450 DRUGS OF ANIMAL ORIGIN 



solution (one heaping teaspoonful of sodium chloride to the quart of 

 sterile water), to which is added 1 per cent, of cocaine, or more if desired. 

 A stronger solution of adrenalin chloride than this (1 to 10,000) is not 

 usually desirable in operative work, because it is irritating, and in some 

 instances when stronger solutions were used so much ischemia was pro- 

 duced that the blood vessels could not be found and ligated and secondary 

 hemorrhage ensued. It is usually sufficient to add Tl\,x adrenalin solu- 

 tion (1-1000) to each ounce of novocaine or cocaine solution. 



The combination of cocaine with adrenalin marks a distinct progress 

 in local anesthesia. Four advantages are claimed for this combination; 

 1 , that the operation is made comparatively bloodless ; 2, that the cocaine 

 is retained in the operative field a longer time, owing to the contracted 

 state of the vessels, and does not escape into the general circulation ; this 

 is a double advantage — in prolonging anesthesia and in preventing sys- 

 temic effect of cocaine; 3, that adrenalin is a circulatory stimulant and 

 will offset the toxic action of cocaine; 4f, that adrenalin counteracts the 

 vascular relaxation seen sometimes after the use of cocaine. 



Adrenalin has also proved of great service in arresting hemorrhages 

 from wounds, mucous membranes and cavities of the body. A solution 

 equivalent to a 1 to 5000 of adrenalin in sterile salt solution may be 

 applied for this purpose directly to the bleeding surface, or gauze satu- 

 rated with it may be packed into wounds and cavities, as the nose, uterus 

 and vagina. Adrenalin chloride is useful also in many inflammatory dis- 

 eases of the eye and nose in the same strength. Catarrhal conjunctivitis, 

 keratitis, episcleritis and iritis yield to its influence, particularly when it 

 is combined with other astringents on .account of its transient action. It 

 is instilled with atropine in iritis. Adrenalin chloride in a 1 to 5,000 solu- 

 tion containing 2 per cent, of boric acid forms a useful preparation for 

 general applications in inflammations of mucous membranes. Increased 

 congestion may follow in some cases. Two to four mils of adrenalin solu- 

 tion are injected on either side of the fetlock in acute laminitis to lessen 

 the blood supply in the foot. Reports have been somewhat conflicting. 



Internal. — Adrenalin has been given empirically in azoturia with 

 favorable results according to the reports of many reliable practitioners. 

 Two drams of the 1-1000 solution in a little water are given subcu- 

 taneously every two hours, combined with arecoline under the skin. 

 Adrenalin is employed internally to arrest bleeding from the stomach, 

 intestines and uterus. Its local application in hemorrhage from the 

 bladder, rectum, nose, vagina and uterus is, however, much more effective. 

 Adrenalin given subcutaneously may at once relax bronchial spasm and 

 relieve asthma. It is not of benefit for the arrest of internal hemorrhage 

 other than in the digestive tract. This follows because it does not con- 

 tract the vessels of the brain and lungs and because its effect in increas- 

 ing general blood tension is inimical to its local effects in constricting 

 vessels. Reichert, as the result of his experiments on morphinized dogs, 

 believes that adrenalin is a valuable and rapidly acting stimulant to the 

 heart, vasomotor system and respiration in poisoning by opium and 

 anesthetics. Adrenalin solution undiluted may be applied on absorbent 

 cotton in pruritus of anus or vulva. 



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