HEMOPHILIA 425 



globin (30 to 35 per cent., according to Sahli), macrocytes, poikilocytes, 

 microcytes, increase of blood-plaques; no leukocytosis. These conditions im- 

 proved under suitable treatment (good nutrition, fresh air, processes for 

 hardening the body, avoidance of everything detrimental to health). I should 

 like to mention here that frequent inhalations of oxygen did not show the 

 slightest influence upon the general condition or upon the composition of 

 the blood. 



6. Cohen reports a very remarkable blood finding in a bleeder (Zeitschr. 

 f. Tclin. Med., Festschrift, 1890) : The blood was almost colorless, did not 

 coagulate upon beating, and upon standing left only isolated, friable, white 

 coagula of fibrin of the size of a bean; microscopically the well-known poly- 

 morphia of the red blood cells was found, such as occurs in anemic conditions, 

 but no rouleaux formation. 



Various theories have been proposed in literature as to the origin of hemo- 

 philia. Among the best known that of Immermann is the most important 

 and most widely circulated. It depends upon certain views of Virchow to 

 which we have already in part referred, but to which we must now recur. 

 Immermann expounds this theory in the following way : 



Hemophilia is a form of the hemorrhagic diathesis which is chiefly charac- 

 terized by a hereditary predisposition ^ and a habitual manifestation ; the 

 hemorrhages which are readily produced, frequent, severe, stubborn, and dan- 

 gerous, are chiefly caused by a hereditary and habitual disproportion between 

 the Hood volume and the capacity of the vascular apparatus, which results in 

 an unusual increase of secondary pressure in the latter. Functional erethism 

 of the heart and unusual development of its muscles may in some cases of the 

 affection be responsible for the production of hemorrhages, as well as for its 

 abnormal clinical course, and for the tendency to fluxion in the affected indi- 

 vidual ; possibly ■ other neurotic influences may occasionally arise to increase 

 periodically the continuously fluxionary diathesis. 



Oertel expresses himself likewise regarding the nature of hemophilia. He 

 is of the opinion that hemophilia is to be regarded as a hydremic plethora of 

 high degree. Following the same train of thought as Immermann and Oertel, 

 G. Cohen (Zeitschrift f. hlin. Med., Festschrift, 1890) has founded a general 

 treatment of hemophilia, the main object of which is to combat the hydremic 

 plethora by an energetic cataphoresis and diuresis. The decided improvement 

 which Cohen brought about — this refers only to a single case — furnishes some 

 evidence of the correctness of this theory. 



Cohen's patient was the ninth of eleven children and was born in 1852; 

 at the time she came under treatment she was thirty-eight years old. Her 

 father suffered repeatedly from severe ejiistaxis; twice tampons had to be used. 

 A grandchild of her sister suffered from morbus maculosus with effusion of 

 blood into the joints and renal hemorrhages and died of this disease when 

 twenty years of age. There is no other history of hemophilia in the family, 

 except a severe hemorrhage after extraction of a tooth in an older sister of 

 the patient. This patient was a delicate chlorotic girl, with scant menstrua- 



' DiflFerently expressed : " The heredity of certain pathological properties." 



