208 THE DUCTLESS GLANDS 



accomplished by intramuscular injections. Adrenalin is not 

 indicated in all intestinal haemorrhages. The condition of the 

 blood-pressure is the criterion for its use. In haemorrhages of 

 short duration, when the pressure has not fallen to any extent, 

 a judicious dose of nitrites proves of more benefit than adrena- 

 lin. When the bleeding has been profuse, however, and a low 

 pressure already exists, it becomes vital that haemorrhage 

 should be checked without further reduction of pressure. 

 Adrenalin finds its use in this field. The use of adrenalin should 

 always be closely followed by blood-pressure observation. A 

 dose sure to be below the safety limit should first be tried and 

 the pressure carefully estimated. If no rise occurs, gradually 

 increasing doses may be injected until a slight elevation of 

 pressure is present, in which case we may be certain that 

 enough has been introduced to affect haemorrhage, and at least- 

 no significant preliminary increase has resulted. 



Adrenin in Cardio-Vascular Conditions. In cardio-vascular 

 conditions adrenin is most distinctly indicated when there is 

 marked vasodilation and the heart muscle is in good condition. 

 These indications are present in chloral-poisoning, shock, and 

 asphyxia. Gottlieb pointed out that when a rabbit has re- 

 ceived increasing doses of chloral until the heart comes to a 

 standstill, adrenal extract will start the heart beating and 

 maintain it for from twenty to thirty minutes. He considers 

 that adrenalin is superior to digitalis for this purpose. Crile 

 strongly advocates the use of adrenalin in " surgical shock," 

 and although good results have been stated to accrue from its 

 employment in ether-poisoning, yet, according to Schafer and 

 Scharlieb, it is of little avail to restore a heart paralyzed by 

 chloroform. 



In the cardiac insufficiency of diphtheria in which disease, 

 as Elliott and Tuckett have shown, there is a deficiency of 

 chromogen in the adrenal medulla Gottlieb has reported that 

 adrenin administered intravenously is of temporary benefit. 

 The same applies to phosphorus-poisoning. Schafer suggests 

 that administration by the mouth or subcutaneously, having 

 a slower effect, might be beneficial in such cases. Rolleston 

 has recently discussed the value of adrenalin in such cases as 

 the cardiac failure of diphtheria, and lays stress, as others ha\ < 

 'Inne, upon the possibility that the increase of the peripheral 

 resistance may give the failing ventricle more work to do. 



