136 MEDULLA 



vasoconstriction following epinephrine can be of any thera- 

 peutic effectiveness. On the other hand, where there exists, 

 as a result of a weakened cardiac action, a low blood pressure, 

 epinephrine acts as an efficient analeptic. This is the case, for 

 example, in the collapse following excessive anesthesia 257 or 

 in the use of a spinal anesthetic. 520 Due to the frequency with 

 which epinephrine induces ventricular fibrillation in the presence 

 of chloroform anesthesia, its use is contraindicated during or im- 

 mediately after chloroform anesthesia. 



Epinephrine may be used in averting the symptoms of hy- 

 poglycemia {e.g., after an overdose of insulin) providing there 

 is an adequate store of glycogen in the liver. If no such store 

 exists, epinephrine obviously can only have a deleterious effect. 



Epinephrine has also been advocated for use in poisoning 

 (to prevent absorption), in diptheria, heart block, Addison's 

 disease, osteomalacia, rodent ulcer, tobacco amblyopia, and 

 osseous repair. It is doubtful if it has any therapeutic value 

 in these conditions. 



Epinephrine injections have been advocated as a diagnostic 

 aid in thyroid disease, 117 hypertension, angina pectoris, irrit- 

 able heart, and other conditions but its use for this purpose 

 has not met with success. The use of epinephrine in angina 

 pectoris is to be deprecated because of the strain it puts upon 

 the heart. 243 



MODES OF ADMINISTRATION 



Epinephrine is administered clinically by subcutaneous, in- 

 tramuscular, intravenous, or intracardial injection, or by local 

 application to mucous membranes. Its oral use has at times 

 been advocated but it is doubtful, in view of the rapid destruc- 

 tion of epinephrine by the gastric and intestinal secretions and 

 the extremely slow rate of its absorption by mucous linings, if 

 such oral therapy can be of any significance. Such effects as 

 have been claimed to result from oral therapy may in part be 

 due to the oxidation products of epinephrine. These deriva- 



