SUB-CUTANEOUS AND PARENCHYMATOUS INJECTIONS.
Originally Hildebrandt used the ergotin of the German Pharmacopeia, dissolved in water and in glycerine. Wernich prepared a pure dialysate of ergotin; Dragendorff recommended sclerotinic acid, which in my hands has been productive of no results, as well in man as in animals; latterly Marckwald has used ergotinin, an excessively costly preparation; and finally Bombelonsch's preparation has been extensively used, although its composition is not known.
I use almost exclusively the ergotinum vie depuratum, which is pre pared by dissolving the extract of ergot of the German and Austrian Pharmacopeia in water, then filtering it. The watery solution, to which I add nothing, since mixtures are likely to cause pain or induration, must be absolutely clear, and, since it rapidly alters, it must be always freshly made.
It has been objected to these injections that they are very painful, and cause indurations, even abscesses; but when such is the case it is usually on account of lack of care in performing the slight operation. In a thousand or so such injections I have never witnessed abscess.
This method of treatment by ergotin requires a long time, and often from fifty to one hundred injections must be administered before we reach any result, and since the injection causes slight pain, it is essential that the patient should possess endurance and strength.
In the performance of even this slight operation, strict antiseptic pre cautions should be taken. A freshly made, filtered solution should be used each time. The skin of the surface into which the injection is to be made must be washed and brushed with soap and water and disinfected with carbolic. The absolutely clean syringe is to be filled full of the solution, and a fold of skin having been lifted the needle is plunged deep into the subcutaneous cellular tissue. Injections which only enter the corium regularly produce painful indurations. After the emptying of the syringe the fluid is disseminated by rubbing, a few cold-water pads are applied over the puncture site, mid the patient is told co keep quiet for about one half an hour. This injunction applies more particularly
to susceptible individuals, for there are many women in whom the injec tions may be made without the precaution of after rest.
The pain which follows the injection is localized at the puncture site, and often extends to the uterus, which is caused to contract by the ergo tin. Only when the above precautions are neglected do we occasionally see painful indurations or even abscesses.
Hildebrandt used at the outset a solution of one to seven, but I always use a half or whole syringeful of a one to ten solution. We should first test the sensibility of the patient, and use but little ergotin. Collapse, nausea, cramps are sometimes noted, and in one instance, after the use of a total dose of fifteen grains to one drachm for a week, I noted gan grene of a finger. As a result of numerous observations, and the same has been the experience of Marckwald, Rohrig, and others, it seems to me that the associated use of hot baths not only increases the action of the ergotin injections, but causes them to be better borne.
The parenchymatous injections recommended by Simpson in 1856, have often been used since by Thiersch, Luecko, Hueter, (}allard, Williams, Hegar and Kaltenbach, Collins, Bennet, Delore and others, and latterly Schiicking has warmly advocated them.
Simpson and Thiersch used parenchymatous injections into tumors, particularly carcinoma, in order to cause them to break down, and since these injections have been resorted to in order to obtain a more direct action of the agent; thus ergotin is injected into the tissue of the uterus, instead of into the subcutaneous cellular tissue, and resorbents (iodine and solutions of iodide of pawls) are injected into old parametric exuda tions, and parenchymatous injections are also resorted to in inflamma tions of the uterus, after Hueter's method, carbolic acid or Fowler's solution being used (Schficking).