GENERAL DISORDERS OF NUTRITION. 



which often amounts to many pounds. Besides these dangerous ex- 

 ternal haemorrhages, extensive extravasations occur beneath the skin, 

 in consequence of the slightest contusion. Wunderlich tells of a boy, 

 who, after receiving a flogging at school, came home black and blue, 

 and so covered with stripes and welts that a charge was preferred of 

 cruelty. It afterward appeared that he had the haemorrhagic dia- 

 thesis. 



Spontaneous bleeding cr haemorrhages without assignable cause do 

 not generally take place until after the patient has suffered repeatedly 

 from traumatic haemorrhages. They generally proceed from the nose : 

 but likewise arise from the bronchi, stomach, intestines, and kidney, and 

 may also occur in the substance of the skin and subcutaneous areolar 

 tissue. They are generally preceded by molimina, such as palpitation 

 of the heart, stupor, signs of cerebral congestion, pain in the limbs, 

 and, in some cases, painful tumefaction of the joints, particularly those 

 of the knee and ankle. There have been instances in which the bleed- 

 ing from the navel-string could not be stanched, but more usually it 

 is not until the period of dentition, and sometimes after the sixth or 

 eighth year of life, or later, that the diathesis betrays itself by a dan- 

 gerous haemorrhage. Most patients die young few surviving the 

 period of childhood. Cases are known, however, in which the patient 

 has lived to a good old age, the tendency to bleed diminishing, or 

 ceasing altogether, as life advanced. 



TREATMENT. No remedy is known likely to prove efficacious in 

 congenital haemorrhagic diathesis, and we must therefore confine our 

 efforts to a careful regulation of the habits, and the removal of all nox- 

 ious agencies ; so that, perhaps, by improving the general condition of 

 the constitution, this dangerous diathesis may subside. Of course, all 

 wounds must be scrupulously avoided. When the bleeding occurs in 

 spite of such precautions, besides the ordinary haemostatic articles, 

 among which steady pressure and the actual cautery are the best, 

 glauber salts in cathartic doses should be prescribed, and, when the 

 bleeding threatens life, two to five grains of secale cormitum every 

 half-hour. These two prescriptions have been of great benefit in somr 

 instances. 



CHAPTER VI. 



SCROFULA. 



ETIOLOGY. The term scrofula signifies a morbid (cachectic) con- 

 dition of the system, manifested by a remarkable liability to certain 

 forms of nutritive disorder of the skin, mucous membranes, joints, 

 bones, organs of special sense, and, above all, the lymphatic glands. 



