HEMOPHILIA 431 



of instances the large arteries and their first branches show an unusually 

 narrow lumen. In the examination of the structure of the larger and smaller 

 arteries, the extremely thin, sometimes actually transparent condition of the 

 intima is often conspicuous. Partial fatty degeneration is not rarely observed. 



Virchow called attention to the smallness of the heart in hemophilia, to 

 the narrowness and thinness of the walls of the vessels, which is similar to that 

 in chlorosis. On account of the rarity of autopsy reports in this disease, it is 

 highly interesting to refer, to this finding in a case observed by Virchow, 'upon 

 which he held an autopsy, and which he has detailed {Deutsche Klinik', 1859, 

 and Canstatt's Jahresl., 1859). " The blood, as in other cases of hemophilia' 

 was not deficient in fibrin; it formed a decided bufEy coat. The arteries and 

 veins showed no large ruptures — in fact, no conspicuous changes ; the hemor- 

 rhages, therefore, must have been from the capillaries. The veins were very 

 wide, the arteries very elastic and narrow. The capillaries and nerves showed 

 no decided alterations. In the central part of the vascular apparatus an 

 abnormality was found which was certainly congenital ; the thymus gland was 

 still very large, the heart pale and small, the aorta narrow, its walls thin and 

 very elastic, with wavy rises due to slight sclerosis and fatty degeneration of 

 the intima, particularly in the descending thoracic aorta. This entire finding 

 closely resembled chlorotic conditions to which I (Virchow) have previously 

 called attention. The development of the heart from the aorta is much re- 

 tarded in chlorotics; enlargement of the heart is late and occurs only occa- 

 sionally. Hemorrhages are very frequent and severe in chlorotics, and these 

 can probably be traced to the arterial changes which have been observed; at 

 all events the round ulcers of the stomach which occur chiefly in chlorotics 

 certainly bear a relation to individual arteries. There is much in favor of the 

 congenital, or at least very early, development of the predisposition to chloro- 

 sis; and this may be positively maintained in the case of hemophilia. The 

 blood collected from this case rapidly decomposed, depositing xanthoglobulin 

 crystals as well as triple phosphates and leucin. This case teaches us that in 

 hemophilia it is not an unusual fluidity, a dissolution of the blood, which 

 produces the tendency to hemorrhage, because blood rich in fibrin, just as in 

 scurvy, may be found in the hemorrhagic diathesis. Noivhere was tendency 

 to rupture of the Mood-vessels noted. Therefore the question arises whether, 

 in this case, as in chlorosis, the narrowness and extreme elasticity of the 

 vessels (arteries) so increase the blood-pressure in the capillaries that a pre- 

 disposition to rupture and consequent hemorrhage is produced. In this case 

 the cause of the hemorrhagic diathesis was to be sought in a deficiency of the 

 vascular formation, and it is certainly noteworthy that the thymus gland had 

 persisted for so long a time." 



Virchow, therefore, considered retardation of vascular development to be 

 an especial pathologico-anatomical sign in hemophilia. He observes, how- 

 ever, that exactly the same conditions as were noted by him in hemophilia 

 occur also in chlorosis. The question why retardation in vascular develop- 

 ment causes two such entirely different diseases as chlorosis and hemophilia 

 has not yet been answered. If we are inclined to be critical, we may assume 

 from this condition of affairs that retardation of vascular formation cannot 



