The social condition of the family does not
alter the predisposition; the old Duke of Albany was a "bleeder";
and bleeder families are numerous, healthy looking, and have
fine, soft skins.
The duration of this tendency, and its perpetuation in a family,
is remarkable. The Appleton-Swain family of Reading, Mass., has
shown examples for two centuries. Osler has been advised of
instances already occurring in the seventh generation. Kolster
has investigated hemophilia in women, and reports a case of
bleeding in the daughter of a hemophilic woman. He also analyzes
50 genealogic trees of hemophilic families, and remarks that
Nasse's law of transmission does not hold true. In 14 cases the
transmission was direct from the father to the child, and in 11
cases it was direct from the mother to the infant.
The hemorrhagic symptoms of bleeders may be divided into external
bleedings, either spontaneous or traumatic; interstitial
bleedings, petechiae, and ecchymoses; and the joint-affections.
The external bleedings are seldom spontaneous, and generally
follow cuts, bruises, scratches, and often result seriously. A
minor operation on a hemophile may end in death; so slight an
operation as drawing a tooth has been followed by the most
disastrous consequences.
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