Convulsive ergotism, as above described, often carries with it a ravenous desire for food. A vesicular eruption on the skin, often with petechia?, is also a very frequent addition. In continental Europe it has often come on in the shape of an epidemic, the period during which the disorder has prevailed extending to three or four weeks, and life being extensively destroyed.

The gangrenous form of ergotism commences with a sense of pain and weariness in the limbs; the countenance becomes heavy-looking and stupid, and the skin acquires a leaden or cadaverous hue. Afterwards there is malaise, with exhaustion, coldness of the whole body, and numbness of the hands and arms, while formication is perceived in every part of the surface. The lower extremities become similarly affected with the upper ones; later on, the abdominal muscles are spasmodically contracted; and, about the sixth day from the commencement, nausea, vomiting, and diarrhoea make their appearance, with severe colicky pains in the bowels and bladder.

In the case upon which these details are founded, upon the fourteenth day two of the children of the family lay as if stupefied. If they were disturbed they raved wildly, and complained of pains in the head and limbs. At the same time a pruriginous eruption appeared upon the skin, the unfortunate sufferers expiring on the twenty-first day in violent convulsions.

Bonjean relates a fatal case in which there was pain in the left groin, coldness and pain in the legs, a dark spot, upon each calf, formed by an eruption of vesicles, the itching of which was violent, and gangrene of the lower third of each leg. The feet were black and dry; the upper portions of the legs became affected with humid gangrene; in three weeks the sphacelated parts began to separate, and soon afterwards it became necessary to amputate each limb below the knee. Very little blood flowed while the operation was in course of being performed.

The epidemics of which ergotism has constituted so frightful and by no means rare a feature have always been of one or other of these two descriptions. In some of these epidemics the convulsive form has prevailed; in others it has assumed the gangrenous form. It is upon the distinction in the character of the epidemics that the disorder itself has been resolved into the dual form described. In almost every instance the individuals who suffered and survived became for a time either imbecile or idiotic. A favorable crisis in the progress of the disorder was invariably supposed to be indicated by swelling of the feet, bleeding ulcers, diarrhoea, and eruptions upon the skin.1

Therapeutic Action. - In Parturition the therapeutic value of ergot is unquestionably its most important feature as a medicinal agent. The nature of this action has been spoken of in the previous section, and to repeat the facts is unnecessary. There are other uses of ergot of very considerable importance. Uterine haemorrhage, for instance, accompanied by spasmodic contraction of that organ, and by distressing pains of a bearing-down description, is speedily checked by ergot. So, too, is haemorrhage accompanied by atony of the uterus. In uterine haemorrhage of any kind, whether or not connected with pregnancy, ergot, in a word, is generally of great service. It is recommended also for the expulsion from the cavity of the uterus of clots of blood, polypi, and hydatids. In cases of threatened miscarriage, when slight haemorrhage has commenced, accompanied by bearing-down pains, I have often employed this medicine in small doses, or such as are sufficient to partially brace the uterus without inducing the physiological result of uterine pains, and this with excellent results.

In Amenorrhcea. - Some practitioners frequently prescribe ergot V7ith a view to the restoration of the monthly flow after a suppression of considerable duration, and where preparations of iron have failed of success. Neligan states that he has employed it in chlorotic amenorrhoea, also with the most beneficial results. Leucorrhoea, occurring in the intervals of menorrhagia, is frequently arrested by a decoction of ergot, given by vaginal injection. This also conduces to the arrest of the tendency to menorrhagia at the following monthly period.

As a general Styptic, ergot is believed to possess the property of causing contraction of the capillaries in general. At any rate, it is most useful in removing purpura and other capillary haemorrhages. In dysentery and haemorrhages arising from enteric fever, and in haemorrhages arising from inflammation of other mucous surfaces, it is unquestionably of great service.

Epistaxis, Haemoptysis, and Haematemesis, I have often seen stopped by resort to ergot, and this when most other means of cure have appeared to fail.

Paralysis, whether accompanied or not by contractions of the limbs, is often treated beneficially with ergot; paralytic dysuria also, particularly when the patient has a very distinct and continuous sensation of the bladder being only very partially relieved of its contents.

When this medicine proves inefficacious, the failure is often to be ascribed either to peculiarity of constitution in the individual, or to inferiority in the quality of the ergot, a condition of very frequent occurrence.

1 I am indebted to Stille for many valuable particulars in regard to the physiological action of ergot; but to many of the less urgent symptoms it is capable of pro-dnrtag I can speak from personal knowledge, having frequently administered it as a medicine, and taken it experimentally myself.

In Neuralgias ergot has been much employed of late years. It is chiefly in visceral neuralgias (gastralgia especially) that this remedy seems likely to prove useful.

Ergotine. - A special section must be devoted to the therapeutic use of this substance, which has rapidly assumed great importance of late years. It must, however, be understood that the ergotine which has been employed in actual medicine is not the pure alkaloid, but an impure preparation - either that of Wiggers or that of Bonjean. The latter is decidedly the most convenient from its complete solubility in water and in alcohol. Bonjean's was called extrait hoemostatique, and especially recommended for uterine and pulmonary haemorrhages. It is a reddish-brown substance, with a roast-meat-like smell, and a pungent bitter taste.

Aneurism, however, was the disease, the treatment of which with ergotine fully aroused attention to the importance of this remedy. In 1869 Langenbeck published a remarkable paper, in which he gave an account of two cases of aneurism (one probably aortic) successfully treated by the subcutaneous injection of ergotine under the skin covering the tumor, repeated for many days together. Similar results were afterwards obtained by Dutoit, of Berne, and others. The treatment has since been repeated in various countries, and, on the whole, with an encouraging amount of success.

In Haemoptysis, since the renewed attention to it which was caused by Langenbeck's observations, ergotine has proved a very valuable remedy. A very interesting paper by Dr. Currie Ritchie 1 relates a number of cases in which the results were striking. Ergotine, from T. and H. Smith, of Edinburgh (five grains in ten minims of distilled water), was subcutaneous-ly injected in seven cases; in an eighth this was found too irritant, and Langenbeck's formula was successfully followed, viz., three grains of ergotine in equal parts of glycerine and rectified spirit. Either one or two injections of five grains of ergotine seemed always sufficient to completely arrest the bleeding.

In Menorrhagia, even when connected with fibroid tumors, and other formidable organic affections of the uterus, there can be no doubt of the efficacy of ergotine. In these affections, as also indeed in haemoptysis, I have had large personal experience of its efficacy, particularly when subcutaneously injected. Dr. Meadows deserves the credit of having pointed out, as long ago as 18G8,2 that sub-involution, chronic subacute metritis, and hypertrophy of the uterus "are alike in this respect, that they are invariably associated with increased vascularity of the organ, though this is mostly of the passive or congestive kind; they are consequently liable to excessive discharges either of mucus or of blood; and they are further characterized by increased bulk of tissue." Dr. M. brings forward much valuable evidence to show that these maladies may be successfully dealt with by means of ergot of rye.

I have personally used both the ethereal extract (which Meadows employed), and, with preference, the subcutaneous injection of ergotine. I wish to give a caution against the employment of the large doses of the latter that have been recommended by several authors. Instead of four or

1 Practitioner, vol. vi., 1871. 2 Ibid., voL i., Sept., 1868 five grains, which seems to be the quantity ordinarily used, I inject either one or two grains in glycerine and water, and never inject more than one grain in the same place, much preferring to make a second puncture if necessary. I find the smaller doses sufficient for the production of the characteristic action of the drug upon blood-vessels, and upon unstriped muscular fibre generally, and the local effects of the injection are much less severe than with larger doses. It does not seem to be generally known that ergotine is very irritant to the subcutaneous tissue, and that quite a common result of a five grain injection is the formation of a large, livid, tumor-like swelling, with the appearance of a black cicatrix in the centre. Fortunately this kind of swelling seldom or never suppurates, but it is a very awkward occurrence, and is apt to annoy and alarm the patient, besides giving a great deal of pain in some cases.

I have on three different occasions injected one to two grains of ergotine into patients suffering from haemorrhage of the bowels as a consequence of enteric fever. I have also used it in a similar manner with several patients having severe epistaxis; and in both sets of cases with the best result.

Hildebrandt treated nine cases of fibroid tumors of the uterus by the subcutaneous injection of ergotine. "In four," he says, "the diminution of the tumor was free from doubt; in the others troublesome symptoms subsided."

Preparations and Dose. - Ergota, 3ss. - j. (2. - 4.); Extr. Ergotae Fluid., 3 ss. - j. (2. - 4.); Vinum Ergotre, 3 ij. - iv. (8. - 15.). "Ergotine" and Extr. Ergotae (Squibb) are not officinal: dose of either, gr. v. - xv. (.30 - 1.).