Epidemics of St Anthony’s Fire, or Ergotism.
One form of epidemic malady, intimately connected with bad harvests and a poor state of agriculture, namely Ergotism, from the mixture of poisoned grains in the rye or other corn, is conspicuously missed from English records of the medieval period, although it plays a great part in the history of French epidemics of the Middle Ages, under such names as ignis sacer, ignis S. Antonii, or ignis infernalis. According to the proverbial saying already quoted, France was as notorious for ignis as England for famine, and Normandy for lepra: “Tres plagae tribus regionibus appropriari solent, Anglorum fames, Gallorum ignis, Normannorum lepra[111].” The malady was of a nature to attract notice and excite pity; it is entered by chroniclers, and is a frequent topic in French legends of the Saints. Its occurrence in epidemic form can be traced in France, with a degree of probability, as far back as 857 (perhaps to 590); six great outbreaks are recorded in the tenth century, seven in the eleventh, ten in the twelfth, and three in the thirteenth, the medieval series ending with one in the year 1373. The estimates of mortality in the several epidemics of ergotism over a larger or smaller area of France, range as high as 40,000, and 14,000, which numbers may be taken to be the roughest of guesses; but in later times upwards of 500 deaths from ergotism have been accurately counted in a single outbreak within a limited district. The epidemics have been observed in particular seasons, sometimes twenty years or more elapsing without the disease being seen; they have occurred also in particular provinces—in the basin of the Loire, in Lorraine, and, since the close of the medieval period, especially in the Sologne. The disease has usually been traced to a spoiled rye crop; but there is undoubted evidence from the more recent period that a poison with corresponding effects can be produced in some other cereals, even in wheat itself.
In a field of rye, especially after a wet sowing or a wet season of growth, a certain proportion of the heads bear long brown or purple corns, one or more upon a head, projecting in the shape of a cock’s spur, whence the French name of ergot. The spur appears to be, and probably is, an overgrown grain of rye; it is grooved like a rye-corn, occupies the place of the corn between the two chaff-coverings, and contains an abundant whitish meal. Microscopic research has detected in or upon the spurred rye the filaments of a minute parasitic mould; so that it is to the invasion by a parasite that we may trace the enormous overgrowth of one or more grains on an ear, and it is probably to the ferment-action of the fungus that we should ascribe the poisonous properties of the meal. The proportion of all the stalks in a field so affected will vary considerably, as well as the proportion of grains on each affected head of corn[112]. Rye affected with ergot is apt to be a poor crop at any rate; one or more spurred corns on a head tend to keep the rest of the grains small or unfilled; and if there be many stalks in the field so affected, the spurred grain will bulk considerably in the whole yield. When the diseased grains are ground to meal along with the healthy grains, the meal and the bread will contain an appreciable quantity of the poison of ergot; and if rye-bread were the staple food, there would be a great risk, after an unusually bad harvest, of an outbreak of the remarkable constitutional effects of ergotism. Rye-bread with much ergot in it may be rather blacker than usual; but it is said to have no peculiar taste.
It is almost exclusively among the peasantry that symptoms of ergotism have been seen, and among children particularly. The attack usually began with intense pains in the legs or feet, causing the victims to writhe and scream. A fire seemed to burn between the flesh and the bones, and, at a later stage, even in the bowels, the surface of the body being all the while cold as ice. Sometimes the skin of affected limbs became livid or black; now and then large blebs or blisters arose upon it, as in bad kinds of erysipelas. Gangrene or sloughing of the extremities followed; a foot or a hand fell off, or the flesh of a whole limb was destroyed down to the bones, by a process which began in the deeper textures. The spontaneous separation of a gangrenous hand or foot was on the whole a good sign for the recovery of the patient. Such was the ignis sacer, or ignis S. Antonii which figures prominently, I am told, in the French legends of the Saints, and of which epidemics are recorded in the French medieval chronicles. Corresponding effects of ergotism may or may not have occurred during the medieval period in other countries of Europe where rye was grown.
The remarkable thing is, that when we do begin in the sixteenth and seventeenth centuries to obtain evidence of agrarian epidemics in Germany, Sweden and Russia, which have eventually come to be identified, in the light of more recent knowledge, with ergotism, the type of the disease is different, not perhaps fundamentally or in the ultimate pathological analysis, but at all events different as being a functional disorder of the nervous system, instead of a disorder, on nervous lines, affecting the nutrition of parts and their structural integrity. This newer form, distinctive of Germany and north-eastern Europe, was known by the name of Kriebelkrankheit, from the creeping or itching sensations in the limbs at the beginning of it; these heightened sensibilities often amounted to acute pain, as in the beginning of the gangrenous form also; but the affection of the sensory nerves, instead of leading to a breakdown in the nutrition of the parts and to gangrene, was followed by disorder of the motor nerves,—by spasms of the hands and arms, feet and legs, very often passing into contractures of the joints which no force could unbend, and in some cases passing into periodic convulsive fits of the whole body like epilepsy, whence the name of convulsive ergotism[113].
Side by side with these German, Swedish and Russian outbreaks of convulsive ergotism, or Kriebelkrankheit (called by Linnaeus in Sweden by the Latin name raphania), there had been a renewal or continuance of the medieval epidemics in France, notably in the Sologne; but the French ergotism has retained its old type of ignis or gangrene. It was not until the eighteenth century that the learned world became clear as to the connexion between either of those forms of disease among the peasantry and a damaged rye-crop, although the country people themselves, and the observant medical practitioners of the affected districts, had put this and that together long before. Thus, as late as 1672-75, there were communications made to the Paris Academy of Medicine[114] by observers in the Sologne and especially around Montargis, in which ergot of rye is clearly described, as well as the associated symptoms of gangrenous disease in the peasantry; but the connexion between the two was still regarded as open to doubt, and as a question that could only be settled by experiment; while there is not a hint given that these modern outbreaks were of the same nature as the notorious medieval ignis sacer. According to Häser, it was not until the French essay of Read (Strasbourg, 1771) that the identity of the old ignis with the modern gangrenous ergotism was pointed out.
The result of the modern study of outbreaks of ergotism, including the minute record of individual cases, has been to show that there is no hard and fast line between the gangrenous and convulsive forms, that the French epidemics, although on the whole marked by the phenomena of gangrene, have not been wanting in functional nervous symptoms, and that the German or northern outbreaks have often been of a mixed type. Thus, in the French accounts of 1676, “malign fevers accompanied with drowsiness and raving,” are mentioned along with “the gangrene in the arms but mostly in the legs, which ordinarily are corrupted first.”
Again, the observations of Th. O. Heusinger[115] on an outbreak near Marburg in 1855-56, led him decidedly to conclude for the essential sameness of ignis and Kriebelkrankheit, and for the existence of a middle type, although undoubtedly the sensory and motor disorders, including hyperaesthesia, pain and anaesthesia on the one hand, and contractures of the joints, choreic movements and convulsions on the other, were more distinctive of the epidemics of ergotism on German or northern European soil.
Thus far the foreign experience of ergotism, both medieval and modern, and of its several types. We shall now be in a position to examine the English records for indications of the same effects of damaged grain.
In the English medieval chronicles an occasional reference may be found to ignis or wild fire. The reference to wild fire in Derbyshire in the Anglo-Saxon Chronicle under the year 1049, probably means some meteorological phenomenon, elsewhere called ignis sylvaticus: “Eac þ wilde fyr on Deorbyscire micel yfel dyde[116].” Whatever the ignis sylvaticus or ignis aereus was, which destroyed houses as well as crops, there appears to be no warrant for the conclusion of C. F. Heusinger that it was the same as the ignis sacer of the French peasantry[117]. An undoubted reference to ignis infernalis as a human malady occurs in the Topography of Ireland by Giraldus Cambrensis: a certain archer who had ravished a woman at St Fechin’s mill at Fore was overtaken by swift vengeance, “igne infernali in membro percussus, usque in ipsum corpus statim exarsit, et nocte eadem exspiravit.” Taking the incident as legendary, and the diagnosis as valueless, we may still conclude that the name, at least, of ignis infernalis was familiar to English writers. But in all the accounts of English famines and wide-spread sicknesses in the medieval period which have been extracted from the nearest contemporary authorities, I have found no mention of any disease that might correspond to ergotism[118].
The first undoubted instance of ergotism in England belongs to the eighteenth century. On or about the 10th of January, 1762, a peasant’s family (father, mother, and six children) of Wattisham in Suffolk, were attacked almost simultaneously with the symptoms of gangrenous ergotism, several of them eventually losing portions of their limbs. The disease began with intense pain in the legs, and contractures of the hands and feet. It was proved that they had not been using rye flour; but their bread for a short time before had been made exclusively from damaged wheat, grown in the neighbourhood and kept apart from the farmer’s good corn so as not to spoil his sample. It had been sent to the mill just before Christmas, and had been used by some others besides the family who developed the symptoms of ergotism[119].
In that authentic instance of ergotism (although not from rye), there was one symptom, the contractures of the hands and feet, which is distinctive of the convulsive form; so that the English type may be said to have been a mixture of the French form and of the form special to the north-eastern countries of Europe. With that instance as a type, let us now inquire whether any epidemics in England at earlier periods may not be brought under the head of ergotism. It is to be kept in mind that none of the medieval outbreaks were called by their present name, or traced to their true source, until centuries after; so that our task is, not to search the records for the name of ergotism, but to scrutinize any anomalous outbreak of disease, or any outbreak distinguished in the chronicles by some unusual mark, with a view to discovering whether it suits the hypothesis of ergotism. I shall have to speak of three such outbreaks in the fourteenth century, and of one in Lancashire and Cheshire in 1702[120].
The first of these is given by Knighton for a period and a locality that may have been within his own cognizance. In the summer of 1340 there happened in England generally, but especially in the county of Leicester, a certain deplorable and enormous infirmity. It was marked by paroxysms or fits, attended by intolerable suffering; while the fit lasted, the victims emitted a noise like the barking of dogs. A “great pestilence,” or perhaps a great mortality, is said to have ensued[121]. In that record the salient points are, firstly the wide or epidemic incidence of the malady, at all events in Leicestershire, which was Knighton’s own county; secondly the paroxysmal nature of the attacks, and the strange noises emitted therewith; thirdly the intolerable suffering (poena) that attended each fit (passio). Except for the clear indication of pain, one might think of the strange hysterical outbreaks, extending, by a kind of psychical contagion, to whole communities, which were observed about the same period in some parts of the continent of Europe. But of these medieval psychopathies, as they are called, there is hardly any trace in England. The Flagellants came over from Zealand to London in 1349, and gave exhibitions at St Paul’s, but that pseudo-religious mania does not appear to have taken hold among the English. The epidemic recorded by Knighton had probably a more material cause. To illustrate the somewhat meagre reference by Knighton to the strange epidemic of 1340, I shall proceed at once to the remarkable outbreak in Lancashire and Cheshire in 1702, which was clearly not a psychopathy or hysterical outbreak, and yet had a seemingly hysterical element in it. An account of it was sent to the Royal Society by Dr Charles Leigh “of Lancashire[122].”
“We have this year [1702] had an epidemical fever, attended with very surprising symptoms. In the beginning, the patient was frequently attacked with the colica ventriculi; convulsions in various parts, sometimes violent vomitings, and a dysentery; the jaundice, and in many of them, a suppression of urine; and what urine was made was highly saturated with choler. About the state of the distemper, large purple spots appeared, and on each side of ’em two large blisters, which continued three or four days: these blisters were so placed about the spots that they might in some measure be term’d satellites or tenders: of these there were in many four different eruptions. But the most remarkable instance I saw in the fever was in a poor boy of Lymm in Cheshire, one John Pownel, about 13 years of age, who was affected with the following symptoms:—
“Upon the crisis or turn of the fever, he was seized with an aphonia, and was speechless six weeks [? days], with the following convulsions: the distemper infested the nerves of both arms and legs which produced the Chorea Sancti Viti, or St Vitus’s dance; and the legs sometimes were both so contracted that no person could reduce them to their natural position. Besides these, he had most terrible symptoms, which began in the following manner: [description of convulsions follows] ... and then he barked in all the usual notes of a dog, sometimes snarling, barking, and at the last howling like an hound. After this the nerves of the mandibles were convulsed, and then the jaws clashed together with that violence that several of his teeth were beaten out, and then at several times there came a great foam from his mouth.... These symptoms were so amazing that several persons about him believed he was possessed. I told them there was no ground for such suppositions, but that the distemper was natural, and a species of an epilepsy, and by the effects I convinced them of the truth of it; for in a week’s time I recovered the boy his speech, his senses returned, his convulsions vanished, and the boy is now very cheerful. There have been other persons in this country much after the same manner.”
This epidemic of 1702 in Lancashire and Cheshire was recorded as something unusual. It had certain intestinal symptoms such as colic, which may well have followed the use of poisoned food and are indeed described among the symptoms of ergotism; there were also convulsions, large purple spots with blisters coming and going on the skin near them, and, in the single case that is given with details, there were contractures of the legs “so that no person could reduce them to their natural position,” and a continuance for several days of painful epileptiform fits attended with noises like the barking of a dog, or the hissing of a goose, “all which different sounds (I take it) proceed from the different contractions of the lungs variously forcing out the air.” The remarkable case of the boy, certified by several witnesses, is expressly given as one belonging to the general epidemic of the locality, others having been affected “much after the same manner.” Whatever suggestion there may be of ergotism in these particulars, nothing is said of gangrene of the limbs, although the livid spots and blisters are part of the symptoms of gangrenous ergotism, just as the convulsions and contractures are of convulsive ergotism. In the Suffolk cases of 1762 there were both contractures of the limbs and gangrene.
Knighton’s mention of the barking noises emitted by the sufferers of 1340 has suggested to Nichols, the author of the History of Leicestershire[123], a comparison of them with the cases investigated by Dr Freind in the year 1700, at the village of Blackthorn in Oxfordshire. Having heard a great rumour in the summer of that year that certain girls at that Oxfordshire village were taken with frequent barkings like dogs, Dr Freind made a journey to the place to investigate the cases[124].
He found that this pestis or plague had invaded two families in the village, on terms of close intimacy with each other. Two or three girls in each family are specially referred to: they were seized at intervals of a few hours with spasms of the neck and mouth, attended by vociferous cries; the spasmodic movements increased to a climax, when the victims sank exhausted. The fits had kept occurring for several weeks, and had appeared in the second family at a considerable interval after the first. The symptoms, said Freind, were those that had been described by Seidelius—distortion of the mouth, indecorous working of the tongue, and noises emitted like barking. He found nothing in the girls’ symptoms that could not be referred to a form of St Vitus’ dance or to hysteria, in which maladies, laughter, howling and beating of the breast are occasionally seen as well as the spasmodic working of the neck and limbs.
The question remains whether the cases of 1700 in the Oxfordshire village, assuming Dr Freind’s reading of them to be correct, were as illustrative of the outbreak of 1340 as the cases of 1702 in Lancashire and Cheshire, which were probably too numerous and too much complicated with symptoms of material toxic disorder to be explained as hysterical. There is, indeed, a larger question raised, whether the so-called psychopathies of the medieval and more recent periods may not have had a beginning, at least, in some toxic property of the staple food. The imagination readily fixes upon such symptoms as foaming at the mouth and barking noises, exalts these phenomena over deeper symptoms that a physician might have detected, and finds a simple explanation of the whole complex seizure as demoniac possession or, in modern phrase, as a psychopathy. Without questioning the subjective or imitative nature of many outbreaks which have been set down to hysteria, it may be well to use some discrimination before we exclude altogether an element of material poisoning such as ergot in the staple food, more especially in the case of the wide-spread hysterical epidemics of Sweden, a country subject to ergotism also[125].
These eighteenth-century instances have been brought in to illustrate Knighton’s account of the epidemic of 1340. The next strange outbreak of the fourteenth century is recorded by the St Albans historian (“Walsingham”) under a year between 1361 and 1365, probably the year 1362. Like so many more of the medieval records of epidemic sickness, it is a meagre and confused statement: “Numbers died of the disease of lethargy, prophesying troubles to many; many women also died by the flux; and there was a general murrain of cattle[126].” Along with that enigmatical entry, we may take the last of the kind that here concerns us. At Cambridge, in 1389, there occurred an epidemic of “phrensy;” it is described as “a great and formidable pestilence, which arose suddenly, and in which men were attacked all at once by the disease of phrensy of the mind, dying without the viaticum, and in a state of unconsciousness[127].” The names of phrensy and lethargy occur in the manuscript medical treatises of the time in the chapters upon diseases of the brain and nerves[128]; strictly they are names of symptoms, and not of forms or types of disease, and they may be used loosely of various morbid states which have little in common. A lethargy would in some cases be a name for coma in fever, or for a paralytic stroke; a phrensy might be actual mania, or it might be the delirium of plague or typhus fever. The “lethargy” of 1362 is alleged of a number of people as if in an epidemic, whatever the singular phrase “prophetantes infortunia multis” may mean; and the “phrensy of the mind” of which many died suddenly at Cambridge in 1389, does not look as if it had been a symptom of plague or pestilential fever. The judicious reader will make what he can of these disappointingly meagre details. But for his guidance it may be added that the French accounts of ergotism in 1676 give one of the poisonous effects as being “to cause sometimes malign fevers accompanied with drowsiness and raving,” which terms might stand for lethargy and phrensy; also that it has not always been easy, in an epidemic among the peasantry after a bad harvest, to distinguish the cases of ergotism from the cases of typhus, the contractures of the limbs, which seem so special to ergotism, having been described also for undoubted cases of typhus[129].
Whether these anomalous epidemics in medieval England were instances of convulsive ergotism or not, the English records are on the whole wanting in the evidence of such wide-spread and frequent disasters from a poisoned harvest as distinguish the French annals of the same period. One reason of our immunity may have been that the grain was better grown; another reason certainly is that rye was a comparatively rare crop in England, wheaten bread being preferred, although bread made from beans and barley was not uncommon. Thorold Rogers says: “Rye was scantily cultivated. An occasional crop on many estates, it is habitually sown in few. It is regularly sown in Cambridgeshire and some other of the eastern counties. As the period before us passes on [1259-1400], it becomes still more rare, and as will be seen below, some of the later years of this enquiry contain no entries of its purchase and sale[130].” But it is clear from the entries in chronicles, more particularly about the very period of the fourteenth century to which the three epidemics suggestive of ergotism belong, that the English peasantry suffered from the poisonous effects of damaged food, even if they suffered little from spurred rye. Thus, under the year 1383, in the history known as Walsingham’s, there is an unmistakeable reference to many fatalities, as well as serious maladies, caused by the eating of damaged fruit[131]. Again, under 1391, it is stated that this was “a hard and difficult year for the poor owing to a dearth of fruits, which had now lasted two years; whence it happened that at the time of the nuts and apples, many of the poor died of dysentery brought on by eating them; and the pestilence would have been worse had it not been for the laudable diligence of the Mayor of London, who caused corn to be brought to London from over sea[132].”