HEMOPHILIA 



443 



philia had previously appeared, Senator believes, in the absence of other 

 causes, that he may assume a hematuria of hemophilic origin. The continued 

 hemorrhage resulted in a severe anemia which resisted all internal remedies, 

 and for this reason nephrectomy was proposed and performed. The organ 

 was laid bare and removed, although apparently unchanged. The further 

 course of the disease was very favorable. Upon the second day after the 

 operation the blood disappeared from the urine and never recurred. Four 

 weeks later the patient left the hospital entirely well. The examination of 

 the extirpated kidney showed small inflammatory foci and extravasations; 

 otherwise the organ was absolutely normal. 



I shall add to this two other analogous cases observed in v. Leyden's clinic 

 and described by G. Klemperer : 



1. A man, aged thirty-five, admitted to the clinic on the 15th of April, 

 1893. The father of the patient died of enteric fever, the mother is living 

 and since earliest childhood has suffered from frequent subcutaneous hemor- 

 rhages and marked bleeding even after insignificant injuries. A brother died 

 of hemorrhage during an amputation. Another brother of the patient is also 

 predisposed to hemorrhages. The patient himself, immediately after birth, 

 had a severe hemorrhage from the umbilical cord. In childhood hemorrhages 

 frequently occurred from the nose and other parts of the body after insignifi- 

 cant trauma. Prom his third year, he suffered from swelling of the joints 

 of the upper and lower extremities. As a rule these swellings occurred sud- 

 denly without cause, usually early in the morning ; they were extremely pain- 

 ful, but often disappeared on the same evening ; complete motility of the limbs, 

 however, did not return until some months after the attack. At fifteen the 

 patient had a fracture of the thigh and severe subcutaneous hemorrhages de- 

 layed normal recovery. His first attack of hematuria occurred at sixteen, 

 accompanied by dull pain in the right renal region, which soon became colic- 

 like; this was followed by nausea and vomiting. The urine was of a bloody 

 red or black color. This condition lasted for several months, the hemorrhages 

 recurring at intervals of from six months to two years. One attack of hema- 

 turia lasted thirteen weeks. The patient did not seek professional aid, as 

 he believed himself to be a bleeder, and looked upon the hematuria as a symp- 

 tom of the general affection. During the attacks he remained quiet, and 

 relieved the pain by large doses of morphin which had first been used at the 

 time of the enlargement of the joints. The patient came to the clinic princi- 

 pally for the treatment of his morphinism. He is pale, nervous ; the internal 

 organs are normal. Upon the fourth day after admission a renal hemorrhage 

 occurred which lasted for two weeks. The urine contained pure blood. The 

 patient was discharged cured upon the 15th of May, 1893. Toward the end 

 of his stay in the hospital two hemorrhages into the wrist-joints occurred. 

 Subsequently this happened quite frequently. Up to March, 1896, the hema- 

 turia had not recurred. 



2. The other case was that of an official aged twenty-six years, the history 

 showing but slight hereditary predisposition. The patient himself was a 

 bleeder. From the age of sixteen, almost every year attacks of hematuria 

 occurred, which occasionally were repeated several times in the year, and lasted 



