CHANGES SUGGESTIVE OF LUES. 335 



referred to lues probably may not be such. This opinion was expressed also by 

 Williams (1917), and Thomsen called attention to the fact that luetic changes in 

 the fetal organs, so common in the seventh to the tenth month, are exceptional 

 in the first 6 months of gestation. But it is well to remember in this connection the 

 caution of Mracek (1903) that cases of abortion occurring in the third and fourth, 

 and especially in still earlier months, usually do not come to hospitals for treat- 

 ment, and that observations on the placental lesions in lues hence have been made 

 very largely upon material from the seventh and eighth months. Mracek found 

 luetic placental lesions as early as the fifth month, and Siemens (1916) slightly 

 earlier than this. Since 10 of the placentae in a series of 78 examined by Mracek 

 weighed from 200 to 300 grams, it is evident from this fact alone that he dealt 

 with some rather early cases of gestation. In a routine examination of 400 pla- 

 centae, Slemons found luetic lesions present in 6 out of 17 premature deliveries 

 in which the fetus had a length of 30 to 40 cm. and a weight of 1,000 to 2,000 

 grams. Since fetuses in the Carnegie Collection with a length of 30 to 40 cm. 

 have an age of approximately 34 weeks, and those weighing 1,000 to 2,000 grams 

 an age of 28 to 35 Y^ weeks, it is evident that the weight of these luetic fetuses ex- 

 amined by Slemons was relatively low, as might be expected. 



The appearance of fetal luetic lesions may depend upon many factors, and 

 Thomsen's observation, that luetic inflammatory changes in the extra-abdominal 

 portions of the umbilical vessels never were present before the fifth and sixth 

 month, can not be regarded as final, in view of the differences of opinion concern- 

 ing the specific nature of these changes. Thomsen also implied that the vascular 

 were accompanied by other changes in the fetal organs. 



That changes which are entirely comparable to what has been called "granu- 

 lation cell proliferation" by E. Fraenkel (1873), or "granular hyperplasia" by Erco- 

 lani (1871, 1873) occur in very young villi, is abundantly evident from an exam- 

 ination of specimens in the Carnegie Collection. However, it does not therefore 

 follow that such specimens are necessarily luetic. Thomsen, too, recognized that 

 these changes in the villi, to which, and edema, he attributed the disproportion in 

 weight between fetus and placenta, possibly occur in other conditions, but it is 

 significant that he never found them present in controls. Thomsen further em- 

 phasized that this hyperplasia of the stroma of the villi is never so pronounced 

 in other conditions as in lues, and that the degree of hyperplasia of the stroma and 

 of infiltration of the extra-abdominal portions of the umbilical vessels run parallel 

 with the severity of the infection. Thomsen also concluded that, although other 

 diseases can cause similar changes in the umbilical vessels, such occurrences are 

 extremely rare. Mracek found changes in the cord present in only 10 out of 78 

 cases of lues, and Simmonds (1912) in 20 out of 40 full-term labors in which the 

 presence of maternal lues had been established. Moreover, Simmonds found 

 inflammatory changes in the cord present in 32 cases in which lues was excluded, 

 and the fact that vascular changes have been found to be uncommon near 

 the placental, and spirochaetae near the abdominal end of the cord still waits for 

 explanation. 



