26. Chronic ergotism appears in two clearly distinct forms, – one characterised chiefly by the presence of convulsions, with considerable disturbance of sensation – therefore called “spasmodic ergotism” or “Kriebelkrankheit; ” the other by gangrene of face and extremities, therefore called “gangrenous ergotism.”
26 a. When flour strongly impregnated with ergot has been eaten for several consecutive day, the first symptom of poisoning occurs in the form of a peculiar irritation of the cutaneous nerves, much like the sensation of an ant creeping over the skin (formication). This continues during the whole course of the illness, and is the last symptom 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 increases to actual numbness and even to complete anaesthesia of the parts affected. Simultaneously with this formication symptoms set in stomach and intestinal canal similar to those of acute ergot-poisoning. Vomiting and diarrhoea alternate with violent colicky pains; and curiously enough this is accompanied with intense, insatiable hunger, the patients devouring everything eatable that comes in their way. There is also present a peculiar sensation of discomfort, anxiety, and weariness, giddiness, and general uneasiness, and of distressing pressure at pit of stomach. Formication now grows to acute pain, and there are involuntary twitchings in various groups of muscles, as those of the tongue and extremities; these soon pass into continuous contractions, which specially affect the flexors, so that the arm, evening g., remains fixed in a bent position. This muscular cramp (which is very painful) will last 1/2 hours – I. h. or even more. Retching and vomiting persist, but bowels are now somewhat sluggish. The contractions are succeeded by a state of utter; exhaustion; later, they appear simultaneously in various parts, epigastrium is tightly distended, facial muscles are distorted, legs are flexed; hands frequently assume a beak-like form, fingers being drawn towards the middle one, and simultaneously flexed towards ball of thumb, – the foot assumes a similar form. Pupils are usually contracted, sometimes irregular; eyes are fixed. Skin is covered with cold perspiration. Urinary secretion is diminished; and there is severe dysuria, dependent on spasm of bladder. Pulse is weak and low. In severe cases patient loses power of sight, speech, and hearing, and then consciousness; delirium sets in; face is pale and sallow; head, like body, feels cold; and thus, with continuance of the spasms, and gradually advancing cardiac paralysis, death may supervene. This may occur as early as the 3rd day after the commencement of the symptoms, 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 of later; the spasms may have ceased, yet loss of sight and hearing, with violent headache, stupor, and delirium, may set in, attended with diarrhea; 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.[“MEIER, of Kronstadt, has shown that cataract is a very usual consequence of chronic ergotism(Arch. Gen. de Medorrhinum, 1863, p.350).” (STILLE)
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. Evidence of venous hyperaemia are found in abdominal glands, in liver, and in spleen, which are somewhat swollen and dark – coloured.
26 b. Gangrenous ergotism is most probably only a quantitative aggravation 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; it is only after 1 – 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 frequency on toes and feet, but also on fingers and hands, more rarely on ears and nose; soon the epidermis is raised like a bladder by serous exudation, the ichorous contents of this are discharged, and a gangrenous spot more or less large is left, which develops itself very rapidly. That 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 infrequently 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, pyaemia and septicaemia 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 cases 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 Ziemssen’s Cyclopedia, xvii, 904 – 918.)
27. In 1841 a family of 8 persons lived upon heavily ergoted rye 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 right side of face; subsequently, abdominal muscles were spasmodically contracted. About the 6th day nausea, vomiting and diarrhea took place, with severe pains in bowels and bladder. About the 14th day, 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 day in violent convulsions. Bonjean relates a case of the gangrenous form of ergotism; 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 left groin; a dark spot on both calves; coldness and pain in legs, followed by an eruption of vesicles with violent itching; then gangrene of lower third of both legs. In weeks sphacelated parts began to separate; feet were black and dry; upper 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 metastatic. In the other child but one leg was attacked; symptoms were as in first case, but spontaneous separation of limb at knee took place, and recovery followed. (STILLE, op. cit.)
Hughes was a great writer and a scholar. He actively cooperated with Dr. T.F. Allen to compile his 'Encyclopedia' and rendered immeasurable aid to Dr. Dudgeon in translating Hahnemann's 'Materia Medica Pura' into English. In 1889 he was appointed an Editor of the 'British Homoeopathic Journal' and continued in that capacity until his demise. In 1876, Dr. Hughes was appointed as the Permanent Secretary of the Organization of the International Congress of Homoeopathy Physicians in Philadelphia. He also presided over the International Congress in London.