ORGANOTHERAPY AND HORMONOTHERAPY 135 



from the field of application, however, there is still much uncertainty and 

 difference of opinion. 



The local vasoconstricting action at the point of application is so 

 widely employed and so well understood that it will be treated here but 

 briefly. One of the greatest and most valuable uses of epinephrin is 

 found in the field of local anesthesia*. Here it is almost universally in- 

 jected simultaneously with the local anesthetic agent, as, by its local 

 vasoconstricting action, it prevents the too rapid absorption of the anes- 

 thetic, and thus prolongs the anesthetic effects and prevents systemic poi- 

 soning. For this purpose very dilute solutions (1-75,000 to 1-150,000) 

 are sufficient. By thus using epinephrin, it is possible to inject amounts 

 of cocain and its substitutes which are many times the ordinary fatal 

 dose under conditions permitting prompt absorption. It must be re- 

 membered that the epinephrin should not be added to the anesthetic solu- 

 tion before it is sterilized by boiling, as its solutions do not withstand high 

 temperature. 



In the mouth and upper air passages,, to which it can be directly ap- 

 plied, it is widely used for the control of hemorrhage, to render the mucous 

 membranes and submucous tissues bloodless, and to lessen the hyperemia 

 of inflammation. To meet these indications, it may be applied directly in 

 the form of aqueous or oily solutions in sprays, by painting, or by instilla- 

 tion. In the nares, sprays, instillations and ointments which liquefy at 

 the body temperature, or plugs of absorbent material moistened with 

 aqueous solutions, are most frequently used, although under certain con- 

 ditions the solution may be injected into the subcutaneous tissues. As such 

 submucous injections are occasionally followed by very marked systemic 

 reactions, they must be employed with caution especially if chloroform 

 is being used. It is to be remembered also that the primary vasocon- 

 striction is almost always followed by a late vasodilatation, which 

 favors the later development of turgescence of the mucous membranes and 

 hemorrhage. In coryza and hay fever, such local applications can give 

 very marked temporary relief. Hemorrhage from the gums is often 

 promptly and permanently checked, and in acute pharyngitis, spraying 

 often gives marked relief of the disagreeable subjective symptoms by 

 lessening the hyperemia. In acute laryngitis and tracheltis the use of 

 aqueous or oily sprays is often of benefit and even the cough of acute bron- 

 chitis may occasionally be palliated temporarily by inhalation of finely 

 nebulized oily solutions. 



The temporary relief of cases of chronic bronchitis which has followed 

 such inhalations is probably due to their effects on the bronchial muscles. 

 Reported beneficial results from such inhalations in bronchopneu- 

 monia appear to me extremely doubtful. The claim that when thus 

 administered epinephrin can check hemorrhage from the lungs also appears 

 at least questionable. As for all such local applications only neutral or 



