Alex­ei had hemo­phil­ia, a genet­ic dis­ease that affects only males. Hemo­phil­ia is trans­mit­ted by the moth­er. The dis­ease was wide-spread in Alexandra’s fam­i­ly—her own broth­er had died of it. She suf­fered tremen­dous guilt over hav­ing passed the dis­ease on to her son. There was no cure (there’s still no cure) and there was no treat­ment for the symp­toms. Alex­ei was often in agony from inter­nal bleeding—each episode life-threatening. 

Two sailors were appoint­ed to watch over Alex­ei around the clock. Andrey Derevenko and Kle­men­ty Nagorny were called the “sailor nan­nies.”  Their job was to catch Alex­ei before he fell—every time.