ORGANOTHERAPY AND HORMONOTHERAPY 129 



enough from the mouth and stomach to produce systemic effects, and that 

 occasionally, following applications to the nose, conjunctiva, or urethra, 

 marked systemic effects have resulted. The literature is full of state- 

 ments of the efficiency of suprarenal preparation administered orally. 

 Recently with the assistance of Mr. A. L. Vidrine, Tulane, 1921, I have 

 again investigated this matter. In a series of over forty cases, all of whom 

 reacted unmistakably to the subcutaneous administration of 0.5 c.c., or 

 less, 1-1,000 solution of adrenalin chlorid, doses up to 4 mg. administered 

 orally have with two exceptions failed to produce either objective or sub- 

 jective effects, unless a fall of about 10 mm. Hg in systolic and diastolic 

 blood-pressure may be considered as an effect similar to that produced 

 in the laboratory by very small doses. That it does not entirely es- 

 cape absorption when orally administered, is proved by the occasional 

 unmistakable clinical effects, and by its demonstration in the urine of 

 animals to which it had been administered orally (Embden and v. Fiirth). 

 Lesne reports that when rectally administered to rabbits its toxic effect 

 approximates that following subcutaneous injection. In one instance, I 

 have seen striking systemic effects follow the insertion of a rectal sup- 

 pository containing 0.6 mg. adrenalin chlorid, but I have failed in numer- 

 ous subsequent efforts to get similar effects. 



The effects of subcutaneous injections are inconstant. Frequently the 

 systemic reaction from ordinary dosage is so slight that it is difficult or 

 impossible of detection, while at times the reaction is quite prompt and 

 well developed. In my own experience, the effects on the blood-pressure 

 and heart rate have of tenest been very slight or entirely lacking, but when 

 thus administered its effects on the bronchi have been unmistakable. 



Intramuscular injection usually permits of sufficiently rapid absorp- 

 tion to promptly produce some rise in blood-pressure, acceleration of the 

 heart-rate and other systemic effects. I have once, in a patient later shown 

 to be hyper susceptible to this drug, seen the intramuscular injection of 1.5 

 mg. adrenalin chlorid followed by effects on the circulation quite compar- 

 able to those seen in the laboratory following intravenous injection, namely, 

 rise of blood-pressure from 110 to over 200 mm. Hg with alternately 

 slowed and irregularly accelerated heart action. 



From intravenous administration there is instantaneous and marked 

 reaction to such a degree that the dose must be very small, well diluted, 

 and slowly injected. 



The rapidity with which the effects of a dose of epinephrin pass off 

 appears best explained on the assumption that it is rapidly changed and 

 rendered inert, or that it is absorbed and held fast by various tissues and 

 cells, or that both of these factors are active. 



Excretion. Embden and von Fiirth found in the urine a by no means 

 small percentage of the amounts which had been orally administered and 

 there are also a number of other observations which make it probable that 



