116). In the bone changes and in those of the skin we have an iden tical process, as will be shown later, although the conditions are not so evident at a glance as they are in the case of the viscera.
In all affected organs one may have localized denser collections of cells which are recognizable even macroscopically and are often spoken of as miliary syphilomata, but are not gummata.
This diffuse cell proliferation, or hypertrophy, of the mesenchyma which can so pervade whole organs of stillborn syphilitic infants that the parenchyma is no longer recognizable, was interpreted by Karvonen as a fatal arrest of development of the mesenchmya and not as an inflamma tory process involving the supporting tissue of the developing paren chyma, as Hecker and I teach. The same author, later Becker, Terrier and Erdmann, pointed out the physiological richness in round cells of the fatal parenchyma. Since, however, these organs in syphilitic fce tuses, in which the cell infiltration of the interstitial connective tissue is often a very extensive one, are heavier and larger than those that arc not syphilitic, one cannot doubt that the pathological nature of this hyperplasia is that of an inflammatory proliferation.
2. In the foetal organs involved in this hyperplastic process there are characteristic and peculiar arrests of development of the paren chyma. Incomplete development of the Malpighian bodies, persistent epithelial ducts and the formation of cysts in the renal cortex, masses of epithelial cells that have been separated off and isolated, in the lungs, liver, kidneys, pancreas and gastrointestinal tract and cyst formations lined with epithelium in the thymus may all be mentioned here. It is certain that the hyperplasia of the connective tissue areas goes hand in hand with a bypoplasia of the parenchyma. The growing osseous system of the fcetus and of the young infant shows similar disturbances of development.
Hereditary syphilitic changes of the visceral organs of foetuses frequently are not demonstrable macroscopically. Only when we have circumscribed, focal collections of cell infiltration, and the formation of hard elevations, like callosities, is the diagnosis easy. At other times there is simply an increase of volume and consistency, most constantly in the liver and spleen, the weight of which as compared with the body weight is greater than normal in congenitally syphilitic fetuses. The ratio of the weight. of the liver to the weight of the foetus is normally as 1:21.5, in syphilis as 1:14.7; that of the spleen is normally as 1:325,
in syphilis neonatorum as 1: 19S.
The liver of syphilitic foetuses is always permeated by a large amount of interstitial cell infiltration, the dependence of which upon the vascular system is here very evident. One frequently finds in this organ which is usually very vascular, small yellowish masses from the size of a hemp-seed to that of the head of a pin, composed of cloudy and necrotic liver cells surrounded by inflammatory cells arranged about them as a focus. These are peculiar exudative formations that occur solely in early hereditary syphilis, and are to be interpreted as areas of anemic necrosis. Very similar areas of necrosis are found in the kid neys, especially however in the suprarenal bodies, and also in the epiphy seal cartilages and in the cartilaginous ends of the bones of syphilitic dead born children.
More rarely there occur well developed sclerotic processes, i.e., contractions in syphilis of the fatal liver. An indurative enlargement of the spleen and pancreas is frequent. In the kidneys, besides the con stant part taken by the vascular system in the form of a diffuse peri vascular infiltration, there is practically always present an incomplete development of the cortical parenchyma with rudimentary develop ment of the Malpighian bodies and of the tubular system.
The lung frequently shows characteristic changes that make it re semble sarcomatous tissue, clue to the uniform infiltration with round lymphoid cells (Ziegler). Enclosed within these areas of interstitial cell infiltration are found remnants of fatal lung tissue from a former period of development, in the form of masses of cylindrical or cubical epitheliomata, or epithelial tubules. Another change results from a com bination of an extensive desquamation of the alveolar epithelium which has undergone fatty granular degeneration and cell proliferation in the interalveolar lung tissue, from which there results a uniform whitish gray discoloration of the affected portion of the lung and the peculiar homog eneous appearance of the cut surface (pneumonia alba, see Fig. 116). Such lungs may even have undergone respiratory movements, and are occasionally found in congenitally syphilitic infants that have lived for a number of clays. One must not forget however that other kinds of pneumonia may occur in newborn syphilitic infants.