Ergotinum

Volume I — Special Symptomatology

(An active principle of Secale cornutum.)

Phakmacology. — There are several substances known as Ergotine, viz.: the " Ergotine of Wiggers," and "Winkler's Ergotine," to which may be added the most recent and, probably, the best, " Squibb's Ergotine." They are all extracts, not alkaloids. To be active in its powers, and fully represent the Secale, it must be a compound extract, containing the so-called Secaline and E choline. It is found in Ustilago.

They are all dark-brown, semi-fluid, or soft-solid substances, having the characteristic odor of the Ergot of Rye, viz.: an odor of herring-brine, or propylamine. Soluble in water, or dilute alcohol. Squibb's Ergotine (or Extract), is the most trustworthy preparation.

Officinal Preparations— (1) Triturations with pure sugar of milk (for internal administration); (2) Solution, 5 grs. in two drams of water (for hypodermic injection) ; (3) Dilutions, with dilute alcohol to the 3x afterwards with strong alcohol.

(See Therapeutics, Vol. II.)

Volume II — Special Therapeutics

Ergotin was discovered by the chemist Wiggers, and was believed by Professor Sell r off to contain all the medicinal properties of Secale. It has not been used to any considerable extent in this country, and very rarely by our school. In its crude form it looks like an oleo-resin, a thick, syrupy, brown substance, with the peculiar smell and taste of good powdered Ergot. The triturations are best made with granulated sugar of milk.

In the “North American Journal” for 1859 is to be found a translation by Hoffendahl of a paper on Ergotin by Dr. Kafka, of Prague, who uses the following language: “Just as Atropia is applicable when Belladonna is indicated, but appears insufficient, in the same manner Ergotin is to be used when Secale does not answer our expectations, perhaps because the preparation is not reliable, or the remedy is not sufficiently powerful.” To which I will add that the preparations of Ergot are notoriously unreliable, especially when kept for a long time.

The trituration of Ergotin (of Wiggers or Bonjean) is a veryconvenient preparation, and will keep for any length of time in any climate.

Kafka’s clinical experience with Ergotin was altogether in uterine haemorrhage. He gives the well-known indications of Secale, namely: “Excessive and protracted menstruation; menorrhagia; venous congestion of the womb; haemorrhage from the womb, passive and paralytic, of dark fluid blood, pouring out at every motion or elevation of the body ; haemorrhage during and after delivery; haemorrhage from cancer of the womb; insufficient contraction of the womb after abortion ; irregular, feeble, deferred, or spasmodic labor-pains.”

You will observe that all these symptoms, except the last one, are secondary symptoms of Ergot. Kafka gave for these conditions grain doses of the first decimal trituration, which is in accordance with the requirements of my law of dose.

The primary uterine symptoms of Ergot are: Very severe, spasmodic, very painful contractions of the uterus , almost continuous; if occurring during menstruation, the flow scanty, only a few drops; if during labor the pains seem to do no good, for the very severity and continuousness of the contractions wear out the mother, and may injure the child; if they occur at other times they are due to some spinal irritation, and are called “ uterine cramps;” also uterine congestion, of an active, arterial character, such as occurs before inflammation sets in.

When these symptoms occur you will do injury if you prescribe the first decimal trituration. Keep above the third, not too frequently repeated.

Kafka gives one case of protracted menstruation, one of haemorrhage after delivery , one of climacteric menorrhagia, and one of profuse menstruation. In all these cases this characteristic symptom was present : “ Little or no pain, the blood in dark clots, or dark fluid, aggravated by any motion or mental excitement .” In all, Secale 1st was tried, ineffectually, while Ergotin 1st acted promptly.

I have used Ergotin occasionally ever since I read that article, and its administration has generally resulted satisfactorily. But I use it in other conditions besides uterine troubles.

The recent researches of Brown-Sequard and other eminent experimenters show that Ergot has uniformly this primary effect,

namely, a contraction of the bloodvessels in every portion of the body. In organs like the brain and lungs, the effect is bloodlessness or anaemia. In the uterus and other hollow organs it contracts all their tissues as well as their bloodvessels.

The secondary effect or reaction is a relaxation or even paresis of the coats of the bloodvessels; thence, passive congestion, haemorrhages, relaxation of muscular tissues, and finally their complete paralysis.

Brown-Sequard, Hawley, and others claim that Atropia has this same effect upon the bloodvessels of the spinal cord, but I have my doubts. The proofs are not sufficient to satisfy me. !Nor is the Atropia useful in any case of haemorrhage, as it would be if its action was similar to Ergot. I know of no drug that acts exactly like Ergot, unless it is Ustilago, a similar fungi. Caulophyllum somewhat resembles it, but how close we cannot now determine.

In accordance with its pathological effects, and selecting it by its secondary symptoms, I have used Ergotin very successfully in very severe congestive headaches , when they occur in persons of lax fibre, large, phlegmatic, lymphatic individuals, whose bloodvessels are doubtless relaxed and easily distended, almost to bursting, whenever the circulation is abnormally directed. Such headaches usually occur at the climacteric period in women, and in old drunkards of both sexes. The pain seems to rise up into the head from the back of the neck, the occiput first suffers, then it extends all over the head, and the agony and distress, more than the acute pain, become almost unbearable. The face is rather pale and cool than suffused, the extremities cold and livid. (This is not the case when Belladonna or the Bromides are indicated, for the face is hot and red, with throbbing temples.) The congestion is more internal, central, than general or peripheral. Sometimes the head is drawn backwards by almost continuous contractions.

In this condition Ergotin, in doses of one-tenth or one-twentieth grain (using the lx trit.), given every half hour, soon removes the sometimes dangerous condition.

In cerebro-spinal meningitis, when the above symptoms occur, the Ergotin acts very satisfactorily.

In passive pulmonary haemorrhage it acts as well as in uterine, in which my experience accords with Kafka’s.

There is another very valuable use of Ergotin, which should not be lost sight of by our school, namely, its value in paralysis. In all the cases of severe poisoning on record, and in all the experiments on animals, paralysis is generally a prominent effect of the drug. Yet the old school are now using it extensively in paralysis, and with good results. Brown-Sequard was the first to recommend it in a distinct form of paralysis, and to point out the pathological condition upon which the paraplegia depends, and which large doses of Ergot cures. In his admirable brochure, “ Paralysis of the Lower Extremities,” he says :

“This powerful remedy has been employed quite blindly, although its mode of action being better known than Belladonna, it would have been easier to discern in what cases of paraplegia it is able to be of benefit. Ergot, like Belladonna, produces a contraction in the bloodvessels of the spinal cord and its membranes, and therefore diminishes the amount of blood circulating in these organs. The following is a summary of the indications and contraindications for its use :

“ 1st. Ergot must be employed in cases of paraplegia with irritation of motor, sensitive, or vasomotor nerves, i. e., in congestion or inflammation of the spinal cord and its meninges.

“ 2d. Ergot must be avoided as an agent only able to increase the paralysis in cases of paraplegia without symptoms of irritation, such as cases of reflex paraplegia, or of non-inflam matory softening of the spinal cord.”

These directions for the use of Ergot may do very well for the allopath, but our therapeutics need a broader scope. Let us inquire IIow does Ergot cause paralysis f Evidently by causing such an anaemia of the spinal cord as to diminish or abolish its nutrition, and thereby its vitality.

This is the condition which Brown-Sequard describes as being present in reflex paraplegia, and in which he declares Ergot to be injurious. And so it would be in massive doses, but we, who believe in the efficacy of attenuated medicines w'hen indicated, are not confined to the use of Ergot in material doses.

I believe, and have substantiated it in practice, that Ergot is

useful in 'paraplegia from reflex irritation, i. e., when anemia of the cord is present, and non-inflam matory softening is imminent. But in such cases the dose must be in the attenuations above the 3X trituration of Ergotin, or above the lx of a good tincture.

Although it has been decreed that it may be used, and has been used with apparent success in congestion and inflammation of the spinal cord, I do not think it is safe in large doses if the disease is acute and intense. The secondary action of Ergot is passive congestion ( engorgement is a better word) of the cord and its meninges. In active inflammation I prefer Veratrum viride, but in passive congestion or chronic inflammation, or even the second stage of spinal meningitis (when of a low type), I am willing to accord a curative value to Ergot, and admit that it must be prescribed in material doses, e.g., the lx of Ergotin, or pulv. Ergot, or drop doses of a good ethereal tincture or a fluid extract, repeated every two or three hours until improvement sets in. In old cases a dose three or four times a day will suffice.

Finally, you will find Ergotin a valuable remedy in some obstinate neuralgias (sciatica and odontalgia). In nightsweats, in chronic diarrhoea and chronic dysentery, in certain cases of the haemorrhagic diathesis, in hypertrophy of the uterus, in uterine tumors, aneurisms, impotence, spermatorrhoea, and probably varicose ulcers and senile gangrene.