1897 Journal of the American Medical Association (JAMA)  
On April 29, the body of a child was brought to the laboratory of Rush Medical College for examination. The autopsy was performed immediately, before postmortem changes could have possibly occurred. The child was born in the practice of Dr. A. B. Strong, who furnishes the following history: The mother was 20 years of age, a primipara, with a good personal and family history. She had been married one year. The labor was an uneventful one, a vertex presentation. The child was alive when born, but
more » ... died after gasping a few times. The father was 23 years old and denied any specific history, as did the mother, and presented no suspicious scars. Dr. Strong, his interest in the case having been aroused by the condition of the child, conducted a careful investigation into the history of the parents, but was unable to obtain the slightest evidence of a primary specific infection in either. The mother was troubled after the birth of the child with constant dreaming, a symptom not present before that time, and which was not relieved by administration of potassium iodid. The father spoke of aches and pains in the lower extremities which he said he had had for years. On examination two subcutaneous swellings were found attached to the crest of the tibia, just below the tubercle, and a third on the inner side of the right femur. Treatment with the iodid of potassium and the biniodid of mercury was followed by some reduction in the size of these swellings and the disappearance of the subjective symptoms. On cross examination the patient stated that these swellings had been present since he was a boy. Asked about his father he stated that he knew little about him beyond that he was a sailor. Beyond this reference to the third generation there was no obtainable evidence as to the source of infection. The findings at the autopsy were as follows: The body was that of a child, 50 cm. long, and weighing 2500 gm. The abdomen was rounded and firm, and the umbilical cord, which was moist and fresh, was tied with a silk ligature. The skin was covered over almost the entire body with eruptions, most numerous about the ears, face, forehead, hands, feet and buttocks. Most of these eruptions contained a serous fluid, but many were filled with a purulent fluid, and some with a firm, cheesy substance. The peritoneal and pericardial cavities were normal, as were the pleural except for a thin, white, pellicle, covering the pleural surface of the base of the left lung. The heart muscle showed several white, indurated areas, the largest lying on the ventral surface, and about the size of a dime. The heart was not opened, but on account of this rather unusual condition was preserved for a more complete special examination by Dr. Le Count. The thymus contained several soft, light colored areas, which on section yielded a gray viscid, fluid. Otherwise the organ appeared normal. Beyond an unusual amount of blood the thyroid and salivary glands showed no changes. The lungs were firm, noncrepitant throughout, and pieces placed in water sank quickly to the bottom. They presented both under the pleura and in the deeper parts of the lungs, white areas, firm and smooth on the cut surface-a typical pneumonia alba. The liver was large and firm, the right lobe reaching nearly to the level of the umbilicus. On section it was found to be very full of blood, but there were no other changes. The biliary system was normal. In the stomach was found a large amount of jellylike mucus, and the intestines contained the usual amount of meconium. The cecum was attached to all the adjacent coils of intestine by firm, fibrous adhesions, except the vermiform appendix, which was free. The mesenteric glands were enlarged. The kidneys and supra-renal capsules appeared normal. The spleen was slightly enlarged and full of blood. No changes could be detected in the central nervous system. At the epiphyses of both the long and short bones the line of ossification was very broad, irregular and hemorrhagic. Ossification had not begun in the lower epiphysis of the femur. Under the microscope many changes very typical of syphilis in the new-born were observed. The description of the various organs follows: Lungs.-Both lungs were almost completely consolidated, the air vesicles having been dilated in but a few places. The expanded vesicles contain a granular substance which in most places completely fills the lumen, and contains many poly-morpho-nuolear leucocytes and some flattened epithelial cells. The walls of the vesicles are quite thick, with some infiltration of leucocytes, and with greatly dilated capillaries. In many places the epithelial lining of the alveoli is absent. The formation of the consolidated portion by non-expanded alveoli can be determined only with difficulty, because of the degree of infiltration of the tissues. Everywhere, within and between the alveolar walls are poly-morpho-nuolear leucocytes, for the most part scattered singly but in some places collected in groups of a dozen or more. Occasionally the alveolar walls have been separated by slight hemorrhages, in which the blood contains many leucocytes but is not disorganized. Practically all of the bronchi and bronchioles have been filled with masses of cells, in some of which the nuclei stain deeply, in others scarcely at all. The walls show a diffuse infiltration with leucocytes, many of which are also to be found in the contents of the lumen. All the vessels are dilated with blood, and the walls of the smaller arteries are greatly thickened so that the lumen is practically occluded. The pleura, which is quite thick, is not as much infiltrated as the subadjacent tissues, but in the outer portion many of the nuclei fail to stain, and the tissue elements are much disorganized. The vessels in the pleura are much dilated with blood, and in some places slight hemorrhages have occurred. Liver.-The vessels are greatly engorged, but nowhere can the blood be found outside the regular channels. The connective tissue is everywhere infiltrated with leucocytes, which are also collected in groups in many of the intra-lobular capillaries. The parenchyma cells in some places seem slightly vacu-Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/05/2015
doi:10.1001/jama.1897.02440150018002f fatcat:hyhkrensifcubiwawpqbqmu77i