HEMOPHILIA 427 



lasting for hours, by effusions of folia Jaborandi, fior. tiliae, and the admin- 

 istration of large doses of digitalis. The patient was cured at the age of 

 thirty-eight after suffering from the disease for twenty-five years. 



In the study of the etiology of hemophilia, those who adhere to the Im- 

 mermann-Oertel theory doubt much the prominent role which the hereditary 

 narrowing of the aortic system is said to play. This hereditary anomaly also 

 produces chlorosis, a disease which, in spite of the similarity of individual ana- 

 tomical relations, has nothing in common with the manifestations of hemo- 

 philia. It may possibly be opposed to this that a second injurious factor, an 

 abnormal composition of the blood, is added to the smallness and narrowness 

 of the vascular system, and from this combination hemophilia arises, or, more 

 correctly, some of the symptoms of the affection. In opposition to this is the 

 fact that the examinations of the blood in hemophilia up to the present time 

 have shown nothing constant nor positive; only in quite isolated instances 

 have microcytosis, macrocytosis, poikilocytosis, and absence of rouleaux for- 

 mation been observed. Similar deficiency of hemoglobin in the erythrocytes 

 and in the total blood has been repeatedly noted in anemic individuals after 

 successive hemorrhages (especially of a traumatic or neoplastic nature) with- 

 out the tendency to an acquired hemorrhagic diathesis, so that a characteristic 

 or pathognomonic significance cannot be ascribed to it. All hypotheses which 

 attribute hemophilia to an abnormal composition of the blood are lacking in 

 the proofs upon which a scientific proposition should be based. 



That hemophilia is a neuropathic diathesis is v. Kecklinghausen's hypothe- 

 sis (Handbuch der Allg. Pathol, des Kreislaufes und der Erndlirung). In 

 the next article, when describing morbus maculosus, we shall refer more 

 minutely to the spontaneous hemorrhages due to the vasomotors, and shall 

 here only mention that this author ascribes to these hemorrhages (in support 

 of his theory) the prominent nervous symptoms which occur in certain cases 

 of hemophilia and occasionally in entire families of bleeders. But the ques- 

 tion arises whether in a general disease such as hemophilia the spontaneous 

 and unexpected manifestations which occur may not naturally. keep the patient 

 in a constant state of tension and expectancy, and thus implicate the nervous 

 system, and whether or not the nervous disturbances are of a secondary 

 nature. 



Finally, we must mention another view, already referred to in scurvy, that 

 hemophilia is a toxic infectious disease. This is the opinion of W. Koch of 

 Dorpat, but it has received but slight attention in scientific circles. Koch, 

 in his book " Bleeder's Disease and Its Varieties," analyzes the evidence on 

 which is based the conception of hemophilia as an independent affection. He 

 criticises adversely the reports of the disease which have been obtained up 

 to the present time. He points out how faulty these are, and their many 

 contradictions. The conclusion which he reaches is, approximately, that hemo- 

 philia is not an independent disease, but that it is an infectious disease and 

 identical with scurvy. " I believe," says Koch, " that the blood of hemophilics 

 exudes through the walls of the vessels, which give no evidence of anatomical 

 change, because specific toxins are mixed with the blood ; I therefore believe 

 hemophilia to be an infectious disease, and, on account of the coincident symp- 



