IIEMOI'IIILIA 297 



liver, but if iniicli blood has been lost by lieiiioiThage on free surfaces, 

 the iron conteiit of the liver is decreased, as it is taken away to form 

 new hemoglobin (Quincke).-^ Excretion of bile-pigments is in- 

 creased by destruction of blood (Stadelmann), but not greatly in 

 the case of hemorrhages, for the blood is decomposed and absorbed 

 too slowly. Schurig -* found that hemoglobin injected into the tis- 

 sues is partly decomi)osed in situ with formation of iron compounds, 

 but the greater part enters the circulation as hemoglobin, and is 

 partly converted into bile-pigment by the liver-cells, the rest being 

 converted into simpler iron compounds by the spleen, bone-marrow, 

 and renal cortex. 



If the hemorrhagic extravasation has been large in amount, the 

 deeper ])ortioiis of the mass are not soon, if ever, invaded by leuco- 

 cytes or tissue-cells. Consequently the blood is acted upon very 

 slowly by the enzymes liberated by the leucocytes it contains itself, 

 and by the small amounts of proteases in the serum. Furthermore, 

 the products of decomposition are not soon absorbed, but accumulate 

 in considerable amounts, so that we often find crystalline deposits of 

 hematoidin, sometimes even of hematin, hemoglobin, or parahcmoglo- 

 hin- (Nencki) -"' or methemogJohin. 



The least soluble constituent of the red corpuscle stroma, choles- 

 terol, also accumulates in such extravasations as large, thin plates ; 

 after most of- the other products of distintegration have been absorbed 

 from such accumulations of blood, the most conspicuous part of the 

 residue may be a mass of cholesterol crystals imbedded in prolifer- 

 ating connective tissue. 



HEMOPHILIA 2G 



There are several pathological conditions associated with increased 

 tendency to bleeding, notably scurvy and the various forms of pur- 

 puras, but especially the remarkable hereditary condition, hemophilia. 

 In the purpuric diseases various of the factors concerned in coagula- 

 tion of the blood have been found altered,-"''' notably the blood plate- 

 lets,-^'' but Howell found no change in either prothrombin or anti- 

 thrombin in purpura hemorrhagica and other related conditions. 

 Similar negative results were obtained in scurvy by Hess.-*"= Melena 



fluorescent from absorbed pigment, according to !Marie and Lcri, Union Pharm., 

 Aug. 15, 1914. 



23Deut. Arch. klin. Med., 1880 (25), 567: 1880 (27), 103. , 



24 Arch. exp. Path. u. Pharm., 1808 (41), 29. 



23 Arch. exp. Path. u. Pharm., 1886 (20), .3.S2. 



26 Literature and resume given bv Stonipcl, Cent. f. Grenzgel). ^Ted. ni. Chir.. 

 1900 (3). 753; Sahli, Zeit. f. klin. :\ied.. lOO.i (56), 294: :Marchand, in Krehl and 

 Marchand's Handb. allg. Pathol., 1912. II (1), 307. Also later references in this 

 text. 



26a See Hurwitz and Lucas, Arch. Int. Med.. 1916 (17), 543: Minot ei ah, ibid.^ 

 1916 (17), 101. r">. 



26b See Lee and Robertson, Jour. Med. Res., 1916 (33>, 32*r 



26cAmer. Jour. Dis. Children, 1914 (8), 386. 



