The prognosis of haemophilic arthritis is grave. Surgical treatment is abso lutely contra-indicated. In at least one ease which had been treated by actual cautery, under the mistaken impression that the affection was a white swelling of the knee and required eounter-irrita tion, the dropping of the scabs, caused by the eautery, was followed by fatal bleeding. Nov(-Josseramh (Revue de Chir., No. 12, '99).
Prognosis.—IImnophilia is particu larly to be feared when it occurs in chil dren in an aggravated form. In slight cases the disease frequently disappears at puberty. The hmmorrhages are usually more dangerous in boys than in girls; uterine hmmorrhages, though copious, seldom endanger life.
Treatment.—The treatment of haemo philia mainly consists in the avoidance of exciting factors. The extraction of teeth should especially be guarded against and preference be given to meas ures, such as gradual loosening and evic tion with rubber, of a tooth, rather than to the forceps. Scratches, cuts, etc., should be avoided; hence an occupation exposing the sufferer to solutions of con tinuity becomes dangerous. Violent ex ercise is occasionally the only exciting factor.
Fatal case of haemophilia, following extraction of a tooth, in a young man. Bates (Annals of Surg., May, '94).
Prophylactic treatment between at tacks is also indicated. Of all the prepa rations, hydrastis Canadensis has proved most successful, when administered in large doses, 10 to 15 drops of the fluid extract, three times a day.
Large doses of fluid extract of hydras tis (20 drops) advised in htemophilia.
Delafield (Med. Age, Apr. ]1, '92).
The various preparations of iron have been recommended; ferratin is probably the most useful preparation at our dis posal. The perchloride has been mended by Legge. Strychnine is cated on account of the involvement of the vasomotor system. Saline tives, by reducing the arterial tension, are valuable when prodromic symptoms are noticed.
Case of a woman who, because of haemophilia, suffered from very excessive antemia. She was treated by the various lumnostatics, and by repeated injections of ergotine, without much result. Finally 3 capsules of thyroid gland were given each day, with the result that the loss of blood was immediately arrested. The patient gained in weight, the purpuric spots disappeared, the gums became firm, and some color began to appear in the face. Cardiac palpitation was decreased. At no time was the dose greater than 3 capsules a day. Delace (Jour. de MOd. de Paris, Jan. 23, '98).
In the treatment of hemophilic hemorrhage the recumbent position (ex cept when the bleeding is at the nose) is of primary importance to reduce cardiac action. In women an alum plug inserted in the vagina, as recommended by erly Cole, is an efficient means. Lime juice internally and hypodermic tions of ergot should supplement the use of local styptics, the best of which are turpentine and perchloride of iron when these can be used. When the hmmor rhage is from the nasal cavities, the ous measures recommended under Epi