(Continued from page 8)

Whenever one of these episodes struck the young Prince down the doctors said they could not explain the fevers that were a part of the boy's symptoms.  Any modern day physician will readily agree that the symptoms of fever and delirium are not consistent with a diagnosis of haemophilia.  People suffering from the disease do bruise easily and bleed when they are cut, but they do not suffer fevers as a result.

All of the historic accounts explain that during his most serious episode Alexei suffered from internal haemorrhage, bleeding in the joints, abdominal swelling, and pallor.  It is said that on one occasion Alexei's fever reached a high of 105° Fahrenheit.  The description in the Tsar's letter of the boy's symptoms of delirium suggests the involvement of the central nervous system.  All of the symptoms that the boy experienced during his worst episodes more accurately describe what the medical profession now calls THROMBOCYTOPENIA.

Thrombocytopenia can either appear on its own or is associated with APLASTIC ANEMIA or LEUKEMIA.  These two diseases are very similar in appearance and which one the patient has can only be determined by doing a number of specific tests.  Aplastic anaemia can also cross that fine line between the two and become leukemia later in life... if it doesn't kill the patient first.

Alexei's doctors surmised that his hemorrhaging caused a loss of blood flow to the head, thereby producing his delirium and pale appearance.  This hypothesis may have been a little too simplistic.  As well as causing hemorrhaging, pallor, and fever, leukemia produces delirium by affecting the central nervous system.  It was also assumed that a swelling high in the abdomen was due to a hemorrhaging stomach.  One of the things that the boy did to relieve the pain was pull up his left leg.  This is more suggestive of an enlarged spleen... one of the features of thrombocytopenia.  Removal of the spleen is a frequent remedy.

In 1935 the head of the Imperial Court Secretariat, Alexander Mossolov, wrote that court physician Serge Fedorov had disagreed with his colleagues.  Mossolov quoted Dr. Fedorov as having said, "It is most urgently necessary to apply far more drastic measures, but they involve a risk".  Was he considering a splenectomy?  Sometime later the doctor threw up his hands in frustration and said, "You can see what is going on here".  Such a statement tends to suggest that decisions were being made about the boy's health over which he had no control.

No reliable methods of blood testing for such diseases existed at the time.  The medical community had only just discovered blood typing the year before Alexei's birth in 1904.  All that his doctors had as a basis for their diagnosis were the stories about the Royal family's medical history and what little understanding there was at the time of the symptoms the boy displayed.

©  J. Kendrick 1997                                                                                                                               (Continued on page 10)