HEMOPHILIA 453 



selves, their play with other children is to be watched. The nurse must be 

 instructed to see that the children do not injure themselves; their toys are 

 to be so chosen that injury to the skin may be avoided. Hemophilic children 

 must not be chastised. As soon as the children are intelligent enough, they 

 and their playmates are to be instructed that injuries by falling or blows, 

 a prick with a needle or pen, should be avoided. If the children are sent to 

 school the parents should inform the teacher that the pupil is a member of a 

 bleeder family. It is advisable that the physician instruct the teacher, in 

 so far as may be necessary for the welfare of the child while in school, as to 

 the symptoms of hemophilia. The teacher will then understand how to con- 

 duct himself toward a hemophilic pupil, and what instructions he should give 

 the other pupils as to their behavior to the bleeder. Hemophilic children 

 should not take part in gymnastic exercises; they should never be subjected 

 to corporeal punishment. 



In the choice of an occupation the bleeders are limited at once by the cir- 

 cumstance that in comparison with others they are weak. They must, there- 

 fore, choose occupations in which great bodily strength is unnecessary. Those 

 without means should be advised to become clerks or designers. Among the 

 lighter trades they should not be taught those trades in which slight injuries 

 are apt to occur, such as watch-making, engraving, paper-hanging, and that 

 of goldsmith and barber. Bleeders whose circumstances permit may with 

 advantage pursue the learned occupations. Such students should not take part 

 in games, nor should they be accepted in the army. 



General Treatment. Hemophiliacs should be placed on a special diet, and 

 fluids which slightly stimulate the vascular system (alcohol, tea and cofEee) 

 are to be avoided. The use of milk, lemonade, orangeade, etc., is to be ad- 

 vised. Solid food is to be of the bland kind ; spiced foods should be prohibited. 

 Vegetables (particularly fresh vegetables, fruit, salads) are beneficial. The 

 general nutrition is to be stimulated by baths, cold ablutions, occasionally sea 

 baths, and by residence in the country. 



Special Treatment. Attempts have been made to control the disease by 

 the administration of drugs. In a case reported by Wickham Legg, the use 

 of iron chlorid is said to have brought about improvement, but in a case of 

 my own this was ineffectual. The following drugs have also been tested: 

 Mineral acids, sugar, lead acetate, magnesium sulphate and sodium sulphate. 

 Of the mineral acids, chiefly upon Werlhof's advice, sulphuric acid in the 

 form of the elixir acidi Halleri has been employed. The freshly expressed 

 juice of lemons has been warmly advised. From this the deeply-rooted, popu- 

 lar belief in the lemon treatment, and, in milder cases, the orange treatment, 

 has developed, in which in a gradually increasing number, from one to ten 

 lemons daily, that is, their juice, are consumed. This "treatment" is con- 

 tinued for from six to eight weeks. But its benefits are as slight as from the 

 long-continued use of Haller's acid. 



The salines are perhaps of use in the sense that they relieve the congestive 

 conditions which play a role in hemophilia. General strengthening and tonic 

 remedies have frequently been resorted to during the periods free from hem- 

 orrhage ; and during this time, and also when any signs portend an approach- 



