62 
Ustilago  Jloydis. 
Am.  Jour.  Phann . 
Jan.,  1888. 
the  irregular  contractions  of  the  utems,  of  which  the  hour-glas?  is  a  well-known 
example.  The  employment  of  ustilago  seems  to  be  entirely  free  from  such 
unpl easant  complicatiou s. 
In  addition  to  being  a  valualjle  adjuvant  in  stimulating  weak  uterine  contrac- 
tions, ustilago  seems  to  possess  tlie  property,  wliicli  some  years  ago  was  ascribed 
to  quinine,  namely,  of  exciting  uterine  pains  when  entirely  suspended.  This 
has  been  noticed  by  Leonard  and  others. 
As  to  the  time  recjuired  for  the  action  of  tlie  drug  to  l)ecome  apparent,  it  may 
be  said  tliat  it  differs  in  different  cases.  dei:»endin2-.  andouljte<liy.  upon  the 
rapidit)''  with  which  it  is  al  )srjrljeil  fr(:im  the  ga-tri  i-intestinai  tract  and  carried 
into  tlie  system.  In  the  above  record,  in  rmly  two  in-tanees,  did  it  I'e'iuire  over 
thirty-five  mintites  before  the  tistilago  acted  tipon  the  uterine  tissues,  and  in 
the  latter  case  most  of  the  drug  was  ejected  l)y  emesis.  In  the  remaining  seven 
cases  the  average  time  reqtiired  was  twenty-tive  mimites. 
The  effect  produced  by  ustilago  tiiioii  the  i  itlier  unstriped  musctilar  tissues  of 
the  body  has  not  been  inciuired  into.  Proi)al>ly  it  produces  the  same  increase 
of  intestinal  peristalsis,  and  the  same  rise  in  the  arterial  pressure  due  to  vaso- 
motor spasm  as  is  prodticed  by  ergr»t.    This  is  yet  open  to  investigation. 
2.  The  indications  for  {Jn  entploumenf  of  tlie  drug. 
It  may  be  noticed  that  m  all  the  aljove  cases  the  tistilago  was  not  administered 
until  complete  dilatation  of  the  os  had  been  accomplished.  Whether  or  not  a 
disastrous  effect  would  be  prodticed  by  the  administi-ation  of  the  drtt^r  prior  to 
the  commencement  of  the  second  stage  of  labor  cannot  lie  stated.  As  yet.  that 
question  has  not  been  decided.  From  the  sttidy  of  the  physiological  action  of 
ustilago,  we  should  think  a"l  danger  of  the  irregtilar  contractions  of  its  compeer, 
the  ergot  of  rye,  wotiid  be  precluded,  and  that  if  there  were  any  possibilities  of 
the  exigencies  of  the  case  demanding  its  tise,  it  might  be  employed  with  impti- 
nity  dtiriiig  the  first  stage  of  labor.  At  present,  however,  we  shall  C(»nsi(ier  the 
first  indication  for  its  use  to  be  the  failtire  of  the  pains,  with  compUtri  dilatation 
of  the  OS  uteri. 
In  none  of  the  cases  was  the  drag  employed  tiutil  the  pains  of  labor  had  either 
become  so  weak  that  they  were  inefficient  to  accomplish  the  exjitilsion  of  the 
foetus,  or  until  they  were  entirely  stispended.  This,  then,  we  consider  the  sec- 
ond indication  for  its  use,  namely,  the  inemciency  or  entire  suspension  of  the  partu- 
rient pain. 
A  fter  the  tistilago  had  been  taken,  it  may  also  be  noticed  that  in  no  case  was 
there  the  slightest  tendency  toward  a  post-partiim  hemorrhage.  In  each  case 
after  the  expulsion  of  the  placenta:  the  utertis  remained  in  a  state  of  firm  con- 
traction. While,  dm'ing  the  three  months  the  great  majority  of  the  remaining 
cases,  in  which  the  customary  ergot  had  been  employed,  showed  no  tendency 
whatever  toward  this  alarming  accident,  however,  in  two  instances  was  there 
such  an  occurrence  demanding  prompt  attention.  The  third  indication,  then, 
for  the  employment  of  ustilago  we  shall  consider  to  be  a  condition  of  uterine 
inertia  threatening  or  producing  post-pa rturn  hemorrhage. 
3.  The  dose  and  mode  of  administration. 
The  preparation  of  ustilago  employed  in  all  reported  cases,  as  well  as  in  om- 
own,  was  a  good  fluid  extract.  The  dose  of  this  varies  from  one-half  to  two 
drachms,  one  drachm  being  a  fair  average.    This  may  be  repeated  at  intervals 
