ERGOT POISONING

CASE REPORT Mrs. J. W. was an emergency admission to Withington Hospital, Manchester, on 8th September, 1956, at 3.40 p.m. as a case of incomplete septic abortion. Her three previous pregnancies had been uneventful and had terminated in normal delivery at term of healthy babies. She had had no illnesses previously. The last menstrual period had commenced on 15th July, 1956, and she was therefore 8-weeks pregnant. She stated that, on the morning of 6th September, 1956, she took two ergot tablets B.P.C., each of 24 grains strength. In the morning she experienced a tingling sensation in her hands and feet, and noticed that her nose had a bluish tinge. At this time she took a further three tablets of ergot. On the following morning, 7th September, 1956, she experienced continuous low backache which was accompanied by the loss of a small quantity of blood per vaginam. At noon she had a rigor which lasted 15 minutes, and this was followed by severe, continuous frontal headache. Her breathing became difficult and she had pain across the lower posterior thorax, which was aggravated by movement and deep breathing. She felt breathless and apprehensive. A second rigor occurred at 11 p.m. The vaginal bleeding increased and she passed several clots. Though she had experienced vomiting for the past month, it now became very much worse and was accompdnied by continuous anorexia and retching. On the morning of admission to hospital, 8th September, 1956, in addition to the symptoms described above, she thought she had become jaundiced and she noticed that her feet felt cold. She denied any attempt at vaginal interference to procure an abortion, but it was later revealed that, on two occasions over the previous three weeks, she had used a syringe containing water to douche herself. The first attempt produced slight vaginal bleeding and abdominal pain, but this quickly settled. The second attempt produced similar results and was carried out a few days before she took the ergot. On examination the patient was noted to be a wellnourished adult female who was mentally alert but appeared to be breathless whilst sitting up in bed. The most notable feature was a deep blue cyanotic colour of the nose with a central black eschar. The hands were cold and cyanosed, but both radial pulses were present. The feet presented a similar appearance but there were areas of black discoloration on several of her toes. No pulsation was detected in either the dorsalis pedis or posterior tibia1 arteries. There was a ring of blue discoloration below the umbilicus which corresponded to the pressure area of a suspender belt. The conjunctivae were definitely icteric and there was a suspicion of generalized icterus, though it was difficult to be sure of this as the body had a peculiar dusky, patchy cyanosis superimposed on a generalized erythematous background. The patient was talkative and coherent, but seemed unaware of the gravity of her condition and was disorientated as regards time and place. The temperature was 103" F., the pulse 100 beats per minute and the respirations 30 per minute. The blood pressure was 110/70. The tongue was furred and foetor oris was marked. Clinical examination of the heart and lungs was essentially normal, and no abnormality was found in the central nervous system. Abdominal examination revealed no abnormality apart from some suprapubic tenderness. There was slight guarding and release tenderness on deep palpation in the hypogastrium and the bowel sounds were diminished. The liver was not palpable, but the patient complained of pain on palpation of the right sub-costal area during deep breathing. The spleen was not palpable. No renal tenderness was elicited.