ERGOT 579 especially those of the extremities. Dimness of vision, loss of hearing, ataxia, epileptiform convulsions and dementia are the next symptoms from, which the patient suffers. Death occurs from asphyxia due to spasm and weakness of the respiratory muscles. In the gangrenous form there is general lassitude with vague pains irt the limbs, often accompanied by an alternate feeling of cold and heat or a sensation of tingling and numbness. Later, the limbs become swollen and! the skin is covered with red patches and blisters, followed by gangrene due to constriction and closure of the blood vessels. The gangrene which is usually of the dry type affects the fingers and toes, and may extend upto the elbow or knee. Sometimes, gangrene may occur in the nose, ears and even internal organs. Stewart McKay 22 reports the case of a married woman, aged 30 years, who suffered from gangrene of the fingers following the administration of- liquid ergot. She purchased from a chemist a twelve-ounce bottle containing ergot and finished it in. one week with, the idea of inducing abortion. Eui having had no desired effect in three days she obtained a second bottle containing the stronger medicine, which she finished in seven days. However, before she had finished the mixture she noticed that her arms began to ache, her skin was itching and her fingers were swollen, which slowly became gangrenous, though she did not abort. Drs. Robertson and Ashby 23 describe an outbreak of chronic ergot poisoning among the Jewish population of Manchester which used black bread made from rye flour as an article of diet. The general symptoms complained of were coldness in the extremities, numbness and lack of sensation in the fingers—a sensation like an insect creeping over the skin—headaches, depression, twitchings in the limbs, and staggering gait. One of the affected had a definite dry gangrene of both hands. From investigations it was found that the average Jewish person consumed about half a pound of rye bread per diem, the flour of which contained one per cent of ergot. Half a pound of bread contained about five to six ounces of flour, the rest being the water which was added before baking. Five ounces of flour equal 2285 grains, of which one per cent was ergotised. Each person thus consumed 22.85 grains of ergot daily. During August 1951, a case of massed food poisoning occurred in the town of Pont- Saint-Esprit, where some 230 persons were poisoned by consuming bread or cake made from flour contaminated with ergot during one day only. The symptoms appeared after a latent period of 48 hours. These were weakness, parsesthesise and dizziness, followed by difficulty in swallowing and, in. about one-third of the cases, diarrhoea and vomiting. Pallor, low blood pressure, and bradycardia were very common, while hypothermia, mydriasis with loss of the pupillary reflexes and insomnia were observed in all the cases. On the third day mental excitement was manifest, with alternating phases of anxiety and euphoria, followed by severe heartburn, copious acid regurgitation and hypersalivation, increased vomiting and attacks of vascular spasm. The paraesthesiae increased until many patients had an intolerable sensation of internal and external fire. By the fifth day vomiting and diarrhoea stopped, but the sensation of fire extended from the mouth to the anus, acrid sweat was profuse, dehydration marked, and a frequent sensation of impending death occurred in severe cases. On the eighth day psychical disorders appeared in several cases, and were accom- panied by tremor, increased dizziness, staggering gait and a tendency to fall backwards. Reflexes were normal. Auditory and visual hallucinations mostly related to movement and fire and were terrifying. Sensory delusions were mostly concerned with the sensation of burning flames bursting from various parts of the body. Mania was evident in a few cases. Muscular tremor spasms and convulsions were also present. After the fourth week many of the symptoms began to clear slowly, but renewed attacks of hallucinations were common, and where the vascular spasm was prolonged, there was danger of gangrene. All patients lost weight and all women aborted. Most of the females now began to suffer from severe menorrhagia, and a papular pruritic dermatitis of the limbs, relieved by antihistaminies was common at this time. Acetylcholine and nicotinic acid were effective in spasm. In children the onset of symptoms was more rapid and the incidents brief and violent. The hallucinations of fire were accompanied in infants by characteristic motions of the hands, as if rubbing the fingers—G. Giraud and H. Latour, Bulletin de VAcademic Nationale de Medicine, 136, July 8, 1952, pp. 422-436; The Medico- Leg. Jour., Part IV, 1952, p. 175. - Fatal Dose and Fatal Period.—These have not been determined. Death does not seem to occur from'a single large dose, "but from small or medicinal 22. Brit Med, Jour., August 18, 1906, p. 365. ' ', . . 23. Brit. Med, Jour., Feb. 25, 1928, p. 302.