Peritoneum.—We have noted the hemorrhagic peritonitis of Simpson.
The spleen is hypertrophied, softened, indented, permeated with indu rated nuclei, as the disorganization is more or less advanced.
The pancreas presents analogous alterations to those of the liver. Pro liferation of the fibro-plastic tissue, induration, hypertrophy; on section it is whitish, brilliant. The structure of the acini has disappeared to the naked eye. The proliferation is extended, not only to the intermediate tissue of the glandular groups, but also to the intermediate tissue of the acini; it compresses them, destroys their epithelium, thickens the walls of the vessels and destroys the capillaries.
The kidneys are hypertrophied, the Malpighian pyramids contain little yellow nuclei, indurated, with commencing suppuration.
On the intestines one finds blackish, indurated patches occupying the entire wall of the intestine, and constituted by net-work of fibres, holding entangled at their centre fatty and purulent globules, and their cells hav ing prismatic angles, rounded, strongly tinged with brown.
Finally we find the osseous lesions which, noted vaguely by Waldeyer, Wagner, Korner, Taylor, have been studied in detail by Parrot and Ruge. Parrot finds that in every fcetus bearing on the skin, the mucous mem brane or in the viscera, the marks of hereditary syphilis, the bony sya tem is altered. These lesions may exist alone. Parrot has observed them in a very clear case. The long bones of the extremities, excepting those of the hands and feet, are with the scapula3, the iliac and cranial bones, most frequently attacked; then the ribs, the clavicles, the metacar pal and metatarsal bones, and lastly the vertebrx. But these last are only affected when the disease is of long standing. The symmetry of the lesions is constant Parrot thinks that there are four varieties, or better, four degrees of the lesion.
" 1. Seen in fcetuses, and in infanta dead a few days after delivery. The bones are heavier than normal. Under the periosteum, are found osteophytes. Around the diaphysis the same osteophytes are found, per pendicular to the diaphysal axis. The medullary substance is very much diminished, and the medullary canal almost obliterated. The scapula and
the iliac bone are also covered with osteophytes.
" 2. The bones are less heavy, the new-formation layers less dense, and more porous. The changes affect in particular the inferior part of the diaphysis of the humerus, the upper part of the ulna, the anterior surface of the femur, and the internal of the tibia. • A peculiar characteristic of this degree is the gelatinous atrophy of thetbones. The spongy tissue is, in particular, affected. To this atrophy, is added the pseudo-syphilitic paralysis of the new-born. Fracture occurs at the cartilage. Pus forms; osseous fragments become detached; abscesses occur, which may spread to the joints and break outwardly.
" 3. This is characterized by medullarization, which appears in cases of longer duration. The osteophytes are still present, often, as also, the gelatinous atrophy. But the changes are most apparent in the medullary substance, which spreads, invading gradually, in particular, the inferior region of the humerus near the nutrient foramen. It is here, indeed, that we find the distinctive mark of the disease. There occurs enlarge ment of this extremity, especially from before backwards. A section per pendicularly through the diaphysis, reveals the lesion best. The diaphy sis is enlarged, the antero-posterior diameter may be doubled. This is due to one or two layers of osteophytes. The chondro-calcareous layer is not so hard as in the normal.
" 4. This degree is characterized by the formation of a spongy tissue at the periphery and end of the diaphysis, where it tends to replace the chondro-calcareous layer. The characteristic deformity of the humerus diagnosticates the lesion. This degree is found in children beyond six months. The older the infant, the more it approaches rickets in appear ance.
"Syphilitic bones of the first degree,with their compact osteophytes, and their gelatiniform atrophy, are the very reverse of rachitic bones. The two other degrees resemble one another, but the characteristic shape of certain bones, in particular the humerus, and the greater density of the spongy tissue, and, further, the less development of the cartilaginous layer, are certain signs of syphilis." (Parrot.)