On this, as on every other point connected with the use of Ergot, much difference of opinion prevails. Dr. Houston,: of New York, observes that it has caused many fatal demonstrations, and adds, " From what I have seen and heard, more children have perished by the injudicious use of Ergot, during the few years which have followed its introduction into the practice of this country (America), than have been sacrificed by the unwarrantable use of the crochet for a century past." A similar opinion has been expressed, in different words, by Drs. Hossack, Moore, Holcombe, Moreau, Patterson,§ and more recently by Prof. Meigs.|| On the other hand, Michell¶ considers that it has saved the lives of many children. Dr. Church** also says that he has not observed that the Ergot, in any case, caused the death of the child. Dr. Wright expresses a similar opinion. There is, however, a great mass of evidence in favour of the opinion that the Ergot does act injuriously on the foetus. I would refer particularly to a valuable paper by Dr. Hardy, whose observations seem to have been conducted with great care and minuteness. Out of forty-seven infants, seven were expelled alive naturally, seven were born alive by the application of the forceps and vectis, and thirty-three were expelled dead. This, however, is a much larger ratio than occurs in ordinary practice, when the Ergot has been administered. Dr. Hardy observed the most common effect of the Ergot to be a diminution in the pulsations of the foetal heart, succeeded, after a short time, by an irregularity of the beats, which continues more or less until the sounds intermit, and at length, after a variable period, become quite inaudible. He further observed, that in those cases where the number of pulsations has been steadily reduced below 110, accompanied at the same time by intermissions, the child will be rarely, if ever, saved, although its delivery should be effected with the greatest possible speed; he adds, however, that the mere depression of the foetal heart below 100, without intermissions, is not in itself sufficient to cause this result, as instances have occurred where the number of pulsations have been reduced as low as 06, and yet by speedy delivery, and the adoption of the usual remedies, the children have been saved; but in none of these instances was there a steady, distinct, and well-marked intermission. These observations point out the necessity of the use of the stethoscope, in order to ascertain the condition of the foetal circulation. These remarks coincide fully with those of Dr. Ely* and Dr. Beatty. The latter fixes the limit beyond which the child will rarely be born alive, after the Ergot has been administered, at two hours. To this rule he met with but three exceptions. "It by no means follows from this," he observes, "that a child born within this period should always survive; in two instances the children were lost, although only twenty minutes in one, and five-and-twenty in another, elapsed between the administration of the Ergot and the birth of the child." Dr. Beatty gives the following distinguishing characteristics of a foetus expelled after the use of the Ergot: general lividity of the surface; universal rigidity of the muscular system, producing the stiffened limbs and clenched hands of those infants in whom life was ex-tinguished; and a remarkable kind of alternating spasm and palsy, which supervened in those who survived. Dr. Hardy further observes, that the depressing effects of the Ergot on the foetus, in those cases in which the child is expelled alive, are so great, that frequently a considerable time elapses after birth, before, the children can be perfectly restored; and that infants born in a weak state, where no Ergot has been used, are restored to animation with much less difficulty than in those cases in which this medicine has been employed during labour. Dr.Catlett* considers that its use gives rise to a predisposition to Hydrocephalus, in the early stage of infantile life. Different opinions have been advanced to account for the mortality of children, after the use of the Ergot. Dr. Beatty, Dr. Hardy, and others, attribute it to a poisonous effect indirectly exerted upon the foetus; and others, and among them Prof. Meigs. to the vigorous contractions of the uterus, and its pressure on the cord. The first opinion is supported by Dr. Hardy, by the fact that the depression of the heart's action in the foetus took place in numerous instances in which the Ergot produced little or no effect upon the uterus, or on the pulse of the mother. In support of the second opinion, Dr. Patterson mentions that, "in two cases of apparently strong healthy children, expelled dead after the use of the Ergot, the conjunctiva was found literally gorged with blood;" but this point requires further elucidation. In addition to the above physicians Girardin, Burns, Moreau, Churchill, &c, have expressed their opinion that the child is more frequently still-born after the use of the Ergot, than when it has not been employed; although they differ as to the mode in which the fatal result is brought about. In conclusion, I would remark, that although the above observations point out the danger which sometimes, indeed frequently, attends the employment of Ergot, yet that the danger is not of so serious a character, nor so constant in its recurrence, as to prevent the practitioner from employing it in proper cases, and with due caution, as laid down in the preceding sections.
* Dub. Quart. Journ., Feb. 1851.
Lancet, Dec. 16, 1848.
Amer. Med. Surg. Journ., Jan. 1829.
§ Ed. Med. Surg. Journ., Jan. 1, 1840.
|| Dub. Quart. Journ., Feb. 1851. ¶ On the Use of the Ergot, p. 78. ** Philadelph. Journ., May 1824. Op cit., p. 27.
Dub. Journ. of Med. Sciences, May 1845.
* Lond. Journ. of Med., Nov. 1851. Dub. Journ. of Med. Science, vol. xxi. p. 361.
Op. cit., vol. xxv. p. 213.