George Barger

Ergot and Ergotism, 1931

Chapter 2

TWO TYPES OF ERGOTISM                     21
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
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 literature of modern times clearly shows the existence .of two distinct types of ergot poisoning, the convulsive and the gangrenous, respectively east and west of the Rhine. Many authors have regarded these varieties as two distinct diseases. If we represent symptoms of gangrenous ergotism by dashes and those of the convulsive type by dots, this view may be represented diagrammatically by the letter V; the two diseases have merely a common starting point in ergot.
\           /              !
\         /                 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
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
Fig. 6.—Lesions of the Spinal Cord.
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
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,
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
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
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
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.
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
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
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
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,ihe calf. The .jmlse arH grP^tit^^J2?giT^L^-i't'^^" fy^3!; sometime-Mere was jglight vomiting. The intellect was dulled. In %veteurse oT> a lew ~ieks the part affectc'                   n a fooi. than a hand) ;
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
CONVULSIVE SYMPTOMS                       33
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,
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
34                                      ERGOTISM
HUNGER AND WORMS                          35
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^» "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
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
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
FlG. 7.—Gangrenous Ergotism, Hungary, early 20th century. (Observed by Dr K. Chyzer. From a photograph lent by Prof. G. Mansfeld, Pecs.)
Fig. 8.—Convulsive Ergotism. (Heusinger, 1856.)
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).
38                                      ERGOTISM
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:—
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
Per cent.
Bohemia, 1736-37
Serine j
Hanover, 1770-71
Finland, 1840 41 .
Hessen, 1855-56 .
Siebenblirgen, 1857
1 283
Finland, 1862-63 .
J H29
about 10
Hessen, 1879-81 .
M enche
UNRNOWN TO THE ANCIENTS                 41
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.
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
42                                      ERGOTISM
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
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
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
Fig. 9.—Fatal case of Convulsive Ergotism, 1909, in Bihar (S.E. Hungary, now Rumania). (Photograph due to Prof. I. v. Magyary-Kossa, Budapest.)
Fig. 10.—Convulsive Ergotism, Hungary, early 20th century. (Observed by Dr K. Chyzer. Photograph due to Prof. G. Mansfeld, Pecs.)
FlG. ii.—Ergotism in France.
46                                          ERGOTISM
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
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
THE STOCK POT                            49
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
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).
THE ABBEY OF ST ANTHONY                    51
(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).
(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
A recent writer makes it Vienna !
52                                          ERGOTISM
ST HUGH, BISHOP OF LINCOLN                  53
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
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
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
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
mentioned by chroniclers. One in 1235 was, however, repeatedly referred to:
(39)   I2(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,
THE FIRE OF ST ANTHONY                    $7
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
©o <Bo« fc«m b«rng«bftrcbtc i£br/ :ptt* fcltwti ^Omf^mfottP nit imbr.
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 ;
Fig. 14.
6o                                      ERGOTISM
IN FRANCE                                     61
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
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
LUCERNE AND WATTISHAM                   63
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.
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
- 64                                      ERGOTISM
IRELAND AND LANCASHIRE                   65
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
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
KRIEBELKRANKHEIT                          67
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
CONFUSION WITH SCURVY                    69
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
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
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
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
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].
(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
TAUBE AND WICHMANN                       75
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
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
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
[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
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.
PETER THE GREAT                            81
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
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
RUSSIAN EPIDEMIC OF 1926                   83
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
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.
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.