49 Ergotism
Ergotism is a disease condition acquired by eating cereal grains infected with ergot fungus. Known since the time of Galen, it was prevalent in medieval Europe, particularly among the poor who, during famine, consumed bread made from spoiled rye.
Ergot (secale cornutum, spur of the com, homed rye, womb grain), the dried sclerotium of Claviceps purpurea, develops on the ovary of common rye, or on com, where it was previously known as com smut. The actual cause of ergot in grasses was hotly debated by early naturalists, some of whom thought it occurred in rainy weather and was attributable to fog or impure atmosphere. Others believed it to be the work of worms or butterflies, whereas still others regarded it as the product of improper fecundation or perhaps the cooking of the sexual parts of the plants.Classification
Ergotism has two forms: (1) convulsive, or spasmodic, also known as creeping, which affects the central nervous system; and (2) gangrenous, which affects the blood vessels and blood supply to the extremities. Common names for the gangrenous form are St. Anthony’s fire (after the patron saint of the disease), hidden fire, saint’s fire, evil fire, devil’s fire, and holy fire. As a result of early imprecision in disease specificity and diagnosis, physicians confused ergotism with the plague and a variety of other diseases including leprosy, anthrax, typhus, smallpox, and scurvy.
Clinical Manifestations and Pathology
Convulsive or spasmodic ergotism affects the central nervous system, causing areas of degeneration in the spinal cord. Early German accounts mentioned tingling and mortification in the fingers and toes, with occasional extension to the rest of the body, and vomiting, diarrhea, intense hunger, anxiety, unrest, headache, vertigo, noises in the ear, stupor, and insomnia as symptoms. Often the limbs became stiff, accompanied by convulsive contractions of the muscles which led to staggering and awkward movements, often aggravated by being touched.
Although many victims recovered, symptoms sometimes remained for long periods, resulting in permanent stiffness of the joints, muscular weakness, optic disorders, and occasional imbecility. In the 1930s, Ralph Stockman demonstrated that convulsive ergotism was “caused by poisons (phytates) normally present in rye and other grains” which, unless broken down in the bowel, were absorbed, creating lesions in the nervous system.Midwives and empirics discovered that spasmodic ergotism caused abortion or miscarriage in pregnant women, the drying up of milk in lactating mothers, and amenhorrea in young girls. This abortifacient or oxytocic effect was later noted by orthodox medicine and led to the widespread use of ergot to accelerate uterine action. Before long, doctors began distinguishing ergot with such sobriquets as poudre obstetrical, forcing powders, or more commonly, forcing drops. Not surprisingly, it also played a major role among quacks, charlatans, and “private specialists” who promised a quick and painless cure for women desiring to “regulate” their menstrual cycles. The term “regulation” was euphemistically used to mean the termination of a pregnancy. For some, ergot substituted for the more common borax, cinnamon, and turpentine as an abortifacient.
Gangrenous ergotism often began with itching and formications in the feet, or sensations of extreme coldness, followed by burning pain, or a crop of blisters. A dark spot usually appeared on the nose or affected extremity, leading to loss of sensibility in the part. Early nineteenth-century accounts mentioned headache, dizziness, nausea, vomiting, diarrhea, and spreading erysipelatous redness. The epidermis was raised by serous exudation, and the surface assumed the appearance of gangrene with the extremities becoming withered and blackened. Usually the gangrene was dry, but the moist variety was not unknown. The patient suffered from a continual low fever and phthisical symptoms, and faced eventual death from exhaustion or septicemia.
Often, however, recovery followed loss of the affected limb. When gangrene attacked the viscera, however, death occurred quickly. Matthias Grunewald’s Isenheim Altarpiece, commissioned between 1508 and 1516 at the An- tonite monastery, and currently displayed in the Musee d’Unterlinden in Colmar, testifies to the outbreak of St. Anthony’s fire in France and its gruesome impact on those afflicted.History and Geography
First allusions to ergotism are concurrent with the French monastic hospices, which cared for the common people and which took special note of the disease. Along with these observations came the designation of patron saints for ergotism, including St. Benedict of Umbria, St. Martial of Limoges, St. Genevieve of Paris, St. Martin of Tours, and St. Anthony of Egypt whose remains were carried to France in the eleventh century. From this last saint the name St. Anthony’s fire was derived.
In his Handbook of Geographical and Historical Pathology (1883-6), August Hirsch recorded 132 epidemics of ergotism between 591 and 1789. Accounts of ergotism are also found in the Annals of the Convent at Xanten, near the Rhine, detailing an outbreak in 857, and are described by Franςois Eudes de Mezeray in the seventeenth century as St. Anthony’s fire. Later French epidemics of the gangrenous type reportedly killed 40,000 in 922 and 14,000 in Paris alone during 1128-9. The spasmodic form occurred in Spain in 1581 and 1590 and in Germany in 1595; epidemics in the Sologne district of France, in Germany, and in Switzerland recurred throughout the seventeenth century. The French districts of Sologne and Dauphine, frequently subject to flooding, suffered continuously from outbreaks of ergotism, as did Artois, Lorraine, and the Limousin. The disease also affected the Netherlands, Sweden, Majorca, Italy, Poland, and central Russia, where outbreaks were reported as late as 1926. Hirsch noted three epidemics in the British Isles, and during the American Revolutionary War soldiers stationed in upper New York State reportedly sickened on ergotted flour shipped from Ohio.
A later American outbreak reportedly occurred at a New York prison in 1825.More recent research has suggested that ergotism can explain the convulsions and hallucinations that attended religious revivals, including the Salem witchcraft affair, as well as the time of “The Great Fear” (between July 20 and August 6, 1789), which swept through the rural Coimtryside prior to the French Revolution, and even the seasonability of mortality and conception patterns in Europe.
Epidemiology and Etiology
Research in the 1930s suggested that the distribution of convulsive and gangrenous ergotism was a function of the presence or absence of vitamin A in the diet. An analysis of the 1770 epidemic of gangrenous ergotism in Sologne and of convulsive ergotism in Hanover indicated that Sologne, on the left bank of the Rhine, was a dairy district that provided a diet rich in vitamin A, whereas Hanover, on the right bank, was unable to sustain a dairy economy. The striking difference in the effects of ergot on the two communities in close proximity caused researchers to study their differing experiences in a laboratory by feeding ergot to dogs along with different levels of vitamin A. The results confirmed the efficacy of vitamin A in mitigating the effects of ergotism.
Similarly, while some researchers believed that England’s relative freedom from ergotism was due to the abundant ingestion of meat and potatoes, others demonstrated that the English diet, which was rich in milk and butter products, had enabled its inhabitants to remain relatively free from the convulsive effects of ergotized grain. In areas rich in dairy products, the phytase and the bowel bacteria broke down the poisonous phytates of the grain into the comparatively innocuous inorganic phosphates. Thus, the convulsive ergotism which had been common to nondairy areas was virtually absent in England and certain sections of France.
John S. Haller, Jr.
Bibliography
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Berde, B., and H. O. Schild, eds. 1978. Ergot alkaloids and related compounds. Berlin.
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Haller, John S., Jr. 1981. Smut’s dark poison: Ergot in history and medicine. Transactions and Studies, College of Physicians of Philadelphia, Ser. 5, ΠI: 62—79.
Hirsch, August. 1883-6. Handbook of geographical and historical pathology, 3 vols. London.
Matossian, Mary. 1982a. Ergot and the Salem witchcraft affair. American Scientist 70: 355—7.
1982b. Religious revivals and ergotism in America. Clio Medica 16: 185—92.
Stockman, Ralph. 1934. The cause of convulsive ergotism. Journal of Hygiene 34: 235-41.