452 THE HEMORRHAGIC DIATHESES 



ants succumbed directly to hemorrhage. The first symptoms of the disease 

 were noted after the children had reached the age of six months. 



TREATMENT 



General prophylaxis. On account of the hereditary nature of the disease, 

 and in view of the fact that the affection is mainly transmitted by the female, 

 it is obvious that the proper restriction of marriage would lessen hemophilia. 

 From considerations of this kind laws have been framed in accordance with 

 which the question of marriage in bleeder families should be considered. The 

 fundamental rules, based upon Grandidier's rich experiences in this respect, 

 are as follows : 



1. All females, members of bleeder families, whether they themselves are 

 bleeders or not, are to be advised not to marry. 



2. All male members who themselves are not bleeders may unquestionably 

 be permitted to marry. 



A male bleeder is only to be dissuaded from marrying if it can be proven 

 that in his family hemophilic males have reared hemophilic children, although 

 the males in question married healthy women from healthy families. 



A factor which is said to favor hemophilia is the intermarriage of rela- 

 tives. Whether this is justifiable or not is difficult to determine. So far as 

 we have positive knowledge, the conditions are the same as in the intermarriage 

 of relatives generally. There can be no doubt that professional prohibition 

 of marriage has very little effect. The desire of a hemophilic family to see 

 a daughter married may be much_ stronger than the fear that from the marriage 

 bleeders may be born. 



Of paramount importance in combating hemophilia is individual prophy- 

 laxis. This is to begin as soon as the child is born, and during the years of 

 infancy it must be very strict in accordance with the experience that at this 

 age the hemorrhages of hemophiliacs are especially prone to be exceedingly 

 serious. In nurslings in whom there is a suspicion of hemophilia, all attempts 

 to remove slight congenital defects are absolutely prohibited. To this cate- 

 gory belong the operations for hare-lip, malformation of the palate, severing 

 the frenum of the tongue, the operation for syndactylism, the removal of naevi, 

 etc. Eitual circumcision of the children of Jewish and Mohammedan families 

 is to be strictly prohibited. In girls the usual piercing of the lobe of the ear 

 for earrings must be omitted. Experience shows that vaccination of hemo- 

 philiacs does not give rise to threatening hemorrhage; it may therefore be 

 practised in infants (and also re-vaccination) without danger. Great atten- 

 tion must be paid to the teeth in the children of bleeder families. The peri- 

 odical observation of the teeth by a thorough and experienced dentist, and 

 the careful treatment of even the slightest affections of the teeth are necessary 

 in order to preserve them. In view of the extreme danger of surgical operations 

 upon the oral cavity, particularly extraction of the teeth, care must be exercised 

 to prevent such operations in so far as possible in children of bleeder families. 

 The application of leeches, blisters, wet-cups, in children as well as in adult 

 bleeders, is to be avoided. When the children begin to go about by them- 



