13 4 JOHN T. HALSEY 



manent improvement. (Post hoc or propter hoc?) When chloroform has 

 been used, however, intravenous injections may he attended with a certain 

 amount of danger, and should be given with great caution. More- 

 over, the differentiation between such a condition of collapse due to 

 anesthesia and that due to shock would appear to be always difficult and 

 at times impossible. As there is reason to doubt the value of epinephrin in 

 the treatment of shock, it is therefore questionable whether it is good 

 practice to use epinephrin at all in such cases. 



Functional Suprarenal Insufficiency (Hypoadrenia), Although per- 

 haps not definitely demonstrated, it is not improbable that there are indi- 

 viduals in whom the suprarenal glands are to some degree incompetent 

 either congenitally or as a result of exhaustion of these organs through 

 excessive physical exertion. That such is the case has been assumed by 

 certain authors who find in the administration of the whole gland or of its 

 active principle a specific and successful therapy. In general those who 

 recognize this symptom-complex report better results from administration 

 of preparations of the whole gland than from that of the active principle. 

 It does not seem possible at present to form any opinion as to the fre- 

 quency with which such conditions are capable of recognition, nor of the 

 value of the treatment adopted. 



In the collapse with alarming circulatory failure occasionally seen 

 following extreme physical exertion, whether or not this be really due to 

 suprarenal failure, there would appear to be no disadvantage and possibly 

 real benefit from the administration of epinephrin intramuscularly or, 

 with great caution, intravenously. 



Erb's Myasthenia. Although there is no known pathologic basis for 

 assuming suprarenal insufficiency as the cause of this condition, this as- 

 sumption has been made and, according to Bayer, the administration of 

 suprarenal preparations has been followed by favorable results in a 

 number of cases reported by various observers. 



Hormonotherapy (Symptomatic Suprarenal Therapy) 



In addition to their employment in conditions more or less certainly 

 due to suprarenal insufficiency, there is a wide field in which suprarenal 

 preparations are administered for the purpose of exerting their pharma- 

 codynamic actions as a means of combating various symptoms and dis- 

 turbances of function. 



Vasoconstricting Action. Foremost among such therapeutic applica- 

 tions of this drug is the utilization of its local vasoconstricting action. 

 r !lns phase- of its use is extended and varied, and here in large measure 

 suprarenal therapy rests on a firm basis, both theoretically and clinically. 

 In cniimvtion with its employment to secure such effects at points remote 



