The beneficial effects of ergot in certain forms of mental disease are to be attributed to its controlling power over the intracranial vessels. In 200 cases of insanity in which I have employed ergot, I have found it useful in none in which the theory of its action which I have suggested was not available; while in all those in which it has proved most advantageous, this theory was vindicated in various ways.

In recurrent mania the characteristic feature consists in occasional outbreaks of excitement, separated by intervening periods in which sanity seems to be nearly or completely re-established. The duration of these intervening periods, as well as of the maniacal paroxysms, is subject to so much variation, even in the same case, that it is often difficult to estimate the effects of any treatment employed; sometimes, however, the effect is so immediate and decisive that it must be recognized; and this has been so in many instances in which ergot has been resorted to.

In a case of recurrent insanity in which the attack is ushered in by epileptiform seizure, and in which periodicity may or may not be observable, ergot is again equally beneficial.

In a few cases of chronic mania in which the lucid intervals  have not been distinctly marked, ergot has still been beneficial. In these, however, there have always been singular  fluctuations in the degree of maniacal excitement, and the retention of intelligence apart from the delusional region of thought.

A mother aged 39

The following is one of my cases:

M.B, aged 39, admitted May 16th, 1865, labours under the distressing idea that her children and relations have been the victims of a foul plot, have been chopped into mincemeat by the officers of the asylum, and that their mutilated remains, tied up in canvas bags, are concealed in the cellars beneath the ward which she inhabits, whence they hourly cry aloud for vengeance. 

Familiarity has bred in her a sort of complacent toleration of her family wrongs. In her ordinary state she is comparatively tranquil, and will even hold intercourse with the mutilators of her offspring. She paces up and down the corridors, listening attentively at certain corners for voices from the horrible canvas bags, and whispering back messages of comfort.

However, once in every two or three months her wrongs press in upon her with renewed force and poignancy. Calmness gives place to noisy vituperation, and self-control to violence. With a flushed face, a glaring eye, and swinging arms, she paces about denouncing the traitors and murderers who surround her, in a harsh dissonant voice and with copious abuse.

She passes, in short, into a maniacal exacerbation in which  there are heat of head, acceleration of the pulse, restlessness, sleeplessness, and general noisy excitement.

Having tried, without satisfactory results, in these exacerbations, opium, cannabis indica with bromide of potassium, and muriate of ammonia, it occurred to me about eighteen months ago to employ ergot, which has since been used in every recurring attack with unimpeachable benefit.

On the first occasion the attack, which had not reached the middle of its usual course, was at once arrested. On all subsequent  occasions it has arrested or modified the attack. The facial hyperaemia disappears, the pulse is reduced in frequency, and the extraordinary excitement diminished. It has to be continued for some time, as when it is omitted turbulence and clamour return.