The subcutaneous injection of ergot has become so important a therapeutical resource that it is necessary to treat the subject in a separate division. The solution employed for this purpose is usually as follows: Rx Ergotinae (aq. ex.), 3 j; glycerini, 3 j; aquae destil., 3 vij. M. Sig.: Eight minims contain one grain of ergotin. Squibb has prepared "an extract of ergot which is almost entirely soluble in cold water, and represents good rye ergot in the proportion of one grain of extract for five grains of ergot. Sixty grains of this extract, dissolved in two hundred and fifty minims of water—the solution filtered, and made up to three hundred minims by passing water through the filter to wash it and the residue upon it—makes a solution which represents ergot in the proportion of minim for grain, and is of the same strength as the fluid extract of ergot, but is free from alcohol or other irritant substance." This preparation the author has found to be admirably adapted for subcutaneous administration. When the aqueous extract of ergot of good quality can not be obtained, the fluid extract may be used.

The rules for the administration of ergot are the same as for other agents applied in this way.

In the treatment of haemorrhage, when a prompt effect is desired, the hypodermatic injection is preferable to the stomach administration. In haemoptysis, the injection may be practiced while suitable remedies are administered by the stomach. In haematemesis, especially if the stomach be irritable, better results may be obtained by subcutaneous use of ergot than by any form of internal medicine. In post-partum haemorrhage, when to await the action of ergot may endanger the life of the mother, the subcutaneous administration should be resorted to. The happy results which have attended this mode of administration in serious cases, demand that the accoucheur be provided with the necessary appliances for the hypodermatic injection of ergot in every obstetrical case. This mode of using ergot is not only prompter in results, but is more effective in securing uterine contractions and arrest of haemorrhage.

The good results which are obtained from the stomach administration of ergot in subinvolution of the uterus and in chronic metritis, are much more quickly and decisively obtained from the subcutaneous administration. Since the memoir of Hildebrandt appeared, numerous cases of successful treatment of uterine fibroids by hypodermatic injection of ergotin have been published. There seems to be no longer any doubt that this agent administered in this way, and less effectively and for a much longer period by the stomach also, has the power to arrest the growth of uterine fibroids, to cause them to atrophy, or to set up such a degree of uterine action as to compel their extrusion as polypi from the uterine cavity. It has, of course, long been known that ergot administered by the stomach may induce such a degree of uterine contraction as to expel a polypus. In those instances in which the hypodermatic injection fails to arrest the growth of a polypus, notable improvement in the amount of the haemorrhage and of the muco-purulent discharge is, at least, a result of the treatment. The author is enabled to speak from personal observation of the excellent results obtained by this mode of treatment in many cases.

From two to six grains of the aqueous extract of ergot (ergotin) may be injected under the skin in these cases of uterine fibroids on alternate days, or thrice or twice each week. The abdomen is usually preferred as the site of the injection. More or less pain is experienced at the moment of the insertion of the solution, and an indurated spot, which may be more or less sore, will remain for a week or more. Suppuration may result from the injection, but it is not a frequent accident.

The hypodermatic injection is an effective mode of treating varicocele. About two grains of the extract in solution is a suitable dose. The needle is inserted so that its point will rest among the dilated veins, but care must be taken not to puncture a vein. Very severe pain follows, and there may be great faintness, but the effects subside in a few hours unless considerable swelling should ensue, which is quite usual. A single injection may cure a very extensive varicocele, and more than two are rarely necessary. Varicose veins in other parts, especially of the inferior extremities, have been cured by the same treatment. The following is the mode of proceeding in these cases: the needle is inserted under the skin, in close juxtaposition to the enlarged vein, and the fluid is so injected as to lie alongside of the vein, but not to enter it. The cure which follows in many of these cases has been ascribed to the inflammatory swelling which takes place, but there is, doubtless, besides this effect, a dynamical influence exerted on the vessel-walls.

It has lately been asserted that deficient erections and loss of the capacity for coitus are not infrequently due to enlargement of the dorsal vein of the penis, and consequent too rapid emptying of the veins of the erectile tissue. Acting upon this plausible suggestion, the author has practiced the hypodermatic injection of ergotin about the dorsal vein of the penis, and he has had apparently excellent results.

Before closing this article, it may be advisable to recall to the reader's attention the fact that the hypodermatic injection of ergot, or its internal administration in large doses, may cause such tonic contraction of the sphincter vesicae as to render micturition impossible. Careful inquiry and frequent examinations of the hypogastric region should be made during a course of ergot preparations.

Authorities referred to:

Bailly, Prof. M. Ergot, Ergotine

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