72

ELEMENTS OF MATERIA MEDICA.

Usbs. —To Dr. Stearns, of the United States, is due the credit of introducingergot of rye to the notice of the profession as an agent specifically exciting ute-rine contractions. (New York Med. Repos. vol. xi. 1807, quoted in the UnitedStates Dispensatory.) In 1814 a paper was published by Mr. Prescot, (Med.and Phys. Journ. vol. xxxii. p. 90, 1815,) on the effects of it in exciting la-bour-pains, and in uterine hemorrhage. It was not employed in England until1824. The following are theprincipal uses of it:

1. To increase the expulsatory ejforts of the womb in protracted or liftgeringlabours. —When the delay of delivery is ascribable solely to the feeble con-tractions of the Uterus, ergot is admissible, provided, first, tbat there be a properconformation of the pelvis and soft parts ; secondly, that the os uteri, vagina,and os externum, be dilated, or readily dilatable, and lubricated with a sufficientsecretion ; and, lastly, that the child be presenting naturally, or so that it shallform no great mechanical impediment to delivery. A natural position of thehead is not an absolute essential for the use of ergot, since this medicine is ad-missible in some cases of breech presentation. (Dr. F. H. Ramsbotham, Lond.Med. Gaz. xiv. 86.) The circumstances which especially contra-indicate orpreclude the use of this medicine are those which creale an unusual resistanceto the passageof the child : such are, disproportion between the size of the headand of the pelvis, great rigidity of the soft parts, and extraneous growths.Moreover, " earliness of the stage" of labour is laid down by Dr. Bigelow,'Quart. Journ. of Literature, Science, and Arts, ii. 53,) as a circumstance con-tra-indicating the use of ergot. The proper period for its exhibition is when thehead of the child has passed the brirn of the pelvis. Some practitioners assertthat a dilated or lax condition of the os uteri is not an essential requisite for theexhibition of ergol. It has been contended that one of the valuable properliesof this medicine is to cause the dilatation of the ulerine orifice, and cases are notwanting to confirm these statements. (Bayle, op. cit. p. 539.)

2. To hasten delivery when the life of the patient is endangered by somealarming Symptom. —Thus, in serious hemorrhages occurring during labour,after the rupture of the membranes, and where the placenta is not situated overthe os uteri, the ergot is especially indicated. 1 It has also been employed toaccelerate delivery in puerperal convulsions. Five successful cases of its useare recorded by Bayle, (Bibl. Therap. iii. 448 and 548,) on the authority ofWaterhouse, Mitchell, Roche, Brinkle, and Godquiu. But the narcotic Opera-tion of ergot presents a serious objeetion to its use in cerebral afTections.

3. To provoke the ezpulsion of the placenta when its retention depends on aivant of contraction ofthe Uterus. —In such cases ergot has often proved of greatadvantage. 3 When the hemorrhage is excessive the ergot must not be regardedas a Substitute for manual extraction, since, during the time required for its Ope-ration, the patient may die from loss of blood. (Dr. F. H. Ramsbotham, Lond.Med. Gaz. xiv. 738.) In retention ofthe placenta from spasmodic or irregulärcontraction ofthe uterus, as well as from morbid adhesion, ergot is improper oruseless. (Dr. Jackson, Lond. Med Gaz. iv. 105.)

4. To provoke the ezpulsion of sanguineous clots, hydatids, and polypifromthe uterus. —Coagula of blood collected within the womb after delivery maysometimes require the use of ergot to excite the uterus to expel them, as in thecase mentioned by Mackenzie. (Neal, Researches, p. 88.) Ergot is also valu-able in promoting the expulsion of those remarkable formations called uterinehydatids, (Acephalocystis facemosa, H. Cloq.) and which are distinguished fromthe acephalocysts of other parts of the body by their not possessing an inde-pendent life, so that when separated from their pedicles they die. (Cruveilhier,

i Dr. Blundell, Lancct for 1S27-8, vol. i. p. 805; Dr. F. H Ramsbotham, Lond. Med. Gaz. vol. xvi. pp. 86and 692

s Dr. Blundell, Lancct, 1827-8, vol. ii. p. 25!); Bayle (Bibl. Tkerap. vol. iii. 541), has recorded nine cases,from Baiardini, Bordol, Davies, Duchäteau, aud Morgan ; and many olllers will be found in the medicalJournals,