CHRONIC POISONING.—When ergot is used for a long time as food (bread made from diseased grain) chronic poisoning occurs which may assume two forms, the convulsive and the gangrenous, which are well described by Bartholow:— The convulsive form begins by ver tigo, disorders of vision, tinnitus aurium, numbness of the fingers and toes, and afterward of the integuments. These symptoms are followed by spasmodic con tractions of the muscles, opisthotonos or emprosthotonos supervening. Complete anaesthesia after superficial follows, and gangrene may occur. The organs of sense are blunted. The pupils are di lated; sometimes unequal and various disturbances of vision ensue. Epilepti form convulsions may occur in addition to the tetanoid spasms; delirium ap pears, followed by complete insensibility.
Between the latter part of 1889 and autumn of 1890, in the State of Wjatka, 2749 people suffered from ergot poison ing, 535 cases of which proved fatal. Convulsions were observed in all cases; no gangrene was noticed. In 7 cases the liver, spleen, and kidneys were examined microscopically. The spleen showed the following changes: The connective-tis sue frame-work strongly marked, the pulp hypermmic, the Malpighian bodies distinctly marked, a few greatly en larged and hyperplastic, others appear in the centre as a uniform layer with no nuclei. The arterial walls, particularly the central vessels of the Malpighian bodies, are thickened, glossy, and show hyaline degeneration. The liver is hy peremic, the liver-cells atrophied, the nucleus either lost or the staining un satisfactory: the arterial wall had the same changes as in the spleen. the lumen at times entirely obliterated, results of coagulation-necrosis of the liver-cells. In the kidneys the changes prevail in the cortex-substance, hyperfemia of the glomeruli, formation of a uniform mass in Bowman's capsule, with consecutive compression and changes of the glom eruli, glossy-looking changes in the bl ood -vessel s, with coagulation-necrosis of the epithelium of urinary tubules. N.
Winogradow (Wratch, Nos. 21. 23, '95).
The gangrenous form is ushered in by a tingling numbness, formication, fatigue, earthy hue of the skin, coldness of the surface; nausea, vomiting, and diarrhoea, with intestinal colic, follow. Muscular contractions take place, an eruption of vesicles filled with a dark, ichorous fluid appears on the extremities, and gangrene, dry or moist, sets in. Bartholow refers the phenomena to two causes: to the dyscrasia which exists in the subject of this malady referable to insufficient food and bad hygienic sur roundings, and to the action of the ergot in diminishing the blood-supply to the cerebro-spinal axis, to the vegetative organs, and to the. skin and muscular system.
Treatment of Poisoning by Ergot.—In cases of acute poisoning the bowels should be opened by quick purgatives: by castor-oil or Epsom salts. Tannic or gallic acid should be given internally. The recumbent posture should be main tained, the patient be stimulated with brandy or other spirits, and given amyl nitrite by inhalation.
Therapeutics.—The therapeutic value of ergot depends upon its characteristic action on unstriped muscular fibre and its influence on the sympathetic system. It is mostly used by obstetricians and gynecologists to cause uterine contrac tion. Its action on the non-pregnant normal uterus is slight and uncertain, and increases in certainty and efficiency as the womb increases in size. Its use as an oxytocic is not generally sanctioned by the authorities.
LABOR.—Full doses of ergot are never to be given to hasten the delivery of a foetus, because it causes tonic contraction of the uterus, interruption of the pla cental circulation, endangering the child through asphyxia, and should operative procedures be necessary they are greatly embarrassed by the rigidity of the uterus, and the danger of the uterine rupture is increased.