The liver may be affected, and, according to Dr. Parrot, is most fre quently found diseased in infants who die six weeks after birth. The or gan is enlarged and hardened, and may be the seat of a sclerosis, diffused, as in the lungs, or, more rarely, of the circumscribed form. to Gabler, who first drew attention to this condition, the organ in the dif fused fibroid change is hypertrophied, globular, hard, and elastic, and its edges are rounder than in health. It creaks on section, and the cut sur face is pinkish-white or yellow, and shows layers of small, white, opaque grains on a yellowish uniform ground. The capillary vessels are obliter ated, and the calibre of the larger vessels is increased. These changes are due to the development of new fibro-plastic tissue which compresses the hepatic cells, obliterates the vessels, and checks or prevents secretion of bile. Gummata may be combined with the preceding, and are seen as circumscribed nodules embedded in healthy tissue. The masses are bright yellow, and present under the microscope the usual round or oval cells. There is commonly more or less softening in the centre, while at the cir cumference the normal hepatic cells, between which the infiltration is ad vancing, become hypertrophied.
The spleen is often enlarged, and, according to Dr. Gee, if the enlarge ment is great the child will probably die. Dr. Gee considers the degree of enlargement to be an index of the severity of the cachexia. If the child improves the size of the spleen does not diminish as the other symptoms disappear, but continues unaltered—often for years. In the spleen, as in the other solid organs, the disease consists principally of a diffused inter stitial hyperplasia.
The heart and lungs may be also affected. Gummata have been found in the former organ, and Dr. Coupland has described a specimen in which the muscular walls were thickened and hardened, and showed under the microscope an almost universal infiltration of small round cells amongst the muscular fibres. In the same case the kidneys, although normal to the eye, were seen to be undergOing similar changes, and their substance was unnaturally firm.
The thymus gland is seldom diseased. Sometimes collections of mat ter are found scattered through its interior, but it is not clear that these are the consequence of the syphilitic taint.
The suprarenal bodies are said by Virchow to be frequently the seat of a fatty degeneration. Hither has described a condition in which these bodies are large, grayish on the outside, translucent, and thick, with nu merous white, irregular spots dispersed through their substance.
The bones are often the seat of profound structural disease. Our knowledge of the bone disease which occurs as a consequence of inherited syphilis is only of recent origin. Dr. G. Wegner was the first to describe these lesions, and attribute them to their true cause, in 1870. More re cently Drs. Parrot and Cornil have laboured at the same subject. Dr.
Taylor, of New York, who has collected many cases of his own and analysed those of others, gives a graphic account of these affections in his well known volume.
Disease of the osseous system is a far from uncommon lesion. Accord ing to Dr. Abelin, of Stockholm, it is found in ten per cent. of the cases. The bones especially affected are the long bones of the limbs ; next come the bones of the skull, the ribs, the scapulae, and the iliac bones. In the long bones there are two chief varieties. One begins with the periosteum —periosteogenesis: the other is not connected with the periosteum, but • is confined to the ossifying line of the diaphysis—osteochondritis.
Periosteogenesis begins as a periostitis. Parrot divides it into two forms : the osteoid and the spongioid or rachitic. The former may occur from the earliest period of life ; the latter is rarely seen in infants of less than six months old.
In the osteoid form we find one or more layers of a new growth which is composed of interlacing trabecnlm lying perpendicularly to the axis of the shaft. The periosteum is thickened and adherent to the growth, and the latter has a chalky appearance from copious infiltration with calcareous salts. Consequently it is whiter and more friable than the bone beneath, and the line of junction is well defined. The osteoicl material is found on the shafts of the long bones and on the cranial bones. In the latter situ ation it may reach an inch or more in thickness. By the microscope we find differences in structure from true bone. There are no bone cor puscles regularly disposed round the Haversian canals ; instead, corpuscles —three-sided or polygonal, resembling the stellate corpuscles of connec tive tissue—auastomose by their processes with the cells of the periosteum, with corpuscles in the medullary spaces, and with one another.
In the spongioid form, which is not seen in children under six months of age, a new fibroid tissue, pearly gray or yellowish in colour, is formed between the and the bone. It is more vascular than normal osseous tissue.
The osteoid and spongy growths are often combined. If the new ma- , terial consist of several layers, some may be more trabecular, others more spongy in structure—the chalky layer being nearer the bone, the fibroid immediately beneath the periosteum. While this process is going on around it, the shaft of the bone may be unaltered. This is usually the case in very young babies. In older children the calcareous matter of the shaft may become absorbed, and the tissue be separated into layers by the formation of furrows filled with medulla. The bone as a consequence becomes light, porous, and brittle. The ends of the bones are thickened, partly by the periosteogenetic growth, partly by granulations thrown out from the spongioid tissue. of the shaft.