Licence: In copyright
Credit: A case of hemophilia / by R.F. Sheehan. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
4/11 (page 362)
![Lr.1. IC2. 362 CLINICAL REPORTS. A Case of Hemophilia. By R. F. SHEEHAN, M. D„ Buffalo, N. Y. Late House Physician at the Buffalo General Hospital. The patient A. M., age 16 years, entered the service of Dr. H. R. Hopkins, June 30, 1905, about 4 P. M. On June 26 he went to a dentist, who found that two molars complained of were too carious to be filled or crowned, and decided to extract them. They were drawn at 3 P. M. that day. The patient went home and soon began to bleed quite freely. He returned to the dentist, who packed the cavities; the bleeding, however, continued at intervals of from three to six hours until the present, patient loosing from 100 to 150 cc. of blood each time. He had complained of severe headaches and great thirst, and was given all the fluid desired. At times he had become faint and stupid. Upon entrance June 30, at 4 P. M., the patient showed marked pallor, was very dull and extremely weak. Ex- amination of the mouth revealed a blood clot, as large as an egg between the alveolar processes and projecting into the buccal cavity on the right side. When the clot and packing were re- moved, it showed that the second molar in the upper and lower jaws had been removed, and with the upper tooth a portion of the alveolar process. i'k il'J: 1 There was considerable oozing from both cavities, especially the upper, because of the more lacerated gum and alveolar pro- cess. Pressure was made b}' means of small pads and bandages upon the common temporal, and upon the facial artery at the ramus. The mouth was then cleansed with swabs and a solution of hydrogen dioxide, the cavities repacked with cotton satur- ated with 1, 1000 solution adrenalin chloride. It was necessary to repeat this every six to eight hours be- cause of the clot formation which, however, was less each time. The presence of the clot caused a very unpleasant odor, whichl was most distressing to the patient, and prevented him from] taking any nourishment by the mouth. He was given small nutritive enemata every eight hours and between times an enema of normal salt solution 250 cc.. in whichi was placed 1 gm. calcii chloridi. In addition, he had every 4| hours adrenalin 0.0006 hypodermically, for its effect in promot ing blood coagulation. The effect upofl the blood pressure being! observed, it was upon entrance 108 mm. hg., and rose to 130[ mm. hg. by 8 P. M. of the first day, at which point it was mam tained. He was also given hypodermically, strychniae sulfati; 0.002, as a stimulant, every 4 hours. July 1, at 8 P. M., the pressure was removed from the artcr ies. The next day, upon cleansing the mouth, the clot was foum to be quite small, bleeding had ceased from the lower cavity, aiv there was but very little from the upper one. The latter again packed as before, and the following day it was possibid Si '.'tf leir I Ti ‘■Hat In D](https://iiif.wellcomecollection.org/image/b22429153_0004.jp2/full/800%2C/0/default.jpg)
