138 JOHN T. HALSEY 



on the oth^r hand the blood-coagulating effect could be of decisive value. 

 While for this indication epinephrin is ordinarily administered hypo- 

 dermically or intravenously, various writers, among others Warren Cole- 

 man, report success from large doses administered orally (90 grains per 

 diem of dried and powdered suprarenal substance). The clinical effect on 

 intestinal hemorrhage of epinephrin injections remains problematical, but 

 personally I am in favor of its cautious intravenous administration in 

 cases of exsanguinating hemorrhage, and, in less severe cases, of its hypo- 

 dermic administration in small doses, 10 minims every hour for several 

 doses, followed by 6 to 8 doses at 3- to 6-hour intervals. 



In hemorrhage from the kidney it has been administered hypo- 

 dermically and orally with claimed benefit. In experimental renal hem- 

 orrhage Wiggers (c) found that the intramuscular or intravenous adminis- 

 tration of moderate doses was very efficient. Those having faith in its 

 value when orally administered, base their belief on the clinical outcome 

 of cases in which it has been employed, and on the assumption that when 

 thus administered it is to some extent excreted through the kidneys, and 

 thus has the opportunity of causing renal vasoconstriction. That in the 

 doses employed it produces such effects has not been demonstrated. The 

 use of suprarenal preparations in the treatment of hemorrhage of the 

 female genital tract is discussed elsewhere. 



In internal hemorrhage of other causation, such as that of purpura 

 hemorrhagica, yellow fever, and other diseases with a hemorrhagic tend- 

 ency, its use orally or hypodermically is recommended, but its value in this 

 type of case is, to say the least, very doubtful. 



In various affections of the skin benefit has been claimed from the 

 administration of suprarenal preparations. Urticaria, either chronic or 

 acute, is often most promptly and strikingly benefited by their hypodermic 

 administration (0.5-0.7 c.cin. 1-1,000 solution), although the relief ob- 

 tained is frequently but temporary; and there are not lacking reports of 

 cures (?) of chronic or recurring urticarias following regular oral ad- 

 ministration. Good results are also claimed from the use of suprarenal 

 preparations (orally or hypodermically) in purpura liemorrhagica, but 

 such reports, together with successes from their use (internally or locally) 

 in acne rosacea, and in various conditions associated with pigmentation 

 must be viewed with considerable skepticism. 



Therapeutic Utilization of the Antispastic Action. Aside from the 

 conditions in which the therapeutic effects of suprarenal medication would 

 apixMir to bo chiefly due to its vasoconstricting action, there are others in 

 which it is employed for its antispastic action. 



In bronchial asthma the clinical value of this type of pharmacodynamic 

 action has heen most brilliantly demonstrated. Bullowa and Kaplan in 

 1!)03 appear to have been the first to recommend the administration of epi- 

 nephrin for the relief of asthmatic paroxysms. Although these authors 



