Report of a case of hemophilia / by G.S. Towne.

  • Towne, G.S.
Date:
1910
Catalogue details

Licence: In copyright

Credit: Report of a case of hemophilia / by G.S. Towne. 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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    ditions under which the disease may thus arise in healthy stock. The hereditary transmission of this disease is truly remarkable. Osier mentions the Appleton-Swain family of Reading, Mass., in which there have been cases for the past two centuries, cover- ing a series of seven generations. The usual mode of trans- mission is through the mother, who is not herself a bleeder, but the daughter of one. The reversion to the ancestral stock through the mother alone is almost the rule, and the daughters of a bleeder though healthy and free from any tendencies are almost certain to transmit the disposition to the male offspring. A peculiar fact also is the ratio of cases which occur between the sexes. One author places the ratio at eleven males to one female, another at thirteen to one. As a rule the disease makes its appearance during the first two years of the patient’s life. It is rare for the manifestations to be delayed until the tenth or twelfth year. Again, all grades of social life are equally alfected. Such families of bleeders are usually large, the members very healthy in appearance with fine soft skins. The pathology of this most interesting disease is obscure. While a congenital fragility of the vessels is said to exist, it has never been proven. It has been observed that bleeders always suffer from prodromic symptoms which are due to an increase in the volume of blood. Hence variability in the volume has been invoked as causal. Disturbed innervation diminishing from time to time the vascular tone is thought by Musser, Pierce and others to be the pathological factor. It is mere hypothesis, as have been all suggestions thus far put forward, regarding the pathology of hemophilia. As suggested by Eicharst it may be possible that the changes in the blood are chemical and that our present laboratory methods are not adequate to discover them. Attention is commonly called to a bleeder by the occurrence of a hemorrhage difficult to control though induced by some trifling cause. The extraction of a tooth is one of the most frequent of these events. It may be the prick of a pin or a scratch or a slight cut as in vaccination or nothing at all may be discovered. The tendency may manifest itself at the umbil- ical cord at birth or in Jewish children at the circumcision. On the other hand the same accidents which are without results early in life may induce it later. Uncontrollable epistaxis is one of the most frequent manifestations, occurring in 169 out of