FETAL SYPHILIS In this chapter will be discused those changes brought about by the action of the transmitted syphilitic poison upon the fatal organism, from the time of the formation of the OVUM to the time of birth. There is here always the expression of severe infection of the fdet us causes] by recent syphilis in the parents. The gravity of syphilitic manifestations in the fwtus is due to specific changes in the viscera, which changes are usually absent, or only slightly present, in those cases beginning after birth. In fatal syphilis there is a striking affinity of the infectious material for the large glandular organs and for the growing portions of the osseous system, while the skin, which is a favorite place for an attack after birth is relatively immune before birth. There is developmental ground for this in that these organs which, at the time of the formation of the specific poison in the organism, show a peculiar hyperarmia, either functional, or associated with growth, take up the poison with especial avidity. If the contagion manifests itself in an early period of foetal life, then those internal glandular organs, the lungs, liver, kidneys and pancreas, that develop early are involved. Later, on ac count of the rapid growth in length of the foetus, there appear changes at the epiphyseal borders in the hollow bones. The skin, on the other hand does not really develop its glandular apparatus till the later months of intrauterine life, when it is preparing for its extra-uterine life, and so does not show characteristic changes till shortly before or after birth.
General Characteristics of Early Congenital Syphilis.—If one bears in mind the embryological conditions, it is a simple matter to find a satisfactory explanation of the genesis of the early lesions of hereditary syphilis. As opposed to acquired syphilis, the typical lesion of early hereditary syphilis is found in a diffuse cell proliferation having its origin in the perivascular connective tissue of the smallest vessels, i.e., the mesenchyma. For this reason one very rarely sees a solitary
syphiloma in the foetus, or in the young infant, but rather, almost in variably, diffuse cell proliferation and inflammation.
It is a mistake to consider the visceral and bone changes of foetuses and of newborn and young infants as tertiary, and the skin manifes tations as secondary lesions, because they are identical with those occurring in these structures in acquired syphilis. The diffuse charac ter of those lesions of early hereditary syphilis, no matter where local ized speaks for a single uniform genesis, excluding the possibility of a division into secondary and tertiary lesions. The predilection of this inherited contagion as determined by embryological conditions, for those tissues that are especially characterized by marked vascularity and rapid growth during this period, speaks for the assumption that in the le sions of early congenital syphilis we have to do with a single, uniformly irritating action of the specific poisonous substance, which is earliest and most active wherever there is the greatest afflux of tissue juices. This has nothing in common with the usual classification of syphilis into stages.
The anatomical picture of the changes occurring in early congenital syphilis is an identical one in all organs. The most essential changes are found in the liver, lungs, kidneys, pancreas, spleen, thymus, and at the growing points in the bony system. Two kinds of lesions are most prominent : 1. Diffuse cell proliferation, starting from the smallest blood ves sels, in the interstitial connective tissue of these organs with a decided tendency to later contraction and to prominent participation on the part of the vascular system. In the small blood vessels this proliferating process begins in the outer walls in the form of a cuff and regularly ad vances peripherally toward the connective tissue, more rarely toward the inner wall of the vessels, frequently leading to obliteration (Fig.