ORGANOTHERAPY AND HORMONOTHERAPY 139 



were led to its trial on the incorrect assumption that it would prove useful 

 by causing constriction of the pulmonary vessels or by lessening the bron- 

 chial secretions, their experience and that of others quickly demonstrated 

 that but few other remedies so promptly and satisfactorily relieve these dis- 

 tressing paroxysms. It was only in 1911 that Januschke and Pollak 

 brought the correct explanation of its true method of action by their dem- 

 onstration, that epinephrin prevents and relaxes spasm of the bronchial 

 muscles. While the relief afforded persists in many cases for but a few 

 hours, it is often much more lasting. Its freedom from the disagreeable 

 and harmful effects of other drugs used for this indication has led to a very 

 general conviction that we possess no other agent so useful here as is 

 epinephrin. While occasionally success is obtained by oral or rectal ad- 

 ministration, 43 in the large majority of cases the beneficial effects are 

 to be obtained only by hypodermic administration. The do*se ranges from 

 5 to 15 minims (occasionally 20 minims or more). Matthews reports 

 success in a number of cases from its use as a nasal spray (1-4,000 to 

 1-10,000). 



Not a few patients react very disagreeably to such injections. When 

 this is the case, I have usually found that by trial a dose can be determined 

 which is large enough to relieve the paroxysm without causing more than a 

 mild systemic reaction, or none at all. The warning is often given against 

 the use of this drug in asthmatics suffering from cardiac or arterial 

 disease. As it has been repeatedly shown that the asthma is relieved 

 without raising the blood-pressure (as a matter of fact, this is often found 

 to have fallen when the paroxysm has been relieved), there seems to be 

 little justification for this warning. While in many asthmatics epinephrin 

 may be successfully used in repeated attacks, it is unfortunately 

 true that (as a rule) if the paroxysms recur very frequently, the drug 

 gradually loses its effect, and that even increased dosage no longer relieves. 

 From time to time the claim has been made that, in addition to securing 

 symptomatic relief, epinephrin, regularly administered, in some cases 

 permanently cures bronchial asthma, but the experience of most clinicians 

 does not bear out this claim. 



The fact that epinephrin (in sufficient dosage) inhibits the movement 

 of the alimentary canal, has suggested its trial in various conditions of 

 hyperactivity, or spasm of stomach and intestines. Among these is the 

 persistent vomiting of pregnancy, in which condition brilliant suc- 

 cess has been frequently reported. Equally good results have been 

 obtained in persistent vomiting of other causation. These results sug- 

 gested to Maverick its trial in seasickness, in which condition he and 

 others report many successes. Equally good results are claimed from oral 



43 In my personal experience in a relatively large series of cases satisfactory relief 

 has been obtained only from hypodermic administration, although very rarely a mod- 

 erate amount of relief has followed its oral administration. Of a limited number of 

 cases in which the drug was given rectally, none responded at all. 



