. American journal of obstetrics and gynecology. which is usually compressed and collapsed, as is shown in the cross 74 THE AMERICAN JOURNAL OP OBSTETRICS AND GYNECOLOGY sections of the early tubal pre^iancy (Fig. 1). In this case, the womanhad the first symptoms of pain the day before the operation, althoughshe passed her menstrual time by six days. The first pains were colickyand not severe. The intramural extravasation is well shown with thetubal lumen pushed to one side and the lumen everxwhere intact. Thehemorrhage was seen microscopically to be within the muscular coatsof the tube wall a
. American journal of obstetrics and gynecology. which is usually compressed and collapsed, as is shown in the cross 74 THE AMERICAN JOURNAL OP OBSTETRICS AND GYNECOLOGY sections of the early tubal pre^iancy (Fig. 1). In this case, the womanhad the first symptoms of pain the day before the operation, althoughshe passed her menstrual time by six days. The first pains were colickyand not severe. The intramural extravasation is well shown with thetubal lumen pushed to one side and the lumen everxwhere intact. Thehemorrhage was seen microscopically to be within the muscular coatsof the tube wall and outside the The muscular coats wereapparently not only separated bj the pregnancy, but also by the forceof the hemorrhage which found a line of cleavage between the coatsalready altered by the proteolytic ferment of the o^nim. The bloodnot only occupies the space between the distended and separated coatsof muscle, l)ut also occupies the place of muscle that has been de-stroyed. No hlddil had ])assc(l the fnnbi-ial etid of the tul) Fig:. 2.—Microscopic drawing from unruptured case, sliowing hemorrhage (black)separating the outer longitudinal coat from the inner (right) muscular coat. The canal, itself, in Iaily tubal pn>giiancv usually comj), asmay be seen from the cross sections, which were made from the paraffinblocks. In this ease, it would be difficult for this tubal pregnancy torupture by mechanical force into the collapsed tubal lumen. The tubelumen in tubal pregnancy is not a hollow viscus to be burst into, butit is closed or compressed. In these cross sections, it may be seen thatthe iiemorrhage goes all around the tube lumen without perforating the canal is perforated, it is by destruction of the tube wall fromwithout inwards by the corrosive action of the trophoblast. The dis-section apart of the tube walls seems to be due not only to the force ofthe hemorrhage, but also to the preliminary weakening of the line ofcleavage between
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