76 THE H^MORRHAGIC DIATHESIS 



purpura, pernicious anaemia, and occasionally in 

 jaundice have the same explanation. 



It is important to bear in mind the fact that 

 certain cases of jaundice may ooze to death by 

 capillary haemorrhage after operation ; most of us 

 can recollect instances of this calamity. It has been 

 recommended to give drachm doses of calcium 

 chloride for three days before the operation, but 

 probably a more useful proceeding would be to take 

 the coagulation time by means of a Wright's tube, 

 and to refuse to operate on any cases showing serious 

 delay. 



TREATMENT OF 

 THE H^MORRHAGIC 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, perhaps a 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. 



