Cyst-like structures in the thymus are very characteristic of heredi tary syphilis. They are filled with a secretion that resembles pus and are to be interpreted as epithelial spaces of the foetal thymus separated, or pinched off, by inflammatory cell proliferation.
Similar perivascular hyperplasias and parenchymatous hypoplasias occur likewise in the central nervous system, in the gastro-intestinal mucous membrane, and in the testicles and epididymis. The lesions of the osseous system will be discussed in a connected manner in a later chapter.
Death of the Fcetus due to can occur at any period of intra-uterine life, but is most frequent between the fourth and the seventh months of pregnancy. A. Fournier found 230 abortions among 527 syphilitic pregnancies; Le Pileur 154 abortions or still births among 414 syphilitic pregnancies; and Coffin 27 dead premature infants out of 2S pregnancies. Habitual abortion is to be attributed to syphilis in the great majority of cases.
In such infants born dead during the first half of pregnancy anatom ical changes in the fatus are not always clearly marked and are often demonstrable only when histological sections arc compared with those from syphilitic foetuses of the same age. These changes, however, are never absent during the second half of pregnancy. Severe general in toxication is responsible for death in the first case, but especially so is an early involvement of the placenta.. Both maternal and fatal por tions of the latter can become diseased, and especially so in cases of a purely spermatic infection and of one that had an intra-uterine origin. The syphilitic faAus digs its own grave in its mother's womb by means of early involvement of the placenta, by changes in its blood vessels, by proliferating granulations, by the formation of callosities and finally by contractions, that impede circulation. Apart. from these specific changes which will be described later, all kinds of developmental disturbances can occur in these syphilitic premature and stillborn fatuses, such as spina bifida, anencephalus, harelip, clubfoot, congenital heart disease, and monstrosities of all kinds.
Frequently the cause of these early premature and still births is found in hydramnios resulting from an early phlebitis of the umbilical vein, which in turn is dependent upon specific changes in the placenta.
Changes in the placenta are regularly found in fatal syphilis. The placenta is larger and heavier than normal. It is pale, has deformed lobes, is frequently yellowish in color, and the umbilical cord is hard and thickened. Histologically, the placental blood vessels show perivascular cell infiltration, and a pathological condition of the intima; the pla cental parenchyma shows, further, diffuse or nodular masses of cells and extensive foci of tissues that have undergone fatty degeneration. In the umbilical cord are frequently found perivascular infiltrations and characteristic changes in the blood vessels, on which alone the diagnosis of hereditary syphilis can be made if there is doubt otherwise as to the cause of fatal death.
The living offspring of syphilitic parents, though they may show no clinical evidence of the disease, very frequently manifest constitutional inferiority as shown by general physical weakness. Among 4S syphi litic children born alive in Tarnier's clinic in 1.900 and 1901 fourteen had a normal weight (not under 3250 grams), 3S an abnormally small weight, 15 of these weighing less than 2500 grams. The losses in weight of these foetuses is the more striking, because they have regularly severe visceral affections which lead to an increase in weight of the larger glands (Hecker, Hochsinger).
In a few premature or full term infants characteristic changes are found in the skin and mucous membranes at birth. The most impor tant skin lesion in this connection is syphilitic pemphigus. More rarely these children are born with a papular eruption. The most prominent congenital lesion of the mucous membranes is syphilitic coryza. Very frequently affections of the bones, of the eyes, and of the nervous sys tem are present at birth, to say nothing of those that involve the liver, the spleen, the pancreas and the intestinal mucous membranes.