DEGENERATIONS 
OF 
THE PLACENTA 
AS A 
CAUSE OF THE DEATH OF THE CHILD. 
BY 
CHARLES A. LEALE, M. D., 
[.REPRINTED FROM THE TRANSACTIONS OF THE NEW YORK ACADEMY 
OF MEDICINE,I 
ctna fides at/tabe commune. 
NEW YORK: 
D. APPLETON AND COMPANY, 
549 & 551 BROADWAY. 
1876. DEGENERATIONS 
OF 
THE PLACENTA 
AS A 
CAUSE OF THE DEATH OF THE CHILD. 
BY 
CHARLES A. ALE, M. L>., 
[REPRINTED FROM THE TRANSACTIONS OF THE NEW YORK ACADEMY 
OF MEDICINE.] 
UNA FIDES ALTABB COMMUNE. 
HEW YORK: 
D. APPLET O N AND COMPANY, 
549 & 551 BROADWAY. 
1876. DEGENERATIONS OF THE PLACENTA AS A CAUSE OF 
THE DEATH OF THE CHILD. 
Bx CHARLES A. LB ALE, M. D. 
Read May 18, 1876. 
The degenerations of the placenta, commencing during the 
early months of pregnancy, affecting the life of the fcetus, offer 
a vast field for medical scientific investigation, and the knowl- 
edge of their causes, prevention, and cure, will enable the 
physician, in many instances, to guard against a frequent cause 
of abortion in the anaemic, and in those suffering from con- 
stitutional diseases, which, as many authors have asserted, is one 
of the most frequent causes of producing a change in the struct- 
ure of a tissue absolutely necessary for the development and 
existence of the foetus; and when we are called to witness the 
sorrow of women whose in tensest desire is to have offsprings 
but who, after suffering all the miseries incident to a long preg- 
nancy, at the end of nine months are to be again disappointed, 
we are surely called upon, not only to tender our sympathies, 
but to investigate the cause, and if possible, avert the recur- 
rence of such a catastrophe. Having notes of the instances 
where this condition has occurred during the past ten years, I 
will present for consideration a few clinical facts which may 
fortify us in the future, and lead us to consider the best meas- 
ures to adopt to prevent what is one of the most disagreeable 
duties of a physician, viz., to deliver a woman of a dead 
child. 
By fatty degeneration of the placenta we mean that gradual 
transformation into fat, and in the end complete loss of use- 
fulness and final destruction of the tissues, found in a healthy 4 
placenta, which may be often recognized by the naked eye, 
either as yellow solid fat, yellow liquid fat, or granular fatty 
masses, found occupying the former positions of the foetal 
tufts and villi of the spongy portion of the placenta. In the 
tissues of the umbilical cord, and in the membranes surround- 
ing the foetus, we find the fatty degeneration of a granular 
form, as numbers of small elevations feeling like shot, com- 
pletely destroying that transparency of healthy membranes, 
and causing the amnion to become dirty-looking, yellowish 
and opaque. As will hereafter be explained, it will be seen 
that we have the yellow softening, the result of the occlusion 
or retardation of the passage of blood through the nutrient 
vessels as we have found in the syphilitic form. 
The cheesy degeneration, or fatty granular metamorphosis 
of Yirchow, as in one from a patient expiring in the last stage 
of phthisis pulraonalis. The atrophic fatty degeneration also 
found in a placenta from a mother having pulmonary phthisis. 
The waxy or lardaceous, from a very gross scrofulous mother, 
in which no free fatty infiltration could be found. 
Paget states that “ in most instances the fatty degeneration 
affects, first and chiefly, the contents of cells or tubules, or the 
proper substance of the membrane. And when it thus happens, 
the nuclei almost always waste, and either shrivel or disappear 
after gradually fading in their outlines. This may be com- 
monly seen in the fatty degeneration of the renal and hepatic 
cells, and of the muscular fibres. The whole history of fatty 
degenerations concurs to prove that they are the result of de- 
fect, not of disease of the nutritive process; and that they may 
therefore be classed with the atrophy which we recognize in 
merely diminished quality of formation.” Therefore we can 
easily imagine why a woman, who has either conceived with a 
diseased sperm, or is herself the subject of syphilis, phthisis 
pulmonalis, scrofula, etc., from simply that defect of nutrition 
and malassimilation, can have a degeneration of a fatty charac- 
ter start in a placenta, and thereby be the direct means of 
preventing her from giving birth to living children at the full 
term of gestation. Illustrative Cases. 
Fatty Degeneration of the Placenta originating in Sperm 
from Syphilitic Father, the Mother never having had any of 
the usual Manifestations of the Disease.—At a meeting of the 
Pathological Society, April 22, 1814,1 I presented a placenta 
weighing only six ounces, discharged from a lady confined at 
full term. Throughout the substance of the organ were three 
lobes of fat, each about the size of a small hen-egg, which 
could easily be seen through the thick membranes of the foetal 
portion of the placenta as semitranslucent masses, while a very 
delicate transparent membrane was all that covered them 
on viewing the organ from its maternal surface. They were 
situated at equal distances from, each other, and midway be- 
tween the insertion of the cord and periphery of the placenta \ 
lines drawn from their distal extremities would have repre- 
sented a right-angled triangle. On removing the delicate mem- 
brane on the maternal surface they were found to be cavities 
filled with liquid fat, having their base and sides lined with 
soft yellow fatty tissue, showing complete destruction of at 
least one-third of the entire placental tufts. On the surface 
of the amnion over its entire extent were seen a large number 
of granular fatty spots, the size of small peas, which destroyed 
the usual transparency of healthy membrane giving to it a 
dirty yellowish and thickened appearance. 
The infant was a miserable, puny, and wrinkled boy, weigh- 
ing about five pounds, having barely sufficients, trength to 
cry. 
The mother, up to the time of marriage, had been a very 
healthy, rosy-cheeked, robust lady, but soon after conception 
she changed in appearance, became pale, fretful, and extremely 
haggard-looking, losing all energy and becoming so sensitive 
to slight variations of temperature as to have frequent attacks 
of bronchial irritation and leading her relatives to suppose 
her to have chronic pulmonary trouble. On examination 
1 Medical Record, p. 302, 18T4. 6 
her heart and lungs were found to be in an excellent condi- 
tion. She had been treated by several physicians for a variety 
ot troubles, yet from none did she derive any benefit. She 
had never had, to her knowledge, any sore on genital organs, 
nor any cutaneous eruption, nor any of the usual symptoms of 
■syphilis. When I first saw the father a short time after the birth 
of the child he was asked how long since he had had syphilis, 
which was answered by a positive denial, but inadvertently 
said that he had been troubled with a sore throat for several 
months, which on examination proved to be syphilitic. On 
being informed of this fact, he acknowledged that he not only 
had had chancre, but also had been covered with the secondary 
eruption ; that he had been told he was cured, but had always 
since been troubled with a tender sore throat. On examining 
the glans penis, distinct syphilitic mucous patches were then 
visible. 
Simple Fatty Degeneration from Placentitis, the Result of 
a Contusion.—Mrs. K., at the eighth month of her pregnancy, 
while returning from Brooklyn, was forcibly thrown forward 
in a collision, causing her to strike against the abdomen near 
the umbilicus. Considerable fever followed, but she went her 
full term, and I delivered her of a paralyzed child, with club 
feet, and having a large hsematoma over parietal bone. The 
child died in a few hours after its birth; the mother had a 
good recovery. The placenta showed evidences of placentitis, 
was adherent to the uterus, and evidently had been the seat of 
inflammation after the accident. 
Fibrinous Deposits in the Placenta; Hydrocephalic and 
Rickety Child, the Father haring Morbus Coxarius, and the 
Mother Cavities in both Lungs.—E. F, R,, aged twenty-two 
years, in consequence of phthisis pulmonalis, was advised not 
to marry. She had a severe cough of over three years’ dura- 
tion, frequent night-sweats, and latterly three quite profuse 
haemorrhages from the lungs. Her intended was deformed by 
hip-disease, there being about three inches shortening, and a 
false joint. 
They did marry, and her health immediately began to im- prove after conception had occurred. There was no nausea, 
hut her cough continued, with profuse expectorations of thick 
muco-purulent matter, fully four ounces in some days. 
She did not believe herself to be pregnant, and supposed 
the stopping of her courses due to extending disease of the 
lungs. She came to me for advice, and was then told to 
walk and ride in the open air, eat hearty nutritious diet, and 
do all to increase her strength, and to return at the end of the 
following month. Signs of pregnancy had now commenced 
to appear, by discolorations around the nipples, increased size 
of breasts, and abdominal distention. She still had a hard 
cough, and cavities in the lungs could be easily detected. 
Night-sweats occasionally occurred. 
April IT, 1867, after an easy labor she gave birth to a very 
feeble child, of eight months intra-uterine life. The mother 
had a tedious convalescence, but her cough diminished in se- 
verity, and after the first month she rapidly gained strength 
and flesh. The child was fed on goat’s milk, and throve very 
well. He is now over nine years old, and very precocious, 
with a head twenty-one and a half inches in circumference. 
He promises to be much stronger than either parent. 
The mother has since had two children, each the subject 
of chronic nasal catarrh. She easily gets cold and has a pro- 
tracted cough follow, but is to-day in far better health than on 
the day of her marriage. 
The placenta with each child contained large fibrinous 
deposits. 
Tuberculous Degeneration of the Placenta ; Child born at 
six months in conseguence of and during a Violent Parox- 
ysm of Coughing • Death of Mother thirty-seven hours after 
Delivery ; Death of Child twenty four hours after its Birth. 
■—September 29, 1868, I saw, for the first time, Mrs. P., 
aged twenty-eight years, the mother of one living child, and 
on examination found cavities in both lungs, and a large re- 
maining portion the seat of chronic solidification with ex- 
tensive pleuritic adhesions; each thoracic cavity contained 
about a pint of liquid. She stated that during the past year 8 
she had had almost constant fever, frequent night-sweats, and 
had rapidly lost strength. 
She did not suppose herself to he pregnant until after feel- 
ing the movements of the child for some time, which were al- 
ways feeble; the cessation of her menses, she was told, was in 
consequence of disease, far advanced, in the lungs. 
When I arrived, she was so much exhausted that we all 
expected death to occur at any moment. I had not been in 
the house many minutes, and before examining the uterus, the 
child was born during a very violent paroxysm of coughing; 
the placenta soon followed. Yery little haemorrhage occurred, 
and by means of pressure on fundus uteri it was kept firmly 
contracted. Brandy revived her a little, the cough was much 
less severe. She became cyanotic, bathed in perspiration, 
and died in thirty-seven hours, from insufficient lung-tissue 
to support life. 
Syphilitic Fatty Degeneration of the Placenta.—On June 
25, 1868, I visited a lady who aborted at her sixth month, a 
few moments after I arrived at her bedside, she at the time 
telling me that during the preceding six years she had several 
times aborted without any known cause, as she strongly de- 
sired to have children. The foetus was not so well developed 
as a child at that term, although the bony skeleton was as 
mature, yet there was a great deficiency of flesh, which hung 
loosely about the bones, the skin being wrinkled, the child 
having evidently died from absence of proper nutrition. 
The placenta was found to have undergone such extensive 
fatty degeneration as to prevent the free circulation of blood 
through its placental tufts ; it was carefully kept until the fol- 
lowing day, when Dr. S. T, Hubbard saw her. He then stated 
to me that at her previous abortion he had also found as the 
cause fatty degeneration of the placenta. I then endeavored 
to find a cause, but after careful inquiry and examination 
found none. Three years after, the father came to my office 
for copper-colored stains on skin of forehead, and acknowl- 
edged that, over fifteen years prior, he had had a very severe 
attack of syphilis. 9 
Apoplexy and Calcareous Degeneration of the Placenta.— 
October 30, 18T5, I delivered Mrs. S. of a boy weighing 
eleven and a quarter pounds. The father and mother were each 
twenty-six years old. The mother was perfectly healthy, had 
been married six years, this being her fourth child. The 
father, during his wife’s last pregnancy, had been very hysteri- 
cal, and on one occasion, after considerable scolding, had fallen 
to the floor, as his wife supposed in an attack of apoplexy. On 
ray arrival I found him grinding his teeth and having muscu- 
lar contortions, which they were trying to overcome by forci- 
bly restraining him on his back on the floor. The mother 
passed through all this excitement and did her part to control 
her husband. While I was in the house a telegram was re- 
ceived stating that their youngest child had been in convul- 
sions for the past twelve hours, and for the parents to come 
immediately a distance of over 200 miles. The mother then 
was four months advanced in pregnancy. After this all went 
on very well until the second day before delivery, which oc- 
curred at the end of the fortieth week of gestation, when she 
suddenly became very faint, while reaching to put clothing 
away on high shelves. Her labor was normal. The placenta 
was large and had a number of partially-organized clots in its 
substance. There were also a number of calcareous masses 
about the size of pigeon-eggs, which I supposed to have been 
the result of changes occurring at the period of excitement 
five months before delivery. 
The following case illustrates that cancer may not affect 
the placenta. 
Extensive Cancerous Disease of the Os Uteri; Apparent 
Cure ; Subsequent Conception and Delivery of Healthy Child 
at Full Term; Reappearance of the Disease; Death from 
Exhausting Hemorrhages seven months after Delivery; No 
Disease of the Placenta.—During the autumn of 1868, Mrs. 
E. P. C., aged twenty seven years, was treated by me for 
cancerous erosions of the os uteri which had caused frequent 
and profuse haemorrhages ; after three months’ treatment, I 
produced an apparent cure by the application of fuming 10 
nitric acid to all indurated and ulcerating parts, leaving 
the stump covered by a pale, healthy-looking, but almost 
bloodless mucous membrane. After this she became regular 
and did not have any ichorous, watery discharge between 
the menstrual periods, and on viewing all the parts to be 
seen she appeared to be cured. In a short time she be- 
came pregnant, had no trouble, and at the end of nine 
months, on December 6, 1869, I delivered her of a healthy 
girl; the disease very soon reappeared, was checked as much 
as possible until the last of June, when the ulcerations had 
caused a vesico-vaginal fistula. June 22, 1870, she was ex- 
amined in consultation by Dr. Thomas Addis Emmet. The 
disease extended rapidly and death soon followed from ex- 
haustion. 
In the Medical Times and Gazette, September 5, 1874, 
a report of the Obstetrical Society of London is given, 
where at the meeting of July 1, 1874, Dr. J. C. Hays ex- 
hibited a fatty placenta taken from a patient who furnished a 
very instructive history. She was thirty-seven years of age; 
married sixteen years. There were no grounds for any sus- 
picion of syphilis. She bore three living and perfectly 
healthy children. During her fourth pregnancy she received 
a severe fright, and shortly afterward was delivered prema- 
turely of an eight-months still-born foetus. Her health then 
began to fail, and in succession followed twelve still-born 
children, nearly all of which had reached at least seven 
months7 maturity. During the last four or five pregnancies 
she had suffered from serious and frequent haemorrhages, 
dating from the third month of gestation, and occurring 
sometimes every fortnight till labor supervened ; they were 
quite sudden and without any recognizable cause, and came 
in gushes not unfrequently during the night, unattended by 
pains. When first seen, February 7, 1874, she was four 
months advanced in pregnancy, and had had two serious 
losses of blood. She was very anaemic and extremely debili- 
tated. Rest was enjoined, and fifteen minims of the liq. ferri 
perchloridi prescribed thrice daily. Her color and strength 11 
rapidly came back, and there was no return of the haemor- 
rhage. Foetal movements were distinctly felt until within six 
days of labor, which happened at full term, and the foetus, 
though small, bore all the appearances of maturity, and seemed 
to have been dead about a week. Since the birth of her last 
living child gestation had never continued so long. The 
placenta was small, weighing only twelve and a half ounces; 
it had a pale-yellowish appearance, contained little blood, and 
nodules of fat, characteristic to the naked eye, were studded 
over the maternal surface, especially along its margin. 
The fatty change was most advanced toward its surface, a 
large portion of the decidua being merely an aggregation of 
oil-globules. The adjoining foetal villi, with the investing 
chorion, were seriously affected, but those close upon the 
foetal surface were simply granular in appearance. 
Dr. Hays, after referring to the investigations of Dr. Barnes, 
published in the Medico-Chirurgical Transactions, stated 
that he considered the disease in this case to have originated 
in the maternal portion of the placenta, this view being borne 
out by the weakly condition of the patient and the micro- 
scopical examination. 
Ho doubt the previous premature births and the haemor- 
rhages had been due to the same condition of the placenta. 
He could not regard the disease as originating in placentitis; 
this was contrary to all analogy. It was a degenerative 
change, occurring under the same conditions which induced 
fatty heart, fatty kidneys, and fatty arteries in the brain. 
Should the patient become again pregnant, the propriety of 
inducing artificially premature labor would be considered. 
Dr. Barnes thought that the case proved that the disease 
may originate during the life of the child. This notion had 
been controverted. It was said to take place after the death 
of the child. But it was hardly possible that all this mischief 
could have occurred in the short time after the death of the 
child; it was very much more likely to have preceded this 
event, and, in fact, caused the premature destruction of the 
child. As regards the change commencing in the maternal or 12 
foetal portion of the placenta, it affected mainly the villi of 
the chorion. He likened it to fatty degenerations of other 
organs, and had not stated that the change arose from placen- 
titis. The case was full of interest and. had important patho- 
logical bearings. 
Had the vice-president of this academy and one of their 
own honorary members been present at that meeting and 
known the results of a case almost analogous in every respect 
terminating during his absence, he could have given con- 
clusive evidence that this change in the placenta does occur 
during the life of the child, and that on the preceding June, 
in Kew York, a result had been obtained in proof that his 
theory was founded on fact. 
I will now give an illustrative case showing that extensive 
fatty degeneration of the placenta occurs during the life of the 
foetus in utero, and that the induction, artificially, of prema- 
ture delivery can accomplish the birth of a living child, which 
now at the age of three years is in excellent health and has a 
fine physique, the mother in this instance having become 
very anaemic in consequence of six rapidly succeeding preg- 
nancies, where the death of the foetus, or that of the child 
immediately after birth, was caused by degeneration arising 
in the placenta. 
Mrs. 8., aged thirty-seven years, at the time of marriage, 
considered herself to be in excellent health, not conceiving 
until the termination of the ninth month after marriage, 
when she almost immediately began to lose flesh and have 
constant nausea, which caused such debility that her husband 
spent the following season with her traveling in Europe. Mrs. 
B. continued to grow worse, and at end of her seventh month 
gave birth to a very feeble child, which lived about five minutes. 
Eleven months after she conceived the second time, and almost 
immediately her stomach rejected the food, and uncontrollable 
nausea and prostration followed; at the end of seven months 
and ten days, during a violent attack of vomiting, she was 
delivered of a dead, decomposing foetus; profuse haemorrhage 
followed for several weeks, leaving her very anaemic. In 13 
thirteen months she conceived the third time, nausea and 
vomiting reappearing, and a disinclination to take nourish- 
ment. This foetus also she lost at six and a half months, her 
attending physician then stating that the child had been dead 
over two weeks in utero. 
Shortly after this, while still very anaemic, she became 
pregnant for the fourth time, increasing very rapidly in size 
after the sixth month. At seven months the pressure on the 
diaphragm, from the increased size of uterus, in consequence 
of an abnormal accumulation of amniotic fluid, became so 
painful, that her only rest was while in the erect posture, and 
her only sleep was while she rested her arms, shoulders, and 
head on her piano (a table about forty inches high). This 
condition continued for two weeks, when, at the end of seven 
and a half months, acute lancinating pains in the diaphragm 
became so severe that general prostration ensued, almost 
proving fatal by syncope. Soon after rallying, uterine con- 
tractions commenced, and a very feeble, wrinkled child was 
born, only having sufficient strength to live for two hours. 
Her exhausted condition and frequent disappointments now 
caused her to be very melancholy; she refused sympathy, 
thinking that she could never accomplish her chief desire, 
viz., to have a child live. A change of residence to new 
scenes and associations enabled her to become both mentally 
and physically better, but yet quite weak, when she conceived 
for the flfth time, and placed herself under the care of Pro- 
fessor Fordyce Barker, who gave chlorate of potash and iron, 
at the same time paying particular attention to general hy- 
giene. She felt motion up to the end of the eighth month, 
when she complained of abdominal pains, for the relief of 
which morphia was given. She went about one week longer, 
when Dr. Barker delivered her of a child, it having been dead 
about four days. Dr. Barker now had an opportunity to 
examine the placenta, which he found to be far advanced in 
fatty degeneration, and determined, should she again become 
pregnant, to produce premature delivery whenever he found 
the foetal heart’s action becoming feeble, or signs of prostration 14 
in the mother alarming, waiting, if possible, until after the 
end of the eighth month. 
In May, 1873, just prior to Dr. Barker’s departure for 
Europe, he requested me to take charge of her, at the same 
time giving me a history of her previous and present preg- 
nancies, and stating his conclusions. 
She had then been married about twelve years, this being 
her sixth pregnancy ; she was very anaemic, the mucous mem- 
branes of mouth and conjunctiva being almost pearly-white; 
yet she was more cheerful, and endeavored to do all that was 
possible to regain strength. 
On June Ist I visited her, and found very little change 
in her condition, and, in accordance with suggestions, ex- 
amined all urine passed during the previous twenty-four 
hours; it measured twenty-eight ounces, was of a light amber 
color, specific gravity 1020, and did not contain a trace of 
albumen or sugar. Dr. Barker’s directions were continued, 
nothing of importance occurring until the morning of June 
24th, when I was hastily called to see her, and found that, in 
consequence of having eaten a large quantity of stewed green 
rhubarb on the previous night, she had acute indigestion, which 
in a few hours had caused severe vomiting and purging, and 
had lasted all night. On my arrival in the morning she was 
in a very much exhausted condition; the vomiting had ceased, 
but the purging and cramps were severe, accompanied by 
violent attacks of tenesmus. She was requested to lie down 
in bed, and while the hand was on abdomen a slight move- 
ment of the foetus was felt. 
On listening, the foetal heart could be heard and its pulsa- 
tions counted; the os uteri was rigid and not in the slightest 
degree dilated. With hand on her abdomen, and frequent 
listenings to strength of foetal pulsations, careful observation 
was continued for two hours, there being considerable difficulty 
in controlling her excitement, as well as the nervousness of her 
husband and relatives. 
By this time I noticed that the strength of the foetal heart- 
sounds was gradually failing, and the mother was becoming 15 
hysterical, I then told them that it was time to follow Dr. 
Barker’s advice, and immediately began to induce premature 
delivery, all willingly assenting. I commenced by gently 
pressing the forefinger against the rigid os uteri, and counter- 
pressure with opposite hand made over the fundus. The 
pressure was so gentle that it took nearly an hour to dilate 
the os sufficiently to allow the end of finger to enter, when 
the uterine contractions began with moderate severity, and 
occurred at regular intervals. This procedure was continued 
gently for five hours, when severe uterine pains began to such 
a degree that the father, in his excitement, urged me to save 
the mother, and not mind the child. At the end of one hour’s 
severe pain she gave birth to a small, wrinkled, and nearly 
dead child, not having sufficient strength to cry, only occa- 
sionally emitting a feeble whine, characteristic of the weak and 
premature child. It was immediately submerged, except face, 
in a bath of water at 100° Fahr., to keep it as warm as while 
in utero, and, after a very superficial washing, wrapped in warm 
blankets (not dressed), and the body surrounded by bottles of 
hot water, to supply that heat which its feeble condition ren- 
dered it incapable of generating. A few drops of water were 
given to the child, and it was left with the nurse to care for 
the mother, who became very much excited, apprehensive of 
losing her child. The placenta, by gentle traction and press- 
ure over fundus uteri, was expelled entire, and, on examina- 
tion, was found to have undergone extensive fatty degenera- 
tion. Post-jpartum pains of mother were relieved by morphia 
in quarter-grain doses. 
The child, when it was about twenty-four hours old, be- 
came cyanotic, cold, and gasped for breath, and was now 
too weak to emit the peculiar feeble whine of premature and 
dying children; fresh, soft flannels were warmed, in which 
it was wrapped, and spirits of camphor, on a small piece, di- 
rectly applied over surface of abdomen. The artificial heat, 
by means of bottles filled with hot water, was continuously 
applied, and the little one fed on its mother’s milk, which had 
been drawn by the nurse. For six days and nights this was 16 
continued, requiring the alternate attention of three expe- 
rienced nurses, and almost the entire time of the attending 
physician. On the sixth day the child had hepatitis, became 
decidedly jaundiced, had great tenderness over the liver, with 
marked enlargement and distinct induration, probably arising 
from umbilical phlebitis, although the navel appeared normal. 
The warmed applications of camphor on flannel were constantly 
kept on its abdomen, and, to relieve constipation, a piece of 
flaked manna, the size of a filbert, dissolved in water, was given, 
producing the desired effect in a very gentle manner. On the 
eighth and tenth days even the sclerotic membrane of each 
eye became of a canary-yellow color. The jaundice was very 
persistent, lasting more than six weeks, and all this time the 
child continued very feeble. When the child was three 
weeks old, a small red papule, about the size of a large pea, 
appeared on the inner side of the left knee; it was three lines 
in diameter and one in elevation, of a . dirty-red color, and 
had uneven edges. In six days partial desquamation, but no 
suppuration, occurred, leaving a decidedly copper-colored, 
saucer-shaped depression, which soon became of a darker cop- 
per color. 
Nothing at first was done for it, and at each visit the mother 
would inquire if I could not give her something to remove 
“ that copper-colored spot,” which seemed to annoy her very 
much. The nurse was directed to wet it thrice daily with 
sweet oil, so that its progress might be observed, and inspec- 
tion of the entire skin of child was made. Not a single other 
papule appeared on the skin. The mucous membrane at anus, 
and the surrounding integument, at the age of four weeks, 
assumed a red, coppery hue, which resisted the usual applica- 
tions for simple excoriations. The palms of hands and soles 
of feet were more red than usual, and wrinkled. The child 
continued very feeble, but was able to nurse. 
The parents stated that they did not remember ever 
having had any eruption, but I decided to treat the child by 
the inunction of the unguentum hydrargyri fort., a piece the 
size of a bean to be rubbed in groin and under the arms, also 17 
over abdomen, under the flannel band, twice daily, and around 
tbe excoriations at the nates. The inunctions had been ap- 
plied only a week before the irritated condition of the anus 
improved, and the copper-colored depression, which had also 
been anointed, commenced to fade, gradually doing so until 
the end of two weeks, when all cutaneous eruptions had dis- 
appeared ; the inunction, however, was continued in all near- 
ly three weeks without producing any salivation, the child 
continually improving. The child at the age of ten months 
had never had any return of the trouble, and continued to 
grow rapidly. It had no teeth, fed well, was cheerful, but 
rapidly developed at the frontal portion of cerebrum. The 
bones of the skull were serai-translucent, and the blue veins in 
temporal region distinctly visible; the bones of the legs and 
arms appeared normal, and intellectually the child was unusu- 
ally bright. At twenty-six months old I again saw her; she had 
been several voyages on the ocean, had remained in the country 
during the warmest part of the summer, had passed the win- 
ter months in the South; she had sixteen teeth, was very ac- 
tive, and physically and intellectually appeared as well as 
most children at the same age. 
The mother, previous to marriage, had enjoyed good health, 
but her frequent abortions and disappointments had caused 
her to become very anaemic and melancholy; she became so 
desponding that, at one time, fears were entertained that she 
might lose her reason, she spent the following season in 
Europe, and under Dr. Barker’s treatment and guidance im- 
proved so much that, as the previous history shows, she became 
a happy mother. 
The father, aged fifty-two years, denied ever having had 
syphilis; he had not been in good health for three years, and 
two years previous to the birth of this child had placed himself 
under my care. He stated that he had been almost constantly 
employed for twenty years, and for the past five years noticed 
failing health ; he then had constant headache, and a temper- 
ature of Fahr.; had had chronic bronchitis for several 
years, and was nervously prostrated ; had occipital and tem- 18 
poral pains whenever he took any violent exercise. On exam- 
ination of his urine, no albumen, sugar, or casts were found ; 
he had no valvular disease of heart, but that organ was ex- 
ceedingly irritable, and, following the slightest excitement,, 
it would violently palpitate, and the temporal arteries would 
become very much distended ; as he told me, felt like bursting. 
My diagnosis in note-book at that time stated : “ Commencing 
atheroma of cerebral arteries and fatty degeneration of mus- 
cular tissue of heart.” 
Conclusions.—Degenerations of the placenta are a more 
frequent and unrecognized cause of the death of the foetus 
than is generally supposed; these degenerations may com- 
mence early in pregnancy, and slowly progress until over 
one-half of the entire foetal tufts have been rendered useless 
before causing the death of the child. 
Cause of Degenerations.—Uterine or ovarian abnormali- 
ties; insufficient vitality of ovule ; disease of ovule ; insufficient 
vital force of the sperm ; disease of the sperm ; emotional causes 
from shock producing either paralysis, or partial or incomplete 
detachment of the placenta. 
Varieties of Degenerations of the Placenta observed during 
the past ten yeaYs.—Tuberculous degeneration ; calcareous de- 
generation; degeneration with extensive fibrinous deposits; 
anaemic degeneration, with atrophy; simple fatty from pri- 
mary placentitis; fatty degeneration from apoplexy of pla- 
centa; fatty degeneration from scrofula; fatty degeneration 
from syphilis ; waxy degenerations from leucocythemic mother.. 
The tuberculous placenta, to the naked eye, very much re- 
sembles the same condition found in the lungs, it being a solid, 
heterogeneous mass, not capable of being normally inflated, 
and on transverse section showing the yellow fibrinous de- 
posits, surrounded by tissues altered by inflammation, with 
cavities filled with pus and degenerated cheesy matter. 
Apoplexy of the placenta I believe to be caused by either 
violent rupture of the blood-vessels of the organ, or in 
consequence of some degeneration, where, as the result of 
overreaching, tension was exerted on the fragile, calcareous,. 19 
inelastic vessels, easily breaking them, and thereby permitting 
extravasation of blood into the surrounding tissue. - 
In placentas from very anaemic, emaciated mothers we find 
different conditions. If the exhaustion of the mother has been 
very rapid for a few weeks prior to child-birth, we have por- 
tions of the foetal villi representing a recent change into fat. 
In others, where apparently this fatty change has occurred at 
some more remote time, we find a shrinking, with little re- 
maining liquid oil-globules or fatty tissue, while in other por- 
tions of the placenta the lobes have entirely disappeared, and 
only a dense fibrinous substance representing how the organ 
has become contracted. 
Fibrinous deposits in the placenta have only been observed 
in those from mothers who are themselves very anaemic from 
some protracted blood disease, and whose blood is deficient in 
red corpuscles. The deposits have been observed in placentas 
thrown off’ as early as the seventh month, and, from the inti- 
mate connection of the deposits with the underlying villi, 
appear to have been the direct cause of preventing the proper 
nutrition, and therefore effecting the death of the child. 
Fatty degeneration of the placenta caused by syphilis mani- 
fests itself when the mother, as is usual, has an abundance of 
adipose cellular tissue, by several of the lobes being trans- 
formed into fat, which is apparent to the naked eye, being 
seen through the membranes as yellow masses, and on opening 
are found to be cavities filled with liquid fat, which can be 
poured out, and resembles the yellow olive-oil, the empty 
cavities being surrounded by a bright yellow placental sub- 
stance filled with microscopic oil-globules. 
Primary placentitis may be caused directly by violent 
contusions. After inflammation of the placenta has occurred, 
firm adhesions may follow, rendering it difficult to detach the 
after-birth from the womb. This is most readily done by in- 
troducing the entire hand into the uterus, and, with the little- 
finger on the ulna border edge, pass it beneath the placenta, 
and remove the entire mass with the hand from the uterus, 
when it generally remains contracted. This procedure I 20 
have several times resorted to, and not in a single instance 
have known any unpleasant condition follow. 
In waxy degeneration, as a rule, we have generally an unu- 
sually large placenta, which, when the uterine contractions 
have been protracted and severe, may be expelled, almost en- 
tirely freed from blood, and to the naked eye looks like a 
homogeneous mass, which, on being cooled, becomes hard, and 
can be easily cut into slices. Microscopically examined, under 
a high power, a profusion of very minute glistening oil- 
globules, in unbroken cellular tissue, can be seen. 
The children are generally like the parents, gross, fat, and 
phlegmatic, having a superabundance of the white blood-cor- 
puscles. 
The blood from the uterus is of a lighter yellow huffy 
color than that from healthy, robust parents. 
In regard to the treatment of either one or both parents, 
when syphilis is supposed to exist, the mercurial vapor-bath, 
will probably give a better success than by any other methods 
In phthisis pulraonalis, a gentle cathartic, if necessary to 
produce one movement from bowels each day, a generous 
diet, good hygiene, and the inunction of entire skin of body 
three times a week after a general bath. 
In scrofula the preparations of iodine, and, if admissible, 
iron, both in very small doses, viz, : tr. iodini co., mj. ter 
in die. 
In profound anaemia, where all treatment has either failed 
or is not admissible, where a degeneration of the placenta has 
been known to cause the death of the child, and the mother 
becomes again pregnant, and the same condition is feared, the 
artificial induction of premature delivery, at about the thirty- 
sixth week, gives the most favorable opportunity for the mother 
to have a child capable of living, as recommended by Dr. 
Hays and Dr. Barnes, at the London Obstetrical Society, July 
1, 1874; and, on the preceding month (June), successfully ac- 
complished, I believe for the first time, by Dr. Fordyce Barker, 
of Hew York.