Therapeutics. — Suprarenal therapy has now exceeded thyroid therapy in far reaching application. Indeed, supra renal extractives seem endowed with properties which Bates summarizes by the word "marvelous." Unlike other po tent agents, they are devoid of pernicious after-effects. The author just named states, for example, that, while we expect great dilatation of blood-vessels to follow powerful contraction, "in 2000 cases noted in which the suprarenal produced this contraction the expected dilatation did not occur." Again, though a drug which, in minute doses, produced power ful effects is deemed a poison, such can not be said of pure adrenal products. "No untoward effect," he writes, "has ever followed the local or internal ad ministration of the untainted gland. Two pounds of the fresh suprarenal cap sule in the form of an aqueous extract has been swallowed without any apparent ill effects." Its application to the eye does not cause irritation, and it does not cause dilatation or contraction of the pupil. It is not cumulative when taken internally, and it does not possess at tributes which involve the danger of a "habit," as do cocaine, alcohol, etc.
We cannot agree with Dr. Bates when he states that no untoward effects ever follow the local use of adrenal extract. There sometimes occurs everdistension of the sinuses of the turbinals, for in stance, as noted by Kyle and others, and secondary hmmorrhage is more likely to follow its use.
The extract, applied locally, reduces congestion and is of especial benefit in rhinitis and hay fever. Eye: Local ap plication lessens congestion in conjuncti vitis, keratitis, and iritis, and hastens the absorption of inflammatory tissue. In la erymal stricture and abscess the writer injects a solution of the extract through the "puncta." The vascularity is rapidly diminished, and any pus present may be expressed via the canal. Ear: Locally applied to the Eustachian tube, the con gestion is reduced and deafness and tin nitus disappear. Its haemostatic proper ties are well known, and it can be used thus with confidence, as no clots are formed. In Addison's disease and asthma it has given good results, and 2 grains of the dried extract internally in exophthalmic goitre will lessen the heart rate and decrease the size of the thyroid. The normal heart is not affected when given internally, neither the normal blood-pressure nor pulse, but an inter mittent pulse becomes regular, a weak pulse stronger, and feeble cardiac muscle remarkably stimulated. All the effects produced are only temporary, so that re peated applications are necessary. But in all forms of inflammation it is very useful in reducing tension and pain. Bates (Med. News. p. 441, Mar.. 1900).
After the use of suprarenal extract there is danger of secondary hemor rhages, which come on several hours after the operations, and are often so pro fuse as to alarm the patient. Conclu
sions are that there is a likelihood of having more profuse secondary llmor rhages after the use of cocaine and suprarenal extract than after the use of cocaine alone. F. E. Hopkins (Phila. Med. Jour.. May 5, 1900).
This does not, however, reduce the therapeutic value of adrenal extractives.
Solutions of adrenal extract, or of its more convenient preparations on the market (epinephrin, adrenalin, etc.), in 1 to 1000 or 1 to 5000 solution arrest epistaxis and limit hemorrhage during intran.asal operations, while greatly in creasing the operative field by contract ing the tissues. The solution is to be ap plied with a pledget of cotton and left in situ about five minutes, when the tis sues are blanched and ready for operative work. I t may also be applied in the form of a spray in hay fever and local in flammatory disorders, 1 part of adrenalin in 6 of the normal salt solution is to be preferred in the latter.
Thirty-five cases iu tabulated form, showing that the useful effects of the suprarenal gland were obtained. In two eases the nose was not packed, but the patients were placed in bed and kept quiet for two days and adrenalin, 1 to 10,000, was applied by means of spray every two hours. There was no sub sequent hmmorrhage in either of these eases. The author has employed no suprarenal extract since taking up the use of adrenalin. Emil Mayer (Phila. Med. .Lour., April 27. 1901).
Great relief and almost complete com fort. from the topical use of adrenalin solution applied on a cotton wad, or as a spray in the proportion of 1 to 5000. S. Soils-Cohen (Amer. Med., Sept. 7, 1901).
The following solution is a valuable local application in hay fever, and is also remarkably efficient in controlling inflammation or bleeding and in produc ing anaesthesia of the mucous mem brane:— B Adrenal, 20 grains.
Phenic acid, 2 grains.
Eu•aine-B, 5 grains.
Distilled water, 2 drachms.
ten minutes; filter.
This solution is permanent, will not decompose nor lose its physiological activity for several months. Somers (Merck's Archives, June, 1900).
The best way of applying solution adrenalin chloride is in emtjunetion with a 2-per-cent. solution of cocaine. In the nose a pledget of cotton saturated with a 2-per-cent. solution of cocaine should be allowed to remain in contact with the tissues not longer than two minutes, and its use should be intme dia tely followed by the similar applica tion of solution adrenalin chloride. Prior to operative procedures the 1 to 1000 or the 1 to 2000 solution should be employed: for the relief of local con gestion the 1 to 10.000 will give the most satisfactory results. The adre nalin pledget should be left in contact with the tissues for ten to fifteen minutes, depending upon the result de sired, as well as the amount of swelling to be reduced. D. Braden Kyle (Therap. Gaz., July 15, 1902).