The sexual organs as a rule are normal, although Ritter reports genital hemorrhages and vaginal catarrh occurring during the course of septic infection in the newborn.
12. The bo-nes and joints show severe changes in occasional cases; periostitis and osteomyelitis occur rarely in the infant; multiple inflam matory foci in the joints, especially the hip and shoulder joints (Czcrny and Moser) betray their existence by the immobility and the (edema of the affected extremity and more rarely by a reddening over the joint. Pressure over the diseased area and passive movement of the affected extremity elicit expressions of pain. With appropriate passive motion at the ends of the bones one is often able to elicit a fine crepitation, a sign of epiphyseal separation, which does not occur with hereditary syphilis alone.
13. The blood may show startling changes. A decrease in the num ber of erythrocytes is frequent; a polynuclear lettcocytosis has been found more rarely. Noteworthy is the deficient coagulability of the blood, which must be attributed to the action of toxins and reminds one of the behavior of the blood when peptone and certain other poisons (leech extract, etc.) have been injected. In some cases (Winckel's dis ease) the blood was "syrup thick," and microscopically countless blood granules, due to destruction of the red cells, were found. In other cases heemoglobin and also methfemoglobin were demonstrated in the serum with the spectroscope.
Anatomical pathological changes found in sepsis of the newborn, with the exception of certain characteristics due to the peculiar behavior of certain organs in infancy, are the same as those in sepsis of the adult. In the acute cases and those without metastatic abscesses there are two principal lesions regularly found; namely, haemorrhages and parenchymatous degeneration of the heart muscle, liver and kidneys. The hfemorrhages are scattered throughout practi cally all the organs; aside from the clinically demonstrable luemor rhages in the skin, mucous membranes and retina, they are found regu larly in the dura, sometimes in the pia and more rarely in the brain substance.
The findings in the various organs agree and vary with the clinical symptoms and there will be mentioned only those results of pathological examination to which no reference has been made in discussing the clinical manifestations.
The brain is often crdematous and hyperaemic; the meninges are congested and scattered with hemorrhages. Haemorrhages in the brain substance itself are not so common; encephalitis and meningitis have been observed at times, brain abscesses rarely. Foci of lobular pneumo nia are very often demonstrable, as also ateleetatic areas, small multiple embolic abscesses and frequently also infarctions. Fatty degenera tion of the alveolar epithelium is not uncommon in the form of sepsis described as Buhl's disease. The pleura; are often the seat of inflam mation, usually serofibrinous or purulent. The heart muscle, in conse quence of the intoxication, shows parenchymatous or fatty degenera tion; it is pale and often shows the so-called tiger markings; the valves are only rarely the seat of an inflammatory process, the pericardium much more frequently. The liver usually shows parenchymatous degen eration. Not uncommonly, as the result of an umbilical phlebitis, we have multiple abscesses in the liver, which in life give rise to no symp toms. The spleen shows signs of acute or chronic swelling. The gastro intestinal tract may be found either normal or slightly inflamed. In occasional cases we have a pronounced acute gastro-enteritis and in these cases the mesenteric lymph-glands are found considerably swollen. Haemorrhages are found very commonly in the mucosa as well as in the serosa of the stomach and the entire intestinal canal. The peritoneum is the seat of an acute inflammation practically only in cases of umbili cal sepsis, otherwise it is normal. The kidneys show pathological changes in every case; at times only a parenchymatous degeneration and at times fatty degeneration with necrosis of the renal epithelium; haemorrhages, round-cell infiltrations, interstitial inflammatory changes and diseases of the pelvis are the findings corresponding to the varying involvement of the urinary apparatus in the septic process. Even in the milder cases we very often find hemorrhages in the bone marrow and sometimes metastatic periostitis, osteomyelitis and arthritis; the latter with either serous or purulent effusion. At the umbilicus not un commonly we find the changes described in the chapter on diseases of the umbilicus.