422 



THE HEMORRHAGIC DIATHESES 



healthy may develop symptoms of hemophilia. These conditions, which in 

 themselves cannot be accounted for, are increased in importance by the fact 

 that spontaneous cases of " hemophilia " vrhich develop in later life occur only 

 as quite localized hemorrhages limited to an individual organ. 



Regarding the geographic distribution of the disease it appears that Ger- 

 many furnishes the main contingent of cases; yet other countries are not 

 entirely exempt from the disease. The following table, compiled by Gran- 

 didier, gives the following figures : 



The actual causes of hemophilia are entirely unknovna to us; everywhere 

 we meet with hypotheses. If the disease, as is assumed, be a parablastic 

 disturbance this may take place in the course of fetal development in two 

 ways; either in a greater or less development of the connective tissue germ 

 or because individual portions of this structure suffer particularly. Of special 

 importance is the fact that it is the maternal element which transmits the 

 disease without being itself necessarily involved, this property being an inherent 

 function of the maternal body, and much more marked in the feminine 

 descent than in the masculine. This faculty can exist only in the parablastic 

 tissue, and especially in the vascular system which arises from it. Conse- 

 quently it is very likely that the parablast, of all the tissues of the organism, 

 is most influenced by the mother, being less subject to paternal impressions 

 than any of the other constituents. 



There are two factors which stand out prominently in the investigation of 

 the causes of the disease : ilie structure of the vascular system and the com- 

 position of the Mood itself. As hemophilia is not to be considered a temporary 

 but a permanent pathologic condition which is congenital and hereditary, we 

 are compelled to assume a disturbance in " the first formation," which affects 

 a portion of the connective tissue germ. Nevertheless, hypotheses of this 

 nature are not at present capable of verification by scientific investigation; 

 therefore, in regarcl to the actual condition, we have been compelled to rely 

 upon the scant anatomical findings which have now and then been reported, 

 but which, considered collectively, have not solved the puzzling nature of the 

 disease in question. 



