Secale cornutum

Lecture XIII — Secale cornutum

Secale cornutum is commonly called "spurred rye." Ergot, a term borrowed from the French, is the name of the drug in the old school pharmacopoeia. The drug is not obtained from the rye itself, but from a fungous growth which attacks the grain, probably when it is very young.

Secale cornutum, or Ergot, has long been used in the dominant school on account of its well-known property of producing contraction of non-striated muscular fibres when given in appreciable doses. It exerts this action particularly on those involuntary muscular fibres which have a circular or transverse direction. I believe that it does this through an influence exerted over the vaso-motor nerves, and that all its symptoms are explainable on this ground. In the first place, the effects of Secale may be divided into two sets, those referable to the circulation, and those referable directly to the nervous system. We shall consider the last-named first. We find Ergot producing a peculiar type of convulsions, which constitute a prominent symptom of Ergotism, a condition of chronic poisoning produced by Ergot. Ergotism is not at all uncommon on the continent of Europe, especially in some of the provinces of Germany, where the farmers grow a great deal of rye. Rye is the principal grain, and thus Ergot poisoning is frequent. Of late years, by exercising more care, the number of cases of Ergotism has lessened. Eet us now return from this little digression and describe the character of the convulsions. At times the body is rigid and at others the rigidity alternates with relaxation; particularly is this noticed in the fingers. The hands are clenched, or the fingers are spread wide apart. The facial muscles twitch. Twitching commences in the face and spreads over the whole body. The abdomen is drawn in by the contraction of the musculi recti abdominales. There is suppression of urine, and at the same time retention from spasmodic contraction of the neck of the bladder. By the use of the catheter a small amount of prune-juice-like fluid may be obtained. There is a great deal of spasmodic retching, but not much real vomiting. The stomach is violently contracted. Coming now to the action of Secale on the circulation, we find that the symptoms referred to disordered circulation are traceable to the action of the drug on the involuntary muscular fibres of the bloodvessels. The first effect is one of contraction, while the secondary action produces a dilatation. The fingers look bluish-black, as though the blood had settled there. The skin is wrinkled and dry. After a time sloughing of the whole or part of the limb results. Now, the explanation of this is as follows: there has been a prolonged contraction of the capillaries, interfering with the circulation, and bringing about a stasis of blood. Thus local nutrition is deranged and the part in consequence dies. This action of Secale has led to its use in dry gangrene, especially of the toes in old people.

Coming next to the uterus as a muscular organ containing nonstriated muscular fibres, we find that Ergot produces marked contraction of this viscus, acting more on the pregnant than on the non-pregnant uterus, more upon the uterus of parous than of nulliparous women. The more the uterine muscular fibres are multiplied the more powerful is the action of Ergot. What symptoms does the drug produce ? You know that it has been used to bring on contraction of the uterus, to cause abortion, to hasten the expulsion of the foetus when abortion is inevitable, to increase labor-pains, to expel the afterbirth, and in fact whenever it is desirable to create uterine contractions. One of its characteristic symptoms is prolonged but ineffectual uterine pains. Another, which you will sometimes notice in cases of retained placenta, is hour-glass contraction of the uterus. This peculiar contraction prevents the expulsion of the placenta. You may remove the after-birth by the aid of the hand, but the safer plan is to give a few doses of Secale.

Secale may also be used in thin and scrawny women, with dry, harsh, shrivelled skins, and sallow faces, who are very weak in labor. The labor-pains seem to be entirely wanting. The uterus is as flabby as though it were merely mucous membrane, instead of a muscular organ. At other times the woman will complain of a sort of prolonged bearing down feeling in the abdomen and the sacral region. Ergot affects the blood itself; it seems to lessen the coagulating function of that fluid. Hence it will cause haemorrhages, which are dark, thin and persistent; haemorrhage from the uterus or from any of the cavities of the body. You may give it in uterine haemorrhage when the flow is passive, dark in color and, it may be, offensive. The woman may be reduced to such an extent that she is almost exsanguinated and lies unconscious and cold. Before losing consciousness she complains of tingling all over the body, and requests the attendants to rub her limbs. Formication is the best word to describe this tingling sensation under Secale. She constantly holds her fingers spread asunder. This symptom seems to bother her even more than the haemorrhage itself. In such cases Secale is the remedy. Again, we may use Secale in retained placenta, when it arises, not from hour-glass contraction of the uterus (although this condition may obtain), but after miscarriage, especially that occurring during the early months of pregnancy. The discharge corresponding to the lochia is offensive. The patient is cold and often almost pulseless, from loss of blood; the uterine contractions are very imperfect, or else there is prolonged tonic contraction. In such cases, Secale is further indicated by its mental symptoms. The patient has mania, during which she laughs, claps her hands over her head, in fact, seems to be beside herself.

Secale acts very prominently on the gastro-enteric organs. It produces a picture very much like that of cholera, and will be found useful whether it be cholera infantum, cholera morbus, or cholera Asiatica. It is indicated when the patient is cold and almost pulseless, with spasmodic twitching of the muscles in various parts of the body; the spreading asunder of the fingers is especially noticeable. The eyes are sunken, and the features pinched. There is a great deal of spasmodic retching, although not much vomiting. The surface of the body is harsh, shrivelled, and dry, as though there were no moisture left in the system. The urine is suppressed. There is tingling or formication all over the body. The stools are profuse and watery, and are ejected with great violence. The patient, though cold, cannot bear to be covered.

In cholera infantum Secale is indicated more particularly by profuse undigested stools, which are watery and very offensive, are discharged by fits and starts, and are followed by intense prostration. Now, Secale must be separated from the remedies that are similar to it, or you cannot use it to the best advantage.

It has been observed in the case of a manufactory in which substances containing arsenic were made, that the fumes of the arsenic destroyed all the surrounding vegetation with the exception of the rye, which grew more luxuriantly under the fumes of this factory thau it did in other localities. When we come to study the medicinal effects of Secale and Arsenicum we ,find that they have many symptoms in common. Both produce shrivelling of the tissues, both produce gangrene, both produce choleraic symptoms, and they follow each other well. The following few distinctions are sufficient: in the first place, the Arsenicum gangrene and almost all of its other symptoms are worse from cold and better from warmth. The patient wants to be wrapped up warmly. The Secale patient finds relief from cold. The same is true of ulcers. If you have an indolent ulcer, with burning pains and discharge of an ichorous offensive pus, you almost always think of Arsenicum. Yet Secale is the remedy if there is relief from cold.

In cholera, both remedies have profuse, offensive, watery stools, which are very exhausting. Arsenicum lacks the tingling which is almost always present when Secale is the remedy. Arsenicum has more restlessness, anxiety, anxious tossing about and irritability of fibre. The patient wants to be warmly wrapped, while the Secale patient wants to be cool.

During the stage of collapse, Secale is indicated by the symptoms I have mentioned. Here, it is very similar to Carbo veg. The latter remedy is indicated when the prostration is so great that the patient lies quiet, too weak to move, with passive haemorrhage from the nose, and, perhaps, from the bowels as well. The body is cold, especially from the feet to the knees. The pulse is rapid, almost threadlike, and the breath is cold. In such alarming cases Carbo veg. may sometimes save the patient's life.

Another similar remedy, Camphor, is to be used in preference to Secale, Arsenicum, or Carbo veg. in cholera, when the system is overwhelmed by the suddenness or violence of the poison, before there is any vomiting or diarrhoea, and when the prostration is intense and the body is as cold as ice. The voice is squeaky or husky. Camphor is here used in the mother tincture, a few drops in water, and a dose given every fifteen minutes until the reaction takes place, when some other remedy may be needed.

Veratrum album resembles Secale in the coldness and blueness of the surface, with profuse watery stools; but it differs in one symptom, namely, the cold sweat on the forehead. None of the remedies just mentioned have this symptom except Arsenicum, and under this remedy the restlessness is greater than under Veratrum, while the cold sweat on the forehead is less marked.

In the uterine symptoms, haemorrhages, etc. , we have to remember some remedies that are closely allied to Secale. I may incidentally mention Carbo veg. here as a remedy similar to Secale in persistent epistaxis. The bleeding continues day after day, apparently not decreasing in the least, the blood being dark and non-coagulable. You must distinguish between the two remedies by their other characteristic symptoms.

Ustilago is to be remembered as a companion of Secale. It is a fungus which grows on corn and is similar in action to Ergot. Careful chemical analysis shows that it contains Ergotin just as does Secale. Ustilago may be used in haemorrhages somewhat different in character from those of Secale. The haemorrhages in which it is most effective are those from the uterus, when the flow is bright red, partly fluid, and partly clotted. With this condition present you may use Ustilago, whether the haemorrhage occur at the climaxis or during labor, abortion, or menstruation. Unlike Secale, this remedy causes passive congestion of the uterus. It is especially indicated when the slight manipulation necessary for a digital examination causes oozing of blood. Another condition for which it is the remedy is menorrhagia from retroflexion of the uterus. I have generally used it in the sixth potency. It seems to give tone to the uterus, so that the organ no longer feels soft and spongy to the examining finger. The circulation through the uterus is improved, and bleeding takes place less readily.

We have two or three other remedies useful in these cases of engorged uterus, and as this condition is so difficult to cure I will give them to you here.

One of them is Bovista, the puff-ball. When this plant is mature, the envelope of the ball bursts, and there is ejected from the cavity a brownish powder, which consists of the spores of the plant. This, when applied to the skin, produces an eruption resembling herpes, which bleeds readily. Bovista affects the circulation in a very peculiar way. It seems to produce a relaxation of the entire capillary system, but whether it acts through the blood or through the nervous system, I am unable to state. This relaxation of the capillaries favors the haemorrhagic diathesis. On account of this unique action of Bovista, we find it useful in epistaxis, associated either with menstrual irregularity, or with traumatism.

Bovista is indicated in uterine haemorrhage when the uterus is engorged, particularly when there is a flow of blood between the menstrual periods from any little over-exertion. Here it is exactly like Ambra grisea, but the menstrual flow of Bovista occurs chiefly or only at night or early in the morning. It would seem that the exercise during the day, by favoring the circulation, tends to diminish the uterine congestion.

Haemorrhage when the uterus is engorged is also found under Ustilago and Secale.

Another peculiarity of Bovista, which I might mention here, is a puffy condition of the surface of the body. A lady, for instance, after holding her scissors, notices that a deep crease has been made in the thumb and finger by the instrument, showing that there is a slight ©edematous condition produced by the sluggish passage of the blood through the veins.

Bovista also produces some symptoms of suffocation. It is used, in some countries, to stupefy bees in order to facilitate the collection of honey. The symptoms of asphyxia are very much like those produced by the fumes of charcoal, and Bovista has proved useful as an antidote to the effects of charcoal fumes.

Other antidotes to charcoal fumes are Arnica and Opium. In addition to these symptoms of Bovista, you should remember another group, likewise dependent upon the circulation. The heart feels enormously large, with oppression of the chest and palpitation after a meal and during menstruation. Associated with the heart disease, and also with deranged menses, is a headache deep in the brain, with a feeling as though the head were enormously large or swollen.

Mitchella repens may be used in cases of engorged uterus when the flow is more active than in the case of the remedies already mentioned. The blood is brighter in color, and the haemorrhage is associated with dysuria.

The next remedy that I want to mention as similar to Secale in haemorrhages is Trillium pendulum. This remedy is useful in an entirely different type of haemorrhage from that calling for the former. It is indicated when the flow of blood is bright red and profuse, and is attended by a faint feeling in the epigastrium, pain in the back, coldness of the extremities, prostration, and rapid, feeble pulse. It is more closely allied to Cinchona than to any of the remedies thus far mentioned. It is indicated more by the active acute haemorrhage than by the chronic slow oozing calling for Secale. There is gushing of bright red blood at every least motion. She feels as though the sacro-iliac synchondroses were falling apart and wants the pelvis tightly bound.

Hamaynelis is likewise indicated in haemorrhage. It acts as you know principally upon the veins. It is called for when there is hammering headache, especially about the temples. Strange to say the patient exhibits no alarm or anxiety concerning the haemorrhage. The flow is dark and rather passive and there is a feeling of soreness in the affected part. The patient is greatly exhausted by the flow of blood.

Erigeron Canadensis is indicated in haemorrhages from the uterus associated with painful urination. How can you distinguish it from Mitchella ? The Erigeron haemorrhage comes in fits and starts; it comes with a sudden gush and then stops again.

Sometimes the cavity remaining after the extraction of a tooth bleeds persistently. If you can clean out that cavity so as to remove the clot, and apply to it a piece of cotton soaked in tincture of Trillium, you will often check the haemorrhage even when other styptics fail. I have never used Erigeron in that way and cannot, therefore, tell what effect it would have. I have used Trillium in the same way in nosebleed.

I would like to mention here Ferrum phosphoricum. It acts upon the circulation very much as does Hamamelis. It is an excellent remedy in that stage of inflammation which we describe as '

' dilatation of the blood-vessels." If administered then, it prevents further extension of the disease. Thus in engorgement of the lungs, it prevents the subsequent pneumonia. The chest feels sore and bruised, the pulse is full and round, but not rope-like as under Aconite. The expectoration is scanty and blood-streaked. Whenever the discharge contains blood and you have not the sthenic fever that belongs to Aconite, you may depend upon Ferrum phos. Sometimes in the summer diarrhoea of children, the bloodvessels of the intestinal tract become greatly distended. The stools are watery and contain mucus and blood. There may be a little urging to stool but no tenesmus. If tenesmus appears, Ferrum phos. ceases to be the remedy. If your case advances to the production of pus or muco-pus, Ferrum phos. can do no good.

You may also use Ferrum phos. in the beginning of hydrocephaloid, when, during a violent attack of summer complaint, the child becomes drowsy and heavy, its ej^es are suffused with blood, and there is a full, soft pulse. It has not the hard, tense pulse of Aconite or Belladonna.