I think those Russian people that were able to see the Tsarevich or hear of him much at all in his father's vast empire may have suspected that something was the matter when they began hearing excuses for Alexei Nikolaevich not being able to attend public appearances. As the Heir, and one suspects as the littlest member of the Imperial Family, he inspired a great deal of enthusiasm and not to see him was a disappointment. 'The Tsarevich sprained his ankle' was not too far from the truth sometimes, but 'Alexei Nikolaevich has a bad cold' began to wear thin. Rumors started sometime before the Spala incident in 1912, when people really started to talk.
A lot of those rumors appeared in the newspapers beginning in October 1912, when it was possible the boy might die.
The Tsarevich was stabbed by anarchists aboard the Standart', 'Alexei Nikolaevich is near death from injuries suffered in a bomb blast', 'The Heir has become seriously injured thanks to a very bad fall from a horse... from a cupboard... during play.' We have even read here the sensational statements of Spiridovich, that his two sailor nannies actually tried to murder the child on the Standart!
As Alexei Nikolaevich began to recover and bulletins became more hopeful there was a lot of explaining to do, and in November the wire services began to publish what were supposed to have been statements from his doctors. The translations can be seen in the New York and London Times...
'The Tsarevitch has tuberculosis of the hip joint and hemophilia...' 'The Russian heir has one skin too few, as it was with the English Prince Leopold.' 'He has the nervous excitement seen in children not expected to live too long' 'He is not expected to become Tsar'.
This, of course, smacked of the truth. Yet the Palace staff released bulletins saying in so many words 'There is no truth to the latest rumours concerning the Heir to the Throne.' Although newsreels showed the boy in his glory at Stavka a few years later, talk of a frail boy whose condition was an open secret never really stopped.