Read before the Medical and Chirurgical Faculty of Maryland, 
Annual Session, April, 1874. 
Hypodermic Injection of Erpt In Fost-Partnm Heiorrlap, 
P. C. WILLIAMS, M. 1). 
I hazard nothing in saying that violent post-partum hemorr- 
hage is one of the most serious accidents that come under flie care 
of the physician. Anything, therefore, that suggests additional 
means of relief in this alarming complication deserves careful con- 
sideration. The known effects of ergot in promoting uterine con- 
traction long since determined me to try its hypodermic use when- 
ever I was called upon to treat post-partum hemorrhage. 
The first opportunity that presented itself was in the case of 
Mrs. R., a young woman of fine physique, in good health, and 
who had no untoward symptoms during her pregnancy. Mrs. R. 
was confined with her first child in October, 1873. She had a 
long, exhausting labor, during which I gave four or five drachm 
doses of fluid extract of ergot, wdth very little effect. After the 
head had remained for some time in the cavity of the pelvis without 
apparent progress, I determined to apply the forceps. Chloroform 
was administered and the child was extracted without difficulty. 
The placenta was expelled in due time, and everything pro- 
gressed satisfactorily, until suddenly, without appreciable cause, 
the uterus became completely relaxed, and produced a profuse 
hemorrhage, which exhausted the patient with great rapidity. 
After using the customary remedies, such as pressure, insertion of the . 
hand into uterus, ice externally, and ice in the uterus, Ac., without 
the slightest effect, I injected half a drachm of fluid extract of ergot 
in the inside of the left thigh. Immediately I again thrust my 
hand into the uterus, and my anxiety was relieved by discovering 
that the uterus was beginning to contract vigorously, and it , 
promptly expelled ray hand from its cavity. t 
The contraction remained firm, and the hemorrhage was com- 
pletely stopped. The convalescence of this patient was rapid and 
satisfactory. 2 
HYPODERMIC INJECTION OF ERGOT, ETC. 
The second case to which I call attention is that of a lady 
about 35 years of age, of medium height, frail figure, and rather 
contracted pelvis. She has been married ten years. Prior to 
the confinement in question, she had but one child ; which was born 
with extreme difficulty about eight years ago. During her recent 
pregnancy, her general health was good. Towards the latter por- 
tion of her pregnancy she suffered very much from pain in the 
right hypochondriac region, which was very violent up to the time 
of her confinement, and totally forbade her lying on the left side. 
Her labor was long and severe. During the last few hours of it 
I kept her more or less under the influence of chloroform, and 
occasionally gave ergot to prevent the chloroform diminishing the 
activity of the pains. No progress being made, I applied the 
forceps and delivered the child. After waiting a short time for 
the expulsion of the placenta, I endeavored to leraove it by trac- 
tion upon the cord, which unfortunately broke. Examination 
then revealed that the placenta was adherent over its entire sur- 
face. I again administered chloroform, and after prolonged and 
tedious effort succeeded in detaching the placenta. The uterus 
contracted well. 
I went across the room to superintend an inefficient nurse, but 
in a little while was recalled to the bedside of the patient by a 
gush of blood which was distinctly audible. The flooding was 
alarmingly copious. 
Remembering my experience in the former case, I immediately 
injected half a drachm of fluid extract of ergot on the inside of the 
thigh. 
The flooding was promptly arrested, and did not return. My 
patient was prostrated to such a degree, however, that for several 
hours she could not make the slightest movement without produc- 
ing serious attacks of syncope. 
This condition was relieved by a few hypodermic injections of 
brandy. 
This patient improved rapidly, and was soon restored to her 
usual health. 
The third case occurred on the 13th of March, 1874. Mrs. 
S., about 35 years old, and mother of several children, was a 
patient of Dr. Whitridge. HYPODERMIC INJECTION OF ERGOT, ETC. 
Mrs. S. had several severe uterine hemorrhages during the 
latter part of her pregnancy, but was always relieved by a few' 
days’ rest in bed. Dr. Whitridge was sent for early on the 13th 
March ; but before he reached the house, the patient was bleeding 
so profusely that she sent for Dr. Hartman, who lives in the im- 
mediate neighborhood. Dr. Hartman soon discovered that he had 
to deal with a placenta prsevia. He promptly “ turned ” and 
delivered the child and the placenta. The patient seemed to be 
doing well, and the Doctor went home. Shortly afterward, Dr. 
Whitridge arrived and found Mrs. S. flooding to such a degree as 
to render her pulse almost imperceptible. The Doctor resorted to 
the usual treatment without avail. He then injected diluted sub- 
sulphate of iron into the vagina and uterus. He then sent for me 
to see her in consultation with him. In the meantime, finding 
that the flooding still continued, he injected fluid extract of ergot 
hypodermically. This injection arrested the hemorrhage before I 
reached the house. Her exhaustion was so extreme that wre ad- 
ministered a second hypodermic injection of ergot to guard against 
the recurrence of hemorrhage. The hemorrhage did not return, 
and the patient was restored to health by liberal diet and tonics. 
I have thus given three cases of post-partum hemorrhage which 
present three different conditions. 
The first was a case of uncomplicated labor, but slow and 
tedious, producing great fatigue, which was the probable cause of 
the subsequent uterine relaxation and the hemorrhage. The ad- 
ministration of chloroform may also have been a predisposing 
cause of the hemorrhage, although I was careful, as I always am, 
to accompany the use of chloroform with the internal adminis- 
tration of ergot. 
In the second case, chloroform was also administered, and its 
use was much prolonged by the necessity of tearing away the 
adherent placenta. 
The prolonged use of chloroform and the adherent placenta 
were doubtless the causes of the flooding in this case, nor was it pre- 
vented by the free use of ergot by the stomach. 
In the third case no chloroform was used, yet the flooding was 
quite as great as in either of the other cases. 
In the first and third cases, various means were resorted to HYPODERMIC INJECTION OF ERGOT, ETC. 
without the slightest effect, until ergot was given hypodermically. 
In the second case, nothing was used but the hypodermic injection 
of ergot. 
In these three cases the effect of the hypodermic was almost 
instantaneous, and it was permanent. 
It seems to me, therefore, that the hypodermic used of ergot 
offers a safe, prompt, and efficient remedy for post-partum hemorr- 
hage; and I earnestly advise its administration. 
In the cases here reported I used the fluid extract of ergot. 
It produced no abscesses, and was entirely satisfactory in its offects. 
According to the experiments of Dr. Squibb, of Brooklyn, ergot- 
ine does not represent the full therapeutic value of ergot, and 
therefore cannot be relied upon. Dr. Squibb, at the suggestion of 
Dr. Marion Sims, has made a solid extract which is very efficient, 
and has been frequently used in New York and elsewhere for the 
treatment of uterine fibroids. The solid extract is rendered fluid 
by u rubbing it up ” with water, in the proportion of one grain of 
extract to one minim of water, when it is available for hypodermic 
use. 
This is doubtless the best preparation of ergot, ;and should be 
preferred when it is accessible. The fluid extract can always be 
procured, and its effects are so prompt and efficient that I have no 
hesitation in advising its administration whenever the solid extract 
cannot be obtained.