Case in a 12-year-old boy whose five brothers and sisters had died of haemo philia. Ffirth (inter. klin. Hunch., Sept. 16, 'SS).
It is generally possible to demonstrate the hereditary character of this affec tion, which is the most hereditary of all disease. F. 1'. Henry (Boston 111(41. and Surg. Jour.. Mar. 14, '95).
Case of retinal haemorrhage seen in a patient giving a family history of haemo philia for four generations. The right eye, blind for eight years, showed the remains of an old haemorrhage into the vitreous. In the left eye there was a small, recent hemorrhage of the retina, with apparently miliary aneurisms on the retinal artery. Recovery of sight in the left eye was attained by absolute rest, milk diet, and the administration of iodide of potassium internally. Violet (Reeneil d'Ophtal., June, History of a personal ease of hem ophilia. Five of the children of the patient's great-grandmother died early, and none of the others, save one, now survives. Of these, three children out of the six known to patient's mother died young. This accords with the fact that a large percentage of the bleeders die early. Contrary to the usual state ment, both the males and the females seem to have been bleeders, but only one (a male) died from the effects of hemor rhages. The preponderance of the males is seen in two of the families named. This excess of sons over daughters has been given as a reason for the rarity of this disease.
The bleeding tendency in each instance was transmitted through the females. IV. R. Steiner (Johns Hopkins Hosp. Bull., Feb., 1900).
Among other etiological factors con sidered are a lack of fibrin or of fibri nogenous elements and neurasthenia bearing mainly upon the vasomotor con strictors.
Case of a girl of 16 years, in good health and with no marked history of hysteria, who began to bleed from the pulp of her fingers. This occurred with out provocation and without rupture of the skin, and was not attended by any further symptoms, excepting despond ency, almost amounting to melancholia. Yahoubian (Gaz. Med. d'Orient., Mar.
15, '01).
Case of a young woman who suffered from epistaxis, menorrhagia, metros. rha2ia, hremorrhagic diarrhcea, etc., al ways accompanied by great mental strain, fits of crying, fright, anger, and the like; at times, death seemed immi nent. Anderson (Sled. and Surg. Rep., Mar. 28, '91).
Pathology.—The prevailing view is that haemophilia is mainly due to a mor bid condition of the vascular walls, and affecting especially the middle or mus cular layer. According to Kuhlmann, the changes are such as to seriously com promise the anatomical and physiological functions. These changes are: Granu lation-necrosis occurring in tuberculosis, syphilis, leprosy, etc., and due to direct chemical changes between the ological products of certain organisms and the protoplasm of the histological elements; amylosis occurring during tensive suppuration processes, and due to a similar direct change; necrosis or mucoid degeneration ring in cancerous and diphtheritic proc esses; liquefaction - necrosis occurring in typhus, variola, etc.; fatty and calca reous degeneration, in which the plasm is replaced by fatty granules and crystals of carbonate and phosphate of lime. The vasomotor system doubtless plays a part in the process.
It is possible that abnormal alkalinity of the blood may, by impairing the ca pacity of the blood for coagulation, assist in the production of hmmorrhages.
Syphilis may manifest itself in an htemorrhagic diathesis. Gregorio Cosella (Arehivii Ital. di Clin. Med., July, '89).
Essence of haemophilia believed to lie in a heightened activity of the blood making organs, the haemorrhages into the joints and elsewhere being regarded as discharges, or eliminations of super fluous blood. M. Cohn (Centralb. fiir klin. Med., Oct. 12, 'SD).
In a case of repeated and excessive epistaxis in a man of 49 years lime-water in liberal quantity caused the hmmor rhage to cease and remain absent until the patient neglected the use of the remedy. Watkins (N. Y. Med. Jour., Aug. 13, '92).