View source for Ergotism

{{Short description|Effect of long-term ergot poisoning}}
{{distinguish|egotism}}
{{mdy|date=June 2023}}
{{Infobox medical condition (new)
| name            = Ergotism
| synonyms        = Saint Anthony's fire, ergotoxicosis
| image           = Barger.TIF
| caption         = Advanced ergotism with [[gangrene]]
| pronounce       =
| field           =
| symptoms        = {{indented plainlist|
* Convulsive ergotism: [[spasm]]s, [[diarrhea]], [[paresthesias]], [[mania]], [[psychosis]], [[headaches]], [[nausea]], [[vomiting]]
* Gangrenous ergotism: [[desquamation]], weak peripheral pulses, loss of peripheral sensation, [[edema]]}}
| complications   =
| onset           =
| duration        =
| types           = Convulsive, gangrenous
| causes          = Long-term [[ergot]] poisoning
| risks           =
| diagnosis       =
| differential    =
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}

'''Ergotism''' (pron. {{IPAc-en|ˈ|ɜr|g|ə|t|ˌ|ɪ|z|ə|m}} {{respell|UR|gət-iz-əm}}) is the effect of long-term [[Ergot#Effects on humans, other mammals and LSD|ergot poisoning]], traditionally due to the [[ingestion]] of the [[alkaloids]] produced by the ''[[Claviceps purpurea]]'' fungus—from the Latin {{lang|la|clava}} "club" or clavus "nail" and {{lang|la|-ceps}} for "head", i.e. the purple club-headed fungus—that infects [[rye]] and other [[cereal]]s, and more recently by the action of a number of [[ergoline]]-based drugs. It is also known as '''ergotoxicosis''', '''ergot poisoning''', and '''Saint Anthony's fire'''.

==Signs and symptoms==
Ergotism is the effect of long-term [[Ergot#Effects on humans, other mammals and LSD|ergot poisoning]].<ref name=":0" /> The symptoms can be roughly divided into [[convulsive]] symptoms and [[gangrenous]] symptoms.<ref name=":0" /> 

Ergot alkaloids, the active compounds produced by the ergot fungus, can cause severe [[vasoconstriction]], leading to symptoms like gangrene and convulsions. Additionally, ergot alkaloids can mimic [[neurotransmitters]] and hormones in the human body, causing hallucinations and affecting hormonal balance. Chronic exposure to ergot alkaloids has been linked to reproductive issues, such as spontaneous abortions and infertility, due to their action on the pituitary gland.<ref name=":0">{{Cite journal |last1=van Dongen |first1=Pieter W.J. |last2=de Groot |first2=Akosua N.J.A. |date=June 1995 |title=History of ergot alkaloids from ergotism to ergometrine |url=http://dx.doi.org/10.1016/0028-2243(95)02104-z |journal=European Journal of Obstetrics & Gynecology and Reproductive Biology |volume=60 |issue=2 |pages=109–116 |doi=10.1016/0028-2243(95)02104-z |pmid=7641960 |issn=0301-2115}}</ref> 

===Convulsive===
[[File:Convulsivus005.tif|thumb|Convulsive symptoms of ergotism]]
Convulsive symptoms include painful seizures and [[spasm]]s, [[diarrhea]], [[paresthesia]]s, itching, mental effects including [[mania]] or [[psychosis]], headaches, [[nausea]], and vomiting. Usually the gastrointestinal effects precede [[central nervous system]] effects.{{citation needed|date=April 2022}}

===Gangrenous===
The dry [[gangrene]] is a result of [[vasoconstriction]] induced by the [[ergotamine]]-[[ergocristine]] alkaloids of the fungus.{{citation needed|date=April 2022}} It affects the more poorly vascularized [[Anatomical terms of location#Proximal and distal|distal]] structures, such as the fingers and toes. Symptoms include [[desquamation]] or peeling, weak peripheral [[pulse]]s, loss of peripheral sensation, [[edema]] and ultimately the death and loss of affected [[Tissue (biology)|tissues]]. Vasoconstriction is treated with [[vasodilators]].<ref>{{Cite journal |vauthors=Piquemal R, Emmerich J, Guilmot JL, Fiessinger JN |date=June 1998 |title=Successful treatment of ergotism with Iloprost—a case report |journal=Angiology |volume=49 |issue=6 |pages=493–497 |doi=10.1177/000331979804900612 |pmid=9631897 |s2cid=6348648}}</ref>

==Causes==
[[File:Claviceps purpurea.JPG|thumb|''[[Claviceps purpurea]]'' fungal [[sclerotium]] growing on barley]]
Historically, eating [[grain]] products, particularly [[rye]], contaminated with the fungus ''[[Claviceps purpurea]]'' was the cause of ergotism.<ref name="Harveson">{{Cite web |last=Harveson |first=Bob |date=2017-08-17 |title=Has Ergot Altered Events in World History? |url=https://cropwatch.unl.edu/2017/has-ergot-altered-events-world-history |website=Cropwatch |publisher=unl.edu}}</ref>

The toxic ergoline [[Derivative (chemistry)|derivatives]] are found in ergot-based [[medication|drugs]] (such as [[methylergometrine]], [[ergotamine]] or, previously, [[ergotoxine]]). The deleterious [[adverse effect|side effects]] occur either under high [[Dose (biochemistry)|dose]] or when moderate doses interact with [[potentiators]] such as [[erythromycin]].{{citation needed|date=April 2022}}

The alkaloids can pass through [[lactation]] from mother to child, causing ergotism in infants.{{citation needed|date=April 2022}}

===Identification of agent===
[[File:Hordeum vulgare Claviceps purpurea 23-7-2009.JPG|thumb|Ergot in [[barley]]]]
Dark-purple or black grain kernels, known as ergot bodies, can be identifiable in the heads of [[cereal]] or grass just before harvest. In most plants the ergot bodies are larger than normal grain kernels, but can be smaller if the grain is a type of wheat.{{cn|date=January 2023}}

==Prevention==

Removal of ergot bodies is done by placing the yield in a [[brine]] solution; the ergot bodies float, while the healthy grains sink.<ref>{{Cite web |last1=Wegulo |first1=Stephen N. |last2=Carlson |first2=Michael P. |date=2011 |title=Ergot of Small Grain Cereals and Grasses and Its Health Effects on Humans and Livestock |url=http://ianrpubs.unl.edu/live/ec1880/build/ec1880.pdf |website=University of Nebraska–Lincoln Extension}}</ref> Infested fields must be deep-ploughed; ergot cannot germinate if buried more than one inch (2.5&nbsp;cm) in soil{{citation needed|date=December 2021}} and therefore will not release its spores into the air. Rotating crops using non-susceptible plants helps reduce infestations, since ergot spores live only one year.{{citation needed|date=December 2021}} [[Crop rotation]] and deep tillage, such as deep [[Plough#Mould-board ploughing|mold-board ploughing]], are important components in managing ergot, as many cereal crops in the 21st century are sown with a "no-till" practice (new crops are sown directly into the stubble from the previous crop to reduce soil erosion). Wild and escaped grasses and pastures can be mown before they flower to help limit the spread of ergot.

Chemical controls can also be used but are not considered economical, especially in commercial operations, and germination of ergot spores can still occur under favourable conditions even with the use of such controls.

==History==
[[File:Mathis Gothart Grünewald 018.jpg|thumb|Detail from the painting ''Temptation of St Anthony'' by [[Matthias Grünewald]], showing a patient with advanced ergotism]]
Throughout history, outbreaks of ergotism have been documented, particularly in Europe. One of the most notable incidents occurred in 944 AD in France, where ergot poisoning led to widespread hallucinations, gangrene, and convulsions. Another significant case is associated with the Salem witch trials in 1692, where some historians believe ergotism may have contributed to the symptoms reported by the accusers.<ref>{{Cite journal |title=French Revolution |url=http://dx.doi.org/10.1163/1877-5888_rpp_com_07798 |access-date=2024-08-06 |website=Religion Past and Present|doi=10.1163/1877-5888_rpp_com_07798 |url-access=subscription }}</ref>  

[[Epidemic]]s of the disease were identified throughout history, though the references in classical writings are inconclusive. Rye, the main [[Vector (epidemiology)|vector]] (route) for transmitting ergotism, was not grown much around the [[Mediterranean]]. When Fuchs separated references to ergotism from [[erysipelas]] and other conditions in 1834, he found the earliest reference to ergotism in the ''[[Annales Xantenses]]'' for the year 857: "a great plague of swollen blisters consumed the people by a loathsome rot, so that their limbs were loosened and fell off before death".{{cn|date=January 2023}}

In the Middle Ages the gangrenous poisoning was known as "holy fire" or "Saint Anthony's fire", named after monks of the [[Hospital Brothers of St. Anthony|Order of St.&nbsp;Anthony]], who were particularly successful at treating this ailment. According to [[Snorri Sturluson]] in his {{lang|is|[[Heimskringla]]}}, King [[Magnus II of Norway]], son of [[Harald Hardrada|King Harald Sigurtharson]], who was the half-brother of Saint King [[Olaf II of Norway|Olaf Haraldsson]], died from ergotism shortly after the [[Battle of Hastings]]. The 12th-century chronicler [[Geoffroy du Breuil of Vigeois]] recorded the mysterious outbreaks in the [[Limousin (province)|Limousin]] region of France, where the gangrenous form of ergotism was associated with the local [[Saint Martial]]. Likewise, an outbreak in Paris around 1129 was reported to be cured by the relics of Saint [[Genevieve]], a miracle commemorated in the {{nowrap|26 November}} "Feast of the Burning Ones".<ref>{{Cite web |last=Jean Dupré |year=1481 |title=Missale Parisiense |url=http://gallica.bnf.fr |via=Gallica |quote=fol. 241r |location=Paris}}</ref>

The blight, named cockspur<ref>{{OED|cockspur|id=35492}}</ref> owing to the appearance of infected grains, was identified and named by [[Denis Dodart]], who reported the relation between ergotized rye and bread poisoning in a letter to the [[French Royal Academy of Sciences]] in 1676 ([[John Ray]] mentioned ergot for the first time in English the next year). "Ergotism" in this modern sense was first recorded in 1853.{{cn|date=January 2023}}

Notable epidemics of ergotism occurred into the 19th century, as in the Italian island of [[Alicudi]].<ref>{{cite web |last=Strafile |first=Andrea |title=The Bread That Made an Entire Island Hallucinate |date=16 March 2021 |url=https://www.vice.com/en/article/the-bread-that-made-an-entire-island-hallucinate/ |access-date=14 April 2021 |archive-date=14 April 2021 |archive-url=https://web.archive.org/web/20210414135943/https://www.vice.com/en/article/wx8agw/the-bread-that-made-an-entire-island-hallucinate |url-status=live }}</ref> Fewer outbreaks have occurred since then owing to rye being carefully monitored in developed countries. However, [[1951 Pont-Saint-Esprit mass poisoning|a severe outbreak]] of something akin to ergot poisoning occurred in the French village of [[Pont-Saint-Esprit]] in 1951, resulting in five deaths.<ref>{{Cite book |last=Richards |first=Ira S. |title=Principles and Practice of Toxicology in Public Health |publisher=Jones & Bartlett |year=2008 |isbn=978-0-7637-3823-5 |location=Sudbury, [[Massachusetts|MA]] |page=64}}</ref> The outbreak and the diagnostic confusion surrounding it are vividly described in [[John Grant Fuller]]'s book ''The Day of St Anthony's Fire''.<ref name="Fuller1969">{{Cite book |last=Fuller |first=John |title=The Day of St Anthony's Fire |publisher=Hutchinson |year=1969 |isbn=0-09-095460-2 |location=London}}</ref>

Ergot [[Sclerotium|sclerotiums]] were found in the gut of the [[Grauballe Man]], a [[bog bodies|bog body]] dated the late 3rd century BC.<ref>{{Cite journal |last1=Stødkilde-Jørgensen |first1=Hans |last2=Jacobsen |first2=Niels Otto |last3=Warncke |first3=Esbern |last4=Heinemeier |first4=Jan |date=March 2008 |title=The intestines of a more than 2000 years old peat-bog man: microscopy, magnetic resonance imaging and 14C-dating |journal=Journal of Archaeological Science |volume=35 |issue=3 |pages=530–534 |doi=10.1016/j.jas.2007.05.010|bibcode=2008JArSc..35..530S }}</ref>

When milled, the ergot is reduced to a red powder,<ref>{{Cite web |last=Cadwick |first=Ian |url=http://ianchadwick.com/blog/bread-madness-and-christianity |title=Bread, Madness and Christianity |date=2013-11-09 |work=Scripturient Blog Commentary |access-date=2014-11-30}}</ref> obvious in lighter grasses but easy to miss in dark rye flour. In less wealthy countries, ergotism still occurs; an outbreak in [[Ethiopia]] occurred in mid-2001 from contaminated [[barley]]. Whenever there is a combination of moist weather, cool temperatures, delayed harvest in lowland crops and rye consumption, an outbreak is possible.

Poisonings due to consumption of seeds treated with [[Mercury (element)|mercury]] compounds are sometimes misidentified as ergotism.<ref>{{Cite book |last=Ott |first=Jonathan |title=Pharmacotheon: Entheogenic Drugs, their Plant Sources and History |publisher=Natural Products |year=1993 |location=Kennewick, WA |page=145 |author-link=Jonathan Ott}}.</ref><ref>{{Citation |last=Hofmann |first=Albert |title=LSD: My Problem Child |page=6 |year=1980 |archive-url=http://arquivo.pt/wayback/20160522103440/http://www.lycaeum.org/books/books/my_problem_child/chapter1.html |url-status=dead |chapter=1: How LSD Originated |chapter-url=http://www.lycaeum.org/books/books/my_problem_child/chapter1.html |place=New York, NY |publisher=McGraw-Hill |archive-date=2016-05-22 |author-link=Albert Hofmann}}.</ref> There have been numerous cases of mass-poisoning due to consumption of mercury-treated seeds.<ref>{{Citation |last=Cotton |first=Simon |title=Molecule of the Month |date=October 2003 |url=http://www.chm.bris.ac.uk/motm/motm.htm |contribution=Dimethylmercury and Mercury Poisoning |contribution-url=http://www.chm.bris.ac.uk/motm/dimethylmercury/dmmh.htm |place=UK |publisher=School of Chemistry, [[University of Bristol]] |quote=More horrifying than this were epidemics of poisoning, caused by people eating treated seed grains.  There was a serious epidemic in Iraq in 1956 and again in 1960, whilst use of seed wheat (which had been treated with a mixture of C<sub>2</sub>H<sub>5</sub>HgCl and C<sub>6</sub>H<sub>5</sub>HgOCOCH<sub>3</sub>) for food, caused the poisoning of about 100 people in West Pakistan in 1961. Another outbreak happened in Guatemala in 1965. Most serious was the disaster in Iraq in 1971–2, when according to official figures 459 died. Grain had been treated with methyl mercury compounds as a fungicide and should have been planted. Instead it was sold for milling and made into bread. It had been dyed red as a warning and also had warning labels in English and Spanish that no one could understand.}}.</ref>

===Salem witchcraft accusations===
The [[Convulsion|convulsive]] symptoms from ergot-tainted rye may have been the source of accusations of [[Medical explanations of bewitchment|bewitchment]] that spurred the [[Salem witch trials]]. This medical explanation for the theory of "bewitchment" was first propounded by [[Linnda R.&nbsp;Caporael]] in 1976 in an article in ''[[Science (journal)|Science]]''.<ref name="Caporael 1976">{{Cite journal |last=Caporael |first=Linnda R. |author-link=Linnda R. Caporael |date=April 1976 |title=Ergotism: The Satan Loose in Salem |journal=Science |volume=192 |issue=4234 |pages=21–26 |bibcode=1976Sci...192...21C |doi=10.1126/science.769159 |pmid=769159}}</ref> In her article, Caporael argues that the convulsive symptoms such as [[Formication|crawling sensations in the skin]], [[Paresthesia|tingling in the fingers]], [[Vertigo (medical)|vertigo]], ''[[Tinnitus|tinnitus aurium]]'', [[headache]]s, disturbances in sensation, [[hallucination]], painful [[Muscle contraction|muscular contractions]], [[vomiting]], and [[diarrhea]], as well as psychological symptoms such as [[mania]], [[melancholia]], [[psychosis]], and [[delirium]], were all symptoms reported in the Salem witchcraft records. Caporael also states that there was an abundance of rye in the region, as well as climate conditions that could support the tainting of rye.<ref name="Caporael 1976" /> In 1982, historian [[Mary Kilbourne Matossian|Mary Matossian]] raised Caporael's theory in an article in ''[[American Scientist]]'', in which she argued that symptoms of "bewitchment" resemble the ones exhibited in those affected by ergot poisoning.<ref>{{Cite journal |last=Matossian |first=Mary |date=July–August 1982 |title=Ergot and the Salem Witchcraft Affair |journal=American Scientist |volume=70 |issue=4 |pages=355–357 |bibcode=1982AmSci..70..355M |pmid=6756230}}</ref>

The hypothesis that ergotism could explain cases of bewitchment has been subject to significant debate and has been criticized by several scholars. Within a year of Caporael's article, historians Nicholas Spanos and Jack Gottlieb refuted the idea in the same journal.<ref>{{Cite journal |last1=Spanos |first1=Nicholas |last2=Gottlieb |first2=John 'Jack' |date=December 1976 |title=Ergotism and the Salem Village Witch Trials |journal=Science |volume=194 |issue=4272 |pages=1390–1394 |bibcode=1976Sci...194.1390S |doi=10.1126/science.795029 |pmid=795029 |s2cid=41615273}}</ref> In Spanos and Gottlieb's rebuttal to Caporael's article, they concluded that there are several flaws in the explanation. They noted that if ergotism was present in Salem, the symptoms would have occurred by household, not individual. Whole families, and particularly all the young children in a household, would have shown symptoms, but this was not the case. In general, the proportion of children affected was significantly less than in a typical ergotism epidemic. Spanos and Gottlieb also state that most of ergot poisoning's symptoms, like crawling and tingling sensations, vertigo, tinnitus, vomiting, and diarrhea, do not appear in the records of events in Salem. Lastly, they note that convulsive ergotism epidemics only take place in communities suffering from vitamin A deficiencies; they argued that residents of Salem, living in a farming community with ample access to [[Dairy product|dairy]], would have had no reason to be [[Vitamin A deficiency|deficient]] in [[vitamin A]]. Therefore, an outbreak of ergotism as the cause of the Salem epidemic was unlikely. Historians published in the early 21st century continue to stand by Spanos and Gottlieb's conclusion.<ref>{{Cite book |last=Ray |first=Benjamin |title=Satan & Salem: The Witch-Hunt Crisis of 1692 |publisher=University of Virginia Press |year=2013 |location=Charlottesville}}</ref>

Historian Leon Harrier has argued that only some members of a household might have shown symptoms because they had underlying conditions. Being chemically similar to [[lysergic acid diethylamide]] (LSD), ergot would not survive in the acidic environment of a typical human's stomach, especially in properly cooked food.{{cn|date=January 2020}} But if some residents of a household were malnourished and had bleeding stomach ulcers, those individuals would have had a heightened risk of absorbing the toxin (even with properly cooked food items) through the stomach lining, offering a direct route to the bloodstream. Only those with these preexisting conditions would have been affected by ingesting contaminated grains, leaving the majority unaffected. 

Anthropologist H. Sidky noted that ergotism had been known for centuries before the Salem witch trials and argued that its symptoms would have been recognizable during the time of the Salem witch trials.<ref>{{Cite book |last=Sidky |first=H. |title=Witchcraft, Lycanthropy, Drugs and Disease: An Anthropological Study of the European Witch Hunts |publisher=[[Peter Lang (publishing company)|Peter Lang]] |year=1997 |isbn=0-8204-3354-3}}{{page needed|date=July 2014}}</ref> 

In 2003 it was pointed out that ergots produced by different strains of ''[[Claviceps purpurea]]'', as well as those growing in different soils, may produce different ergot alkaloid compositions. This may explain the different manifestations of ergotism in different outbreaks. For example, an alkaloid present in high concentrations in ergots from Europe east of the [[Rhine]] may have caused convulsive ergotism, while ergot from the west caused epidemics of gangrenous ergotism.<ref>{{Cite journal |last=Eadie M.J. |date=July 2003 |title=Convulsive ergotism: epidemics of the serotonin syndrome? |journal=Lancet Neurology |volume=2 |issue=7 |pages=429–434 |doi=10.1016/S1474-4422(03)00439-3 |pmid=12849122 |s2cid=12158282}}</ref>

== Cultural and religious beliefs ==
In medieval Europe, outbreaks of ergotism were sometimes interpreted as divine punishment or witchcraft. The condition's symptoms, particularly hallucinations and convulsions, often led to accusations of demonic possession. The disease's association with St. Anthony's Fire is linked to the Order of St. Anthony, a medieval Christian order that provided care for ergotism sufferers.<ref>{{Cite book |last=Pócs |first=Éva |date=January 1998 |title=Between the Living and the Dead |url=http://dx.doi.org/10.1515/9786155225307 |publisher=Central European University Press |doi=10.1515/9786155225307|isbn=978-615-5225-30-7 }}</ref>

== Environmental factors ==
The prevalence of ergotism was closely linked to environmental conditions, such as cold, damp weather, which promoted the growth of the ergot fungus. Poor storage of grain also contributed to the risk of contamination. Changes in agricultural practices and the introduction of disease-resistant crop varieties have largely eliminated ergotism in modern times.<ref>{{Cite journal |date=2020-09-05 |title=Immunotherapy-Resistant Cancers Eliminated in Mouse Study |url=http://dx.doi.org/10.1097/01.cot.0000697480.19628.fd |journal=Oncology Times |volume=42 |issue=17 |pages=18 |doi=10.1097/01.cot.0000697480.19628.fd |issn=0276-2234}}</ref>  

==See also==
* [[Dancing plague of 1518]]
* [[Great Fear]] of 1789

==References==

{{Reflist}}

== External links ==
* {{Commons category-inline|Ergotism}}
{{Medical resources
|  DiseasesDB     = 30715
|  ICD10          = {{ICD10|T|62|2|t|51}}
|  ICD9           = {{ICD9|988.2}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    =
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D004881
}}
{{Poisoning and toxicity}}
{{Authority control}}

[[Category:Mass poisoning]]
[[Category:Neurological disorders]]
[[Category:Toxic effect of noxious substances eaten as food]]
[[Category:American witchcraft]]
[[Category:Salem witch trials]]