HEMOPHILIA.
Prepentive treatment in this congenital and hereditary disease is of vital importance. It consists in the avoidance of injuries, wounds, contusions, and abrasions all through life. No surgical cutting operation must be attempted in a subject suffering under this condition. Even vaccination must be performed with extreme care, as death has resulted when the searifications were permitted to involve the deep layer of the true skin, and a fatal issue has many times been reported after the skilful extraction of a diseased tooth. 'the general health of the so-called " bleeder " must he maintained at the highest standard, and as all athletic games in which any accident or rough play is likely to occur are to be avoided, the patient must make up for their absence by an open air life, with walking exercises, swimming, and boating.
The condition is practically never seen in females, hut is handed down always through the female line; hence the daughter of a bleeder, though immune herself, will be very liable to transmit the diathesis to her male children, and marriage under such circumstances is always to he dis countenanced. The victim of the condition should be warned of his congenital weakness as soon as he comes to years of discretion in order that he may avoid as far as possible all danger.
When epistaxis or any breach of surface bats occurred, or when blood has been poured out into a joint, Chloride or Lactate of Calcium should be given freely by the mouth, and absolute rest in bed enjoined. The lime salt cannot be continuously employed as a preventive, because after saturation of the blood has been produced for any considerable time by a lime salt the coagulation time of the blood is delayed instead of being hastened. inhalation of Oxygen and Thyroid feeding have proved useful in some cases. and the practitioners of a former generation believed in the efficacy of a combination of Perchloride of iron and Chlorate of Potash internally. All astringents of the tannin group. ergot, lead, &c., are worthless. Yeast and Nucleinic Acid are recommended on theoretical bounds.
Epistaxis, which causes the greatest number of deaths in bleeders. must be promptly treated by gentle plugging with lint soaked in Adrenalin solution. It is inadvisable to give internally adrenalin or any other drug which raises the systemic pressure. A jet of may be played
into the nostril.
When the bleeding proceeds from the cavity of a recently extracted tooth it should be plugged with a pledget of lint moistened with Adrenalin solution and pressure continuously applied by bandaging the jaws over a pad of lint placed above the gap in the dental arch, or a suitable tem porary plate may be adjusted and worn till all danger has passed away.
At the earliest appearance of such haAnorrhaf2es, precautions should be taken to make up for the loss of blood which has already occurred and is likely to continue. A large enema of Saline solution should be slowly injected into the rectum when the head of the patient has been lowered and the pelvis raised. i dr. of the lime salt may be advantage ously combined with the saline, or Gelatin (2o per cent.) added to it.
In desperate cases the saline must be given hypodermically, but never, if avoidable, by the veins. By resorting early to the saline enema when this is retained the danger of haemorrhage from the hypodermic puncture is avoided. If puncture be necessary, Gelatin should be injected along with the saline, and the gelatin may be also given by the mouth. In some cases a full dose (6 drs.) of Antidiphtheritic Serum given hypo dermically has proved valuable.
Wounds must be treated by Adrenalin solution. ligatures being in admissible. Corrosive styptics and the cautery likewise should not he employed, as the bleeding after the separation of sloughs or eschars may prove more serious even than the original haemorrhage. Pressure is the main remedy to be relied upon when the bleeding does not stop after the application of adrenalin, and it should always he employed in con junction with it.
Only in the presence of impending death can blood transfusion be considered as justifiable. It would seem a rational procedure to add per cent. Gum Acacia to saline solution for injection into a vein in order to increase the viscosity of the blood.
When haemorrhage occurs into a joint. the limb must be rendered quite immovable by splints, and ice or evaporating lotions applied and the absorption of the effused blood encouraged by pressure. Puncture of the joint should, when possible, be avoided, and a free incision never is justifiable.