CHAPTER XVII. 



CHANGES SUGGESTIVE OF LUES. 



Since Schaudin's discovery, attention naturally has been directed very largely 

 from placental lesions of syphilis to the presence of spirochsetse. But unfortunately 

 the hope that the presence of this organism would form not only a crucial but also 

 an infallible criterion for the determination of fetal lues does not seem to have 

 been realized. The search for spirochsetee seems to have been attended by such 

 uncertain results that a routine examination of the placenta has not even been 

 recommended by prominent obstetricians. Slemons (1917 b ), for example, stated 

 that the presence of spirochseta? in the placenta can be demonstrated in only 

 about one-third of the cases of lues, and Mracek (1903) found no histologic evi- 

 dence of lues in 82 out of 160 placentae from syphilitic women. Slemons found 

 the examination of stained sections more satisfactory than a gross examination of 

 the villi, and stated that a proliferative inflammation of the vessels in the terminal 

 villi constitutes the beginning change in lues. The lumina are said to become 

 obliterated, the connective tissue of the villi increased, and the villous epithelium 

 not only proliferates, but also invades the stroma. 



Some uncertainty still seems to attach to the use of the Wassermann test, for 

 Williams (1917) emphasized that lues may develop in an infant even when this 

 test applied to the mother was found negative at the time of its birth. As stated 

 by Williams, others also have observed the contrary condition of a positive Was- 

 sermann in the newborn, later becoming negative spontaneously. Slemons, how- 

 ever, found the Wassermann reaction and the placental histology to coincide in 

 95 per cent of 345 cases, and in 99 per cent even, if misleading cases of toxemia of 

 pregnancy were first excluded. Lues was present in 10 of the 345 cases examined 

 by Slemons, who emphasized the fact that areas in which the structure of the 

 placenta is normal may be present. From these things it seems that, regarding 

 the existence of lues in early specimens, one is thrown back again upon the old ques- 

 tion whether fetal lues in its early stages is characterized by any lesion or by any 

 group of lesions which can be regarded as pathognomonic. Since it is recognized 

 that the existence of maternal lues does not necessarily imply its existence in the 

 fetus, the importance of independent criteria regarding its existence in the fetus 

 becomes much greater. This is true in spite of the fact that belief in the trans- 

 mission of paternal lues direct to the offspring without infection of the mother 

 now seems to be quite generally abandoned. This was inevitable as soon as the 

 cause of lues became known. 



Even in this day there seems to be no agreement upon what constitutes valid 

 histologic evidence of the existence of fetal lues, but the opinion that recurring 

 abortion of a macerated fetus, in the absence of other causes, is strongly indicative 

 of lues seems to be held quite generally. It was the belief of obstetricians and 

 gynecologists that abortion or premature labor occurred in a large percentage of 

 cases in which maternal lues antedated conception by several years. Seitz (1904 a ) 



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