The determination of the exact cause of death in the new-born is often very difficult or impossible. In many cases no adequate lesions can be found to explain the occurrence of sudden death in the first days or weeks after birth. Among the more frequent causes of such deaths are congenital syphilis, asphyxia neonatorum (cardiac syphilis, presence of amniotic fluid, etc., in respiratory passages, congenital cardiac lesions, injury to brain, meningeal or cerebral hæmorrhage, congenital marasmus, intra-uterine infections, umbilical infections, enlarged thymus, “overlying,” poisoning, congenital hæmophilia, melaena neonatorum, etc.), adrenal hæmorrhage, malformations of gastro-intestinal tract, absence of common duct, nephritis, pneumonia, etc. The most important congenital infections are syphilis, gonorrhœa, tuberculosis, variola, typhoid, pyogenic infection, tetanus, measles, scarlatina, influenza, meningitis, malaria, recurrent fever, pneumococcus, colon bacillus and others, mostly very rare. Congenital leukæmia has been observed. Numerous cases of congenital neoplasm have been reported (hæmangioma, lymphangioma, fibroma, lipoma, neurofibroma, papilloma of the larynx, adenoma, carcinoma [liver, kidneys, stomach, intestine], cystic tumors of liver, pancreas, kidneys and ovary, rhabdomyoma or rhabdomyosarcoma of kidney, heart, etc., adenosarcoma of kidney, dermoid cysts and various forms of teratomata). Congenital syphilis is so common and such an important condition in the new-born that especial search should always be made for evidence of its presence. Smears of all the organs should be made in the cases examined soon after death, and either stained or examined at once by the dark-field method for the presence of the spirochæte. The most common anatomic manifestations of congenital syphilis are pemphigus, macules, papules, or maceration of the skin, white pneumonia, cardiac dilatation due to interstitial myocarditis, interstitial hepatitis, splenic enlargement and osteochondritis syphilitica. The long bones should always be examined for the last-named condition; they should be removed and cut longitudinally. In the boundary between epiphysis and diaphysis the presence of a yellow, hard zone points to this condition. The area of ossification is increased, irregular, and is separated from the bone by the yellowish zone, which in its earliest stages is soft and cellular, later sclerotic. The area of proliferating cartilage is also increased and may contain medullary spaces, showing as red lines. In rachitis the ossification-zone is wholly or partly wanting, while the zone of proliferating cartilage is broader and rich in red medullary spaces. In place of the ossification-zone there may be present a layer of soft, grayish-white osteoid tissue containing medullary spaces. No sharp line exists between the different zones. CHAPTER XIV. THE MEDICOLEGAL AUTOPSY.