Volume 2

Treasury of human inheritance / edited by Karl Pearson, R.A. Fisher, L.S. Penrose.

Date:
1909-
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Treasury of human inheritance / edited by Karl Pearson, R.A. Fisher, L.S. Penrose. Source: Wellcome Collection.

    33/240 (page 187)
    Karl Pearson has also pointed out to us that the marriage rate of male bleeders in bleeder families is very low as compared with similar rates in the females, being 9'6 % : 36-8 %. Geographical Distribution and Racial Disposition. In the earlier literature on haemophilia the question of the geographical distribution of the cases was discussed at length and was considered to be a matter of great moment. We are, however, in agreement with Virchow and with Dr Wickham Legg' 331 ', who pointed out long ago (1872) “that the number of recorded cases depends not upon the frequency of haemo philia in a given country, but upon the previous education of the medical men, and the interest they take in the disease.” Hirsch, in his monumental Handbuch der historisch-geographischen Pathologie, made no reference to the disease. The in numerable records of bleeders and alleged bleeders from Germany, first in the Rhine country and subsequently in Prussia, can be traced especially to the influences of Nasse and Schônlein. Nasse was director of the medical clinics, first in Halle and later in Bonn, and had a large number of students under him. His attention had been particularly directed to the disease from his acquaintance with Consbruch at Bielefeld, where he was born in 1778. Similarly J. F. Schônlein, the first clinician of his day, drew very large audiences round him, first in Würzburg (1817—1833) and later in Berlin (1840—-1859), and through his influence many cases came to be reported either in inaugural dissertations or in medical journals. In this way the knowledge of haemophilia became widely disseminated in Germany, and medical men were on the outlook for cases which in due time were published. The same remarks apply to other countries. Cases are reported; they create a general interest and for a time there is a flux of publications both good and bad. The point need not be laboured. It goes on at the present time with every new advance in medicine. There would, however, appear to be something in the view that haemophilia is largely confined to the Teutonic race, the vast bulk of genuine cases having been reported from Germany, Switzerland, England and the United States. Although an extensive literature on haemophilia exists in French, a careful study of the publications has convinced us that a very large number of these cases have little or no claim to the title of haemophilia. In this we are supported by so learned an observer as Hayem' 54 ’, who says “Cette maladie singulière est extrêmement rare en France et pour ma part je n’ai pas encore eu l’occasion d’en observer un seul exemple parfaite ment authentique, c’est à dire se rattachant à la forme constitutionnelle héréditaire ” (p. 999). Strange to say, however, Hayem himself, two years later'”', recorded a case of epistaxis and menorrhagia after coitus, although he adds “ cette observation presente une lacune; l'examen de l’uterus n’a pas été fait” (p. 392). The most typical French case, recorded by Delmas m and Simon' 3 “', refers to a French-American family from Louisiana, temporarily resident in Bordeaux. The cases described as haemo philia in the Italian, Spanish and Greek languages are not suggestive of accurate diagnosis. The Russian literature which has been examined for us by Professor Sirotinin of St Petersburg and Dr Blumenthal of Moscow presents, according to them, little evidence of true haemophilia. On the authority of Sirotinin we have