Constipation is likely to be particularly injurious to the subjects of haemophilia,. Therefore it is very important to see that the bowels are properly relieved. The child should take a dose of gray powder with jala pine every two or three weeks, followed by a saline ; and the latter, in the shape of Dinneford's magnesia or the granular citrate of magnesia, may be given regularly every week. The dietary should include a good proportion of vegetables ; and the white meats and fish are preferable to too much beef and mutton. In case any of the premonitory symptoms of haemor rhage are observed, all meats should be at once forbidden, and a mercurial purge be administered, followed by a saline. Regular exercise should be enforced ; but boisterous games, such as cricket, foot-ball, etc., can only be indulged in at a great risk.
When bleeding occurs, the treatment will depend upon the source of the haemorrhage. If this be at the surface, so that pressure can be brought to bear upon the part, as in the case of a cut or other injury, the applica tion of a graduated compress, after careful cleaning of the wound, should be had recourse to. The local use of perchlmide of iron, nitrate of silver, and other styptics, and of ice, is also recommended. In cases of sponta neous haemorrhage astringents applied locally are our chief resource. In epistaxis the nasal passages must be first cleared out by injections of ice cold water. Afterwards the solution of perchloride of iron (of the strength
of one drachm of the strong solution to an ounce of water) should be in jected or sprayed into the nostrils. If this method fail, the anterior and posterior flares must be plugged. If the haemorrhage occur from the socket of a tooth, crystals of the perchloricle of iron applied locally will sometimes arrest it ; or the alveolus may be packed with a graduated com press soaked in the iron solution. Bleeding from the bowels usually comes from the lower part of the rectum, and can often be staunched by injec tions of the iron solution (one or two drachms to the ounce). Bleeding from the gums is usually stopped by washes of tannin, alum, or rhata,ny- ; and the child should be prevented if possible from encouraging the bleed ing by sucking his gums. Iron and other styptics given internally seem to be of small value ; but ergot is stated to have proved of service.
The subjects of this tendency should be warmly dressed and carefully protected from the cold. If possible their residence should be elsewhere than in cold, damp situations. The joint affection must be treated by per fect rest, and cold or warm applications as are most agreeable to the patient. At a late stage blisters to the joint are said to be useful, but counterirri tation with the actual cautery is to be avoided.