Respiration

After the intravenous injection of 0.001 gm. per kilo of ergotoxine, the respiratory center is depressed, as shown by slow and shallow breathing or Cheyne-Stokes respiration (Wiggers). From broncho-constriction owing to direct stimulation of bronchial muscle (Jackson), an intravenous of beta-iminazoylethylamine in an unanesthetized animal may cause asthma.

Uterus

Though the other principles stimulate the uterus, the very pronounced action of ergot is due in large measure to beta-iminazolylethylamine. With a solution of 1: 600,000 Lieb obtained powerful contraction with temporary tetany. The uterine constriction is promoted to a slight degree through a central action, but essentially through stimulation of the uterine muscle. In the early stages of pregnancy the increase may be seen in the strengthening of the normal intermittent contractions which take place at this time; and there is a prevalent belief both in the profession and among the laity that in the early months of pregnancy ergot is abortifacient. But experiments with pregnant animals have not shown it to possess this power to any great degree; and in pregnant women, it has very frequently failed to have the slightest effect. It is of considerable interest that in some cases of ergotism pregnancy has gone on to term without interruption.

In labor, moderate doses tend to increase the strength of the normal intermittent contractions, while large doses (1 dram - 4 gm.) produce a continuous or tetanic contraction of the uterus. This makes ergot of value after labor to promote the normal postpartum uterine contraction; but it should not be administered until the uterus is empty, lest the organ go into tetanic contraction and compress the contents without expelling them. The drug usually takes thirty to sixty minutes to act when given by mouth.

The stoppage of uterine hemorrhage is essentially due to the uterine contraction, and is not to any great degree, if at all, attributable to contraction of the uterine arteries.

Toxicology

Acute poisoning is usually the result of large closes taken to produce abortion. The symptoms are - (1) those of gastro-enteritis, with nausea, vomiting, diarrhea, and abdominal pain, and (2) various nervous manifestations, such as itching, tingling, hyperesthesia, and anesthesia of the skin, mental depression, convulsions, coma, and collapse. The treatment is symptomatic for gastro-enteritis and collapse. In a fatal case Rosenbloom and Schildecker found ergotinine in stomach, intestines, liver, and kidneys.

Chronic Poisoning Or Ergotism

This is not seen in this country, though it has been in the past common enough in Europe from the consumption of bread made from ergot-infected rye. The ergotism manifests itself either by gangrene or by certain pronounced nervous symptoms. The gangrene is caused by persistent contraction of the arteries in some particular part of the body, chiefly the fingers, toes, ears, and tip of the nose. But there may be sloughing in any part of the body surface, or ulcer of the stomach, or even gangrene of the lung or of the uterus. The small arteries of the part are found to contain hyaline plugs, as in any case of dry gangrene. The nervous type shows in gastrointestinal disturbances, itching of the skin, headache, dizziness, disordered vision, temporary or permanent blindness, drowsiness, mental depression, and clonic or epileptiform convulsions which may leave permanent contractures in hands, feet, arms, legs, or trunk. These manifestations are thought to be due to spasm in the arteries of the central nervous system; the permanent effects are due to softening from the shutting off of the arteries. Fuchs has pointed out that ergot is a cause of endemic tetany.

Therapeutics

The main employment of ergot is - (1) To prevent postpartum hemorrhage, which it does by inducing uterine contraction rather than by narrowing the vessels; (2) to check Menorrhagia, and (3) to overcome subinvolution of the uterus. Though it has been used for hemorrhage from stomach, lungs, kidneys, etc., there is no indication that a therapeutic dose produces constriction of the arteries in these regions. In any dose whatever it does not constrict the pulmonary arteries.

It has been employed to raise blood-pressure, but for this purpose, as we have seen, the active principles are to be used, and not ergot itself. Thus tyramine might be employed in shock or collapse. To obtain arterial constriction, Wiggers used 1/65 grain (0.001 gm.) of ergotoxine phosphate per kilo in dogs. He advised that the dose should not be repeated, as the paralysis of the nerve-endings might come on.

On empiric grounds ergot has been proposed for a great many different conditions; for example, it is spoken highly of in diabetes insipidus, enuresis nocturna, and delirium tremens. The author found it useless in diabetes mellitus and the night-sweats of tuberculosis. Ransom speaks highly of it in delirium tremens. (See Alcohol.)

Ergotoxine is employed in physiologic experimentation to paralyze sympathetic nerve-endings, especially the vasoconstrictors.