If the patient can retain fluids taken by the mouth—such as hot coffee, barley water, or soda water—these should be freely given, unless the injury necessitates operative treatment under a general anæsthetic.

Transfusion of blood is most valuable as a preliminary to operation in patients who are bloodless as a result of hæmorrhage from gastric and duodenal ulcers, and in bleeders.

Hæmophilia

The term hæmophilia is applied to an inherited disease which renders the patient liable to serious hæmorrhage from even the most trivial injuries; and the subjects of it are popularly known as “bleeders.”

The cause of the disease and its true nature are as yet unknown. There is no proof of any structural defect in the blood vessels, and beyond the fact that there is a diminution in the number of blood-plates, it has not been demonstrated that there is any alteration in the composition of the blood.

The affection is in a marked degree hereditary, all the branches of an affected family being liable to suffer. Its mode of transmission to individuals, moreover, is characteristic: the male members of the stock alone suffer from the affection in its typical form, while the tendency is transmitted through the female line. Thus the daughters of a father who is a bleeder, whilst they do not themselves suffer from the disease, transmit the tendency to their male offspring. The sons, on the other hand, neither suffer themselves nor transmit the disease to their children ([Fig. 64]). The female members of a hæmophilic stock are often very prolific, and there is usually a predominance of daughters in their families.

Fig. 64.—Genealogical Tree of a Hæmophilic Family.
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The disease is met with in boys who are otherwise healthy, and usually manifests itself during the first few years of life. In rare instances profuse hæmorrhage takes place when the umbilical cord separates. As a rule the first evidence is the occurrence of long-continued and uncontrollable bleeding from a comparatively slight injury, such as the scratch of a pin, the extraction of a tooth, or after the operation of circumcision. The blood oozes slowly from the capillaries; at first it appears normal, but after flowing for some days, or it may be weeks, it becomes pale, thin, and watery, and shows less and less tendency to coagulate.