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].”