1534 .STUDIES ON PATHOLOGIC OVA. 



credited Lutowski as finding that such a result inevitably followed, and himself 

 found gestation interrupted in 91.6 per cent of such cases. Seitz classified 50 

 per cent of these interruptions of gestation as premature, 16.6 per cent as immature, 

 and 21 per cent as abortions. Fuoss (1888) also quoted Ruge as saying that the 

 fetus is still-born in 80 per cent of the cases of lues. The number of cases in which 

 children which were born prematurely, but living, died soon after birth, is also 

 surprisingly large in the series of Thomsen (1905), in spite of recourse to anti-luetic 

 treatment, and Siemens (1916) reported that all luetic children among 17 which 

 were prematurely born died. 



Thomsen found that lues could be excluded with considerable certainty in 

 only 11 out of 27 controlled cases which had given birth to macerated fetuses. 

 But more important still is the fact revealed by examination of Thomson's pro- 

 tocols, that 24 out of 27 still-born fetuses of luetic mothers were macerated. It 

 should be added, however, that no evidence of the existence of lues was present 

 in 8 of these 24 macerated fetuses. Premature labor occurred in only 62 per cent 

 of Thomson's series of luetic mothers, as compared with 91 per cent in that of 

 Seitz, and 100 per cent in the series of Lutowski. However, Urfey (1901) cautioned 

 against the assumption that repeated abortion in the later months of pregnancy 

 always is due to lues, and held that a non-specific chronic endometritis is not 

 infrequently the cause. This indeed seems highly probable when considering the 

 marked changes which may be produced in the decidua by chronic inflammation. 

 Unfortunately, Thomson's protocols do not state whether the evidence of lues 

 was based on gross or upon microscopic examination or upon both. This is espe- 

 cially regrettable, because this series included cases which bore no gross but only 

 microscopic evidence of the existence of lues. 



The foregoing statement abundantly emphasizes the lack of correlation existing 

 between the effects of lues upon the life of the conceptuses and the continuation of 

 the gestation and the histologic and bacteriologic evidences contained in the con- 

 ceptus. If neither spirochaetse nor characteristic histologic changes can be found 

 in many of these prematurely born and macerated, luetic conceptuses, then one 

 would seem to be compelled to assume not only that death of the conceptus is due 

 to the influence of toxins, but that toxins may cause its death without producing 

 any recognizable structural change in either placenta or fetus. The use of anti- 

 luetic treatment may be responsible for the differences in the varying frequency 

 with which luetic mothers give birth to luetic babies, and it is possible that the 

 use of antiluetic treatment may affect the time of appearance of fetal lesions. 

 Surely, a chronic systemic disease, which is believed almost invariably to cause 

 the death of the conceptus and premature birth, especially after the sixth month 

 of gestation, can scarcely be presumed to produce no structural fetal changes 

 whatsoever before this time. This would seem to be possible only if the maturing 

 fetus showed a decidedly diminishing resistance, both to the luetic disturbances 

 and to infection. 



How early luetic lesions may appear in the fetus has been especially considered 

 by Engman (1912), who thinks that many placental lesions which have been 



