In cases of obstruction from any cause the nasal passage is packed with cot ton-wool saturated with adrenalin chloride solution. When the swelling has been reduced the membrane should be coeninized and the passages explored, until the cause of the trouble is located. when the operation May be performed with safety. D. S. Reynolds (Med. Mirror, Aug., 1902).
In pharyngeal and laryngeal inflam mations a solution of 1 to 10,000, ually increased to a 1 to 2000, is often of advantage applied in the form of a fine spray. It may also be painted over inflamed tonsils with a- camel's-hair pen cil or a pledget of absorbent cotton.
Case of chronic laryngitis in which 1 to 10.000 normal salt solution of ad renalin chloride was applied two or three times. In the course of five minutes the congestion had been con siderably reduced; the blanching process did not extend at all beyond the parts actually touched.
Case of acute laryngitis with oedema of the glottis, in which there was great swelling and redness of the epiglottis, with difficult respiration, which seemed likely to necessitate a speedy trache otomy. The interne was directed to apply to the larynx, every three or four hours. a spray of 1 part of adrenalin to 10.000 normal salt solution. This was done. with the effect of giving the patient speedy relief. lie said that he felt as though the parts had been con tracted. In addition to this treatment the patient was given grain of ni trate of piloearpine, which caused free salivation and profuse sweating. This was repeated twice a day for two days; therefore it cannot be raid just what the influence of the adrenalin was: how ever. its immediate effects were good, as demonstrated several times. The pa tient made a speedy recovery. E. Fletcher Ingals (Jour. Amer. Med. As soc., April 27, 1901).
A few minutes' application of a solu tion of adrenalin chloride (1 to 1000) to the mucosa of the respiratory tract makes possible an absolutely bloodless operation; its value as an adjunct in operative procedures cannot he over estimated. It has a wide field of use fulness as a therapeutic agent because of its rapid and safe contraction of the superficial capillaries. The author has found the 1 to 1000 solution useful in acute and subacute laryngitis, especially in the case of vocalists. A simple con gestion of the larynx may be reduced readily and vocalization restored with out discomfort or irritation. M. A. Goldstein (St. Louis Med. Rev., Aug. 10, 1902).
Internal Administration.—Suprarenal substance and extractives have been used internally with more or less advantage in inflammatory disorders of the respiratory and cardiac systems, including asthma, bronchitis, hmmoptysis, and in exoph thalmic goitre, malaria, diabetes, and mental disorders. As is the case with thyroid substance and its extractives, su prarenal substance and its extracts are not destroyed in the digestive process.
The use of suprarenal powder in dis eases of the heart in one hundred cases warranted the following conclusions: After the administration of the supra renal powder the following was ob served: 1. A weak and irregular acting heart became stronger and more regu lar. 2. A dilated heart was contracted.
3. A diffused apex-beat became localized.
4. A diffused, loud, and rough mitral regurgitant murmur became localized, smoother, and lessened in intensity, while in some eases the im•mur disap peared. 5. A murmur which, owing to the extreme weakness of the heart, could scarcely be heard, became more distinct, thus aiding in the diagnosi.s. G. The normal cardiac sounds. when dis tinct, became clearer and more easily distinguished. 7. In some cases a rapid pulse became less rapid; in other cases a slow pulse became faster. S. Patients who were very weak, with organic heart disease, were improved. 9. No effect was observed in organic heart disease when the pulse was strong and regular. Three grains of the powder were found effective, but Larger doses proved harm less. Samuel Floersheim (New York Med. Jour., May 4, 1901).
Two cases in which suprarenal extract proved effective when other remedies had failed. One patient was a woman aged 82, suffering from mitral insuffi ciency with swollen extremities. gastric irritability, and other symptoms of ear dine failure. She had received digitalis. caffeine. strophanthus, etc.. with unsat isfacto•y results. Suprarenal extract was given in 3-grain doses, thrice daily after meals. Prompt and continuous improvement followed, the oedema disap peared, vomiting ceased, and the patient could soon resume her walks. The sec ond case, a man of 76, had swollen feet, and a cardiac lesion was suspected. The usual heart-tonics failed to give re lief, until suprarenal extract was tried. and almost immediate amelioration resulted. Six weeks later all (edema was gone. The tonic influence of the remedy on the vascular system was marked. W. E. Decks (Montreal Med. Jour., Nov.. 1901).
The chief physiological action of suprarenal-gland extracts is increase of arterial pressure. but they also produce a tonic effect upon the heart and on muscle generally and possibly some diminution of metabolism. Owing to the transitory nature of the effects pro duced by intravenous injection of the extracts, they must be given by the mouth if any prolonged action is to be obtained. Digestion is not impaired by moderate doses. Both for a priori rea sons and as a matter of experience they appear to be indicated in conditions of excitement and exaltation, in which state the blood-pressure is usually low ered. In mental diseases administration for a certain length of time will be found necessary in most cases to pro duce marked effect where excitement is violent. Although the state of the blood pressure, as a rule, forms a conven ient indication for their use, high press ure does not absolutely contra-indicate them, if there is some reason to think that it is not associated with the mental state, as an abnormally high pressure may still be lower than the average of an individual case. Suprarenal extracts seem unlikely to be of benefit in cases of melancholia, and where there is much stupor. It therefore seems probable, on the whole, that the psychoses in which this will be found most useful is in acute mania of fairly recent origin uncom plicated by stupor. W. R. Dawson (Jour. Mental Science, Oct., 1001).