140 THE HEMORRHAGIC DIATHESIS 



TREATMENT OF 

 THE H/EMORRHAGIC DIATHESIS. 



It will be gathered that unfortunately the under- 

 lying causes of haemophilia do not lend themselves 

 to direct remedy. We cannot, except by one drastic 

 proceeding, influence the quality or quantity of the 

 more complicated and specialized fibrinoplastic 

 elements in the blood, and we can use only those 

 means which in a general way are understood to 

 increase the coagulability. 



Sometimes the ordinary surgical means such as 

 rest, pressure, plugging, or adrenalin may be success- 

 ful. It is usually advised not to stitch wounds, 

 for fear of bleeding from the punctures, but if these 

 are made with a small, round-bodied needle, the 

 elasticity of the skin will prevent oozing. Therefore, 

 if tight stitching would obviously bring useful 

 pressure to bear, it should be resorted to, but only 

 in the skin, not in mucous membranes. 



It has been advised, and the advice is physio- 

 logically sound, to apply normal human blood to the 

 oozing point. Unhappily, even if a mass of clot is 

 formed over the wound, it soon gets pushed away by 

 the collection of unclotted blood beneath it. For 

 the normal arrest of haemorrhage it is necessary either 

 that clotting should take place inside the bleeding 

 vessel or that it should fill the wound so tightly about 

 this vessel as to present a complete block to the flow. 

 It is often impossible to get the remedy near enough 

 to the actual rent in the artery or capillary to bring 

 this about, and the shape of the wound may not lend 

 itself to filUng up tightly with firm clot. Nevertheless, 



