Hemophilia is referred as “the royal disease,” because it affected the royal families of England, Germany, Russia and Spain in the 19th and 20th centuries. Hemophilia was passed down from Queen Victoria of England, who ruled from 1837-1901, to the royal's families. Her gene for hemophilia was caused by mutation. She passed the trait on to her three of nine children. Her son, Leopold, had hemophilia and died of a hemorrhage after a fall when he was 30. Her two daughters, Alice and Beatrice, were carriers and passed it on to several of their children. Alice’s daughter Alix married Russia's Czar Nicholas in 1854 , whose son Alexei had hemophilia. Beatrice's daughter married into the Spain royal family. She passed the gene to the male heir to the Spanish throne. Hemophilia was carried through various royal families after Victoria.