Clinical Manifestations and Pathology

Convulsive or spasmodic ergotism affects the central nervous system, causing areas of degeneration in the spinal cord. Early German accounts mentioned tingling and mortification in the fingers and toes, with occasional extension to the rest of the body, and vomiting, diarrhea, intense hunger, anxiety, unrest, headache, vertigo, noises in the ear, stupor, and insomnia as symptoms. Often the limbs became stiff, accompanied by convulsive contractions of the muscles which led to staggering and awkward movements, often aggravated by being touched. Although many victims recovered, symptoms sometimes remained for long periods, resulting in permanent stiffness of the joints, muscular weakness, optic disorders, and occasional imbecility. In the 1930s, Ralph Stockman demonstrated that convulsive ergotism was "caused by poisons (phytates) normally present in rye and other grains" which, unless broken down in the bowel, were absorbed, creating lesions in the nervous system.

Midwives and empirics discovered that spasmodic ergotism caused abortion or miscarriage in pregnant women, the drying up of milk in lactating mothers, and amenhorrea in young girls. This abortifacient or oxytocic effect was later noted by orthodox medicine and led to the widespread use of ergot to accelerate uterine action. Before long, doctors began distinguishing ergot with such sobriquets as poudre obstetrical, forcing powders, or more commonly, forcing drops. Not surprisingly, it also played a major role among quacks, charlatans, and "private specialists" who promised a quick and painless cure for women desiring to "regulate" their menstrual cycles. The term "regulation" was euphemistically used to mean the termination of a pregnancy. For some, ergot substituted for the more common borax, cinnamon, and turpentine as an abortifacient.

Gangrenous ergotism often began with itching and formications in the feet, or sensations of extreme coldness, followed by burning pain, or a crop of blisters. A dark spot usually appeared on the nose or affected extremity, leading to loss of sensibility in the part. Early nineteenth-century accounts mentioned headache, dizziness, nausea, vomiting, diarrhea, and spreading erysipelatous redness. The epidermis was raised by serous exudation, and the surface assumed the appearance of gangrene with the extremities becoming withered and blackened. Usually the gangrene was dry, but the moist variety was not unknown. The patient suffered from a continual low fever and phthisical symptoms, and faced eventual death from exhaustion or septicemia. Often, however, recovery followed loss of the affected limb. When gangrene attacked the viscera, however, death occurred quickly. Matthias Grunewald's Isenheim Altarpiece, commissioned between 1508 and 1516 at the An-tonite monastery, and currently displayed in the Musée d'Unterlinden in Colmar, testifies to the outbreak of St. Anthony's fire in France and its gruesome impact on those afflicted.

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