HEMOPHILIA 451 



Desnos has seen in a large number of gouty patients hematuria which 

 either preceded or followed the attacks of gout. This gouty hematuria was 

 either accompanied by renal colic or ran its course without pain; the condi- 

 tion may be brought about by " congestion," but may find its explanation fre- 

 quently in the influence of stone. 



On account of limitation of space, it is impossible for me to discuss more 

 minutely the literature of the last few years, and I shall refer only to the 

 very comprehensive discussion in the Berlin Society of Internal Medicine in 

 January, 1903, of the excellent article of Professor Senator, " Renal Colic, 

 Eenal Hemorrhage and ISTephritis," which gives succinctly the views regard- 

 ing these questions of such prominent authors as Senator, James Israel, G. 

 Klemperer, and L. Casper. Any one desiring to learn the present status of 

 this question will find in this source material upon which to form his opinion, 

 although it is impossible at this time to state a definite conclusion. The sub- 

 ject is still open to discussion, and the combined labors of the surgeon and 

 the internal clinician will be required to clear it from all doubt. 



I must emphasize a fact which is frequently observed, that in hemophilia, 

 hemorrhages from other parts of the body cease when hematuria occurs. 



Senator was the first to throw light on this dark subject, and it is cer- 

 tainly owing to his labors that some renal hemorrhages have been recognized 

 as of hemophilic origin. Although some have doubted whether, in his case, 

 the condition was actually renal hemophilia or, on the contrary, hemorrhage 

 due to another and, at that time, unrecognizable cause, there is much in favor 

 of his view that cases of hereditary renal hemophilia have lately been observed 

 (Attlee and Guthrie, St. Bartholomew Hospital Journal, December, 1901, and 

 The Lancet, May 3, 1903, xviii; compare also Senator, "Renal Diseases," 2d 

 edition, p. 515, additions). KTo matter how we view this condition it is greatly 

 to Senator's credit, and will remain so, to have been the first to recognize the 

 just importance of, and to throw the proper scientific light upon, the under- 

 lying cause ! 



Hematuria must not be looked upon as the only local hemorrhage in hemo- 

 philia. ' Under similar circumstances pulmonary and gastric hemon-hages are 

 occasionally noted in bleeders, at the age of puberty or even later, who have 

 until then been free from hemorrhage, and for these there is not the slightest 

 anatomical basis. Cases of hematuria have awakened interest especially by 

 their being unilateral, and also because it has been possible by operative pro- 

 cedures to make an exact and certain diagnosis during life, which is impossi- 

 ble in the ease of other organs, particularly of the stomach and lungs. In the 

 future the diagnosis of essential hematuria will necessitate much greater 

 exactness. 



PROGNOSIS 



The prognosis of hemophilia is unfavorable : 60 per cent, of bleeders suc- 

 cumb before the eighth year of life and only 11 per cent, reach the twenty- 

 second year. After puberty the chances are somewhat better; but, even in 

 later life, a slight injury may terminate fatally. In a family in Finland in 

 five generations from a'stock not previously hemophilic fourteen male descend- 



