HEMOPHILIA 455 



the entire system (change of air in combination with the administration of 

 iron, quinin and arsenic) and, on the other hand, the increase of the coagula- 

 bility of the blood (calcium ehlorid). The course of the labor was in exact 

 accordance with his expectations. The loss of blood was very slight, the child 

 showed no signs of hemophilia, and was stronger than the children previously 

 borne. 



The treatment of the hemophilic joints is especially important. F. Konig 

 advises the following method: A fresh hemarthros, above all in a bleeder, is 

 to be so treated that the patient cannot use the affected joint ; moderate com- 

 pression decidedly promotes absorption. The question whether any operative 

 treatment of the diseased joint is permissible Konig answers affirmatively, in 

 so far as puncture of the joint is concerned. Konig has performed puncture 

 in the knee-joint three times, twice with carbolic acid washing. The opera- 

 tion was always harmless, one patient was much improved, and the other 

 patient was cured ; but Konig advises that this be the limit of operative pro- 

 cedure. Of three patients into whose joints he opened, by mistake, supposing 

 the condition to be tuberculosis, two bled to death, and one after many hem- 

 orrhages recovered, but had a stiff joint remaining. According to Guyot, the 

 treatment of the hemophilic arthropathies in the acute stage must be entirely 

 expectant; later, however, puncture of the joint and incision, with removal 

 of coagula, is said to facilitate recovery, after which recurrences of the bleed- 

 ing are less to be feared. 



The latest reports regarding the therapy of bleeder's joints are from Hoffa's 

 Clinic, and in the article by Gocht, previously referred to, great importance 

 is attached to the prophylaxis of hemophilia. Improvement of the general 

 condition by good food, residence in pure air, and hardening of the body, as 

 well as the avoidance of all injuries which may give rise to hemorrhages, are 

 the most important measures. Boys must be trained to this from the onset, 

 and as early as possible they must be taught to avoid running, jumping, and 

 other active children's games. If it is known that the child is a bleeder before 

 it learns to walk, the greatest care must be exercised. The joint hemorrhages 

 which follow the most insignificant, scarcely avoidable, injuries are numerous 

 enough, aside from the greater injuries which may bring about hemorrhage, 

 and must be carefully guarded against. 



The first lesion to be described in Gocht's article is a fresh effusion of 

 blood into the knee-joint. In marked cases enormous swelling arises. The 

 joint is so tense and so filled with fluid that the resistance of the capsule of 

 the joint checks a further exudation of blood. The symptoms are the same 

 as after severe contusions of the joint, except that in many cases from the onset 

 the function is scarcely disturbed. Sometimes the knee assumes the medium- 

 flexure position, at other times not so, or only for a few hours until the cap- 

 sule has accommodated itself to the exudation. The treatment varies. Where 

 there is decided pain, absolute rest, moist compresses, ice, or compression 

 with bandages may be beneficial ; in other cases the patients are kept per- 

 fectly quiet or are permitted to walk about carefully. Gocht determined from 

 his experience in the Clinic that generally a moderate use of the joint in walk- 

 ing has no injurious effect upon the absorption of the effusion in the joint. 



