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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    in the arm in Case VI, the needle, instead of going directly through the skin into the vein, ran into the subcutaneous tissues. A small haematoma appeared and there was deep staining of the skin from the wrist to the axilla. A similar accident occurred once or twice with Case XI, but there was never any haema- toma and the amount of bruising was very slight. In the third group a still greater degree of injury was required to lead to any appreciable amount of haemorrhage. The only practical difference between the patients in this group and ordinary individuals was that on the occurrence of such a wound or injury as would always produce an appreciable amount of bleeding in any one, the bleeding in them persisted for a longer time. Cases I and II are in this group. In both of them there had been no sign for years that they were in any way different from other people. This, however, was only due to the fact that for a long time they had not sustained any severe injury. For when Case I had a tooth extracted the bleeding persisted for 10 days, and showed that his long freedom from symptoms was only a matter of degree, and was not an indication that he was completely normal. As regards the severity of the disease, therefore, the cases are clearly separable into the three groups of severe, moderate, and slight cases. If the deficiency in coagulability is in itself sufficient to explain the symptoms, it would follow that the severer the manifestations of the disease the longer the coagulation time would be, and vice versa. That such in fact is the case will be seen in the following table, in which each case is grouped according to the degree of incidence of the clinical symptoms, and the average coagulation time of all the observations taken on the case is given :— Severe symptoms. Moderate symptoms. Slight symptoms. Case III = 68 min. Case XI = 86 min. Case I = 15 min. „ IY = 74 „ „ II = 15 min. 15 sec. „ V = 54 „ „ VI = 77 „ „ VII = 63 „ „ VIII = 72 „ „ IX = 85 „ „ X = 67 „ „ XII = 70 „ III. A consideration of the 'process of coagulation in normal and haemophilic wounds. The coagulation times which have been given are a measure of the time required for the clotting of the first drop of blood issuing from a small puncture wound, but they do not give any indication of the changes in coagulability which take place in blood flowing from a wound, from the moment when it is inflicted up to the time when such an amount of clot has formed that the bleeding ceases. Under normal circumstances there is a rapid and progressive increase in the coagulability of each successive specimen of blood; the first drop takes the longest time and the last coagulates practically instantaneously. But c 2