HEMORRHAGE 245 



formed during normal katabolism of hemoglobin, and they meet 

 the same fate in the end. 



If the hemorrhages are very abundant, some hemoglobin 

 may be absorbed as such and appear in the urine, but this prob- 

 ably seldom happens unless red corpuscles are also being 

 destroyed in the circulating blood. An increased amount of iron 

 accumulates in the liver, but if much blood has been lost by 

 hemorrhage on free surfaces, the iron content of the liver is 

 decreased, as it is taken away to form new hemoglobin (Quincke ' ). 

 Excretion of bile-pigments is increased by destruction of blood 

 (Stadelmann), but not greatly in the case of hemorrhages, for the 

 blood is decomposed and absorbed too slowly. Schurig 2 found 

 that hemoglobin injected into the tissues is partly decomposed 

 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 

 iron compounds by the spleen, bone-marrow, and renal cortex. 



If the hemorrhagic extravasation has been large in amount, 

 the deeper portions of the mass are not soon, if ever, invaded 

 by leucocytes 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 parahemoglobin (Nencki 3 ) or 

 methemoglobin. 



The least soluble constituent of the red corpuscle stroma, 

 cholesterin, also accumulates in such extravasations as large, thin 

 plates ; after most of the other products of disintegration have 

 been absorbed from such accumulations of blood, the most con- 

 spicuous part of the residue may be a mass of cholesterin crys- 

 tals imbedded in proliferating connective tissue. 



HEMOPHILIA * 



Since hemophilia seems, superficially at least, to depend upon 

 some alteration in a chemical property of the blood, namely, 

 coagulability, it is frequently regarded as an example of heredi- 

 tary transmission of a chemical peculiarity. The exact cause 



1 Deut. Arch. klin. Med., 1880 (25), 567; 1880 (27), 193. 



2 Arch. exp. Path. u. Pharm., 1898 (41), 29. 



3 Arch. exp. Path. u. Pharm., 1886 (20), 332. 

 * Literature and resume given by Stempel, Cent. f. Grenzgeb. Med. u. Chir., 

 1900 (3), 753 ; Sahli, Zeit. f. klin. Med., 1905 (56), 294. 



