Volume IV — Main text

Clitvictfi purpmrta, Tulunc. Ergot of tye, «purrt<i rye, Nai. Ord., Fungi.

. Provlngs. — I. a. Six persons swallowed, at 9 a.m., each 3 cupfuls of water which had been poured when boiling hot on some ergot, in proportion of 2 lb. of former to 2 oz.. of latter. In 2 h. 3 of the provers experienced feeling of increased warmth in abdomen, particularly about stomach, malaise, and much nausea with inclination to vomit. These feelings went off by noon. The other 3 felt nothing but warmth and stimulation in stomach.

b. Five of the provers now swallowed, at 9 a.m., each 3ij of the powder, sprinkled on thin slices of bread and butter.

A. felt, an h, after dose, slightly painful sensation in epigastrium, some confusion in head, feelings resembling giddiness, with slight congestion in head, and red and warm face. At Ii.30 considerable dr)ness of throat and soft palate, and periodically recurring pain in hypogastrium, often accompanied with risings of disagreeable taste. 12, slight qualms, increased secretion of tenacious saliva, transient inclination to vomit, passage of foetid flatus. 12.30, increase of painful tenderness of epigastrium and rumbling in hypogastrium, nausea and confusion in head continuing. [, a second stool, which was thin, and voided with some tenesmus. At 2, when he dined, all these symptoms, save for an occasional twinge of pain, had disappeared ; but he felt very thirsty.

B. experienced, \ h. after dose, warmth in stomach and dryness in mouth. Soon after, increased secretion of saliva, frequent eructations and slight nausea. These feelings increased till towards 11, when he began to feel inclined to vomit \ a walk did not dissipate the inclination, and at 1 1 he brought up a portion of the bread he had eaten for breakfast and the remainder at 11.30. 10 m. later vomiting recurred, with much effort ; but, stomach being empty, nothing came up but mucus. Nausea now abated, but eructation and increased secretion of saliva continued till after i2. Aversion to food lasted all d.^ and he still felt in e. lassitude and heaviness in limbs.

C. had, an h. after breakfast, violent nausea, sense of choking, abundant salivation, soon followed by pain in head and belly ; no relief from lying down, from walking out, or from drinking coffee. Nausea, headache and abdominal pain (latter especially) were felt till 2, when he dined without appetite, but felt better afterwards. Towards 8 p.m. several fluid evacuations occurred, with cessation of all unpleasant symptoms.

D. describes himself as having felt, \ h. after swallowing drug, as if he had eaten nothing for some d. He became so hungry as to take his dinner with high relish at 1 1 a.m. In ^ h. after finishing it, however, he became sick, his mouth filled with watery saliva, and he shortly vomited all he had taken, with violent pain in abdomen. In 5 m. ne again vomited, but only mucus. Nausea and pain were still present at 5 p.m. At this time shivering came on, lasting some

DDie m^

and passed off with moderate sweating : therewith pain went away, and prover felt quite well.

£. observed following symptoms : — lo a.m., increased warmth in stomach, nipping pain in bowels, face warm and flushed. 10.30, confusion and pain in head, dryness and some burning in mouth and throat. Dryness had barely lasted an h. when it gave place to great accumulation of saliva and mucus, which he had to spit out continually ; at same time increase of pain in stomach and disgust to all food, amounting at 1 1 to desire to vomit. Abdominal pain was by this time so violent that he could not stand upright, but kept curled up in bed. There was no actual vomiting, even when fauces were irritated with finger, and between 11 and I2 his distress was intolerable. There was then rumbling in bowels, emission of a quantity of flatus, and towards i a thin foetid evacuation, which relieved the pain. At 3 p.m. a cup of coffee dispelled the nausea he still felt, and he was quite well in e.

c. Three weeks later, each prover took 3J in same manner.

A., soon after taking medicine, experienced warmth in stomach, frequent eructations, and headache for a few m. at a time. Towards I p.m. these symptoms disappeared, and he ate his dinner with appetite.

B. experienced same feelings, with addition of nausea, which went off, however, about i p.m.

C. felt, in ^ h., the warmth already mentioned, with dryness in mouth } and, \ h. later, frequent eructations and increased secretion of saliva. At 1 1 he became slightly squeamish, and continued so till i z, but without vomiting. Appetite diminished ; for several d. he felt an aversion to fatty articles of diet and to meat.

The eflects on D. were almost identical.

£. took 5ij, and was attacked in ^ h. with colic and headache, and at 12 with rumbling in hypogastrium. These symptoms were quite bearable, however, and (together with giddiness, which had lasted \ h.) went off at i p.m. Towards e. he felt very sick, and became so in the e. for several d.

d. Two months later some of the provers tested ergot which had been roasted, so that it had lost its characteristic odour. No effect followed in any, though the doses were raised to 5ij.

e. Four of the number now tried the effect of the meal of the spurred

?e mixed with twice its weight of sound meal, and made into bread, hey ate, at 10 a.m., each 5ij of the bread, buttered with goose-fat, and sprinkled with salt. They were all in perfect health, and save for some coffee and porridge at 6 a.m., had eaten nothing that d.

A., in an h., had feeling of increased warmth in stomach, then increased secretion of saliva, some nausea, and congestion in head. After lasting less than i h. these symptoms began to wear away, and in 2 h. there was no trace of them save slight lassitude.

B. had watering of mouth, warmth in stomach, and congestion in head, i h. after taking the bread. He afterwards experienced violent rumbling in the lower belly^ nausea, disgust for food, and violent headache. These symptoms continued for 3 h., so that he could not eat his dinner, and he felt lassitude for some time.

C. had precisely the same symptoms at nearly corresponding times ;

they continued 3 h., 2nd left behind dull headache and lassitude in al the limbs.

U. felt nothing but some degree of nausea. f. After 10 d., seven other persons joined in a second experiment," taking 3iij each of the bread at 10 a.m.

F. and G. — In \ h. great nausea and desire to vomit ; accumulation of saliva in mouth ; eructations, such as precede vomiting ; confusion of head ; burning in stomach, afterwards pressure and sense of fulness there, with headache. With A. these symptoms lasted till nearly 3. 30 p.m. \ but with B., who had bathed head, face, neck, and arms in cold water, they were felt in no great intensity till 2, when they gradually went away. He observed that, during the first effects of the medicine, pulse was somewhat accelerated, and also fuller and harder than natural. Both dined with moderate appetite at i o'clock.

H., L, and J. felt nothing for \ h., but then the above detailed symptoms came over them with much greater violence than with F. and G. All three were forced to vomit 2 or 3 times in an h., but were not thereby relieved, for both nausea and headache continued violent till late in e. In H's case, immediately after first vomiting, a very thin evacuation took place, preceded by rumbling ; and he found great relief from bathing his head with eau de Cologne. These thri provers fell into a lethargic state about 4 h. after eating the bread, observed enlargement of his pupils \ none of them could, for sickness, till c., and J. was very tired next d.

K. and L, felt effects of drug in an h. after taking it ; these resembled symptoms of F. and G., but there was more confusion of head, and for 3 li. they felt drowsy ; in F. pulse was unusually full, hard, and quick. By 5 p.m. no symptoms remained, (Lorinser,* Vtnucht Btob. ubtr d, IVirk. des Mutterkorns^ Berlin, 1 8 24..)

DiEz took at 9 a.m., fasting, 5ij of powdered ergot diffused 1 water. At 10 there was increased secretion of saliva, mouth watering copiously with a limpid fluid for 2 h. ; at 10.30, much sour eructation, inclination to vomit, confusion of head, giddiness, enlargement of pupils, momentary shivering alternating with feeling of warmth rising up into head, sweating on forehead, tongue white-coated, pulse 92 instead of 65, small but not irregular. At 12 he went to bed. Waking at 3, he felt confusion of head and some remaining lassitude. At 5 he voided a thin greenish stool. (Phcebus, Gi/tgewdchst^ p. 102.)
CoRDiER took,April i6th,7.30a.m.,3ij,chewingitforalongtime. He had a long-lasting peculiar taste and a sharp nauseating after-taste. g.30 a.m., 2 or 3 eructations with the taste of the drug, slight discomfuri in stomach, inclination to vomit. 10 a.m., there rose into mouth a gulp of colourless, clear^ not viscid, very acid fluid, also tasting of the drug, which relieved the discomfort of stomach, but its passage over the tongue caused him to spit much and for a long time. 11 a.m., took breakfast with little appetite and vomited it \ h. afterwards quite

• " Similar effects were obtaincil by Gross and an associate (CaNSTaTt's Jakrt$btri(ht, 1845, P- *56)» nf f^ch '00k a drachm ; and such also are the symptoittiascribcd to the medicine by Raige-D^lorme {Diet, dt Mid., md ed., xviii, a.?!),

(STltLi.)

ea^i

undigested. About noon, with more effort vomited a few mouthfuls of viscid turbid slime, with no traces of the drug in it. In afternoon became limp and ill, the transpiration had a disgusting odour, be felt out of sorts. Ate his supper as usual, and the taste of drug persisted till e. (Rec. period, de la Soc. de Mid.^ Ixxxiii, pt. i, p. 20, 1823 ; in Franfs Mag.y iii, 626.)

Patze took 3J of powdered ergot. In \ h. peculiar taste in mouth, as if he had smoked a long time, or taken some etherial oil ; therewith peculiar feeling of lightness in head, particularly of occiput. After \ h. more, strong dragging in spermatic cord, so that testicles seemed drawn up to inguinal ring j this lasted \ h. At same time unpleasant pressure at stomach, which increased to such an extent as to obstruct breathing ; therewith strong desire to eat. After i h. great sleepiness. Sleep during following n. disturbed by anxious dreams. Next m. head confused ; tongue covered with dry, tenacious, whitishyellow coating j pain in stomach very tormenting, attended with pyrosis ; face i»Ie and collapsed. In course of d. feeling c^ insensibility on front of thigh and on calf, and of painful creeping in finger-tips. Bowels somewhat confined. Symptoms increased for 4 d., and head became so giddy and sight and hearing so clouded that he could hardly walk. He had frequent eructations of offensive flatus ; pain in stomach and heartburn were most distressing ; much sour-tasting salivation ; epistaxis. Countenance took on an earthy appearance ; eyes were deep sunk in head ; and skin, usually inclined to perspire, was constantly quite dry. Stool occurred on 4th d. for first time sinc£ taking drug. {Med. Zeit. v. Ver.f. Htilk. In Preuss,^ 1844, p. 69 ; from Framfs Mag., i, 129.)
Parola took 20 gr. of powdered ergot. In an b. he bad nausea, heaviness of head, painful constriction of epigastrium ; a cold shudder ran through limbs ; muscular inactivity, to such a degree that he found it difficult to use his fingers ; pulse sank from 74 to 62. He continued in this state for 3 h. ; pulse was at one time as low as 60. {Gaz. Med., 1844, No. 19.)
A man, set. 24, free from all ailment, pulse 67, resp. 20, received 30 gr. In 2 h. he complained of feeling weary, shivered, skin grew cold, breathing oppressed, pulse feeble and slow (60), countenance pale, pupils enlarged. An equal dose next d. produced same effi:cts, but more coldness and lassitude; pulse was 58, resp. 15. Weakness and slow pulse continued for 2 d. ajfter. {Ibid.)
A student in pharmacy, well save for some enlargement of 1. ventricle, took 10 gr. of ergotin (Wiggers) on June 3rd, 12 gr. on 6th, and on 7th 3 gr. of the resinous extract. His pulse, which was 67, hard and full^ fell after ist dose to 61, after 2nd to 60, and became more and more compressible. After 3rd dose a remarkable change took place ; he became altogether feeble, as if he had been bled, puue was only 46, face pale and sunken. {Ibid.)
ScHROFF observed that pure ergorin, in doses of gr. ^ to gr. j, produced fulness of head, headache, and dilatation of pupils, followed by colic and retardation of pulse. (Reil's A^t, Aied d. rein. them. Pfianztnsuffe, p. 166; from Stille.^

vot. IV. ..... 4

g. a. At iiuon, pulse being 84, took 1 grm. 50 rciitigr. of the powdered ergot From i p.m. the pulse, taken every | h., showed the following changes : 76, 74, 72, 68, 70, 68, 66, 64, 62, 62, 64, 64, 64. The la$t number persisted till 6 p.m. It felt softer and more compressible than usual. At 3 p.m. some heaviness in forehead, which did not last long. Some borborygmus and eructation of wind with smell of ergot i slight transient colics in abdomen. Urine considerably increased, clear and acid. In 4 similar experiments, each made at 10 d. interval, the average pulse, which was before the experiment 84, was as follows : 80, 80, 78, 78, 76, 76, 74, 76, 74, 72, 72, 70, 70,

b. At I p.m., the pulse being 84, took 3 pills, each containing 30 centigr. of the extract. The pulse then fell as follows ; 80, 80,76, 72, 70, 68, 66, 64, 60, 60. 5 h. after the dose some borborygmus. Not such tranquil sleep at n. as usual. Next m. some slight colic, followed by 2 stools. (Arnal, Bull, gen, de The'r., xxxvi, 534O

Ergot was under observation on three occasions, doses being from 3SS to 5J of the fluid extr. With 5J doses, the efFects on the vascularity were m the direction of diminution, as with quinine. Thus, to quote from our notes taken at the time, "in one h., r. disc decidedly paler, with retina also of paler tint, I. also paler. Almost complete sleep produced." Again, " in 20 m. r. disc paler, on apparent inner side decidedly, on outer side a little. L. eye altogether a little paler." '^ An h. after administration, retinae and discs of both eyes decidedly pale, and this specially observable in r." "In 1^ h. retinx not quite mi so pale i discs same as before. Subject of experiment very sleepy." H With 5SS doses the results were more equivocal, a transitory paleness ~ appearing, however, to be produced about an h. after administration. (NicoL and Mossop, " Action of certain neurotics on Cerebral Circulation," as observed with ophthalmoscope in fundus oculi. {Brit, and For. M.-Ch. Rev., I, 203.)

li, CoTTMANN experimented on strong healthy lunatics, with 3j — 353 doses. A diminution in the frequency of the pulse, and, in several, 1 of its volume, were the only phenomena observed, except in 3 cases ; A in these it produced slight nausea, but no vomiting ; in 2 others, to fl whom it had been given the d, before, violent emesis was produced in the course of i h. When administered in ^ss doses, it either produced nausea, and consequently sedation, or diminished the frequency of the pulse without nauseating, in 25 — 30 m. When given in 3j doses, it appeared to excite rather than diminish the pulse in that time ; but in I 5 or 20 m. more the pulse lust a few beats, but not to the same extent as when larger doses were given. (Brit, and for. M.-Ch. Rrv.^" ix, 563. 1840.) ■

De Gravina swallowed 24 gr. in powder, which in J h. pro-^ duced sense of weight at epigastrium, which, slight at first, became in a short time very painful. This was t'oliowed by nausea and eructations having the odour of the ergot, and terminated in attempts to vomit. Face became very pale, and skin cold (especially on face) {fli there was great oppression of head with incapacity for mental exertion"| apathy, and feeling of complete prostration and vertigo on walking across room. Pulse, which before experiment was 65, fell to 54, and

became small ; resp. decreased from i8 to 13. There was complete disgust for food, with occasional feeling of coldness at stomach, which thence pervaded whole frame. All these symptoms were removed and a voracious appetite excited by taking a glass of strong wine. {B. and F. M.-Ch. Rtv.^ X, 555. 1840.)

JoRG experimented on himself and pupils. When taken in large doses S. was always found to produce nausea and vomiting, pains in abdomen and diarrhoea, weight and pain in head, and vertigo, with

feneral malaise and depression. {Gebrauch innerer Reixmittel zur hford. der Geburt des Kindes. Zeitz, 1833.)

a. Dr. Gibbon gave 16 gr. of powdered ergot in decoction to a man whose pulse was 64, sitting (which position he maintained). In 20 m. it was 58, moderately full ; in 30 m., 48, small ; in 45 m., same \ after this it slowly rose.

b. Same man, pulse 60, took 5J. In 25 m. pulse was 52, full and tense ; 35 — 45 m., 51. It then slowly rose.

c. Took 5J, pulse 64. In 20 m. pulse was 52 ; in 30 m., 46, slight nausea ; in 40 m., 45, nausea increased ; 5 m. later vomiting occurred, after which pulse rose to 60, but i h. after dose it was only 46. {^Amer. Joum. of Med, Sc.y 1844, i, 244.)

a. Dr. G. himself now took 10 gr. of an aqueous extract, pulse being 70. In 30 m. it was 60, and in ij h. 57.

b. Same took 30 dr. of oil, which reduced pulse from 70 to 56. Tincture had less effect. {Ibid.)

a. Dr. H. Gross took at 9 a.m. 5J of ergot in powder. After 1 h. felt heat in gastric region, increased flow of saliva, and occasional eructation ; soon after this great dryness of mouth and nose, not relieved by drinking water } confusion of head, vertigo, and moderate pain in scrob. cordis. These symptoms increased rapidly, the confusion of head became violent headache, and there were ineffectual efforts to vomit. Food excited loathing, a few mouthfuls of it caused inclination to vomit. After 2 h. felt better, but there remained to next d. headache and exhaustion.

b. A friend took the same dose at same time. At 10 a.m. he had increased secretion of saliva, nauseous taste, frequent eructation and slight confusion of head. Soon these symptoms increased, the saliva flowed into mouth in such great quantities that the mouth was always full of it, at same time heartburn, inclination to vomit, and violent headache. A walk relieved the symptoms, and in i h. they were all gone, and he could eat his dinner with appetite.

c. A repetition of the drug caused the same symptoms, only more severely. The nausea was great, and there ensued vomiting, which relieved the symptoms, but all next d. there was slight loathing, exhaustion, and headache.

d. Two d. later they both ate 5ij of bread made or pure ergot at 9 a.m. Whilst chewing it G. felt loathing and inclination to vomit, he had to drink much water and make a great eflx)rt to prevent vomiting. After I h. heat and redness of face, increased secretion of saliva, moderate pain in scrob. cordis, and quickened pulse ; shortly afterwards dryness of mouth and nose, nausea, and headache. These symptoms

(

soon disappeared, and he could eat liJs dinner at i o'clock as u>.uil. The Iricnd experienced identical symptoms. (H. Gross, Mid. ^Lntung Prtuatns^ xiv, 59. 1846.)

Dr. Hooker proved oil of ergot (obtained by macerating powder in sulphuric ether, decanting and evaporating).

a. A medical student, xt. 19, took 355 at 2 p.m., just after a plentiful dinner, pulse being 82, rcsp. 19. In 7 m. he felt agreeable sensa. tion in head, as from ether, followed by unpleasant feeling of weight and confusion, most in occiput. In 30 m. he complained^ while riding, of sensations resembling those of sea-sickness and amounting to positive nausea \ their seat seemed not to be in stomach, but higher up and cowards back. He now felt general languor and lassitude, and had constant inclination to spit j also sensations before eyes as if it lightened. The disagreeable feelings were at their height 45 m. after taking drug. At 3 he took 3J. In less than 7 m. came the pleasant feeling in head, with general exhilaration, dispersing temporarily the previous symptoms, which, however, soon returned in increased intensity. He complained of painful stiffness in muscles, and extreme lassitude in lower limbs i skin was everywhere of somewhat livid hue ; pupils were enlarged, and countenance wore a remarkably heavy and idiotic expression. In 40 m. after 2nd dose, pulse was 65, resp. 14. At 4 he again took 3J. Again the unpleasantness was dispelled, and again it returned. At 5 pulse was only 36, and feeble ; resp. had sunk to 8, and were scarcely perceptible for their feebleness. Skin was pale, and when pressed with finger colour was long in returning. (From after 2nd dose, frequent and copious emission of urine had occurred.) Sleep in n. was quite sound.

h. Analogous effects were observed in the case of another student, set. 20. In both effects lasted a week. For 3 d. pulse continued under 50 \ pupils were dilated, breathing slow, skin livid ; there was want of appetite, general lassitude, stiffness of limbs, and feeling of soreness in muscles of lower extremities.

c. H. gave same to 6 women in labour, in 30 — 75 dr. doses. He could not perceive any effect on uterine contractions, but found that the children presented for some time after birth a livid appearance, great irregularity and difficulty in breathing, and other characteristic signs of ergotism.* {Boit. Med. and Surg, jaurn., x, 298.)

Glocick gave to a healthy woman, aet. 32, who had had children, a few d. before period, 30 dr. of oil. Pulse was 83, resp. 22. In 5 m. feeling of pleasant buoyancy, followed in 20 m. by nausea and unpleasant feelings in stomach and bowels ; then violent pain in hepatic region and hypogastrium, collection of saliva in mouth, and want of readiness in executing muscular movements. Head, too, was uncomfortable, and she fancied she saw sparks flitting before her eyes ; face was pale ; shuddering at intervals. In ^ h. symptoms began to abate; in an h. pulse was 55, resp, 17. She now took 60 dr. In 5 m. transient exhilaration ; soon nausea, giddiness, confusion of thought, going

• On administering simple decoction of S. in full doses to two other young men none of the above effects ensued ; and, given in labour, it promoted uterine contnic* tions, and exerted no narcotic influence on mothers or children,

itfMi

on increasing for lo m., dull pain in back, cutting pain in whole body, especially in region of liver and in pelvis (but not resembling pains which precede labour) ; at same time a feeling beginning in back, and extending through arms to end of fingers, as if large portions of nervous fibre were compressed; pain shot from sacrum to thigh, and muscles began to stiffen. In | h. after 2nd dose pulse was 60, resp. 14 ; there was bluish look, cold skin, and dilated pupils. After 32 m. violent and repeated vomiting occurred, giving great relief. Next d. she was tired, and averse to food. {Diss, de Sec. corn.y Dorpat, 1H37.) 19. A lady, aet. 28, received, 2 h. after a meal, 8 d. after a period, 9ij of ergot from which oil had been removed. After 12 m., inclination to vomit and slight accumulation of saliva ; also gentle pressure in pelvic region, from sacrum to pubes, as in labour. Same effects followed 5j uken an h. later. (Ibid.)

»o. (No information as to prover or dose). Confusion of head, after i h. Sad disposition. Great anxiety. Stupor. Great drowsiness. Very prostrated alter sleep. Thinking power weakened. Disinclination to all work. Vertigo lasting 24 h. aiiter the dose. Headache on 1. side. Pressure in eyeball. Frequent diplopia. Visual power much diminished. Roaring in ears. Dysecoia. Prickling in tongue. Taste very blunted. Violent burning in oesophagus. Frequent flow of saliva trom mouth. Great thirst. Nausea lasting 24 h. after dose. Loathing. Frightful pains in stomach lasting 4 d. after dose. Burning in urethra when urinating. Increased flow of urine. The urine has a copious red sediment, which stained the utensil. Frequent urging to urinate, which it requires some effort to pass. Bruised feeling in limu, and diffiralty of moving feet (>f. h. Z., i, 17.)

II. Poisonings. — i. Friday, Sept. 6th, 12 m., I was called in haste to attend Mrs. B — , xt. 22, nervo-bilious temperament, who was suffering, as her husband supposed, from fever and ague j but, on inquiry, I ascertained that in the 2 preceding d. she had taken ergot with the intention of producing miscarriage. She had been married about 2 mo., and during that time having suffered from continued menstruation, which was unusual with her, she concluded that it was caused by pregnancy. She, therefore, by the advice of a female abortionist, and in the temporary absence of her husband, procured ^s of pulv. ergotae, taking the whole at short intervals. On examination, I found the following symptoms : Rigors followed by heat and violent thirst ; severe pain in l»ck part of head ; tongue heavily coated white ; nausea and vomiting } diarrhoea ; violent pain in small of back, epigastric and hypogastric regions ; severe pain in limbs ; pains of expulsive character in uterus ; giddiness and sensation as if about to fall on the slightest movement ; crawling all over body ; stammering and hesitation in answering questions. Same d., 9 p.m.. Dr. W. H. Watson was called in consultation. On examination, per vaginam, found os tincae open so as to admit first phalanx of index finger, very sensitive to touch, hot and engorged, with profuse flowing. Patient was in great pain with muttering delirium, very restless, agitated and fearful of death. Pulse was depressed, very quick and fluttering, ranging to 120; tongue dry and brown at tip ; urgent thirst with desire for acidulated drinks ; urine scanty and dark coloured } frequent brown and slimy discharges from bowels ; pain in head, still confined to occipital region ; face flushed and livid at times } eyes wild and distorted, with pupils much

dilated ; marked hesitation in answering questions -, constant moaning and swaying of arms to and from head ; vomiting of dark brown, slimy mucus and also of everything taken into the stomach ; abdomen tympanitic; respiration costal j weakness of memory; formication; inclination to sopor and desire to be left undisturbed, 7th, 10 a.m., patient no better, but symptoms somewhat relieved ; great prostration , pulse 120, small and compressible; tongue coated with heavy brown fur and pointed at end ; skin hot, dry, and of yellowish-brown colour, resembling that of a mulatto ; eyes staring and wild, with dilatation of pupils ; conjunctiva and sclerotic coat yellow and injected. Diarrhoea continued, discharges from the bowels very foetid and dark coloured ; discharges from vagina almost black, fluid and very fcetid ; exhalations from skin also foetid. Patient complained ofgreat soreness all over body; could not lie with ease in any position, and could not be moved without taking hold of her hands; throat sore, with difficulty of swallowing; extremities livid, palms of a bluish colour, and formication all over body. 8 p.m., greater irritability of stomach, and more difficulty of retaining food and medicine than in m. ; violent pain in stomach and bowels near the umbilicus; sore throat ; inability to swallow while lying down ; thirst less urgent; vaginal and urinary discharges of a dark wine or " prune juice" colour. 8th, 9 a.m., patient slept 1 J h. in n., the first sleep she had enjoyed during her illness ; pulse 1 10, somewhat fuller than d. before ; throat not as sore ; more ease in swallowing; soreness of the body not diminished ; urine very scanty, almost suppressed ; tongue heavily coated with brownish fur, dry at tip and edges, stiff and swollen. Patient is very weak, cannot move herself in bed ; vomited twice during n. ; loathes everything except sour drinks ; has had no movement of the bowels or passage of urine during n. 7 p.m., symptoms still unfavourable; urine suppressed. On introducing catheter, about a gill of dark prune-coloured urine passed, which appeared to be full of gritty sediment and emitted a very disagreeable udour. Pulse 100, quite fuU ; haemorrhage from nose ; great thirst ; desire for acids ; skin dry, hot, and yellowish brown, gth, 10 a.m., mind clear; great prostration ; tongue dry and brown ; pulse 96, quite full ; great thirst and desire for sour drinks. Skin hot, dry and of yellowish brown colour, but not as dark as it was d. before ; urine suppressed, but on using catheter about a teaspoonful escaped, which was very dark and foetid, a few drops falling on the linen stained it dark brown ; pain in vulva and region of kidneys. Said she had thought she could pass urine in n., but failed to do so. Percussion of abdomen over bladder showed that it contained no urine. Movement of bowels early in m. was more natural than before ; soreness of body and throat slightly improved ; bleeding at nose continues. 8 p.m., there is now some nausea and vomiting, in addition to above symptoms ; haemorrhage at nose worse than before ; drowsiness and inclination to sopor ; urine suppressed, only a few drops having been passed during d. 1 0th, 9 a.m., patient remains in about same condition as d. before ; urine suppressed ; rumbling of wind in bowels ; tenderness of vulva ; exhalations from skin of a vinous odour; eyes sunken and surrounded with a blue margin, conjunctiva bright yellow, pupils but little dilated ;

unpleasant sensation in head but no pain ; pulse 93, quite full ; tongue dry, brown at tip and leaden-coloured at root ; epistaxis j great thirst j nausea and vomiting ; skin dry, hot and yellow. 8 p.m., pulse 90, full, but easily compressed. Passed 3 tablespoonfuls of urine by means of the catheter, of lighter colour than formerly; vomiting continued, of sour, dark green matter ; sour eructations, singultus ; vinous exhalations from skin ; bowels constipated ; tongue dry, coated a brownish leaden colour ; great thirst and desire for sour drinks ; bowels tympanitic; cutting pain and smarting in urethra, as if a knife were drawn through the parts, when attempting to urinate ; very annoying pain in 1. shoulder, i ith, g a.m., pulse 90, appears to have more volume, but easily compressed ; thirst and craving for acids, as before; tongue covered with a brownish, leaden-coloured coat in centre, red at tip and edges. Sensorium disturbed in n. ; could not get rid of the impression that there were two sick persons in the bed, one of whom recovered and the other did not. Vomited a pint of matter in m., very sour, and of dark green colour; procured a tablespooonful of urine by use of catheter ; no movement from bowels ; pain in vulva, and also in 1. shoulder ; itching all over body ; mind clear ; dizziness on moving head ; skin hot and dry, but of better colour; eyes very yellow, pupils not as much dilated. Patient appears to have a little more strength, 8 p.m., pulse 100, not as full, and wiry ; vomiting of green, sour mucus ; passed a tablespoonful of urine containing albumen ; great sensitiveness of bladder and ovarian region ; pain in stomach and bowels ; perspiration all over body except face ; throbbing in head ; sinking and sickness, oppression and heaviness, at stomach ; skin of natural appearance on feet and hands ; intense itching all over body ; restlessness and drowsiness ; constant sighing, singultus and sour eructations. I2th, 9 a.m., pulse 100, small and feeble; tongue red, but quite clean. Patient slept somewhat during n. and did not vomit until m. When rising up in bed, everything turns black before her eyes; great prostration ; retching; vomiting of sour, green mucus; pain in stomach, bowels and vulva; soreness and throbbing heat in latter; dizziness of head on moving; heaviness of head; soreness, bloating and rumbling of wind in bowels ; scanty discharges from bladder, of yellow colour, and very foetid; no movement of bowels; thirst, and sordeson teeth. 4 and 8 p.m., pulse fuller, with more volume ; passed two or three tablespoonfuls of urine, which was shown by testing to contain a large amount of albumen ; vomited dark green and sour mucus, containing shreds of disorganized membrane ; pain and soreness in stomach, bowels and vulva j singultus ; borborygmus ; tongue clean, very dry and red at tip ; great thirst, and dryness of mouth and throat, with burning and tingling of tongue ; sensation as of boiling water running from vulva up to mouth. 13th, 9 a.m., per vaginam examination made. Uterus and r. ovary very much congested and very sensitive to touch ; sphincter vagins and vagina very much relaxed ; patient describes pains in bowels to be as if a hundred knives were drawn through the parts down to the womb, ovaries, urethra and vulva. An injection which passed away during visit contained shreds of mucous membrane. Matter vomited also contained such shreds; dark,

bloody and very foetid matter expectorated from the mouth ; thought we detected casts of uriniferous tubes in the ounce of albuminous and bloody urine obtained by means of catheter ; itching all over body, so as to cause the patient to tear her skin ; scalding and burning in mouth, throat and stomach ; singultus ; capillaries of skin appear to be empty ; mind clear, but same hesitation in answering questions still observable. 8 p.m., pulse 92, full ; skin moist ; vomiting continues as before ; constant bleeding at mouth ; tongue dry, glazed and stiff, appearing as if baked, with hard crust formed on surface; thirst and loathing ; discharges from bowels of a great quantity of disorganized mucous membrane, resembling that thrown off in dysentery ; urine albuminous i drowsiness and prostration ; sordes on teeth, and singultus. 14th, 10 a.m., patient evidently failing; pulse 80, full while quiet, but quick and very feeble while making the least exertion ; vomiting of dark, bilious matter at intervals of a few m. ; mouth sore and bleeding-, head dizzy and heavy ; tongue clear, red and somewhat more moist than last night, pointed at tip ; urine albuminous, but of better colour and larger quantity than at any time since suppression commenced -, no movement from bowels ; an injection of beef tea was retained all n. ; patient says she must have something to relieve her or she must die; skin soft and more natural to the touch, but still very yellow ; conjunctiva and sclerotic of a belter colour. 8 p.m., pulse 80 and full; thirst diminished; tongue clear, red and moist; sordes on teeth; singultus ; haemorrhage from the mouth ; urine more copious, containing mucus and albumen ; tenderness in the r. hypochondriac region; stinging, cutting pains in rectum ; great irritability of sphincter ani with spasms ; spasm of meatus urinarius ; hemorrhage from bowels ; constant nausea and vomiting, matter vomited is of dark-green colour containing mucus, bile, and shreds of membrane ; great distress and oppression at stomach ; headache in occipital region ; head vacant with feeling as if something whirled round in it ; drowsiness ; sudden waking from sleep and looking wild as if frightened, followed by palpitation } more blood in surface veins ; mouth sore as if salivated ; expectoration ■ of bloody saliva, 15th, 10 a.m., pulse 80, moderately full, but easily I compressed ; giddiness and whirling of head, everything looks black " when moving it ; nausea and vomiting ; colour of the eyes more natural ; thirst ; singultus ; great distress and oppression at stomach ; pain in liver, stomach and bowels, and vulva ; urine more copious but albuminous; paralysis of bladder and of anus; pain and spasm in rectum ; pain in ovaries and uterus ; foetid breath and urine ; foetid discharges from vagina ; bleeding at mouth ; haemorrhage from bowels ; excruciating pain in h^emorrhoidal veins; more blood in surface veins; no movement from bowels; torpidity of liver; great tenderness of vulva ; skin yellow, soft and moist ; mouth very sore ; loathing of food or drink ; anxiety and fear of death. 7 and JO p.m., pulse 80, moderately full, not corresponding to the prostration ; hxmorrhage from nose, mouth, stomach and bowels; severe cutting pain in rectum; tongue red and dry ; thirst ; stomach cannot retain even medicine or water; passed per catheter about 3 tablespoon fu Is of urine containing albumen ; no movement from bowels ; dizziness and heaviness of head

1 mei

anxiety ; obstinacy ; sudden waking from sleep, with wild, staring look ; convulsive movements and twitching of muscles and tendons of limbs and face ; moaning ; sighing ; bloody sordes ; singultus ; foetid taste in the mouth ; olfactory nerves very sensitive ; weight and oppression of stomach ; vertigo ; dizziness of vision, especially when rising or moving in bed; loathing of life; despair. ]6th, lO a.m., patient more feeble j pulse 80 to 90, weak and variable ; tongue red, dry, cracked and bleeding; soreness and hemorrhage of the mouth ; foetid breath and exhalations, so that it was almost impossible to remain in the room even with a constant circulation of air; urine passed involuntarily for first time, more copious and containing blood and albumen ; haemorrhage from the bowels, blood does not clot, is very thin and almost black ; vomiting of blood, bile, membrane and cofFeeground matter ; movement from bowels of watery faeculent matter ; head heavy and dizzy ; thirst ; loathing; inability to retain anything on stomach ; little pain or soreness in any part of body except stomach ; skin moist and yellow ; twitching of muscles ; constant moaning and fear of death, with strong desire to live. 3 p.m., pulse feeble, intermittent, ranging from 80 to 90 ; twitching of muscles ; numbness of limbs; eyes blurred, with dimness of vision ; head heavy and dizzy; light painful to eyes ; bowels pass faeculent matter ; indisposition to move or speak, becomes very much exhausted when doing either ; bleeding at nose ; less vomiting ; little pain, but great weight and oppression at pit of stomach ; great thirst, but unable to drink much on account of its causing distress in stomach. 8 p.m., called in haste and found the patient in a dying condition. She gradually became insensible and died without struggling ; vomiting ceased 8 h. before death. About an h. before death she complained of great weight and oppression in stomach, as if a stone were there. She expressed the opinion to her husband a few m. before death that she could not live long. She continued rational to within a few m. of death. Postmortem examination was solicited, but not granted. (Dr. C. Judson Hill, Trans. o/N. T. State Horn. Society^ ii, 214.)

On Sunday, the last of Oct., I was requested to visit a lady in great haste, as she was supposed to have yellow fever in its most rapid and malignant form, accompanied with black vomit and other symptoms of that disease. The fever was then prevailing in the city, and a death had occurred from black vomit in the house adjoining. As soon as I was ushered into the room, the patient, in great alarm and agitation, requested her friends and the nurse to leave the room, when, pointing to a quantity of dark brown fluid which she had just vomited, she besought me in extreme anguish to have pity on a miserable being who was about to die from the consequences of her own crime. After extracting from me the promise that I would not, under any circumstances, expose her guilt, to the mortification of her friends and the exultation of her enemies after her death, which she deemed inevitable, she informed me that until Tuesday last she had enjoyed excellent health ; she was 32 years of age, had borne three children, with no peculiarity worthy of remark, and was now in the 6th mo. of pregnancy. On Tuesday m. last she commenced taking powder of

ergot, in doses of 40 gr. every 25 or 30 m,, for the purpose of producing abortion. Three or four doses were taken, with no apparent effect on the uterus, and, a chill coming on, followed immediately by nausea, sharp pain in head, with dizziness and partial blindness, tt became necessary to discontinue the medicme. Three or four h. afttr the chill, spontaneous diarrhoea commenced, continuing 5 to 6 h., with relief to nausea and headache. She passed a restless, feverish, and sleepless n., in a state of great nervous agitation. On Wednesday tn, the diarrhcca had ceased, and the pain in head and fever had returned, with thirst and great irritability of stomach, toast water, lemonade, and iced water being ejected almost as soon as swallowed. Supposing it to be a bilious fever, the patient, after applying a mustard cataplasm to the epigastrium, took a dose of calomel and jalap, which acted well p.m. She slept well, and the next m. felt quite well, which confirmed her in the opinion that the sickness had been caused alone by the presence of bile in the stomach, and that the ergot used was entirely inert. Resolved not to abandon her purpose, she then sent to another apothecary, and procured 1 oz. of a parcel of which a portion had been used the day before by a physician of the city with prompt and energetic action. This quantity was divided into four doses, three of which were taken in 6 h. without producing the slightest expulsive uterine effort : in the words of the patient, " no pains or signs of labour.'' She became so sick that she could take no more. Then followed excessive nausea and debility, with very little vomiting of a dark brown coffee-ground looking fluid ; pain in head and eyes ; a burning, torpid, prickly sensation over whole surface, with much difficulty in moving extremities, accompanied bv sensation like that produced in a limb by pressure on the trunk of a nerve, when we say that the limb is " asleep." 7^hese symptoms during Friday and Saturday increased in violence, attended by entire absence of sleep j pain in head became intense, with transient delirium; pain in back and limbs; incessant vomiting of a brownish water with occasional streaks of blood ; great prostration accompanied with a slow feeble pulse ; pupils dilated ; vision imperfect, at times almost total blindness ; tongue dry, scarlet at edges, crimson and black in middle ; intense thirst, with no abatement by iced water or lemonade ; burning in fauces and along oesophagus to stomach ; tenderness of epigastrium ; much difficulty in swallowing. The voluntary muscles responded irregularly, with occasional violent spasms of those of extremities and back. The skin was dry and of a muddy yellow hue. On Sunday at 9 a.m., when I first saw the patient, I found the above detailed symptoms, with the addition of the apparently well-marked black vomit. I assured her that although her case might possibly be somewhat influenced by the prevailing epidemic, yet the symptoms could well be produced by the ergot together with her mental excitement ; and that I had little doubt but that her illness was mainly attributable to the tatter causes. Purgatives, including 10 gr. of calomel, were given, and an effervescing mixture every IS m. ; spongingof whole surface with iced water and vinegar, and iced water to head. 4 p.m., bowels have been freely evacuated ; pulse quicker, with more resistance, 82 ; vomiting continues, but with less

violence ; pain in abdomen ; other symptoms nearly the same as in m. Continued the cold applications and sponging ; ordered calomel, gr. x, sulph. quinine, gr. iii ; blister to epigastrium ; for drink — gum water, arrowroot jelly, and claret, lo p.m., skin hot and dry; pulse iioj thirst abated ; vomiting at longer intervals, and the matters ejected changed to the appearance of those taken ; has had two full black watery evacuations from the bowels ; vision improved ; pain in head, back, and limbs abated in some measure. Ordered effervescing draught with sulph. morphia, flax-seed poultices to abdomen and to blistered surface of epigastrium ; cold to head continued ; gum rnucilage and claret for drink during n. Monday, 8 a.m., the patient took .J gr. of sulph. morphia before i, when she slept 4 h., then had a copious dark gummy evacuation from bowels. Violence of all symptoms was much abated ; pulse 100; vomiting ceased i tongue red and dry ; thirst, pain in head and dizziness yet troublesome, but much alleviated. Continued flax-seed poultices to abdomen, and drink of gum water, claret, and arrowroot jelly. 4 p.m., patient much more tranquil ; two or three thin watery stools almost without colour, attended with griping and nausea. Continued prescriptions of m., with addition ot calomel, gr. xv ; opium, gr. j. Tuesday, g a.m., patient much improved ; head, limbs, and bowels almost free from pain ; pul.se 80 ; has slept well during n. ; no evacuation from bowels. Ordered ol. ricini every 2 h. until it operates, and, with the exception of the calomel and opium, the prescriptions of the last n. continued. 4 p.m., patient quite relieved ; oil has acted well ; pulse 80. This afternoon she perceived the motions of the foetus for the first time since Thursday last. \fter this she continued to improve without any occurrence worth notice, and after a few days resumed her accustomed occupations. '(Three months later patient was naturally delivered of a healthy child.) (Fearn, Nrw Orleans Med. 'Journ., 1844-5, ') '•)

About 2 years ago there was brought to our hospital a young ^woman, pale, feeble, and evidently labouring under the effects of

iscmorrhage ; and upon examination the fact was brought out that she lad been suffering from uterine hiemorrhage for weeks. The history of the case, as near as could be obtained, was this : She had for some time been indulging in illicit intercourse, and her menses having ceased, she feared that she was pregnant, and had taken large and repeated doses of ergot; hemorrhage had at last been produced ; the blood at first was slight but was constantly increasing, till she was sent to the hospital, where she died on the next d. What treatment she received I cannot tell, as she was not in my department, and the hospital records barely mention the case, and that she died from uterine hjemorrhage. I was requested to assist at a post-mortem examination, conducted by the county coroner. The examination revealed the fact that she had not been pregnant at all ; and also that there were no lesions of structure in either the vagina or uterus (as we expected to find) from the use of instruments used to procure abortion ; but the ovaiy of the r. side was completely disorganised. (Dr. J. T. Boyd, St. Louis Clinical RtvieWy 1879, p. 253.)

Some years ago I was consulted by a woman of about 35, bilious

temperament, sallow complexion. She without hesitation decbred that she was prcgnajit. A man who had boarded with her had had frequent intercourse with her, and her menses were not regular, &c. The woman appeared in great distress of mind, from the fact that her husband, who had been absent for some time, was expected home in 2 mo., and exposure was inevitable, as she was certain she was ^ moj. gone in pregnancy. She had taken large doses of ergot in her ciidejvour to cause a miscarriage, but it had only produced a slight hemorrhage. She was sensible of an enlargement of the uterus ; had a constant feeling as if insects were crawling over her ; dull pain in region of ovaries ; tenderness on pressure over the uterus, &c. I was satisfied that she was labouring under the effect of ergot, and told her so ; requesting her to abandon all medicine, and all efforts at abortion, for in my opinion she was not pregnant, but was keeping up the disagreeable symptoms by the use of medicine. It required a great deal of argument to convince her, but she finally agreed to do nothing more for one month, and then she was to call again. I did not see her till 6 weeki afterward, when she came looking quite happy, saying that she had taken my advice, that all the haemorrhage and the disagreeable symptoms had subsided, and that her menses had appeared and passed off naturally. {Ibid.)

A lady, xt. 28, whose youngest child was 10 years old, finding herself again pregnant, wished to procure abortion, and took an unknown quantity of ergot. She got ill and sent for the doctor, who found the uterus, which previously had been in its normal position, now depressed so as to be almost betwixt the labia (she was in 3rd month of pregnancy). The orifice of uterus was dilated, so that the finger could be introduced. The patient had extreme urging to urinate, and labour pains. She could only obtain a little ease by lying on her belly on wet cioths. Narcotics brought very transient relief. This state lasted 3 d., but no abortion took place, and the uterus gradually resumed its normal places its orifice contracted, and the lady went to the full end of pregnancy, (Wernich, Ffnuch.ii. d, Mutttrkorns^ Berlin, 1874.)
A girl, ast. 22, being pregnant, took an unknown quantity of ergot. She was seized with vomiting and great pain in abdomen. After some discharge of blood from vulva a foetus 5 in. long came away. Next n. she became worse, asked constantly for water, became unconscious, pulse scarcely perceptible, and she died. P.M. — Marked hyperjemia of veins in adipose layer under skin, congestion of vessels of omentum, great injection of vessels of stomach and intestines, reddish-brown colour of lower surface of liver, dark black colour and congestion of spleen, great hypett-emia of renal pelvis, brownish-red injection of external and posterior surface of bladder, pulmonary parenchyma dark blackish red from great congestion, both ventricles of heart empty. (Otto, Betz.^ Memorabilien^ xv, 1 870, Pt. 2, p. 25 ; in Ibid.)
Mary R — , in 4.1 h mo. of pregnancy, was seized after a fright and severe exertion wiih uterine haemorrhage, which continued several d. After opium had been given in vain, 335 of ergot was administered, and repeated in an h. This was at 8 p.m. Next m. she had violetit

headache, and io coarse of d. became delirious and could with difficulty be kept in bed. These symptoms yielded to purgati\es, shaving and blistering head, &c. A few d. after hemorrhage returned i ergot was i^ain given, and again followed by delirium, although in slighter degree. (Maunseu., LtmJ. Med. Gaz»^ xiv, 605.)

Mrs. F — y 2 mos. pr^nant, was attacked with hzmorrhage from vagina, for which, after £u]ure of other means, ergoc was given as above. After taking the two doses she fell asleep, and when she awoke the discharge returned ; another scruple was then given, in an h. after which she vomited. On following d. she was in a state of semistupor, with very violent headache and weak depressed pulse. Similar treatment was adopted with success. {Itid,)
a. On June 3rd, 4 p.m., I was called to see M. M — , act. 28, till lately a hospital nurse, said to have "■ burst " a blood-vessel. Patient volunteered no information, but admitted taking ■■ two handfiils " of ergot. Subsequent events and autopsy proved she had been taking the liquid extr. for months, and had quite recently taken two handfuls of the powder not infused. I observed a basin of reddish-brown pultaceous matter, said to have been vomited by patient at 8 a.m. Had vomited something like this a few d. previously, and complained of lumbar and arthritic pains. Passed a very hard stool on previous e., and a quantity of urine which looked like blood. About same time vomited Oss of blood. During n. and m. had gradually become worse. On examination, face, eyes, neck and upper portion of chest were intensely jaundiced, intensity diminishing from above downwards. She had a pair of genuine "■ black eyes." Rest of body of a natural appearance. Expression anxious and general condition maudlin. Occasional fits of stupor and apathy ensued. A distinct etherish odour could be perceived. Lips and tongue slightly swollen and covered with dry black blood. Edges of tongue and lips were of darker hue than natural, and moist. She lay chiefly on her r. side. Skin pale and cold. Temp. 96° in axilla. Pulse could just be felt, but beat seemed to disappear before I could judge of its character ; to count it was impossible. Respiration noisy, laboured, 48. Thirst intense. No appetite. Could swallow with ease. No stool or micturition since last e. Harsher breathing at base of r. lung than elsewhere. Action of heart as peculiar as pulse j area and force of pulsation both increased, while impulse against chest-wall was of a distinctly rolling character ; 150 such cycles were made to the m. Milk found in breasts. Pregnancy was suspected, and very shortly after a uterine contraction was noticed. From 6 p.m. pulse could not be felt. Labour was induced, and liquor chlori given as an antidote. At 9.35 res(Mration was 56 i it gradually became easier and slower, and stupor deepened. Every now and then a paroxysmal state would intervene and patient sit up in bed. Just before delivery respiration ceased altogether.

b. Autopsy^ 32 h. after death. Appearance similar to that during life, except a welling from mouth and nose of greyish-black and gritty matter, very fluid. Body well nourished. Greenish streaks on abdomen. Cadaveric rigidity passing off. Brain firm and free firom haemorrhage. Membranes looser than usual. Temporal artery bled

profusely in making preliminary incision into scalp. On opening thorax and abdomen an enormous quantity of fat was exposed, with innume(able minute hemorrhages embedded in it. Peritoneum and bowels covered with the same, the latter bound down by adhesions. Large amount of fluid blood in abdominal cavity ; no large vessel ruptured, haemorrhage seeming to result from rupture of enormous number of small ones. Diaphragm arched. Liver natural size ; on section, dry, bloodless, waxy-looking, and slightly dirty yellow. It was easily laccrablc. Spleen smaller than usual, and on section dirty red ; blood oozed copiously from it. Kidneys enlarged, pale, and waxy-looking, capsules easily separable. Stomach exhibited ruptured vessels in its walls, and j contained considerable quantity of same fluid as came from mouth and ; nose. Bowels in same condition. Uterus was about size of an adult head ; its walls stained all over with dark efi'usions ; cavity contained a fiuetus of about 5 mos. Neither liq. amnii nor blood in uterine cavity. Pleura non-adherent. Lungs rather anaemic, with a steel-grey appearance; on this as a ground were scattered innumerable irregular dots size of a small pea, which were hxmorrhages. R. lung congested at its base. Heart enlarged, having a large quantity of fat on its anterior wall and sides externally, but valves were healthy. Cavities practically empty. (A. Davidson, iM.B., Lancet, 1882, ii, 526.)

a. The action of spurred rye on the uterus, when labour has actually commenced, is usually observed m 10 — 20 m. after it has been taken, and is manifested by increase in violence, continuance, and frequency of the pains, which usually never cease until the child is born j nay, they often continue for some m. after, and promote the speedy separation of the placenta and the firm contraction of the uterus in a globular form. The contractions and p.*ins caused by ergot are distinguished from those of natural labour by their continuance ; scarcely any interval can be perceived between them, but a sensation is experienced as of one continued forcing eifort. There is usually much less hicmorrhage after delivery when ergot has been employed.

li. I have known increased frequency and fulness of pulse, copious perspiration, and flushed countenance, follow the use of ergot during parturition. But in most instances the opposite cfl^cct has been induced ; the patient has experienced great faintness, the pulse has been greatly diminished in both frequency and fulness, and the face has become pale or livid.* (Pereira, ep. cit.)

A woman had ergot given to her in a perfectly natural labour, to expedite delivery. It brought on one continued pain of a character and intensity such as she had never experienced before, and during which, to use her own expression, sbe felt as if *'thc whole of her body was coming from her." The child was violently extruded, and the uterus and bladder were driven down into the pelvis, the bladder remaining outside the labia. It was not until some time had elapsed that these organs were restored to their normal position. (Barnes, Lanat, 1853, ii, 43+.)
In one case, in which 1 gave ^ss three times at intervals of i 10 m., pulse came down from 120 to 90, considerable stupor and epis- I • See, inltr alia, Hardy, Dubi. ^arUrly Jeurit. for 1845.

taxis supervened, but no uterine action. In a second pulse came down to even below natural standard, and a similar tendency to coma existed, with corresponding absence of pains. (Cusack, Lond. Med. Gaz.^ xiv, 606.)

A woman, when in her 3rd labour, got in 2 doses an infusion of 5ij of ergot. She was delivered within ^ h. of taking first dose. A few m. after the doctor had left she vomited what appeared to be the medicine. Presently she lost all voluntary motion and even the power of utterance. Her heart beat rapidly for a long time, and her breathing was very laboured. The room appeared to be like water extremely agitated on its surface. She compared it to the^' foaming of a troubled sea." After some h. the heart beat more quietly, and then became more agitated, intermitting in this manner all d. During early part of d. lay quite motionless, but recovered power of movement in e. During d. passed much urine, but knew when it came away. She declared that such was her helplessness at one time that " had the child been falling out of bed, or the house been on fire, she could not have made the least muscular effort." (J. Wright, Edin. Med. and Surg. Joum.^ liii, 12.)
A young woman was attended by a midwife, who gave her for defective labour pains a few corns of ergot, whereon the most violent pains ensued, much stronger than any she had had before experiment. She then suddenly was seized with a kind of insanity, doubled her fists and caught hold of the midwife's head, and the child was born amid the most violent labour pains. (Henrichsen, Huf eland's "Journ.^ xlv, 5, 96.)
A midwife gave a large quantity of ergot to a woman in her confinement. Twenty-four h. after the waters had come away, H. found her lying on the bed, apparently dying ; her extremities were cold, she had cold sweats, especially on face, intermittent spasmodic pulse, violent thirst, great anxiety, could not open eyes, when forcibly opened they were found to bestaring and fixed, face and neck very swollen, she answered little or not at all to questions. In spite of her weakness the labour pains continued to be strong and very rapid. This state of things had lasted 24 h. The external genitals were much swollen, hot, blackish red, the labia majora hung down to middle of thigh, were dry and (edematous, as were also the 1. minora, the rectum was prolapsed at least 3 inches. {Ibid.., 99)
A woman, aet. 27, pregnant for 6th time, received from the attending midwife, who was getting impatient, 5J of powdered ergot. In a few m. very painful contractions came on, and soon there was a great degree of excitement, congestion towards head, and irregular movements of whole frame, especially limbs. The medical attendant found her very excited, with wild look, indistinct vision, and swelled face ; head very uncomfortable. Then came nausea, and vomiting of a yellowish-green frothy mass ; patient complained of burning pain in hypogastrium, and of disagreeable feeling of numbness and creeping in extremities. Vagina was hot ; os uteri open nearly an in., its lips thick but soft. The waters had escaped unnoticed. {Arch. Mid. dt Strasbourg, Julyy }S2S)
A lady of delicate constitution was delivered of a heali male child at 6 a.m. after a 6 h. labour. Profuse hemorrhage eniui On attempt being made to remove placenta, ii was found adhcrcntl and on force being used she fainted, "^j of ergot was infused in 3*'' of boiling water, and half given immediately and the rest 5 m. aft This caused some contractions of the uterus, and the hjemorrhage w arrested. She remained thus till next d. at II a.m., when the inlusioul was given at ^ h. intervals till she had taken ^xij. Uterus was excited by first dose to contract forcibly two or three times, but then rclap»e<l into its former torpidity ; placenta, however, became detached, and was removed. All this while patient was in a state bordering on insensibility i pulse 65, full ; limbs covered with cold sweat. In a little while eyelids, lips and throat began to swell, and the tears to flow profusely; Schneiderian membrane became very irritable and inflamed ; great difficulty in breathing through nose ; injected conjunctiva. Lips and eyelids looked puffy, as if stung by bees, and gradually put on a hvid appearance. Patient could by this time scarcely swallow i voice was low; she complained of not being able to move the jaw, and soon could only be got to say " Yes" or "No." She had previously complained of pain in all the nerves, and feeling of emptiness in head. Amm. carb. in water was given. She gradually recovered power of speaking, but complained of emptiness in head and of great acuteness of hearing, every word, even spoken in the gentlest tone^ re-echoing in her head, and thrilling through every nerve in her body. In a few h, all the above symptoms disappeared, save redness and swelling of eye* lids, which was still faintly perceptible next m. (Hulse, N. Amer, Arch, of Mtd. and Surg. iSr., ii, 84.)
a. In a tedious first labour 3ij of ergot were given in doses. Dr. Johnson saw patient 6 h. afterwards, and found her in z state of incomplete coma, with livid face and muttering dclirium^i pulse 70 and reduced to a thread. She was delivered by forceps, and remained 30 h. delirious and in a state of semi-stupor. She was after* wards threatened with peritonitis, and had a bad recovery.

b. In another case in which ergot was used largely. Dr. Johnson saw complete gangrene of external parts, and death, occur 6 d. after labour. In a third he witnessed extensive sloughing of vagina, without any other probable cause. In neither of these two cases were any instruments used. {Lend. Mid. Gaz., xiv, 606.)

After an instrumental labour, where much uterine inertia was displayed and expected, uterus being well emptied, and binder applied, ^ij of fluid extr. were administered, and — by a misunderstandmg — 353 more given every .^ h. till 5ij besides had been taken. Patient was nowfound with bluish face, apparently in great pain, pupils dilated, pulse quick, very weak, and occasionally irregular ; there was dyspnoea, nausea, buzzing in ears, and at times a tendency to syncope ; skin cool and clammy. Under stimulants she soon recovered. (Keating, iV, r. Med. Record, 1880, ii, 318.)
Barbier had to treat at Neuville a woman suffering from ergotism. The disease was occasioned by her having taken several drachms of ergot to auist labour. Soon after delivery she had violent

pains in the ends of her fingers, and she had swellings of lymphatic vessels, especially of the arms, which ended in the loss of the ends of some of her fingers. (Levrat-Pkrrotton, Rtcherches sur PempUi thdr. du Seigle ergoti^ quoted in Ibid.)*

A brunette, zt. 41, married 22 years, no children, had uterine fibroids 8 years, and previously 3 attacks of pelvic cellulitis. Tumours were discovered in 1881, since which date she had been taking ergot almost constantly, either as fluid extr. or in suppository. Dose of fluid extr. gtt. xv to ^j, ter die. It controlled hemorrhage and reduced size of tumours. In addition it had a peculiar effect, which was uniform whether taken by mouth or suppository, more marked under full doses of extr. After taking it 3 d. she has peculiar depression of spirits ; feels like crying all the time. On 4th d. is ill-tempered and displeased with everything, and wants to quarrel ; will lie in bed and cry all d. Her natural disposition is just the opposite. Effect here noticed occurred constantly following the ergot, and was undoubtedly produced by it. (D. W. Prentiss, M.D., Joum.ofAmer. Mtd. Jss.y xii, 912.)
Dr. Negri gave ergot, generally in 3 to 5 grain doses, for menorrhagia, leucorrhcea, &c. "The effects," he writes, "on the ^general system have not been constant, or the same in different individuals who took it, and none of an alarming character. The greater number of patients complained of giddiness and headache, which followed in general only the first doses of the medicine, and did not last long. A few complained of sickness } and others of a general sense of prostration all over, *■ from the head to the tips of the fingers and toes.' Some women with menorrhagia and leucorrhoea complained of pains in hypi^astric region and loins, and some even of a sense of bearing-down of the womb. A woman who had a chronic ulcer on her r. foot complained of excessive pain in it since she began to take the secale, and others complained of pains along the thighs and legs." {Lond. Med, Gaz,y xiii, 362.)
Dr. Randall gave ergot at the rate of 5SS a d. for amenorrhcea in 7 cases. The only incidental symptoms produced were headache, increased heat of body, and occasional pain in hypc^astric region. {N. Engl. Journ. of Med. and Surg.^ v, 162.)
Trousseau and Maisgnneuve treated 13 cases of menorrhagia and metrorrhagia with ergot. Its hsemostatic action was invariably preceded or accompanied by uterine (not intestinal) colics. The other incidental effects produced by it were mainly cerebro-spinal in their seat ; they were dilatation of pupils, headache, vertigo, and sleepiness. They came on later than the colics, but lasted longer. The mydriasis was most constant. Headache and vertigo were irregular as to frequency and severity, — the latter was sometimes sufficient to simulate drunkenness. They also occasionally observed nausea and vomiting j

• In the Lancet, Sept. 17th, 1870, Mr. J. R. Begg reports a case of "idiopathic gangrene " of the four extremities, nose, and ears. The patient had suffered for ^ean firom coldness of extremities ; but during labour, 5 weeks before present attack, lad taken 65 grs. of ergot in inf\ision. — Eds.

VOL. IV. 5

pruritus, numbness, and lassitude of limbs. There was no sign of irritaiion of stomach or sitin. {Bull, it Ihirap,^ iv, lOO.)

Wright treated a woman for metrorrhagia with jss doses for a fortnight with nothing but beneficial results. But 5 d. after increaj" ing doses to ^j 4 times a d, she complained of being excessively ner« vous and irritable ; sparks appeared to flash before her eyes \ her head< was sometimes heavy and throbbing, and then again so light an giddy that she could scarcely stand. She remarked further that ( waking in m. she felt a peculiar tingling all over body, sometimes ev painful. {Ed. Med. and Surg, ycurn., liii, 1 1.)
Chronic ergotism appears in two clearly distinct forms, — on characterised chiefly by the presence of convulsions, with considerabl disturbance of sensation — therefore called "spasmodic ergotism" " Kriebelkrankheit ;" the other by gangrene of face and extremities therefore called "gangrenous ergotism."

a. When fiour strongly impregnated with ergot has been eaten fi several consecutive d., the first symptom of poisoning occurs in tt form of a peculiar irritation of the cutaneous nerves, much like tl sensation of an ant creeping over the skin (formication). This col tinues during the whole course of the illness, and is the last symptoi to disappear. It affects chiefly the fingers and toes, but may also extend to other parts, as the hands and arms. In some cases it increas to actual numbness and even to complete anaesthesia of the par aftected. Simultaneously with this formication symptoms set in stomach and intestinal canal similar to those of acute ergot-poisonin Vomiting and diarrhoea alternate with violent colicky pains ; ai curiously enough this is accompanied with intense, insatiable hung< the patients devouring everything eatable that comes in their wa There is also present a peculiar sensation of discomfort, anxiety, an weariness, giddiness, and genera! uneasiness, and of distressing pressun at pit of stomach. Formication now grows to acute pain, and thea are involuntary twitchtngs m various groups of muscles, as those of tl tongue and extremities j these soon pass into continuous contractions which specially affect the flexors, so that the arm, if. ^., remains fixed a bent position. This muscular cramp (which is very painful) will ll 4 h. — I h. or even more. Retching and vomiting persist, but bowt are now somewhat sluggish. The contractions are succeeded by state of utter exhaustion ; later, they appear simultaneously in varid parts, epigastrium is tightly distended, facial muscles are distorted, 1< are flexed; hands frequently assume a beak-like form, fingers bei drawn towards the middle one, and simultaneously flexed towards b of thumb, — the foot assumes a similar form. Pupils are usually co tracted, sometimes irregular ; eyes are fixed. Skin is covered W cold perspiration. Urinary secretion is diminished ; and there is sev( dysuria, dependent on spasm of bladder. Pulse is weak and low. severe cases patient loses power of sight, speech, and hearing, and til consciousness ; delirium sets in \ face is pale and sallow \ head, I body, feels cold ; and thus, with continuance of the spasms, and gra( ally advancing cardiac paralysis, death may supervene. This a occur as early as the 3rd d. after the commencement of the symptom

especially when the contractions involve the respiratory and spinal muscles, inducing opisthotonos. In many cases which do not terminate fatally, cataleptic and epileptic attacks occur, with or without loss of consciousness.

The loss of sight may be preceded by all possible visual disturbances — coloured vision, diplopia, &c. Of the other organs, the skin is especially under the influence of the poison. Besides very abundant perspiration, pustules often break out, or even larger furuncles ; there may be a kind of scabious eczema in the later stage of the malady. Other disturbances of nutrition in the peripheral organs are reported, as whitlows on the fingers, occurring as late as the 4th and 5th week, and disease of the finger-nails, which are encircled by a dark ring. Cardiac contractions are generally slow and feeble ; the arteries are constricted and contain little blood. Respiration is very laboured during the spasms, but tolerably regular in the free intervals.

The whole form of the illness is very variable, and its course highly irregular. When death supervenes, it is usually not till after a fortnight or later ; the spasms may have ceased, yet loss of sight and hearing, with violent headache, stupor, and delirium, may set in, attended with diarrhoea ; and thus the fatal stage may assume the form of typhus and general collapse. If the case takes a favourable turn, after 4 — 8 weeks or even longer the spasms diminish in number and intensity, the sensory disorders gradually subside, digestion recovers its tone, and complete recovery may ensue. In many instances, however, recovery is incomplete ; various pains and infirmities remain behind, especially muscular weakness and tremor, and stiffness of joints ; in other cases paralysis and epileptic attacks continue. More rarely melancholia and imbecility are results of this disease ; permanent visual disturbances are also reported.*

Frequent as deaths from spasmodic ergotism were in former times, very few good reports of the results of autopsies lie before us. The few physicians who have reported such autopsies are unanimous in saying that putrefaction sets in very rapidly. The heart is found bloodless and flaccid, the lungs in a condition of venous hyperaemia ; venous injection of cerebral meninges is very marked. Strongly injected patches are often found in stomach and intestines ; sometimes haemorrhagic and even gangrenous erosions are met with. Evidences of venous hyperemia are found in abdominal glands, in liver, and in spleen, which are somewhat swollen and dark-coloured.

t. Gangrenous ergotism is most probably only a quantitative aggra> vation of the spasmodic form of poisoning, due to a larger proportion of ergot in the flour consumed (especially seen in maize-eating countries). In the beginning of the illness the symptoms of both forms are identical i it is only after i — 3 weeks (as a rule) that the distinctive features of the gangrenous form appear. An erysipelatous redness shows itself on some spots in the periphery, most frequently on toes and feet, but also on fingers and hands, more rarely on ears and nose ; soon the epi> dermis is raised like a bladder by serous exudation, the ichorous contents

" Meiir, of Kronstadt, has shown that cataract is a vety usual consequence of chronic ergotism {Jrck. GAi. d* Mid., 1863, p. 350)." (SriLLi.)

of this are discharged, and a gangrenous spot more or less large is left, which develops itself very rapidly. The part affected is very painful while the redness is invading it, but later on it becomes quite insensible. The spot may exhibit either the dry or the moist form of gangrene, according as the discharge from the bulla was checked or encouraged; upon this also depends the greater or less intensity of the odour of putrefaction. In some cases the gangrene is limited to one or more toes, sometimes only to single phalanges ; in other cases, however, the entire foot or hand is affected, and not unfrequently there is extension up to the trunk, so that even limbs may be lost. The gangrenous parts become separated from the healthy tissue by a well-defined line of demarcation, and may either fall off of themselves or need an operation for their removal. This process of demarcation is often attended with serious disturbances of the general condition of the patient; sometimes a modified form of continued fever is developed, followed by phthisical changes ; in a few cases, from absorption of ichorous matter, pysecnia and septicemia set in, and of course are fatal. When the gangrene is confined to parts of minor importance the patient has usually recovered ; greater losses were naturally more frequently mortal. In some cajci obstinate diarrhoea has brought on marasmus and death, even when the extent of the gangrene was not very considerable. We must mention, however, that in many cases the morbid process does not advance beyond the stage of erysipelatous redness ; or even cyanosis may be observed, and yet resolution take place and the circulation be restored.

Very few autopsies have been performed on persons who have died of gangrenous ergotism ; and the reports that we possess contain nothing characteristic of the poison. The most striking fact is that mentioned by Bonjean, who states that he found the arteries leading to the gangrenous limbs in a healthy condition. (Von Boeck, in Ziemaen's Cyclt^adia^ xvti, 904 — 918.)

In 1841 a family of 8 persons lived upon heavily ergoied lyc bread, which was gathered during a wet harvest in the previous year. The chief symptoms were these; malaise, anxiety, exhaustion, faintness, coldness of whole body, sharp pricking pain and formication followed by numbness of hands and afterwards of arms, alternating with spasms so severe as to extort tears. Muscles of lower extremities were affected in same manner, and in one instance those of r. side of face ; subsequently, abdominal muscles were spasmodically contracted. About the 6th d. nausea, vomiting and diarrhoea took place, with severe pains in bowels and bladder. About the i+th d., two of the children lay as if stupefied, or if roused raved wildly, or complained of pain in head and limbs ; at same time a pruriginous eruption appeared on the skin. They died on the 21st d. in violent convulsions. Bonjean relates a case of the gangrenous form of erj^otism : here also the sick family consisted of 8 persons ; of these 4 were not affected, 2 were but little so ; but of the remaining two one perished and the other lost a leg. In the fatal case the symptoms were — pain in 1. groin ; a dark spot on both calves coldness and pain in legs, followed by an eruption of vesicles with violent itching j then gangrene of lower third of both legs. In

reeks sphacelated parts began to sep.irate ; feet were black and dry ; ^pper part of both legs was affected with humid gangrene. Both were amputated below knee; very little blood flowed. No extension of

disease followed, but patient died of pneumonia, which was probably

letastatic. In the other child but one leg was attacked ; symptoms :re as in first case, but spontaneous separation of limb at knee took :c, and recovery followed. (Stillk, op. cit,) a8. On March 31st a man zt. 40, his son, £t. 12, and a girl,

fet. 24, were brought under Dr. Ungefug's care suffering from ergot- _>m (Kriebclkrankheit). They had been eating for a week rye meal, which, it is known, contains a quantity of ergot. The previous d. they were all seized with extremely violent pain in arms and legs, accompanied by electric shocks as in tetanus, face pale and thin, tongue furred white. The father's appetite was normal, one of the children had ravenous hunger. Throat dry 5 arms and legs in a semiflexed prone position, very stiff and painful if attempted to be extended ; pulse and temperature of skin norma] ; pains in sacrum. The elder child died with incessant pains and twitchings, he remained conscious to the last } the man and the other child recovered. — P.AI., 29 h. after death. Cadaveric stiffness and decomposition moderate; brain, cerebral membranes, and transverse sinus full of blood ; lungs congested, filled with frothy fluid dark blood ; bladder full of urine ; spinal cord and its membranes very congested, its substance softened. [Fiertelj.f. gericht. Mtd., ix, i, 1H56.)

In 1831 ergot appeared in unusual quantity in the rye-corn and constituted often one fifth of the whole meal. Wagner attributes the morbid affections he observed in a number of cases to the action of the ergot.

a. August L — , aet. 16, and Rosalind L — , aet. 12, to whom he was called in the n, of the 30th July, had for 8 d. complained of periodical attacks of transient weariness, which continued till the 29th, when there came on in addition painful drawing in hands and feet, which occurred quickly and frequently, allowing of little rest. On the 30th the state was as follows : Complete stiffness of arms and legs. The thighs were drawn forwards and the legs backwards, forming with the thighs an acute angle ; the feet were drawn forwards and the toes backwards. The upper and forearms formed a similar angle directed upwards, the hands drawn towards the chest, and all the fingers bent inwards as though they would tear the flesh from the chest, and this position they maintained persistently. About every i h. there occurred a very painful formication, alternating with burning, from the tips of the toes up to the tips of the fingers, sometimes with a sensation as if ants were running beneath the skin. The tips of fingers and toes were numb. Immediately after the formication the chest was spasmodically contracted, so that the air was rapidly expelled from the lungs, causing the patient to emit a loud cry, and for a short time inspiration was stopped, the patient started up involuntarily from the recumbent position and supported himself on knees, elbows, and head in order to be able to take an inspiration. The skin of the extremities and body became hot, and only moist on the head. Pulse slow and irregular.

i 4

Face bloated, red. The patient retained full consciousness, either by n. or d.

i. Six other cases were observed with similar symptoms, with this difference, that the lower extremities were stretched out straight and the toes bent backwards ; one of the patients vomited frequently.

c. Many other cases were observed, in which the following symptoms occurred : Several complained of heaviness in the legs, vertigo, violent cramps in the calves, and occasionally such violent contraction of the abdominal muscles that the whole abdomen was compressed towards the spine and the patients rolled on the ground uttering shrieks. In one case the contraction assumed the form of several hard balls in the abdomen ; in this case the attack commenced with maniacal and cerebral inflammatory symptoms, for which bloodletting was employed ; then there came on frequent formication, burning, and running under the skin of hands and feet as if worms were wriggling under the skin, cramps of culves, the above mentioned abdominal spasm followed by numbness of skin and then symptoms of inflammation of the bowels, for which bloodletting was again employed. The patients after these attacks seemed quite well, and several d. would pass without a recurrence of the spasms. But the formication and burning in skin with the numbness persisted. Sometimes one or the other arm went to sleep. There were sometimes sensations which the patients could not describe. In this form the affection assumed a chronic character. (Wagner, Hufeland's 'Journ.^ Ixviii, Pt. 4, p, 5. 1831.)

A peasant woman, xt. 48, said that 10 weeks previously she ^ was suddenly seized at n. with violent vomiting, which lasted 2 d. with ^| violent headache and pain all over her body ; after this she had burning headache and feeling of pain and bruised sensation in all the limbs, which persisted and made her keep her bed for 9 d. These symptoms then ceased, and though weak she got about for 8 d. Then there came on in her extremities crawling betwixt skin and flesh, and attacks

of shooting tearing from one point to another, sometimes with, sometimes without cramps \ trembling of arms and legs, especially when she attempted to use them, with such weakness in them that she staggered and could not grasp anything securely, with numbness of fingers and toes. These symptoms increased every d.,so that when seen on Nov. 14th she could not raise her arms or legs, but must maintain a recumbent position. She had formication in extremities, with shooting, tearing pains ; the pain in feet and calves was particularly severe, of a gnawing, boring character, worst at n., hindering her from sleeping ; she IS so paralysed that she cannot raise arms or legs, though she can move them about in bed ; the tips of her fingers and toes arc quite insensible i normal sensibility begins only above elbows and knees. (Huss, Chronic Alcoholhm^ ia'c, 224 ; in Frank's Alag., iv, 687.)

A peasant lad, xt. 22, of strong vigorous frame, was received into hospital March 22nd, j88o. He was affected by ergotism in beginning of December. One day he stood stock-still in the stable and then fell down in convulsions. These were repeated frequently by day and by night. When the attack came on he felt tired

and lay down in bed, then he uttered a cry and had twitchings in arms, the eyes rolled upwards, there was rattling in chest and he roamed at tthc mouth, the hands were doubled into fists, he frequently bit his tongue, consciousness was temporarily lost. Latterly the appetite was remarkably increased ; he slept much, since Christmas he could not follow conversation, was very confused, and often sighed. Pulse full. Knee-jerk absent. He hardly understands what is said to him, his speech is slow, often stammering and incomprehensible. He sometimes laughs suddenly. The epileptic fits occur almost daily. They began usually by heaving a sigh and bowing his head, the eyeballs rolled upwards, the fingers were flexed, the thumbs turned in, then there were convulsive movements in the forearms, face^ and masticatory muscles, during which the tongue was generally bitten ; there were shuddering movements of the trunk. Face at first pale. Pupils seemed contracted at beginning of attack, later dilated. These symptoms only lasted about j a minute, then the convulsions ceased and the patient lay in deep coma, his respiration was rattling and laboured, foam gathered upvon his lips. Muscular convulsions occurred occasion, ally, especially of the chewing muscles. The face became red, sometimes cyanotic, the pupils greatly dilated, not very sensitive to light. Several attacks of epilepsy often occurred during the coma. Ophthalmological inspection showed redness of the papilla optica. In course of time there occurred catarrh of trachea and bronchial tubes, with copious expectoration. From April 20th the fits became very severe, the tongue was bitten to pieces, and its wounds became covered with a greenish fcetid layer. He died suddenly on April 26th. Xuczek made a microscopic examination of the spinal cord. He says : A section of the fresh cord shows nothing peculiar. After the cord had been hardened for several weeks in a solution of bichrom. of pot., parts of posterior columns of the cord were seen by naked eye to be altered and of a much brighter colour. These extend the whole length of the cord from the crossing of the pyramidal bodies to the conus medullaris, as shown by sections in different parts. In the lower part of the lumbar portion the bright part includes the posterior external angle to the posterior border of one side, and the posterior root on the other side. In the upper part the figure gradually grows forvi^ard till towards the anterior angle, sends a prong into the upper part of the dorsal portion of the cord, which grows out to a stripe bounding the column of Goll, whilst the outer bright part gradually retreats to the posterior angle. (Siemens, Arch, f. Psychiatr.^ xi, ;^77.)

A girl, aet. 9, received Jan. 19th, 1881. Had suffered more than a year from symptoms of ergotism, which were aggravated by again partaking of ergot bread. For a fortnight has had psychical disturbances, great restlessness, loud screaming. She is well developed for her age. Pupils dilated, but react to light. No knee-jerk. She wags head to and fro and calls, " Mother ! mother ! " She snaps greedily at everything, is very thirsty, is dirty, stools diarrhoeic, temperature normal, tongue moist. — 2isc. Had an epileptic attack lasting 10 m., followed by shorter coma. After 3 respirations there always occurred pause. Her fits increased in number, and on the 19th Feb. she

died in the coma. The cord having been hardened in pot. bichrom. sol., a considerable degeneration of its posterior columns was visible to naked eye. The microscope showed these degenerated parts to be very advanced atrophy of the nerve-fibres. The degeneration is symmetrica] in both posterior columns, and extends through the whole length of the cord up to the med. oblongata. (Tuczelc relates a long series of cases in which ergotism was attended by various symptoms pointing to affections of the nervous centres, such as epileptic fits, mania, ataxia, stupor, dementia, extreme anxietas, vertigo, religious despair, great lethargy, impossibility to remain standing with eyes shut, loss of power of coherent speech, feeling of being surrounded by 3 tight girdle, occipital headache, analgesia, Romberg's symptoms, and in every case loss of knee-jerk. Four of the cases, including that given above, died, and P.M. examination showed more or less degeneration of the posterior columns of the spinal cord.) (Tuczek, Ibid.., xiii,99). III. Experiments on animals. — i. Percy and Laurent testify that a decoction injected into the veins of a pregnant cow caused the animal to calve speedily ; and in i out of 3 experiments, Mr. Combci has stated, it caused abortion in a bitch.^ Diez found that it caused uterine contractions in dogs, rabbits, and sows. Large doses given to bitches induced an inflammatory condition of the uterus, and destroyed both mother and young. Mr. Youatt, at the Zoological Gardens, found it an unfailing oxytocic ; but points out that in the case oi ruminants its entrance into the fourth or villous stomach must be secured. (Pereira, op. cit.)

CouRHAUT gave a pregnant bitch ^'v of ergot for 6 d. together. On 2nd d. the animal seemed chilly, and on 3rd was seized with severe shiverings. He gave her 6 dr. of ammonia in her food, on which the symptoms abated. On 6th d. she aborted of 4 living pups, shivering violently the while. In 3 h. time the ammonia was repeated, when the shivering gradually ceased. {TraitS de P Ergot. 1827.)
To a bitch big with young was given daily, for several weeks, Jiiiss of ergot, without perceptible effect ; and at full term 6 healthy pups were born. The animal, still kept on the same food, was again impregnated, and showed no signs of ill-health till near end of gestation, when she became snappish and ill at ease, looked drowsy and moped, fur erect and rough. Five d. after normal time she brought forth 3 pups, of which 2 were dead and only half grown, and the 3rd, scarcely more advanced, lived only a few h. Under continuance of the ergot the mother got in the 9th week a large swelling under the lower jaw, which, on being opened, discharged greenish matter, which formed again and again before death. In i ith week 3 fore-teeth fell out, eyes secreted pus, she lost all desire for food, and for some d. before death had diuresis and diarrhcea. She died in 1 2th week, having swallowed 46 oz. of ergot, and her weight reduced from 7^ to 5 J lb. Alimentary canal, with liver and spleen, were less affected than usual; but lungs and mesentery were strewn with tubercles. Fistulous openings discharging pus were found about the roots of the incisors,

• " Dr, Ostcre gave ergot to a sow, a cow, and a cat, before the completion of pregnancy, and In each case induced abortion." (Still^,)

and communicated with a cyst full of pus under the chin.* (Wright, EJ. Med. and Surg. "Journ., lii, 319.}

Same injected a strong infusion into the jugular veins of dogs. The symptoms were dilated pupils, a rapid pulse, convulsions, and flaccidity of limbs followed by tetanic rigidity of them, which lasted after death. When a weaker infusion was employed, it caused great temporary excitement, followed by depression. A still more diluted preparation seemed to exhaust life by a progressive sedative operation. Similar results ensued when the solution was thrown into the peritoneal cavity. {Ibid.)
Same gave to a bitch daily '5) of ergot in 2 or 3 doses. The first week she trembled violently after each dose ; pupils generally dilated after 5 m. ; abdominal parietes were drawn inward ; not unfrequently hiccup came on ; heart beat at first with increased force, but in about 20 m. its pulsations became feebler ; she frothed at the mouth, and at last each dose produced weakness of hind paws, lassitude, and somnolence. Urine was passed frequently and copiously. Eyes were evidently affected, their expression being wild ; and they showed little sensibility on approach of finger to them. After 3 weeks 3 doses of ^ss each were given every d. During 3rd and 4Ch weeks animal was emaciated, dejected, and without appetite ; mouth and nose seemed dry i in standing, the animal generally held one paw from the ground, a fore-paw and a hinder one alternately, and there was twitching of elevated limb. Sensation was impaired, most in posterior parts of body ; extremely offensive flatus and faeces made their escape from anus ; eyes became weak and watering, lids adherent in m. A dose of 3«j being rejected, experiment was continued with daily doses of "^iss. At end of 5th week tears were so corrosive as to denude of hair the parts of the skin on which they fell. Pituitary membrane secreted a purulent fluid ; breathing grew difficult, and sight and hearing obtuse ; diarrhcea and constipation alternated. The last 4 d, dog could no longer chew ; breath was offensive, as indeed was whole body ; breathing and circulation very slow ; temp, of body fell ; tremor came on, sensation was lost, urine escaped uncontrolled, and death at last ensued. The animal had taken 56 oz. in 7 weeks, and weight had fallen from 13 to 7i lb. On dissection, no muscles responded to galvanism, and superficial ones were soft, pale, and lacerable ; heart was found flabby and very small ; lungs darker than usual, extensively bestrewn with tubercles ; mucous membrane of air-tubes thickened and hardened here and there, and covered with reddish-green purulent secretion ; small intestine internally reddened as far as end of jejunum, large one towards end of rectum; spleen much smaller than usual, but liver larger ; all other organs (including uterus) normal, save that dura mater of brain was rather injected. Body began to putrefy m 12 h, {Ibid.y liii, i.)
^iv of ergot were administered every other d., in 3 doses, to a puppy 4 mo. old. His appetite fell off, and in 3 weeks he was brought very low. The 4th week dose was raised to 5VJ, after which he grew

The some experimenter, after many similar trials, concluded that ergot does not exert a parturifacient action on these animals, though it sometimes appears to injure or destroy the fcetuii.

rapidly thin, which was particularly observable in the hind legs, with which he was nearly lame by end of 6th week. The dog became in the meantime nearly blind and deaf; he sat for hours together as if chewing something, then turned his head first one way and then another, or ran to and fro whining ; now and then he passed fuetid bilious faeces ; urine was natural and abundant. There was corrosive discharge from eyes ; action of heart slow and feeble ; temperature and sensibility reduced, while the irritability was increased. At end of yth week animal remained always lying down, and felt painfully any pressure on the 1. hip. He died at beginning of gth week, after taking 23^ oz. of the drug. Body was immediately opened. Only diaphragm and pectorales showed any muscular irritability when galvanised. Heart contained much dark blood ; lungs, too, were unnaturally dark, and contained many ecchymosed specks and tubercles ; mucous membrane of air-passages thickened, of dirty yellow colour and offensive smell. Stomach and intestines were sound, save that latter were constricted, and in some places as it were puckered, and in duodenum there was an abscess a ^ in. long. Kidneys were pale and very soft, spleen small, liver very large and in parts hardened, cervical and inguinal glands large and hard ; brain and spinal cord softened, former in two places almost fluid. Blood and pus were found in cavity of I, hip-joint ; adjoining ligaments were lengthened and loosened in their texture ; synovial membrane thickened and softened. Body soon putrefied. {Hid., p. 5.)

a. A lively spaniel bitch, 9 mo. old, after fasting 24 h.^ was given one m. a meal of porridge in which were gij of powdered ergot. To prevent vomiting, mouth was tied up. In ^ h. efforts to vomit came on, and a clear shining fluid ran from mouth. At 1 1 pupils were dilated. At I she began to be restless ; breathing and heart's action were accelerated. She would neither eat nor drink, when mouth was untied. At 9 p.m. she became calmer, and next d. merely seemed languid and indisposed to eat ; excrement was very hard. Two d. after, ^ss was mixed with meal and water, and forced, in 6 portions, down her throat. In J h. there was a violent effort to vomit, which recurred 4 times. At I p.m. pulse and breathing were accelerated; she trembled violently ; pupils were dilated. Restlessness was much greater than in first experiment ; she ran hither and thither. Conjunctiva of both eyes was pencilled, especially at inner angle, with a^ network of vessels. Next d. all symptoms had improved, and restless-fl ncss had given place to sleepiness and lassitude. The animal ate little,^ and passed hard dry excrement ; tongue was white, conjunctiva rather red, and chick yellowish mucus had accumulated at the inner canthus. On the 5th d., at 8 a.m., ^j was administered in t2 doses, and mouth tied. In ^ h. violent efforts to vomit, in which string round mouth snapped, and whole of drug was thrown up. She continued for several h. very dejected. At 1 p.m. a similar quantity was administered. At 4, acceleration of pulse and breathing, dilatation of pupils, long-continued trembling of whole body. No efforts to vomit, but on mouth being untied ergot came up. The animal was dejected for rest of d.,J •^qd would neither eat nor drink,

h. No symptoms remaining after 6 d. save some lassitude and want of appetite, ^j was given as before at 7 a.m. In a short time came same symptoms as before^ — enlargement of pupils, general shivering, quickened breathing and pulse. At 10 there were several efforts to vomit. At I shivering ceased, and no more mucus ran from mouth ; dog became restless, and ran about with tail in air, often striking her head against objects in the way. At 2 mouth was untied ; tongue was white and dry, as was likewise whole inner surface of mouth. Symptoms went on increasing ; respiration and action of heart grew quicker every h. ; nostrils were stopped up with thick yellow mucus ; conjunctivie of both eyes very red. The animal walked unsteadily and feebly ; hind legs especially seemed weak, and a slight push was su£Scient to throw her on her side. At 9 she drank some milk greedily. She was still weak on 8th d., slow and unsteady in movements ; excrement hard and dry. Yellowish purulent-looking mucus had collected in inner canthi, and partially covered surface of eyes, giving them a dim dull look ; conjunctiva was pretty strongly inject«l. She refused solid food, but lapped up milk and water with avidity. Next d. all morbid symptoms had departed, save some lassitude } there was still thirst without appetite. Towards e. she voided some thin foetid excrement. On the loth d., at 9 a.m., a decoction of Jiss was poured down her throat. Same symptoms followed, but to a much slighter degree. On the nth d. same quantity was given in powder. In | h. she made several attempts at vomiting, and trembled violently ; at 1 1 pupils were strongly dilated. In afternoon great restlessness, constant running from place to place, great acceleration of respiration and pulse. At 5 mouth was untied. In running she separated her legs a good deal, and swayed from side to side as if intoxicated ; often knocked her head, which she always carried low, against things in her way, and several times fell down. She often turned round and round, always r. to 1., and could not be diverted from this motion ; if she was fastened by a string she turned round in this direction till it was tight about her neck. Meanwhile her breathing became hurried and fitful, and she moaned now and then. When spent by her violent efforts she lay down on her belly, but the slightest noise was sufficient to rouse her to renewed exertions. On meat being offered her she ate some voraciously, and then staggered away. Her nose was warm and dry ; her eyes sparkled and moved restlessly hither and thither, and pupils were dilated. She moaned a great deal in the n. Next d. symptoms subsided gradually, but all that d. she walked unsteadily. She drank a quantity of water, and was quite ready for her usual food. On 14th d. she was quite well again.

r. As the most important symptoms came on 6 to 7 h. after taking the ergot, it was given her — 3'j ^^ divided doses — at it p.m. At 5 a.m. great restlessness, trembling of whole body, strongly dilated pupils. At 5.30 she got bandage on her mouth, and vomitea part of the ergot in a half-digested state. In course of d. precisely the same symptoms came on as in previous experiments } but there was with the excitement of the system a greater degree of weakness and paresis. She staggered in walking, was easily thrown on her side, and then had

great difficulty in getting on her feet again -, hind legs were remarkabljr wealc, and in walking she made almost exclusive use of her fore-paws, dragging the others after them. Action of heart was weak, but, as also respiration, accelerated. She left her food untouched. Next d. lassitude, weakness of limbs, want of appetite j eyelids adhered by a sticky effusion ; excrements hard and dry. After this nothing but some lassitude remained. (Gaspard, quoted by Buchner, no reference given.)

Strahler made a number of trials on dogs with ergot in powder or infusion and with ergotin. He says there is an acute and a chronic poisoning. The acuU shows predominant gastric and narcotic symptoms. The gastric symptoms are chiefly nausea, vomiting, colic, diarrhoea, scraping in oesophagus. There is always increased flow of saliva. The gastric symptoms are not persistent, for the appetite soon returns. It acts as a paralyser on the nervous system, first on the brain, causing restlessness, anxiety,fstupefaction J &c. ; after larger doses numb feeling, stiffness, and paralysis of lower extremities ; when the poisoning is more intense there is sometimes paralysis of the upper part of the spinal cord and of the medulla oblongata ; pupils generally dilated, respiration slowed, pulse more or less altered, urinary secretion diminished. The paralytic symptoms are sometimes preceded by twitchings in muscles of cheeks and thighs. In the chronic intoxication the reflex excitability of the spinal cord is sometimes increased to tetanic convulsions ; peripheric symptoms usually precede the central paralytic ones. There is formication, and the appetite is increased to bulimy. — P.Af. Putrefaction takes place rapidly, there are signs of inflammation in stomach and intestines, thickening and corrugated appearance of the coats of the stomach, narrowing and thickening of the intestines, dark colour and fluidity of blood, congestion of blood in brain, liver, spleen, lungs and heart, and especially in the nerve trunks. The gall and urinary bladders are generally full, during life there is retention of urine. In the chronic poisoning the organs are atrophied, and the appearance is livid and cachectic. {Fierteljahrsch.f. gericht, Med.^'. 1856.)
a. Wernich made a number of experiments, chiefly on frogs, and found that the effect of ergotin was to produce great congestion of the veins of omentum, mesentery, intestines, and bladder ; all other organs, especially the spinal cord, were anjcmic. This has also been noticed by Handelin in his experiments with E. on dogs. Briesemann found that whilst the veins were almost everywhere full of blood, the arteries were much contracted and bloodless. W.'s conclusions as to the effect of E- on the circulation are — i. Ergotin first reduces the tone of the vessels, so that a large quantity of blood accumulates in the veins. 2. The arteries appear narrower, because they are more empty. 3. The blood-pressure is first considerably diminished, afterwards it gradually increases. 4. The heart's beats are slower and lethal doses cause the heart to stop in diastole.

b. Action on uterus. — A young rabbit got an injection of 0*3 ergotin in I. thigh. In 10 m. there appeared a slow contraction of uterus from above downwards, this was continued 5 or 6 times in \ h. AQtt^cit.)

Tescier mixed ergot with food of pigs : they showed reluctance to eat it. Its first effects were redness of eyes and ears ; latter organs and limbs then grew cold, joints swelled, gangrene attacked ears, limbs, and tail, and the animals died in convulsions. One of them 6 mo. old lived for 66 d. : its intestines were found inflamed and gangrenous. {Revue Mid., xliii, 140.)
BoNjEAN gave y] daily to cocks and hens. About 7th d. they became dull, languid, without appetite, and were affected with diarrhoea. In some cases the comb grew cold, bluish, flaccid, and covered with ecchymoses ; in others it was ulcerated. Black blood flowed from nostrils ; the animals were unable to walk, their breathing grew slower, and emaciation and death followed. In other cases the plumage was shed, and the beak and claws were surrounded by a bluish circle. {JTraite de P Ergot de SeigUy Paris, 1845.)
As early as 1827 M. Courhaut advanced the opinion that ergot produces a spasm of the blood-vessels \ but, although his theory was very generally adopted, only within a few years has any earnest attempt been made ,to prove or disprove its correctness. In 1870 Dr. Ch. L. Holmes {Arch, de Phys., iii) found that when the blood-vessels of the frog's web were watched under the microscope, and the animal poisoned either with the aqueous extr. or with the powdered drug, the vessels, both venous and arterial, could be seen to undergo a very great contraction. These observations have been confirmed by other observers.* He found also, however, contrary to what might have been expected, an immediate, rapid, and very decided depression of arterial pressure, with violent cries and efforts on the part of the dog, followed by a period of quiet and a rise of the pressure above the normal point. These alterations of pressure, he finds, cannot be dependent on the cardiac action of the drug. He asserts that after section of a sympathetic nerve and injection of ergot the vessels supplied by the divided nerve can be seen to contract ; and Wernich confirms this observation, which, however, is directly contradicted by some apparently careful and elaborate experiments of Dr. Paul Vogt, in which the dilated vessels of the ear of a rabbit whose cervical ganglion had been extirpated could not be made to contract by the hypodermic injection of E. Eberty's results {Inaug. Dissert.., Halle, 1873) are in accord with those of Vogt, and disagree with those of Holmes, especially in their bearing on the question whether the contraction of the arteries is centric or peripheric in its origin. He finds that the arterial pressure rises directly and enormously after the injection of ergotin. This rise, which he acknowledges to be chiefly due to the contraction of the vessels, occurs in the veins as well as in the arteries, and in the frog as well as in the dog and the rabbit. According to his experiments it must be, at least in the batrachian, centric, since here it does not take place after destruction of the medulla. (H. C. Wood, op. cit.)
I subjected a frog to its influence in the following manner. Having extended the web of its foot under a microscope, I injected subcutaneously i gr. of ergotin in solution. The effect was apparent in a fisw m. ; at first the circulation became much quicker, then very

See II, 10 and III, 9 of this article.— Eds.

soon it seemed to stop for a few seconds, and the larger vessels were much diminished in size ; for some m. the circulation was disturbed, it was irregular, spasmodic, the blood now retrograding then advancing. In this fluctuating condition it remained for upwards of ^ h., when the effect gradually passed off, and the current went on steadily and uniformly again. This experiment I have repeated twice in the same frog, and again in another, with the same results. (Meadows, Pract.., i^ 163.)

Volume IV — Appendix

SECALE. (See vol. iv, p. 4.6.)

Dr. H. C. Allen proved drug, mainly in dilutions from 30th to 200th, on 12 students, male and female. Three of these took 2nd dil. (None knew what they were taking).
Man took 5/ of 2nd, in repeated doses. He te^xts % ^voaa^wck

as of intoxication while undressing at n, (3rd and several following e.) ; passive morning epistaxis, I. side, blood bright red ; soreness of throat, with dryness and sense of constriction, better by swallowing,—this worse in m.

4, Another male student took several doses of same dil., without effect.

¢. A third, who took same for two weeks, reports same feeling in throat as a; the soreness was most felt on 1. side, and ran up into ear. (Trans. of Amr. Init. 1885, p- 117-)

II. 33. Mrs. M—, et. 48) suffered from fibroid tumour of uterus, which caused menorrhagia. On and d. of period, flow being excessive and more uncontrollable than usual,at 10a.m. Dr. Huime administered a small teaspoonful of Squibb’s fluid extract, and left patient quite comfortable. On returning, less than 40 m. afterwards, he found her in a half-fainting condition. Countenance was swollen, pallid, and denoted great anxiety ; respirations were shallow and frequent ; extremities were swollen, and hands increased }th in size. Abdomen also was much enlarged; pulse frequent, weak, irregular; pupils equally dilated and vision indistinct. She complained of great dizziness and nausea. Menstrual flow continued as before, and no signs of uterine contraction were evident. She had no pain. Dr, Hulme administered a teaspoonful of whiskey and 10 dr. of aromatic spirit of ammonia every 4h. In 4 h. patient felt stronger, and pulse was regular, though very full and quick. Pupils were still widely dilated, and vertigo prevented patient leaving her bed. Swelling of face and extremities continued to increase for 11 h. In 24 h. symptoms began to decrease, and gradually subsided,—dizziness and indistinct vision being the last to subside, and continuing several d. (Phil. Med. News, Nov. 5th, 1887.)

June 4th, 1890, I was called at 7.30 p.m. to come at once to Mrs. P—, who was suffering from severe abdominal cramps. I found her curled up in bed, shrieking with pain, which seemed to start from the lower part of the abdomen, more on the. side, and run upward towards the chest, shooting and stabbing in character, and coming suddenly in spasmodi¢ attacks. They caused her to toss about in agony. The abdomen was very sensitive to touch ; the pain doubled her up, but she could not bear much pressure. There were also sharp pains from the fingers running up the arms. The pains made her silly and foolish, as if intoxicated, but she had taken no stimulants, She had been taking essence of peppermint in water without relief. I gave her one dose of bellad. She had one severe attack of pain and several milder ones, but was free from them in 15 or 20 m. I then found that she had taken several ergot pills; and, her pains being relieved, she began to complain of numbness in her fingers and toes, in I, hand and arm to shoulder and head, r. arm to elbow, and in feet, legs heavy. She exclaimed, “ Where are my hands? I can not feel them.” She was not conscious of having hands, and did not feel severe pricks of .a pin. The abdomen was, perhaps, slightly swollen, but she felt swollen from abdomen to throat, and said it felt as if the swelling were choking her. Dryness of mouth, with tingling in tongue and throat, Very thirsty,

76 i

craves ice. Sensation in head as if she were afar off; sensation on closing eyes as if falling, as if bed and everything were going down, down. Self-willed, restless, insists on wallcing about room, which brought on an attack of the severe pain before my arrival. Eyes dull, Heavy J face flushed^ acts in a foolish and silly manner j talks and laughs as if intoxicated. The next d., June 5th^ 1 was enabled to obtain & history of the case. It seems that, fearing she was pregnant, she took 6— -8 2 gr. ergot pills the n. before I was called. The next m. 'icwas nauseated and vomited. She had considerable nausea all day and Q almost constant vertigo. She could not see well ; things appeared hazy. She had sensation of falling on closing eyes, and feeling in head *s It she were afar off, at times during the d. About 4.30 p.m. she started to go out, thinking it might make her feel belter, when a severe pain seized her in outer and middle part of 1. thigh, as if she Were clutched by a hand. It moved quickly up to just below the ^•"cst of the ilium and then across abdomen to uterine region, when hc began to have severe cramps and bearing down pains, and she Psscd a small lump of gelatinous mucus, tinged with blood. It was ^•"cfully examined, but seemed nothing more than a Jittlc mucus that "c uterine contraction had expelled. Then the pains became more **vcre, and resulted in the spasmodic, shooting, stabbing parns, for ^'^ich the belladonna was given. She had all these symptoms before ^^ peppermint was taken, which had no effect on any of them. It seems ''tt she laughed and talked nearly all n. This m. she had an almost ^Hstant vertigo ; hands felt big and swollen ; feet felt numb, and on ^walking the soles feel swollen and as it pins were sticking intu them, '^till has the sensation of falling on closing eyes, as if bed were going <*own with her. Legs feel heavy and not just right. Region of *<stomach sore, abdomen slightly swollen, feels swollen and sore ^ eyes slightly sensitive to light. Disagreeable, nasty, brassy taste in mouth. 6th. — She says there is a black and blue spot on outside of 1. hip, a little below crest of ilium, where the clutching pain was most severe, an J also on 1. side of the abdomen, low down, where the pain there was more severe. All this time she was rocking in a rocking-chair, and 1 asked the reason. She said, '^ It makes the dizziness better." The vertigo had been constant, walking, sitting, stooping, going up stairs, &ic., and only relieved by rocking. Very sore in uterine region. Yesterday, about 5 p.m., the same time that the severe cramps seized her the d, before, she began to have cramps in uterine region, bearing down pains, as if menses were coming on. The pains were at first constant, then mtermittent, and were relieved by doubling up, pressure and heat. Eyes still sensitive to light, with desire to close them, but still has sensation of falling on doing so. Sees frightful visions on closing eyes ; she saw a rat in the room, she thought, the 11. before. Chilly all over at 1 1 a.m. } began in feet, went to head. Soles of feet still feel as if asleep when walking. Feels discontented, uneasy, wants to go out. Thirsty for lemonade ; feels dry from mouth to stomach. 7th. — She was out when I called and I did not see her again until the 19th, when she informed me that she had been having the vertigo most of the time, chiefly in the occiput^ but it was much better when rocking.

‘There was numbness in finger tips at times during d., more in fingers of 1. band ; and occasionally numbness and tingling in toes. She still had the sensation of falling on closing the eyes at n., and on waking in m. She had been having a diarrhoea, but as she had been treating it herself with “ home-made ” remedies, the symptoms were not trust worthy enough to be recorded, She had been feeling restless ; uneasy all the time, and yet without energy enough to apply herself to anything's this was before the diarchaea. (8. N- Kibatt, Med. Advance, Nov., 1890.)

35» A number of undesirable incidental effects have been observed after the suocutaneous injection of ergotin. Von Langenbeck, after the injection of 0-3 grm.y noticed the occurrence of specks before the eyes and pain in the shoulders. Eulenberg saw dizziness and vomiting. More threatening were the general symptoms which appeared in a case of poisoning reported by Rezek, after the injection of or04 grm. In 5 m, patient made a few convulsive movements with the whole body } pupils became dilated ; eyeballs rolled ; unconsciousness came on; skin became cool, and pulse ceased, Cold douches and ether dissipated these symptoms. Hildebrandt witnessed milder effects, A lady, after 6 injections, had dizziness, uncertainty of motion, spasmodic contractions of flexors of upper and lower extremities, nausea, and sense of constriction of chest. As soon as drug was discontinued, these phenomena disappeared, to return when it was again employed. (Lewsw, op. cit.)

M. S—, at. 38, widow, without children. Without syphilitic history, she began 4 years ago to complain of rheumatoid pains and headaches, which recurred during the following two years. Then ensued sudden paralysis of the r, third nerve, with diplopia and vertigo. From 2—3 months later there came on weight of limbs with incoordination, also lightning pains, most felt in rectum and perinzum, In 1880, when first seen, there was weakness of sphincters, diminished sensibility of lower extremities, inco-ordination, &c. During 1881 she was better ; could walk well, and had regained power over sphincters. Next spring, not feeling quite so well, she consulted Dr. Charcot, who ordered ergot, 0°25 centigr. per diem, to be increased by 0-05 centigr. daily till she was taking 1 gm, On 2nd d, of the latter dosage she was found paralysed in all her limbs and in voice. (She had hitherto had no medical attendance, but had this loss of power coming on for a 4. or two.) Sensibility was much impaired in the paralysed limbs, even in the arm, which had hitherto remained normal in this respect.” She had no pain, but was absolutely immobile, The ergot was immediately suspended, and progressive improvement set in forthwith. (GRasseT, Progris Médical, 1883.)
@. A young woman, subject to hemoptysis on 2nd or 3rd d. of her menstrual period, was in the habit of taking ergotin (Bonjean’s) to arrest it, She did so as usual on sth Nov. The bleeding having twice recurred the next m., she emptied the phial, taking—it is estimated—about 5—6 grm. There was no more hemoptysis, and the catamenia continued to flow, though less freely. Nothing occurred, save occasional sharp pains in stomach, till e., when patient complained

of a dull pain, somewhat severe, deep in hypogastrium. She felt she wanted air, and sought to go out ; but on reaching the door felt ill, lost consciousness for a moment, and had to be carried back to her couch. Considerable dryness of mouth and throat supervened, mucous membrane felt as if it were wood ; skin also seemed dry and contracted. There was extreme praecordial anguish and considerable dyspnoea; *' air, air," she cried, " I am stifling." There was moreover intolerable pain deep in pectoral and epigastric regions, seeming to follow course of oesophagus and perhaps of bronchi } she compared it to repeated frictions with a flesh-brush ; there was continuous sense of twisting, increased at short and nearly periodic intervals. Then came dizziness, troubled and obscured vision, hummings in ears, feeling of weight in head and of constriction of temples " as if in a vice." There soon followed formication in limbs which was extremely annoying ; sense of shivering and general coldness } and insensibility of surface to touch, pain, and temperature, commencing in fingers and toes, and gradually invading whole body, including lips and tongue. At lo p.m. (about 3 h. after symptoms had set in) occurred, together with increase of constrictive pains, some convulsive shocks, ionic and clonic. These became intense enough to resemble epileptiform spasms, and were followed by contraction of the flexors — fingers being strongly clenched into palms. Pallor was extreme } the sense of coldness and weakness was more marked j the patient seemed suffocating, breathing being superficial and hurried (50), with great anxiety ; pulse small and contracted, regular, slow (50) i axillary temp. 36-4°.

i. Ether was now injected into forearm, with almost immediate relief. Breathing became easy, pains diminished, pulse got up, and warmth returned. N. passed without convulsive attacks, but several times pains increased and extended to hypogastrium, dyspnoea and praecordial anxiety accompanying. There were eructations and frequent desire for stool and urine. Next d. was similarly spent, a few shocks occurring when the pains increased. There was still anaesthesia, but strong pressure could be felt. Patient felt a sense of lassitude nigh to fainting. Next n. was less calm ; there were some suffocative and convulsive attacks. On the 5th there were 5 of these, one of which needed hypodermic ether. Pains, however, were less frequent and severe. Appetite was maintained, but food caused pain as it passed down oesophagus. On 9th all symptoms were less marked ; anzsthesia was going off, and formication returning. Thenceforward convalescence went on unchecked.

The contractions of the flexors persisted throughout the a d. during which the convulsive attacks occurred. (Debierre, Buu. dt ^hirap.^ Jan. 30th, 1884..)

Secale cornutum

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