338 STUDIES ON PATHOLOGIC OVA. 



Whether they could be produced before the advent of the organism itself I am not 

 in a position to say. But if lues can lead to the premature birth of a living child 

 and also to retention of conceptuses which died because of the existence of 

 maternal infection, it would seem that the presence of this serious disease in the 

 mother could be expected to affect the life of the conceptus more profoundly in 

 other ways than through the direct effect of the characteristic lesions themselves. 

 Moreover, it would seem that when other causes can be excluded clinically, one 

 would be justified in suspecting the existence of maternal lues. I am aware 

 of the fact that retention alone, wholly regardless of the cause of death of the con- 

 ceptus, has been suggested as responsible for changes similar to those attributed 

 to lues, but I am quite certain that the changes in some of the cases here concerned 

 undoubtedly are not due to retention. 



The gross appearance of these specimens is so well known that a full description 

 is unnecessary. The fresh decidua is frequently markedly macerated, the placental 

 area of the chorion, when differentiated, is pale and firm and its maternal surface 

 furrowed, the ridges being formed by fibrinoid masses and badly preserved decidua 

 and the sulci by pink, better-preserved decidua. The membranes are degenerate 

 or necrotic even, and thickened, especially in the placental area. The amniotic 

 fluid usually is reduced considerably in quantity and the fetus greatly macerated. 

 The cut surface of the fixed placenta shows the presence of some intervillous 

 blood, in spite of the existence of large waxy areas, which, upon microscopic exami- 

 nation, are found to be composed of degenerate decidua, trophoblast, so-called 

 infarcts, and apparently fibrous areas constituted by large villous stems and 

 coalesced villi. 



As is well known, a history of repeated abortion is common in these cases and 

 the presence of lues frequently unsuspected. In one such case, in which attention 

 was directed to the probable nature of the specimen, further inquiry and examina- 

 tion revealed the existence of relatively recent maternal lesions, including mucous 

 patches. Although this may be a mere coincidence, I am quite certain that the 

 subject deserves further attention. 



The placental changes in most of these specimens remind one somewhat of 

 the placenta accompanying a fetus 12 cm. long, reported by Welch (1888) under 

 the caption, "Hyaline metamorphosis of the placenta," and it is interesting that 

 Welch stated that the changes in the stroma of the villi in this case reminded him 

 of those attributed to lues by Fraenkel. Although the few cases in the Carnegie 

 Collection in which the infant was known to be definitely leutic were of considerable 

 value in this matter, those in which lues was suspected or even reported, or in 

 which the Wassermann test was negative or positive, were of little value, because of 

 the well-known disagreements between the clinical findings and the occurrence 

 of luetic lesions in the fetus. 



