orded in some of the earliest
medical literature. Only recently, however, through the writings of
Buel, Otto, Hay, Coates, and others, has the hereditary nature of the
malady and its curious mode of transmission through the female line
been known. As a rule the mother of a hemophile is not a "bleeder"
herself, but is the daughter of one. The daughters of a hemophile,
though healthy and free from any tendency themselves, are almost
certain to transmit the disposition to the male offspring. The
condition generally appears after some slight injury in the first two
years of life; but must be distinguished from the hemorrhagic
affections of the new-born, which will be discussed later. 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.

Armstrong, Blagden, and Roberts, have seen fatal hemorrhage after the
extraction of teeth. MacCormac observed five bleeders at St. Thomas
Hospital, London, and remarks that one of these persons bled twelve
days after a tooth-extraction. Buchanan and Clay cite similar
instances. Cousins mentions an individual of hemorrhagic diathesis who
succumbed to extensive extravasation of blood at the base of the brain,
following a slight fall during an epileptic convulsion. Dunlape reports
a case of hemorrhagi