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TWO TYPES OF ERGOTISM
21
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CHAPTER II
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a view is represented
above by the letter I. It also is far from satisfactory; there are
records of carefully observed epidemics [e.g. that of 1709
near Lucerne] in which the convulsive symptoms were very much in
the background, in any case by no means so severe or characteristic
as in German epidemics. In the latter formication was very common,
not so in the gangrenous type. Cataract and severe mental derangements
were entirely limited to the convulsive type. If gangrenous ergotism
were merely a severer form of the convulsive variety, mixed epidemics
should have been much more common, whereas they were almost restricted
to a geographical border land. Hence we will here adopt an intermediate
position (Y); the two varieties have a common cause and share a
number of milder symptoms in their earlier stages : on these are
superimposed, on the one hand gangrene, on the other severe
nervous symptoms. Frank [1821] regarded the gangrenous form
as the acute, and convulsive ergotism as the chronic variety of
the same disease. Yet in particularly severe cases there were no
premonitory signs and either gangrene or convulsions were the first
symptoms of the disease. As is pointed out by Desnos in the article
"Ergotisme" in the Nouveau Dictionnaire de medecine et de chirurgie
pratiques [1870], the descriptions of gangrenous ergotism are
apt to be by surgeons called upon to treat only the severest and
most advanced cases when brought into hospital (in the eighteenth
century at Orleans, in the nineteenth at Lyons, by Janson and Barrier).
These surgeons did not themselves observe the minor symptoms preceding
gangrene and either passed them over in silence or were dependent
on hearsay. Where, on the other hand, we have descriptions by physicians
who treated an epidemic on the spot [Lang 1717; Boucher 1749; Courhaut
1814 and 1816] we find mention of lassitude, formication, precordial
anguish, livid colour of the skin, painful contractures and even
convulsions, symptoms constantly mentioned in the German accounts.
Other symptoms common to both types are vomiting, a feelling
of intense heat or cold, pain in the muscles of the calf, the yellow
colour of the face, the formation of vesicles on the hands and feet
(due to trophic disturbance of a nervous kind, as in herpes zoster
?), severe diarrhoea (often a precursor of death) and some impairment
of mental function. Desnos seems to regard convulsive ergotism as
the earlier stage
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ERGOTISM
Relation between
the two types.—It is a coincidence that the earliest detailed
descriptions of ergotism appeared within a few years of the first
unmistakable references to ergot itself, towards the close of the
sixteenth century, at a time when the connection between the two
had not yet been recognised. Before that we have only very doubtful
references by Greek and Roman authors, to what may or may not have
been ergot and its effects (p. 41), and the brief but unmistakable
references to severe epidemics of ergotism, in the chronicles of
the Middle Ages (p. 43). The vast litera
\
/
!
\
/
i
!
\ -
i
!
\ /
i
!
\ /
:
!
v*
;
1
Others again have
not sufficiently insisted on the difference between the two types,
for instance, in treating of them in a common chronological account
(Ehlers, Heusinger). It has even been suggested that a gangrenous
epidemic is merely the severe outcome of a convulsive one, badly
observed. Such 20
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,22
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ERGOTISM
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LESIONS OF THE SPINAL CORD
23
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of the disease,
which, in the severest cases, may be continued to the production
of gangrene (letter I of diagram). This view is not satisfactory,
however. The severer symptoms of convulsive ergotism, unaccompanied
by gangrene, are so pronounced and characteristic that they could
not have escaped the notice of laymen, witness the large number
of popular German names for the disease. Yet there is no mention
of them in the French accounts, and it has long been a problem why
the severer manifestations of the same poison should be so different
in the two countries. Attempts have been made to explain the diversity
by assuming a difference in chemical composition of the ergot.
Kobert distinguished
two active principles; one (sphacelinic acid) was supposed to cause
gangrene, the other (cornutine) was considered to be the cause of
convulsions; he further assumed that French ergot was richer in
the former and German in the latter principle; there might even
be two races of ergot. More precise investigation showed, however,
that both Robert's principles are impure forms of the alkaloid ergotoxine,
and that with the latter gangrene can be produced in animals.1
Gangrenous ergotism must therefore result from poisoning by a specific
alkaloid. If an additional factor is to be invoked, to differentiate
the two forms, it must be in convulsive ergotism. The case of the
gangrenous form is relatively simple: it appeared on a large scale
in the Middle Ages, it remained for some centuries common in particular
districts of France, where it was almost endemic. The problem of
convulsive ergotism is more complicated; the disease was at one
time rarer than the gangrenous type, local in each epidemic, appearing
in fitful fashion in many parts of Central Europe, and persisting
till a much later date. The French disease was recognised in the
Middle Ages as "holy fire" and was known continuously to French
physicians from the seventeenth century onwards, since when its
cause was never called into question. In Germany the disease was
at first generally described as "unusual," "unheard of," and "unknown"
;
1 Yet
Tschirch writes in his Handbuch der Pharmakognosie (vol.
Hi., 1923): "Als Erzeuger des convulsiven Ergotismus wird das sehr
giftige Alkaloid Cornutin betrachtet; als Trager der Gangranwirkung
d.h. als Erzeuger der Kriebelkrankheit (sic), des Ergotismus gangraenosus,
gilt {sic) besonders die Sphacelinsaure und das Ergotoxin."
|
it occurred locally,
at long intervals, often on a restricted scale, and until late in
the eighteenth century its causation by ergot was in dispute. This
would indicate that in addition to ergot a second factor was involved,
already surmised by one or two of the older observers.
^Deficiency
of vitamin-A—-a probable factor in convulsive ergotism.—It
seems from the work of ET~Mellanby [1936J
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Fig.
6.—Lesions of the Spinal Cord.
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The degenerated tracts
are shaded; all sections aie from the middle cervical region ; the
posterior side of the cord is uppermost. I. Dog on a basal diet
deficient in Vitamin-A; II. Dog on basal diet + 2 to 3 grams of
ergot per day; III. Dog on basal diet 4- 2 to 3 grams of ergot per
day + Vitamin-A (mammalian liver oil); IV. Convulsive ergotism
in man. I.-III. after E. Mellanby (private communication); IV. after
Tuczek [1882]. The degenerated areas in man and in the dog
are not identical.
that this other
factor is a deficiency of vitamin-A. He finds that in dogs, deprived
of this vitamin, ergot and to a lesser extent wheat germs, produce
lesions in the spinal cord (Fig. 6) which may occasion the symptoms
of convulsive ergotism in man. The constituent of ergot which brings
this about is .unknown; it is not the alkaloid, but probably a simpler
substance. A deficiency of vitamin-A is liable to occur in the diet
of institutions, which would explain the repeated outbreaks
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24
ERGOTISM
|
DEFICIENCY OF VITAMIN-A
25
necessity. Ergotism
was a disease of the poor peasantry, hence the name Bauernkrankheit,
and probably also Schwere-Nothskrankheit. The well-to-do could separate
the ergot, but the poor could not afford to waste anything. In the
later epidemics the Hanoverian and other German Governments supplied
sound corn, but when this gave out, the peasants were again forced
to use their own supplies, which resulted in a recrudescence of
the disease. The French Government does not seem to have helped
in the same way, although the need of the Sologne also was great.
A difference between
the Sologne and Hanover was in the supply of dairy produce. As has
been said above, there was little or no milk among Wichmann's patients;
he further states that honey was used instead of butter. Milk and
butter were repeatedly mentioned as remedies against the convulsive
disease. Already the Marburg faculty [1597] advised the use of "
good fresh eggs and butter" to ward off the disease (eggs are also
rich in vitamin-A) and Griiner, in re-editing the Marburg account
(q.v.), confirms this opinion in a footnote. Friedrich Hoffmann
[1734], a celebrated physician of the eighteenth century, wrote
"nihil enim certius et efficacius . . . quam opportunus lactis usus."
The Royal College of Physicians of Copenhagen, in replying [1772]
to the Schleswig-Holstein practitioners (q.v.), advised butter
and bacon.
Even better evidence
than that supplied by these opinions, is contained in an account
of a Hanoverian epidemic by A. Hensler, printed by Taube (p. 860).
In 1767 the author was called to a family of eight, all of whom
were suffering from convulsive ergotism; there was much ergot in
the rye from all the fields of the village, yet no other family
was attacked. On inquiry, Hensler learned that his patients alone
had been deprived of milk and butter, owing to their cows having
died ; the frugal housewife had not even supplied the small amount
of bacon usual during the harvest. This observation is as good as
a control experiment. In discussing the causes of ergotism, Hensler
states that he never observed the disease in the fens (Marsch),
a grazing country, but only on the higher ground (Geest). Here it
was much rarer in the fertile districts than on sandy heaths, and
in the latter much less common among farmers than among labourers
and cottagers. The farmers, especially the " Marschbauer," were
amply supplied with meat,
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of convulsive
ergotism in orphanages; Heidelberg [1589? Brendelius], Turin [1789]
and Milan [1795, Moscati], Braunsdorf in Saxony [1832], as well
as in prisons: Treves [1801], New York [1825] (these three quoted
from Hirsch), and in Belgium [1844, Vleminckx].
In order to support
this hypothesis further, it will be necessary to show that the
German sufferers from the disease, in comparison with the
French, received Jijttlejntarmn-A^and further to compare the quantities
of ergot consumed by both. The chief source of the vitamin to be
considered is dairy produce, and with this even the poor peasantry
of the Sologne seem to have been well supplied. Tessier who visited
this district on account of the prevalent ergotism, states that
it was well supplied with cattle [Sur les bestiaux de la Sologne,
1776]. The reverse was the case in those German districts which
were subject to convulsive ergotism. Wichmann, in describing the
state of the country round Celle, in Hanover, after the epidemic
of 1770-71, states that the affected districts were barren sandy
heaths, to which he applies the lines of Ovid {Metamorphoses,
viii, 789-791)—
Triste solum, sterilis,
sine fruge, sine arbore tellus :
Frigus iners illic
habitant Pallorque Tremorque
Et ieiuna Fames.________________i
__________
" Apart from buckwheat,
honey and very little milkj_or_none at all, the solejood
of the peasants was rye, [buckwheat grows" on poor sandysoils,
and according to Tessier, was also cultivated in the Sologne, where
it was not harvested until late October or early November. Sinrejhg
fnpd gnpphVc ^f fb^ p^M0in year werej^en_^h^isj^
(]ate
July or early
August), ^^g^injyjhuch^Jljiut,dujingjmj3^stiiig (Kriimmelkorn in
Germany) was milled immediatelyj it was especially rich ijj_ej^ot^ncg^
the ergot becomes detached more readilyJt.han .Jhe^y^j^ns.
"Since the buckwheat had not yet been harvested, there remained,
besides some fruit and vegetables, nothing, absolutely nothing,
with which to maintain life, except rye, although the various foods
made from it bore different names " (Wichmann). Besides being baked
into bread, it was made into dumplings, pancakes, porridge, soup,
etc. This almost exclusive use of the new rye explains the sudden
outbreaks of ergotism immediately after the harvest. Ignorance
and obstinacy played a part, but the main factor was dire
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26
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ERGOTISM
|
AMOUNT OF ERGOT EATEN
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27
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bacon and milk;
not so the labourers, who could only buy bad rye from the miller.
The epidemic near Lille in 1749 and 1750 was peculiar among French
outbreaks for its manifestation of convulsive symptoms; this may
have been connected with an epizootic disease of cattle, recorded
some years previously.
Finally, it should
be mentioned that Taube and Hensler laid great stress on the large
numbers of round worms {Ascaris) in their patients.
They both devoted a separate section to this subject (respectively
pp. 131-141 and 874-875 in Taube's book). Mr Clifford Dobell and
Dr H. H. Dale have called my attention to a recent paper by Hiraishi,
who quite failed to infect young pigs with Ascaris, whether
from man or from pigs, unless the animals were kept on a diet deficient
in vitamin-A, when he succeeded in every case. It is also significant
that Professor Mellanby has noted a large number of round worms
in his dogs deprived of vitamin-A (private communication).
Amount
of ergot required to produce the two types of ergotism.—Although
it thus seems likely that the paucity of dairy produce in Germany
was a contributory cause of convulsive ergotism, the question remains
why gangrene was hardly ever observed there. We might incline towards
the assumption that the convulsive type is produced by smaller doses
of ergot than the gangrenous, and for this there is some, if not
quite conclusive evidence. No precise data are available concerning
the proportion of ergot in the Sologne. Noel [Acade'mie des Sciences,
1709] mentions one-quarter; Read [2nd edition 1774, p. 82] considered
that one-eighth would in the long run produce giddiness, nausea
and spasmodic movements, whilst one-third, one-quarter or even less
would produce gangrene. Janson states that in 1814 bread baked in
Dauphine" and the Department of the Isere contained 33 to 50 per
cent, of ergot.
In epidemics of
convulsive ergotism the amount was generally less; Wichmann, Heusinger,
Spoof, place it as ua rule at 10 to 12 per cent. Hussa
reported 17, Wagner 20, Lorinser [Silesia 1821] 33 per cent. In
Finland, according to Spoof, it was occasionally as high as 33,
and as low as 4 or 5 per cent. Griepenkerl [1854-56 in Brunswick]
found 3 to 4-5 per cent, by accurate weighing, Siemens [Hessen 1879]
mentions 9 per cent. Flinzer [Saxony 1867] records two deaths from
convulsive ergotism, after eating bread from grain
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containing 6 to
7 per cent, of ergot, during five days. Both patients were 16 years,
of age; adults survived. In the extensive epidemic of 1879, in Hessen,
there was only 2 per cent, of ergot in the rye. By far the most
accurate data have been supplied by Bonjean, and relate to sporadic
cases of both forms of ergotism. He reported that a family in Haute
Savoie consisting of father, mother and seven children ate within
three days (16th to 18th November 1843) 18 livres = 8600 grams of
bread, containing 14 per cent, of ergot. On the average each member
therefore consumed 133 grams of ergot. All suffered from severe
convulsions, lasting a month; Bonjean also investigated gangrenous
ergotism in a family near Chambery in November 1844. He calculated
that the eight members together consumed 960 grams of ergot in three
weeks. A boy of 10 years of age had both legs amputated and died;
another child (one of twins) lost one leg; the others were but little
affected. Bonjean estimated that the dead child had consumed 125
grams of ergot, much the same amount therefore as that which had
produced convulsive ergotism a year previously in another district
of Savoy. . The juxtaposition of these two cases shows some puzzling
features. Although the total amount of ergot was about the same,
the daily dose was much-greater in the convulsive case, the effect
raore sudden and more uniform, extending to all the members of the
farrn!y7~~The slower intoxication in the other case was not followed
by uniformly serious results, since only two children suffered from
gangrene. The individual susceptibility to gangrene seems to vary
greatly; I have not seen any records of whole families being attacked
by it; even in the very severe Wattisham case the father escaped.
On the other hand it was common for all the members of a family
to be attacked by convulsive ergotism —at first the disease was
considered to be infectious—and cases are even on record of whole
families dying from it (Serine). In convulsive ergotism there were
many intermediate stages from mere formication to epileptiform convulsions,
in the gangrenous form the symptoms were mild, unless the critical
limit was exceeded, when gangrene set in.
Mixed epidemics.—If
two factors were necessary to produce convulsive ergotism (avitaminosis
and an ergot constituent) it is possible to understand why convulsions
hardly occurred in France, but it is not so intelligible why gangrene
was not more
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28
|
ERGOTISM
|
OTHER IMPURITIES IN GRAIN
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frequently superimposed
on severe convulsions, for instance in Finland, where the rye seems
to have not infrequently contained one-third of ergot. The only
records which I have been able to trace of both forms occurring
in the same individual are: first that of Brunner [1695] who in
the Harz Mountains saw a woman with daily recurrent convulsions,
who had previously lost a foot from gangrene, and secondly that
of Boucher [i749] who near Lille commonly saw spasmodic contractions
of the limbs, which were later followed by gangrene. If we adopt
the view, put forward above, that the two forms of ergotism have
more in common than is often supposed, these cases are quite intelligible;
it is only surprising that they were not more numerous. This also
applies to the mixed epidemics which were observed in Lorraine
[e.g. 1085] and in Russia [1722, 1824 near Diinaburg, 1832,
1863, 1881 near Pultawa; Robert, Hirsch, Griinfeld].1
It does not appear that in these the same patients were attacked
by both varieties of the disease. Of the Lorraine epidemics, the
chronicle states that .some were twisted by nervous contractions,
whilst others were consumed by the "holy fire." The Lorraine
epidemics occurred on the border-line separating two regions, each
having its own type of disease. East of this line the only gangrenous
epidemics on record seem to have been one in i486 near Meissen in
Saxony (G. Fabricius) and a small one in 1855-56 near Briinn in
Bohemia (Hirsch), together with a few of the many Russian epidemics.2
West of the border-line typical convulsive ergotism was never recorded.
Effect of ergot
from hosts, other than rye, and of other impurities in corn.—The
only English cases of gangrenous ergotism [Wattisham 1762] seem
to have been due to ergotised wheat. In Sweden ergotised barley
(and oats?) apparently caused the disease, rather than rye which
was not much cultivated there. The epidemic of 1855-56 in Hessen
was attributed by Heusinger not so much to ergot of rye, as to
1
A perusal of the original descriptions of the 1709 epidemic near
Lucerne, and of an outbreak in Belgian prisons in 1844 has convinced
me that the former was purely gangrenous, the latter almost purely
convulsive and that neither was of the mixed type, as tabulated
by Hirsch. Colin writes of the Lucerne outbreak: " Cette epidemie
a ete considered, trop facilementpentetre, comme une epidemie
mixte."
2
Robert was in error in describing Hussa's sporadic cases [Bohemia
1856] as gangrenous ; they were convulsive.
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ergot of Bromus
secalinus (German: Trespe), a wild grass, particularly abundant
among the rye in those villages where slovenly agriculture was associated
with ergotism. According to Maurizio this weed was so abundant among
rye that it was sometimes regarded as arising from the latter by
metamorphosis. Griepenkerl devoted a paper to the ergot of " Trespe"
in the same epidemic in Brunswick ; in 1879 in Hessen some samples
of rye contained one-third of this grass seed; it is also mentioned
by Serine. This plant, Bromus secalinus, seems also to have
been abundant in Sweden. Wahlberg [1843] found it to constitute
one-quarter of a sample of rye and both grasses were heavily ergotised.
An epidemic at Leksand in 1813 was due to oats containing 22 per
cent, of Bromus secalinus. The ergot on the latter grass
deserves investigation. The Swedish epidemic of 1765 was attributed
by Wahlin to oats.
The ergot of maize
produces neither gangrene nor convulsions, but causes baldness
in man, and is hence termed mats peladero in Columbia, according
to Roullin. He states that it has a narcotic effect on monkeys and
parrots in the fields; mules lose their coat and hoofs and hens
lay eggs without shells.
Before ergot was
definitely recognised as the cause of the convulsive disease, the
latter was attributed to a variety of other impurities in corn.
Thus in Sweden Linnaeus considered that charlock, Raphanus Raphanistrum,
was the cause ; although there was not the slightest foundation
for this, the name raphania was at one time used, on the
authority of Linnaeus, to designate convulsive ergotism. In Germany
and elsewhere the darnel {Lolium temulentum, zizania, the
tares of Scripture?) was considered by some to be the cause of the
Kriebelkrankheit and more plausibly, since this grass does indeed
contain a narcotic poison. Hussa observed a number of cases of actual
poisoning by rye containing 16 to 20 per cent, of darnel seeds;
the symptoms were frontal headache, giddiness, rumbling in the ears,
gastric pains, twitching of the tongue, difficulty in swallowing
and in speech, vomiting, diarrhoea, fatigue, cold sweat, and trembling
of the limbs. The patients declared that they felt completely intoxicated.
There is here a slight resemblance to some of the symptoms of ergotism,
but various observers agree that the effects of Lolium poisoning
are of
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SO
ERGOTISM
|
GANGRENOUS SYMPTOMS
31
any bleeding,
and she carried it to the hospital in her arms. / Amputation was
not always favoured by the surgeons, who / often preferred to leave
the separation to nature. In bleeding their patients they found
it difficult to obtain a satisfactory \ flow of blood.
The extent of
the gangrene varied from the mere shedding , of nails, and the loss
of fingers or toes (see Fig. 7), to that \ of whole limbs.
It is related in the Histoire de V Academie— [see Acadimie
des Sciences^ 1710, p. 62] that a peasant near Blois lost both
legs at the hip, and Boucher (p. 340) mentions a : woman in whom
both legs were attacked after both arms had ; been amputated; the
loss of all four limbs is reported by duj> Hamel [1748];
such patients did not survive for lonp- , After the loss
of >afsingle limbos
' tys often made agooc1 -*?co«ory
and lived for
many }
^tnes being attacked again in-
a second epidemic.
4
„i-*>n of the hospital at Orleans,
reported
\Acad4mie des ^jiences,
1710] that in fifty patients he had only seen one gangrenous
hand. The much ^^ater susceptibility of the lower limbs is also
illustrated by Bones [1762] and others. It is not clear whether
one sex was more susceptible than the other, but if there was a
difference, it was to the advantage of the female. Noel was surprised
that he had not a single adult woman among his patients. It was
stated by Dodart [1676] that ergot stops the milk secretion in nursing
mothers ; this was not the case in convulsive ergotism, but Griinfeld
abstracted modern Russian papers on the inhibition of milk secretion
by ergot.
Description
of convulsive ergotism. — The numerous synonyms for this disease
may be arranged under the following heads :—
English: convulsive,
spasmodic or nervous ergotism.
German authors
of the latter part of the sixteenth and first
-half of the seventeenth
centuries: Scharbock, Schorbock
( = scurvy), affectus
scorbutico-spasmodicus or scharbockische
Kriebelkrankheit
[Drawitz 1647], febris maligna cum spasmo
(Sennert).
Names referring
to the sensus formicationis: Kriebel-
: krankheit (the
most common name), Kriebelsucht, Kribbel-,
Krabel-, Gribbel-,
Griibelkrankheit. Modern German : kribbeln
= to crawl about,
to swarm; to itch, to tingle, to prick;
compare griibeln
= to stir, to rummage. Myrmeciasis (from
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short duration;
after a sound sleep Hussa's patients were practically normal next
day. Compare also Kircheisen's experiment on himself (p. 77).
Whether the disease
in a prison in Lombardy in 1769 which Sangiorgio attributed to corn
mixed with "covetta" (a grass = Cynosurus ?) was in reality
due to ergot, as has been supposed by many authors, seems to me
doubtful. In any case Sangiorgio makes no mention of ergot.
Description
of gangrenous ergotism.—The patient often began by complaining
of a general lassitude, vague. lumbar p?jnai nr
Pat'nci
,n a l1'rPh
particularly in,
oecame _somewhat
swollen ar
and was attacked by
jgigjenj-, hiirjiing^painSj
as if " un
- traversait le membre*
affecteV' Hence
the names fire (of Anthony, St Martial), mal i?M ar dents,
arsura, ignis sacer, ft satriy pestis igniaria. Other
names were: necrosis ustilaginea and convulsio Soloniensis.
A feeling of intense, heat alternated with one of icy
cold. Not being able to bear the heat in their beds, the sufferers
would j seek relief in the open air, and then feel so cold that
they ! immersed their limbs in hot water. Gradually the part affected
j became numbed; the pains sometimes stopped suddenly. The \
skin was cold, livid, rimpled, and sometimes covered with red_;
or violet vesicles. Salerne mentions that the skin in general, and
particularly of the face, including the white of the eyes, was yellow.
Kobert [1884] mentions subcutaneous icterus in f^taj^_ajttejri£ts_jto__r^
^bortioj^jvitl^ergot Later the)
diseased part
became black (" like charcoal," lis the chronicles j have it), often
quite suddenly, and all sensation was lost. The \ gangrenous
part shrank, became mummified and dry; the whole \ body was
emaciated and the gangrene gradually spread upwards ^-1 s^m^tim<^-tire£e_was
putrefaction (moist gangrene)
In severe cases
the course of the disease was much more rapid; with violent pains
for twenty-four hours, as the only premonitory sign, gangrene might
set in suddenly. The separa-tion of the gangrenous part often took
place spontaneously at a joint without pain or loss of blood. It
is related that a woman was riding to the hospital on an ass, and
was pushed against a shrub; her leg became detached at the knee,
without
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32
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ERGOTISM
|
CONVULSIVE SYMPTOMS
33
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the Greek for
ant) is used in German dissertations of the nineteenth century.
Names referring
to spasms and convulsions: morbus spasmodicus vagus, morbus epidemicus
convulsivus, morbus rigidus; Krampfsucht, Krimpfsucht, Krampfseuche;
das Kromme, krumme Krankheit, krumme Jammer, Krumraer; das Steiffe,
Steifenuss, steiffe Krankheit, Steiffkrampf; ziehende Seuche ( =
Swedish Dragsjuka), ziehender Krampf, Ziehekrank-heit, zusammenziehende
Seuche, das Reiszen ; Grimmsucht (in allusion to mental symptoms
of fury?); Nervenkrankheit.
Names based on
aetiology : Kornstaupe, convulsio cerealis, Schwerenotskrankheit,
Bauernkrankheit [Holstein *7l7\ raphania.
Perhaps the best
modern description of the symptoms of convulsive ergotism is that
by Tuczek (in Penzoldt and Stintzing: Handbuch der speziellen
Therapie), but we will begin here by quoting the oldest account
of the disease in English, from the translation of Sennertus :
De Febribus [Of Agues and Fevers, ^$8], \
" It seized upon men with a twitching and kind of benummed-
■,
\ ness
in the hands and feet, sometimes on one side, sometimes | on the
other, and sometimes on both: Hence a Convulsion \ invaded
men on a sudden when they were about their daylie . employments,
and first the fingers and toes were troubled, which Convulsion afterwards
came to the arms, knees, shoulders, hips, and indeed the whole body,
until the sick would lie down, and roul up their bodies round like
a Ball, or else stretch out themselves straight at length : Terrible
pains accompanied this evil, and great clamours and scrietchings
did the sick make; some vomited when it first took them. This disease
sometimes continued some days or weeks in the limbs, before it seized
on the head, although fitting medicines were administered; which
if they were neglected, the head was then presently troubled, and
some had Epilepsies, after which fits some lay as it were
dead six or eight hours, others were troubled with drowsiness, others
with giddiness, which continued till the fourth day, and beyond
with some, which either blindness or deafness ensued, or the Palsie:
When the fit left them, men were exceeding hungry contrary to nature;
afterwards for the most part a looseness followed, and in the most,
the hands and feet swell'd or broke out with swellings full of waterish
humours,
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but sweat never
ensued. This disease was infectious, and the infection would continue
in the body being taken once, six, seven, or twelve moneths.
" This disease
had its original from pestilential thin humours first invading the
brain and all the nerves; but those malignant humours proceeded
from bad diet when there was scarcity of provision.
"This disease
was grievous, dangerous and hard to be cured, for such as were stricken
with an Epilepsie, were scarce totally cured at all, but at intervals
would have some fits, and such as were troubled with deliriums,
became stupid. Others every yeer in the month of December and January,
would be troubled with it."
This description
by Sennertus closely follows the well-known account by the Marburg
medical faculty [1597]. It applies to severe cases only. Later authors
(Wichmann, Hecker) have distinguished a milder form, which might
pass off in a few weeks without preventing the patients from following
their ordinary occupations. It was characterised by a feeling
of fatigue, heaviness in the head and limbs, giddiness, pressure
and pain in the chest. This was sometimes accompanied by mild
diarrhcea, with or without vomiting, and
lasting for several weeks. A very
compnnn, parly gyrnptnrn
often persisting
throughout the disease, was "the Wind of benummedness " in the
hands and feet, and a tingling sensation "as if ants were
running about under the skin," hence formication.
(Hussa's description speaks of mice, instead of ants.) In well-marked
epidemics this sensation of "pins and needles" is said to have been
experienced by all the inhabitants of a village. It gave the most
common German name to the disease: Kriebelkrankheit.
Waldtschmiedt
and Wichmann state that (in the later stages) formication can be
seen objectively as due to t^jtching of small muscle-fibres,
or even of entire mnqrlpg {orbicularis orisj. The
sensus formicationis was most common in the fingers,
but sometimes extended over the arms and the whole body, and
became most painful when it affected the tongue, These common milder
symptoms did not greatly attract the _ attention of the earlier
physicians, and often passed off; they might, however, be followed
after a few weeks bv more pronounced nervous symptoms, convulsive
clonic muscular
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34
ERGOTISM
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HUNGER AND WORMS
35
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twitchings (von
Leyden) and tonic spasms of the limbs. Often the thighs were
drawn forwards, the leg below the knee bent backwards, the
feet again forwards, the t6es~~tyarkwaids. •^jgllglbLth^JTTI'*
wprp *t™nft\y fWed, with the fingers frent to__a.fi^»
"r g'v'*Pg .tn the h^P^ the rrfra,retferistic
appearance pf an eagle|s_beaJLXvon Leyden ; see Fig. 8, after Heusinger,
reproduced in Robert's Lehrbuch der Intoxicationen). Several
of the older accounts emphasise the force of these contractions:
often a strong man could not extend the limbs, yet their extension
gave some measure of relief to the sufferers, who often begged for
this service to be performed. The flexure was sometimes
so extreme that it iritfrffrprl ""^ ^^ ri'rnila-•
UUli and made the lower part of the limb purple. The patients
were apt to complain of an icy cold, and also of burning heat. When
a spasm was confined to the fingers the patients, unable Nto
work, would walk about until their feet became affected in the same
manner. The spasms might begin in the toes and then gradually extend
upwards. Apart from the limbs, other groups of muscles might also
be affected (see Figs. 9 and 10), resulting in spasms of the face,
the vocal cords, the oesophagus (simulating hydrophobia) and the
diaphragm. In severe cases the tongue was often lacerated and occasionally
bitten off i (Taube, Rothman, Serine, Wagner, Walker). (See Figs.
7-9.) In severer cases, the whole body was attacked by general convulsions,
often so suddenly "that some at table dropped knife or spoon and
sank to the floor, and others fell down in the fields while ploughing"
(Marburg). These convulsions returned at intervals of a few days,
or daily, often at the same hour, most frequently in the forenoon;
or even at hourly intervals (Steffens, Wagner). If not confined
to bed, the sufferers "tumbled about as if drunk." When the flexor
muscles remained the most strongly affected, " the sick would roul
up their bodies round like a Ball"; under the more powerful action
of the extensors, they were stretched stiff " like a piece of wood"
(Marburg) or "like a statue" (Nebel; Taube did not observe this,
but Hussa saw violent opisthotonus). These paroxysms lasted from
a few minutes to several hours and were extremely painful. The loud
cries of the sufferers are often referred to in a graphic manner.
A cold sweat covered the whole body and the spasm of the abdominal
muscles caused violent retching. Occasionally the disease first
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showed itself
by convulsions, two or three days after eating the poisonous bread.
Hussa described a particularly severe attack in a boy who had not
eaten bread for six months and then consumed a large quantity containing
17 per cent, of ergot. Two days later he was seized by violent convulsions.
In the intervals
between the convulsions many patients suffered little discomfort
and clamoured for food ; there would be an alarm in a village one
day, and on the next the patient might be working in the fields.
Ravenous hunger was a most characteristic symptom in severe cases,
but " digestion did not keep pace with this excitation of the abdominal
nerves" (Hirsch). Taube (p. no) gives somes remarkable examples
of this voracious appetite. After finishing a meal, with which
? they declared themselves satisfied, two of his patients
each consumed 3 lbs. of bread within seven minutes, in Taube's
\ presence. He also reports the eating of garments and a
case j of scatophagy by a demented patient. Dr H. H. Dale has_j
suggested to me that the severe hunger was the result of hypoglycemia
due to ergotoxine poisoning (see p. 160), and intensified by the
disappearance of glycogen from the muscles during convulsions. (Hunger
commonly occurs after a somewhat high dose of insulin.) Taube and
Hensler considered that the convulsive attacks were aggravated by
the enormous number of round worms (Ascan's) frequently infesting
their patients, and observed improvement when these had been eliminated
by vermifuges. Taube considered the possibility that the growth
of these worms might be favoured by the great production of mucilage
in the intestine. Their abundance was, however, more probably the
result of shortage of vitamin-A (see p. 26).
Several descriptions
mention severe insomnia. In extreme cases the patients would
lie for six or eight hours as if dead ; in the 1597 epidemic some
narrowly escaped being buried alive (Marburg). In such cases there
followed a pronounced anaesthesia of the skin, the lower limbs became
paralysed, and the arms subject to violent jerky movements; epileptiform
convulsions, delirium, imbecility, and loss of speech were
apt to occur in such patients, who became unconscious and generally
died on the third day after the onset of the first symptoms.
In severe but
non-fatal cases, the disease might last for six to eight weeks,
and convalescence took several months. Convalescents apparently
remained very sensitive to ergot, for
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36
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ERGOTISM
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Hussa recorded
the deaths, due to a single meal of dumplings, in February, of two
patients who had more or less recovered from an attack in the previous
August. Relapses were frequent (see for instance the enumeration
of 39 deaths in a single village during the five years following
the epidemic, Taube, pp. 810-812). These relapses were accompanied
by epilepsy, hemiplegia and paraplegia (von Leyden). Among the aftereffects
of a severe attack may be mentioned : general weakness, trembling
of the limbs, gastric pains, chronic giddiness, permanent contractures
of the hands and feet, anaesthesia of fingers and toes, impairment
of hearing and of sight, and various mental derangements. In illustration
of the anaesthesia of the fingers, Taube relates the case of a woman
who while sewing, perforated her finger without knowing it; others
picked up red-hot charcoal. The effect on the eyes consisted in
an enlarged pupil, amblyopia, the seeing of small objects double,
more rarely cataract, glaucoma and degeneration of the optic nerve.
Cataract developed several months after the beginning of the disease.
Taube describes a number of cases; Meier [1862] and Orlow [1905],
both ophthalmologists, devoted special papers to the subject. Bechterew
observed J cases of nystagmus and 8 of cataract among 89
patients; one-quarter had impaired vision. Orlow states that the
cataract results from defective nutrition, due to a specific change
in the epithelial lining of the ciliary body and of the posterior
surface of the iris [cf. Peters). The functional troubles
in the retina are not due to vaso-constriction, but to the direct
action of the poison. The effects on the mind consisted of dullness
and] stupidity, even in less severe cases (this also in the \
gangrenous type); the more general disturbance in severe cases
'\ was dementia. ("The patient did not give sensible answ
. ■ to questions.") Rarely maniacal excitement was the result; 1
some of Taube's patients were secured by chains. Siemens J
relates that 11 victims of ergotism were received in an asylum
in 1880. Tuczek [1882, 1887] and Walker [1893] report conversations
with patients, and describe histologically the permanent injury
to the posterior columns of the spinal cord (shaded in Fig. 6, IV.).
The knee-jerk is abolished in all moderately severe cases within
a few weeks of the onset of the disease, and is only restored in
a few after the lapse of years. Walker describes patients who suffered
from ergotism
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FlG. 7.—Gangrenous
Ergotism, Hungary, early 20th century. (Observed by Dr K. Chyzer.
From a photograph lent by Prof. G. Mansfeld, Pecs.)
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Z:<5
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Fig.
8.—Convulsive Ergotism. (Heusinger,
1856.)
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CATARACT AND INSANITY
37
in early childhood
and remained normal, or were at most intellectually backward, until
the onset of puberty, when epileptic convulsions, dementia, and
after some years death supervened. Minor nervous defects, spasms
and a dull intellect may persist for a long time in the adult, and
serious relapses occurred years after the first attack. In one patient
formication recurred annually in March for twelve years. Kolossow^
[1914] found mental disturbances in 27 per cent, of his patients;
(in Russia). Psychoses due to ergot have been especially studied
by Gurewitsch [1911] and von Bechterew [1892]. A graphic early description
of a patient with delusional insanity, seven months after the harvest,
was already given by Hoffmeyer [1742]; the constant movements of
the hands and feet were only interrupted by tetatiic' convulsions.
-—
The "looseness,"
mentioned in the English description quoted above, followed frequently,
but not invariably, after severe convulsions; this severe diarrhoea
often persisted for months and was apt to prove fatal; it also preceded
death in gangrenous ergotism. The " swellings full of waterish humours
" were rare in the German epidemic of 1770. They were, however,
commonly observed by the Marburg physicians and by Serine. Boucher
[1749, near Lille] described them as precursors of gangrene; but
in the purely convulsive ergotism true gangrene was never seen ;
Taube emphasises this, and figures the cast-off skin of fingers
and toes in a single curious case, doubtless the result of trophic
disturbance. The shedding of the epidermis of the trunk was also
observed by Hussa, of nails by Heusinger (both in convulsive ergotism).
The belief that
the disease was infectious is already contained in the title of
the Marburg account, and was maintained for a long time; it no doubt
orginated in the circumstance that all members of a family, living
on the same diet, were often taken ill at the same time. Hoffmann's
statement that relapses were most frequent in December and January,
as were fresh cases, is amply confirmed by Taube.
Whatever may have
happened in gangrenous ergotism, there is no evidence that the chronic
convulsive type ever produced abortion (Wagner); in spite of the
special attention paid by Taube to this point, he was unable to
find any influence of the disease on the course of pregnancy. The
same is found in almost all attempts to procure abortion (see p.
179 and p. 229).
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38
ERGOTISM
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CASE MORTALITY
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Several of Taube's
patients bore living children at term, after months of convulsions
and dementia (compare also Menche). In these cases the children
soon -died from convulsions; the poison had evidently been communicated
to the foetus. On the other hand, the disease was never communicated
to breastfed infants; quite a number of cases have been recorded
where all the other members of a family were attacked (Rosenblad
mentions a case in which they all died, except an infant); the disease
developed as soon as the child was weaned, and during the epidemic
Taube advised mothers to continue the nursing of their children
as long as possible. The secretion of milk was not affected either;
cases are on record of a child having been suckled by its mother
shortly before the latter's death from severest convulsions. Here
there seems to be a distinct difference from gangrenous ergotism
[this point is discussed by Krohl, 1894]. Dodart already remarked
that ergot may stop the secretion of milk, an effect which has been
confirmed by Janson clinically and especially by modern Russian
authors, who also showed it experimentally in bitches (Griinfeld).
Both forms of ergotism produce amenorrhcea (Lentin, Janson, etc.).
Most information regarding the post-mortem findings in acute
ergotism is to be obtained from modern attempts to procure abortion
(see p. 230). The examination in chronic convulsive ergotism does
not seem to have revealed any significant changes, except lesions
in the posterior horns of the spinal cord [Vleminckx 1846; Tuczek
1887; Walker 1893] and bleeding and softening in the
brain [Bechterew 1892]. Taube and others state that putrefaction
sets in very rapidly. In chronic cases the patients usually suffer
from defective nutrition and become emaciated. (See Fig. 9.) In
order to give an idea of the mortality, I quote what I believe to
be some of the most significant statistics:—
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Briickmann [1741,
Brandenburg] gives 26-7 per cent; von Leyden [1867-68, East
Prussia] 6 to 9 per cent.; Griinfeld (Russia, nineteenth century)
11 to 66 per cent.; Poehl [Russia, 1832, 1837] 25 to 55 per cent
Apart from these latter figures, the mortality is thus seen to be
generally between 10 and 20 per cent. The high percentage given
by Meier is probably due to the fact that he, as an ophthalmologist,
failed to include a number of milder cases. For the same reason
Bruckmann's and many Russian figures may be too high. Taube on the
other hand personally treated very nearly all the six hundred cases
in the district under his charge.
All accounts of
convulsive ergotism agree that children were more liable to convulsive
ergotism than adults; thus 56 per cent, in the Finnish epidemic
of 1862 were under 10 years of age; 60 per cent of Serine's cases
were under 15 years of age; the mortality of children under 10 years
of age in the Hessen epidemic of 1855-56 was about 50 per cent Hoffmann
stated that females were more liable to the disease than males,
and this seems to have been true in some epidemics; on the other
hand, Taube and Spoof reported a preponderance of males (60 per
cent.) so that there seems to be no definite influence of sex (this
is also Wagner's view).
Bibliography
of the history of ergotism.—The first histories are due to physicians
who observed the last great epidemics of the eighteenth century.
Read [1771] gave a sketch of the gangrenous variety and identified
it with the St Anthony's fire of the Middle Ages, as Sauvages first
did three years earlier in his Nosologia Methodica. De Jussieu,
Paulet, Saillant and Tessier [1776] published a much more comprehensive
history of this disease, with quotations from the chronicles, and
Saillant at the same time contributed a (less detailed) account
of convulsive ergotism, which he recognised as a separate disease.
The history of the latter was treated very fully by Taube [1782],
and Baldinger [1793] contributed its first accurate bibliography.
Later writers on the history of ergotism did not have similar opportunities
of observing an epidemic themselves. Thus in the epidemiologies
of Fodere, Ozanam and Schnurrer [all three published about 1823]
there is considerable mention of ergotism, but also some
confusion. Ozanam, for instance, has a chapter on ergot, convulsio
cerealts, ustilago, raphania, mal de Sologne, and one on
feu sacrS, feu de St Antoine, mal des ardens, feu
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4o
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ERGOTISM
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UNRNOWN TO THE ANCIENTS
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persique.
Thus he did not recognise the identity of the modern disease
of the Sologne with the holy fire of the Middle Ages, as his countrymen
had already done half a century earlier. The true nature of ignis
sacer was, however, elucidated by Sprengel in a short paper,
and particularly by Fuchs in an admirable monograph on gangrenous
ergotism [1834]. Fuchs gives most complete references to chronicles
and other sources with copious quotations; his enthusiasm has made
him include a few epidemics of very doubtful nature. A full description
and history, more especially of the convulsive type, was supplied
by Hecker [1839]. The brief account by Hirsch, in his handbook of
geographical and historical pathology [English translation, 1885],
is chiefly of value for its very full chronological table of epidemics,
in each case with references to the original authorities. Robert's
historical study [1889] is mainly important for his attempt to show
that ergotism occurred among the Ancients, a view not shared by
Husemann in Neuburger and Pagel [1903]. Robert and his pupil Grunfeld
have also made information about Russian epidemics available. Ergotism
in the first half of the nineteenth century was specially dealt
with by Heusinger [1856] who refused to recognise two distinct diseases.
Leteurtre's " Documents" [1871] is mostly concerned with the disease
in France, and much less accurate than its title would imply.1
Ehlers [1894] devoted a small book entirely to the history of ergotism.
Translated into French, this work is the most readily available
comprehensive account; unfortunately the author did not differentiate
sufficiently between the two varieties of the disease, and seems
to have relied mainly on previous compilations ; he has, however,
collected some information about early Scandinavian epidemics.
In England and
Ireland only sporadic cases of ergotism have become known, and there
is no full account of the disease in the English language; the best
is that by Christison. Allbutt and Dixon [1906] state that epidemic
gangrene = Rriebeikrankheit(I) and have relied almost entirely on
Ehlers' book, criticised above.
Supposed references
to ergot and ergotism by the Ancients.—Robert [1889], m
a learned article, collected a large
1 On
the other hand, there is a full and careful account of convulsive
ergotism under the aetiologically unsound title raphanie, in the
Dictionnaire encyclopedique
des sciences medicales{\%-]^ [iii.], 2, pp. 297-323), by Leon
Colin.
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number of passages
from Greek and Roman authors, referring, as he supposed, to ergot
and its effects, but it would seem that he was carried away by enthusiasm
for his subject. Husemann (in Neuburger und Pagel, q.v.)
could not agree that ergot was known to the Greeks and Romans, already
for the simple reason that rye was hardly grown round the Mediterranean
in classical times (see the section on Rye, chapter I.). This does
not indeed dispose of the possibility that other cereals, or even
fodder grasses, were occasionally ergotised, but a scrutiny of the
passages mentioned by Robert would seem to leave little doubt that
ergot was unknown to classical writers. Passages in Pliny's Natural
History, and particularly his mention of the Rubigalia (lib.
xviii., cap. 69), have often been cited by writers on ergot. This
festival was instituted to ward off a disease of corn, which was
in all probability not ergot, but rust, as the name would indeed
indicate; nor is there anything in Pliny's descriptions of. barley,
wheat and rye (xviii. 18, 20, 40), which to my mind suggests a reference
to ergot. The same applies to the noxious wheat mentioned by Columella
{de re rustica, ii. 9). Robert even quotes a passage from
Plautus {Miles Gloriosus, act ii., scene 3, line 50; mirumst
lolio victitare te tarn vili tritico), and suggests quite gratuitously
that in this case instead of darnel {lolium), ergot was meant.
Perhaps the least improbable reference to ergot itself is by Galen
(2nd century A.D.) in de alimentorum facultatibus (lib. i.,
cap. 37; in Riihn's edition, vol. vi., p. 553, Leipzig, 1823). In
discussing seeds which are apt to be present in corn as impurities,
Galen mentions a black wheat {fxekafx-wvpov) which is formed
by a change {he fxera^oXtj?) from wheat, but is much less
harmful than darnel or tares. It is not clear whether the "black
wheat" was formed by an actual transformation of the seed on a wheat
plant, or whether it was an entirely different species, assumed
to be formed from sown wheat by a kind of mutation, in which classical
writers were apt to believe (compare for instance, Columella). That
"black wheat" was an entirely different plant is the view of modern
writers. But if the wheat grain itself was transformed, the reference
might still refer both to smut and to ergot. In the same chapter
Galen discusses symptoms due to a heavy contamination of corn with
darnel in a year when, owing to scarcity, the farmers and bakers
did not clean the corn with the sieves intended for the
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42
ERGOTISM
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THE "HOLY FIRE
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purpose; the symptoms
(headache, and afterwards ulcers) were not exactly those of ergotism.
This passage has been dealt with at length, because it illustrates
the difficulties of identifying ergot in classical writings; it
also shows that Galen was fully aware of the dangers of poisonous
corn, and of the need of cleaning it.
Most of Robert's
passages are not supposed references to ergot itself, but to its
effects. He [1899] attempted to show that the plague at Athens in
the Peloponnesian War was an epidemic of smallpox in a population
suffering from latent ergotism. Thucydides (ii. 47) states that
the mortality was highest among the physicians, which points to
an infectious disease (plague?). Robert quoted modern Russian cases
in support of his view that intercurrent infections of typhoid,
pneumonia, etc., may cause latent ergotism to develop into gangrene.
He further assumed that the Athenians lived on ergotised grain imported
from what is now Southern Russia, and that the home-grown grain
of the Spartans was not ergotised. Robert's theories have been adversely
criticised.
Caesar, in the
Civil War (ii. 22) mentions a grave pestilence at the siege
of Marseilles, due to poisonous grain, but here there is no mention
of the symptoms. The ignis sacer of Lucretius {De Rerum
Natura, vi. 1166) was not ergotism, to which this term was only
applied in the later Middle Ages.
Robert cites a
number of isolated references to gangrene and other possible effects
of ergot in the writings of Hippocrates, Dioscorides and Galen.
Single cases of gangrene may well have been due to other causes.
Hippocrates! mentions abortion in certain women after a wet winter
and dry spring (favouring the growth of ergot ?), and elsewhere
he attributes an oxytocic action to barley (assumed by Robert to
be ergotised). The disease, resulting in the loss of hoofs in cattle,
mentioned by Aristotle {Historia Anitnalium, viii. 23, 24)
was foot-and-mouth disease, according to Aubert and Wimmer (q.v.);
yet even had it been due to ergotised fodder grass, the main question
must be answered in the negative : there is no evidence £hat ergotised
cereals were known to the Greeks and Romans; /nor were there outbreaks
of ergotism, such as those caused by j ergot of rye in the Middle
Ages.
i According to
Schelenz ergot seems to have been used in Chinese midwifery at a
very early date. Leclerc considers that
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ergot was known
to the Moorish physician Avicenna (980-1037) ; for other references
to its supposed use in Arabian medicine, see also Schelenz and a
paper by Achundow.
Ergotism in the
Middle Ages.—The chronicles of the eleventh and twelfth centuries,
particularly in France, mention epidemics of a disease which they
call fire, often "holy fire" or ignis sacer, and sometimes
arsura, clades or pestis igniaria,feu sacri or
mal des ardens. In the thirteenth century this fire became associated
with St Anthony and St Martial, and was also known as ignis Beatce
Virginis, invisibilis or infernalis. References to it
became rarer and ceased in the fourteenth century, until it was
identified in the eighteenth as gangrenous ergotism. The name
ignis sacer had already been used by ancient writers {e.g.
Lucretius) for an entirely different disorder, a chronic skin
disease or erysipelas, and was also used in the fourteenth and subsequent
centuries as a synonym for ignis persicus or anthrax. These
and various other sources of confusion in the nomenclature
misled some epidemiologists, until Fuchs [1834] cleared up the
matter by basing his inquiry on the symptoms mentioned in
the chronicles.
He found the earliest
reference to ergotism in the Annales Xantenses for the year
857. (1) A great plague of swollen blisters consumed the people
by a loathsome rot, so that their limbs were loosened and fell off
before death.
(1) Plaga magna
vesicarum turgentium grassatur in populo et detestabili eos putredine
consumpsit, ita ut membra dissoluta ante mortem deciderent (Pertz,
ii. 230). These annals are so called because they describe in detail
the sack of the church of Xanten, near the lower Rhine, in 863 by
the Norsemen. Exactly where and by whom they were written is not
known; there is only one copy, discovered in 1827. (See Map, Fig.
15, p. 67.)
The falling-off
of limbs is the most characteristic indication of gangrenous ergotism.
The gangrene was often dry and not putrefactive; the vesicles are
a less prominent symptom. It is stated elsewhere (Bouquet, vii.
71) that the winter of 856-857 was very severe and dry, and that
there was a great pestilence.
A plague of "fire"
is first mentioned in 945, in and around ; Paris. Limbs
were burnt up and gradually consumed, until death ended the torment.
As many as could reach the church of St Mary in Paris were saved,
and Duke Hugh fed them with
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44
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ERGOTISM
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daily rations.
When some of the patients went home, the quenched fire was rekindled,
but returning to the church, they again recovered. The duke was
Hugh the Great, Count of Paris and father of Hugh Capet, the founder
of the royal dynasty. Evidently he had a store of sound grain, and
relapses occurred when the patients fell back on their own supplies.
(2)
In pago Parisiacensi, necnon etiam per divisos circumquaque pagos,
hominum diversa membra ignis plaga. pervaduntur; quaeque sensim
exusta consumebantur, donee mors tandem finiret supplicia: quorum
quidam, nonnulla Sanctorum loca petentes, evasere tormenta. Plures
tamen Parisius in Ecclesia sanctse Dei genetricis Maria? sanati
sunt, adeb ut quotquot illd pervenire poverint, asserantur ab hac
peste salvati: quos Hugo quoque Dux stipendiis aluit quotidianis.
Horum dum quidam vellent ad propria redire, extincto refervescunt
incendio, regressique ad Ecclesiam liberantur. (Chronicle of Flodoard,
archivist of Rheims, who was fifty-one when the epidemic took place.
Pertz, iii. 393; Bouquet, viii. 199.)
In 994 there was
a violent epidemic in Aquitaine and Limousin (see Fig. 11). It is
mentioned in half a dozen chronicles one of which (3) states that
over 40,000 persons died by this pestilence. (Perhaps the writer
confused it with bubonic plague.) After an extremely severe winter
there followed a great drought and scarcity (10). The end of the
millennium was approaching^' and when a plague of invisible fire
broke out, cutting off limbs from the body and consuming many in
a single night (9), the sufferers thronged to the churches and invoked
the help of the Saints (8). The cries of those in pain and the shedding
of burned up limbs alike excited pity; the stench of rotten flesh
was unbearable; many were however cooled by the sprinkling of holy
water and snatched from mortal peril (8). The bishops of Aquitaine
assembled at Limoges (Lemovica) and the bones of St Martial, a bishop
of that town in the third century and patron of Gaul, were shown
to the people (3-6). These relics were restored to their grave on
7th December and the pestilence ceased (3). It is evident that the
epidemic occurred during several months following the harvest.
(3) . . .
plaga ignis super corpora Aquitanorum dessevit, et mortui sunt plus
40 millia hominum ab eadem pestilentia. Ideb . . . Episcopi Aquitaniae
adunati Lemovicas, levaverunt corpus S. Martialis Apostoli, et in
Montem-gaudii transtulerunt; et exinde pridie Nonas Decembris
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Fig. 9.—Fatal case of Convulsive
Ergotism, 1909, in Bihar (S.E. Hungary, now Rumania). (Photograph
due to Prof. I. v. Magyary-Kossa, Budapest.)
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Fig. 10.—Convulsive Ergotism,
Hungary, early 20th century. (Observed by Dr K. Chyzer. Photograph
due to Prof. G. Mansfeld, Pecs.)
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THE BONES OF ST MARTIAL
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FlG.
ii.—Ergotism in France.
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46
ERGOTISM
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THE DIVINE WRATH
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47
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tumulo suo restituerunt,
et cessavit pestilentia ignis (Commemoratio abbatum S. Martialis,
by Ademar de Chabannes, circa 988-1034; Bouquet, x. 318).
(4)
His temporibus pestilentise ignis super Lemovicinos exarsit: corpora
enim virorum et mulierum supra numerum invisibili igne depascebantur;
et ubique planctus terram replebat. . . . Tunc omnes Aquitaniae
Episcopi in unum Lemovicae congregati sunt: corpora quoque et reliquiae
Sanctorum undecumque solemniter advectae sunt ibi; et corpus S.
Martialis Patroni Gallise de sepulchro sublatum est (chronicle of
Ademar de Chabannes, Bouquet, x. 147).
(5)
His diebus lues gravissima Lemovicinos devoravit, incendens corpora,
et exardescendo devorans, donee omnes Aquitaniae Episcopi Lemovicae
congregati, corpus B. Martialis ab imo sublatum sepulchro mortalium
'visibus ostenderunt, et mox pestis ipsa cessavit (Fragmenta Historian
Aquitaniae, Bouquet, x. 147 footnote).
(6) Notandum
. . . corpus S. Martialis, anno scilicet 994 fuisse cum magna processione
in Montem Gaudii-Jovis reverenter deportatum propter gravissimam
plagam ignis . . . extinguendam (Gesta Lemo-vicensium Episcoporum,
Bouquet, x. 147 footnote).
(7)
Mirum in modum ardenti igne cruciantur et perimuntur Aquitani (MS.
Sangerm., Bouquet, x. 318).
(8) Contigit
aliquando judicio Dei, quodam carnis incendio multos periclitari
mortalium ex populo Christianorum: quorum multitudines ob sui remedia
deposcenda, Sanctorum expetere loca certantes. Hue etiam quam plurimi
tunc fidelium miseratione subsidioque delati sunt; qui secus Ecclesise
fusi jacentes introitum ob intolerabilem passionem, die noctuque
magnis clamoribus Salvatoris mundi clementiam, Sancti Praesulis
Genulfi suffragia proclamabant. Erat autem non solum audire stridores
eorum prae dolore, vel exustas a corporibus effluere partes videre
miseria; verum etiam ex putrae carnis fcetore res in-toleranda,
qua clade multi eorum consumpti sunt: multi etiam aquis aspersi
sacratis, rore misericordiae Dei per gloriosa Confessoris Christi
Genulfi merita refrigerati sunt, et ab illo mortis erepti periculo
(History of the Translation of St Genulfus, Bouquet, x. 361).
(9)
Desaeviebat eodem tempore clades pessima in hominibus, ignis scilicet
occultus, qui quodcumque membrorum arripuisset, exurendo truncabat
a corpore: plerosque etiam in spacio unius noctis hujus ignis consumpsit
exustio (Glabri Rodulphi Historiarum liber ii., cap. vii., de incendiis,
Bouquet, x. 20; Raoul Giaber was a monk at Cluny 1031-33, where
this was probably written.)
(10) Anno
Dom. Incarn. dccccxciiii.
Hiems durissima ... ad ultimum Non. Julii [7th July] grande
factum estgelu; tantaque siccitas . . . ut pisces morerentur ...
et fruges perirent. . . . Subsecuta quoque
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est grandis pestilentia.
(Ex Chronico Saxonico, 994, Bouquet, x. 228-229.)
A circumstantial
account of what must have been the same epidemic occurs in the life
of Adalbero II. (Bishop of Metz from 984 to 1005) written about
1012 by his friend and admirer Constantine, abbot of St Symphorian
of that town. The author relates how, when there was a great pestilence
in Burgundy and all the neighbouring countries, many sufferers,
having heard the fame of the pious prelate, flocked to his palace,
and were fed and washed by him personally, to the number of eighty
or one hundred each day. The disease showed itself by a burning
in the hands and feet and the patients, sometimes having lost one
foot, sometimes both, arrived leaning on sticks or carried on carts.
The biographer mentions that he himself took part in the care of
the sick and washed their wounds with his own hands. The stench
was unbearable.
(11) . .
. in Burgundiae cunctis finibus cladis pessima multitudinem magnam
populorum invasit, qua manibus pedibusque ardentes miserabili poena,
hie perdito uno, hie utroque truncatus pede, hie medio adustus,
aliquis tunc primum incipiens, non multum sero veniens, audito sancto
pontificis rumore, innitentes baculis aut carriotis devecti, undecumque
confluebant . . . Vere loquar, septem diebus huic divino servitio
cooperator interfui, et propriis manibus aut lavabam aut detergebam,
dum non minus centum aut octoginta, ut diximus, cotidie lavaret
et cibo recrearet . . . fetor etiam intolerabilis. Pertz, iv. 658.
That in these times
of famine the poor consumed ergot is not surprising, since even
cannibalism was reported in 996.
(12) . .
. tanta penuria bladi [of grain] et aliorum alimentorum omnium invaluit,
ut, quod auditu est horribile, homo homine vesci cogebatur (Richerius,
Chronicon monasterii senonensis, in Calmet, Histoire de Lorraine
III., cli.)
In 1039, or perhaps
a few years later, a "deadly burning" consumed many of all classes
(13). It was regarded as a sign of the divine wrath for the breaking
of the truce of God (which, inter alia, restricted fighting
to Mondays, Tuesdays, and Wednesdays). The sins of the princes were
visited on their peoples; some patients survived in a mutilated
condition as an example to those coming after. The Verdun Chronicle
(14) mentions a fire which "twisted" the people; the nervous
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48
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ERGOTISM
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THE STOCK POT
49
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symptoms seem indeed
to have been prominent, for the effects of gangrene are not alluded
to. (In other Lorraine epidemics both sets of symptoms are mentioned,
see below.) There was a remarkable remedy for the disease : relics
of the Saints were sprinkled with holy water and then washed with
wine; the wine was besprinkled with a powder, scraped from the stones
of the Holy Sepulchre, and was given to the sick, after they had
sworn to maintain the peace. So great was the number of the sufferers,
that it was found expedient to have a vessel of this potion in readiness
for those who did not come at the usual time for the ablution of
bones,.after Mass.
(13)
Deinde quoque occulto Dei judicio ccepit desaevire in ipsorum plebibus
divina ultio: consumpsit enim quidam mortifer ardor multos tam de
magnatibus, quam de mediocribus atque infimispopuli; quosdam vero
truncatis membrorum partibus reservavit ad futurorum exemplum. Tunc
etiam pene gens totius Orbis sustinuit penuriam pro raritate vini
et tritici {Glabri Rodulphi Historiarum liber v., Bouquet, x. 59-60).
(14)
a.d. 1041 . . . divino
judicio ccepit dessevire ignis qui eos torquebat: et eo anno fere
totus orbis penuriam passus est. . . . Sequuta est e vestigio mortalitas
hominum praemaxima anno ab Incarn. Dora,
mxlii. Multi eorum,
qui torquebantur ab igne, venientes ad virum Dei . . . curabantur.
. . . Videres Monasterium eximii Patris, ardentium turmis refertum;
quos ipse Sanctorum reliquis, aqua benedicta. respersis et vino
lotis, et pulvere qui de petra sepulchri Domini radebatur vino ipso
consperso et ad potandum miser is dato, pace firmata et jurata pristinse
sanitati reddebat. Pro innumeris autem turbis confluentium infirmorum
vas potui illi paratum erat, ut si advenirent aegroti, potus salutaris
non deesset; ne fallerentur, si hora. incompetenti venissent; neve
tunc foret necessitas recurrendi ad ablutionem Reliquiarum; quod
post expletionem Missa; impleri mos erat. (Chronicon Virdunense,
Bouquet, xi. 145.)
Both the convulsive
and the gangrenous symptoms are explicitly mentioned in the next
account. [Lorraine, 1085] (15).
" Many were tortured
and twisted by a contraction of the nerves; others died miserably,
their limbs eaten up by the holy fire and blackened like charcoal."
Here for the first time the fire is called " holy."
(15) Anno
Henrici Imp. xxix. (the German Emperor Henry IV., 1056-1106; hence
a.d. 1085) factus
est terrse motus magnus, et in Occidentali parte Lotharingise pestilentia
magna, ita quod multi nervorum contractione distorti cruciabantur;
alii, sacro igne membris
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exesis, ad instar
carbonum nigrescentibus, miserabiliter moriebantur (Chronicon Turonense,
by a canon of St Martin of Tours, Bouquet, xii. 465)-
There are several
accounts of an epidemic in 1089 (one places it in 1088, another
in 1090). It started near Orleans (20) in the middle of August,
in Flanders a fortnight later (17), evidently immediately after
the harvest in both regions; it also visited Lorraine. The account
of the disease in the latter province is similar to that of 1085
and is alone in mentioning nervous contractions as well as (moist)
gangrene (16). Those suffering from the latter either died miserably,
or deprived of hands and feet, they were condemned to an "even more
miserable life." Bones were cut off with a knife, when the fire
had eaten up their flesh (20). Most writers called the disease
ignis sacer (16-19) or arsura{2\)\ one (Adalgisus)
considered it identical with the Greek erysipelas (19). He evidently
clearly recognised the difference between the holy fire and bubonic
plague, for he described an outbreak of the latter disease (at Chalons
in mi) in very different terms, mentioning its rapid course and
high mortality, and the flight from plague spots.
(16) Anno
mlxxxix. . . . Annus
pestilens, maxime in occidentali parte Lotharingise, ubi multi sacro
igne interiora consumente com-putrescentes, exesis membris instar
carbonum nigrescentibus, aut miserabiliter moriuntur, aut manibus
ac pedibus putrefactis truncati, miserabiliori vitse reservantur,
multi vero nervorum contractione distorti tormentantur (Chronographia
Sigeberti Gemblacencis, Bouquet, xiii. 259. Sigebert, a monk at
Gembloux in Brabant, was one of the most famous of medieval chroniclers;
he died in 1112).
(17)
[1088] . . . Tertio Calend. Septembris visus est igneus draco volare
per medium cceli . . . statimque subsecutus est pestilens ille morbus,
qui Ignis sacer vocatur, quam turn arsuram appellabant quidam (J.
Meyer, Annales rerum Flandricarum, liber iii., p. 31 a).
(18) [1089].
Qu0 anno sseviit vehementer in Flandria sacer ignis,
quam ignariam vocabant pestem {ibid., p. 31 a).
(19) Sacer
ignis, quern Graeci heresipilam dicunt. . . . Flandriae incubuerat
partibus, christicolarum quamplurima multitudine tam horribilis
cladis verbere grassante partim prostrata, partim gemente, et prse
doloris immanitate dentibus stridente, partim morte jam multata
(Miracles of St Theoderic of Reims, by Adalgisus, soon after "23;
Bouquet, xiv. 142).
D
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50
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ERGOTISM
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THE ABBEY OF ST ANTHONY
51
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(20) Medio
fere mense augusto [incerti anni], ingens lues populum Aurelianensem
[of Orleans] devastare coepit. . . . Deinde plurimorum ossa ferro
recidebantur acuto, quorum carries exederat ignis (Bouquet,
. xiv. 142, footnote).
(21) [1090].
Hoc anno orta est pestis in hominibus, quae Arsura dicitur, qua
etiam multi perierunt (Chronicon Lobiense, Bouquet, xiii. 581).
(22) [1089].
Pestilentia terribilis. . . . Ardentium (Chronicon S. Jacobi Leodiensis,
Bouquet, xiii. 600).
There were bad
harvests and neglect of agriculture in these troublous times preceding
the Crusades. Famine, wars and disease carried off many in Germany,
France and Italy; in several places the cemeteries were rilled,
and great pits were dug to serve as a common grave (23). De Jussieu
e.a. considered that among the evils of this time the holy
fire may even have been a minor one; yet one of the accounts (25)
says the number of its victims was incredibly great, when recording
ij that the Bishop of Tournai instituted a day of prayer against
'; the disease in 1092, on the Feast of the Elevation of
the Cross, 14th September.
Another account
(26) mentions that the relics of the Saints were translated at Limoges
about the Feast of the Nativity of the Virgin (8th September), so
that there and at Tournai the epidemic was at its height within
a few weeks of the harvest.
(23)
a.d. 1094. Ipsa quoque
coemiteria Ecclesiarum ade6 sepulturis impleta sunt, ut homines
ibi mortuos suos sepelire non potuerint. Unde in pluribus locis
facta, praegrandi fossa, extra ccemiterium, omnes suos mortuos in
illam conjecerunt. Haec autem mortalitas non solum Teutonicos, sed
et Franciam, Burgundiam, Italiam usque vexabat. . . . Superstites
a secularibus vanitatibus, id est a jocis, tabernis et aliis hujusmodi
superfiuis abstinere studuerent, et ad Confessionem et poenitentiam
currere, seque Sacerdotibus commendare non cessaverunt (Chronicon
Bertoldi Constantiensis, Bouquet, xi. 27).
(24) Nam
Gallias per aliquot annos nunc seditio civilis, nunc fames, nunc
mortalitas nimis afflixerat, postrem6 plaga ilia quae circa Nivalensem
[Nivelles, Belgium] S. Gertrudis Ecclesiam orta est, usque ad vitae
desperationem terruerat; tactus enim quisquam igne invisibili quacumque
corporis parte, tamdiu sensibili tormento incomparabiliter et irremediabiliter
ardebat, quousque vel spiritum cum cruciatu, vel cruciatum cum ipso
tacto membro amitteret. Testantur hoc nonnuUi manibus vel pedibus
hac poena truncati (Chronicon Saxonicum Ekkehardi monachi Sangallensis,
Bouquet, xiii. 716).
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(25)
[io92]-
Tornaci religiosa instituta supplicatio ab Rabodone episcopo
die exaltationis sanctse Crucis ob pestem quam vocabant igniariam,
hoc est sacrum ignem. . . . Nam alii instar carbonum nigrescentes,
alii exes is morbo visceribus tabescentes, pars truncati miserabiliter
membris, incredibile est dictu quam multi mortales sacro illo igni
sunt absumpti (J. Meyer, Annales rerum Flandricarum, liber
iii., p. 31 b)-
(26)
a.d. mxciv iterata
lues subcutanei ignis plebem Aquitanicam atrocissime torrebat. ...
De toto . . . Lemovicino ad sanctissimum Martialem delata sunt sancta
Sanctorum corpora. . . . Facta est haec translatio Sanctorum circa
festivitatem Nativitatis perpetuse Virginis Mariee. (Chronicon Gaufredi
Vosiensis, not written till about 1170; Bouquet, xii. 427.)
(27)-Anno
mxcv. Fames diu concepta
gravissime ingravatur, et fit annus calamitosus. . . . Hoc anno,
sacro igne multi accenduntur, membris instar carbonum nigrescentibus
(Chronographia Sigeberti Gemblacensis, Bouquet, xiii. 260).
About this time
(1093) the Order of St Anthony was founded near Vienne,1
in Dauphine, by one Gaston, a nobleman who built a hospital near
the church containing the relics of the Saint, brought in 1070 from
Constantinople. Pope Urban II. recognised the Order in 1095 at the
Council of Clermont-Ferrand (which gave the impulse to the Crusades).
In 1297 Pope Boniface VIII. raised the priory to the dignity of
an abbey (see Histoire du clerge seculier et rigulier, i.
192, where, however, there is no mention of the holy fire). During
the twelfth century the holy fire became associated with St Anthony,
and many suffering from the disease began to visit the Saint's relics.
Of these pilgrims there is an interesting account (28) from an English
source, in the life of St Hugh of Avalon, Bishop of Lincoln (1186-1200)
and chief builder of its cathedral. Hugh was a member of the Carthusian
Order (founded about the same time and in the same region as that
of St Anthony) and was called to England by Henry II. about 1174.
During the last year of his life (1200), the bishop visited the
Grande Chartreuse and also the shrine of St Anthony; on this journey
his biographer and private chaplain accompanied him, and so described
at first hand the effects of the holy fire. The sick either died
within seven days of their arrival, or were "miraculously" restored
to health, notwithstanding the loss
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A recent writer makes it Vienna !
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52
ERGOTISM
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ST HUGH, BISHOP OF LINCOLN
53
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of their limbs.
Such recovery was, however, also observed in modern times; the chief
virtue of the hospital must have consisted in wholesome food.
(28) Vidimus enim
juvenes et virgines, senes cum junioribus, per sanctum Dei Antonium
salvatos ab igne sacro, semiustis carnibus, consumptisque ossibus,
variisque mutilatos artuum compagibus, ita in diroidiis viventes
corporibus, ut quasi integra viderentur incolumitate gaudentes.
Concurritur siquidem a totis mundi finibus ... qui omnes fere infra
diem septimam divinitus curantur. Nam si quis sub hoc dierum spatio
corporis sanitatem non recepit, . . . morte intercedente confestim
excedit. . . .
Est autem in ipsis
miraculis hoc insignius miraculum. Igne namque restincto in membris
patientium, caro et cutis, vel artus quisque, quos morbus vorax
sensim depascendo exederit, minime quidem restaurantur. Verum, quod
est mirabilius, nudatis ossibus quae truci incendio superfuerint,
sanitas et soliditas cicatricibus ipsis residui corporis tanta confertur,
ut videas plurimos in omni aetate et sexu utroque, brachiis jam
usque ad cubitos, aut lacertis usque ad humeros absumptis, similiter.
et tibiis usque ad genua, vel cruribus usque ad renes aut inguina
exustis funditus et abrasis, tanquam sanissimos multa alacritate
poliere (Magna vita S. Hugonis episcopi Lincolniensis, ed. Rev.
J. F. Dimock, Rolls Series, No. 37, p. 308).
According to de
Jussieu, e.a. there were several houses of the Order of St
Anthony in France for the care of sufferers from the holy fire ;
one at Lyons was called Domus Contractoria, and the walls
of these hospitals were painted a symbolic red. Thus in Rabelais'
Pantagruel, chapter xxx.: " Une muraille, en laquelle estoit
painct le feu de St Antoine," and Satyre Menippee, vertu du catholicon,
art. viii., " faites peindre a l'entour de votre maison, non du
feu de St Antoine, mais. . . ." According to Ozanam and Bacquias
mummified cast-off lim,bs were still preserved in the Abbey of St
Anthony in 1702. Durrer states that at one time there were 390 houses
of the Order in various countries; of the four Swiss the oldest
was founded at Basle in 1304.
In 1109 (or 1108)
a (not very severe) epidemic occurred near Chartres and Orleans
(the disease remained almost endemic near the latter town until
the eighteenth century). The summer was very wet (29). Ives, Bishop
of Chartres, in a letter to Pope Paschal II., saw in it a punishment
for the iniquity of the people (30). Another author (31) remarks
that
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famine, holy fire
and leprosy were respectively peculiar to England, France and Normandy.
(In England, and probably *also in Normandy, less rye was cultivated
than in France.)
(29)
a.d. mcix. ... In
Gallia, maxime in Aurelianensi et Carno-tensi provincia [Orleans
and Chartres] clades ignifera multos invasit, debilitavit, et quosdam
occidit. Nimietas pluviarum fructus terrse suffo-cavit . . ■ valida
fames terrigenas passim maceravit in mundo. (Historic ecclesiastical
of Orderic, born in 1075 in Shropshire; became a monk of the Monastery
of Uticum = St Evroul en Ouche in Normandy and received the name
Vitalis; the epidemic therefore happened in his life-time. Bouquet,
xii. 708.)
(30) In tantum
enim apud nos in majoribus populi abundavit iniquitas, ut nee paternis
admonitionibus obediant, nee Deum terrentem timeant; cum et ex sterilitate
terras fame pauperes eorum afficiat, et morbo qui dicitur sacer-ignis
multorum membra ad praecisionem, multorum corpora ducat ad mortem
(Epistolje Ivonis Carnotensis episcopi; ad Paschalem II. Papam;
Bouquet, xv. 148),
(31)
Anno mcix . . . multi
sacro igne accenduntur, membris instar carbonum nigrescentibus.
Tres plagse tribus region ibus appropriari solent, Anglorum fames,
Gallorum ignis, Normannorum lepra (Chronicon Alberici, Bouquet,
xiii. 690; this author copied other chronicles. The first sentence
occurs also in Sigebert of Gembloux, Bouquet, xiii. 264; the second
is from Elinandus).
Fuchs states that
according to Short (of the air, weather, etc., p. 108) in the year
1110 " the people over all England were afflicted with sore diseases,
especially an epidemic Erysipelas, where of many died; the Parts
being black and shrivelled up." I have neither been able to trace
this book, nor to find any evidence on which the statement and others
referring to the years 1182 and 1196, are based. In France there
was an unusually severe epidemic in 1128 and 1129 after a succession
of several years of famine (Chronicon Lamberti Waterlosii for 1124
and 1126, Bouquet, xiii. 498; J. Meyer, Annates rerum Flandricarum,
liber iv.; Mezeray, Histoire de France^ mentions
two consecutive years of famine caused by rain).
Among the many
accounts, the most detailed description of the disease is contained
in a book on the miracles of St Mary of Soissons, de curatione
ardentium, by a contemporary, Hugh Farsit (32). He calls the
disease a wasting one {tabificus; another account
(33) speaks of qucedam pestilentia flegmatica; it was not
acute, like bubonic plague or anthrax). Under the
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54
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ERGOTISM
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IN THE TWELFTH CENTURY
55
Monastery of St Stephen at Caen, written about
1143; Bouquet,
xii. 780.)
% (34) Anno mcxxviii
. . . multi de pago Suessonico sacro igne accensi, ad Ecclesiam
beatae Dei genitricis Marias . . . convenerunt; ... ita ut intra
quindecim dies centum et tres nominatim ab hoc igne restinguerentur,
et tres puellae distortse sanitati redderentur (Alterius Roberti
appendix ad Sigebertum, Bouquet, xiii. 328; Pertz, vi. 475; Howlett,
Rolls Series, No. 82; possibly by Robert du Mont, 1128-1186, Abbot
of Mont St Michel).
(35)
a.d. 1129. Hoc anno
plaga ignis divini Carnotum, Parisios, Suessionem, Cameracum, Atrebatum,
et alia multa loca mirabiliter pervadit; . . . Juvenes etenim, senes
cum junioribus, virgines etiam tenerae, in pedibus, in manibus,
in mamillis, et quod gravius est, in genis exuruntur, et celeriter
exstinguuntur (Anselmi Gemblacensis appendix ad Sigebertum, Bouquet,
xiii. 269).
(36)
a.d. 1129 {circa)
En eel tamps la maladie du fu qui vient de Dieu, fu moult griefs
a Chartres, a Paris, a Soissons, a Cambray, a Arras et par moult
d'aultres lieux. (Chronique de Cambrai, Bouquet, xiii. 495 ; this
seems to be the oldest mention in French.)
(37)
K-T>- II2^ ■ • • hivisibilis
ignis plurimos depastus est in regno Francorum (Chronicon S. Petri
Vivi Senonensis, Bouquet, xii. 283] this chronicle relates to Sens
in Burgundy, whither the epidemic evidently did not extend. The
same sentence occurs in Chronicon Turonense, Tours, Bouquet, xii.
470, and the epidemic is further mentioned (for the year 1129) in
Chronicon Lobiense, Bouquet, xiii. 582, and in Anonymi Blandiniensis
appendicula, St Pierre, near Gent, Bouquet, xiv. 18).
(38) Morbus
igneus . . . quern physici sacrum ignem appellant, ea. nominum institutione
qua nomen unius contrarii alterius significa-tionem sortitur (Liber
miraculorum B. Genovefaa virginis; Paris, Bouquet, xiv. 235).
For 1141 an epidemic
is briefly mentioned in Anonymi Blandiniensis appendicula, Bouquet,
xiv. 20; in Chronicon Lobiense, Bouquet, xiii. 582; and by Waterlos
in the Cambrai Chronicle, Bouquet, xiii. 501. For the year 1151
there is a single reference to holy fire by Robert of Mont St Michel
in his appendix to Sigebert's Chronicle, Bouquet, xiii. 293, and
in this year it is said to have rained from midsummer to the middle
of August (Bouquet, xiii. 275).
After the middle
of the twelfth century contemporary/ references to ergotism become
much rarer, and we may safely/ conclude that there were few epidemics
important enough to bd
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stretched and livid
skin the flesh was separated from the bones and consumed (32). Death
was denied to the sufferers until the fire invaded the vital organs.
Most strangely this fire could consume without heat, and poured
over the sufferers such an icy cold, that they could not be warmed
by any means ; and what was no less strange, if by divine grace,
the fire had been extinguished, so great a heat pervaded the limbs
of the sick, that it was often accompanied by cancer (gangrene?)
unless treated by medicaments. These details, as to the colour of
the skin, and the feeling of great heat and cold, are repeated in
modern descriptions of convulsive ergotism,^. by Lang, and leave
no doubt at all as to the identity of the disease. In 1129 the divine
fire raged in Chartres, Paris, Soissons, Cambrai and many other
places (33-36). It attacked not only the limbs, but also the breasts
and the face (35). The Blessed Virgin appeared in September with
a host of angels and in Notre Dame of Soissons 103 persons were
cured of the holy fire within a fortnight, and also three girls
whose limbs were twisted (34) ; convulsive symptoms were evidently
rare.
(32) Anno
ad incarnat. Domini mcxxviii
. . . concessa est potestas adversse virtuti plaga invisibili
percutere homines divers ae setatis et sexus in pago Suessionensi;
ita ut semel succensa corpora eorum cum intolerabili cruciatu arderent
usque ad exclusionem animae, nisi sola Dei misericordia occurreret.
Est autem morbus hie tabificus, sub extenta liventi cute carnem
ab ossibus separans et consumens, et mora. temporis augmenta doloris
et ardoris capiens, per singula momenta cogit miseros mori, et tamen
desiderantibus mortem tantum remedium denegatur: donee, prioribus
depastis artubus, celer ignis invadat membra vitalia; et, quod minim
est, ignis hie sine calore validus ad consumendum, tanto frigore
velut glaciali perfundit miserabiles, ut nullis remediis possint
calefieri. Item quod non minus est mirabile, ex quo divina gratia
restinctus fuerit, fugato mortali frigore, tantus calor in eisdem
partibus aegros pervadit, ut morbus cancri eidem fervori perssepe
se societ, nisi medicamentis occurratur. Horror est et infirmantes
et recens sanatos intueri, et vestigio mortis evasae in corporibus
eorum et faciebus exterminatis oculis pererrare (Hugo Farsitus :
De miraculis B. Mariae Suessionensis, de curatione Ardentium, Bouquet,
xiv. 234; quoted by Alberic in a slightly different form; Bouquet,
xiii. 697).
(33)
a.d. mcxxviii. . .
. Magnam multitudinem virorum et mulierum mortalitas, sacer ignis,
quae dam pestilentia flegmatica, maxime in pago Carnotensi [Chartres]
prostravit. (Chronicle of the
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56
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ERGOTISM
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mentioned by chroniclers.
One in 1235 was, however, repeatedly referred to:
(39)
I23° (I235?)-
Fames magna . . . Sequitur tanta mortalitas quod tam igne sacro
quam pestilentia multa millia hominum moriuntur (Chronicon Girardi
de Fracheto, Bouquet, xxi. 3-4).
(40)
1235 . . . facta est magna valde fames in Francia, maxime in Aquitania,
ita ut homines herbas campestres sicut animalia comederent. . .
. Ibidem quoque facta est magna pestilentia, qua multa pauperes,
magni et parvi, sacro igne accendebantur. (Speculo historiali Vincentii
Bellovacensis, Bouquet, xxi. 72. Almost identical with chronicon
Guillelmi de Nangiaco (Guillaume de Nangio) in Bouquet, xx. 547-)
(41)
1235. Pestilentia etiam sacri ignis tanta fuit, tunc in Lemo-vicinio
et in Pictavia [Limousin and Poitou], quod divites et pauperes et
pueros et senes ignis accendebat. (Majus chronicon Lemovicense,
Bouquet, xxi. 764.)
For the fourteenth
century Fuchs only mentions an outbreak of " Infirmitas Sancti
Antonii" in Brittany in 1347 (Chronicon Briocense, a bad compilation,
written about fifty years later). This, the last, appears to be
the sole reference in the chronicles, in which the fire is named
after the Saint, and the association of the two must be inferred
chiefly from what is known of the Abbey of St Anthony, especially
from the description of the visit of Hugh, Bishop of Lincoln in
1200, quoted above. Another contemporary record of this association
has been preserved in the fifteenth-century frescoes of the Chapel
of St Anthony at Waltalingen, north of Zurich; two of these are
reproduced from Durrer. Fig. 12 shows the Saint blessing the victims
of gangrenous ergotism; one on the right has lost a foot (and a
hand?); in Fig. 13 an appeal is made to him by sufferers whose limbs
have been twisted by the convulsive variety of the disease (compare
the left hand of the man on the right with Figs. 8 and 9). There
is indeed not infrequent mention of St Anthony's fire in early printed
books, down to the first half of the sixteenth century, but such
simple allusion does not include any symptoms which would permit
of certain identification with the holy fire. One passage from Rabelais
was quoted above which, according to his modern editor refers to
ergotism, but in others it is more probable that Rabelais meant
syphilis. Fuchs and Ehlers have collected a number of such later
doubtful printed references. They include an interesting one in
a book on military surgery by Gerssdorff,
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THE FIRE OF ST ANTHONY
$7
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first published
at Strassburg in 1535. The section "von dem kalten Brandt" has a
woodcut (Fig. 14) representing the appeal to St Anthony by a peasant
who has lost his right foot, and holds up his left hand enveloped
in symbolic flames. Ehlers seems to suggest that this illustration
refers to gangrenous ergotism; perhaps it does, but the text of
GerssdorfT s book brings no certainty on this point. It identifies
the cold fire with " estiomenum," the fire of St Anthony and St
Martial and "cancrena" of the Greeks. It identifies the hot fire
with ignis persicus (= anthrax), and with pruna ; it is also
called St Anthony's fire and ignis sacer. Evidently GerssdorfT
had no clear conception of St Anthony's fire, and when other authors
identify it with smallpox and even with syphilis, the confusion
towards the end of the Middle Ages is seen to be complete. Incidentally
GerssdorfT was one of the last writers to employ the term ignis
sacer, which along with St Anthony's fire, fell out of use.
Fuchs cites a few epidemics of alleged ergotism in southern Europe,
taken from Villalba's Epidemio-logia Espanola and from Portuguese
writers. They do not refer to contemporary sources and such of these
passages as I have been able to trace have not convinced me that
they deal with ergotism. The most likely is perhaps an outbreak
at the siege of Majorca in 1230, mentioned by Villalba (p. 57).
De Jussieu e.a. quote the description by an Italian writer
of the fifteenth century, Petrus Parisus, of a disease in" Sicily,
in which large livid and dark patches were formed under the knee
and extended to the calf. The leg was shortened and convulsed. The
patches seemed dried up, as if burned in a fire or dried for a long
time in the sun. They were swollen, devoid of sensation and mortified,
as is apt to happen in confirmed gangrene. ("Prive di senso et mortificate,
come suole accedere nelle cancrene confirmate.")
Since very little
rye was grown in Italy (cf. p. 3) it is not surprising that
the Italian chronicles, in contrast to the French, do not mention
the holy fire. It is all the more remarkable that it is so rarely
mentioned in Germany, where much rye was grown and convulsive ergotism
was common in modern times. This problem is referred to in the discussion
on the relationship of the two types. Some mention of gangrenous
ergotism may yet be discovered in Pertz's collection of German chronicles,
for the most part published after Fuchs' monograph. The
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SOLOGNE
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59
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<$onitmMtcn(8x<mtt.
©o <Bo« fc«m b«rng«bftrcbtc i£br/
:ptt* fcltwti ^Omf^mfottP
nit imbr.
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search is laborious
because the indexes are apparently not detailed enough. I have found
only one such reference (42) in the annals of Meissen (in Saxony)
for the year i486, which mention an outbreak of "scurvy," a name
later applied in Germany to convulsive ergotism. This, together
with the mention of gangrene and the separation of flesh from the
bones, makes it very probable that the " new and unheard of disease
" was gangrenous ergotism. The fact that it was described as contagious
is not much opposed to this view; (convulsive) ergotism was later
often so described, since several members of a family were mostly
attacked at the same time.
(42) Grassatus
est novus et inauditus in his terris morbus, quern nautse Saxonici
dicant, Den Schorbock: quae est inflammatio in membris partium camosarumcui:
quo celerius adhibetur medicina, e6 citius malum restinguitur: Sin
mora accedit paulo tardior, sequitur membri affecti mortificatio,
quam siderationem nostri, Graeci o-^aKeAov dicunt, ultimum gangraenae
malum: nam caro de ossibus defluit, et continua quseque a. lue corripiuntur.
Fuit idem morbus contagiosus, multorum mortalium gravi periculo.
(Annales urbis Misnae i486, in G. Fabricius, vol. ii., p. 71.)
Gangrenous ergotism
in modern times. — The modern history of gangrenous ergotism
starts with a letter written by Dodart [1676] to the French Academy
of Sciences, which describes the disease in the Sologne, a marshy
district south of Orleans. The attention of the Academy of Sciences
had been directed to it and Dodart was asked to report. He ascertained
from Tuillier (or Thuillier, a later spelling), a physician at Angers,
that the latter's father had already observed the disease in 1630,
knew that it was due to ergot, and had noticed the fatal effects
of the latter on poultry. Thus in France the cause of the disease
was established from the beginning, and was never in doubt among
the educated; in ^ Germany controversy about the cause of convulsive
ergotism continued down to 1800. Dodart stated that the diseased
rye was called ergot in the Sologne, on account of its resemblance
to a cock's spur, and bled cornu in the Gatinais district, respectively
south and east of Orleans. Ergot was also found in Berry t
(south of the Sologne), and the country round Blois (south-west
of Orleans), and occurred mostly on light sandy soils. In l
some years the ergot was not found to have any harmful effects
;
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Fig.
14.
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6o
ERGOTISM
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IN FRANCE
61
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these were chiefly
observed when a hot summer followed a wet spring. Ergot was said
to be most poisonous when fresh, and to lose its toxicity on keeping.
Dodart gives a brief description of the gangrene, which could only
be treated by amputation.
The publication
of Dodart's letter did much to call attention to the harmful character
of ergot, not only in France, but also in Germany [Brunner, 1695,
and others]. The next French outbreak took place in 1709, and was
recorded by the Academie des Sciences [1710]. According to
Noel, physician of the Orleans hospital, the rye crop of the Sologne
in 1709 contained nearly one-quarter of ergot, and after eating
bread from the new harvest the peasants felt almost drunk. The disease
also appeared in Languedoc and in Dauphine ; in the latter province
it was identified at the Abbey of St Anthony as the mediseval fire
of that Saint. A severe outbreak in 1747 was briefly recorded by
du Hamel [1748].
An epidemic of
gangrene occurred in the marshy country round Lille (but not in
the town) in 1749 and 1750, immediately after the war of the Austrian
Succession. It was described in considerable detail by Boucher [1762]
and is remarkable in several respects. In the first place this author
expressly excludes any "particular degeneration" of the food and
does not make a single reference to ergot; he quotes the Acadhnie
des Sciences [171 o] only in discussing the advisability of
amputation; he attributes the disease to extremes of temperatures
and to cold mists, to which the peasants working in the fields were
exposed. The spring of 1749 was unusually wet and in the summer
of that year great heat and rains alternated. All later French authors
agree, however, in regarding this epidemic as also due to ergot.
The second peculiar feature, rare in France, was the description
of nervous symptoms in the early stages of the disease. " La maladie
etoit ordinairement annoncee par des contractions spasmodiques violentes
des muscles des jambes, ou du bras et de 1'avant-bras, et par des
douleurs vives." The contraction of the flexor muscles was sometimes
so violent as to make the heels nearly touch the buttocks. This
is characteristic of convulsive ergotism, but no mention is made
of other symptoms of that disease, and the spasmodic contractions
later gave way to gangrene. It may be that the nervous symptoms
in Flanders were connected with a great mortality of cattle a year
or two earlier, mentioned by
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Boucher; it may
be also that Boucher saw the earlier and milder manifestations of
the disease. This was obviously not the case with Salerne, who in
1755 described another epidemic in the Sologne; patients began to
arrive at Orleans in the middle of August, and among them the mortality
was very high. Of 120 patients, whether operated or no, only five
left the hospital. For three to four weeks before death there was
generally a severe colic. In cases of recovery from the gangrene
the patients remained dull and stupid for the rest of their lives
(likewise in severe convulsive ergotism this, together with mania
and other forms of insanity, was not uncommon).
Delarse and Taranget
[1765] and Read [1771] described an outbreak of gangrene observed
by them in 1764 near Arras and Douai.
The year 1770
was marked by a great outbreak of ergotism in several countries
of Europe. In France gangrene appeared in Sologne, Maine, Limousin
and Auvergne. Vetillart [1770] reports that a peasant saw a farmer
sifting his grain and begged the rejected portion, consisting largely
of ergot. 1 Being in great want he did not heed warnings,
and made bread of the diseased grain. In the course of a month the
man, his wife and two children died; a third, still breast fed,
was given a porridge made from the flour; it alone escaped death,
but became completely deaf and lost both legs.
In 1777, 8000
people are said to have died of gangrene within a short time in
the Sologne district where, according to Tessier [1776, iii.], suitable
sieves were not in use; in the same year le Brun described a rather
mild epidemic in the Landes, where Raulin had earlier attributed
gangrene to atmospheric conditions. In the nineteenth century there
were still several well-marked epidemics of gangrenous ergotism
in France. The first followed the terrible winter of 1812-13, which
defeated Napoleon in Russia. It continued in 1814, 1816 and 1820,
particularly in the Departments of Saone-et-Loire and Allier; these
epidemics were described by Bordot [1818], Francois, Orjollet [1818],
Courhaut [1827] and Janson [1844]. Gangrene was preceded in many
cases by contraction of the limbs and formication.
The last epidemic
in France was described by Barrier, surgeon of the Hotel-Dieu at
Lyons, and occurred in 1855 in southern. France (departments of
Isere, Ardeche, Haute-Loire and Rhone, i.e., those bordering
on the Rhone river at and south
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62
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ERGOTISM
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LUCERNE AND WATTISHAM
63
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of Lyons). These
epidemics of the nineteenth century yielded to medical treatment
and the mortality was not so high as in the eighteenth. Apart from
them only sporadic cases of ergotism were observed.
Few epidemics
of gangrenous ergotism have been recorded outside France. The best
known was in Switzerland in 1709 (at the same time as a French
one); its notoriety is due to the accuracy of its description by
C. N. Lang,1 rather than to its severity or extent. In
the canton of Lucerne there were in 1709, in the course of ten weeks,
only fifty patients, most of whom suffered no permanent damage;
some lost toes or finger, or a foot, a few lost a leg ; only one
man died. During a recurrence in 1716 there were only ten cases,
and these yielded to treatment. In 1709 there were observed in Berne
only six cases requiring amputation. When we compare these figures
with those of Salerne, quoted above, it is evident that the latter,
in contrast to Lang, saw only the severest and most advanced cases.
Lang mentioned spasmodic movements (" gichterische Bewegungen")
in some patients, who did not suffer from gangrene, "either on account
of the smaller quantity of poison absorbed or on account of a more
robust constitution." This has given rise to the statement that
the Swiss epidemic was of a mixed type, but the severer manifestations
of convulsive ergotism were entirely wanting. Lang attributed the
disease to ergot, of which he gave a good description and a fairly
good plate {Spica secalis luxuriantis C. B.fiin. 23).
He considered that ergot is toxic only in certain years, when attacked
by honey-dew, from which the rye inside the ear is protected. "Just
as a beneficent God did not create any poison, which is wholly useless
to man, so the poisonous ergot grains have some good in them with
which they may serve to comfort mankind." This sentence introduces
a mention of the obstetrical use of ergot, recorded by Lonicerus;
Lang thought, however, that so dangerous a drug should not be administered
internally.
In a few epidemics
in Germany and Eastern Europe cases of gangrene have
been described, but here the convulsive
1 Lang
held a public medical office at Lucerne and was also a naturalist
of some distinction. His book on ergot was already rare in the eighteenth
century, and is not included in the British Museum -and the national
libraries of Berlin, Berne, Munich and Paris
; there are two copies in the library of the University of Basle.
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symptoms predominate,
so that they are dealt with in a later section. The occurrence of
gangrenous ergotism among a poor Kabyl population in Algeria,
living on ergotised barley, was described as late as 1898 by
Legrain (photograph of gangrenous feet).
In England
there appears to have been only one occurrence of typical gangrenous
ergotism, in the family of a poor agricultural labourer at Wattisham,
near Bury St Edmunds, in 1762. This outbreak aroused much interest
at the time; it was described by Wollaston and by Bones in the
Proceedings of the Royal Society, and also in the parish
register, of which Henslow (^.z/.)"has published an extract. There
is a commemorative tablet on the church tower. On 10th January two
children complained of pains in the calf of the leg; two days later
all except the father were attacked. The pain became so violent
that the neighbourhood was alarmed by the shrieks of the sufferers,
and after about a week one or more legs were " sphacelated." The
mortified parts were amputated at the ankle or knee, with little
or no pain; the foot of one child was separated without the aid
of the surgeon; the mother and five children all lost one or both
feet or legs. The father escaped such dire calamity and suffered
only from numbness of the hands and loss of finger nails. These
cases of " mortification of the limbs" are very typical of severe
gangrenous ergotism ; the dry gangrene was rapid in its onset, so
that the preliminary symptoms of cold and numbness were absent,
or at least not prominent enough for mention, except in the much
milder case of the father; apparently the gangrene was not fatal
to life. There was no rye in the neighbourhood but apart from dried
pease, pickled pork, bread, cheese, milk and small beer,
the family lived on bread from "clog-wheat, or revets, or bearded
wheat" (Triticum turgiduml) which had been laid, was discoloured,
and had been kept separate by the farmer. Some other men who had
eaten it also suffered from numbness in the hands and a feeling
of cold, but the farmer's family who had used this wheat exclusively
was not affected. It is not stated whether the wheat was ergotised,
but this must almost certainly have been the case {cf. p.
99) as to
the liability of this wheat to be ergotised). Its effect must, however,
have been reinforced by poverty or some other factor, in the case
of the mother and children. Their greater susceptibility is typical
of convulsive, rather than of
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- 64
ERGOTISM
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IRELAND AND LANCASHIRE
65
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gangrenous ergotism,
which according to most authors attacked men more than women. The
wide differences in the severity of the disease among members of
the same family seems, however, not uncommon in the gangrenous
type. According to Carbonneaux le Perdriel [1862] wheat ergot is
medicinally more active than that of rye. The Wattisham outbreak
was accepted by Tissot [1765] as undoubtedly one of ergotism, but
this unique occurrence still presents many obscure features.
In the nineteenth
century mild cases of ergotism in Ireland. were described
by Nuttall and by Colles in 1847. The only patient who came to the
Dublin hospital was a young man from a farm in Co. Meath who had
fed on bread from (ergotised) rye on marshy ground. In the year
1846 the rye crop was particularly bad and scanty (in the same year
the potato crop failed entirely). This patient had in the following
April a cold pricking sensation in his fingers, and cramp in the
legs; he lost all nails of both hands and one toe by gangrene. His
hair fell out and his pupils were dilated. He reported that he had
also lost his nails three years before, and that a few relatives
and neighbours were similarly affected. The disease seems to have
been known in the district for a long time; its cause had, however,
not been recognised.
An even milder
but more extensive epidemic of ergotism was reported recently from
Manchester by Robertson and Ashby [1928], and by Morgan [1929],
among Jewish immigrants from Central Europe who lived on rye bread.
The symptoms were coldness in the extremities, numbness and lack
of sensation in the fingers (tailors pricked themselves without
feeling it), sensation of an insect creeping under or over the skin,
headache, depression, gastric disturbances, shooting pains and
twitching in the limbs and a staggering gait. These symptoms are
characteristic of mild ergotism of the nervous kind. (Strictly speaking
this epidemic should therefore be discussed in the next section.)
All the 200 patients complained of formication, and all were in
the habit of eating bread made from one part of rye meal with four
parts of wheaten flour. The epidemic started in October 1927 after
a wet summer. The rye was grown in south Yorkshire, had been ground
to meal in a stone mill and had probably not been cleaned or screened.
It yielded 0-9 per cent, of ergot by hand-picking, and colorimetric
analysis showed 1-5 per cent, (which
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is perhaps
nearer the mark). Gaddum found later 001 per cent. alkaloid in the
ergot by pharmacological means. Something like 5 grams of ergot
must have been contained in a half-pound loaf, and in October 1927
the alkaloidal content may have been higher than that found by Gaddum.
Robertson and Ashby's publication induced Dilling and Kelly to communicate
a case of gangrene of symmetrical toes which they had observed in
1923 in a patient at Liverpool who ate only rye bread. In
two successive Novembers a toe was amputated. The rye had been grown
in Lancashire in 1922, a wet year, and was suspect. The flour was
later shown pharmacologically to contain at least o-1 per cent,
of ergot.
These sporadic
cases of ergotism show how little is known about the subject in
this country. English analysts do not seem ta be aware of the many
papers published in Germany, . Austria and Russia on the detection
and estimation of ergot in flour (see Chapter VI.). How the
ergot content of 1 per cent, was deduced in the Manchester epidemic
is by no means clear.
Convulsive
ergotism in Germany and Bohemia.—A few authors mention that
convulsive ergotism (as a result of the importation of diseased
rye from Prussia into Brabant in 1556), was first referred to by
Dodonaeus, but his Historia frumen--torum [1569] and his
Herbal, even in its later editions (e.g. 1616, well
after Lonicer and Schwenckfelt) merely contain the statement that
bread made from bad and decayed rye {malum et corrupturn)
causes various wearisome diseases, in particular that known as Schorbock
or Schoorbuyck (scurvy). As will be shown below, older German writers
regarded convulsive ergotism as a variety of this disease. In his
Medical Observations [1581] Dodonaeus attributes scurvy to
bad food, particularly to bad rye, such as that imported in 1556
from Prussia into Brabant, "when not a few began to suffer from
scurvy ; in most the effects of the evil only showed themselves
in- the gums." There is no mention of the striking symptoms of convulsive
ergotism and although rye was incriminated, it seems most likely
that Dodonaeus refers only to an outbreak of true scurvy.
The first unmistakable
description of convulsive ergotism is contained in the Epistolce
Medicinales of Balduinus Ronsseus [I590], a native
of Ghent, who became physician to the Duke of Braunschweig-Luneburg
and later to the town of Gouda in
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66
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ERGOTISM
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KRIEBELKRANKHEIT
67
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Holland. The author
describes a " new and unheard-of" disease, which broke out in August
1581 in many villages of the Duchy of Liineburg (Fig. 15) ; in two
there were 123 deaths. It began with paralysis and convulsions of
hands and feet "compressing and bending the fingers to a fist, so
that the strongest man could not unbend them." He mentions the cries
of the sufferers {maximum et horrendissimum ululatum), the
intolerable feeling of heat and other symptoms which leave no doubt
that he is referring to a severe epidemic of convulsive ergotism,
which is, moreover, known to have visited the same district in later
times. To Ronsseus the disease was unknown, and he does not mention
the word Kriebelkrankheit, so that this epidemic escaped the attention
of Taube who begins his detailed historical account with Caspar
Schwenckfeld [1603]. This Silesian naturalist, in discussing the
magpie, states that its flesh is an excellent remedy against convulsions
and spasms, and then mentions a new disease which, some fifteen
or ten years previously, had attacked the poor more especially.
The people called
the spasm " das Kromme." The ripening grain had been infested by
some baneful manna or poisonous dew (manna quadam aerea maligna,
seu rore venenato, siligojam maturescens inficiebatur), so that
all who partook of the bread baked from this grain were attacked
by the disease, particularly the old men, women and children. These
details are entirely characteristic, and with the popular German
name leave no doubt as to the identity of the disease. It is interesting
to note that Schwenckfeld, in another work, had three years previously
given one of the first descriptions of ergot itself, and mentioned
its styptic properties (of course at that time it was not known
that honey-dew and ergot are two stages in the life cycle of the
same fungus). Taube assigns the outbreak to the years 1587 and 1592,
but these dates can only be approximate. The district, on the northern
slope of the Riesengebirge, was repeatedly visited in subsequent
centuries by the same disease.
An epidemic which
broke out in the orphanage at Heidelberg in October 1589 is less
certainly identified ; most modern writers (e.g. Kobert)
seem not to have consulted the original, for they wrongly attribute
it to Zarachias Brendelius; it was, however, in a collection by
his namesake Johannes Philippus, that the report was published of
the Heidelberg physicians, charged with
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68
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ERGOTISM
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CONFUSION WITH SCURVY
69
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investigating
the outbreak. They wrote: ,( Adfectus iste . . . motus
convulsivus praecipue diaphragmatis, oris ventriculi, oesophagi,
nervorum recurrentium, quae sunt vocis instrumenta, et musculorum
thoracis et epigastrii." They attributed it to a wet season having
spoilt the vegetables, which the orphans had consumed greedily,
along with much milk. The symptoms were therefore not typical of
convulsive ergotism, nor would there appear to have been a shortage
of vitamin-A. The disease lasted for more than three months; two
similar isolated cases were observed at Worms. It seems to me that
the Heidelberg outbreak has been wrongly identified as ergotism.
The next epidemic, in Hessen and Westphalia, during 1596 and 1597,
was one of the most important in the history of the subject, for
it led the Marburg medical faculty to publish their famous description
and warning in the vernacular, for the benefit of the people [Marburg,
1597]. "Of an unusual, poisonous, infectious disease, hitherto unknown
in these parts, which disease is called by the common people here
in Hessen the tingling disease, the cramp or the spastic evil"
{die Kriebelkrankheit, Krimffsucht oder ziehende Seuche).
The original is now very rare. A Latin translation was published
by Horst [1661]; it was freely retranslated into German by Leisner
[1676], and the original text with valuable introduction and notes
was reprinted by Gruner [see Marburg 1793]; considerable extracts
were also reprinted by Wichmann [1799].
The Marburg faculty
gave the first detailed description of convulsive ergotism. The
cries of the sufferers could be heard in villages " beyond the eighth
or the tenth house and quite far off in the fields." " Good fresh
eggs and butter " are specially recommended as preventives; a purgative
and a sudorific (Kribel Pulver) are prescribed for treatment, and
were used throughout the seventeenth century; the beneficial effect
of emetics was not discovered until later. The Marburg physicians
were in error in considering the disease to be infectious, a belief
shared by some later writers, no doubt because often in a family
several members were attacked who would naturally live on the same
diet. The exact cause of the disease remained as yet unknown and
the Marburg faculty merely attributed it to bad food in general.
For a long time
there were no further precise descriptions of convulsive ergotism.
The disease was often regarded as
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a variety of scurvy
(" Schorbock " or " Scharbock"). In this connection Reusner [Be
Scorbuto > 1600] referred to the above-mentioned epidemic of
1596- 97; Sennertus [in
his De Scorbuto tractatus, 1624] reprinted the above-mentioned
letter of Ronsseus. Drawitz [1647] in his Unterricht von schmertz-ntachendem
Scharbock was the first to use the name Affectus scorbutico-spasmodicus
or scharbockische Kriebelkrankheit; he considered the disease due
to bad food in times of scarcity. He still regarded it as infectious.
The sufferers often seemed to be bewitched, or possessed by demons;
their cries could be heard four or five houses off. In the Vielvergroster
und heller polirter Schorbocks - Spiegel of 1659 Horst discusses
the question whether convulsive ergotism (Kriebelkrankheit) has
anything in common with scurvy. Sennertus, in his book
De Febribus, speaks of the Kriebelkrankheit as febris maligna
cum spasmo (" malignant fever with the cramp," as the English
edition of 1658 has it). New outbreaks occurred in Vogtland (the
south-west corner of Saxony) in 1648 and 1649 (after the Thirty
Years' War) and in 1675 (Leisner, F. Hoffmann). In 1672 and 1675
the disease occurred in Westphalia (Barbeck, May).
In France ergot
was identified as the cause of gangrene by Dodart in 1676. That
it was also the cause of the convulsive disease seems to have been
first recognised (or at least published) by J. C. Brunner in 1695,
a century after accurate descriptions of the Kriebelkrankheit had
been available. During a visit to the Harz Mountains he observed
the effects of the scarcity of food {ex inordinata militum consumptione:
Peace of Ryswyk, 1697). He discusses the effects of darnel and
of certain black grains in the rye, known locally as Martinskorn,
of which he learned with surprise that the natives believed them
to cause convulsions. Brunner was even more surprised to learn that
the black grains also caused fatal gangrene. He saw a woman who
suffered from daily recurring convulsions; her fingers were as if
burnt at the tips, rigid, indurated, devoid of sensation and of
movement. On questioning a surgeon he was told that rye was the
cause; this surgeon had amputated one of her feet which had become
gangrenous from the same cause. Brunner thus saw both kinds of ergotism
in the same patient. Wepfer, in 1694, observed a single case of
« Kriebelsucht" with violent convulsions, and
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70
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ERGOTISM
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ATTRIBUTED TO WITCHCRAFT
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after nine months
greatly diminished vision. This, like Brunner's cases, came from
the Harz Mountains, where in one village there were 150 patients.
The disease was attributed to black grains of rye, with a white
interior resulting from honeydew in the previous summer. The poor
did not separate these grains from sound corn, as was usual among
the well-to-do.
About this time
there are other less precise references to ergotism; Ramazzini attributed
an epidemic of 1693 in Lombardy to rubigo (rust), Hoyer one
of 1699-1700 near Miilhausen to honey-dew, which he considered identical
with rubigo. Hoyer did not connect the epidemic with ergot,
although he stated that in 1699 there was more " Mutterkorn " in
Thuringia than had been observed in living memory (see also Sydenham).
Later writers (Hoffmann, Taube, p. 31) identified outbreaks in 1702
near Freiberg in Saxony, and in Hanover with convulsive ergotism,
but ergot was not indeed inculpated again until 1709, when there
occurred in Switzerland an epidemic of gangrenous ergotism, described
in detail by C. N. Lang; Scheuchzer also blamed ergot. The disease
reappeared in a mild form in Switzerland in 1716, and in this and
the following year an outbreak of the purely convulsive type occurred
both in Holstein and in Saxony, giving rise to numerous publications
(nearly a dozen in 1717). The Holstein "peasants'disease" was described
in the Breslauer Sammlung and in a dissertation under Waldtschmiedt;
although they refer to ergot as the cause of gangrene, these two
accounts do not attribute the convulsive disease to it, but rather
to a peculiar constituent of the air. In Saxony grain was, however,
regarded as the cause of the convulsions; this was implied in the
local name "Kornstaupe" {Breslauer Sammlung, Haberkorn, Longolius).
Nevertheless most authors did not incriminate ergot; Longolius,
for instance, attributed the disease to honey-dew. Budseus indeed
regarded ergot as the primary cause, but honey-dew, poisonous vegetables
and fungi as contributory; two-thirds of his book was devoted to
promoting the sale of his own remedies, based on the prescriptions
of the Marburg faculty 120 years before. The Saxon epidemic was
also dealt with by Wedel and by Wilisch. The latter writes of the
" rare disease " of which few have heard and still fewer have seen
anything. Severe cases differed only from true epilepsy in that
the patients were conscious. Often
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three-quarters
of the grain consisted of ergot and other impurities. It was even
the subject of a printed sermon (Bruno) and of a theological thesis
(Kunad); a belief _in_-witchcraft was gHjl prevalent and many believed
the suife^er^-imm^jaDJiyiilsive ergotism tcTHe~ possessed by demons.
About this time some cases in St Annaberg in Saxony led to much
controversy, as is reflected in such a title as Opisthotonus
dcemoniacus deluce-datus et defensus. Arnold in his translation
[1726] of Bishop Hutchinson's Historical Essay on Witchcraft,
discusses this controversy at length. Alhrecht_£i743] remarks
that J( through ignorance of natural causes" the common
people were apt to "aserihe the symptoms of this peculiar disease
to the action of spells" (statim adfascina refert). Later
in the eighteenth century the help of the clergy was enlisted in
teaching the people the harmful effects of ergot.
After the many
publications due to the epidemic of 1717 "the pens of the learned
rested until 1723," when in a dissertation under Christian Vater
the Silesian disease was again described and the harmful effects
of ergot were insisted on. Poultry died from eating it; pregnant
sows aborted; horses and cattle became ill; flies were killed after
feeding on an infusion of ergot in milk.
In 1722 and in
the spring of 1723 outbreaks occurred in Pommerania north of Stettin,
and in the Prignitz district, north-east of Wittenberg [Muller and
Glockengiesser in Acta medicoruni Berolinensium, for 1726;
Ludolff, 1727]. At first regarded as new {autem adeo novus non
est), the disease cannot yet have been well known to the physicians
of the time. Ergot was fully recognised as the cause, and the Prussian
Government exchanged the bad rye for sound grain. Nevertheless Burghart
questioned the poisonous nature of ergot in the next epidemic [1736,
at the foot of the Sudeten Mountains, in Silesia]. The disease also
occurred on the other side of this range, in northern Bohemia, where
it was carefully described by J. A. Serine. Out of 500 patients
more than 100 died between September 1736 and March 1737. About
three-fifths of the patients were under 15 years of age. Two houses
died out completely. The poor suffered from a very great and indescribable
famine; only one of the well-to-do was attacked, and he also had
ergot among his corn. There was not a single case in the town of
Niemes, where the bread was of good quality. The people
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72
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ERGOTISM
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SCRINC AND TAUBE
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73
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believed the disease
to be infectious, but Serine was convinced of the contrary and regarded
the bad bread as the only cause. He considered that the toxicity
of the latter was due to ergot and in part also to Bromus secalinus
(" Trespe " ; see also p. 29). Serine's publication in a Latin
journal was provided with numerous footnotes in German, in order
to avoid misunderstanding, and the author was emphatic that the
disease was the real Kriebelkrankheit.
Henceforth convulsive
ergotism became well known in [Germany, and the celebrated Friedrich
Hoffmann of Halle jcollected most of the available knowledge in
his Medicina jrationalis systematica [1738], although he
did not himself observe any cases.1 In 1741 and 1742
small but locally violent outbreaks occurred in Brandenburg, near
Neu-Ruppin and Stendal. There are several descriptions: a dissertation
by Miiller under von Bergen; an account by Briickmann who reported
that in one village 150 persons were attacked, of whom 40 died between
September 1741 and April 1742; most of the patients were children;
two cases of cataract were observed; there was also much ergotised
barley. Hoffmeyer's account is interesting because of his conversation
with a patient suffering from delusional insanity [March 1742].
The winter of 1740-41 had been excessively cold and the following
spring was very wet. All these authors agree in attributing the
disease to ergot; on the other hand Kannegieser, describing a simultaneous
outbreak in Holstein, blames the cold air {inteinperies aeris,
quce toties nebulas fcetidas malignos rores et rubigenes effecit
virosas). According to him the urban population eat the same
rye as the rural, yet did not suffer.
The next record
related to a small epidemic near Potsdam which Cothenius ascribed
to ergot; even the spirit made
1 His
confused ideas as to the origin of the disease are typical of the
period ; rust {rubigo) and honey-dew descended from the air,
and produced darnel (Joliuni) and ergot: "causa est in aere
. . . aer suas exhalationes in forma rubiginis malignae, vel frumentaceae,
vel mellitae, in fruges campestres, maxime Secale, eo cum florerent
tempore deposuit; et hinc, non solum universum fere frumentum coinquinavit,
verum etiam ad lolium praesertim frumentaceum, fatuum aut temulentum,
quod Botanici vocant zizanium, nostri das Mutter-Brandtkorn, den
tauben Rocken, generandum multum contribute." Ergot was also confused
with Usiilago = smut, e.g. necrosis ustilaginea of
Sauvages [1768], and smutty rye in the English translation of Zimmermann's
Experience in Physic [1782].
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(distilled?) from
ergotised rye was harmful. Unimportant dissertations (under Fabricius,
Ludolff the younger, Detharding and particularly Linnaeus, see below)
created confusion concerning the cause of the poisonous properties
of grain, until the great epidemic of 1770-71 which gave rise to
so many publications and to such knowledge that since then few serious
outbreaks have occurred in sufficiently civilised countries. In
1770, when gangrenous ergotism was observed in France, the convulsive
type appeared extensively in northern Germany, Holstein and Sweden.
Much the most important account is that by Johann Taube (1727-99),
a Hanoverian court physician and corresponding member of the Gesellschaft
der Wissenschaften of Gottingen. He indeed published a preliminary
note in 1771, but his magnum opus of 920 pages appeared in 1782
(Fig. 16, p. 74). In the first 240 pages he abstracts nearly all
German writers on the subject, and gives his own careful description
of the disease, together with what was then known about ergot. The
bulk of the work is taken up by numerous detailed reports on patients
in hospital, and the last 132 pages form an appendix, consisting
of eight accounts by neighbouring colleagues. Taube mentions that
the winter of 1769-70 was not continuously severe ; the spring was
late, in June there was much cold and mist, particularly during
the flowering of the rye, and then after heavy rains, followed a
period of great heat and drought; much honey-dew was observed and
was not washed off by rain, but dried up and harvested ; even long
before the harvest fears of disease were expressed. Taube states
that the peasants in his district (Celle, 25 miles north of Hanover)
were in the habit of collecting the so-called Knimmelkorn which
falls out of the ears in harvesting, and baking bread from this
before threshing the main harvest, partly from curiosity, partly
from necessity. Since the larger grains of ergot fall out readily,
Krummelkorn is particularly rich in ergot, and several days after
the new bread had been eaten the disease appeared; on 29th August
1770, Taube was called to his first four patients, two of whom soon
died. Many more cases occurred in September and October and were
often rapidly fatal; later, the disease took a less rapid course.
Early in December a few cases occurred in the town of Celle as a
result of importation of rye from some of the affected villages.
As was generally observed in previous epidemics, only particular
villages were attacked; in February
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TAUBE AND WICHMANN
75
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1771 a violent
outbreak occurred in a village previously free from the disease,
after the threshing of rye from an infected locality. The Hanoverian
Government, acting on medical advice, gave warning to millers and
bakers, and exchanged ergotised rye for sound grain in the villages,
so that many patients recovered in the course of a week ; yet others
could not be convinced that the rye was poisonous and preferred
to "eat death in their own harvest" rather than accept the exchange.
Later, when the Government supplies gave out, absolute necessity
caused a recrudescence of the disease in the spring of 1771 ; the
last deaths occurred in September of that year. Taube gives a statistic
of 600 cases from Celle and some forty villages. Of 505 patients
who remained at home 91 died; of 95 patients removed to hospitals
only 6 died, so that treatment was effective (emetics, purgatives,
and better food! Shocks from a frictional electrical machine were
tried extensively, but seem to have been useless). Of 91 dead, 56
were males, 35 females; 41 were between 2 and ro years of age. Taube
records several cases of insanity, and of cataract, but observed
no gangrene of whole parts. He, however, figures a unique case in
which the dried skin of fingers and toes was cast off in one piece.
Hensler of Altona, in an appendix to Taube's treatise, gives a graphic
picture of the misery of the peasants. "Many permanently retained
stiff hands and bent fingers and toes. In all respects this is one
of the severest plagues of the agricultural labourer. Even if he
be not permanently deprived of the use of his hands, he is lamed
in the best part of the year, the spring, when he should be obtaining
a livelihood for himself and his children. . . . The misery of a
labourer's family may be imagined, when some children lie in spasms
on the floor and others cry for bread, while their parents are and
long will be unable to help. Few scenes are more poignant."
Next in importance
after Taube's book, is the account by his friend and colleague Wichmann,
of the same epidemic near Celle. He distinguishes three stages of
the disease, and gives interesting information as to the diet of
the peasants. The widespread interest taken in convulsive ergotism
at that time is proved by a collection of nineteen reports from
physicians all over Schleswig-Holstein to the Konigl. deutsche
Kammer at Copenhagen. The Royal College of Physicians of that
town in
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76
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ERGOTISM
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VIOLENT POLEMICS
77
pamphlet by Kircheisen
exculpating it. This author ate, in the course of three days, bread
containing a pound of darnel seeds and recovered, after taking an
emetic, which hardly proved his contention that darnel was the cause
of the Kriebelkrankheit. Griiner in a preface to this pamphlet writes:
" Wofern meine Stimme et was vermag, kann ich nicht umhin, die Unschad-lichkeit
des Mutterkorns aus Erfahrung zu vertheidigen." Fortunately convulsive
ergotism had by then become rare in Germany.
The great diminution
of ergotism after 1772 is due to various causes. In the first place
the cleaning of the grain became general, partly through Governmental
action. (For examples .of official warnings, after 1770, see Marx;
in Austria after 1812 insufficiently cleaned rye was confiscated.)
Further, owing to improvements in agriculture, particularly by drainage,
ergot became less common. Another important factor, as Hecker points
out, was the great increase in the cultivation of the potato, much
stimulated by Frederick the Great. According to Hecker it already
had an influence on the Silesian campaign during the Seven Years'
War. The great extension of potato growing, however, only resulted
in Germany from the famine of 1770-71, when the advantage of a subsidiary
food supply became evident in certain villages. In the south maize
later fulfilled the same function (Meier).
Nevertheless convulsive
ergotism continued in Germany, as did the gangrenous type in France;
indeed there is a dissertation by Heusinger [1856, i.] specially
devoted to the nineteenth century. Sporadic German cases from 1805-21
are most fully dealt with by Lorinser (pp. 49-66). In the latter
year, which was very wet, the rye harvest in some parts of lower
Silesia contained over one-third of ergot. It is related that the
father of a family separated the ergot from several bushels of rye,
but later, persuaded by his wife, added it all again to the first
bushel to be milled. Thus the percentage of ergot in the flour was
multiplied, and within six days the father and three children died;
the mother alone survived. A more extensive outbreak occurred in
1831 and 1832, in a swampy district of the Nieder Lausitz in Saxony
; the descriptions of this outbreak by Wagner, a local physician,
and by his nephew and namesake, are among the most useful in the
literature. An epidemic of 1855-56, in Upper Hessen, was described
and illustrated by Heusinger
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reply advised
the cleaning of grain and the plentiful use of bacon and butter
in the diet. Rodder attributed the disease to ergot {Secale corniculare)
and to seeds of Lolium, etc.
The numerous other
publications of the time are mainly of interest, because they show
that even at this late period the belief in the poisonous qualities
of ergot was far from universal. Indeed, temporarily the defenders
of ergot were in the majority. Taube devotes a special section to
them. Foremost among these was Schleger [1770], professor at Cassel,
who attempted to prove the harmless nature of ergot by animal experiments,
as did Model by chemical ones. When Nebel of Giessen described the
1770 epidemic in Hessen and gave very good evidence that ergot was
the cause of the Kriebelkrankheit, Schleger [1772] replied, without
adducing additional experiments; in any case his doses of ergot
were far too small. Nebel's retort was virulent; inter alia
he attacked his opponent's Latinity! Baldinger (Jena) also wrote
against Schleger and translated Nebel's first paper into German,
providing it with a preface of its own. Vogel (Gottingen) defended
ergot in his Schutzschrift fur das Mutterkorn als einer angeblichen
Ursache der sogenannt. Kriebelkrankheit [1771], but next year,
in his textbook of medicine, he was more cautious. With the exception
of Nebel, none of these polemical writers appear to have seen many
cases, but others who had to deal with local epidemics (Brawe of
Verden, near Bremen, Herrmann in Hessen, Marcard of Stade near Hamburg)
failed to recognise ergot as the cause. The same applies to Eschenbach
(Rostock), Leidenfrost (Duisburg), Focke (Celle). (I have not seen
the writings of Miicke, who observed the disease at Werningerode
in the Harz Mountains, of Weickart who saw it near Fulda, of Smieder
and of Richter.) Long after the epidemic of 1770 Lentin of Gottingen
remained in doubt as to the effects of ergot, which he considered
innocuous unless honey-dew descended on it. He even gives the peculiar
advice to wash such contaminated ergot with dilute potash and then
to feed it to cattle. Ergot itself could not be harmful since it
was merely a stick of corn sap dried in the air !
The inability
of many physicians of this time to see in ergot the cause of a disease
is no less remarkable than the persistence of the peasants in eating
bread made from ergotised rye. After the great epidemic of 1770-71
the harm done by ergot became generally recognised, although as
late as 1800 there appeared a
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78
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ERGOTISM
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RAPHANIA
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79
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[1856, ii.] of
Marburg. He records 102 cases with 12 deaths (11 children and 1
adult). Jahrmaerker traced the records of many patients and examined
a few survivors as late as 1911. Of Heusinger's cases at least 19
ultimately died of ergotism ; of 35 children under 10 years of age
18 died. At least half the patients never recovered completely.
The year 1854 produced sporadic fatal cases in Bohemia, described
in considerable detail by Hussa. In 1867-68 several cases from East
Prussia in the hospital at Konigsberg came to the notice of von
Leyden who afterwards dealt with them somewhat briefly in his textbook
of diseases of the spinal cord. The same year 1867 (with a cold
spring after a mild winter) produced two other small outbreaks in
Germany. Flinzer observed one on a farm near Annaberg in Saxony;
he picked out 10 to 12 per cent, of ergot from a rye of which three
parts had been mixed with one each of oats and barley ; the meal
must therefore have contained at least 6 to 7 per cent, of ergot.
The bread baked from this was almost black, and had a sweetish,
not unpleasant taste. The bread was eaten only from 6th to nth October;
on the 10th a boy of sixteen became ill; he died next day. A girl
of the same age became ill on the 12th and died on the 22nd. Several
adults were severely attacked, but survived. A less severe outbreak
near Roding in Bavaria was described by J. Mayer (19 non-fatal cases;
up to 1-5 per cent, ergot in the flour.)
The last German
epidemic of any considerable extent Occurred near Frankenburg in
Upper Hessen in the autumn of 1879, with further outbreaks in the
spring of 1880 and 1881. According to Menche the summer of 1879
had been very wet, and a warning appeared in the local paper even
before the disease declared itself. After the first cases in September,
the grain was confiscated and the millers were fined. Nevertheless,
200 cases of ergotism were notified to the police and the physicians
calculated that there were in all about 500 cases in fifteen villages.
The mortality was about 5 per cent; eight samples of confiscated
rye contained on the average 2 per cent. of ergot (hand picked);
in some samples there was one-third of Bromus secalinus;
the bread was dark with a bluish tinge and a sweetish taste. This
epidemic is of importance because over sixty patients were observed
at intervals over a period of twenty years by neurologists and psychiatrists
(Siemens, Tuczek, Walker, Jahrmaerker [1902]), who also observed
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lesions in the
posterior columns of the spinal cord. Only about
one-quarter of
this group of patients were completely cured.
A small epidemic
near Breslau was described by Tuczek [1884].
Convulsive
ergotism in Sweden, Norway and Finland.—
After Germany
these three countries rank next in interest, not so much because
the disease was common (there was much more in Russia), but because
it was exclusively convulsive in type (Dragsjuka = ziehende Seuche)
and led to several important accounts. The first of these is in
a dissertation by Heiligtag, a pupil of Rosen of Lund, and refers
to an epidemic of 1746-47. An epidemic of 1755-56 is referred to
by Bergius. Much confusion was created by a dissertation of Linne's
pupil Rothman [1763], in which the disease was wrongly attributed
to charlock (Raphanus Raphanistrum). It occurred in the province
of Krono-berg and near Carlskrona in southern Sweden. Little or
no rye was grown; the real cause seems to have been ergotised barley
{cf. also Bruckmann, in Germany, 1741-42). Since the fields
were heavily infested with charlock, Rothman, without direct experiment,
quite illogically considered this weed to be the cause of the disease,
which he termed raphania. It is a remarkable proof of the
great authority possessed by Linnaeus that the term raphania persisted
for a long time, even long after Linne's countryman Wahlin [1771]
had proved its inapplicability. Wahlin reported on epidemics in
the provinces of Jonkoping and Westergotland, principally in 1765,
and recognised that ergot was (mostly on barley) their true cause.
Bad cereals (rye, barley, oats) are also blamed by Rosenblad [1783]
who relates how a whole family died after eating porridge, and only
a breast-fed infant escaped.
Hirsch mentions
altogether ten Swedish epidemics from 1745-1867, nearly all in the
south; how heavily rye was still ergotised at a late date, results
from a report by Wahlberg, who in 1843 found a sample from Calmar
to consist of rye J; ergot of rye \ ; Bromus secalinus,
also heavily ergotised, \ ; this rye had actually killed
a woman. For further details of the history of ergotism in Sweden,
see Hedbom [1890].
The only Norwegian
epidemic on record is said to have occurred in 1851, in the Smaalehnene
province, south of Oslo, near the Swedish frontier. The discussion
in the Medical Society of Christiania, q.v., as to whether
ergot was the cause, is not wholly convincing.
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8o
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ERGOTISM
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PETER THE GREAT
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In Finland, probably
owing to the many lakes and backward condition of agriculture, convulsive
ergotism still occurred very frequently in the nineteenth century.
Spoof [1872] devoted a monograph (with map) to this subject; from
1836-71 the disease occurred sporadically in thirty-three years,
therefore almost annually; particularly severe epidemics occurred
in 1840-44 and in 1862-63. The only cereal incriminated was rye,
which in 1840 was often ergotised to the extent of one-eighth ;
in one district more than half the grain was ergot. The epidemic
of 1862-63 extended over the whole of Finland. Spoof tabulates over
1400 cases, with a mortality of 27 to 22-7 per cent, according to
the district.
Ergotism in
Russia.—The disease was common down to recent times and apparently
endemic in some districts; there was a very extensive epidemic as
late as 1926-27. The first recorded outbreak was due to a bad harvest
in 1722, chiefly between Moscow and the Volga and was investigated
by command of Peter the Great by the German physician Schober who
in 1723 published a brief account of it in the Breslauer Sammlung
(g.v.). It is also referred to in a letter of the French ambassador
Campredon, dated 29th January 1723, and published by the Imperial
Historical Society of St Petersburg in 1885, here quoted from Robert
{Historische Studien, i., p. 41); it shows the influence
of ergot on politics :—
" Je crois le
Czar trop prudent pour s'engager dans une guerre qui diminuerait
considerablement ses forces, quelque succes qu'elle put avoir. Toute
la cavalerie, qu'il avait menee a. Astrakan, est ruinee, et ses
finances sont en tres mauvais etat. La mauvaise recolte de l'annee
passee, la quantite prodigieuse des grains, qui ont peri sur la
mer Caspienne, rendront la fourniture des magasins difficile, et
il est deja mort par la disette plus de vingt mille personnes aux
environs de Nijny. On a cru d'abord que c'etait la peste, mais les
medecins qu'on a envoyes, apres un examen fort exact ont rapporte
que cette maladie n'etait point contagieuse, qu'elle ne provenait
que du mauvais grain, que les gens ont mange. II est rougeatre et
ressemble assez a l'yvraye, ayant ete gate, a ce qu'on juge par
les brouillards envenimes. Les personnes, au moment qu'elles ont
mange de ce pain, sont devenues etourdies, avec de grandes contractions
de nerfs, en sorte que ceux, qui ne sont pas morts ce jour, ont
perdu les mains et les pieds, qui leur sont tombes, comme il
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arrive en ce pays-ci,
lorsque ces membres ont ete geles. Aucun des remedes, dont on se
sert dans les maladies contagieuses, n'ont opere sur les malades,
et il n'y a que ceux qui ont pris de bonnes nourritures et mange
d'autre pain, qui ont echappe. La dissertation, que les medecins
ont faite a cette occasion, est tres curieuse, et si je puis en
avoir une copie, j'aurai l'honneur de 1'envoyer a votre eminence.
Or comme cette maladie peut avoir de facheuses suites, par la difficulte
de trouver de bon seigle pour la subsistance des habitants et d'une
armee et par la quantite du mauvais, qu'on a ordonne de bruler et
que d'ailleurs les evenements d'une guerre contre les turcs pourraient
affaiblir tout d'un coup et peut-etre sans ressource les forces
et la consideration du Czar, il est apparent, au moins jusqu'a present,
que les mouvements, qu'il fait faire a ses troupes, n'ont pour premier
motif que d'en faire montre a l'envoye turc, qu'on fait marcher
fort lentement."
It would seem
that the epidemic was both convulsive and gangrenous. Such a mixture
of the two types was again observed in Russia in 1824, 1832, 1863
and 1881, although the vast majority of epidemics in that country
were purely of the convulsive type. This appears from a review of
the Russian literature by Grunfeld [1889] dealing with epidemics
from 1832-83. Those of 1832 and 1837 involved large tracts of country
; at one time or another most parts of Russia were affected, but
the principal region was a belt between latitudes 550
and' 6o° (embracing the provinces Novgorod, Kostroma, Viatka,
Kazan, Simbirsk, the Ural Mountains) and the Volga basin southwards
to the province of the Don Cossacks. The mortality was very high,
in a number of the earlier epidemics over 50 per cent.; in 1832
and 1837 in the provinces Kazan, Kostroma and Viatka 25
to 57 per cent. [Poehl] (probably only severe cases were included
in the statistics). Epidemics of 1832 in the Novgorod province,
and of 1863 in that of Simbirsk were mixed; one in 1834 among the
Don Cossacks (much further south) was predominantly gangrenous.
More recent epidemics
are mentioned by Bechterew (Viatka province, 1889-91) and Kolossow
(provinces of Kostroma 1904, Viatka 1905-06, Tver 1911, Vladimir
1911; all these are in the northerly agricultural region, latitude
570 to 5 8°. An extensive epidemic occurred in 1926-27
in the neighbourhood of Sarapoul (between Kazan and the Ural Mountains),
in the Votyak region
F
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82
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ERGOTISM
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RUSSIAN EPIDEMIC OF 1926
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and near Perm.
It has been described by Maksudow, who was sent by the University
of Kazan to investigate the epidemic on the spot, and by Rojdestvensky
[1928]. From September 1926 to August 1927 inclusive 11,319 cases
became known to the authorities; of these 1618 were treated in hospital,
of whom 93 died. There were, however, many deaths outside the hospitals
and many cases were not officially notified. The northern and north-eastern
limits of the epidemic were not defined but the above figures refer
to a total population of 506,000, of which therefore at least 2
per cent, were attacked.
The wet and cold
summer of 1926 extended the flowering period of the rye to more
than three weeks (cf. Chapter III.). In June, July and August
the rainfall was double the normal. The rye was moreover injured
by night frosts in May, so that in the whole district the crop amounted
to two-thirds of the normal; in some places as much as 85 per cent,
was lost. This led to great scarcity and the use of unsound grain
(the price in 1926 was often double that of 1925). The proportion
of rye in the ergot varied considerably in different districts,
from 1 to 26-7 per cent by weight In winnowed grain the average
was 1-12 per cent, in grain taken from mills 0-56 to 2-40 per cent.
Of ^•j samples of flour, 31 were found to contain an inadmissible
amount of ergot. Freshly harvested rye was found to be the most
toxic. The correlation of grain inspection and medical statistics
show that the disease occurred when there was 1 per cent, of ergot
in the rye; 7 per cent, caused fatal poisoning. In 30 per cent of
the cases the disease was acute, and passed off in three to four
days; the chronic form lasted three to four months. The case mortality
varied with the district from o to 9 per cent; over the whole
region it was o-8 per cent. The symptoms were almost entirely nervous;
formication only occurred occasionally (in contrast to the older
German epidemics); there was often great hunger; psychoses and disturbance
of vision are reported. There were also cases of gangrene, in which
fingers and toes had to be amputated. Acute cases were treated with
emetics and heart stimulants, the chronic with intravenous injections
of 5 to 25 c.c. of 0-25 per cent magnesium sulphate at intervals
of one to two days. The removal of the ergot from the rye was attempted
by means of sieves (which, however, only removed the large sclerotia)
and more successfully by steeping the grain in 30
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per cent, salt
solution, when all the ergot and 10 per cent. of the grain rose
to the surface. Occasionally cows, to whom the latter mixture
was given, were poisoned. The ergot was' bought up by the Government
at 1-25 to 2-50 Rbs. (2s. 6d. to 5s.) per kilo, but nevertheless
only 1600 kilos out of an estimated 4000 tons were offered for sale.
The epidemic declined in March. In 1927 the rye was again ergotised,
up to 1-5 per cent, and a small second outbreak occurred (42 cases
were treated in September, 18 in October, 87 in November and 186
in December, mostly as out-patients). Epileptiform convulsions were
still observed during this period.
Convulsive
ergotism in other countries.—A recent very mild epidemic in
England is mentioned in the section on gangrenous ergotism.1
Some mystery is attached to an outbreak in three Belgian
prisons, in October 1844, although it was reported on at great length
by Vleminckx, in the Academy of Medicine. Hirsch is in error, when
he refers this epidemic to the mixed type; there is no mention at
all of gangrene; the symptoms were quite typical of convulsive ergotism;
for a time there were at Brussels 100 to 160 cases in hospital;
two post-mortem examinations showed lesions of the spinal cord.
The element of mystery arises from the fact that at Brussels and
at Namur little or no ergot was found in the rye, and this cereal,
as well as wheat, was exculpated in the discussion in the Academy.
The prison authorities at Ghent incriminated the rye and oats used
for making soup.
Convulsive ergotism
in Bohemia [1736, 1854] and in Denmark [Holstein 1770]
has been included in the German chronology. In Lombardy',
Ramazzini reported cases in 1693. Two extensive outbreaks occurred
in 1789 at Turin, and in 1795 at Milan (Moskati), both times in
the month of June and in a school or orphanage. The time of year
is more characteristic of pellagra, with which some have identified
the disease, but the symptoms were those of convulsive ergotism.
1 Apart
from this outbreak, there is no evidence of convulsive ergotism
in England. Willis [1667] indeed refers to the description by Gregor
Horstius of a convulsive disease in Hessen and Westphalia in the
seventeenth century (which was undoubtedly ergotism), and then states
that an epidemic in England in the spring of i66[ was certainly
of a similar type. This has induced some later writers to infer
that convulsant ergotism occurred in England in that year. Willis'
description of the symptoms hardly warrants this view, which is
also extremely improbable on other grounds.
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84
ERGOTISM
A severe epidemic
occurred in 1857 in Transylvania (Sieben-burgen, then part
of Hungary) among a poor Rumanian population addicted to alcohol.
It attracted the attention of Meier, an ophthalmologist, on account
of the resultant cataract; he, however, supplies other details.
There came to his knowledge 283 cases, 98 deaths and 23 cases of
juvenile cataract.
Thieme mentions
that extensive epidemics occurred in Hungary in 1786 and
1788, which were stopped by confiscation of the grain. Sporadic
cases occurred as late as 1908 in Bihar, then in Hungary, now in
Rumania. A convulsive one terminated fatally after three years.
(See Figs. 7, 9 and 10). Sporadic cases have also been described
of late years by Glaessner and A. Fuchs. The latter indeed believes
that outbreaks of tetany in Austria in the spring are in reality
cases of ergotism.
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