OEGANOTHEKAPY AND HORMONOTHERAPY 133 



have been very extensively employed, and there is much divergence in the 

 reports as to its clinical value. In my own cases, results have been most 

 disappointing, and I believe that such has been the experience of the 

 majority. On the other hand, there are a large number of observers whose 

 experience has convinced them of the very real value of suprarenal therapy 

 under these conditions. Sergent finds in the collapse of infectious disease, 

 trauma, etc., that suprarenal extract, or epinephrin, is very valuable. He 

 believes that the dosage usually given is too small, "that those who give 10 

 to 15 drops of the 1-1,000 solution orally can expect nothing." He advo- 

 cates in acute cases hypodermic administration of 2 to 3 mg. of epinephrin 

 per diem in 4 to 6 doses, and in addition gives orally 2 to 4 doses of 0.5 mg. 

 each. In less acute and threatening conditions, he advises its use orally 

 in amounts ranging up to 3 or 4 mg. per diem in 6 to 8 doses. Sajous is 

 convinced of its value in adynamic cases of typhoid fever and other in- 

 fections. Josue (1916) assumes that in certain cases of chronic circula- 

 tory failure the cardiac weakness is due to suprarenal insufficiency (asys- 

 tole surrenale), and claims striking benefit from the oral administration 

 of extract of the whole gland (1% grains t.i.d.), or from the injection in 

 divided doses of 1.0 c.cm. of a liquid extract of the whole gland. In my 

 own personal observations of such cases, no benefit has been noted follow- 

 ing the oral administration of epinephrin. After its hypodermic admin- 

 istration, there has been at times a, very temporary increase in the force 

 of the heart beat, but no permanent benefit even from repeated injec- 

 tions. 



In the collapse of infectious disease many authors advise much larger 

 doses, up to 6 to 12 mg. per diem, and Kircheim has used as much as 48 

 mg. in 48 hours. The subcutaneous administration is generally preferred 

 to other methods, but in very acute conditions 0.5 to 1 liter of 1-100,000 to 

 1-200,000 in normal saline may be given intravenously. Such infusions 

 frequently bring about a very striking temporary improvement, and occa- 

 sionally at least it is maintained. Of late the trend of clinical opinion 

 would appear to deny or doubt the value of suprarenal medication in this 

 type of circulatory failure. 



Shock has also been considered by some as wholly or in part due to 

 acute suprarenal insufficiency. For this hypothesis, proof or even sug- 

 gestive evidence is completely lacking, and more recent clinical and experi- 

 mental studies of shock have led to the conclusion that in shock epinephrin 

 is usually useless or even harmful. 



A number of experimental and clinical observations saggest that, if 

 not regularly, at least frequently, long continued narcosis brings about a 

 temporary suprarenal insufficiency. Whether or not this is the correct 

 explanation for the collapse, which occasionally follows prolonged anes- 

 thesia, the administration under these conditions of epinephrin hypo- 

 dermically or intravenously has often been followed by prompt and per- 



