THE

DUBLIN JOURNAL

OF

MEDICAL SCIENCE,

MAY 1, 1844.

PART I.

ORIGINAL COMMUNICATIONS.

ART. VII. Contributions to Midwifery, No. V.-On the Influence of Ergot of Rye on the Foetus in Utero. By THOMAS EDWARD BEATTY, M. D., M.R.I. A., Fellow of, and Professor of Midwifery to the Royal College of Surgeons in Ireland; Physician to the City of Dublin Hospital; Consulting Accoucheur to the South Eastern Lying-in Hospital; Vice-President of the Dublin Obstetrical Society; and Honorary Member of the Obstetrical Society of Edinburgh.

[Read before the Dublin Obstetrical Society.]

Ir is not my intention on the present occasion to occupy the time of the Society by any very lengthened observations on the use of the ergot of rye ; but I wish to lay before the members an account of some effects of this drug, which during an extentensive employment of it I have observed, and of which I have not been able to find any notice in the authors who have treated of the medicine. Since the revival of the use of the secale corVOL. XXV. NO. 74.

2 D

nutum by Dr. Stearns of New York, up to the present time, a variety of conflicting opinions have been entertained respecting its value as an obstetrical agent. Some authors of the highest repute have declared its utter inutility and incompetence to excite uterine action, no matter how eligible the circumstances, or how carefully the dose has been apportioned. Another class, of equally high character, is found to attribute the most rapid and energetic effects to its employment; so much so, as to lead to its denouncement as too violent an agent for obstetrical purposes, appearing to be injurious to the child at all times; its impression being destructively transmitted from the mother to the infant; in some instances even involving both in the same sacrifice. A third and numerous class of high authorities is recorded as maintaining an opinion equally at variance with the truth as the two preceding, viz. that the ergot may be always given with advantage, the safety of the mother or of the child being never endangered. It would be tedious and misplaced to quote the authorities above alluded to on the present occasion ; and moreover it is unnecessary to do so, inasmuch as they will be found in Mr. Wright's elaborate and valuable prize essay on Ergot of Rye in the fifty-third volume of the Edinburgh Medical and Surgical Journal.

Viewing this discrepancy of opinion among authors of acknowledged celebrity, it becomes an object, not only of theoretical, but of practical interest, to endeavour to search out the cause or causes which have been instrumental in producing such an effect.

When we find such names as Chaussier, La Chapelle, Desormeaux, Gardien, and Capuron in the list of those who maintain the inertness of the secale cornutum, if we had not practical experience to the contrary, we would be inclined to bow to such high authority, and agree with the latter, that "it is a drug which it is requisite speedily to expunge from the list of the Materia Medica." But when we have witnessed the efficacy of the medicine in numerous instances, and find its character sub

stantiated by the united experience of its many successful employers, we are disposed to look for some reason for its failure in the hands of the practitioners above mentioned. Two causes of such a failure may be suggested: first, the administration of the drug in inadequate doses; second, the inferior quality of that which was employed. It is not improbable that the French authors, whose names have been just mentioned, were disposed to use the ergot with great caution, owing to the circumstance of the drug being at that time considered in France and Switzerland as a highly noxious substance, and capable of producing fatal effects in those to whom it was administered. This may have led them to employ it in quantities too small to produce the desired effect upon the uterine fibres. But it is more likely that the second cause just alluded to may have led to the failure, for it is owing to investigations conducted more recently that we have become aware of the perishable nature of the medicine, and the readiness with which its peculiar virtues are destroyed. Ignorance of this fact may have led to the administration of the ergot in an inert condition, owing to its having been deteriorated by keeping. There is scarcely any medicine that spoils more quickly, and requires more care in its preservation, than the one under consideration; and even in the present day, with all the knowledge of its properties which we possess, I have reason to know that it is at times employed in a state in which it is utterly devoid of its peculiar properties, and completely inert as an obstetrical agent.

Some time ago I was in attendance on a lady at a short distance from this city, in whose case I wished to administer the ergot. Having recently used the dose, which I habitually carry about me, I sent a messenger to a very respectable apothecary living in the adjoining suburb, to whom I wrote a note, requesting that if he had any good and fresh ergot he would send me some, and if not that he would send on the messenger to my own house for it. In a short time the man returned with a paper from the apothecary, on opening which I found a black,

damp mass, more like wet turf-mould than any thing else. If I had used this in ignorance of its being spoiled, of course disappointment would have been the consequence, and my faith in the power of the drug would have been shaken.

The second objection, viz. that the ergot is at all times destructive to the life of the child, has probably arisen from the employment of the medicine at improper times. Thus recourse has been frequently had to its aid in cases of difficult labour arising from mechanical opposition to the exit of the child. In such a case the destruction of the infant is almost sure to follow, for the delay which necessarily occurs between the administration of the dose and the expulsion of the head is almost certain to produce fatal results.

In a former communication* I have stated that I consider a delay of two hours after the ergot has been taken, as sufficient to cause the death of the child. I will revert to this subject in a subsequent page, at present I will only observe, that persons who employed the drug under circumstances like these must have been led to form the opinion that it was highly dangerous to the life of the infant.

The third class of authors above alluded to have formed far too sweeping an opinion of the merits of this medicine, when they state that it may be always given with advantage; the safety of the mother or of the child being never endangered. This is a kind of praise most likely to do mischief, and damage the reputation of a valuable remedy, by inducing others to employ it under circumstances in which it is quite inadmissible.

From a very extensive use of the ergot I am quite prepared to maintain that none of the three opinions is correct, but that the truth lies between them. The medicine, when fresh, and carefully preserved, is in fact one of great energy, and influences not only the mother but also the infant. It requires to be used with great discretion, for while it will in one case effect the de

* Dublin Medical Journal, vol. xxi. p. 361.

livery of a living child, it will in another destroy the life of the child before birth, or operate so injuriously upon it as to cause its death shortly after it is born; or produce a peculiar effect on its nervous system which I have observed, and will presently describe, but which I do not find described in any work that I have perused.

The difference of effect upon the infant depends upon the length of time that intervenes between the administration of the dose to the mother and the conclusion of the labour. If this takes place quickly no mischief is done to the child; if it be alive when the medicine is taken, it will be born so; but if a delay of even two hours should occur, the probability is the child will be still-born. It is, I believe, generally imagined (and I entertained the opinion myself until lately) that the death of the child is owing to the kind of action excited in the uterus by the ergot, differing from the natural labour pain in this, that after the contraction of the uterus has been excited, no complete relaxation of its fibres takes place; there is an occasional increase in the strength of the effort, but it never relaxes so long as the influence of the ergot continues. It is, as it were, one continued pain, at times greater, but never entirely ceasing. The effect of this continued contraction of the fibres of the uterus upon the great blood-vessels which traverse its walls to reach the surface of the placenta, must be to intercept the circulation to a certain degree. Now although this cause contributes, no doubt, in some cases to produce unfavourable effects upon the child, I am disposed to think that it is not the only cause of fatal mischief in all, but that in some there is a noxious influence exerted on the nervous system of the infant, producing results of different degrees of intensity, and that these effects vary from the death of the infant, to certain spasmodic affections of the muscular system after birth. A few cases from my note book will serve to illustrate the position I have here taken up. I will first read some in which the medicine was given with advantage to the mother and safety to the child.