington.
This specimen was kindly sent me by Dr. Lamb, who had obtained it from Dr. Munson. The woman from whom it was obtained menstruated last between August 15 and 20, and aborted November 12. The embryo was preserved in a 50 per cent mixture of commercial formalin. The chorion is atrophic with but few villi. The embryo has a stub head and the extremities on the right side are atrophic, while those on the left appear to be normal.
Fig. I32. — Photograph of the embryo. Natural size.
The organs of the embryo are about normal in form and structure. The cord and brain are slightly dissociated. There is a small number of migrating cells in the tissues of the body as well as within the peritoneal cavity.
Embryo No. 133
Ovum, 32 mm. in diameter.
Dr. J. M. Hundley, Baltimore.
“Last period began September 15, 1898, and continued eight days; bloody discharge began November 11th and abortion occurred on the 19th. Both parents perfectly healthy. Hardened in 75 per cent alcohol.”
When the specimen came into my hands I believed it to be normal, but after cutting out a piece of chorion I found the coelom completely filled with a dense mass of magma reticulé. In taking off the piece of chorion I cut the attachment of the umbilical cord and thus located the embryo. The mass of magma and a portion of the chorion encircling the embryo were removed and cut into serial sections.
Fig. 133.—Ovum with piece of chorion removed, showing dense magma within. Natural size.
The villi of the chorion are fibrous but normal in shape, with but litle syncytium at their tips. The syncytium immediately over the walls of the chorion is greatly increased in quantity. The coelom is filled with magma and migrating cells. The amnion is complete. Umbilical vesicle is filled with desquamated entoderm cells. The embryo is distorted and cramped; epidermis is exfoliated at the points where the amnion contains masses of migrating cells; nervous system distended and dissociated; organs and peritoneal cavity fairly well outlined; liver filled with blood which forms large islands at points; front end of head greatly distorted, eye macerated and whole head gorged with round cells.
Embryo No. 134
Ovum, 17 x II mm. ; vesicle within, which is compressed. measures in the sections 9 x 3 mm.
Dr. G. N. Sommer, Trenton, N. J.
A number of the sections of this unique specimen were sent me by Dr. G. N. Sommer, of Trenton, N. J., who also informs me that the ovum had been passed with considerable pain and hemorrhage by a young multipara, due to the introduction of a bougie by the woman to produce abortion. The monthly period had been five days overdue when the abortion occurred. The bougie had been introduced several days earlier.
In stirring up the ovum the woman punctured it and it then became filled with mother’s blood, which formed a clot around the embryo. The leucocytes invaded the walls of the ovum, the stem of the vesicle and even the blood—vessels of the embryo, and show all stages of fragmentation within the tissues of the embryo.
The vesicle itself is most interesting, as it shows the effect of an infraction upon a very young normal embryo. The stem of the vesicle is quite extensive, in which are embryo blood-vessels filled with blood. Many of them extend into the chorion and some of them into villi. The walls of the vesicle are composed of three distinct layers. The inner is composed throughout of a single layer of sharply defined cubical epithelium, the entoderm. Immediately next to this is an extensive mesoderm, which continues into the mesodermal layer of the stem to the chorion. Near the attachment of the vesicle to the chorion there is a sharp invagination of the vesicle which is lined with :1 thick layer of epithelial cells, the ectoderm. This layer lines only the invagination and does not extend over the rest of the vesicle. Beyond and on the distal side of the invagination the mesoderm is arranged in five groups of cells which suggest in every way myotomes. In this region there are embryonic blood-vessels filled with blood. The syncytium is very extensive.
Fig. I34a.—Section through the ovum and embryonic vesicle. The umbilical vesicle is torn and collapsed. The invagination of its walls and the myotome-like bodies are shown in figs. b and c. B blood clot; L, leucocytes.
Fig. I34b.— Photograph of the imagination shown in dark in Fig. :1.
The blood clot from the mother within the coelom is recent, as is shown by the fact that there are present may red blood corpuscles. In the periphery of the clot next to the chorion the red corpuscles are partly broken down and appear as an imperfect granular detritus, within which there is a network of fibrin. There are as yet no pigmentary changes in the tissues adjacent to the clot. The clot extends through a tear in the chorion into the coelom, and as this portion is approached it is noticed that its characters change. The red blood corpuscles diminish in number, and the main coagulum consists of leucocytes which extend through the surrounding tissues. This mass of leucocytes also extends along the border of the red clot into the cavity and walls of the vesicle. The blastoderm cells are intact on one side of the vesicle, whereas on the other they have suffered desquamation and have retracted from its walls. A part of the leucocytes composing this part of the clot are in a very imperfect state of preservation. They show great irregularities in the forms ‘of their nuclei and are in a state of fragmentation. Fragmented leucocytes extend throughout the clot, a great portion of the chorion and through the walls of the embryonic vesicle.
Fig. I34c.—Myotome—1ike bodies, three of which are shown in the collapsed vesicle shown in Fig. a.
The tissue elements of the embryo are for the most_part well preserved. There is no evidence of extensive necrosis. Occasionally, where the clot of red and white corpuscles and fibrin becomes clearly intermingled with the villi of the chorion the syncytial cells stain imperfectly. The evidence of gross necrosis is entirely wanting.
The blood—vessels of the chorion contain numerous leucocytes, constituting in some instances what appears to be leucocytic thrombi. One section was stained for bacteria, but none were found.
The process as a whole is to be interpreted as an acute hemorrhagic inflammation of the embryonic structures. The large number of leucocytes undergoing fragmentation indicates that the inflammatory irritant was of a severe nature, and had acted with a considerable degree of intensity, as is not only shown by the rich immigration of leucocytes, but the severe retrogressive changes which they have undergone.
Embryo No. 135
Ovum, 105 x 65 x 65 mm.; embryo, C. R., 9 mm.
Dr. Mosely, Baltimore.
The ovum was sent fresh to the laboratory and hardened in strong formalin. It is fairly smooth, its walls being thin and the villi are wanting. Upon opening it I found it filled completely with a gelatin-like mass which is neither fibrous nor granular. Within this mass there is an atrophic embryo standing upon a thin umbilical cord. The entire chorion is
Fig. I35a.—Embryo upon a. mass of magma within the ccelom. ‘ One-half natural size. 20° MALL, [VoL. XIX.
lined with the amnion. The head of the embryo is atrophic, the body being shaped like a grain of wheat. The extremities are more rudimentary on the right side than on the left. The sections of the embryo show the cord distended, the brain almost completely destroyed and the mesoderm of the top of the head converted into a mass of mucoid tissue. The head end of the chorda is greatly hypertrophied. being converted into a mucoid tumor. O11 either side of this tumor there are two large cartilages, normal in structure. Farther headwards, buried deep in the mesoderm, there are two additional pearl—like bodies, which, on account of their appearance as well as by their being encircled by an oval zone of pigmented cells, identifies them as the lenses of the eyes. These bodies have within them lens fibers, making them look much like the lenses of amphibians.
Fig. 1351), c, (l.-Tl‘H‘C€ views of the embryo. Natural size.
The front end of the head is necrotic. The heart is convoluted, its outline obscure and it is distended and filled with a mass of blood cells. The outline of all of the abdominal organs and of the peritoneal cavity can be determined, although the tissues are considerably obscured by the great quantity of round cells within them.
The entire wall of the chorion is very thin, and it is lined throughout with a delicate amnion. The villi have all (lisappeared and in their place there are islands of necrotic syn— cytiuin covered with a hyaline layer of fibrin. The whole
chorion is infiltrated with leucocytes, which form small abscesses at points.
Embryo No. 136
Carnegie Embryo No. 136
Ovum, 14 x 6 1 mm.; embryo, C. R., 5 mm.
Dr. Campbell, Halifax, N. S.
“Beginning of last period August 21, 1898. Abortion October 16. Entire ovum was hardened in 95 per cent alcohol.”
The ovum is covered with rudimentary villi, and when opened was found to be completely filled with magma reticulé. Shining through this mass can be seen the embryo, curled up, with extremities, myotomes, heart and umbilical vesicle visible. This remarkable specimen is a four—weeks embryo within a two—weeks ovum. The entire ovum with the embryo was cut into serial sections.
|Fig. 136a. — Photograph of the ovum. Natural size.||Fig. 136b. — Interior of the ovum, showing faint outline of the embryo buried in magma.|
The villi of the chorion are atrophic and fibrous, with great buds of syncytium hanging to them as well as to the main wall of the chorion. Between the villi there is a small amount of mucus or fibrin, within which there are numerous leucocytes. Amnion, umbilical vesicle and embryo are apparently normal and of the four-weeks stage. The embryo is twisted on its long axis at about 90 degrees. The organs are normal. The peritoneal cavity is normal in shape and filled with blood, appearing as a fresh hemorrhage; the pericardial cavity is empty.
Embryo No. 137
Ovum, 65 x 50 x 30 mm.; embryo, C. R., I6 mm.
Dr. Watson, Baltimore.
“Last period commenced September 26, 1898. Abortion, December 2:.”
The ovum is nearly covered with long and well—developed villi, having a bare pole on one side. The coelom contains no magma. The embryo is broken from the cord and is macerated on its ventral end. The head is atrophic; arms and legs are normal. At the middle of the umbilical cord there is the marked swelling seen in other specimens of this kind.
Sections of the chorion show the villi to be normal in form but somewhat hyaline in structure and without blood—vessels. There is a considerable quantity of syncytium. The thickened umbilical cord has within it a cavity partly filled with a reticular substance, homogeneous in appearance, and more in— tensely stained than the surrounding tissues. W'ithin the cord there are large blood-vessels, greatly distended with blood
cells, which extend through the walls into the surrounding tissues.
Fig. I37.—Photograph of embryo. Natural size.
Ten millimeters from the attachment of the cord to the chorion is the umbilical vesicle. It measures 3 x 2 mm.; its walls are all degenerated and its cells, which are necrotic, fill its cavity. The stem of the umbilical vesicle reaches but half way to the umbilical cord.
The central nervous system of the embryo is distended and dissociated, the spinal cord being segmental to correspond with the vertebrae. The liver is necrotic and filled with blood. The heart is collapsed and dissociated. The large blood—ves— sels are collapsed and empty, while the small ones are filled with blood._ The outlines of abdominal organs are pretty sharp, the tissues nearly normal in appearance and fairly free from migrating cells.
Most of the epidermis has fallen off the embryo, but where it remains intact it often shows irregular thickening.
Embryo No. 141
Ovum, 40 x 30 x 20 mm.: embryo, 8 mm.
Dr. _\/Vest, Bellaire, Ohio.
“The specimen is from a woman, a mother of nine children, who has always been healthy until about ten years ago. From this time her health gradually became worse and worse. She is extremely neurasthenic. Stomach is dilated, digestion poor. Bladder irritable and urine scanty. Uterus large, thick and retroverted ; leucorrhoea. The uterus is about three times its normal size and has a number of cysts in the cervix. There were several earlier abortions, the one before this, which took
Fig. I4x.—Piece of chorion with dense magma and misshapen embryo. Slightly reduced.
place December I 3, 1897 (No. I10), having been sent to you. The last period began on October 27, 1898, and the abortion followed on January 13.”
The chorion is fleshy, like No. 110, with but few villi, and within the coelom there is a great quantity of magma reticulé and a dissociated embryo about four weeks old.
The sections show that the chorion and villi are matted together and contain but few b1ood—vessels. The syncytium is very extensive, and where it is in large masses the most central cells are necrotic. The mesoderm of the chorion is fibrous and hypertrophic. There is a considerable quantity of mucus or fibrin, rich in leucocytes, between the villi. This condition may have been more extensive elsewhere, as only the chorion in the neighborhood of the embryo was examined.
The great quantity of magma reticulé within the coelom has numerous migrating cells scattered through it.
The amnion is partly in contact with the chorion and at the points of contact is normal in appearance. VV here it is separated from the chorion by the excessive quantity of magma the walls of the amnion are greatly hypertrophied. The umbilical vesicle is collapsed and its walls have undergone hyaline degeneration completely. .
The central nervous system of the embryo is greatly dilated and dissociated. The body cavity can barely be outlined. The large blood—vessels are faintly marked by the blood within them. The rest of the tissues are one homogeneous mass of tissue cells infiltrated with round cells, within which can still be recognized cartilages and nerve bundles. The boundaries of the heart and liver are wholly obliterated, due to their dissociation.
Embryo No. 142
Carnegie Embryo No. 142
Ovum, 50 x 40 x 30 mm.; embryo, C. R., I5 mm.
Dr. Sommer, Trenton, N. J.
“Last period began September 28, 1898. On January 3 there were marked uterine pains; free hemorrhage February I, and abortion February 4.”
The chorion is fleshy, with some villi. Within there is a macerated embryo about five weeks old imbedded in a mass of fibrin-like magma. Between the magma and walls of the chorion there is a large space filled with clear fluid.
Serial sections of the embryo and chorion show most remarkable changes. The chorion and amnion are greatly thickened, are very fibrous and look in every respect like the membranes in fleshy moles (No. 82, for instance). The villi are matted together by a mixtvre of blood, fibrin and numerous necrotic as well as living cells. The fibrinous mass within the amnion is in all probability blood w 1ich has entered from the exterior. It has all the appearance of blood clots found elsewhere in the body, but in addition” it has been invaded by wandering cells from the embryo. The coelonris partly filled with a granular magma into which project numerous slender villi arising from the walls of the thickened amnion.
The activity of the syncytial layer has been most pronounced. At all points it invades blood clots and the mesodermal tissue of the walls of the chorion and the villi. Occasionally it almost perforates the chorion to enter the coelom. At one point syncytial cells are within the coelom, but the serial sections do not extend far enough to show the point of communication. More marked is a great area of active syncytium within the amnion, surrounded with a clot of mother's blood. Not only does it spread as a double layer of cells to the attachment of the umbilical cord to the chorion, but at numerous points the nests of syncytium have nearly perforated the walls of the thickened amnion to enter the coelom. The whole picture reminds one much of cancer specimens. The presence of the large blood clots within the amnion indicates that the membrane must have been punctured, probably by the activity of the syncytium, long before the abortion took place. This, of course, would allow the syncytium to enter the coelom and amnion to there make its further attack, which in turn may have caused the amnion to thicken and sprout so much.
Fig. 142. — Ovum with embryo. Natural size.
The embryo itself has also undergone most marked changes. The dimensions of the ovum, the length and degree of development of the embryo indicate that the pathological changes began not later than the sixth week of pregnancy, while the menstrual history of the mother indicates that at least I4 weeks have elapsed between the conception and the abortion. In other words, the pathological process has been under way for at least eight weeks. The extreme changes within the embryo also speak for this. The nervous system is markedly dissociated and macerated. Arms and legs, external features, as well as most of the internal organs, have vanished. The liver is still marked, but is necrotic. VVan<ler— ing cells have invaded all of the tissues and are also beginning to attack the cartilaginous bodies of the vertebrae. Large nests of them are also irnbedded in the clots of blood which surround the embryo. The main blood-vessels of the embryo can still be traced through the surrounding tissues. The cord is filled with embryo’s blood, but this is also necrotic.
From all appearances had this ovum remained in the uterus much longer it would soon have become filled with mother’s blood, which in turn would soon have solidified to make of the specimen a typical fleshy mole.
Fig. 143. — Photograph of the vesicle. Natural size.
Embryo No. 143
Large double sac, 15 x 10 mm., attached to the wall of the chorion.
Dr. Stick, Glenville, Pa.
The chorion appears normal. The double cyst—like body has thin walls and is filled with a clear fluid. The specimen has been in strong alcohol for nearly twenty years.
Serial sections show a chorion, normal in appearance, to which is attached the double vesicle as shown in the photograph. The structure of the walls of the two sacs is identical with that of the mesoderm of the chorion with all of .the epithelial cells fallen off. The two sacs do not communicate; the larger has smooth walls; the smaller has numerous small vesicles, about I mm. in diameter, opening into it, and the cluster of “air cells” are directly blended with the mesoderm of the chorion. The specimen undoubtedly belongs to the vesicular forms, peculiar only on account of its size.
Embryo No. 147
Ovum, 30 x 27 x 20 mm.; vesicle, I mm. in diameter.
Dr. Pole, Baltimore.
“Last period began January 1, 1899, and the specimen was discharged March 23.”
The ovum is only in part covered with villi, the remaining portion of the chorion being clear and transparent. The coelom is completely filled with magma which has turned very white in the alcohol in which this specimen was preserved.
Fig. I47.——lnterior of ovum. Slightly enlarged.
On one side of the coelom, closely attached to the chorion, there is a small vesicle and an irregular mass which may represent the remnants of the embryo.
Sections of the chorion Show that the mesoderm is very fibrous and rich in cells. The vesicle within is about one millimeter in diameter and is located two millimeters from the chorion, but not at all attached to it._ Its walls are composed of only one layer of cells on one side of the vesicle, while on the opposite side it has a second layer or mesoderm, .5 mm. thick, in which are imbedded numerous blood—vessels filled with blood. There are a few blood—vessels filled with blood in the chorion in the immediate neighborhood of the vesicle.
Embryo No. 150
Ovum, 3 5 x 30 x 10 mm.; embryo, 5 mm.
Dr. Oertel, Augusta, Ga.
There are but few villi on the chorion. The embryo is distorted and the arm on one. side is unusually large.
The sections of the embryo show an extreme degree of pathological change. The nervous system is swollen and solid, and the contour of the viscera is wholly obliterated. The large blood—vessels are greatly distended with blood. Round cells are distributed equally throughout the body of the embryo.
Embryo No. 152
Ovum, 70 x 42 x 38 mm.; embryo, C. R.., 31 mm.
Dr. H. J. Boldt, New York.
“The specimen is from a woman suffering with endometritis, this being her third successive abortion, which took place in each instance during the third month of pregnancy. The beginning of the last period preceding this abortion took place on April 16; conception April 20 (?); and abortion June 25, I899.”
When the specimen came into my hands, the chorion was found to be smooth and apparently free from villi. The cavity of the amnion is filled with a mass of granular magma covering entirely an embryo over two months old. The umbilical cord is much twisted and thin, measuring .5 mm. in diameter. The embryo was cut into serial sections and different portions of the chorion were also examined.
Microscopic examination shows that the chorion and amnion are fibrous. The_ villi of the chorion are matted together with fibrin and a mass of cells, which have undergone hyaline degeneration. The stroma of the villi is very fibrous, being invaded at many points by syncytial cells and leucocytes. At numerous points there are large nests of leucocytes forming abscesses. It is a plain case of the endometritis infecting the chorion.
The embryo is imbedded in a large quantity of magma giving every appearance of embryo No. 79 again. The organs of the embryo are dissociated and macerated and the tissues stain poorly, indicating that the embryo had died a considerable time before the abortion took place. Again the central nervous system is swollen and dissociated. Migrating cells are found in clumps or scattered in all of the tissues. In general, the connective tissues are more fibrous than normal, the true skin showing considerable hypertrophy. The epidermis is wanting.
Embryo No. 153
Solid mass, 50 x 20 x 20 111111.
Dr. Stick, Glenville, Pa.
Last period began April 30; abortion, July 15, I899.
The mass is pear—shaped and proves to be a ruptured chorion partly inverted and imbedded in an organized clot of blood and fibrin. The chorion is, of course, ruptured and at the point of rupture there is a mass of blood, which forms the large end of the pear—shaped mass. There is no amnion within the chorion, nor could the embryo be found. A portion of mucous membrane of the uterus is attached to the chorion. The villi of the chorion are normal in form, but the mesoderm of many of them have undergone a kind of coagulation necrosis. The syncytial cells are generally normal in appearance. There are many leucocytes throughout the tissues, especially within the mesoderm of the inverted chorion.
Embryo No. 154
Ovum, IO x 7 x 7 mm., found within a _ma_ss of blood within the uterine tube. Dr. Boldt, New York.
The ovum was cut into serial sections, but no trace of an embryo could be found. The sections show, however, that the chorion had been torn, but the edges of the tear were rounded and infiltrated with mesodermal cells. The main wall of the mesoderm and the villi in the neighborhood of the tear are fibrous and artophic. The rest of the villi are normal in appearance.
Embryo No. 158
Tubal pregnancy; vesicle, 2 mm. in diameter.
Professor VV. T. Howard, Cleveland, Ohio.
The specimen came to me imbedded in celloidin and mounted on blocks ready to cut. From each block sections were cut, three of which proved to be through the chorion. In one of these sections there was the remnant of an embryo within the chorion; from this piece I removed the celloidin and reimbedded it in paraffin and cut it into serial sections. 50 microns thick.
The microscopical examination of the sections shows that the chorion is denuded entirely of its villi, being in apposition and apparently continuous with the wall of the uterine tube. Occasionally the line of separation is marked by a row of irregular cells, probably the remnants of the epithelial covering of the chorion. The mesodermic portion of the chorion is somewhat fibrous, being smooth on its coelom side and without an adhering amnion. The nodule within is shriveled ancl necrotic, only a few of its nuclei staining. It appears as a double sac, together measuring 2 mm. in diameter, with a clump of necrotic cells, appearing like those of the umbilical cord, between them. In none of the sections is the embryonic mass attached to the chorion. At one place, however, the cord-like structure runs into a long process toward the chorion with a blood-vessel (?) filled with blood in its center.
My interpretation of the embryonic mass is that it is composed of amnion and umbilical vesicle of about equal size, shriveled and partly torn into pieces, but still held together by the remnants of the embryo and umbilical cord.
Embryo No. 159
Fragments of a chorion about as large as a walnut.
Dr. Golden, Elkins, W. Va.
“From a woman in good health who had aborted a year before during the third month of pregnancy. During the second month of the pregnancy, from which the present specimen was obtained, there was a slight How of blood without any pain. i It continued for two days. Ten days later it recurred and continued for 24 hours. Three days later it recurred again, became profuse and the abortion followed. The supposed duration of the pregnancy is ten weeks. No indication whatever of endometritis. Both father and mother are perfectly healthy and are very anxious to have children.”
The specimen consists of portions of the mucous membrane of the uterus, large portions of the chorion, amnion, but no embryo is present. The mucous membrane is full of small abscesses, and leucocytes have invaded all portions of the chorion. The syncytium is very active, and at numerous points the syncytium and leucocytes have invaded the mesoderm of the chorion. The amnion is greatly curled up and thickened. Its walls have undergone hyaline degeneration. The cells covering the amnion on the side towards the coelom are generally proliferated, often forming islands.
Embryo No. 161
Chorion, 50 x 25 x 25 mm.; embryo, I0 mm.
Dr. Cassidy, Baltimore.
“Last period at the end of August. Abortion, November I7, 1899. After missing the next period patient took medicine and had a rubber tube introduced into the uterus. Purulent leucorrhoea during the past six months.”
The entire ovum was given me hardened in alcohol. It was covered with hard clots of blood; on one side the villi appear to be normal. Upon opening theovum a mass measuring IO x 5 x 5 mm. was found attached to its walls, which, after sectioning, proved to be a strangulated embryo. It was imbedded and cut into serial sections.
The sections prove the mass to be an embryo of the fifth week, filled and covered with round cells. These cells have obliterated the structure of the head entirely, but as the tail end of the body is approached the outline of the organs can still be defined. The villi of the chorion are developed in a great mass of blood and pus; the syncytium is excessive. Within the stroma of the villi there are, at many points, many round cells which appear to be migrating cells from the embryo.
Embryo No. 162
Mole, 70 x 30 x 30 mm.; embryo, 1 mm.
Dr. Wanstall, Baltimore.
The specimen came to me in formalin with the following note from Dr. Wanstall: “Last period from September 2 to 7, that is her usual time, five days. The woman began bleeding November 9, and passed the specimen on November 22. She is the mother of five children and says that this is the only time she has aborted. There is not the slightest indication of uterine disease.”
Fig. 162. — Section through the embryo. X I5 times. Ch, chorion; am, amnion; h, heart; umb, umbilical vesicle; in, intestine; all, allantois or possibly liver.
Within the specimen there is a cavity measuring 3 5. x I2 x I2 mm, lined with a smooth wall and filled with a jelly-like substance, within which there is a very small embryo which was cut" into serial sections 50 microns thick. The sections show a remarkable atrophy of the embryo and umbilical vesicle. The chorion ,is very thin and is composed of mesoderm only. The villi and epithelial cells are wanting, but in their place there is a thick layer of mother’s blood. The entire chorion is lined with an amnion and into its cavity the nodule-like embryo projects. Its tissues are not uniform, being thickened at some points, necrotic at others, and mucoid at others. Throughout the center of the nodule there are some capillaries filled with blood. At the point of juncture between the amnion and chorion there are three projections from the embryo into the coelom~( I) the umbilical vescicle; (2) the allantois; and (3) the heart. That the second is the allantois is indicated by its cavity, which is multiple at points. The heart is within a pocket of the coelom and has an irregular lumen which is well filled with blood. At the base of the nodule there is a short tube which communicates with the allantois, the intestine.
Embryo No. 166
Ovum, 40 x 40 x 40 min; embryo, 2.5 mm. Dr. Cassett, Baltimore. Last period on October 18. On December 29 there was a
discharge of blood which continued until the 31st, when the mole was expelled.
The mole is composed of very thick, fleshy walls within which there is a cavity with a smooth wall, measuring 30 x
Fig. 166. — Section through the embryo. X 15 times. Ch, chorion; am, amnion; n, nervous system; x, heart or umbilical vesicle.
20 x 20 mm. On one side there is a small atrophic embryo 2.5 mm. long.
The sections of the chorion show that its villi are well formed and are imbedded in a mass of blood from the mother. Possibly the syncytial layer of epithelium is increased. The coelom side of the chorion is smooth and is in contact with the amnion. Attached to the amnion there is the embryonic mass or remnant which does not reach to the chorion ; there is no umbilical vesicle to be found. The amnion and embryo are completely separated from the chorion. There are no blood-vessels in the chorion.
The embryo is cylindrical in form, being attached through— out half of its length to the amnion and passing through it. In the center of the embryo there is a solid column of cells quite sharply defined—the remnants of the central nervous system. At the tail end of the embryo there is a blind tube, the allantois. The coelom of the embryo, which is as a pocket on its ventral side, contains an irregular sac which may be either the heart or the umbilical vesicle; probably the former.
Embryo No. 174
Ovum, 3 5 x 25 x 25 mm. ; embryo, 13 mm. long.
Dr. Gibbs, Baltimore.
Last period January II, 1900; bleeding five weeks later, which continued until the eighth week, when the abortion followed. The ovum is smooth, having but few villi, and is filled with a granular magma.
Sections of the chorion show a marked degeneration of its walls, nearly all of its villi having been destroyed. Those few fragments of villi which remain are imbedded in blood and are riddled with the cells of the syncytial layer. The mesodermal layer of the chorion is no longer sharply defined and is more or less filled with cells with fragmented nuclei, the origin of which cannot be determined.
Fig. 174. - Embryo lying on piece of the chorion. Enlarged 2 diameters.
The embryo is of the stage of five or six weeks with pretty sharply defined organs and tissues which are more or less dissociated and infiltrated with wandering cells. Most of the epidermis has fallen off; in the region of the olfactory pit (which is almost obliterated) the epidermis forms two marked horn-like elevations. The central nervous system is swollen and dissociated more than the remaining tissues of the body, the change being greater in the brain than in the cord. The vascular system is gorged with blood which is beginning to invade the surrounding tissues. This increase is most marked in the umbilical cord, which appears oedematous.
Embryo No. 177
Embryo, C. R., I2 mm.
Dr. Harrison, Baltimore.
The sections show well outlined all of the organs of an embryo of the end of the fifth week, but they are dissociated and swollen. So extensive is the dissociation in the head that the brain has become practically solid, the vesicles being nearly obliterated. The process is not so extensive in the spinal cord. Most of the epidermis has fallen off.
The vascular system is again greatly distended with blood which is infiltrating the tissues, especially those surrounding
Fig. I77.—-The photograph shows the rounded head and stubby leg. Enlarged 2 diameters.
the larger arteries and veins. In general the tissues show the changes always seen in embryos which have been gradually strangulated before the abortion.
In this specimen there is one marked variation in the changes usually found. T he precartilage outlines all of the vertebrae and ribs, but no true cartilage is as yet formed in them. Back of the eyes in the occipital region there are on either side of the head two cartilages well developed, much too advanced for embryos of this stage. A more advanced stage of this cartilage will be found in embryo No. I 3 5. The head is also beginning to become Stumpy; the frontal process is necrotic and is beginning to fall off.
Embryo No. 180
Ovum, 20 x I 5 x IO 1nm.; vesicle, 2 mm.
Dr. C. W’. Dodge, Rochester, N. Y.
“I have in my possession a human embryo which, if I may judge from some of your papers which I have seen, is likely to be more valuable to you than to me, and for this reason I have kept it intact, instead of sectioning it as I have been sorely tempted to do. its history is as follows: The woman from whom it came is a patient of Dr. Edward Mott Moore, J11, of this city. On March 28, last, her right ovary was removed. She left the hospital on April I 5, and coitus occurred May I 3. On June 19 menstruation appeared and this ovum was expelled, which was brought to me in a pill box (the membranes being broken in handling), and put at once into 4 per cent formalin, in which solution it still remains. As the dates given above are vouched for by the patient and the physician, it seems to me that we have here an unusually accurate and perfect history of the embryo, and, while it is not so very young, its history may give .it additional interest."
Sections of the chorion show that its mesoderm is of normal thickness,,but is fibrous and rich in nuclei. '.l.‘hroughout the main wall of the chorion, but ‘not in its villi, there are numerous blood-vessels filled with blood, showing that at one time an embryo may have existed.
The villi are normal in form, with a very extensive syncytial layer of cells over them. At points the syncytium forms large islands. which can easily be seen with the naked eye. Immediately over the vesicle within, an island of this kind, a millimeter in diameter, arises from the main wall of the chorion and sends processes up between the villi. The mesoderm immediately below this island is thinner than the rest, making it appear as if the violent growth of the syncytium took everything before it, but that in the attempt to produce new villi the fibrous mesoderm of the chorion would not follow. At many points between the villi there is a slimy mass of albumen well infiltrated with leucocytes and numerous small islands of syncytium, some of which can be followed back to their origin from the villi.
The vesicle within is composed of but one layer of cells, those of the mesoderm with blood islands imbedded within it. No trace of an entoderm can be made out, although the lumen of the vesicle extends into a pedicle which, as a single strand of cells, attaches itself to the chorion.
Embryo No. 181
Ovum, 18 x 18 x 10 mm.
Dr. D. S. Lamb, Washington.
The ovum is filled with reticular and granular magma and no remnants of an embryo could be found, although every particle which_might contain it, with the adjoining chorion, was cut into serial sections. The mesoderm of the chorion and villi is oedematous; the epithelial covering is poorly developed, often being composed of but one layer of cells.
Embryo No. 182
Head and upper end of the body of an embryo about five weeks old.
Dr. D. S. Lamb, Washington.
Sections of this embryo show an extreme degree of disintegration of the embryo. The brain is converted into a mass of cells filling the central canal entirely and extending into the surrounding tissues of the embryo, the line of demarcation being obliterated. The large veins of the body are gorged with blood which also extends into the surrounding mesoderm. On the frontal side of the head there is a straw colored necrotic mass with some migrating cells within it. On the dorsal side of the head the mesoderm is thin and blistered, indicating the beginning of spina bifida. The cartilages alone are still well defined.
Fig. 182. — Piece of head showing necrotic mass over the mid—brain. Enlarged 2 diameters.
Embryo No. 185
Ovum, 40 x 25 x 15 mm.
Dr. Sabin, Baltimore.
The abortion occurred seven weeks after the beginning of the last period. The specimen was brought to me in formalin, and upon opening it I found that the coelom was stuffed with reticular and granular magma. No trace of an embryo could be found, although the entire ovum was cut into serial sections.
The main wall of the chorion is completely filled with leucocytes from the mother and show all stages of fragmentation of the nuclei. They form a fairly sharp border on the coelom side, making the chorion appear as the wall of an abscess. The invasion of the chorion with leucocytes must have been merely from the coelom side, as the villi are not invaded to any extent. Some of the villi are oedematous, others atrophied, being covered with a normal amount of syncytial cells.
Embryo No. 188
Ovum, 45 x 40 x 40 mm. ; embryo, C. R., I7 mm.
Dr. G. N. Sommer, Trenton, N. J.
“Last menstruation began January 6; bleeding began March 19, and ended in a few hours with the abortion. The unopened ovum was immediately placed in ninety-five per cent alcohol.”
The coelom is filled with granular magma, the chorion is very fibrous, and the villi are mostly wanting. The tissue of the mesoderm is very rich in nuclei, none of which appear to belong to leucocytes from the mother. Three kinds can easily be recognized——(I) those which normally belong to the mesoderm; (2) blood cells from the embryo; and (3) an extensive invasion of the syncytial cells. This third group can be traced directly from large mounds of syncytium lying upon the chorion, from which they extend throughout the mesoderm, frequently entering the larger blood-vessels. Often large giant cells are seen, showing the usual characteristics of the syncytium after it has invaded the mesoderm of the chorion. The villi are affected less than the main walls of the chorion. No cells from the syncytial layer of the chorion were found in any of the blood-vessels of either the embryo or the umbilical cord. .
The organs of this embryo are all normal in form and of the proper degree of development for an embryo of this size. The tissues are dissociated somewhat, the most marked being that of the brain. The veins of the body are all gorged with blood, with but little migration of blood cells into the surrounding tissues.
Embryo No. 189
Ovum, 28 x 25 x I 5 m1n.; embryo, 4 mm.
Dr. T. E. Oertel, Augusta, Ga.
The ovum, filled with granular and reticular magma and contains a deformed embryo, lying within a distended amnion, 8 mm. in diameter.
The umbilical vesicle and amnion appear to be normal for an embryo of this size; the body, however, is greatly deformed, the central nervous system being open throughout its extent and encircles the dwarfed embryo like a broad hoop around a ball. A number of the motor roots of the spinal nerves are "developed, more in the region of the tail than elsewhere. There are no cranial nerves. The heart is a vesicle filled with blood, hanging into the coelom and slightly attached to the body wall. Its vascular connection with the body is cut off entirely. The blood-vessels of the body are irregular in shape and entirely changed from the normal type. They are filled with blood which extends through their walls into the surrounding tissues. The branchial arches cor respond to an embryo of this size. There are still traces of optic Vesicles, chorda and possibly allantois present, the liver and stomach and intestine having degenerated.
Fig. 4189a.—-Photograph of the embryo. Enlarged 2 times.
Fig. I89b.—-Section through the head of the embryo. X 30 times. The medullary plate, 171, is open throughout its whole extent.
Embryo No. 190
Ovum, 25 X 22 X 12 mm.
Dr. C. M. Ellis, Elkton, Md.
The ovum is filled with reticular magma within which no trace of an embryo can be found, although the entire specimen was stained and cut into serial sections. The chorion and villi are apparently normal, containing blood-vessels from the embryo.
Embryo No. 195
Ovum, 30 x 30 x 30 mm.
Dr. D. S. Lamb, Washington.
No embryo could be found, although the entire ovum was cut into sections. The specimen is well covered with villi and contains some reticular magma. The mesoderm of the chorion antl villi appears normal and is rich in blood-vessels filled with embryo’s blood.
Embryo No. 196
Tubal pregnancy; embryo, 2.5 mm. long.
Professor Brodel, Baltimore.
The specimen, hardened in formalin, contained two suspicious bodies which were both cut into serial sections. One of these proved to be the embryo greatly deformed, representing a stage about three weeks old. The tissues of the embryo are quite homogeneous, only the central nervous system being recognizable. One eye and a large blood—vessel can still be faintly outlined. At points the amnion and umbilical vesicle are blended completely with the chorion.
Fig. 196.—Tube cut open, showing the embryo. From a sketch by Professor Brodel.
The outside of the chorion has attached to it a few long and thick villi which do not branch. The chorion and these villi are covered with a layer of syncytium of unequal thickness, which frequently invades the mesoderm. The whole chorion is embedded in a large mass of mother’s blood.
The most remarkable part of this specimen is found within the blood-vessels of the chorion. They are gorged with nucleated blood corpuscles filled with a pigment of the same color as that of the surrounding mother’s blood. It appears as if the syncytium, in destroying the mesoderm of the chorion and the mother’s blood, at the same time made it possible for the blood of the embryo to take up the blood pigment thus liberated. At any rate, the blood of a human embryo three weeks old contains no pigment, and the sections of this specimen permit of this interpretation. There is also a con-' siderable quantity of mother’s blood within the ovum around the embryo, but as the specimen was opened before it was hardened and the corpuscles are all perfect, they need not be taken into consideration in the interpretation just given.
Embryo No. 198
ovum, 25 x 25 x 25 mm.
Dr. Larsen, Chicago.
The specimen came to me hardened in a mixture of bichromate of potash and formalin. The interior is filled with considerable reticular magma and large lumps of granular magma. Imbedded in this there is a large cylindrical pedicle 7 mm. long bent upon itself. Sections of this specimen show that pedicle to be the umbilical cord rounded off at its former juncture with the embryo.
Fig. !98.—-Pedicle within chorion. Enlarged 2 diameters.
The mesoderm of the cord, chorion and villi is fibrous, having also an excess of spindle—shaped cells. The bloodvessels are all very large, those of the villi as well as most of those of the main wall being gorged with blood. The large blood-vessels of the cord are empty. "Within the cavity of the amnion scattered throughout the magma there are numerous flakes of tissue of the embryo and a great many free cells.
Embryo No. 200
Ovum, 35 x 25 x 20 mm.; embryo, C. R., 14, mm.
Professor Brodel, Baltimore.
The central nervous system is dissociated and macerated very much, the form of the brain and spinal cord being lost entirely. The organs are all deformed, the liver in addition being necrotic, as it does not stain at all. There is ulceration of the front of -the head, but over the rest of it, in spite of the extensive internal change, the epidermis is intact.
The walls of the umbilical vesicle are broken down entirely and its lumen is filled with a mass of necrotic cells. The amnion, chorion, and villi are more fibrous than normal.
F10. 2oo.——Broken embryo within piece of the chorion, showing stumpy arm. Natural size.
Embryo No. 201
Ovum, 80 x 60 x 50 111111.; embryo, C. R., 20 mm.
Professor Brodel, Baltimore.
The ovum was received without villi and upon opening it it was found filled with a fluid which had hardened into a jelly in formalin. The embryo is atrophic, with a necrotic mass on top of its head.
The fleshy chorion proved when sectioned to be a mixture of true chorion, villi, blood, fibrin, decidua, blood sinuses, pus and syncytium. The layers are not at all in regular order, and show all stages of disintegration. The mesoderm of the villi is fibrous and is often invaded by leucocytes and syncytium. At other points the syncytium invades the blood clot and frequently maternal blood sinuses are filled with leucocytes and syncytium.
Fig. 2o1a.——Photograp'h of the embryo. Enlarged 2 diameters.
Within the embryo most extensive changes have taken place. The brainis greatly deformed and is severed, through a growth of tissue, from the spinal cord in the region of the medulla back of the deformed ear. In fact, the brain is included within the cap-like body on top of the head. The spinal cord begins quite abruptly in the upper cervical region and ends in the same way in the upper lumbar region. At its end there is a curious fibrous tumor measuring half the diameter of the cord. The cord, so far as it is developed. appears to be normal, but it is dissociated somewhat. Below the upper lumbar region the spinal cord is ‘wholly wanting, the spinal canal being filled up with mesodermal tissue rich in blood-vessels. Where the cord is missing most of the spinal nerves appear to remain, and many dorsal ganglia can be made out. This all indicates that the changes in the cen tral nervous system took place after the spinal nerves were developed from it.
Fro. zorb.-—Diagrammatic reconstruction of the embryo, showing the extent of the central nervous system. X.5 times.
The two eyes are united into a single one with a double retina, two lenses, a single choroid, and a single optic nerve; back of this it is double again. It. certainly appears as if the two eyes have wandered together and -have united in the middle line.
The epidermis is quite complete, being broken through at the back oi the head. The extensive ulcer which is found here is very rich in blood-vessels, involves the walls of the brain, but does not reach into its ventricle. At the highest point of the head the epidermis has developed into a papi1liform body; below this there is a large necrotic area in which there is a great quantity of yellow pigment granules.
Fig. 201c.——Section through the top of the double eye of the embryo. X 30 times. The eyes are buried deep in the head, being covered with mesoderm and epidermis.
The mouth is closed, although the alimentary canal from there to the stomach is open and appears normal. The intestine is matted together, the cloaca and anus being obliterated. The epithelium of the upper portion of the intestine shows marked growths into this matted mass.
Fig. 2oId.—-Section through the optic nerve and double eye. X 30 times.
Fig. 2oIe.——Photograph through a section of the ear, showing the plug which closes the external meatus entirely.
The thoracic region, liver and vascular system have undergone practically no change. The extensive growth of mesodermal tissue throughout the embryo has caused an extensive destruction and arrest of further development of the muscular system. This is shown by all kinds of secondary changes in the connective tissue, especially that of the skin, which is markedly fibrous, as may be seen in Fig. 2oIe. Here the change is so great that it obliterates the external auditory canal entirely.
Embryo No. 204
Ovum, 14 x 12 x 8 mm.
Dr. D. S. Lamb, VVashington.
The specimen, said to be three weeks old, was found filled with a mass of granular magma. The whole ovum was stained and cut, but no trace of an embryo could be found. The chorion and villi appear normal.
Embryo No. 205
Ovum, 40 x X30 x 30 mm.; embryo, C. R., 6 mm.
Dr. D. S. Lamb, Washington.
“The specimen is about four weeks old and is from a woman who had been married three months. Syphilis is suspected in the case.”
The chorion is partly encircled with the decidua, which is more or less necrotic and well infiltrated with leucocytes, showing that an inflammatory process was present in the uterus. The chorion is fibrous at points and at others oedematous, with but few blood—vessels present. The villi are irregular and often very fibrous, being hypertrophied as well as atrophied. Their outlines are irregular and'they are covered with a dense and very irregular mass of syncytial cells. But few of the villi have blood—vessels within them and they are all empty.
The amnion is completely adherentto the chorion throughout its extent, making these two membranes appear as one. On the amnion side there are numerous fibrous tuberosities which appear much as small villi inverted. At other points the epithelial covering of the amnion builds by itself a double layer of cells, which often gives rise to papilliform processes much like the syncytium on the outside. Sometimes this layer of epithelium is raised, forming a blister with a fibrinlike substance, possibly magma reticulé, throughout which are scattered transparent round cells with very small nuclei.
The umbilical cord is quite fibrous, with large irregular openings scattered throughout it. These are filled with a mucoid substance in which a few nuclei are scattered. The blood—vessels are all obliterated with the exception of the point of the attachment of the cord to the embryo, where irregular vessels are filled with blood.
The external form of the embryo is well preserved and is covered entirely with epidermis which is much thickened. The brain and spinal cord are swollen, the former being practically solid in the region of the fore-brain. The heart and large vessels are gorged with blood which extends from them into the surrounding tissues, obliterating them almost entirely. Within this mass of migrating cells can be seen the outlines of some of the organs of an embryo about four weeks old. The liver, stomach, and lungs are riddled, and but the faintest mark of an endocoelom can be seen. It appears as if all the blood of this specimen accumulated within the embryo, the cord and the chorion being free, the extensive epidermis preventing the migration of the blood cells into the amniotic cavity.
Embryo No. 207
Ovum, 70 x 45 x 45 mm.; twin embryos, 16 mm. long.
From Professor Brodel, Baltimore.
The specimen came to me unopened and hardened in a strong solution of formalin. Its exterior is smooth with small villi at one of its poles. VVithin there are two embryos, both macerated, with atrophic heads. The larger embryo measures C. R., 16 mm. The other is a little smaller, but as it is broken, an exact measurement could not be made. The cords of both embryos are atrophic.
There is some granular magma within the amniotic cavity with several large clumps in the coelom, where the two amnions meet.
Sections of the membranes show that the chorion is denuded of most of its villi, with the exception of the point over the atachment of the cord of the broken embryo. The entire chorion is covered with its decidua, which is rich in blood sinuses and infiltrated with leucocytes. But few remnants of the syncytial layer of the chorion remain.
The whole embryo is still covered by epidermis excepting on top of the head, at the tail end of the body, and at the attachment of the umbilical cord. At these points there is a
Fig. 2o7a.—A whole ovum. Reduced.
marked destruction of the tissues, which are beginning to disintegrate. The top of the head is ulcerated, in front it is necrotic and pigmented, as is frequently the case in other embryos. The nervous system shows the usual changes seen in strangulated embryos. The vascular system of the embryo is gorged with blood, but none is within the vessels of either the cord or the chorion. VVithin the body there is quite an extensive migration of blood cells into the tissues, obliterating them in part, but the process of destruction is not so far advanced as in No. 205. The majority of the organs can be still outlined. We have here a rapid infiltration with migrating cells of an embryo of forty days, with cytolysis rather than dissociation of the tissues.
The changes in the broken embryo are practically the same as in the unbroken one, although they are more advanced. Only the head, extremities and cord remain entire, and in
Fig. 2o7b.-—Photograph of the interior of the ovum, showing both embryos. Natural size.
these the changes are more marked than in the corresponding parts of the unbroken embryo. In the former it is practically a mass of individual cells, while in the latter the brain is swollen and quite solid.
Embryo No. 209
Carnegie Embryo No. 209
Ovum, 20 x 15 x 10 mm.; embryo normal in form, about two and one-half weeks old.
Dr. G. N. J. Sommer, Trenton, N. J.
“The woman from whom the specimen was obtained is thirty years old. Three years ago she had :1 miscarriage during the third month of pregnancy, and three months ago she was delivered of a monster at the end of gestation. The specimen was one of hydrocephalus and spina bifida with hydramnios, fully eight liters of fluid coming away at the time of delivery. She nienstruated the first time yesterday since her confinement, bleeding profusely all day, and in the evening the ovum came away with a few blood clots. Within the sac I could see the embryo, about 5 mm. long. attached to the chorion by the cord.”
The specimen came to me in 9.5 per cent alcohol, and upon opening it a large amount of magma was found within the coelom. Not finding the embryo, the whole specimen was stained, imbedded in paraffin and cut into serial sections 50 microns thick. It happened that the embryo was cut into coronal sections, and those containing the embryo with the chorion attached to it were mounted.
The form of the structures of the embryo is normal, only the tissue did not stain well, indicating that it had been dead for some time before the abortion. Over the back and tail of the embryo the amnion is closely adherent, but it is wanting over the head. Here it ends abruptly, and this could not be due to rough handling, for the embryo is well packed with magma up against the chorion. Over the embryo the chorion is very thin and without villi, which explains why the embryo was seen in the fresh specimen. At some distance from the embryo the chorion appears to be normal in structure.
Embryo No. 212
Embryo, C. R., I 5 mm.
Dr. West, Bellaire, Ohio.
The macerated embryo is from a large ovum which was aborted October 9, I902. Last menstrual period began on April 3, I89 days before the abortion.
The tissues of the embryo show that its development was arrested during the sixth week. The central nervous system is completely dissociated, being but a mass of cells. The other tissues of the body, except those of the head, have undergone no secondary changes. The face and the top of the head have been converted into a thickened mass of necrotic tissue, in which may be seen large veins filled with blood. The eyes are immediately below the skin, thoroughly dissociated. but the vesicular lenses can still be outlined.
Embryo No. 215
Ovum, 45 x 40 x 40 mm.; embryo, C. R., 17 mm. Dr. Unger, Mercersburg, Pa. Brodel Collection.
Fig. 2I5.——Photograph of macerated embryo in a piece of the chorion. Natural size.
The specimen is smooth and fleshy and filled with granular magma, in which was found the remnants of a macerated embryo. Sections of the chorion show that the decidua is attached and that the amnion lines the whole ovum. The chorion is well developed, but the villi are matted together; it corresponds with its history, which states that the specimen is about 12 weeks old. It was preserved in IO per cent alcohol.
Embryo No. 223
Mole, 40 x 18 x 15 mm. Professor Brodel, Baltimore. At the point of attachment to the uterus the “fibroid mass” is very rich in villi, which at its rounded end is composed wholly of blood. The entire tumor is encapsulated with a layer of pus. Between the villi the meshes are filled with syncytium, which often give the picture of a cancer. ‘Where the syncytial cells are far removed from the blood they are often necrotic.
Fig. 223a.—Photograpl1 of the mole. Natural size.
Fig. 223b.— Diagram of the structure of the mole. B, blood and fibrin; P, pus; S, syncytium; NS, necrotic syncytium; V, villi.
Embryo No. 226
Ovum, 60 x 60 x 30 mm; embryo, C. R., 24 mm.
Dr. West, Bellaire, Ohio.
“T he woman, mother of three children, menstruated last on March 3 and aborted on May 29.” The ovum is covered with a few large villi two mm. in diameter at their base, and irregular clots of blood. Elsewhere it is smooth. The amnion is filled with a granular mass, which was swept out easily when opened. Between the amnion and chorion there is an irregular mass of mother’s blood, which is partly organized, showing that the chorion had ruptured some time before the abortion took place. The tissues of the villi and the chorion are somewhat fibrous. with very few degenerated blood-vessels within them, indicating that the circulation had ceased some time before the abortion, which is confirmed by a study of the embryo.
The external form of the embryo indicates that it was nearly 50 days old when it died. for, with the exception of the head, its form is practically normal. The menstrual history makes it 87 days, and if 28 is subtracted, ten days are still left, which is time enough in which to bring on the internal changes found within it.
In general the 01‘g'Z'l1lS are sharply defined, but they do not stain well: the cells appear as in CO.'lg‘1llZlll011 necrosis. The
Fig. 226a.——Photogrz1ph of the embryo. ]7.nh11'g'ccl 2 diznneters.
cartilages are also well formed, and the maxilla. mandible, clavicle, humerus, ulna‘, radius, femur and tibia have begun to ossify. All this indicates that this embryo died quite suddenly and that the changes within it are to be viewed as post-mortem changes.
The vascular system is well developed, the heart muscle being normal in shape but very fibrillar; it does not stain well. Most of the large vessels are empty and the blood cells are scattered throughout the tissues of the embryo and the cord. The muscle fibers are unusually well marked, and the connective tissue seems to he thickened.
The most marked changes are seen in the head. Much of the epidermis is still in place, but some of it has fallen off. At the back of the head the destructive process has included the back of the brain and the upper part of the spinal cord. The fore-brain, mid—brain and the spinal cord of the trunk are still intact and dissociated. The eyes are of normal shape and position, but much macerated. The nerves of the head can still be outlined, which shows quite conclusively that the destruction of the medulla is of recent date.
Fig. 226b.-—-Reconstruction of the central nervous system of the embryo.
Embryo No. 223
Ovum, 60 x 25 x 25 mm.; embryo, 4 mm. Dr. West, Bellaire, Ohio. “The specimen is from the first pregnancy of a fairly healthy woman. Last period July I to 3, and the abortion took place on October 10, I903.”
Fig. 228a.-—-Photograph of the ovum. Natural size.
The solid blood—red specimen contains a regular cavity, 30 x 18 x 18 mm, which is filled with a granular magma, on one side of which is attached an embryo shaped like an hour-glass.
Sections of the mole show that it is composed of thick walls in which there is much blood, villi, a great deal of decidua and some pus, especially on its outside. The meso derm of the villi and chorion is very fibrous and devoid of blood—vess<-:ls.
Fig. 228b.——Diagra1nmatic section of the embryo. X 20 times.
The cavity of chorion is lined with a very thick amnion and the remnant of an embryo indicates that its development was arrested towards the end of the third week. The deforming process must have been active for at least 50 days.
The vascular system is still represented by a mass of cells on the ventral side of the embryo, behind which there is a large vessel full of blood extending towards the remnant of the umbilical vesicle. No vessels extend to the chorion.
The central nervous system fills the main part of the embryo, being much dilated in the head and pretty well filled with round cells throughout. In front of the brain are two vesicles which communicate with it through two long tubes. These no doubt represent the eyes. In the neck there is a small gland, possibly the thyroid.
Embryo No. 230
Ovum, 75 x 60 x 50 mm.; embryo, C. R., 57 mm.
Dr. West, Bellaire, Ohio.
“The mother has had three children and three miscarriages. She always menstruates regularly during her pregnancy, and she has been undecided during the past seven months whether or not she was pregnant.”
Upon opening the ovum it was found that the foetus is greatly cramped and imbedded in much granular magma. The cord is thin and knotted. The right leg has a club-foot and the left has a dislocated knee-joint. Evidently the embryo has been dead for a long time.
The tissues of the embryo and membranes appear normal; they barely stain at all. The outer zones of the chorion are slightly infiltrated with leucocytes.
The dislocated knee and the club-foot show that the cartilag‘es are markedly deformed, but on account of the absence of tissue reactions it must be concluded that this change took place after the death of the embryo. The liver, brain, spinal cord and eye are macerated, converted into a pulpy mass and do not stain. All of the epidermis has fallen off. Apparently the embryo died suddenly, for there are practically no tissue reactions to suggest the contrary.
Fig. 2305.. Fig. 2301:.
Fig. 230a. — Ovum cut open, showing embryo within imbedded in a mass of granular magma. Reduced.
Fig. 230b. — Embryo cleared of magma.
Fig. 23oc. — Arms and legs of embryo. Two views of each are shown. 240 M ALL. [VoL. XIX.
Embryo No. 232
Ovum, 45 x 25 x 25 mm.; embryo, C. R., 14 mm.
Professor Brodel, Baltimore.
Most of the chorion is devoid of villi except that immediately over the attachment of the cord, which appears to be normal. The villi of the chorion are somewhat fibrous, with
Fig. 232a.—-Entire ovum with villi on one cml. Natural size.
blood—vessels less numerous than usual, and are covered with a rich layer of syncytial cells. The amnion reaches the chorion. The embryo is atrophic and is imbedded in a mass of granular magma, in which there are numerous round cells.
Fig. 232b.—Embryo within the chorion.
Most of the epidermis has fallen off. The head is cylindrical in form, containing a solidified brain and dissociated eyes. The lenses are composed of broken cells surrounded by a very thick hyaline capsule. The organs of the body are not sharply defined, being filled with many round cells. The blood-vessels are mostly empty. Even the nerves and cartilages have lost their sharp borders. The extremities are stubby, being composed of densely packed round cells which show no differentiation.
Embryo No. 233
Mole, 70 x 45 X 40 mm.
Dr. Miller, Hagerstown, Md. Brodel Collection.
The irregular mass appears as an ovum filled with blood. Sections show, however, that there is a mixture without rhyme or reason of all kinds of deformed villi, blood, syn Fig. 233.-——External and cut surfaces of the mole. Natural size. 242 M ALL. [VoL. XIX.
cytium, decidua and pus. No doubt at its attachment to the uterus it received fresh blood into its center, while the leucocytes attacked it on its exterior. Most of the villi are encircled with fragmented leucocytes, which seem to have gained the upper hand.
Embryo No. 243
Ovurn, 30 x 20 x 10 mm.
Professor Brodel, Baltimore.
The specimen is pear—shaped with smooth thin walls, over which there are scattered a few thin villi. The whole specimen was cut into serial sections and no trace of an embryo could be found.
Fig. 243.—-External view of ovum. Enlarged 2 diameters.
Embryo No. 244
Embryo, 4 mm. long. From Dr. Kel1y’s Szmatorium. Brodel Collection. The specimen is enclosed in the amnion, which measures 25 x 15 x 15 mm. and is surrounded by a mass of granular magma.
Fig. 244a.——Embryo, surrounded with grzumlur magma, attached to the amnion. X 2 times.
Fig. 244b.——Section through the head of the embryo. X 20 times.
Fig. 244c.——Secti0n through the body of the embryo. X 20 times.
The sections show that the amnion is attached along most of the ventral side of the embryo, somewhat as it is in the normal specimen at the end of the second week. The central nervous system is still quite sharply defined, being more characteristic in the head than in the trunk. The heart is composed of a solid mass of cells in front of the embryo, which extends as a horn-like process to the head. Between the heart and the body there is large group of epithelial cells, in which there are scattered some small round cells, probably the remnant of the liver. Otherwise the tissue of the embryo is of even structure with an occasional necrotic area. The epidermis is mostly wanting. There is neither umbilical cord nor um— bilical vesicle present, the free embryo being attached to the amnion only.
Embryo No. 246
Ovum, 30 x 21 x 14 mm; embryo, 3 mm.
Dr. VVegefarth, Baltimore. Brodel Collection.
Dr. VVege'farth writes: “The woman from whom this specimen was obtained is the mother of two children, the youngest about seven years of age. Since then she has had five miscarriages, all of about the same age as this specimen. No history of syphilis, but have started to give her iodide of potash, with the hope that she may give birth to a child. I shall be glad to have you turn the specimen over to Professor Mall if it will be of any use to him. It would be interesting
Fig. 246a.—-Ovum with window cut out of it, showing dense magma and embryo within.
if the great fire we had recently could have played any part in this trouble, as she felt well up to that time, and the fright due to the fear that the fire would burn out her neighborhood, too, kept her in a state of great excitement for about 24 hours.”
The external surface of the ovum is normal in appearance, but when it was opened it was found to contain a deformed embryo lying beside a very large amnion. Sections of the chorion show that its structure is somewhat hyaline and the villi are devoid of blood-vessels. The embryo and membranes were cut together and the sections show that the amnion is greatly hypertrophied, folded and torn, and that the embryo
Fig. 246b.—Embryo covered with folds of the amnion. X 10 times.
is deformed and injured but lying outside of the amnion. The heart and great blood-vessels are empty, the brain is distended and partly filled with round cells; together they give the appearance of an embryo of the beginning of the third week.
No liver can be found, but there are loops of intestine present.
as during the fourth week. The otic vesicles are well defined, but the optic vesicles are wanting.
No umbilical vesicle can be found, but this may have been lost when the amnion was torn. The amnion, however, runs down in a thickened ridge which contains two large blood vessels and an epithelial tube, the allantois, between them. At no place is the amnion attached to the chorion, nor are there indications that they have been torn apart.
Embryo No. 247
Ovum, 40 x 40 x 17 mm.; vesicle, 2}/2 mm.
Dr. Seymour, Trappe, Md. Brodel Collection.
The ovum was found filled with granular magma and in the center of this, far away from the chorion, a free umbilical vesicle was found. Sections of the chorion show that it is nearly normal in structure without any signs of an amnion on its inside. The villi are without capillaries. At points between the villi the syncytial cells form mounds below the epithelium, which have a tendency to penetrate the mesoderm of the chorion.
The pear—shaped body is probably the umbilical vesicle, with a cavity lined with epithelium and a considerable amount of mesoderm around it, in which there are numerous bloodvessels filled with blood. There are some accessory vesicles in this layer similar to those found in No. 78.
Embryo No. 250
Carnegie Embryo No. 250
Ovum, 10 x 9 x 9 mm.; embryo, 2 mm.
Dr. Sampson, Baltimore.
The specimen came imbedded in a mass of decidua, which was obtained by scraping the uterus. When opened it was found filled with magma reticulé, in which could be seen, immediately beneath the chorion, a small embryo, and further away, towards the center of the coelom, the umbilical vesicle. The whole ovum was cut into serial sections.
The chorion and villi are apparently normal in shape and structure, being also very rich in blood-vessels which are filled with embryo’s blood. The villi are bathed in mother's blood and covered with an active syncytium. The decidua is somewhat infiltrated with leucocytes, but there are no abscesses.
The front end of the amnion is torn and its free edge and the embryo are imbedded in reticular magma, indicating that the injury took place before the abortion. The general shape of the embryo and its degree of development are practically normal. The heart is well formed and it, with the bloodvessels, is filled with blood. The alimentary canal, brain, spinal cord, otic and eye vesicles, myotomes and branchial arches are much like embryo No. I2, which is practically a normal embryo of the beginning of the second week. The septum transversum is well marked and the thyroid gland is just beginning.
The tissues of the embryo, however, and the cavity of the front end of the brain are filled with numerous small round cells wth fragmented nuclei. All stages of fragmentation are seen, just as may be seen in the leucocytes in small abscesses. Most of the red blood cells are within the blood-vessels, but those within the tissues appear perfectly normal. On account of the diminished number of mesoderm cells, in fact, they diminish in proportion to the number of fragmented cells present, the conclusion must be drawn that the latter arise from the former. The epidermis covers the whole embryo.
Fig. 250a. — Ovum, opened to show the embryonic mass, within the (lCC1(lllEl. X about 2 (liamctcrs.
Fig. 250b. — Section of embryo, encircled with magma, within the chorion. The amnion is torn. X I7 diameters.
Fig. 250c. ~ Section of chorion, villi and decidua. There is a large quantity of mucmd mass between the VI“). X 17 diameters.
Fig. 250d. — Section through hind—brain, M, adjacent mescuchyme and cpitliclial hmng of pharynx P, to show cytolysis and dissociation of the tissues. X 250 times.
Fig. 250e. — The dotted area in the section shows the portion which is enlarged in Fig. 250d.
The primary change in this specimen is no doubt in the mesoderm, for all the rest of the embryo appears normal. That the equilibrium was overthrown is indicated by the necrotic amnion and the great amount of reticular magma in the exocoelom.
Embryo No. 251
Ovum, 30 x 25 x 25 mm.; embryo, C. R., 9 mm.
Dr. Ritter, Brooklyn.
Last period January I6, abortion April 3. Half of the chorion is covered with villi and the other half is bare, thickened and hemorrhagic. The amnion lines the entire chorion and the cord is very thin. Sections show that the mesoderm of the villi are rich in cells, fibrous and are devoid of blood vessels. The main wall of the chorion is apparently normal, with a large number of vessels filled with blood scattered through it. The decidua is very extensive, is hemorrhagic and has a large number of abscesses in it. Apparently there was an extensive endometritis.
Fm, 2513.-—Embryo attached to the chorion. Enlarged nearly 2 diameters.
Fig. 25Ib.—Section of the embryo. X 8 times. Fig. 251c.—Section through the lens and adjacent tissue.
The head of the embryo is atrophic and is nearly filled with a distended, dissociated and macerated brain. The eyes are solid and the lenses have become dissociated, but they are encircled with sharply defined and thickened hyaline capsules. The brain is protruding behind the head. The heart and blood—vessels are distended and filled with blood. The organs and tissues of the body are not well defined, and are filled with round cells. The epidermis is wanting. The extremities are stubby, without structure and filled with round cells. The cartilages are sharply defined, and the liver appears to be about normal.
Embryo No. 252
Embryo, 5 mm. long. Dr. Lamb, \/Vasliington.
“first pregnancy in an unmarried woman twenty—three years old. Patient missed a month, then had free hemor Ki
Fig. 252a.——Photograpl1 of embryo, with amnion on one side and the thickened chorion on the other. Natural size.
Fig. 252b.-—Section through the eye, small black spot in Fig. 252:1. X 20 times. E, eye; B, brain.
rhage which continued for a month, when the embryo was expeller .” This would make its age three months, counting from the last period.
This remarkable specimen shows to what extent an embryo may grow after its regular development has been arrested. The specimen came to me attached to a solid body, as the photograph shows, and it appears to be an embryo about three weeks old. The free end of the embryo is bent upon itself and runs to :1 point where two intensely black spots may be seen.
Fig. 252c.—Section through the -embryo at its attachment to the chorion. X 20 times.
The membrane or body behind the embryo is undoubtedly the amnion curled up, for it is covered with epithelium on the side towards the embryo side, which continues over its body. 011 the other side the mesoderm, which is thickened and hyaline, is free, there being no border cells nor villi.
Fig. 252d.——Section through the embryo below its attachment to the chorion. The body immediately beneath the epidermis is a solid lentoid structure.
The skin is markedly thickened, the epidermis sometimes forming small papillae, or are sometimes buried, forming pear-like bodies similar to those of epithelial cancer. Within the body there is a large cavity filled with round cells. Near the attachment to the amnion there are several such “abscess1ike” masses within the embryo.
The pigment dots, on account of their position, undoubtedly represent the eyes of the embryo. Each forms a small sac immediately below the skin filled with large free pigment cells. Deeper within the “head” of the embryo a band of pigment cells connects the two “eyes,” as may be the case if we consider these cells as the connecting optic nerves.
Embryo No. 253
Ovum, 35 x 30 x 15 mm. ; embryo, 4 min. Professor Brodel, Baltimore. Chorion and villi are somewhat hyaline, with indications of blood-vessels within them. Amnion, which measures 19 x
Fig. 253.—Embryo within the chorion. X 1.8 times. The collapsed bag behind the embryo is the amnion.
I 3 x 13 mm., is attached at one point, has hyaline walls and does not contain the embryo.
The embryo is a swollen infiltrated specimen of the third week, with no brain and little of its spinal cord left. The rest of the structures (heart, coelom and Wolffian body) are quite sharply defined, but are all infiltrated with round cells.
Most of the epidermis is intact. The arm buds are well defined.
Embryo No. 255
Ovum, 20 X 20 x 10 mm.
Professor Brédel, Baltimore.
The villi are atrophic and fibrous. At points the syncytial layer is well mixed with leucocytes, which also have invaded some of the villi as well as the mesoderm of the chorion. The whole chorion was cut into serial sections, but no trace of an embryo was found. There are no blood-vessels in the chorion, nor were any remnants of the amnion found.
No. 257. Ovum, 55 x 40 x 40 mm., with a pedicle within, I4 x 2 mm., to which is attached a body 4 x 0.5 mm.
Fig. 257.—Photograph of the specimen. X 1.5 times.
From Mr. Lankford, Baltimore.
A large portion of the chorion is covered with well formed and apparently normal villi; a portion is hemorrhagic and another is fibrous, appearing as though it had protruded through the os. Sections through this portion show that the villi are atrophic and have undergone fibrous degeneration. The chorion is thickened and the decidua is infiltrated with leucocytes.
The inside of the chorion is lined with epithelial cells, which are continuous with those over the cord; it appears as if the amnion had become completely blended with the chorion.
The cord is also fibrous, with some spots which have undergone mucoid degeneration. It contains three large blood vessels,——a vein and two arteries. The body at the end of the cord is simply its continuation, with the umbilical vein running throughout it lengthwise.
Embryo No. 261
Chorion, I20 x 70 x 70 mm.; embryo, about 90 mm. long. Dr. VV. M. Lewis, Baltimore.
Fig. 26Ia.—-External view of specimen. Three-fifths natural size.
The ruptured and distorted foetus, which no doubt had been dead for a long time, is imbedded in a mass of granular magma.
Sections of the placenta show that the villi and chorion are very fibrous and almost devoid of syncytium. The umbilical cord is somewhat fibrous, with blood—vessels within filled with
Fig. 26Ib.———Foetus within its membranes. Reduced.
blood. The decidua contains large sinuses and is also well filled with round cells.
The tissues of the hand and skin are somewhat infiltrated with round cells, but other changes within them are not marked. It appears as if the embryo died quite suddenly, and therefore there are no marked tissue reactions.
Embryo No. 262
Mole, 80 x 15 x 15 mm.
Dr. Giering, Baltimore.
The specimen was several days old when it came into my hands and was then hardened in formalin. The interior is filled with a large amount of granular magma, in which is imbedded a necrotic embryo, I4 mm. long.
Fig. 262a.—Photograph of the mole. Natural size.
Fig. 262b.—~'Section of the embryo. Enlarged about X0 times.
The decidua is filled with small abscesses, the leucocytes invading the villi as well as the main walls of the chorion. The changes in the embryo are extreme, the nervous system being solid, filling up the stumpy head. The outlines of the organs are hazy, they being filled more or less with round. cells. The embryo is falling into pieces; some of the epi-dermis is still intact.
Embryo No. 263d
Ovum, 27 mm. in diameter; embryo, C. R., 15 mm.
Dr. Lyman, Baltimore.
The villi are apparently normal in form and in structure. Possibly the mesoderm is a little fibrous. The blood-vessels appear to be normal. The cord is dilated, showing the double enlargements, which are mucoid in structure.
The brain and Spinal cord are dissociated, with the brain protruding into the mouth, but the other organs are fairly
Fig. 263d a.—Embryo within the ovum. X 2 times.
well outlined. The heart and large b1ood—vessels are filled with blood and there is some infiltration of the surrounding tissues with round cells. The epidermis has fallen off. The changes within the embryo may be clue to maceration. but on
Fig. 263d b.-——Sagittal section of the embryo. X 7 times.
account of the sharply defined tissues of the chorion and slight amount of fibrous changes in the villi and the mucoid dilatations in the cord with some wandering cells in the tissues, I am inclined to think that this specimen represents the earliest stage of a strangulated embryo of the sixth week.
Fig. 264.——Section of the vesicle attached to the chorion. X I5 times.
Embryo No. 264
Ovum, 25 x 20 x I5 mm., with a cavity within 10 mm. in diameter.
Dr. Gardner, Baltimore.
“Last period occurred on August I2; abortion October 9; but the menses had been irregular for three months before.”
The coelom is filled with hard hyaline magma, rich in round cells, in which is imbedded the umbilical vesicle measuring 2% mm. in diameter. The chorion is thickened and fibrous and is covered with some villi, which are also fibrous. The vesicle shows all the characteristics of the umbilical vesicle and is attached to the chorion by a thick fibrous pedicle. At the point of juncture it is rich in -large blood—vessels filled with blood. These radiate into the surrounding chorion, but do not reach into the villi.
Embryo No. 268
Embryo, C. R., 22 mm."
Dr. Kammerer, New York..
The form of the embryo is normal, but its body is straighter than usual. It was hardened in formalin and some of the tissues are well preserved, but others, e. g., brain, liver, lungs and muscles, are dissociated. The blood-vessels are filled with blood and there are no wandering cells in the tissues. Compare the form of this embryo with that of No. 256, Plate III, Fig. 8.
Embryo No. 270
Ovum, 40 x 30 x 30 mm.; embryo, C. R., 14 mm.
Dr. Wilson, Baltimore.
The chorion is only partly covered with villi, which are atrophic and fibrous in structure, but contain some blood vessels in them. The main wall of the chorion is also fibrous and of irregular thickness. with some blood-vessels in it. The amnion has reached the chorion and is filled with granular magma, which completely envelopes the embryo.
The central nervous system is distended. dissociated and macerated. The large blood-vessels and heart are distended with blood and the tissues of the body are somewhat infiltrated with round cells. The outlines of the organs are slightly obscured, but some of the tissues of the body are sharpened by the process of maceration, which does not seem to have been of long duration.
Fig. 268.— Photograph of the embryo. X 4 times.
Fig. 270a. Fig. 27cb.
Fig. 27oa.— Photograph of the ovum. Natural size.
Fig. _>7o1‘:.——Embryo within the chorinu, containing granular magma. < 2 nmes.
Fig. 270c. — Sagittal section of the embryo. X 7% times.
Embryo No. 275
Ovum, 40 x 30 x 25 mm.; embryo straightened and about three weeks old.
Dr. Tobie, Portland, Me.
The chorion of this specimen, thought to be two months old, is thin and covered with some villi which are imbedded in much blood. In structure it is fibrous, with a diminished amount of syncytium upon it, and contains no blood-vessels.
Within there is a cavity, the amniotic, filled with a clear fluid, into which the deformed embryo projects. The exocoelom is from two to three millimeters wide, and is filled with typical magma reticulé.
The structures of the embryo form almost a continuous mass of tissue, in which the irregular central nervous system
Fig. 275b.-—Photograph of sections of the ovum, showing the embryo in one of them. Natural size.
can still be outlined. Enough is left to show that the specimen began to become infiltrated towards the end of the third week.
Most of the epidermis is still intact. The lenses of the eyes form small pearls enclosed in capsules lying beneath the
Fig. 275c.—-Section of the head—end of the embryo, amnion and chorion. X 15 times.
skin. In front of them there are two small bodies connected with the epidermis, which might pass for lenses, but are prob«
ably changed olfactory pits. In a number of places the tissues are fibrous.
Embryo No. 276
Ovum, 70 x 3 5 x 3 5 mm.; embryo, 13.5 mm.
Dr. Stanley, Portland, Me.
Dr. Stanley writes that the time between the last menstrual period and abortion is 80 days.
The walls of the chorion are partly infiltrated with blood and on one side is closely adherent to a fleshy mass———the decidua. Sections of these regions show that the decidua has large blood sinuses and numerous small abscesses in it. T he villi of the chorion are imbedded in a mass of blood, are covered with a normal amount of syncytium, but in structure they are fibrous and devoid of blood-vessels. in addition,
Fig. 27§b.—Interior 9f the ovum, showing broken embryo on one side of 1t. Natural Size.
they are invaded at numerous points by the syncytium, which forms in them small vesicles, lined with two layers of cells, and often filled with dense masses of small round cells. These vesicles are very numerous and usually communicate with the
F10. 276c.——Section of the embryo. X 8‘/2 times.
surface of the villi by means of bands of epithelial cells. The walls of the chorion are in apposition to those of the amnion, but they are not invaded by syncytium.
The changes within the embryo are equally remarkable. The spinal cord is dilated and dissociated; the medulla is solid, fills the entire head and protrudes from an opening formed by the destruction of the forepart of the head. In front of this opening the atrophic upper jaw may be seen. containing nerves, and behind the epidermis has grown into a small ridge, encircling the opening. What has taken place in this embryo took place mechanically in No. 256 (see Plate III). The outlines of the organs are not sharp, but those of the precartilages are very definite. The blood—Vessels are greatly dilated and filled with blood cells, which make them look like abscesses. They are especially well marked along the line from the umbilical cord to the heart. In their immediate neighborhood there is more or less infiltration with round cells. The smaller veins and arteries are still filled with blood.
Embryo No. 278
Ovum, 6 x 4 mm.
Dr. Stanton, Albany, N. Y.
“This specimen was found accidentally in curettings from a woman supposed to have chronic endometritis following pregnancy. There is nothing in the history by which the age of the specimen could be estimated.” Part of the specimen had been cut into sections before the specimen was sent with the statement that no embryo had been found, it having fallen out.
I found that the half sent contained a coelom, 3 x 2.5 mm. filled with magma, in which there was a cavity about I. 5 x I mm. Sections showed that the cavity was natural and not sharply defined, without anything to indicate that an embryo had been in it. On the contrary, it was found that the magma reticulé was filled with a loose net-work of mesoderm cells, which bound one side of the chorion with the other, as indicated in. the diagram which is from a reconstruction. These cells are directly continuous with those of the mesoderm and resemble them in every particular. At one point there is a small group of epithelial cells, which may represent what was originally the embryo.
Otherwise the chorion and its villi are normal in appearance, being encapsulated in decidua which has in it some uterine glands. All in all, this specimen reminds one of Peters’s ovum very much. There are some leucocytes in the (lecidua, but no accumulations of them, indicating inflammation of the uterus.
1711;. z78zx.«——}’l1uto<-‘m.)h of 2: section of the ovum with svncvtium:1ml<lcci(1uz1. )< 1: timcs. a
Fig. 278b.-—Outline of the main wall of the chorion, C , showing the strands of mesoderm, M, that cross the coelom, in which there is a small epithelial mass, E, possibly the remains of the embryo. X 18 times.
Fig. 278c.—High power drawing of the epithelial mass, strands of meso~ derm and chorion. X 50 times.
F16. 278d.—The epithelial mass. X 500 times.
Fig. 278e.——Attachment of the chorion to the decidua. X 50 times. CM, chorion; T, trophoblast; D, decidua; 5,_ syncytium_; EV, blood-vessel; G, uterine gland; I.S., intervillous space.
I consider this specimen one in which the embryo has been destroyed, leaving a normal chorion without an embryo.
Embryo No. 279
fleshy chorion, 100 x 60 x 60 mm. Into the cavity the umbilical cord, 30 x 5 mm., projects.
Dr. Kemp, Baltimore.
Part of the chorion is hemorrhagic; the rest appears normal. Sections show that the villi are nearly normal, with :1 deficient amount of syncytium over them, even where they are well imbedded in blood. \Vithin there is an amnion, and the worm—1ike process which proves to be the umbilical cord. with its three blood-vessels. The vessels are well developed
Fig. 279.—Photograph of a section of the specimen showing the cavity and cord within. Slightly reduced.
and fully one millimeter in diameter; there are also numerous vessels in the villi of the chorion. The tissue of the chorion is hyaline, with a diminished number of nuclei in it.
Undoubtedly the foetus escaped in some way shortly before the abortion, the membranes and cord remaining some time, long enough to undergo these changes. The blood-vessels of the cord and chorion are empty, but well developed.
Embryo No. 280
Mole, 40 x 25 x 25 mm. Dr. Magness, Baltimore. Within the mole, which is said to be five or six weeks old,
fiG; 280. — Photograph of the mole. X 1% times.
there is an irregular cavity with smooth walls, measuring 10 x 5 x 5 mm. Sections were cut of the thick hemorrhagic walls, which showed that the walls of the chorion are thin. with considerable reticular magma attached to them on the inside. No amnion was found. The villi are not very large, are well developed, contain remnants of blood-vessels and are covered with a mass of necrotic syncytium. The blood and mucus over the syncytium is filled with leucocytes, which invade the mesoderm of many of the villi. It is probable that the whole ovum has been dead for several weeks, the embryo and the amnion having been destroyed entirely.
Embryo No. 285
Ovum, 45 x 35 x 35 mm.; embryo, 8 mm.
Dr. Keown, Baltimore.
“Last menstruation October 9 to I2; abortion December 20, I904. The specimen came away unbroken, was washed in water and placed in alcohol. There is reason to believe that conception did not take place until the time for the period which lapsed. The mother insists that this is the case, and. inasmuch as all three of her children had diphtheria at that time it is probably true.”
The chorion is mostly bare, with some hemorrhage in its walls. The villi which are left are very fibrous, with but few blood-vessels within them. The syncytium over them is very active, and at numerous points it is heaped up in small mounds, which form depressions, making it appear as if they
Fig. 285a.—Photograph of the embryo and chorion. Natural size.
are about to invade the mesoderm of the villi as well as that of the main wall of the chorion. The amnion fills the entire chorion.
Between the villi there is a reticular arrangement of blood and mucus, in which there are numerous leucocytes. The syncytial bodies enter this reticular mass at numerous points and make a very remarkable picture.
The embryo has an atrophic head and cord, showing, however, enough structures to fix its age at four weeks. The spinal cord is dilated and dissociated and the brain is solidified, filling the entire head. The eyes are destroyed. The blood—vessels are enormously distended with blood, which also
fills the tissues of the body, obscuring them to a great extent. The epidermis is intact.
Fig. 2851).--Section of the embryo. X 13 times. F16. 285d.—Section of a fibrous villus which is invaded by lucocytes and adjacent syncytium, S, and mucus, M. X 250 times.
Embryo No. 286
Chorion, 100 x 50 x 40 mm.
Dr. Girdwood, Baltimore.
This remarkable specimen must have been dead in the uterus for about five months, the last period having taken
F16. 286a.-Photograph of the entire specimen. Natural size.
place (luring the latter part of May and the abortion on the 4th of the following January.
The chorion thickens as it passes into the large fleshy placenta on one side and is very thin on the other. The thin twisted cord enters the chorion at the border of the placenta. The embryo is well imbedded in granular magma.
Sections from the placenta at the point the cord enters it show a most remarkable reaction. The amnion is folded upon itself and has undergone hyaline degeneration. The chorion is also hyaline and is infiltrated with leucocytes and syncytium. The villi are fibrous, with numerous spots of hyaline matter scattered through them. With them the lining cells of the large blood—vessels show remarkable growth, forming small pearls of endothelial cells. They are also invaded by syncytial cells at some points and at others by masses of leucocytes.
Fig. 286b.—Photograph of the embryo. Natural size.
Between the villi there is a great mass of necrotic syncytium mixed more or less with fresh blood. Throughout this general mass numerous small islands of active syncytium may be seen; there are also a great number of scattered leucocytes
Sections of the cord, abdominal viscera and hand show that the embryo must have died quite suddenly, for there are no tissue reactions seen in them. However, the tissues do not stain well, the epidermis has fallen off and the large blood vessels are filled with blood containing the proper number of leucocytes.
Fig. 286c.- Section of a villus. X 62 times. V, villus; N, necrotic villi and syncytium; H, hyaline degeneration of mesoderm and syncytium; X, peculiar masses of cells in the mesoderm, probably degenerated blood-vessels.
Embryo No. 288a
Ovum, 85 x 35 x 35 mm.; embryo, C. R., II mm.
Dr. Brulle, Baltimore.
On one end of the chorion there is a space ( 30 x 30 x 5 mm.) filled with reticular magma. Within this, and pushed to one side, a collapsed amnion may be seen, containing the embryo.
The entire mole is surrounded by decidua and pus, in which there is the collapsed ovum. The intervening space is filled with blood through which ramify a few long slender villi. These are fibrous and devoid of blood-vessels. At points they are invaded by syncytium and leucocytes.
The amnion, which is also fibrous, is partly filled with magma reticulé and is very rich in degenerated migrating cells
Fig. 2883 b.——Photograph of sections of the mole, showing the embryo pushed to one side. Natural size.
from the embryo. The embryo is pushed to one side of the chorion and is pretty well dissociated, but the tissues are sharply enough defined to recognize that the embryo is not over six weeks old. They are well infiltrated with round cells which extend into the surrounding magma; there is no epidermis present.
Embryo No. 289
Embryo of the fourth week, 8 mm. long.
Dr. Brulle, Baltimore.
The specimen is distorted and macerated and it is impossible to determine definitely whether or not it is normal.
Embryo No. 290
Mole, 50 x 15 x 10 mm.
Dr. Warren, Portland, Me.
The specimen is said to be from a six weeks’ gestation, and the abortion is believed to have been induced by some eminenagogue. Sections were cut from different portions of this irregular mass and the remnants of a few villi were found, which were more or less infiltrated with leucocytes. The bulk of the mole is composed of decidua, mucous membrane of the uterus, blood, fibrin and pus.
Fig. 290. — Photograph of the mole. X 2 times.
Embryo No. 291
Embryo, 5 mm. Dr. Wegefarth, Baltimore. Brodel Collection. The membranes are devoid of villi and very thin. The umbilical vesicle is necrotic and filled with an irregular mass.
Fig. 291.—Embryo attached to the chorion. X 4 times.
Sagittal sections of the embryo show that the specimen is pathological, its head being rounded and the epidermis having fallen off. The spinal cord is distended and the brain is solid. Veins and arteries are greatly distended with blood. Eye vesicles are atrophic, and the lenses are dissociated, but encircled by a sharply defined capsule.
Embryo No. 292a
Ovum. 50 x 30 x 30 mm.; embryo, 3% mm.
Dr. West, Bellaire, Ohio.
“The ovum is from a woman thirty—one years old, who has been married for ten years, but never had been pregnant before. Last period November IO, and on December 24, after a hard day's work, she had a sudden gush of blood, and since then has been wasting at times. The ova was expelled February 4.”
The chorion is partly covered with long villi, which are fibrous in some places and oedematous in others. The amnion within, which fills the entire ovum, is partly filled with granular magma, through which can be seen the outlines of an atrophic embryo. Sections of it show that the brain and
Fig. 292a a.—Photograph of ovum. Natural size.
Fig. 292a b.—Photograph of the embryo lying within the magma. X 7 times.
most of the spinal cord have been destroyed; at one point the cord ramifies through the embryo. In the middle of the embryo the aortae and coelom are sharply defined, but elsewhere the tissues are entirely obscured by numerous round cells. The epidermis is intact.
Embryo No. 293
Carnegie Embryo No. 293 Embryo, C. R., I9 mm.
Dr. Lamb, Washingt0n.
Dr. Lamb writes: “Yesterday I sent you an embryo aborted at the third or fourth mouth of pregnancy. I trust that it may be of interest to you. It is from Dr. Munson, of this city. I send it more particularly, however, to get some information. I myself cut it out of the ovum, so that I know that its condition was not caused by any rough handling. The sac contained some fluid in which were many flocculi, which no doubt are the absent portions of the embryo. Along its spine the embryo is whitish, but for the remainder was dark. Now I do not understand that micro—organisms played any role in this case to bring about the condition of the embryo, but it is only a maceration produced by the surrounding fluid medium. Still, I feel some doubt about my being correct, because I have seen so many cases in which there was no evidence of such maceration. In fact, the condition of this embryo is rather exceptional in my observation. Apparently the soft visceral parts have first given way to whatever cause it was. Perhaps to you this is a trivial matter, but I would like to know what you think of it.”
Fig. 293a. — A photograph of the embryo. X 4 times.
Fig. 293b.— Section through the swelling in the back of the embryo, showing the blister of the epidermis. X 12 times.
Sections of the embryo show that all of the tissues are normal in form and in structure, with the exception of a great excess of round cells within them. Especially is this true on the top of the head and along the back of the embryo. The oedematous mass on the back is as a blister with the epidermis lifted off. It is filled with a granular mass, within which there are but few cells. All of the blood-vessels of the embryo are distended with blood; there is also a great quantity of blood within the pericardial cavity and some within the ven— tricles of the brain. Possibly this condition accounts for the excess of round cells in all of the tissues, but it cannot very well account for the condition on top of the head and along the back. Here there is a most decided infiltration of cells.
Embryo No. 295
Foetus with pointed head.
Dr. Miller, Hagerstown, Md. Brodel Collection.
The vessels going to the vertex are much enlarged. The scalp of the protruding vertex is very hemorrhagic, the blood filling the subcutaneous tissue as well as that of the skin. The embryonic hair follicles appear to be normal, but the epidermis is also infiltrated with blood cells, and is crumbling off in flakes.
Fig. 295b.—Photograph of :1 section of the head. Natural size. Fig. 297a.—Pl1otograph of the embryo. X 8 times.
Fig. 297b.~—Section of the embryo. X I5 times.
Embryo No. 297
Embryo, 6 mm. long.
Dr. Lamb, Washington.
This specimen was removed from the uterus with a curette and is said to be nearly three months old. The distorted embryo is of the three—weeks’ stage and shows extreme changes in its organs and tissues. The chorion is thin and atrophic. There is no trace of an umbilical cord, but instead the embryo sits upon the amnion. The spinal cord is dilated and the brain is fully dissociated, filling up the stumpy head entirely. The blood-vessels are much dilated with blood and all of the tissues are infiltrated with round cells which deform the organs and obscure their outlines. The mandible is necrotic and the distended medulla reaches almost to the month.
Embryo No. 298
Dr. Pearce, Albany, N. Y.
“I am sending you by this mail a Fallopian tube removed at an operation on March I 3. The tube shows rupture over an hemorrhagic swelling. The clinical diagnosis is rupture of ectopic pregnancy. It is from a young woman, aged twenty-six, married, who states that the last menstruation was three weeks before the operation. The surgeon is positive that it is a case of ectopic pregnancy. I am not so sure of the diagnosis, but with the history given I thought it worth while to send it to you, without close examination, etc.”
I found two nodules, each about IO x 6 mm., one hemorrhagic and the other with hemorrhagic walls with villus-like bodies upon it. This second body has a 1umen——the coelom ( P). Neither of them contained any trace of an ovum. Then the ends of the rupture were cut into serial sections, and in one of them the remnants of the ovum were found. It is about 4 mm. in diameter, composed of small fibrous villi surrounded by an irregular syncytium, decidua and blood. Some of the villi are invaded by leucocytes.
Fig. 298.——Section of the tube containing remnants of the chorion and villi.
Embryo No. 299
Ovum, 16 x 12 x 10 mm.
Dr. Burns, Memphis, Tenn.
The specimen, apparently normal, is filled with a mass of dense magma reticulé. Serial sections failed to show even a remnant of an embryo. The structure of the chorion and villi is normal, possibly a little oedematous. N o blood—vessels are present.
Embryo No. 302
Ovum, 25 x 20 x I 5 mm.; embryo, 4 mm. Professor Brodel.
The ovum is apparently normal, being covered with irregular villi. Sections show, however, that the villi are fibrous, with remnants of blood—vessels within them. The syncytium is very active and is imbeddecl in a reticular mass of mucus rich in leucocytes and pus.
Fig. 302.—Section of the embryo. X 16 times.
Within the chorion there is a Vesicle (amniotic) one centimeter in diameter iinbedded in much magma reticulé. This in turn is filled with granular magma, in which there is an embryo about 3% weeks old. The umbilical Vesicle is degenerated and lies in the reticular magma.
The blood—vessels and tissues of the embryo are gorged with blood and the outlines of the organs are obliterated. The brain is solid and the spinal cord is distended and dissociated. The eye vesicle and lens are nearly destroyed. The umbilical cord is very short and wide, without marked blood-vessels, but it is infiltrated with round cells.
Embryo No. 304
Ovum, 15 x 7 X 6 mm. Dr. Hunner. Brodel Collection. The specimen is surrounded by some of the decidua and much mucus. which is well infiltrated with leucocytes. The
Fig. 3o43.—Photograph of half the ovum containing the embryo. X 4 times.
villi and chorion are apparently normal, with remnants of blood-vessels within them, and they are covered with an active syncytium. ' The decidua is encircled with pus and ‘fragments 294 MA LL. [\'oL_ XI X.
Fig. 3o4b.—Section of the whole ovum encircled by the (lecidua. X IO times.
Fig. 3o4c.—Section of the villi and surroLmding' tissue. X 65 times.
D, decidua: S, syncy‘tium; L’, villus; Ch, chorion; M, mucoid substance rich in leucocytes.
of uterine mucous membrane, showing that an extensive inflammatory deposit cuts off the normal nutrition of the ovum.
The ovum is partly filled with magma reticulé, in which there is imbedded an umbilical vesicle two millimeters in diameter attached to the remnants of an embryo, without myotomes. The neural canal is present and the body runs out into a stem, containing a tube (allantois), which does not attach itself to the chorion. There are also remnants of an amnion present. All in all, the embryo appears to be much like Graf Spee’s specimen, which is 1.54 mm. long. There is no trace of a heart, but there are numerous blood islands in the umbilical vesicle and there are remnants of blood-vessels in the chorion, showing that the two were connected at an earlier date.
Embryo No. 307
Ovum, 40 mm. in diameter; embryo, 20 mm. long.
Dr. Coe, New York.
The chorion and villi are imbedded in an hemorrhagic mass, and the latter do not appear normal; they are‘ often surrounded by small clumps of leucocytes, which invade the mesoderm of the villi. The embryo was said to have been a beautiful normal one, but it had been harshly treated and practically ruined before it came to me. Sections of the embryo show that the tissues are macerated and distorted and probably normal.
Embryo No. 308
Foetus, C. R., 84 mm.
Dr. Ballard, Baltimore.
“Without any previous bleeding, on February 28, 1905, the foetus as you have it was passed suddenly, accompanied by the usual amount of hemorrhage. Probably one~half of the placenta was retained, and was removed by curettement. Patient is regular in menstruation, and previous to 1niscar— riage menstruated November 19, 1904. She has one boy who will be thirteen months old May 10, 1905, and another
Fig. 308.-—»]’hotograp]1 of the fu~tn.<, showing the cord wrapped around its arms, with :1 111358 of granular magma m the mnniotic cm-'1t_v. Natural size. No. 1;] ORIGIN OF HUJI.-l_\' MONSTERS. 297
son sixteen months older; no other children nor miscarriages.”
[The woman aborted again on November 27, I905 (specimen No. 325), and the ovum proved to be decidedly pathological. On December gr. 1906, after being pregnant for five months, she was taken with penumonia_ and aborted on January 4. The placenta was strongly adherent and was removed with difficulty. She died January 7, I907. Apparently this foetus was normal, but it was not sent to the laboratory.]
After the abortion Dr. Ballard found that the woman had an interstitial fibroid, somewhat diffuse in shape, in the anterior uterine wall. During some years she had some. otorrhoea. There is no reason to suspect that her husband has ever had gonorrhoea or syphilis.
The specimen appears to be normal, but when I opened the amnion, which had not been torn, I found it filled with a mass of granular magma, some of which is shown in the illustration. The cord is well tied around the arms, indicating that the foetus had been doing some lively jumping. Sections of the placenta, at the point the cord enters it, show that the villi are fibrous (P) and covered with an active syncytium, which is imbedded in bloody mucus containing large numbers of clumps of leucocytes with fragmented nuclei. The tissues of the cord appear to be normal; the blood-vessels contain but few blood cells.
Embryo No. 309
Dr. Steensland, Syracuse, N. Y.
Ovum, 23 x 20 x 20 mm. ; embryo, ‘4 mm.
The specimen, apparently normal, had been in alcohol for three or four years, but has been well preserved. The amnion filled the entire chorion, otherwise the interior also appeared normal. Section showed, however, that the dilated amnion was accompanied with marked changes in the embryo. All of the tissues of the embryo are infiltrated with round cells, obliterating, to a great extent, the organs and tissues. The
Fig. 3o9b.—Interior of the chorion, showing the embryo. X 4 times.
central nervous system is markedly dilated and filled with round cells. In front the walls are broken and_ the round cells are extended into the tissues of the front of the head. The eye and ear vesicles are also dilated and filled with round cells. No trace of a lens is seen, and the ear vesicle has two sprouts on its ventral side. The whole epidermis is intact.
Embryo No. 310
Ovum, 18 x 14 x I4111111.
Dr. Watson, Baltimore.
The specimen is covered with villi which in sections proved to be markedly changed. The mesotlerm is hyaline, with vacuoles in which there are free nuclei. The epithelial layer is irregular and invades the wall of the chorion as well as
Fig. 3Iob.—Interior of a piece of the ovum, showing; a large lump of magma. X 2 times.
3l0c.-—Sccti011 of the ovum, showing a mvznding the mam wall of the chorion.
large mass of syncytium
Fig. 3Iod.—Section of a villus. X 250 times. 5', syncytium.
some of the villi. The villi are vacuolated, contain some blood—vessels, and are covered with a fairly active syncytium. Over this there is a mass of mucoid fibrin rich in leucocytes. The interior of the ovum is filled with magma reticulé, and contains no trace of an embryo nor amnion.
Embryo No. 311
Ovum, 36 x 30 x 30 mm.; embryo, C. R., 12.5 mm.
Dr. Watson, Baltimore.
The walls of the chorion are thin and covered with a few scattered and irregular villi. Sections show them to be in all stages of degeneration, the large ones with blood—vessels and a rich syncytium, and the small ones, which are fibrous, devoid of syncytium and infiltrated with leucocytes. The spaces between the villi have a considerable amount of blood between them, and where this comes in contact with an active syncytium the nuclei of the leucocytes are fragmented; elsewhere they are not. Portions of the main wall of the chorion are very thin, fibrous and devoid of an epithelial covering. Throughout the amnion is in contact with the chorion and is often blended with it.
Within the amniotic cavity there is a mass of granular magma which could be seen through the thin walls of the chorion before it was opened.
Fig. 3IIa.——Ovum covered with ragged villi. X 1'/2 times.
Fig. 3IIb.—Intcri0r of ovum with em1)ryo.im1,u:dde(1 in grzmulzu‘ magma.
Fig. 3I1d.—Sagitta1 section through the middle line. X 6 times. 3
Fig. 3IIc.—-—Section of the chorion, showing blood clots between the villi. X 7’/2 times.
The umbilical cord is enlarged in its middle and is very thin at its attachment to the chorion, which is also atrophic at that point. Sections show that the center of the cord is fibrous and that the enlargement is due to the extreme mucoid degeneration of sides. Near its attachment to the body the cord is infiltrated with round cells and the intestine Within the coelom of the cord is irregular and gorged with them; the lumen of the intestine is destroyed entirely.
The embryo is imbedded in the granular magma, and is normal in form. Within, however, most radical changes have taken place. The blood-vessels and heart are distended enormously with blood, and the tissues are gorged with round
Fig. 3IIf.—Section of a villus which is invaded and partly destroyed by leucocytes.
cells. Liver, heart wall, intestine and mesenchyme are being destroyed. The precartilage is more sharply defined than in the normal embryo. The spinal cord is dilated, the brain and eye nearly solid and the ear vesicle is destroyed. The ganglia and nerves are disintegrating. The epidermis is partly wanting, and in the head region the skin is studded with numerous papillomata. The face is adherent to the thorax.
Embryo No. 312
Ovum, 25 x 15 x 10 mm. ; embryo, straightened and 8 mm. long.
Dr. Stanton, Albany, N. Y.
“Abortion followed a blow upon the abdomen.” One side of the ovum is very hemorrhagic and the other side thin. The villi are few in number, fibrous, without a syncytial covering and possibly invaded by leucocytes. The main wall of the chorion appears to be necrotic.
Fig. 312.—Solid ovum with embryo hanging from it. Enlarged nearly 2 diameters.
The embryo is straight, showing three gill arches and some myotomes. Its tissues do not stain well, but the spinal cord can still be outlined. The tissues appear to, be infiltrated with round cells.
Embryo No. 316
Embryo, C. R., 44 mm. Dr. Simms, Baltimore. There are peculiar patches upon the skin, the cord is atrophic, feet and hands club-shaped and one hand is adherent to the side of the head. Sections of the cord show that it is fibrous and infiltrated with round cells along the course of the blood-vessels.
Fig. 316a.—Front view of the embryo. Slightly enlarged.
Fig. 316b. Fig. 316c.
Fig. 316b.—Right side. Notice smooth face with eye obliterated and fold of skin under the axilla.
Fig. 316c.—Left side. The eye is nearly closed and the hand has become adherent to the side of the head.
Fig. 316d.——Section of one of the elevations of the skin of the head shown in Fig. 3I6c.
The skin is thickened and much of the epidermis has fallen off. At points the epithelial cells form mounds without any horny changes in them. The muscles, blood-vessels and nerves of the extremities are converted into one fibrous mass composed of spindle-shaped cells, giving much the appearance of myomatous tissue, infiltrated at points with round cells.
The cartilages are still hyaline, richer, however. in cells than is normal. The bone formation is very extensive, which at the border line between it and the cartilage shows peculiar changes in the latter. There is a mass of this changed cartilage in the os calcis without any surrounding bone formation. In general the cartilages are deformed, due no doubt in part to the distorted joints. VVhe1'e the hand is adherent to the side of the head the epidermis of the two is continuous and blended. The skin and subcutaneous tissue are thickened, being composed of one mass of round cells.
The form of the brain and its structure are pretty well preserved, while the tissues of the liver and intestine are necrotic and macerated. It appears as if the growth of. the embryo had been retarded with a continued growth and change in the connective tissues. Then, after its death, the embryo was retained in the uterus for some time. At points all over the body there are thickened spots in the skin which are epithelial in nature, but they are located below the epidermis.
Embryo No. 320
Ovum, 70 x 50 x 40 mm.; embryo, 18 mm.
Dr. Gibbs, Baltimore.
The chorion is fleshy and thick, with irregular spots of villi covering its surface. Some of the villi are fibrous and others are swollen; all are deficient in syncytium. The decidua is not typical, being well filled with fibrin, with occasional masses of leucocytes. Within, the entire chorion is lined by the amnion, which contains no magma. The umbilical cord is
The tissues of the embryo are pretty well dissociated, the cord and brain being nearly solid, with occasional irregular spaces representing the central canal. The outlines of the alimentary canal are obscure and its epithelial lining is nearly lost. The b1ood—vessels are distended with blood in an irregular fashion. The liver is necrotic and free from blood. The tissues of the body are all dissociated, which condition obscures the muscles and nerves and sharpens the outlines of the cartilages. The epidermis is intact.
Fig. 320a. Whole ovum. Natural size.
Fig. 320b. - Embryo within the ovum. x 2 times.
Fig. 320c. — Sagitta1 section of the embryo. X times.
Fig. 320d. — Scction of the chorion and part of the umbilical cord. X 10 times.
Embryo No. 321
Ovum, 40 x 40 x 20 mm.; embryo, 2 mm.
Dr. Wentz, Hanover, Penna.
The ovum is covered entirely with villi and contains some reticular and much granular magma. The whole chorion is lined by the amnion and the embryo is attached to it at its middle. Traces of the central nervous system can still be seen, and in front of it there is a structure which may represent the heart encircled by a large space, the coelom, this extending to the umbilical cord. The tail end of the embryo is nearly solid. A large share of the dissociation may be due to the dilute alchohol (50 per cent) in’ which the embryo had been placed ten days before I got it. This, however, could not alter the general shape of the embryo and its attachment to the chorion.
Fig. 321a.—Photograph of the ovum. X 2 times.
Fig. 321b.—Embryo attached to the chorion. _)< 4 times.
Fig. 32Ic.— Section of the embryo, main wall of the chorion and villi. X 9 times.
Embryo No. 323
Pear—shaped hydatidiform mole, 120 x 90 X 65 mm.
Dr. Van Williams, Baltimore.
The fresh specimen was brought- to the laboratory and was found to be composed of enlarged villi, most of which measure about 5 mm. and a few fully 20 mm. in diameter. On one end the specimen is fibrous, from which the villi extended into a bloody mass.
Fig. 323.—Photograph of the mole. Natural size.
The villi are very irregular in form, the mesoderm being hyaline, in which there are numerous spindle—shaped nuclei. Some of the “large villi” have in them a lumen which has all of the characteristics of the coelom; in fact, it appears as if the main wall of the chorion ramified in all directions with the growth of the villi.‘ One of these openings is I 5 x 10 mm. and another just beside it is 7 x 2 mm. in diameter.
Between the villi there are great masses of necrotic s_vncytial cells. There is more or less blood between the villi and occasionally small masses of leucocytes may be seen. A few of the villi are being invaded by their epithelial coverings.
Embryo No. 324
Ovum, hemorrhagic and fleshy, 45 x 45 x 22 mm. ; embryo, rounded and 3% mm. long.
Professor Brodel, Baltimore.
The walls of the chorion are thin and fibrous and are lined by the amnion. The villi are few in number, fibrous, devoid of syncytium and imbedded in a large quantity of blood. Unfortunately the embryo was lost while being imbedded, but the excellent drawing of it tells pretty well that its tissues and organs are markedly changed and deformed.
Embryo No. 325
Ovum. 55 x 55 x 35 mm.; embryo, C. R., I3 mm.
Dr. Ballard, Baltimore.
“The specimen was obtained from the same woman that gave No. A308. Last menstrual period, September I 5; abortion, November 27, I905. Periods regular monthly.” The specimen was clean, well covered with villi and well hardened in formalin. The amnion and coelom are filled with magma reticulé, in which is embedded the trunk of an embryo attached to the chorion by a thin cord. On the opposite side of the ovum the head is located, also imbedded in magma. Over the body of the embryo there is a greenish-colored nodule 4 mm. in diameter, which proved to be the degenerated umbilical vesicle. The legs are poorly formed and stubby.
Sections of the chorion show that the mseoderm of the villi is hyaline, in which remnants of blood-vessels may be seen, with a normal number of round nuclei scattered through it. The syncytium also appears to be normal. Between the villi some mucus may be seen, in which there are leucocytes. No decidua is attached to the villi.
The cord is thin at its attachment to the chorion, and it is slightly enlarged midway between the chorion and the embryo. Here it contains large mesodermal spaces, which at points are infiltrated with round cells. The umbilical vesicle is present only in outline. Its lumen is partly filled with debris. H0we\'er, some beautiful multipolar mesoderm cells may be seen.
_. cm Collapsed ovum with embryo
Fig. 324a.——Ovum within the distended uterine tube. Natural size. After Kelly.
Fig. 324l).— The embryo attached to the cl1orion. X 7 times. After Kelly.
Fig. 325a.—PIiotog'1'apli of the whole ovum. Natural size.
Fig. 325l).——Body of the embryo within the ovum. Natural size. There is a large amount of magma within the ccnlgm, and the lump of it overhanging the cut edge of the chorion contains the umbilical vesicle.
The epidermis covers the embryo only in part; a shell of granular magma covers the rest of the body. The tissues of the body are greatly dissociated and macerated, which has caused almost complete obliteration of the outlines of the epithelial lining of the alimentary canal. The central nervous system is nearly solid and the large blood-vessels are gorged with blood. The liver is necrotic. The mesodermal tissues
are obscured, with the exception of the cartilages, whose outlines are sharpened.
Embryo No. 328
Embryo, 41/; mm. long.
Dr. Pohlman, Bloomington, Ind.
The chorion extends into irregular fibrous villi, which are covered with a necrotic decidua infiltrated more or less with leucocytes. The main wall of the chorion is about normal in structure and contains numerous blood-vessels. Within the amnion nearly reaches the chorion; the degenerated umbilical cord is attached to the amnion, but not to the chorion. The umbilical vesicle is well imbedded in magma, is very rich in blood-vessels and on its outside has many papilliform
Fig. 328a.-—Embryo attached to the chorion. X 4 times.
processes, some of which seem to blend with the chorion. In fact, it appears as if the blood-vessels of the umbilical vesicle passed directly over into those of the chorion.
The embryo is somewhat deformed, and it is difficult to follow the outlines of some of its viscera. The central nervous system is dilated and is converted into a mass of round cells lying in the mesoderm without any epithelial lining‘: the otic and optic vesicles are likewise filled with round cells. The larger Vessels are filled with blood, and the tissues are fairly well infiltrated with round cells. The epidermis is intact. Dissociation of the tissues has taken place to such a degree that it is difficult to outline all of the organs with certainty.
fin. 328l).—Section of the chorion and adjacent umbilical vesicle. The chorion is hemorrhagic. The walls of the umbilical vesicle are rich in liloorlwcssels, which communicate directly with those of the chorion.
Fig. 33oAa.——Photograph of ovum. Natural size. Fig. 33oAb.—The embryo. Nearly two diameters.
Fig. 33oAc.—Section of the embryo. X 6 times.
Embryo No. 330
330A. Ovum, 60 x 55 x 50 mm.; embryo, C. R., 12 mm. 330B. Ovum, 55 x 50 x 45 mm.; embryo, C. R., 12 mm. Dr. West, Bellaire, Ohio.
“The woman from whom these twin specimens were obtained is about 25 years of age. fifteen months ago she gave birth to an eight-months child, which lived for two days. Her last regular menstrual period took place during the middle of September. The October and November periods were missed. About the middle of December, at her regular time, bleeding began, which continued until January 21, when these two ova were aborted. I am quite positive, but not certain, that woman has syphilis.”
Both ova have smooth surfaces, being‘ composed of‘-thin walls, upon which there are occasional villi. In both specimens the villi are imbedded in a mass of pus, in which may be found irregular villi, much necrotic syncytium, fibrin and blood. Many leucocytes are found in the mesoderm of the villi. The main wall of the chorion and the amnion of both specimens are of irregular thickness and are well blended with each other.
The changes in the two embryos are very similar. In both the epidermis is intact and the dermis is thickened. In front of the head in the region of the deformed mouth there are peculiar thickenings of the epidermis. Both spinal cords are markedly dissociated. The dissociation of the brains is so extensive that in consequence the cerebral vesicles and midbrains are nearly destroyed and the hind-brains occupy spaces in the centers of the deformed heads.
The large vessels and heart are gorged with blood. In B the wall of the ventricle is well infiltrated and in A nearly destroyed by the migrating cells. The outlines of the organs and tissues are very obscure, the whole being more or less filled with round cells. Some of the liver tissue is necrotic.
Embryo No. 334
fleshy mole, 50 x 40 x 30 mm. ; embryo, 5 mm. Dr. Merrill, Stillwater. Minn.
Fig. 33oBb. Fig. 33oBa.
Fig. 33oBa.—The ovum. Natural size. Fig. 33oBb.—The embryo. Nearly two diameters.
Fig. 33oBc.——Sa,r- All section of the embryo. X 6 times.
“Last period four weeks ago. About ten days ago some bleeding, which repeated itself at intervals, and was finally followed by the abortion.”
Examination of the mass proves that it is made up mostly of uterine mucous membrane, clecidua, blood and pus, and contains a cavity 15 mm. in diameter. The chorion can still be made out as a fibrous band, infiltrated on the outside with leucocytes, and on the inside with small masses of syncytial cells. At points the chorion forms branches, which ramify partly through the mole. These are accompanied with syncytial cells and leucocytes.
The embryo is pretty well destroyed, of the five—weeks stage, and infiltrated with round cells. The head and back
have fallen off, leaving only the viscera attached to the umbilical cord.
Embryo No. 336
Ovum, 35 x 25 x I5 1nm.; embryo, 8 mm.
Dr. West, Bellaire, Ohio.
The ovum is smooth, one end being covered with welldeveloped villi. Their mesoderm is hyaline, with scattered nuclei containing some remains of blood-vessels. The main wall of the chorion is fibrous and infiltrated with blood-cells from the embryo. Within there is a cavity (I5 x I0 mm.) filled with granular magma and containing the umbilical vesicle and the embryo, which is closely encircled by the amnion.
The embryo is somewhat distorted, with large blood-vessels filled with blood and tissues infiltrated with rounds cells. The muscle wall of the ventricle of the heart is normal in appearance and there is every evidence that it kept beating until the last. VVhat is especially noteworthy is that the circulation with the chorion has been cut off, the cord being atrophic and infiltrated, but instead the large omphelo—mesenteric vessels are filled with blood and spread over the yolk sac. The walls of this, however, are necrotic.
Fig. 336.—Section of the deformed embryo. X 12 times. The mass attqclltcd to the exterior of the amnion is a portion of the umbilical Vesicle.
Embryo No. 338
Ovum, 45 x 45 mm.; embryo, C. R., 18 mm.
Professor Minot, Boston.
The specimen is from a patient suffering with arteriosclerosis, who died of cerebral apoplexy in the Boston City Hospital. ‘Pregnancy said to be of from six to eight weeks duration.
Fig. 338a.—Photograph of the specimen. X 2 times.
The chorion is normal in appearance and in structure. The cord of the embryo shows a marked constriction, which in sections appears to be fibrous. The embryo in general is normal in appearance, with the blood-vessels well distended with blood. The central nervous system is dissociated and somewhat macerated. The wall of the heart ventricle is also dissociated, that is, it is infiltrated with round cells.
Fig. 339.—1'-‘liotograph of the embryo. X 2 times.
Embryo No. 339
Chorion, 50 x 30 x 30 mm; embryo, C. R., 16 mm.
Professor Minot, Boston.
The chorion is thin, is covered by but few villi and is hemorrhagic on one end. In structure it is somewhat hyaline at points and at others somewhat fibrous. The cord is thickened and also fibrous. The walls of its blood-vessels are dissociated and the blood from them is infiltrating the surrounding tissues. The embryo is somewhat distorted but normal in form.» Within the tissues are dissociated and macerated. The large blood-vessels are distended with blood, and within the liver and heart the blood cells from them have extended into the surrounding tissues.
Embryo No. 340
Stumpy embryo, 6 mm. long.
The embryo is well infiltrated with round cells, and the dissociation of the tissues is quite complete. Large blood-vessels can still be outlined, and the central nervous system is practically solid.
Fig. 34o.——Sagitta1 section of the embryo. )< 17 times.
Embryo No. 341
Ovum, 70 x 60 x 50 mm.; embryo, I4 1nm.
The ovum is pear-shaped and smooth, being covered with some decidua and at points with hemorrhagic masses. Its tissue does not stain well, but it appears as if some of the villi were fibrous and others oedematous. There is not much syncytium present. Possibly there are masses of leucocytes in the decidua.
Within there are two stumpy embryos, both of which have dilated cords which come to a point where they are attached to the chorion. These dilatations show the usual mucoid changes, with cavity formation. The embryos are dissociated and macerated. The large blood—vessels are filled with blood, and it appears as if the migrating cells had infiltrated much of the tissues.
Fig. 341a.-—Photograph of the ovum.
The twin embryos.
Nearly two dian1cI;ers.
Fig. 34Ic.—Curious invagination of the epidermis on top of the head of one of the embryos.
Embryo No. 342
Ovum, 30 x 20 x 20 mm.; pedicle within, 5 x I mm.
The specimen is from a tubal pregnancy and has a very thin fibrous chorion, with traces of blood-vessels, and is practically without villi. VVithin there is a thickened fibrous
Fig. 342.——ChoriOn, amnion, cord and remnant of the embryo. X 15 times.
amnion, to which the process, the umbilical cord, is attached. The cord is also fibrous, contains remnants of its blood—vessels and has attached at its free end a curious group of round cells, which probably represents what remains of the embryo.
Embryo No. 343
Ovum, 55 x 45 x 35 mm.; embryo, II mm.
The chorion is of unequal thickness and mostly smooth. Sections show that not only is the decidua attached to it, but also portions of the uterus. The (leciclua is necrotic and infiltrated with numerous leucocytes. Below the (lecidua there are distorted villi with fibrous mesoderin. The amnion is in contact with the chorion. Between the villi there is a stringy mucoid mass rich in leucocytes.
Fig. 343a.—-Photograph of the embryo attached to the choriou. X 2 times.
F10. 343b.—-Suction of the embryo. X 8 lilncs. 3,32 M.-~‘I.I.L. [VoL. XIX.
Fig. 3_13c.—1"hot0graph of :1 section of the chorion, showing the mucoid muss infiltrated with lcucocyles l>ct\\‘ccn the villi.
Fig. 343d.—Scction of the point of juncture of cord, amnion, chorion, villi and decidua. >< about 20 times.
The stumpy embryo is attached by means of a fibrous umbilical cord. Its tissues are dissociated and infiltrated with round cells; the blood-vessels and heart are greatly distended with blood. The liver is necrotic. In front of the head the tissue is broken away, leaving a pocket which contained the fore-brain. Above this the brain protrudes. The cord and fourth ventricle are distended and dissociated. The epidermis is intact.
Embryo No. 344
Ovum, 45 x 45 x 45 111111.; embryo, C.R., I6 nnn.
The wall of the chorion is very thin, with a few fibrous villi scatterecl over it. It contains no blood—vessels. The long thin umbilicali cowl is fibrous and shows 1'cmn:1nl's of blood-vessels.
The embryo has :1 roumlcd liead and stumpy legs. Its tissues are dissociated, the brain being distended and macerated, too. The medulla has expanded towards the mouth. Heart and blood-vessels are distended and in many places the walls are destroyed and the blood cells extend into the surrounding tissues. This is very marked in the liver. The legs are filled with an even mass of round cells, 1'. e., the tissues are dissociated. Some of the epidermis has fallen off.
Fig. 344.——Pl1otog'rz1ph of the embryo attached to the chorion. X 2 times.
Embryo No. 345
Ovum, 60 x 50 x 50 mm.; embryo, 19 mm.
The fleshy ovum is composed largely of r.leci<lu2l, in which are buried plugs of mucus, pus and necrotic villi of the chorion. The embryo is normal in shape. The tissues of the embryo are macerated, but on account of the distended medulla which encroaches upon the mouth I think it likely that the tissues were dissociated before they became macerated.
Embryo No. 346
Embryo, C. R., I 3 mm. Professor Minot. A piece of hemorrhagic chorion, which may have been 50 mm. in diameter, is attached to the embryo. Its tissues are macerated, but they are well enough preserved to show that much mucus and pus are between some of the villi. The
Fig. 346.——E'mbryo attached to the ovum. X 2 times.
structures of the chorion, amnion and cord appear normal, but the umbilical vesicle is filled with a necrotic mass.
The embryo is dissociated and macerated, The central nervous system is dilated and the heart is distended with blood, some of which infiltrates the surrounding tissues.
Embryo No. 347
Ovum, 40 x 35 x 30 mm. ; embryo, C. R., II mm. If the head is replaced the C. R. measurement will be less than 8 mm.
The decidua is hemorrhagic and necrotic at points and well infiltrated with leucocytes. The villi and main walls of the
Fig. 347.—Ernbry0 within the chorion. X 2 times.
chorion are fibrous and at points infiltrated with leucocytes. Very little syncytium is present, and but few traces of bloodvessels are found in the chorion.
The embryo is dissociated and macerated, with dilatation of the central nervous system and extension of the medulla. The blood-vessels are distended and the blood cells are continued through their walls into the surrounding tissues.
Embryo No. 348
Ovum, 50 x 30 x 25 mm.; embryo, 12 mm.
Dr. Pearce, Albany, N. Y.
The specimen is smooth, being covered with numerous small hemorrhagic spots and irregular masses of small villi. Sections show that the decidua is infiltrated with leucocytes, with a consequent fibrous degeneration of the villi of the chorion. The villi, as well as the main wall of the chorion, are being invaded by leucocytes and frequently by syncytial cells.
The dissociation of the tissues of the embryo is extreme, the blood from the l)loo(l-vessels having passed throughtheir walls to infiltrate the surrounding tissues. This is especially well marked in the heart and liver. The nervous system is pretty well broken up and the epidermis has fallen off.
Embryo No. 357
Ovum, 90 x 40 x 40 mm.; embryo, C. R., 17 mm.
Dr. Russell, Baltimore.
“The specimen came from an unmarried woman twenty two years old, who said that she was glad it had come away,
Fig. 357.— Embryo within the chorion. Natural size.
for it saved her the trouble of having an abortion induced. Her menstruation was irregular, sometimes every two weeks, sometimes every six weeks. The last period occurred about the middle of January. On March 29 she began to bleed and aborted on April I9. Apparently her uterus is normal.”
The unruptured specimen is inclosed in a layer of decidua and is covered with villi of unequal size, some being very large, as the photograph shows. Within there is a stumpy embryo without a neck and with atrophic leg buds. The cord is transparent and partly filled with granules, which indicates that the embryo had been dead for some time before the abortion.
The mesoderm of the chorion and amnion is thickened, of even-structure, and contains no blood-vessels. In fact, its coelomic cavity is entirely obliterated. The main wall of the chorion is very thin, often being composed of epithelial cells only. The mesoderm of the villi is unusually fibrous and contains no blood-vessels. The very large villi are degenerated, often hollow and do not stain. The syncytium is very deficient in quantity; at points it invades the mesoderm. Over the villi there is a mass of fibrin and disintegrated blood. Leucocytes are not numerous, even in the decidua, which appears to be normal.
The tissues of the embryo are not only dissociated, but also macerated, and they do not stain well. The sharp boundaries are lacking, showing that adjacent tissues have begun to coalesce. In fact, the whole head down to the thorax seems to have been converted into a bag in which fragments of cartilage and nerve tissue may be seen. The front of the head is adherent to the thorax immediately over the heart. The contours of the cartilages, liver, heart and adrenal can be made out, but those of the blood-vessels are obscure.
According to the menstrual history this embryo was in the seventh week when bleeding began, which was followed by the abortion three weeks later. However, the degree of the development of the cartilages and other structures places the embryo in the sixth week. The lack of inflammatory reaction, and the inactivity of the syncytium. suggests that the continued bleeding may have been the primary difficulty, which was followed by death and degeneration of the embryo. No. 1.] ORIGIN 01? IIUMAN MONSTERS. 339
Embryo No. 358
Ovum, 30 x 16 x IO mm.
Dr. Swett, Bangor, Me.
“Pregnancy of six weeks duration.’ The outer surface of the ovum is smooth and the specimen runs out into a pedicle which was undoubtedly attached to the uterus. Sections show that the villi are matted together, with much blood and syncytium between them. Around this there is a fibrous decidua in which there are many leucocytes. The mesoderm of the chorion is somewhat fibrous, the change being especially well marked in some of the villi. No blood-vessels are present in the villi.
The cavity within (coelom) measures 8 x 6 x 6 mm., is lined by a layer of reticular magma, but contains no trace of the amnion nor embryo.
Embryo No. 361
Ovum, 10 mm. in diameter.
Dr. Egbert, Washington.
“The ovum was found in a mass of blood Within the abdominal cavity, clue to a tubal abortion. The operation was performed just 41 days after the beginning of the last menstrual period.”
The specimen came into my hands after it had been in water for 24 hours. It was well covered with villi and filled with a mass of dense reticular and granular magma. No embryo could be found by direct observation. The specimen was macerated too much to allow careful microscopic examination.
Embryo No. 364
Ovum, 90 x 50 x 40 mm.; embryo, 16 mm.
Dr. Merrill, Stillwater, Minn.
The ovum is covered with a few ragged villi, over which there is some decidua which is more or less detached. Dr. Merrill had placed the specimen in formalin and sent it to me accompanied with the following letter, dated July 6, 1906:
“Yesterday I sent another specimen by express. It seemed to me that it would be a good specimen for you. April 7 was the date of the last menstruation; the abortion followed on July 5, I906. The first flow and pain appeared on the night of July 4. The woman has been married four years; this was her first conception. Both she and her husband are very anxious to have a child, so the miscarriage could not have been aided. There was no incident, accident or otherwise to give cause for the abortion. The woman is unusually healthy and the miscarriage took place without chill or rise of temperature. The specimen was placed in formalin, 10 per cent, within two hours after its expulsion.”
Fig. 364a.—The ovum. Natural size.
This history did not satisfy me, so I wrote Dr. Merrill asking a number of questions, for it is from specimens like this that we may hope to find the cause for such malformations. His second letter, dated October 24, 1906, reads as follows: “This specimen is from the first conception, after several years of married life. The woman had been operated upon several years ago for appendicitis. She has not been altogether regular with her menstrual periods, and there is some pain connected with them. She had been treated, some time before I saw her, for vaginal discharge; there may have been endometritis. Prior to her conception I gave her some treatment for leucorrhoeal discharge, also made some slight dilatation of the cervix. She had a long cervical OS with a narrow canal. There was some vaginitis and, as I remember, some endocervicitis rather than endometritis; none of them very marked. Probably there was enough uterine trouble to cause the delayed development of the embryo and the abortion. It was a natural abortion, as the woman was very anxious to have a child. She is what I call a perfectly healthy woman compared with the average woman of the day. The husband is ordinarily healthy, but about a year ago. his wife states, he had some trouble with his genital apparatus. He has night emissions and I judge took medicine for them. As far as I can ascertain, from her outline, he has not had a venereal disease. If so, he did not contaminate her. If he has, as she states, night emissions, perhaps the virility of his semen is below par.”
Fig. 364b. — Front view. X 3 times.
Fig. 364C. - Right side. X 3 times.
Fig. 364d. — Left side. X 3 times.
Fig. 364e.—Section to the left of the middle line.
Fig. 364f.-—Section near the middle line.
These letters give the difficulties in obtaining histories i11 these cases, but they indicate that the cause of the change in the embryo is to be sought in the chorion, which probably failed to attach itself well to the uterus.
Fig. 364g.—Sagittal section.
Fig. 364h.~Section through the villi, showing large amount of mucoid substaiicc rich in Iencocytes between them.
Sections of the chorion show that the villi are far more numerous than was suspected from the simple inspection with the naked eye. The main wall of the chorion is thin and atrophic and is lined with the amnion, which is fully detached where it connects with the umbilical cord. However, it must have been attached at one time, for remnants of blood-vessels from the embryo are seen in the villi of the chorion. The mesoderm of the villi is very fibrous and the villi are matted together by a slimy mass rich in blood and leucocytes with fragmented nuclei. The syncytium is well developed and extends into the mass of blood and slime. The decidua over the chorion has large sinuses within its walls, is quite hemorrhagic and at points has large islands of leucocytes, usually situated along the course of the blood-vessels.
The photographs show the condition of the embryo. Harelip, displaced ears, protruding viscera in front and spina bifida behind. The large blood-vessels and heart are still filled with blood and there is quite 21 general infiltration of the tissues with round cells. The vessels of the embryo end in the cord and do not reach to the chorion. In general, there is mainly a destruction of the tissues due to the irregular growth of the embryo.
The central nervous system has been converted, in great part, into a mass of connective tissue, with remnants of the cord below and a rudimentary brain above, which forms a shield upon the protruding mass. A portion of this shield has grown into the connective tissue below, forming a gland-like structure.
The clavicle, mandible and maxilla have begun to ossify and some of the muscles are well developed.
Embryo No. 365
Embryo, I4 mm.
Professor Pohlman, Bloomington, Ind. This embryo, with spina bifida, iniencephaly and auencephalus, and extremities of normal form, has a straight body and is attached to the end of a very large umbilical cord. Sections show that the spinal cord is absent, but there is a solidified brain which is more or less infiltrated with round cells at its periphery. The same is the case with the eyes. The mouth is closed by the tongue,‘ which has become adherent to the lips. The nodules in front of the body are composed of necrotic epithelial cells.
Fig. 365a. — Front view of the embryo. X 2 times.
Fig. 365b. — Section through the middle line of the head. X 6 times.
Fig. 365d. — Section through the hand.
Some of the tissues of the body are necrotic, but most of them are infiltrated with round cells, and those of the head are quite fibrous in character.
The walls of the alimentary canal and the lungs are also pretty well filled with irregular patches of round cells. Especially well marked is this change in the region of tendons and perichondrium, showing that there is an irregular growth of the mesodermal tissues. The clavicle, maxilla and mandible
are well ossified, which should not be the case in so small an embryo.
Embryo No. 366
Embryo, 9 mm.
Professor Pohlman, Bloomington, Ind.
Sections of the chorion, which is fleshy in appearance, show that its main wall is very thin and that it is lined with the amnion. The villi, few in number, are fibrous or hyaline, are covered with some syncytium, and the spaces between them are filled with blood. Some of the villi adhere by means of the syncytium to the decidua, which is fibrous and necrotic. There is no leucocyte infiltration of the chorion nor the decidua.
The embryo is pretty well infiltrated with round cells and the tissues are dissociated. The tissues are well preserved and appear to have been very much alive. There is a considerable quantity of blood within the cavity of the heart and in the blood-vessels. The central nervous system is dissociated. The lower jaw is large and is adherent to the head above and to the trunk below. The arms and legs are atrophic.
Fig. 366a.—Sagittal section of the embryo. X 10 times.
Fig. 366b.—Section of a villus. X 250 times. Notice large epithelial cells scattered in with the stroma.
Embryo No. 367
Ovum, I0 x 7 x 5 mm.
Professor Brodel, Baltimore.
The ovum from a tubal pregnancy came to me unopened and with some adhering cells and blood clot it was cut into serial sections. The chorion was found to be torn on one side, but its interior is packed with a dense reticular magma. No trace of an embryo was found.
Fig. 367a.—Ovary and tube, clot within and ovum. Natural size.
The mesoderm of the main wall of the chorion is of normal thickness, but on the side towards the coelom it is not sharply defined. Frequently strands of cells are found partly separated and running out into the magma. The tissue of the mesoderm of the villi is not as clearly defined as in normal specimens, some of them having undergone marked degeneration. The villi are developed better on one side of the chorion than on the other, and here they contain structures which are undoubtedly blood-vessels.
Fig. 367b. — Section of a portion of a villus as indicated by the adjoined outline, V. X 250 times. E, epithelial covering; M, mesoderm; 3, space within formed by a destruction of tissues.
Fig. 367c. — Outline of a villus showing the portion from which Fig. 367b was drawn.
The syncitium is not very marked and is held together by a slimy mass which contains some leucocytes. The surrounding tissue, the “decidua,” is full of fibrin and contains numerous fragmented nuclei and some blood.
It is natural to read into this specimen the following history: The embryonic mass grew long enough to send its blood-vessels into the chorion and then the nutrition was cut off because the villi did not attach themselves properly. That this was the case is shown by the capsule of necrotic tissue which encircles the villi. As a result of impaired nutrition the embryo was destroyed, leaving only the isolated chorion filled with reticular magma.
Embryo No. 369
Ovum, 7 x 3 x 3 mm.
Professor Brodel, Baltimore.
The specimen was removed by operation from a tubal pregnancy on October 9, I906. The woman's last period began September 17. The distended tube measured 25 mm. in diameter and when cut open a small lump, 2 mm. in diameter, was seen on one side of its cavity. This was believed to be the embryo, but serial sections proved it to be a small mass of blood very rich in leucocytes.
The sections show the chorion pretty well folded upon itself, which is torn at several points. The torn edges are well rounded, that is, they are healed and are therefore not due to the operation. Few villi are left, and they, with the main walls of the chorion, are very fibrous in structure. There is but little syncytium present. The entire chorion is separated from the wall of the tube by a thick layer of blood, and the tube wall is well infiltrated with leucocytes. What is most remarkable in this specimen is that the amnion lines the chorion completely and all of the mesoderm of the chorion is well filled with blood—vessels from the embryonic mass, which must have been present at one time.
Embryo No. 375
Embryo, C. R., 13 mm.
Professor Gage, Ithaca, N. Y.
A piece of chorion accompanied the embryo, both of which appear quite normal. However, sections of the chorion show that the mesoderm of the villi is very fibrous, while that of its main wall appears normal. The syncytium seems to be deficient in quantity.
Sections of the embryo indicate that it is nearly normal, with some dissociation of the tissues. The larger blood—vessels are gorged with blood, and some of the tissues, especially those in front of the head, are infiltrated with round cells. The central nervous system is swollen and dissociated, as is so frequently the case in many of the other embryos.
Embryo No. 377a
Ovum, 3?) X 22 x 14 mm.
Dr. Crawford, Cedar Rapids, Iowa.
The specimen is well covered with villi, which appear quite normal to the naked eye, but upon microscopic examination it is found that they are very fibrous and tipped with syncytium; at points it forms islands with necrotic centers.
The interior of the ovum contains a considerable amount of reticular magma, within which there is embedded a large sac (5 mm. in diameter) containing a nodule (.5 mm. in diameter ) —the embryo.
Sections show that the whole chorion is lined with the amnion except at the point of the “inclosed sac,” which proves to be the exocoelom. The embryo is composed of an amorphous mass of cells which invade the mesoderm of the chorion. It may represent the last remnant of the umbilical vesicle. No traces of blood—vessels are seen in any portion of the embryonic mass, nor in the mesoderm of the chorion.
Embryo No. 378
Ovum, 12 mm. in diameter.
Professor Brodel, Baltimore.
The specimen came from a tubal pregnancy, is dumb—bell shaped, and had been opened by Professor Brodel, who found no trace of an embryo in it. It was hardened immediately and later cut into serial sections. At no point in the sections could any trace of an embryo be found, although it is possible, but improbable, that it was lost while the fresh specimen was being examined.
Fig. 378.—Outline of the tube, blood clot and ovum. Natural size.
The coelom contains some granular magma. The mesoderm of the main wall of the chorion is apparently normal, but that of the villi is oedematous. There are no blood-vessels present. At many points the syncytium is necrotic, frequently rising from the villi, leaving small vesicles below. The necrotic masses are held together by a slimy mass, within which there are a great many small round cells, undoubtedly leucocytes.
Embryo No. 379
Ovum, 35 x 25 x 15 mm.
Dr. Meyer, Baltimore.
“Last period early in August; abortion, October 20, 1906.”
The specimen is well covered with villi and filled with a considerable amount of reticular magma. Within there is a sac, the amnion, measuring 10 mm. in diameter. It contained a granular mass, which, when floated from alcohol into water, took on the form of an embryo of the fourth week.
Fig. 379. — Section of a portion of a villus. X 250 times. The synctium, S, is invading the mesoderm of the villus.
No internal structures could be seen and in handling the embryo it fell into pieces. No doubt the embryo had been dead for some time.
Sections show that the mesoderm of the umbilical cord, main wall of the chorion and the villi are fibrous, with a curious growth of the blood-vessels in some places. Within them there are numerous fragmented cells, which may have come from the blood "of the embryo. The syncytium is very extensive, necrotic at points and is not infiltrated with leucocytes. In many places it dips deep into the mesoderm of the villi and forms islands of epithelial nests. The wall of the amnion is composed of two layers of cells and appears to be normal.
Embryo No. 395
Ovum and decidua, measuring 17 x 10 x 7 mm.
Dr. Pearce, Albany, N. Y.
Dr. Pearce writes: “I am sending you to—day a small encapsulated mass, found among curettage material, which appears to be a young ovum. I have refrained from attempting to determine definitely whether or not it contains an embryo, for fear of injuring a specimen which might be of value to you.
“The specimen was removed April 20, 1907, six weeks after the last menstruation. The uterus was emptied because the patient had eclampsia three years ago, and since then has had premature delivery of two dead children. The specimen is preserved in 10 per cent formalin.”
The whole mass was stained in cochineal and cut into serial sections, but no embryo was found in it. The sections show it to be composed of numerous villi, decidua and inflammatory tissue. Most of the villi are also fibrous and degenerated, some few, however, contain blood—vessels filled with embryo’s blood. The fragmentary walls of the chorion are very fibrous and the growth of the syncytium is very irregular. Undoubtedly the ovum “collapsed” some days before the uterus was scraped. The whole specimen is buried more or less in a slimy mass rich in leucocytes, which indicates that the uterine tissue was markedly inflamed.
Embryo No. 396
Embryo No. 398
Embryo No. 399
Embryo, 4 mm. long.
Dr. Thompson, Mt. Horeb, Wis. Bardeen Collection.
“The specimen is from a woman twenty years old who has been married ten months. She is a marked bleeder, otherwise strong and healthy. The pelvic organs are normal. The last period occurred during the first week in September and the abortion followed October 9, I906.”
Fig. 399.——External form of the embryo. X 8 times.
The external form looks much like that of a chick. Sections show that the tissues are generally dissociated and also macerated.
Embryo No. 400
Embryo No. 401
Embryo, 5.5 mm. long.
Dr. Hay. Bardeen Collection.
Much of the chorion and many of the villi and the syncytium are necrotic and infiltrated with many leucocytes. The tissues of the embryo are dissociated, maccrated and infiltrated with round cells. However, all of the organs are recognizable. The umbilical vesicle is necrotic and filled with a mass of broken—down cells.
Embryo No. 402
Ovum, 40 x 25 x 20 mm.; embryo, 4 mm. long.
Dr. O’Shaughnessy, New Canaan, Conn.
“The woman, age 30, from whom the specimen was obtained is well built, strong and healthy. Menstruated regularly, but was married 31/2 years before she became pregnant. After the birth of this child she had a slight discharge and was attended by a physician, who stated that she had an ulcerated cervix, for which he made local applications. Shortly after this, two years after her first confinement, she became pregnant again. This confinement, which was attended by me, was rapid and normal in every respect. She remained in bed for I 5 days, the uterus not reducing in size as it should normally.
“Since the second child was born she has had some discharge, but became pregnant again about six or eight weeks ago. This time, however, she aborted. She has never done anything to prevent pregnancy, and both she and her husband are anxious to have a large family. The patient is at present unwell. and still has her chronic discharge.”
The villi of the ovum are not well developed, being irregularly distributed over its surface. Within, the coelom is well filled with reticular magma. The embryo is club-shaped, its head being much too large for the body, the external form being very much like that of No. 399. The umbilical vesicle is of normal size and shape, the' heart is well outlined and the extremities are just beginning to develop.
Mall FP. A study of the causes underlying the origin of human monsters. (1908) J Morphol. 19: 3-368.
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