So WHY would it not have been hemophilia?

[J_Kendrick]

Mr Kendrick,

The paper in which you were fortunate to have published was presented as a Historical Perspective having the status of a curiosity. Such articles are often presented by non medical persons who are invited to write their interpretation on a matter which may have a modicum of interest to a few members of the Hematological community.

With respect, the nature of your paper stands alone within the J. The article is set apart from the scientific endeavors published in the same journal by researchers who do have medical training. Another important consideration which sets your article apart, is that the Hematological research is subject to a more critical standard of peer review prior to publication. Their facts must be substantiated and reproduceable. Their information must not be illusory.

If that is the sort of reasoning that you feel you need to use in order to help yourself deal with this paper's publication, then that is your choice.  This research paper most certainly was *not* presented, as you suggest, as a mere curiosity.  Nor was it written by invitation.  

The American Journal of Hematology is a completely peer-reviewed journal.  Everything that is submitted to the journal must be placed before the peer review panel before it is accepted for publication.  This paper was no exception.  It was fully subjected to the same process of review that is required of any other medical paper that may be submitted to the journal.  Its historical and medical content were thoroughly checked for accuracy and its references were fully reviewed.

The fact that it was presented under the title "Historical Perspective" was not to set it apart from any other papers in the journal, as you have suggested.  It was the decision of the 31 haematology and oncology professors who sit on the journal's editorial board to give this paper its own new category for two purely practical reasons.  The first was that the AJH had never published an investigation of any historical cases before and the subject of this paper did not fit with any of the existing categories in the journal.  The second and far more important reason was simply because this medical paper is almost four times longer than the maximum permitted word length in any of the other categories.  
 
Make no mistake, this paper was fully subjected to exactly the same rigorous process of review as any other medical paper that may be submitted to the journal.   You can rest assured that if this paper had not managed to pass the peer review process that was required of it... then we would not be talking about it here today.  

In regard to other comments made elsewhere on this thread, it is pointless trying to reason with those who would chose to refer to themselves as "right believers".   It has been 87 years since the Imperial murders and in all that time not a single peer-reviewed research paper regarding the Tsarevich Alexei's suspected diagnosis has yet been published in any recognised medical journal anywhere in the world to support their position.  If  they are so certain of their opposing position on this matter then they should write and submit their own medical papers to the journal of their choice.   When they have successfully passed the mandatory peer review process and been granted approval for publication, then we'll talk.

JK

[Pravoslavnaya]

I feel no need to back up the explanation of history, nor do I delude myself that I am qualified to write for a medical journal.  As you have said elsewhere on this thread, it takes a few years for a paper to be accepted for publication in academic documents.  Surely it will take a while for a 'Letter to the Editor' to appear before the public in the American Journal of Hematology due to the publication schedules such things tend towards.  Medical specialists will have written a suitable deconstruction if they care to.

Any determination to debunk the legend of Rasputin is incidental to your real purposes.  He did a lot more to calm Alexandra than to heal Alexei.  The lad did not recover spontaneously; his fever merely broke when the long process began.  I leave it to those more qualified than myself to say more -  if in fact they care to do so without having found the boy in Yekaterinburg, on the basis of logic alone.


Just have the tests paid for as Oleg Filatov, William Lavery and the supporters of Anna Anderson did, and you will at last the denouement of this whole production -- probably not the one that you desire.  It is a pity your interesting but reckless theories about Alexei Nikolaevich's suffering were not proposed altruistically -- as you admit elsewhere here, this impressive Rube Goldberg of yours has appeared - as always for Tammet's sake.  

[olga]

J_Kendrick, just admit it. You think Alexei Nikolaevich didn't have haemophilia because you support Heino Tammet.

[Belochka]

I dont consider bleeding umbilical stumps for up to six weeks as "fairly ordinary"

You are perfectly correct, such an event is cause for concern and parents who experience this are urged to seek prompt medical assistance.

It is not normal, despite what the Mr Kendrick chooses to believe.

[Belochka]

it is pointless trying to reason with those who would chose to refer to themselves as "right believers".   It has been 87 years since the Imperial murders and in all that time not a single peer-reviewed research paper regarding the Tsarevich Alexei's suspected diagnosis has yet been published in any recognised medical journal anywhere in the world to support their position.  If  they are so certain of their opposing position on this matter then they should write and submit their own medical papers to the journal of their choice.   When they have successfully passed the mandatory peer review process and been granted approval for publication, then we'll talk. JK

Mr Kendrick you are not a trained medical scientist, and yet you continue this charade as if you understand Alexei's illness better than his attending learned physicians or his own mother. Hemophilia was understood to be an inherited condition. The learned Russian professors were quite well aware about the nature of Alexei's condition. To insult them as you have, only discredits you further.

Not everything which passes review, whether cursory or stringent, will bear the hallmark of credibility. Perhaps as a journalist you may recall the recent Cold Fusion publication? The world buzzed with excitement until it was proven to be a fallacy.

It is highly offensive to believe that your Historical piece is being used to further your personal agenda in favor of a survivalist hypothesis.

If this contention is mistaken then kindly direct me otherwise.

Perhaps you can explain what you are implying when you use the term "right believers", this definition is not part of my lexicon. One can only summize that at the other end of the continuum "wrong believers" must refer to some form of inventive journalism?

[J_Kendrick]

I feel no need to back up the explanation of history, nor do I delude myself that I am qualified to write for a medical journal.  As you have said elsewhere on this thread, it takes a few years for a paper to be accepted for publication in academic documents.  

Oh no, you don't.  You can't get away with it that easily. :-)

You can't just come out on the attack, and then when your opponent fights back .. simply expect that you can get away with beating a hasty retreat to the traditional fall back position of the "holy martyrs" cult by claiming that you don't need to prove anything because history is on your side.  Just because the Palace gossip Catherine Radziwill had started a rumour that no one at the Palace had ever denied and no one has dared to challenge since (at least, not until now)... does not make it true.   If you must insist on taking pot shots at a published and peer-reviewed paper in an open public forum, then you had better be prepared to back up your words with action.

Fair's fair, after all.   I have stated my position, done the research, submitted it to peer-review, passed the requirements of a panel of experts, and published it in an appropriate journal for all to see.   Now it's your turn.  You can't just throw rocks at me from behind the bushes and then run away.  Come out from behind that pseudonym of yours, step up to the plate, and show us what you've got.

Claiming that you don't feel qualified to write for a medical journal doesn't cut it either.  Contrary to what you may choose to believe, medical and scientific journals do not concern themselves with the qualifications of their contributors.  They are only concerned that your research has been thorough, that your conclusions are sound, and that your work can stand up to the scrutiny of a panel of experts who will check it for accuracy.  Anyone can make submissions to a journal, so long as their work will stand up to the test of review.  Given your obvious opinions about both my research, and me, then if I can write a journal submission and be successful... then surely, so can you.

If you're still not willing to go in that direction, then let's play that DNA game of which you are so particularly fond.  Empress Alexandra's own DNA and the DNA of three of her four daughters have been available for testing for the past 14 years, ever since their remains were exhumed from that burial pit in the Koptyaki Forest in 1991....  So....

Show us the DNA test results on those very same samples from Pig's Meadow that will prove to us once and for all that the Empress Alexandra actually was the carrier of a suspected faulty Factor VIII gene.  The gene is certainly big enough to see and everyone knows where to find it... at gene locus Xq28 on the long arm of the X-Chromosome.  You have four chances to find it... in the DNA of Empress Alexandra and in the DNA of her three discovered daughters.

It's no secret that Alexandra's DNA has been tested for porphyria and the results were found to be negative, even though the results were never published.  So, if Alexandra's bones can be tested for evidence of her great-great-grandfather King George III's suspected disease, then they can most certainly be tested for the evidence of that suspected faulty Factor VIII gene.

I guarantee you won't find any laboratory evidence at all of that suspected faulty gene, because it was never there in the first place.  Any tests that were done for that gene are bound to have been inconclusive, and you can rest assured that any curious scientist who does happen to have samples of Alexandra's DNA in his hot little hands has certainly tried to go looking for it.

And what if they couldn't find any DNA evidence of that suspected faulty gene?... Well...  If there is no laboratory evidence of a faulty Factor VIII gene in Alexandra's DNA, then Alexei most definitely was *not* a haemophiliac, and you will be forced to accept the idea of having to find a very different diagnosis.

Before I sign off... in response to "Belochka"...  

You speak as though Drs. Federov and Botkin themselves had known everything that there was to know about X-linked inheritance and faulty clotting factors.  An interesting notion to be sure, but quite impossible.   The concept of X-linked genes was first discussed in the journal "Elementary Genetics" in 1949... a full 31 years *after* the Imperial murders.   The research that first led to that particular discussion of X-linked inheritance had nothing at all to do with haemophilia.   In fact, the research that had led to that very first published paper about X-linked genes was a study of the inheritance patterns that lead to the birth of Tortoiseshell cats.  The clotting Factors VIII and IX that are now known to cause haemophilia were not even given names until an international medical conference in 1964, in the very same year that Robert Massie first started his research on "Nicholas and Alexandra"... a full 52 years *after* Alexei's most serious  episode at Spala.... 46 years after Dr. Botkin's death in 1918... and 28 years after Dr. Fedorov's passing in 1936.

So... I have another question for you.  Please tell me who was the very first person to diagnose Alexei's great uncle Prince Leopold as a haemophiliac?   Before you do, however, remember this:  Leopold died in 1884... and the very first use ever of the word "haemophiliac" was in the medical journal 'The Lancet'... in the year 1896.   How was it possible to diagnose Leopold as a haemophiliac when he had already been dead for a full 12 years before the word had ever existed?  

Two years before his death, 'The Lancet' had used the word "Haematophilia" in its first reference to Leopold's case in 1882.  But if we were to take that word literally and use today's modern definition of "haematophilia" then it would mean that 'The Lancet' might actually have been saying that Leopold was a vampire.  Then there is the well-known evidence of Leopold's seizures that occurred at the height of his most serious bleeding episodes... which most definitely are *not* a symptom of haemophilia!  You can read all about that too... in the American Journal of Hematology. :-)

... and you asked about my use of the term "Right Believer"... Ask "Pravoslavnaya" to explain the Russian translation.  I'm sure she'll be quite happy to tell you.

JK

[J_Kendrick]

I dont consider bleeding umbilical stumps for up to six weeks as "fairly ordinary"

Ask the closest paediatrican, obstetrician, or haematologist of your choice.  You could even ask the nearest midwife, for that matter.  You'll probably be very surprised by their answers.

Apparently, you haven't spent a lot of time around maternity wards.

JK

[olga]

J_Kendrick, please answer my question.

[Kimberly]

J kendrick,I am a neonatal nurse of some 25 years standing and i have also posed this question to our lead paediatrician and he agreed that he would be EXTREMELY concerned regarding long term bleeding from an umbilical stump and as far as he is concerned this is abnormal.

[Belochka]

... I guarantee you won't find any laboratory evidence at all of that suspected faulty gene, because it was never there in the first place.  Any tests that were done for that gene are bound to have been inconclusive, ...

Well...  If there is no laboratory evidence of a faulty Factor VIII gene in Alexandra's DNA, then Alexei most definitely was *not* a haemophiliac, and you will be forced to accept the idea of having to find a very different diagnosis.

JK

Thank you Kimberly for confirming what I stated earlier.

Mr Kendrick I contend that it is you who would be surprised by the real answers. As a journalist you are not in the informed position to contend that bleeding from the umbilicus for six weeks is normal.

Some of us here are trained medical personnel. Please trust what Kimberly has confirmed. Bleeding from the umbilicus in neonates is abnormal. What we have stated here is absolutely correct.

Your lack of medical training is apparent, by virtue of your continuing misinterpretion of very basic medical facts, which you have tossed to suit your own, now very obvious agenda.

The majority of medical practitioners do not publish. Does that failure in your eyes imply that their learned medical wisdom must be ignored? I think not.
_____________________________________________

Mr Kendrick kindly please explain why you can "guarantee" that the Hemophilia gene will never be located on Alexandra's DNA? How can you be so confident that despite continuing refinement of DNA technological techniques, a laboratory assay will prove any assay to be inconclusive?

If and when the analytical evidence is ever confirmed, then we must at least agree on one point - since this result is unavailable at present, then any suggestion about presence or absence of the Hemophilia gene on Alexandra's DNA is a moot point.

In the absence of conclusive evidence it is erroneous to suggest that because the gene for Hemophilia has not been identified as yet on Alexandra's DNA, then, this information can be translated to reach your innovative notion that Alexandra was not a carrier. Reaching such an interpretation goes against credible investigative reporting.

Presented with the same evidence, conclusions reached can distinguish a medically trained person, to that of a person who is untrained in Hematology. Each investigator will interpret the same information from entirely different base lines. Your Historical Perspective does indicate this variance in interpretation. However what distinguishes your work even further is that you had a very different reason to interpret information in the manner in which you have.

We can be optimistic that one day an accredited medical researcher will analyze Alexandra's DNA to complement the documented physical evidence. Until that day arrives Mr Kendrick, then may I suggest you be truthful to yourself and to the Russian community.

Demonstrating respect for Russia's painful past would be an excellent beginning.

 

[Kimberly]

My pleasure Belochka,and can i add that in a situation like this we would nowadays investigate the caus of the bleeding and run bloodtests including full blood count.pro-thrombin levels,clotting times etc. and if these were deranged i.e. abnormal,further investigations may include detecting levels of clotting factors (particularly v111 and v1x) regards kim

[Georgiy]

The fact that haemophilia was in the family (his cousins died from haemophila related attacks) would suggest that Alexei also had haemophilia.

And, Mr Kendrick, a Passion-Bearer is indeed considered a Saint in the Orthodox Church. If they were not considered Saints, there would not be icons of them. The martyred Tsesarevich and his family are included in the ranks of the Saints of the Orthodox Church. Are you yourself pravoslavny, or do you presume to tell people who are Orthodox, who has been glorified or not by the Church?

[Belochka]

Mr Kendrick,

@ p 95 of your Historical Perspective article, you contend:

... "The first thing they seized upon was four short entries in the Tsar's diary of 1904 that refer to his newborn son's one brief episode of umbilical bleeding during a single evening in early September[3]."

Reference # 3 is Maylunas A. and Mitronenko. S. A Lifelong Passion, Weidenfeld & Nicholson, The Orion Publishing Group pp 247-248

Now let us look at Emperor Nicholai's diary entries:

"Nicky, Diary - 8 September - Peterhof

At 11 o'clock I took the children to church. We lunched alone. Alix and I were very worried because little Alexei started bleeding from the navel, and it continued on and off until evening! We had to send for Korovin and the surgeon Fedorov: at about 7 o'clock they applied a bandage. ....

9 September

In the morning there was blood on the bandage: from 12 o'clock until the evening there was nothing.

10 September

Alexei did not have a show of blood all day.

11 September

Thank God, dear Alexei has had no more bleeding now for 48 hours!." [/i]
_____________________________________________

Mr Kendrick the diary entries clearly state that Alexei bled on two separate days:

1. September 9 during the day UNTIL the evening.

2. On September 10, which is the next day, Alexei bled at least until 12 o'clock.

What one can clearly demonstrate here is that the pattern of bleeding was intermittent. He presented with bleeding episodes on TWO successive days. It was certainly not one single episode "during a single evening" as you have prefered to interpret.

_____________________________________________

Now let us read the contents of your Reference # 4 titled:

"Your Newborn: about your baby; http://babies.sutterhealth.org/afterthebirth/newborn/nb_about.html

it states:

"Navel & Umbilical Cord

The stump of the umbilical cord, which remains temporarily attached to the navel, should be kept clean, dry, and free from diaper irritation. ....

... Usually the stump will fall off between seven and 14 days after birth, but may stay attached up to a month. After the stump has fallen off, there is often a pinkish discharge from the navel. This is nornal (their error in spelling) and does not need any treatment.

*Report any bleeding, unusual discharge, redness, swelling, irritation, or foul odor around the navel to your baby's health care provider."

------------------------------------------------------------------------

Let us now read what you have stated in the same continuing paragraph, at p 95 of your Historical Perspective:

..."Many new parents who have witnessed such bleeding will understand that it can be fairly ordinary as many as six weeks after birth, depending on when the umbilical stump falls away, which can take as long as a month [4]. A century later, it would not now be considered a certain indication of the presence of a specific inherited blood disorder without the aid of additional testing to identify the cause."
------------------------------------------------------------------------

Mr Kendrick, it appears you have selectively used the Sutter Health site's statements. We can agree that a brief "pinkish discharge from the navel"  AFTER the stump has fallen off, can be a normal event.

BUT the site clearly identifies that "ANY BLEEDING", is not a normal event.

This warning is presented at the end of the Navel & Umbilical Cord section MUST BE READ in totality to the section.

The Sutter Health site clearly warns parents should such an event occur in their newborn, it is advisable to seek medical attention. Parents, even a century ago would understand this simple fact. Emperor Nikolai II expressed his own concern in his September 8 diary entry. He would have understood what this would have implied. The learned Professors would have informed their Emperor on September 8.

_____________________________________________

Mr Kendrick one can only be deeply concerned about the manner of your other interpretations within the same paper.

Judging by the two examples I have presented here, I would be very surprised that the review board really tested your evidence against the references which you provided.

_____________________________________________

Furthermore please extend the courtesy of refering to Nikolai Alexandrovich as Emperor. He was not a Tsar - a title which has not been used since Peter the Great adopted the title of Emperor in 1721.

Mr Kendrick,

Georgiy is perfectly correct, a Passion-Bearer is indeed considered a Saint in the Orthodox Church.

You really need to do your homework before you  expouse your misguided interpretations.

One can safely conclude that your irrational hypothesis concerning Mr Tammet's delusive pretensions are simply just that.

[J_Kendrick]

No one disputes that umbilical bleeding in new-borns should be taken seriously, but it is always a matter of degree.

If the bleeding that Nicholas had described was only a matter of worrisome spotting that, in the Tsars' own words.. " continued on and off until evening"... then certainly it should be watched carefully.   But spotting "on and off until evening" is not now considered to be a major concern unless it is seen to continue for more than three days.  That most definitely was *not* the situation in Alexei's case, which did not continue beyond the earliest hours of the following morning.

If the bleeding had been continuously steady... which everyone here seems to imagine but definitely does not fit with Nicholas II's description.... then it would have become serious within a matter of just a few minutes.  If that had been the case, then the new-born Alexei would have been lucky just to have made it to the end of that same week... never mind imagining any chance that he might have had of reaching the date of the murders almost 14 years later

But it was *only* spotting... and it *did stop* by the next morning... and Alexei most certainly *did* make it at least as far as 26 days short of his fourteenth birthday... So obviously the bleeding navel was nowhere near as serious as Catherine Radziwill had first implied in her 1931 interpretation of Nicholas II's diary.. and certainly not as serious as far too many people here are blindly willing to accept without ever daring to question the evidence.

http://www.drspock.com/article/0,1510,4080,00.html
http://www.drpaul.com/newborn/umbilical.html
"This isn't cause for concern and should disappear in two or three days."

Russians traditionally wrap their new-borns with only the faces showing, wrapping them up so tightly in their blankets that it's a wonder the poor little tykes can even find room to breathe.  Their methods might well be a tradition, but this very same Orthodox practice is entirely the wrong thing to do for proper post-natal umbilical care.  

Today's new parents are always advised to keep the healing navel completely free of diapers and other clothing so that the navel is always exposed to the air and properly allowed to dry.  They're also told by their doctors to avoid getting the umbilical stump wet during bathing, because the longer it stays wet... the longer it's going to take for the navel to heal properly and the stump to fall away.

The Tsar's doctors had also made a serious mistake in their treatment, according to our modern day methods of paediatric care.   Nicholas wrote: "..at seven o'clock they applied a bandage."  Today's paediatricians will say, no matter what, no bandages!  The blood can be dabbed away with a cotton swab or a Q-tip, but the navel must always be left exposed to the air and allowed to dry.  Applying a bandage is far more inclined to aggravate the problem than to solve it, and it only serves to impede the proper progression of healing.

Resolving this issue will depend entirely on answering the question of when, precisely, Alexei's umbilical stump had finally fallen away.  Usually this will happen within the first few days and up to as long as two weeks after birth.  But that's not always the case.  Umbilical stumps have often been known to stay attached for periods sometimes as long as six weeks .. and on very rare occasions, even as long as two months.

We have no idea when this one key event had actually occurred with Alexei.  The family diaries make no mention of it at all.  The truth of the matter is that if Alexei's umbilical stump had finally fallen away on that very same day as his recorded umbilical bleeding, then... as far as an accurate diagnosis is concerned.... Nicholas II's first worried diary entry for September 8th 1904 means absolutely nothing.

http://www.briarcliffpediatrics.com/minfofaq_newborncare.html
"When the cord drops off there will frequently be a little bleeding, which is normal.  Clean the blood away with some alcohol and a Q-tip until it is healed"
http://www.babycenter.com/refcap/baby/newborns/127.html
"When the stump falls off, you may detect a little blood on the diaper, which is normal."
http://www.abbott.ca/eng/nutrition/bcb-02.html
Umbilical care
"Within about one to three weeks after birth, your new-born's umbilical stump will turn black, dry out and finally fall off. In the meantime, clean the base of the stump two or three times a day with water on a sterile cotton ball or gauze. In order to keep the stump dry, fasten diapers below the navel. The baby's shirt should also be rolled above the stump, to allow free circulation of air. When the cord falls, there may be slight bleeding in the navel area. This isn't cause for concern and should disappear in two or three days. But if you notice any foul smell, reddening or oozing around the umbilical stump, be sure to report it to your doctor, as well as any bleeding that lasts for more than three days."

No matter how you may choose to argue... It all comes down to this:

Everyone here is so determined to perpetuate the legend that no one ever bothers to do the math.  Doesn't anyone here ever look at a calendar?

Serious bleeding of the navel in new-borns afflicted with haemophilia can be expected to occur almost immediately within the first few days of life.  The same is true with the circumcision of new-borns (which was not a factor in Alexei's case).  These two facts of haematology and paediatrics have been known since the earliest years of the last century, and even before.

From 1923,  J. Buren Sidbury, A.M., M.D
http://www.neonatology.org/classics/sidbury.html
"....the great majority of cases of haemorrhagic disease of the new-born occur
within the first three days of life"

But....  

The Tsar's own diary places Alexei's very first evidence of bleeding on the 8th of September on the old style Julian calendar.  That's 40 clear days... just two days short of a full *six weeks* after Alexei's birth on July 30th (old style).  This one event that is recorded in Nicholas II's diary is most defintely *not* evidence of hemophilia... just for the very simple reason that umbilical bleeding in new-borns afflicted with a Factor VIII or IX deficiency is certainly going to happen a great deal sooner than the almost one and a half full months after birth that is evident in Alexei's case.

Late term bleeding of the umbilicus in this same order of six or seven seeks can certainly be seen as an indicator of a possible problem with Factor XIII.   That possibility must be ruled out, however, because an inherited Factor XIII deficiency is not X-linked and appears equally in both sexes.

Catherine Radziwill's now famous 1931 interpretation of Nicholas II's diary entries about the bleeding navel in September of 1904 certainly does make for a good story... and you can believe it if you like.... But it is bad medical theory and it proves nothing!

JK

[olga]

J_Kendrick, just admit it. You think Alexei Nikolaevich didn't have haemophilia because you support Heino Tammet.