CHANGES SUGGESTIVE OP LUES. 337 



the customary difficulty was encountered regarding lues. Consequently, a series 

 of abortuses from the group of fetus compressus, in which lues was present in 

 mother or offspring, were selected for special study. From the findings in these 

 cases, and taking the entire specimen as well as the clinical history into considera- 

 tion, an attempt was made to isolate a group of specimens which might be regarded 

 as probably luetic. 



Even if it be incorrect, as variously stated, that a large percentage even 

 up to 95 per cent of all long-retained macerated abortuses are luetic, the mere 

 fact that a very large percentage of luetic fetuses are retained for some time before 

 being aborted introduces a special difficulty into the examination of them. It is 

 relatively rare that a satisfactory teased preparation of the villi can be obtained 

 even in early conceptuses. Hence, for this reason alone, the existence of clubbing 

 of the villi, even if present in early cases, is much more difficult to determine. 

 This is true of all specimens which have been retained sufficiently long so that 

 the villi have become macerated, glued, and more or less compressed. Such glue- 

 ing, or matting, apparently can arise in a relatively short time, for it is present in 

 placentae which accompany fetuses which are not markedly macerated. Although 

 often not due to lues, this glueing makes a gross examination of the villi very 

 difficult and unsatisfactory. 



So-called typical, granular hyperplasia of the stroma of the villi can be found 

 present in very small chorionic vesicles and probably can be caused by other 

 things than lues. But obliterative arteritis was not seen in any very young chori- 

 onic vesicles, although present much earlier than the fifth month. In some of 

 these cases the obliterative changes were present not only in the vessels of the 

 villi, but in those of the chorionic membrane as well. It was noticed but rarely 

 in the umbilical vessels, but since the entire cord was included in relatively few 

 specimens, no thorough examination could be made regarding this matter. Con- 

 siderable thickening of the chorionic and amnionic membranes as a result of fibro- 

 sis was quite common, however. When present in a marked degree, the fibrous 

 change in the stroma of the villi and the obliterative changes in the vessels, both 

 of those in the membranes and of the larger villous stems, often were so typical 

 that on the basis of these alone, especially when they were accompanied by some 

 infiltration with mononuclear leucocytes, one is justified, I believe, in regarding 

 these specimens as very probably luetic. The placentae of such of these specimens 

 as had been retained for some time after fetal death showed the presence of coagu- 

 lation necroses so-called infarction with the presence of considerable masses of 

 degenerate trophoblast, and usually also of some calcification. The accompanying 

 decidua also not infrequently showed the presence of fibrosis and later also of 

 endarteritic changes in the decidual vessels. 



If spirochffitae are absent in the conceptus before the fifth month, then it 

 would be unjustifiable to assume that the cases showing these changes were defi- 

 nitely leutic, unless fetal lesions can arise in the absence of the specific organism 

 within the conceptus. Nevertheless, I feel justified in emphasizing that these 

 morphologic changes seem to be characteristic even if not pathognomonic of lues. 



