c diathesis, following suppression of the
catamenia, attended by vicarious hemorrhage from the gums, which
terminated fatally. Erichsenf cites an instance of extravasation of
blood into the calf of the leg of an individual of hemophilic
tendencies. A cavity was opened, which extended from above the knee to
the heel; the clots were removed, and cautery applied to check the
bleeding. There was extension of the blood-cavity to the thigh, with
edema and incipient gangrene, necessitating amputation of the thigh,
with a fatal termination.

Mackenzie reports an instance of hemophilic purpura of the retina,
followed by death. Harkin gives an account of vicarious bleeding from
the under lip in a woman of thirty-eight. The hemorrhage occurred at
every meal and lasted ten minutes. There is no evidence that the woman
was of hemophilic descent.

Of 334 cases of bleeding in hemophilia collected by Grandidier, 169
were from the nose, 43 from the mouth, 15 from the stomach, 36 from the
bowels, 16 from the urethra, 17 from the lungs, and a few from the skin
of the head, eyelids, scrotum, navel, tongue, finger-tips, vulva, and
external ear. Osler remarks that Professor Agnew knew of a case of a
bleeder who had always bled from cuts and bruises above the neck, never
from those below. The joint-affections closely resemble acute
rheumatism. Bleeders do not necessarily die of their early bleedings,
some living to old age. Oliver Appleton, the first reported American
bleeder, died at an advanced age, owing to hemorrhage from a bed-sore
and from the urethra. Fortunately the functions of menstruation and
parturition are not seriously interfered with in hemophilia.
Menstruation is never so excessive as to be fatal. Grandidier states
that of 152 boy subjects 81 died before the termination of the seventh
year. Hemophilia is rarely fatal in the first year.

Of the hemorrhagic diseases of the new-born three are worthy of note.
In syphilis haemorrhagica neonatorum the child may be born healthy, or
just after birth there may appear extensive cutaneous extravasations
with bleeding from the mucous surfaces and from the navel; the child
may become deeply jaundiced. Postmortem examination shows extensive
extravasations into the internal viscera, and also organic syphilitic
lesions.

Winckel's disease, or epidemic hemoglobinuria, is a very fatal
affection, sometimes epidemic in lying-in institutions; it develops
about the fourth day after birth. The