TREATMENT OF AFFECTIONS prophylaxis should endeavor to restrict the procreation of hemophilic children. According to Grandidier's ex perience it is well to discountenance marriage of female members of bleeder families, whether they themselves are bleeders or not; male members, however, unless they are bleeders themselves, may be per mitted to marry. Male bleeders should only then be dissuaded from marrying if there is proof that in their families hemophilic men have procreated hemophilic children, always provided that the males in question had married healthy daughters of healthy families.
Individual prophylaxis should commence immediately after birth, and in view of the dangerous character of the hemorrhages be carried through with persistency during the first few years of life. Every injury, be it ever so slight, should be prevented; for this reason all surgical interference is contraindicated, as for instance operation for cleft palate, removal of nevi, piercing of earlobes, and particularly circumcision. Vaccination, however, has always proved free from danger. Taking great care of the buccal cavity, preventing as far as possible the ex traction of teeth, and selecting toys, furniture and articles for domestic use with circumspection, are important. In later life caution at begin ning of menstruation, interdiction of gymnastic exercises, selection of a suitable vocation, are points commanding attention.
The general treatment should endeavor to strengthen the entire organism, for which purpose a mild diet with plenty of fresh vegetables and salad should be prescribed, avoiding articles which excite the vascu lar system, such as alcohol, coffee, tea. Cold friction, saline baths, resi dence in the country or at the seaside, are efficacious adjuvants.
Internally, vegetable acids (lemon cure) may certainly be tried, although the success is doubtful. The same applies to the administra tion of saline remedies or the reduction in the supply of fluids recom mended by Immermann and Oertel on account of plethora which they are supposed to excite.
The special treatment of the hemorrhages consists in the first place in elevating the affected part of the body, which is often sufficient. In the second place apply compression, tamponade, the cautery, com pression or ligation of the nearest vascular trunks. For a local luemo
static the custom now is to apply, aside from chloride of iron, the adrenal preparations: adrenalin or suprarenin in solutions of 1 : 1000. Hesse recommends a solution of calcium chloride. Good results have been obtained by gelatin treatment, injecting 25 Gm. (5vi) of Merck's 10 per cent. "Gelatina Sterilisata pro Injectione." The treatment of hemophilic articular affections consists in rest and moderate compression; when the pains are severe apply moist packing, from the second or third day massage of the centrally situated parts. As to operative interference nothing but aseptic puncture is admissible. Later on orthopedic measures may become necessary.
view of the uncertain etiology of purpura there can be no question of causal treatment. The foremost measure is thorough.
General all cases, even the mildest, strict rest in bed is necessary. But this very requirement frequently meets with great objection, because the patients, enjoying otherwise good health, can be kept in bed only with difficulty, while parents are not easily con vinced of the necessity of the measure. It should be remembered that the frequency of relapses is usually due to failure to observe these in structions. The sick room should be well ventilated and kept cool. The diet should be bland, not seasoned; all exciting substances,—alcohol, coffee, tea,—should be avoided and the preference given to milk, light farinaceous dishes and vegetables. Large meals are injurious; instead, small portions should be given every two or three hours. Constipation, which may readily occur, should be overcome by the use of grated apples, senna-infusion, castor oil. Highly indicated are regular baths, to which decoctions of oak bark and walnut leaves have been added, as they contribute to the more rapid resorption of skin hemorrhages. In very protracted cases a change of climate is often useful. As an after-cure, a general strengthening of the body is necessary and a stay in the moun tains or at the sea-side advisable. Special attention is frequently de manded by secondary anemia, the treatment of which is to be conducted according to the usual rules.