3. It is not possible to regard the one form as secondary, the other as tertiary, for either may exist with cutaneous dis turbances of the secondary type.
4. Ily analogy, the interstitial fibroid change, so common in infantile syphilis, would appear, in the main, to be sec ondary to a degeneration and necrosis of the hepatic parenchyma, induced by the action of the toxins of the syphilitic virus upon the individual liver-cells. In part it is developed in direct association with the development of udliary gum mata.
While the changes seen in the adult and infantile syphilitic livers are eti ologically and anatomically identical, they may present differences, due, in part, to their relative duration, in part, to the reactive powers of the hepatic par enchyma at different life-periods. J. G. Adami (N. V. 111ed. Jour.. Apr. 22, '99).
Notes have been made on 100 post mortem examinations of congenital syph ilis, and the principal results of this in vestigation are as follow: The liver is always enlarged in the mature and im mature ketus suffering from syphilis, whereas in children who have lived for a short time this enlargement is often ab sent. In the cell accumulations of diffuse and miliary syphiloma of the liver cer tain cell groups are to be differentiated: the cells either resemble proliferating epithelium or else they approximate to newly-formed blood-cells. Both these varieties are seen in the normal foetal liver; they disappear, however, either shortly before or after birth. This pro liferation of epithelium is increased in syphilis. The liver is the chief blood forming organ during foetal life; the young nucleated blood-cells originate from the endothelium of the walls of the capillaries; they are more numerous in the efferent than in the afferent blood vessels. The vessels of the portal sys tem in the fintus are peculiarly rich in cells of an "adenoid lymphoid" character. which begin to resemble the adult variety at birth. The kidneys in the syphilitic fmtus are considerably enlarged; after birth they diminish in weight. The kid ney changes in congenital syphilis are constant; they consist chiefly in an in filtration of the cortical blood-vessels, which after some time cause atrophy and degeneration of the epithelium of the urinary tubules and glomeruli. The kid
ney shares, to a slight extent, in the elaboration of the fmtal blood. The syphilitic splenic tumor is constant in the fmtus. The usual pathological lesion is a small-celled infiltration of the large and medium-sized blood-vessels. The fmtal pancreas shows an increase of weight in the syphilitic subject. The thickened coats of the umbilical vessels without infiltration is no sign of syphilis. The umbilical vessels in congenital syph ilis often show specific changes, and their recognition during life would help in di agnosis. In syphilitic disease of the thy mus, in addition to the formation of ab scesses, the connective-tissue septa be come thickened, causing compression of the lobules. Wegner's syphilitic bone disease is not always present, but the condition is never seen in non-syphilitic infants. Clinically the syphilitic infant has almost always some disturbance of the functions of the kidney. Hecker ' (Deut. Archiv f. kHz'. Med., vol. lxi, pp. 1 and 2, '99).
There is in syphilitic newborn children a marked tendency to apoplectic effusions in various situations, particularly in the meninges of the brain and probably also the cord.
In 62 dead children microscopical ex amination showed that 26 per cent. were positively non-specific, 53 per cent. were syphilitic, and 9.7 per cent. were doubt ful, no result being obtained in 11 per cent. The kidneys were involved in 90 , per cent. of eases, the spleen in 61 per cent., the thymus in 50 per cent., the pan creas in 46 per cent., the hones in 43 per cent., the liver in 23 per cent., the lungs in 17 per cent., and the umbilicus in 16 per cent.; hence, the kidneys most con stantly show pathological changes, while these are comparatively uncommon in the lungs and liver, largely because the latter organs become macerated so easily that the changes are not recognizable. The frequency of syphilitic changes in the spleen and thymus emphasized. Osteochondritis was found in only half of the cases, and is pathognomonic. H. Hecker (Deutsche med. Wochen., Nov. 6, 1902).