Dr. Alfred P. Livingston has for years made a special study of ergot; his conclusions are of exceeding value. In the present paper his observations relating to ergot are derived from its obstetric uses. The general deductions which he thinks warranted from his personal experiences are:
- Its direct and specific effect is the contraction of unstriated muscular fiber or other involuntary contractile tissue. Here he comes into direct opposition with those who have recently stated that ergot is not useful but harmful in cerebral hemorrhages, because it cannot act on the muscular fiber of the cerebral arteries, since they have-no muscular fibers. Dr. Livingston says that no other effect of ergot has more positively been demonstrated than the relief of congested states in the brain. It must therefore act upon some other contractile tissue besides the unstriated muscular fiber.
- It does not markedly contract that which is normal in tone.
- It is emphatic in its contraction of that which is lacking in tone.
- It is striking in such effect in proportion to the recency of occurrence of the atonic state in such fiber.
- Its widest field of usefulness is its application to the muscular coats or other contractile tissue of weak and relaxed blood-vessels.
- It there tends to equalize vascular tension, etc., to distribute the blood equally throughout the body, to restore or promote functional activity of glands and organs generally and vasomotor centers particularly, to promote sleep, to relieve pain, nervousness, and spasm, to prevent or modify the effects of autotoxins and bacteria, to promote assimilation, absorption of exudates and elimination of waste, to relieve nausea, to prevent the ill and dangerous effects of anesthesia, to promote the healing of wounds, to prevent or modify inflammation, to arrest capillary hemorrhage, to relieve narcotic poisoning, and to make the work of the heart more easy and so to prevent its exhaustion or paralysis.
- It is useful to restore tone in the unstriped fiber of the walls of the hollow viscera, stomach, bowels, bladder, uterus, etc.
- The prevalent popular notion existing in the medical profession that it is a dangerous drug and likely to produce ergotism, is unfounded as regards the modern pharmacopeial preparations, at least as regards such as he has used during the past thirty-four years.
- Its local action upon the stomach is often offensive, especially if full doses are given; its absorption from the stomach is uncertain, both as to promptness and degree, and therefore,
- Its administration should be limited as much as possible to hypodermic injection, which assures immediate effect, admits of exact regulation of dose, and avoids nausea and other ill effects of its administration per os.
These deductions, Dr. Livingston tells us, are wholly founded upon his clinical experience. This he considers the only reliable guide as to the applicability of any therapy to disease. The indications for the application of ergot, therefore, he considers to be the recognition of lack of tone in unstriped muscular fiber or other involuntary contractile tissue; and on that single thread he hangs all the manifold indications for ergot, and its myriad utilities in therapeutics,
From this Dr. Livingston goes on to produce a remarkable array of indications for the administration of ergot. Practically, his indication is loss of balance of circulation, for if spasm of the blood-vessels exists in any one part, with local anemia resulting, he looks upon this as evidence of weakness of the contractile coats of some blood-vessels, and so gives ergot. If the walls of the blood vessels are unusually weak or greatly strained he gives ergot. Inflammation of limited areas he treats with ergot. Atony of the hollow viscera, disorders of assimilation and elimination associated with the minuter circulation, impaired functional activity, he looks on as an indication for ergot. In fact, if there is too much blood or too little in any one part, ergot is given.
He thus gives a tremendous range to his favored remedy. In truth, it seems difficult to exclude anything if we allow the correctness of such premises. Dr. Livingston apparently gives to ergot the place which strychnine holds with a large number of the medical profession. Strychnine energizing every function and every tissue in the body, would necessarily be indicated whenever there would be a lapse of functional activity in any part. But then, do we not take the broad ground that illness of any description is indicative of a lapse in functional activity of one or other part of the body ?
We cannot believe with Dr. Livingston in his universal application of ergot, nevertheless there is a great deal to be learned from the observations made by this excellent clinician, who has studied this drug for a life-time in the field of clinical therapeutics.—Am. Jour. of Clinical Med.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.