Poisoning. - There are two varieties of ergot-poisoning, acute and chronic. Under the administration of immoderate doses peculiar symptoms appear, known collectively as acute ergotism. Restlessness, mental worry, headache, tinnitus aurium, dilatation of the pupils, pallor and coldness of the skin, and other effects are present. There is a weak, slow pulse and evident symptoms of respiratory failure. At times cutaneous anesthesia is manifest, or general formication. There may be disturbances of vision and of hearing. Epileptiform spasms, great reduction of respiration and temperature may occur, while obstruction of cardiac movements, with sudden nausea, salivation, violent vomiting, and intense diarrhea, and other alarming manifestations, attest the untoward properties of the drug. In pregnant women colic, abortion, and hemorrhage may occur. Death may take place at the end of about twenty-four hours, but the dose must be enormous. Sixty grains of ergot have produced very severe symptoms. As most of the acute poisonous cases have been complicated by abortion and hemorrhage, the lethal dose is difficult to estimate. Proportions of over 2 per cent. of ergot in rye flour may cause acute intoxication.

Chronic ergotism is confined chiefly to Europe, where ergotized rye is used in bread-making. The disease is marked by convulsive or grangrenous conditions. Numerous irregular types are observed.

The first variety, the convulsive, is characterized by paroxysmal spasms of the flexor muscles, which later become continuous, resulting in opisthotonos or emprosthotonos. There is dimness of vision, while an increasing intensity of symptoms develops affections of other special senses, those of hearing and smell being either impaired or temporarily lost. Violent abdominal cramps also occur, together with painful dyspnea, death resulting from asphyxia or coma.

The second (gangrenous) form is signalized by severity of local phenomena, profound dyscrasia, formication or cutaneous anesthesia, impairment of special senses, and numbness of the muscles or extremities, followed by sloughing or atrophy of the diseased parts and mummification, or dry or moist gangrene.

Fatal results of chronic ergotism are usually traceable to the convulsions, although moist or dry gangrene may in certain cases produce death.

A form of ergotism is described in Lombardy, Italy, occasioned by chronic poisoning with diseased or fermented maize, and affecting principally the cerebrospinal and digestive systems. It causes an acute erythema, which extends rapidly and is attended with much swelling, together with an extreme sensation of burning or itching. Pronounced nervous and general symptoms are present, and the malady not infrequently results in insanity or melancholia. Loco-motor-ataxia-like symptoms are also encountered when the vessels of the cord are involved.

Treatment of Poisoning. - Symptoms of acute poisoning may be alleviated by hot baths and the administration of tannic acid and cardiac stimultants. For the treatment of chronic ergotism hygienic measures and symptomatic remedies are indicated.

Therapeutics. - Externally and Locally. - In the form of lozenges or diluted fluidextract the drug has been employed in acute pharyngitis. The hypodermic injections of Bonjean's ergotin are valuable in nasal hypertrophies, prolapsus of the rectum, hemorrhoids, enlargement of the prostate gland, aneurism, varicocele, and varicose veins.

Internally. - The most important medical use of ergot is to promote uterine contractions in labor. The preponderance of testimony among the most experienced obstetricians is in favor of its use only after the expulsion of the uterine contents. This is a rule, however, which cannot be invariably followed. While the employment of the drug is contraindicated in the first stage of labor, it may be safely employed during the second stage, when there is uterine inertia, provided all the parts be in a normal condition and there exists no mechanical impediment to the rapid delivery of the child. Ergot is of service also when the placenta is retained owing to inefficient and feeble uterine contractions.

No drug possesses so energetic and prompt an action as ergot in postpartum and uterine hemorrhage. It is an exceedingly efficacious remedy also in subinvolution and in uterine fibroids and polypi.

This remedy is also extremely useful in the treatment of plethoric amenorrhea, congestive dysmenorrhea, menorrhagia, chronic metritis, etc.

Dilatation of the cardiac cavities without valvular lesion is much improved by the administration of ergot; the remedy has also been employed with considerable success in chronic diarrhea and dysentery.

Incontinence of urine - depending either upon enlarged prostate, irritability, or a paretic or paralytic condition of the bladder - is greatly relieved by this remedy. The atonic form of spermatorrhea is palliated or cured by ergot.

The drug is of value also in cerebral hyperemia and consequent mania, as well as in cerebrospinal meningitis, congestion of the spine, myelitis, and congestive headaches.

Ergot has been highly recommended, notably by Dr. J. M. Da Costa, in diabetes insipidus, and by such authorities as Heltzmann and D'Enslow in prurigo, erythema, urticaria, and acne rosacea.

Owing to the peculiar action of ergot upon unstriped muscular fiber it is a valuable drug in various forms of hemorrhage.

Finally, this remedy has met with some success in the treatment of leukorrhea, galactorrhea, hypostatic congestion of the lungs, whooping cough, the different varieties of purpura, colliquative sweats, splenic enlargements, and exophthalmic goiter. In the hands of many practitioners ergot is of great value in the treatment of alcoholism and morphinism.

Contraindications. - During the first stage of labor and in cerebral or spinal anemia.

Administration. - For its action upon the uterus a valuable fluidextract is the best preparation as an internal remedy; for hypodermic use of the aqueous extract (Bonjean's ergotin) or some of the non-alcoholic fluid preparations manufactured by certain reliable pharmacists for this particular purpose, should be employed. Ergotin may be incorporated in suppositories when for any reason it is desirable to administer the drug per rectum.