Hereditary haemophilia : deficiency in the coagulability of the blood the only immediate cause of the condition / by Thomas Addis.

  • Addis, Thomas, 1881-1949.
Date:
1910
Catalogue details

Licence: In copyright

Credit: Hereditary haemophilia : deficiency in the coagulability of the blood the only immediate cause of the condition / by Thomas Addis. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    with the tissues coagulates. In doing so it forms a firm barrier against the access of more thrombokinase to the blood in the central part of the wound. Bleeding continues through a funnel of fibrin lining the sides of the wound. The reason why such a partial coagulation occurs in haemophilia will be made clearer by giving the details of an experiment on the effect on the coagulation time of haemophilic and normal blood of adding varying amounts of thrombokinase.7 This was done by running various dilutions of thrombokinase through the glass tubes immediately before they were filled with freshly drawn blood. That amount of thrombokinase which remained adhering to the walls of the tube mixed with the blood and exerted its effect. The temperature was 20° C. Coagulation time of the Coagulation time of the Coagulation time of the blood of Case III. blood of Case IV. blood of a normal person. rombokinase (The coagulation time (The coagulation time (The coagulation time solution. without the addition of without the addition of without the addition of any thrombokinase was any thrombokinase was any thrombokinase was 68 minutes.) 74 minutes.) 10 minutes.) min. sec. min. sec. min. sec. 0-4% 4 30 2 30 2 30 3 0 2 30 2 0 0-1% 5 30 5 15 3 30 6 30 4 15 3 0 05% 7 8 30 0 7 7 0 0 4 4 15 0 0-25% 13 30 9 0 5 45 10 30 8 15 5 15 0-125 % 24 22 45 30 17 0 6 5 30 15 0*062 % 36 41 0 0 33 23 0 0 6 5 15 45 0-031 % 47 45 0 0 48 75 0 0(?) 8 8 45 0 From these figures it is seen that while with large amounts of thrombokinase coagulation may be as rapid as that of normal blood, with smaller amounts, even such as are sufficient notably to accelerate the coagulation of normal blood, there is still a very prolonged coagulation time. This has an evident bearing on the question of the continuation of haemor- rhage in haemophilia in spite of the presence of clots in and around the wound. When an incision is made through the skin the blood streams from the vessels and fills the cavity caused by the retraction of the tissues. Thrombokinase comes from the injured cells and mixes with the blood which is in contact with the sides of the wound. It is here that there is the greatest concentration of thrombokinase and here also that the flow of blood is somewhat retarded. The coagulation of the part of the blood in contact with the tissues is thus markedly accelerated, so that it may coagulate and leave a film of fibrin adherent to the tissues. But in the more centrally situated blood the concentration of 7 The thrombokinase was obtained from a human testicle. The gland was stripped of its coverings and weighed immediately after its removal from the body. It was then ground up in a mortar with sand, extracted for some hours with that amount of distilled water which gave a solution of 4 per cent, and finally filtered and heated to 100° C.