In the October number of The New Zealand Medical Journal, there is an article on the use of pituitrin in labour. The opinions expressed in that article agree with those which have appeared in other publications, but I regret that my own experience has not been so fortunate. I quite admit that in pituitrin we have a very valuable weapon, but I believe that its limits are more restricted than some writers claim. General surgery has gained as much as, if not more than, obstetrics by the introduction of pituitrin.To my mind the greatest objection is the difficulty of judging what its action will be in any particular case. Given intra-muscularly, the maximum effect is obtained in a very short time, and, once it is given, there are no means of controlling its action. Perhaps a concrete example may explain my meaning.Mrs. W., \u00e6tat 25 years, primipara. Labour was proceeding slowly with moderate pains. As conditions were unfavourable for the application of forceps, at the stage of full dilatation I injected 1 c.c. of pituitrin. The pains were soon increased in strength and in frequency. Progress was now rapid, and when the head was on the perineum, the pains were almost continuous. The result was a bad tear of the perineum and a stillborn child, both of which I attribute to the use of pituitrin in that particular case.In another case, no appreciable effect was produced, though all the indications pointed to the administration of pituitrin.Mrs. H., multipara. The pains were infrequent and inefficient. Dilatation proceeded very slowly, and the injection of 1 c.c. of pituitrin on three separate occasions produced nothing but the most transient effect. Delivery was finally completed with forceps.It is stated that the use of pituitrin hastens the third stage. This is certainly true, but in two cases of mine the rapid detachment of the placenta resulted in small pieces of placental tissue being retained.As regards the occurrence of post-partum haemorrhage, this seems to depend on the time at which the pituitrin is administered. As the effect of pituitrin wears off in about one hour, unless delivery is completed within one hour after the exhibition of the pituitrin, there may be considerable uterine relaxation with more or less haemorrhage. I have noticed this tendency in several cases. Of course, a second injection quickly remedies this.Another advantage claimed for pituitrin is that the number of forceps cases is reduced, but in many instances I believe that the use of forceps is a distinct advantage. In primiparous cases especially the application of forceps helps to stretch the perineum; and while exercising traction with the right hand, one can stretch the perineum with two fingers of the left hand. When the head is brought down to the perineum it is advisable to push the anaesthesia and so abolish all straining on the part of the patient. Then it is a simple matter to deliver the head gradually, at the same time working the perineum backwards over the sinciput. In this way it is possible to deliver a primipara with only the smallest tear of the fourchette.If the labour is proceeding slowly and the patient shows signs of becoming exhausted, I prefer to give \u00bc-gr. of morphia. This, while not abolishing uterine action, greatly lessens the sufferings of the patient, and even permits of a few hours sleep in some cases. Later pituitrin or forceps can be used as is thought fit.Personally, I am inclined to restrict the use of pituitrin to a multipara whose perineum has lost its rigidity, and after the third stage to those cases which show a tendency to haemorrhage. Farquhar Matheson, M.B.

In the October number of The New Zealand Medical Journal, there is an article on the use of pituitrin in labour. The opinions expressed in that article agree with those which have appeared in other publications, but I regret that my own experience has not been so fortunate. I quite admit that in pituitrin we have a very valuable weapon, but I believe that its limits are more restricted than some writers claim. General surgery has gained as much as, if not more than, obstetrics by the introduction of pituitrin.To my mind the greatest objection is the difficulty of judging what its action will be in any particular case. Given intra-muscularly, the maximum effect is obtained in a very short time, and, once it is given, there are no means of controlling its action. Perhaps a concrete example may explain my meaning.Mrs. W., \u00e6tat 25 years, primipara. Labour was proceeding slowly with moderate pains. As conditions were unfavourable for the application of forceps, at the stage of full dilatation I injected 1 c.c. of pituitrin. The pains were soon increased in strength and in frequency. Progress was now rapid, and when the head was on the perineum, the pains were almost continuous. The result was a bad tear of the perineum and a stillborn child, both of which I attribute to the use of pituitrin in that particular case.In another case, no appreciable effect was produced, though all the indications pointed to the administration of pituitrin.Mrs. H., multipara. The pains were infrequent and inefficient. Dilatation proceeded very slowly, and the injection of 1 c.c. of pituitrin on three separate occasions produced nothing but the most transient effect. Delivery was finally completed with forceps.It is stated that the use of pituitrin hastens the third stage. This is certainly true, but in two cases of mine the rapid detachment of the placenta resulted in small pieces of placental tissue being retained.As regards the occurrence of post-partum haemorrhage, this seems to depend on the time at which the pituitrin is administered. As the effect of pituitrin wears off in about one hour, unless delivery is completed within one hour after the exhibition of the pituitrin, there may be considerable uterine relaxation with more or less haemorrhage. I have noticed this tendency in several cases. Of course, a second injection quickly remedies this.Another advantage claimed for pituitrin is that the number of forceps cases is reduced, but in many instances I believe that the use of forceps is a distinct advantage. In primiparous cases especially the application of forceps helps to stretch the perineum; and while exercising traction with the right hand, one can stretch the perineum with two fingers of the left hand. When the head is brought down to the perineum it is advisable to push the anaesthesia and so abolish all straining on the part of the patient. Then it is a simple matter to deliver the head gradually, at the same time working the perineum backwards over the sinciput. In this way it is possible to deliver a primipara with only the smallest tear of the fourchette.If the labour is proceeding slowly and the patient shows signs of becoming exhausted, I prefer to give \u00bc-gr. of morphia. This, while not abolishing uterine action, greatly lessens the sufferings of the patient, and even permits of a few hours sleep in some cases. Later pituitrin or forceps can be used as is thought fit.Personally, I am inclined to restrict the use of pituitrin to a multipara whose perineum has lost its rigidity, and after the third stage to those cases which show a tendency to haemorrhage. Farquhar Matheson, M.B.