Dry gangrene seems to have been traced to the habitual use of ergot, without any reasonable possibility of doubt. it has occurred in individual cases, and in communities where ergotted rye has been largely used; and experiments upon the lower animals have satisfactorily shown, that it is one of the regular results of the long-continued action of the poison on the system. MM. Trousseau and Pidoux, while refusing credence altogether to the identity of ergotism with the malignant epidemic affections referred to, recognize dry gangrene as one of its characteristic phenomena. They say that, in large districts of France, the peasants have no other food than ergotted rye, that they are quite familiar with this disease of the grain, and that, in sending their crops to the mill, they only separate the largest grains of ergot, allowing the smaller to be ground with the sound grain for their use. A kind of intoxication is produced in those who consume this food largely, which is well known among them, and which, so far from being alarmed by it, they seem to enjoy as that produced by alcoholic drinks. This affection, however, shows itself only in those seasons when the rye is more than usually diseased with ergot. No effects whatever are noticed in other seasons, in which the same kind of food is used, though not so much contaminated; and no epidemic of the kind above referred to has occurred in these districts, even when the diseased grain has been most used. Nevertheless, the use of this kind of food is not without evil results. The peasants, who have long addicted themselves to the sort of intoxication which the strongly ergotted rye produces, fall at length into a condition analogous to that sort of mental decay which characterizes the abuse of alcohol and opium; and occasionally the gangrenous condition occurs, affecting the hands and feet, and sometimes a whole limb. {Trait. de Thérap., etc., 4e ed., i. 123.) The gangrene is preceded by sensations of formication in the limb and over the body, and sometimes by severe pains. In some instances it ceases after attaining a certain point; and the patient, if sufficiently vigorous, may survive with the loss of a portion of his limbs. In other instances it-proves fatal, either directly in a few days, or indirectly after a longer period, through the exhaustion of the sloughing process.

Acute Poisoning. The general symptoms of acute ergotic poisoning, from the use of the contaminated rye, have been described by Dr. Arpi from personal observation. Usually from half an hour to an hour after a meal, cerebral symptoms begin to appear; such as a feeling of emptiness of the brain, buzzing of the ears, dizziness, muscae volitantes, dilatation of the pupil, and somnolence. There is no striking delirium, and the patient answers questions, but he does so slowly and with hesitation. Trembling of the upper limbs, weakness of the knees, and an unsteady gait occur, and partial paraplegia in the worst cases. The muscular power is not lost, but only the capacity to regulate the movements, as in alcoholic intoxication. When the patient is placed in bed, profound sleep comes on, with a profuse sweat, and a soft, full, accelerated pulse. Sometimes vomiting and diarrhoea, with abdominal pains, are experienced; in which case, the cerebral symptoms are less severe. The affection continues generally about twelve hours, sometimes however is prolonged as much as two days, and then passes off entirely, with the exception of some dulness of head, such as attends recovery from drunkenness. If the patient take another similar meal, he is similarly acted on; and the affection may become chronic, under the continued application of the cause; but abstinence is followed by restoration to health. (Arch. Gen., Janv. 1855, p. 84.) Dr. Ignatius Meier, of vol. ii.-46

Kronstadt, observed, in an epidemic of ergotism in the district of Fo-garas, that cataract was unusually prevalent, and convinced himself, from an investigation of cases, that this affection sometimes occurs as a consequence of ergotism; the cataract always advancing slowly, constantly affecting the substance of the lens, and almost invariably without complication of the retina or optic nerve. (ibid., 6e sér., i. 351.)*

* In the Gazette Medicale de Lyon for the 31st of May, 1855, is a notice of the gangrenous effects attendant upon an epidemic, ascribed to the use of ergotted rye, which occurred in the years 1854 and 1865, in the vicinity of Lyons. The epidemic followed the long prevalence of rainy weather, which had probably favoured the production of ergot. Many cases were taken to the hospital at Lyons. The patients exhibited general symptoms of great debility. The gangrene attacked the extremities exclusively, and was generally of the kind called dry; though there were some cases of moist gangrene, and these were most dangerous in their character. in some instances, it appeared to be owing to the occurrence of coagulation from arteritis; but the doubt may well suggest itself, whether this was not the result of the reaction of the vital power against the gangrene. in most instances, the gangrene destroyed the whole or nearly the whole of one foot, but in some only the great toe. in a few cases, both legs mortified nearly to the knee, and, in one case, that of a youth of 14, this affection extended to the middle of the thigh. When the upper extremities were attacked, the gangrene was generally confined to the fingers, and rarely passed the wrist. [Arch. Gén., 5e sér., vi. p. 605.) in another epidemic, ascribed to the same cause, which occurred in Upper Hesse in the year 1855-6, and was described by Dr. Heusinger, the nervous and spasmodic phenomena were predominant, with little tendency to gangrene. Out of 102 persons attacked, 12 died, and these were all under 12 years of age. Not a single individual in good circumstances was affected; but only the miserably poor, who were compelled to live on a damaged crop, in which ergot was proved to exist. The malady generally commenced with vertigo, and disturbance of sight and hearing, which were followed by formication in the fingers and toes, gradually extending over the body. Spasmodic contractions of the muscles soon appeared; the fingers were firmly flexed, and could be extended only by violence; the forearm was flexed on the arm, and the hands were pressed against the chest; the toes were also flexed, and the ankle and knees strongly drawn inward. The muscles of the abdomen and the chest, including the diaphragm, were also contracted, and the patients breathed with difficulty. The muscles of the face participated in the affection, and even those of the glottis, causing paroxysms of violent dyspnoea. The uterus, whether pregnant or not, was never attacked with spasm. 'The formication and the tonic spasms were often very painful. The pulse was small, the digestion slow, the appetite normal, and in no instance was there fever. in some cases there was a loss of sensation, generally limited to the ends of the fingers and toes, but sometimes occupying large extents of surface, or even the whole body. This anaesthesia always followed the contractions, and was sometimes itself followed by partial gangrene. The loss of sensibility extended sometimes to sight, hearing, smell, and taste. The malady was usually of a paroxysmal character, with intervals more or less prolonged. in the paroxysms there were sometimes tetanic spasms, epileptiform convulsions, loss of consciousness, and delirium of variable duration. The length of the disease was altogether uncertain. Generally it continued several months; the recovery was slow; and relapses common. When death took place, it was always in a convulsive paroxysm, and by asphyxia. (ibid., ix. p. 596, Mai, 1857.) - Note to the second edition.

Suppression of milk in the nursing woman has been ascribed to the same cause. (Ann. de Thérap., 1864, p. 92.)

2. Mode Of Operation

Ergot seems capable of producing local irritation of the stomach and bowels, as indicated by the nausea, vomiting, diarrhoea, and abdominal pains, which have been noticed as among its occasional effects in overdoses. But its characteristic phenomena follow its absorption. These are of two kinds; 1. those dependent on the action upon the uterus, and 2. those upon the brain. it is highly probable that the action on the uterus is produced by an impression on the nervous centres of the organ, and not on the muscular tissue directly; so that the influence of the medicine, after absorption, is mainly if not exclusively on the nervous system. The circulation is said by Dr. Arpi to be somewhat accelerated, and others have made the same statement; but the general current of testimony is in a contrary direction; and, so far as my own observation has gone, I have known the circulation to be depressed, but never, I believe, excited. Nevertheless, it may well happen that an irritant effect on the stomach may sometimes sympathetically excite the heart. But, so far as concerns the direct systemic impression on the male system, it seems to be one of general nervous depression, affecting both the animal and organic functions, and of course involving the heart. in this way may be explained the tendency of ergotism to terminate in dry gangrene of the extremities. The organic nervous influence, under the continued action of the poison, ceases to be exerted upon the capillaries, which become as it were paralyzed, and unable to carry on the blood. The death of the part follows necessarily. The result is apparently owing to a direct depressing influence of the poison on this part of the circulating system; namely, on the extreme vessels. The gangrene is of the dry kind, because the vessels, in their state of nervous death, can no longer receive and carry on the blood, and consequently collapse. it will be found that, by this mode of operation, we are enabled to explain one of the most valuable therapeutic effects of ergot.