454 THE HEMORRHAGIC DIATHESES 



ing hemorrhage, ergot, lead acetate, hydrastis canadensis, as well as opium 

 and silver nitrate, have been employed to combat the hemorrhagic diathesis. 

 Upon the whole little is to be expected from the drug treatment of hemo- 

 philia ! 



Eegarding the treatment of special hemorrhages in the hemophiliac, at- 

 tempts must first be made to control the hemorrhage by mechanical means. 

 The member is to be elevated. Occasionally this alone is sufficient. Secondly, 

 the employment of local styptics comes into question, iron chlorid and gelatin ; 

 under some circumstances the cautery may also be employed. Sometimes we 

 succeed with tampons; sometimes by the application of a rubber bandage to 

 the bleeding member and by compression of the nearest large artery. Some- 

 times the tying of a large vessel becomes necessary. Hemard, to control the 

 hemorrhage after extraction of a tooth, tied the common carotid artery. 



D. McKenzie (British Medical Journal, April 27, 1901) reports the occur- 

 rence in a hemophiliac of an apparently uncontrollable epistaxis which yielded 

 at once to a tampon of cotton soaked in suprarenal extract. 



E. Heymann (Miinchener med. Wochenschr., 1899) reports the case of a 

 bleeder aged twenty-eight, who, after removal of the tonsil, suffered from severe 

 hemorrhage which could not be controlled. Heymann injected under the skin 

 of the thorax 180 c.c. of a 2.5 per cent, neutralized and sterilized solution of 

 gelatin in a physiologic salt solution warmed to 40° C. After fifteen minutes 

 the hemorrhage ceased, and did not recur for thirty hours. The injection was 

 twice repeated, and the hemorrhages invariably became slighter. Heymann 

 concludes from this that an increasing coagulability of the blood was pro- 

 duced. 



Nichols {Medical News, 1898) reports the history of a hemophiliac, twenty- 

 four years old, who, while intoxicated, fell upon broken glass and received 

 extensive incised wounds. For seven days the hemorrhage could only be par- 

 tially controlled, and the patient showed symptoms of a dangerous anemia; 

 Nichols then poured the contents of a culture tube filled with 10 per cent, 

 gelatin into the wound. The hemorrhage permanently ceased. 



My own numerous experiments with gelatin for the purpose of controlling 

 severe hemorrhages and in the treatment of aneurism lead me to doubt the 

 correctness of these observations, although I do not wish to discountenance the 

 occasional use of gelatin for styptic purposes. But, in doubtful cases, we must 

 not expect great results from its employment. 



Adrenalin locally has of late been successfully used in controlling bleed- 

 ing, and is worthy of trial in hemophilia under similar circumstances. 



Of internal remedies ergot and its derivatives have been used. Their 

 effect, however, in the fully developed disease is very questionable. 



Durmg pregnancy in hemophilic women hemorrhages indicate artificial 

 abortion or early induced labor (Kehrer). Broock (Transactions of the Chi- 

 rurgical Society of London, 1900, page 103) reports the case of a woman, 

 a member of a bleeder family, who had borne two children with well-marked 

 symptoms of hemophilia, and, as she had suffered greatly from hemorrhage 

 in each labor, he endeavored to prevent it in the third. He instituted a treat- 

 ment which had for its purpose, on the one hand, a general strengthening of 



