116 JOHN T. HALSEY 



these very exceptional cases in which the toxemia has damaged the heart. 

 Here this treatment may raise the blood-pressure, strengthen the heart, 

 slow its rate, and improve the quality of the pulse. My own experience 

 with this method of treatment of circulatory failure in infections has left 

 me very skeptical as to its value. 31 There is need of .further investigation 

 alons experimental and especially along clinical lines. 



Shock. Mummery and Byrnes appear to have been the first to advo- 

 cate the administration of pituitary substance in shock. Since that time 

 it has been rather extensively tested, and many surgeons have reported 

 favorably as to its value. Blair Bell (c) (1919) considers that while it is 

 not a specific, it is useful both as a prophylactic measure and also after 

 shock has developed. He recommends its injection in doses of 1 c.cm. of 

 the 20 per cent extract of the pars posterior. He stresses the relatively 

 long duration of its effects on the blood-pressure, stating that he has seen 

 this effect maintained for as long as 8 hours after administration. Experi- 

 ence in the jrreat war has led many others to a similar conclusion. The 

 British Medical Research Committee recommended it as of considerable 

 value. Among my own surgical colleagues I find a practically unanimous 

 agreement with this view. However, the available literature leaves the 

 impression that further careful observation, both in clinic and in labora- 

 tory, is needed before it will be possible to form a correct estimate regard- 

 ing the real value of, and the indications for, this drug in the treatment 

 of shock. 



To obtain the effects on the circulation it must be administered hypo- 

 (lennically or intramuscularly in full doses (0.5 to 1.0 c.cm. of the 20 

 per cent extract), and the frequency of repetition must be determined by 

 the effects. Murray (d) and others advise intravenous injection where 

 the indication is very urgent. 



Renal Disease. The diuretic action observed in the laboratory aroused 

 the hope that a similar action might be exerted in ca-ses of renal disease. 

 While in the earlier literature there are a number of papers reporting 

 favorable results from the administration of pituitary substance to nephri- 

 tics and cardiorenal patients, more extended clinical experience has failed 

 to justify a belief in the efficiency of such therapy. 



Alimentary Canal. In paralytic distention of the stomach or intes- 

 tine, and in general abdominal distention the value of posterior pituitary 

 ext raots (first advocated for this indication by Blair Bell and Hick in 

 1001)) is well established. Experience has shown that, after various other 

 measures have failed, an injection of 0.5 to 1.0 c.cm. of the 20 per cent 

 extract often brings about vigorous peristalsis in cases where this con- 



31 In a very considerable number of eases of pneumonia, where I have used pituitary 

 extracts to meet another indication, careful observation of the effects on the circula- 

 tion has not convinced me that these are beneficial. 



