ORGANOTHERAPY AND HORMONOTHERAPY 137 



and then a rise and later a fall of intra-ocular pressure. This rise might 

 be harmful in a case of glaucoma. 



Therapeutic Utilization of Remote (or Systemic) Vasoconstricting 

 Effects. When we come to consider the utilization of the remote (or sys- 

 temic) vasoconstricting effects of suprarenal preparations, we enter a field 

 where there is still much that is uncertain, and in which neither laboratory 

 nor clinic has thus far supplied enough accurate knowledge to definitely set- 

 tle many moot points. This is strikingly demonstrated by the diversity of 

 opinion as to their value in the treatment of inaccessible hemorrhage. 



Inaccessible Hemorrhage. Although epinephrin (usually adminis- 

 tered hypodermically) has been extensively employed in the treatment of 

 hemorrhage from the lungs, there is still much divergence of opinion as 

 to its value. This. appears inevitable in view of the extreme uncertainty 

 of prognosis in this condition, and our complete ignorance of the effects 

 of such administration on the human pulmonary circulation. Labora- 

 tory investigation of intravenous administration shows different re- 

 sults in different animals and with varying dosage (Schafer and Lim). 

 Wiggers (a-) (d) found that pulmonary hemorrhage was increased by 

 epinephrin and advises against its use in hemoptysis. Bayer believes that 

 the weight of opinion is against its use in these conditions, but there are 

 many physicians who will strongly disagree with these conclusions. The 

 power of suprarenal preparations to bring about increased coagulability 

 of the blood may be cited as an argument for its possible value. 



While having relatively little faith in its power to check pulmonary 

 hemorrhage I still try it where other measures have failed. Relying 

 more on a possible blood-coagulating effect than on any favorable action on 

 the pulmonary vessels, I give it in small doses frequently repeated, 7 to 10 

 minims (0.5 to 0.7 c.cm.) of the 1-1,000 solution administered hypo- 

 dermically .every 20 to 30 minutes. Any pronounced objective reaction 

 with increase in rate or force of heart beat is considered a contraindication 

 to further trial. Of its value, I have been unable to form an opinion. 



As to the efficacy of epinephrin in the treatment of intestinal and 

 renal hemorrhage it is equally impossible to reach a definite conclusion. 

 In animals, Wiggers (6), using small doses intramuscularly or intra- 

 venously, occasionally observed a checking of hemorrhage from the intes- 

 tines, but obtained no results from the subcutaneous injection. He con- 

 cluded that in intestinal hemorrhage which has not lowered blood- 

 pressure other measures are of more value than epinephrin, but where a 

 large hemorrhage has lowered the blood-pressure and is still continuing, he 

 believes it should be given in gradually increasing dosage, the effect on 

 the blood-pressure being closely observed. Just enough should be given 

 to cause a moderate rise in the blood-pressure. 



The doses employed may bring about relaxation of the gut at the site 

 of a bleeding ulcer, which might well exert an unfavorable influence, but 



