In many instances children so tainted are born in a state of complete putridity, and with the skin either already stripped off or quite loose and detached; in other instances, which are much more rare, the children have been born alive, with a well-marked syphilitic erup tion on the skin, as in the eases recorded by Cruveilhier,* Dr. Collins,-1- and others. I am indebted to Dr. Collins for a very accurate drawing of one of his cases; the skin of the child generally was of a very dark hue; scat tered over different parts of the body were brownish or copper-coloured blotches, inter mingled with pustules and with large vesicular patches containing a straw-coloured purulent fluid, along with which there were also nume rous superficial ulcerations of a bright red colour.
Affections of the heart and pericardium.— Independently of the innumerable irregularities of structure and malformation to which the heart is liable, experience has shewn that both it and its pericardium are sometimes attacked by disease in titer°.
Denis gives an account of a case of hyper trophy of the heart at birth.t The following case of scirrhous tumours in the heart is described by Billard.§ On ot'ening the body of a child of three days old he found on the anterior surface of the heart along the inter ventricular line three projections of a whitish colour ; they were buried in the substance of the wall of the left ventricle and the inter ventricular septum, projecting a little into the cavity of the organ. When cut into, they creaked under the scalpel, and the cut surface exhibited closely interlaced fibres, perfectly resembling, both in appearance and form, those of scirrhus. Cruveilhier details a highly interesting case of aneurism of the right auricle and ventricle in consequence of the obliteration of the orifice of the pulmonary artery. The child was born at eight months and a half in a state of extreme debility, and lived only five days, all which time the respiration was im perfect, embarrassed, and almost convulsive. On examination the heart was found enor mously enlarged, filling more than half the thorax, and pushing back the lungs, which were of small size. The right cavities were so en larged as to constitute seven-eighths of the whole organ ; the valve of the right auriculo ventricular opening was attached and fixed in such a way that the blood passed as freely from the ventricle into the auricle as in the opposite direction, and there were floating granulations on the free edge of the valve. The orifice of the pulmonary artery was com pletely obliterated, but otherwise the artery and its divisions were healthy.11 " How could life," asks Cruveilhier, " be maintained for five days ? there did not pass a drop of blood into the lungs from the right ventricle. I think
that the entrance of the blood into the lungs was partially accomplished through the ductus arteriosus; it is probable that life would have been maintained if the foramen ovale had remained free and open." It appears to me that the explanation here offered by the author is probably correct, as I once saw an instance in which a cbild affected with the morbus eceruleus lived a year and a half; and on exa mination we found that the aperture of the pulmonary artery was completely obliterated where it should have joined the right ventricle, but the aorta had an opening into it from both ventricles, and the ductus arteriosus was quite open and free ; and my opinion then was that in this way sufficient blood was transmitted to the lungs and revivified for the imperfect support of life; the foramen ovale was open. Billard also met with an instance of aneurism of the ductus arteriosus in a new-born child : the heart was larger than usual, the duct was of the form of a large cherry-kernel and filled with fibrinous co agula disposed in layers, as they are found in the aneurisms of adults.* How far this affection truly deserves the name of aneurism seems somewhat doubtful; but the writer, not long since, met with a similar condition of the ductus arteriosus when examining the body of an infant which died suddenly.
Pericarditis.—Evidences of the existence of this disease have also been frequently met with. In a child only two days old Billard found between the opposite surfaces of the pericar dium adhesions so firm as to lead to the con clusion that they must have been formed during foetal life;t and in the case of a child which lived only an hour Cruveilbier found, in addi tion to anasarca, ascites, and purpura, effusion in the sac of the pleura and a great quantity of fluid in the pericardium.X Speaking of this affection, Andral says, " It is a fact which one would never imagine, a priori, that irritation of the pericardium terminating in the formation of false membranes or purulent effusion into its cavity is a common enough disease in the foetus, even more so, perhaps, than in the adult."§ The thymus gland—Considering the num ber of pathological lesions to which we have just seen that the lungs are liable, although being organs in a state of complete quiescence during foetal life, we cannot be surprised that the thymus, which attains so great a degree of development (if not its greatest) before birth, should frequently exhibit evidences of morbid over-action, and accordingly several instances of the kind have been recorded.