Subcutaneous injections tend to inhibit the flow of saliva and pancreatic juice. Weed and Cushing found an increase in the rate of production of cerebrospinal fluid through stimulation of the secretory activity of the choroid plexus.

Internal Secretions

According to Pal, subcutaneous injections have no effect on normal thyroids, but in hyperthyroidism reduce the excessive thyroid secretion with disappearance of the acute symptoms. He reports good results in 16 cases of exophthalmic goiter; others report similar results. In diabetes insipidus, which is believed to be due to the lack of pituitary secretion, the drug is able to check the polyuria. Goetsch found that the administration either subcutaneously or intravenously lowers the sugar tolerance.

Uterus

An isolated guinea-pig uterus beating regularly and strongly in Ringer's solution, shows an immediate response to the addition of pituitary. The tonus is markedly increased, the individual contractions are shorter, and the relaxations are somewhat quicker. The uterus may go into tetanic contraction.

The effect on the human uterus removed at operation has been well studied by Lieb, by the strip method. On the addition of pituitary the movements of the parturient uterus became stronger and more rapid, and the tone was greatly increased. Except in one instance, and that after a very large amount of pituitary, there was no tetanus, a fact also noted in clinical use. The Fallopian tubes showed an increased rate of contraction without any increase in strength. On the non-pregnant uterus and tube there was either no effect or a distinct depression. It is of interest that during pregnancy the anterior and middle division of the pituitary gland enlarge, but not the posterior, while only the posterior lobe extracts stimulate the uterus. It therefore seems probable that in pregnancy some substance, possibly produced in the anterior lobe, sensitizes the uterus to the product of the posterior lobe.

Toxicology

In isolated dog hearts the author has seen manifestations of overexcitation of the heart with premature beats and marked weakening of both auricle and ventricle. Such conditions have been reported after its use in human obstetrics. Other reported untoward effects from its use in labor are: rupture of the uterus, postpartum uterine atony, contraction of the previously dilated os, premature separation of the placenta, lacerations of the cervix and perineum, weakening and slowing of the fetal heart-sounds, and asphyxia of the fetus from the powerful and frequent contractions of the uterus. DeLee, 1916, cites 18 cases of rupture of the uterus. Vogt, basing his report on 7600 labors, emphasizes the frequency of untoward symptoms and cites cases of maternal collapse from cardiac weakness, and cases of death of the fetus from pressure. Mundell summed up 3952 cases in 1914 and 1293 cases in 1916. In the latter group there were 12 cases of ruptured uterus, 34 cases of fetal death, and 40 cases of asphyxia pallida. He states that because of the frequency of bad effects on both child and mother its field of usefulness in obstetrics is a limited one. The consensus of opinion is that it should not be employed except in cases of uterine inertia and then only when the cervix is effaced.

Anterior Lobe

The anterior lobe and pars intermedia have entirely different effects and uses from those of the posterior lobe. They have a powerful influence in the establishment of normal skeletal and sexual development, and their disease or atrophy results in sexual retrogression in adults. Goetsch and others have found that the administration of anterior lobe extracts to young animals results in more rapid growth and development, coarser and drier hair, larger nipples in the female, more rapid development of the sexual glands of both sexes, with earlier sex maturity and increased sexual activity. In pituitary infantilism or dwarfism the anterior lobe has proved of distinct value. Cushing and his associates have demonstrated that the condition known as dystrophia adiposo-genitalis, with lethargy, slowed vital functions, loss of sexual activity and a tendency to great accumulation of fat, is similar to that at the onset of hibernation in animals, at which time the anterior lobe is atrophied. It is relieved by anterior lobe extract. In premature menopause with hypertrichosis, obesity, etc., it has been used with good effect. In asthma Warfel reported good results in 13 cases from 10 grains (0.7 gm.) of dried anterior lobe daily, and Zueblin from the subcutaneous use in combination with epinephrine. Robertson claims to have obtained an active growth-controlling principle from the anterior lobe, the yield of the ox pituitary averaging 10 mg. He calls it tethelin.

Whole Gland

Goetsch suggests that the whole gland contains opposing elements, the posterior lobe, for example, antagonizing the effect of the anterior lobe on sexual development. Musser gave an extract of the whole gland by mouth to 18 persons for periods of one week to ten months, using tablets equivalent to 0.26 gm. of fresh gland. There was no effect noted from less than four tablets a day. The blood-pressure showed a rise in 17 out of 18 patients, the heart rate usually an increase, but a decided decrease in two, diuresis occurred in six patients, and diarrhea in seven, while daily movements of the bowel appeared in four that had been previously constipated.

Therapeutics

Hypophysis liquid is employed intravenously in shock and intramuscularly or subcutaneously in uterine inertia and in tympanites or intestinal paralysis as in pneumonia or following operations. A dose of 15 minims (1 c.c.) may be repeated in one hour if necessary, and every two to four hours thereafter. Undoubtedly the drug is highly valuable in these conditions. Quigley, Humpstone, Hirsch, and others claim that it will not induce labor. Others point out that it does not bring about a tetanic contraction and is therefore not of use in postpartum hemorrhage.