DURING THE LAST SIX YEARS I have made an extensive series of experiments with ergot of rye in the treatment of the various forms of insanity, and have arrived at some results which I believe to be of considerable practical importance.

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, which we shall consider here with reference to the ergot treatment, 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. This is illustrated by the case below, from my series.¹

Case history: recurrent mania

S.G. , aged 45, single and a domestic servant, was admitted into this Asylum on February 15th 1871.

The history of her case was as follows. She had been an inmate of the Bedford Asylum upon four occasions, but had held a situation in Rotherham without giving any indications of mental unsoundness for several years past. For some weeks previous to the commencement of her present illness, subsequent to some quarrels with her fellow-servants, she had complained of pain in the head and giddiness, but had remained rational until the evening of the 9th of  February, when she grew talkative, restless, and incoherent.

Great violence of conduct and muscular and mental agitation were developed on the 10th, and on the 11th reached such a pitch that mechanical restraint was deemed necessary. She had become steadily worse until brought to this asylum. On examination, she was found to be in a state of mania, talking incessantly in a rambling discursive style, but capable of answering questions, and of recalling, in a confused way, both recent and remote events, when her attention was urgently solicited.

“She described numerous hallucinations – visions of Prince Albert of dazzling brightness, messages from her mother, whispered through the pillow into her right ear, sulphurous odours, and pins and needles in the forearms and back. She was much flushed. Her ears were of a bright red colour, her pupils contracted and sluggish in their movements, and her eyelids twitched spasmodically”

She described numerous hallucinations – visions of Prince Albert of dazzling brightness, messages from her mother, whispered through the pillow into her right ear, sulphurous odours, and pins and needles in the forearms and back. She was much flushed. Her ears were of a bright red colour, her pupils contracted and sluggish in their movements, and her eyelids twitched spasmodically. The pulse was 120, and the tongue coated with a thick white fur. During the night of the 15th, she was very noisy and altogether sleepless, and on the morning of the 16th was in precisely the same state, mental and bodily, as on the previous day.

The liquid extract of ergot was ordered: 3ss to be taken three times a day. After the second dose of this, the restlessness and garrulity began to abate. The night of the 16th was passed in quiet sleep, and on the 18th convalescence was completed. The medicine was continued for a week, and then omitted.

S.G. continued in a rational and healthy state until the 10th of March, when maniacal symptoms again suddenly supervened in the early morning, and went on increasing in severity throughout the day. In the evening, ergot was again administered, as also on the following morning, after a night of stormy excitement. The third dose was followed by mitigation, and the fourth by restoration to tranquillity and a reasonable state of mind. S.G. has remained well up to the present time.

 Reference

1. Browne JC. The Practitioner 1871; vol VI: 321-326