VEGETABLE AND ANIMAL POISONS 599 



Cyanosis, diarrhea and fever may occur. In cases running an unfavorable 

 course, the temperature falls in the later stages, and severe syncope appears. 

 The patient succumbs in a few days, sometimes even after a few hours. The 

 prognosis of ergotin poisoning is always grave, as the sequelee of such poi- 

 soning, even in cases running a favorable course, may be noticeable for years 

 afterward. 



For a positive diagnosis of the affection, ergot must be found in the vom- 

 ited material, in the remains of the flour which has been ingested. For this 

 purpose we use the coloring matter contained in ergot — erythroselerotin. 



Treatment. — As a primary measure the proper instruction of the public 

 should be enjoined. The treatment itself consists in washing out the stom- 

 ach, emptying the intestine by the employment of enemata or of purgatives 

 such as castor oil and calomel; as antidotes, tannin and chlorin water; for the 

 collapse, warm baths with cold affusions; in milder cases stimulants, such as 

 coffee, tea, alcohol. In severe cardiac collapse injections of camphorated oil 

 are recommended. 



The phenomena of chronic ergotism relate particularly to the nervous sys- 

 tem. The most marked symptoms are the paresthesias, in consequence of 

 which the disease is still popularly called itching disease (Kribbelkrankheit). 

 First tonic, then clonic, spasms occur (convulsive ergotism) ; the patient ema- 

 ciates to an extreme; trophic disturbances of all kinds, such as furunculosis, 

 loss of hair, loss of the nails, etc., follow. The most dangerous form is that 

 known to the physician as gangrenous ergotism. Gangrene of an extremity 

 in a short time leads to septic infection to which the patient succumbs. 



The treatment of the intestinal symptoms is the same as in acute ergotism. 

 The severe pains are relieved by sodium salicylate, bromids, and opiates, and 

 protracted lukewarm baths are also beneficial ; gangrene necessitates surgical 

 measures, although they are usually of no avail. 



Following ergotism, we must consider pellagra (mal de sol) due to the 

 ingestion of spoiled maize. Besides a number of dyspeptic difficulties, an 

 erythema presents itself particularly upon the exposed portions of the body 

 and recurs year after year in summer. The patient emaciates, nutrition suf- 

 fers greatly, and he becomes anemic. Nervous symptoms follow; pareses, 

 paralyses, atrophies of the musculature, ptosis, amaurosis, etc. The patient 

 improves in winter ; but anemia, dropsy, and finally fever and delirium often 

 set in, and after suffering for years he succumbs, provided an intercurrent 

 affection such as tuberculosis or sepsis does not cause death before this. 



The prognosis is exceedingly unfavorable, the treatment unfortunately in- 

 effectual, and only by a proper prophylaxis and the avoidance of spoiled maize 

 as food can we prevent the appearance of this dreaded plague. It is endemic 

 in Friaul and Upper Italy as well as in Bukowina. 



Poisoning by toad-stools is of practical interest. We will consider only 

 the amanita phalloides and the agaricus phalloides. These are often con- 

 founded with the field champignons which resemble them. The plum agaricus 

 is the most frequent cause of this form of poisoning. 



The symptoms are profuse diarrhea, vomiting, anuria, spasms and col- 

 lapse, to which the patient may succumb even in the first stage. In the tur- 



