- Ergotine, Ecbolene, Ergotic acid, fixed oil.
- Extractum Ergotae Fluidum, Fluid Extract of Ergot. Dose, from one-half to one dram.
- Specific Ergot. Dose, five to sixty minims.
Ergot is prepared by special processes of purification for hypodermic injection. So used it is immediate in its action and can be so administered when impossible to give it by the stomach. Ergotine in solution in water and glycerine, is excellent for hypodermic administration.
Physiological Action—Ergot causes both acute and chronic poisoning when taken in toxic closes. Acute ergotism is characterized by vomiting, purging, headache, dizziness, drowsiness, slowing of the pulse, dilatation of the pupils, dyspnea, pain in the chest and loins, confusion of the senses, formication, coldness, anesthesia, convulsions, swelling of the face. Chronic ergotism is characterized by neuralgic pains, formication and numbness of the extremities, opisthotonos, violent delirium succeeded by exhaustion, death occurring in coma or in convulsions; or the drug may affect nutrition; muscular weakness is followed by gangrene of the limbs or superficial parts, which become blackened, shriveled and hard—a dry gangrene, generally ending fatally.
Ergot is classed as a motor excitant by most writers, and yet the evidences, as above described, of its depressing influence upon the nervous system and upon the circulation are most conspicuous. In its influence upon the circulation of the brain and spinal cord, it may be given in sufficient doses to produce anemia, and that it does greatly reduce the excitability of the nervous system, under certain circumstances, none will deny. It acts in perfect harmony with the bromides when there is acute cerebral engorgement with great nervous excitability.
There is no doubt that it produces contraction of the arterioles, although there are many evidences to prove that it may permit the venous capillaries to dilate freely.
In its influence upon unstriped muscular fiber the action of ergot is pronounced. It acts upon the muscular structure of the womb, producing extreme tonic or tetanic spasm of the fibrillae, causing a marked reduction in the size of the organ if enlarged, and rapid emptying of its blood vessels, and consequent anemia. Many prominent writers believe the anemia induced, causes the profound muscular contraction. It is more plainly apparent that a peculiar irritating influence of the agent upon such muscular structure induces its contraction, and that such contraction, assisted by the influence of the agent upon the coats of the arterioles, causes them to become emptied to a marked extent, and thus the anemia.
Ergot acts upon the heart muscle in much the same manner as upon the muscular structure of the womb, although much less violently. It will surely reduce the size of a hypertrophied or dilated heart.
Because of the profound irritation of muscular fibrillae and consequent almost immediate contraction induced by Ergot, it is a most active agent in inducing expulsive pains in labor, in overcoming uterine inertia and in controlling uterine hemorrhage.
Specific Symptomatology—Extreme fullness of the circulation of the brain, flushed face, headache, bright, sharp eyes, great restlessness.
The indications for its safe use in labor are: first, uterine inertia; muscular relaxation with a more or less general weakness; second, the first stage of labor must be completed, and the ostium vaginae must be fully dilated.
There must be no obstacle to the free expulsion of the child.
The contractions induced by this agent are not smooth, spontaneous, natural, rhythmical contractions, but are irregular and extreme, and if an overdose be given it may induce a tetanic contraction and a single, most violent, continuous expulsive effort which does not cease until the entire contents of the womb are expelled.
With such an influence, if there be a rigid, undilated os or perineum, or malposition of the child, or extreme dryness of the parts, serious results, as rupture of the womb or extreme laceration of the perineum, are almost unavoidable.
This profound and continuous pressure on the child and placenta arrests haematosis, greatly paralyzes the heart's action, and thus impairs the circulation, inducing cyanosis and often death of the infant before its expulsion is complete.
Again, such pronounced action upon the womb structure may result in subsequent muscular paralysis, with great impairment of its contractile power, and if there be no post-partum hemorrhage there may be subinvolution more or less persistent. It will be seen, therefore, that this remedy in parturition is a dangerous one, and if used at all it should be used only when every contraindication is absent, and every indication present.
Therapy—In labor, when there is threatened post-partum hemorrhage, or when the history of previous labors shows a tendency to such an accident, a full dose of ergot may be given just at the close of the second stage, or after the head has passed the perineum. No harm can come from such a procedure, and it will serve as a positive safeguard. If there is then free hemorrhage and lack of full uterine contraction, the dose may be repeated in perhaps half an hour, but the attendant must be assured that the womb is entirely empty. If the contractions are not firm and continuous, and hemorrhage at all violent should occur, other measures, such as external irritation and compression of the uterine fundus, or the introduction of hot water into the uterine cavity, must be resorted to in addition. Ergot is in general use in post-partum hemorrhage. It must be given in doses of from half a dram to a dram of the fluid extract. If this dose be added to an ounce or two of hot water and drunk, its influence is more immediate and pronounced.
In uterine hemorrhage at the menstrual epoch, menorrhagia, or in metrorrhagia, it is a most valuable agent.
In patients of relaxed muscular fiber its action is very prompt. The dose can be so measured and timed as to reduce the flow to normal time and quantity, while by the use of other agents, a healthy condition is being secured. Its influence, upon the womb structure is at the same time conducive to a sure acting in harmony with other uterine tonics.
In the treatment of uterine subinvolution or of chronic metritis, ergot is a good remedy. The use of the agent conjointly with the bromide of potassium is especially advised in this condition, and with the further administration of properly selected uterine tonics the cure can be speedily completed.
Polypi are expelled from the uterine cavity by ergot, and the agent having a specific action upon the substance of the womb, is opposed to hypertrophy and to the development of abnormal growths within that structure. Uterine fibroids are expelled by ergot if possible, and if impossible, the persistent internal use of the agent is advised as a means of limiting their growth. Interstitial or submucous fibroids only, are influenced by it. Sub-peritoneal fibroids are apt to be a little outside of its influence, because outside of the range of the contraction of the muscular fibers.
Mammary tumors, from uterine irritation, are slowly reduced by the action of ergot.
The hemorrhage and excessive discharges, purulent or otherwise, occasioned by the growth of foreign bodies about the womb, will be beneficially influenced by this agent. The growth of a uterine cancer is sometimes retarded a little, and the hemorrhage from the cancer is more or less controlled by ergot.
Dr. Standlee said that ergot would support the patient's heart exceedingly well when the remedy was indicated, especially when there was muscular fatigue from overwork or from dyscrasia, as in the malarial infections as found in the south, or in malignant malarial hematuria, especially if used hypodermically.
Ergotin so used will control hemorrhage from the lungs. It was administered for this purpose to a drunkard suffering from delirium tremens where it controlled both conditions satisfactorily.
As stated in its physiological action, ergot is a most useful remedy where there is a constant tendency to fullness of the circulation of the brain—hyperemia with flushed condition of the face, with vertigo, nausea, and violent headache. In threatened apoplexy in young, full-blooded, active men; with full cerebral circulation, it overcomes the immediate symptoms of an attack, and if properly administered will cure the tendency.
Where apoplexy from acute cerebral hemorrhage has occurred it is a very useful agent in unloading the distention of the capillaries and assisting in the contraction and removal of the clot.
In children, where there has been a fall upon the head, or a violent blow, with symptoms of concussion of the brain, ergot is the most prompt remedy known. It should be given in from five to ten drop doses, and repeated in half an hour if necessary. Spasm should be averted by passiflora, chloral, the bromides, or, a full dose of gelsemium may be given. But the circulation of the brain must be controlled at once by ergot and its influence sustained by smaller doses until inflammation is no longer pending.
In certain forms of inflammation of the brain and its meninges, where the capillary circulation is very full, ergot is most pronounced and certain in its action.
In cerebro-spinal meningitis of an acute endemic or epidemic form, it may be given in the early stages of the attack, but should be withheld in the latter stages. Other directly indicated agents should not, however, be neglected for this. It is especially applicable to children in the early stages of acute cerebral or cerebro-spinal inflammation.
Ergot in doses of five drops three or four times daily for a few days will benefit many severe cases of typhoid fever, especially if there be an engorged condition of the cerebral circulation, with tendency to dullness, stupor and mild delirium, with high temperature. It directly influences the intestinal canal, overcoming the relaxed and paralytic condition of its muscular structure, correcting diarrhea, controlling hemorrhage and improving the circulation. An occasional dose of fifteen or twenty minims will sometimes do much good.
In the treatment of both passive and active hemorrhage, ergot is a most excellent remedy. It contracts the walls of the arterioles, shutting off a full supply of blood and immediately restraining the flow. from open vessels. It is thus at once useful in hemoptysis, in hemorrhage from the mouth, gums, throat or pharynx, and from the stomach and intestinal canal. A local astringent in gastric hemorrhage from ulcer is often better, and also in intestinal hemorrhage in typhoid. It is good practice to give a local styptic alternately with ergot, where there is a persistent tendency to hemorrhage in these cases.
In hemophilia ergot is recommended. In this condition in infants it may be used for a short time locally and internally.
Hemorrhages about the eye-ball are controlled from its local application, and acute conjunctivitis and phlyctenular ophthalmia will be benefited, if it be used locally and internally in small quantities.
Occasional large doses of ergot in the treatment of pneumonia are spoken of as highly beneficial by excellent authorities. The remedy exercises its influence upon the capillaries.
In hemoptysis ergot is prompt and efficient. It need not be given in large doses. Three to five drops, four times daily, will usually restrain the tendency to hemorrhage, and in a free discharge of blood, a ten-drop dose is usually sufficient, or it may be repeated.
In hematuria ergot is a prompt remedy if from traumatism, or if from active congestion, but gallic acid is usually better in passive conditions, and in conditions due to structural change.
In paralysis of the walls of the bladder after retention of urine, causing over-distention, ergot serves a good purpose. If hemorrhage be present it is quickly controlled and the muscular atonicity of the walls is greatly benefited.
Ergot is given in urinary incontinence when the cystic walls are greatly relaxed, or when there is a mild form of local paralysis.
Ergotin in full doses has quite a prompt influence upon diabetes insipidus. It is also useful in diabetes mellitus, but is not depended upon alone. In children afflicted with the latter disease it may be given in positive doses for a time, but should not be given continuously.
In that form of spermatorrhea where there is a tendency to fullness of the circulation of the parts, with erratic and spasmodic erections, and undue sexual excitement, the emissions quickly occurring after erection, there is no better remedy known than ergot. It should be given in about twenty drop doses at bedtime, and its influence is increased and a soothing influence upon the nervous system induced by giving it with ten grains of the sodium bromide.
In the treatment of aneurism, and of enlarged veins, and of varicocele, ergot is much used. Its influence is more positive though upon the arterial than upon the venous coats. It is used with good results in hemorrhoids. Bartholow and others injected it into the dorsum of the penis to contract the veins there and overcome impotency.
The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.