The Substance Responsible for the Traditional Clinical Effect of Ergot

Abstract

DIFFERENTIATrON OF SEX CHARACTERISTICS METDIHCABTRNAL a suprarenal cortex, and only occasionally to a malignant tumour. Not infrequently hyperplasia or neoplasia (adenoma) of the pars anterior of the pituitary also leads to virilism in women. With hyperplasia there is usually acromegaly. It is interesting to note that a marked change to virilism does not occur in women as the direct result of these lesions after the menopause, although, as we know, in many after that epoch certain masculine characteristics, such as hair on the face, are common. Similar changes may follow obphorectomy with the artificial menopause. With cortical suprarenal tumours the changes observed in women are remarkable. Many grow beards, and some appear in fairs as the well-known bearded women. They may have the voices of sergeant-majors, and be rough and aggressive in manner. When seen early, removal of the offending tumour may lead to retrogression of most of the masculine characteristics, but the altered larynx never reverts to its former shape and size. With acromegaly there is a limited change towards masculinity with amenorrhoea. The voice invariably deepens. In one case I found that the clitoris had become so greatly hypertrophied that it was causing the patient much distress. Acromegaly in men, as Harvey Cushing has shown, causes increased virilism, just as do suprarenal tumours. Feminism in Men A change in characteristics towards femininity is seen in men who have destructive lesions of the pars anterior of the pituitary, such as may be caused by cysts in that organ or by supraselfa tumours. In these circumstances the syndrome known as dystrophia adiposogenitalis is present. Hair disappears from the face and pubes, while the contour of the body and limbs assumes a feminine type. After castration, too, a certain degree of feminism develops. No doubt in all these circumstances the masculinity-maintaining mechanism is interrupted. SUMMARY The relation of the sex-directing factors of heredity and sex-chromosomal constitution have been discussed, and the continued sex differentiation in vertebrates through the sex-determining action of organs of internal secretion has been described, together with the nature of the later general sex characteristics brought into being by the endocrine genital system. Sex aberrations from biological, sociological, legal, and medical points of view have been considered.

The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?

“…23 Its administration causes an intense and sustained uterine contraction (in contrast to the intermittent contractions caused by oxytocin). A systematic review of its use for prophylaxis shows it to reduce the PPH rate (when used as part of the active management of the third stage of labour), compared with physiological management.…”

“…Ergot derivatives were the first treatments described for PPH, with initial reports as far back as the end of the 19th century; 22 however, it was not until 1935 that the active substance was purified and named ergometrine. 23 Its administration causes an intense and sustained uterine contraction (in contrast to the intermittent contractions caused by oxytocin). A systematic review of its use for prophylaxis shows it to reduce the PPH rate (when used as part of the active management of the third stage of labour), compared with physiological management.…”

Routine oxytocin in the third stage of labour: a placebo controlled randomised trial

“…Postpartum haemorrhage remains an important cause of maternal mortality in developing countries, though the mortality rate has dramatically decreased in Western countries during the twentieth century. This change has coincided with the introduction of oxytocic drugs in the management of the third stage of labour 1,2 , though other factors may also have contributed to this improvement (e.g. improved nutritional status and socio‐economic standards, and the availability of blood transfusion services).…”

John Chassar Moir (1900-1977) and the discovery of ergometrine

“…Sadly, on the very day of publication, Dr Dudley died prematurely at the age of 49 years. 4 The following year Moir wrote 5 :…”