336 STUDIES ON PATHOLOGIC OVA. 



If such changes as these alone could be regarded as pathognomonic of lues, 

 it would be a relatively easy matter to determine its presence. Thomsen also laid 

 great stress on the presence of abscesses in the placenta, accompanied by hyper- 

 plasia of the stroma, and stated that he had never observed such a coincidence in 

 any condition except lues, adding that although he found placental abscesses 

 only 8 times in 100 cases in which maternal or fetal lues had been established, he 

 never found them present in 1,250 placentae in which lues could be excluded with 

 considerable certainty. Thomsen further stated that infiltration of the mem- 

 branes, although not specific, nevertheless is quite characteristic of lues, and is 

 most marked when the s} r philitic infection is severe. 



If Thomsen's conclusion were justified, one would be compelled to believe 

 that fetal lesions which are pathognomonic of lues nevertheless exist. It may be 

 recalled in this connection that Schwab (1905) also emphasized the necessity for 

 considering the "tout ensemble" and claimed that a fairly reliable diagnosis. of lues 

 can be made from an examination of the placenta alone. According to Schwab, 

 the lesion complex consists of (1) a disproportion in weight between the fetus and 

 the placenta, with an excess in weight of the latter; (2) hypertrophy of the villi; 

 (3) perivascular cirrhoses; (4) inconstant proliferation of the syncytium; and (5) 

 arteritis of the decidual vessels. Schwab recognized that any of these lesions may 

 be present in other conditions, and laid special emphasis on the total picture. 

 Solowij (1902) had gone much farther than this, however, for he held that lues is 

 the cause of most placental lesions, even in the cases in which neither parent 

 shows evidence of the presence of the disease in active form. Solowij even regarded 

 this as established clinically, and held that lues alone produced the changes in the 

 arteries described by him. 



Slemons believed that the most trustworthy evidence of the existence of fetal 

 lues is found in the chorionic villi, which are clubbed and the vessels of which 

 are not apparent in luetic cases. Slemons asserted that "when delivery occurs 

 prematurely, the placental findings are significant; for in that case the question 

 of syphilis may always be fairly raised." Since Slemons found placental evidences 

 of lues in 10 per cent of 400 placenta? accompanying a living child of the fifth 

 or later months, it would seem that a higher percentage of cases from the earlier 

 months would contain evidences of lues, unless it can be assumed that early 

 conceptuses are more resistant to infection. The failure to find spirochaeta? in 

 conceptuses before the fifth month would seem to suggest that no lesions can be 

 expected before this time unless they can result from the influence of toxins. Should 

 this be considered as impossible and the failure to find spirochaetas be accepted 

 as conclusive evidence of their absence, then lues apparently must be excluded 

 as a cause of abortion before the fifth month, except in so far as the disease may 

 affect the health of the mother adversely, or cause changes at the implantation site. 



While considering the probable factors in the termination of gestation in the 

 case of abortuses in the Carnegie Collection, it became evident that mechanical 

 interference therapeutic or otherwise and hydatiform degeneration seemed to 

 be the predominating causes. These can be recognized with some certainty, but 



