136 JOHN T. HALSEY 



feeble alkajine solutions may be employed (even weakly acid solutions 

 being too irritant), it is well to remember that epinephrin rapidly de- 

 teriorates in alkaline solutions, and that consequently such solutions if 

 not freshly prepared will have lost much or all of their epinephrin 

 activity. 



In the alimentary canal, suprarenal preparations may be applied 

 directly to, and can exert their local vasoconstricting power only on, the 

 esophagus, stomach, and lower bowel. In these situations, they have been 

 employed with at least occasional success in treatment of hemorrhage re- 

 suiting from carcinoma and ulcer, but the results are all too often un- 

 satisfactory, as must be expected from the pathology. It should, however, 

 be tried in these cases. Fifteen to thirty minims (1 to 2 c.cm.) of the 

 1 to 1,000 solution in 1 or 2 oz. of water may be swallowed without fear 

 of harmful systemic effects. Hemorrhoids, whether bleeding or not, are 

 occasionally benefited by introduction of epinephrin suppositories, or by 

 small enemata of weak solutions (1-10,000 to 1-20,000), which may also 

 prove useful in bleeding from the lower bowel. (While in a considerable 

 number of cases I have given epinephrin solutions or suppositories rectally 

 without obtaining any systemic effects, on one occasion a very violent 

 systemic reaction followed the introduction of a suppository containing 

 epinephrin. It is therefore possible that such effects may occasionally 

 follow the use of epinephrin enemata.) Bleeding, duodenal ulcers also 

 would seem to be accessible to epinephrin administered by mouth or 

 through a duodenal tube, but no mention of its successful use in such 

 cases has been found in the literature. Before orally administered epi- 

 nephrin can reach bleeding typhoid ulcers, it would appear certain that it 

 must he rendered inert or be completely absorbed. Consequently, such 

 use of this drug in typhoid hemorrhage seems useless. Its use hypo- 

 derm ically or intravenously to meet this indication will be discussed else^ 

 where. 



In the genito-urinary trad the urethra, ureters and pelvis of the kid- 

 ney are all accessible to the local application of epinephrin solutions, 

 which have been employed with success in the treatment of hemorrhage 

 and inflammation in these situations. From these mucous membranes 

 there is little or no danger that there will be sufficient absorption to cause 

 systemic effects, although Bastedo states that such have occasionally fol- 

 lowed application to the urethra. Their use by oral and subcutaneous 

 routes in treatment of renal conditions, and in the female genital organs, 

 is discussed elsewhere 1 . 



In tho eye instillation of epinephrin solutions ordinarily causes con- 

 siderable smarting, but they may occasionally be used with benefit to facili- 

 tate the finding of a foreign body in cases where the conjunctiva is in- 

 tensely hyperemic. (Oocain solutions would seem better, however, in 

 such cases.) Local application of epinephrin appears to cause first a fall 



