11. THE AWAKENING FROM THE HYPOGLYCEMIC SHOCK

exert a harmful effect on the heart. Carbon dioxide inhalation works very well and is a powerful circulatory stimulant. Its danger lies in shock acidosis, the tendency to which is increased by carbon dioxide. For this reason we prefer oxycarbon inhalations (carbogen), which is oxygen with 5% carbon dioxide added. The use of physical agents such as warmth, binders, elevation of the limbs, infusions of glucose in Ringer’s solution, and tutofusin is important in collapse. We have had no experience with cortigen as a means of controlling collapse. Its use seems well founded since Pol produced histological changes in the adrenal medulla and cortex by injections of insulin. Although circulatory death in hypoglycemia is regularly cardiac and practically instantaneous, it is expedient in case the heart stops suddenly to try as a last resort-at least as a matter of form-the methods of artificial respiration and artificial circulation with simultaneous intracardiac injection of c.c. of adrenalin. In conclusion, extensive cardiological research with the insulin shock therapy in schizophrenia has shown that in healthy individuals there is hardly any grave danger so far as the circulatory organs are concerned. At present it is too early to pass judgment on all late circulatory complications. Without doubt the insulin shock therapy is a test of fire for the heart and vessels and should be carried out only with the greatest caution and foresight. Not only for the treatment of diabetes with insulin, but also for the insulin shock therapy, t...