SYPHILITIC LESIONS OF THE PLACENTA.
It is only recently that syphilitic affections of the plaeA3nta have been studied. Duchamp has given the best resunti of the subject. He shows that while Astruc, in 1796, recognized abortion as a consequence of syph ilis, Murat first, in 1820, noticed certain bla.ck spots upon the organ, due to hemorrhage, though Paul Dubois, Putkgnat, and d'Outrepont denied their significance. Simpson and Lebert, in 1822, Virchow, BArensprung, Wilk, Meryhet, Slavjansky, Kleinwachter, Mayer, Adamson, Birne, Ver dier, Hennig, and ourselves, have noticed these lesions in the placentas of syphilitic children. Frankel, in concert with Waldeyer and Kolaczek, was, however, the first to bestow serious attention on the subject.
He could collect fifteen observations of syphilis transmitted from the father, in which nothing more than hypertrophy of the villi could be found; but wben the mothers were diseased, the lesions were more com plex. His conclusions were as follows: 1st. There is a syphilitic placenta, with characteristic features.
2d. It is only found in cases of congenital or hereditary fcetal syphilis.
3d. The seat of the lesion is different when the mother is affected, or when the virus is simply transported by the zoosperm to the egg.
a. In the latter case the placenta is degenerated and the fcetus is dis eased, and the villi of the fcetal placenta are filled with fatty granulations; their vessels are obliterated, and their epithelial coverings thickened or absent.
b. The mother being infected, one of three conditions may be present: 1. If the mother is infected during the generative act, at the same time as the fcetus, syphilitic foci will often develop in the maternal pla centa (placental endometritis.) 2. If the mother is syphilitic before conception, or becomes so shortly after, the chane,es of the placenta remaining healthy are about even. In
the latter cuaes the endometritis gummosa of Virchow is observed.
3. If the mother is not infected until after the seventh month of preg nancy, both fcetus and placenta escape entirely.
4. Infection of the fcetus during delivery has not been proved.
Macdonald, in 1875, noticed hyperplasia of the villi in cases of paternal origin. The vessels are especially affected, and there is considerable peri vascular hyperplasia, followed by vascular atrophy and disappearances of the villous tissue. The rest of the placenta is the seat of congestions and bloody effusions. In cases of maternal origin there is hyperplasia of the elements of the decidua, with compression and atrophy of the villi—in fact, the endometritis of Virchow and of Slavjansky.
When both mother and father are syphilitic, the lesions are mixed. Nevertheless, Tarnier and Depaul doubt the existence of specific lesions of the placenta. De Sin6ty, if he has not found lesions in every case, has proved that the following three important changes may occur.
1. Hypertrophy of the villi, which may be doubled, or even tripled in size.
2. Fibroid degeneration of the villi.
3. Nodules of oheesy-degenerated granulations.
The coincidence of the fibroid and caaeous degenerations is found in syphilitic gummata, and notably in those of the liver, and although de Sinety has not found this ensemble of lesions in any other disease than syphilis, he does not enter upon the question of the specific nature of the lesion; he does not deny that a disease other than the pox may cause them, but he suspects syphilis when he finds all three lesions. In two cases his surmises have been clinically confirmed. (Duchamp.)