What could human art do for a disease

One can not unfortunately be enlightened by the writers of the Middle Ages, whose theme is made in advance, and which replace by the marvelous, the rational explanations of natural phenomena. Not until the XVIII th century to see take this problem into serious scientific conditions. It was then that some experimenters thought that they had lifted the veil that had covered this etiology for so long. The evil of ardents and its derivatives have been, to hear them, only a form of ergotism . This convenient hypothesis was eagerly welcomed as a kind of revelation against which it is difficult to claim.

“There is every reason to believe, Read said, that the different diseases that afflicted France in the X th , XI e , XII th , XIII th and XVI th centuries, as the sacred fire of burning sickness , infernal fire and evil St. Anthony owed their origin to the use of ergoted rye .

Mr D r Roche has adopted verbatim and trust the opinion of the Commissioners of the Royal Society on the separation of burning sickness and fire Saint-Antoine. The affection thus named was, he says, probably nothing more than gangrenous ergotism . He regrets, however, that “the absolute lack of detail in the accounts of these scourges does not permit us to affirm anything in this respect .”

In a reading made at the Royal Academy of Medicine of Belgium, November 24, 1849, Dr. de Mersseman sought to establish that the disease of sacred fire, which is so often mentioned in the chronicles of the Middle Ages, was leprosy . The reasons and the reconciliations which he invoked in support of this rather unforeseen thesis, did not seem to allow Dr. Fallot to be able to support the control of a severe criticism, founded on the enlightened interpretation of the facts. This doctor prefers to believe with Ozanam that this disease is only a matter of ergotism , and he relies mainly on a learned work of Dr. C.-H. Fuchs of Berlin .

He argues, like him, that the chronicles prior to X th century, designate this condition under the generic name of plague ; but that from that time it is described under those of ignis sacer , arsura , evil ardents , clades or pestis inguinaria . After the XII th century, it is called: ignis Sancti Antonii , Sancti Martialis , Beatae Virginis , ignis vel invisibilis infernalis .

As from the XIV th century, the authors change the destination of the name, sacred fire and give him no more than gangrene in the slough, the mortification in general, or the most varied skin diseases ( herpes , shingles , coal , etc.).

I leave to M. Fallot, or, to speak better, to Dr. Fuchs, whose indications he follows, the responsibility for a historical synonymy to which I should have to reproach many times. I limit myself to a brief account of the principal reasons which, according to the German author, demonstrate the truth of the cereal or ergotic etiology.

1 o Explosion of the disease in years with severe winter, wet and rainy summer, after poor harvests, and during famine or famine.

2 o Restricted circumscription of the disease in France, in Lorraine, Flanders, Aquitaine, Dauphine, Ile de France; immunity of Italy with a better understood culture.

3 o Also limited duration of the epidemic, rarely exceeding one year, and in this case, consecutive to two previous years of scarcity. Cessation at the return of spring.

4 o Finally, identity of symptoms in different places and times .

All these motifs probably form a specious argumentation. But besides that they do not prove the original intervention of the ergot, and that they give substance to discussion, one realizes very quickly, when one wants to verify them, that they were arbitrarily alleged, in the interest of a system.

Thus, for example, the radius of the sphere of activity of the scourge is not so limited as one would like to say, since, after having ravaged immense French provinces, it has also extended to a part of Europe, and that Italy itself has not been defended, as it is claimed, by the superiority of its mode of cultivation. Petrus Parisus, author of the XV th century saw reign trépano and Palermo in Sicily, an epidemic that has the greatest relationship with that of France and the north.

This writer represents to us the greatest number of patients, as having under the articulation of both knees, large, livid, dark spots which extended to the calf. A permanent spasm held the retracted leg. The affected parts were so hard and dry that they appeared to have been exposed to fire or the heat of the sun. They were numb, deprived of feeling, and in this state of mortification which characterizes confirmed gangrene .

M. Fallot also reduced the total duration of the disease of the Middle Ages free of charge. It is well known that it has lasted several centuries with the usual alternatives of popular diseases of the same order.

It is known that these diseases, after their first explosion, affect the sporadic form for a certain time, to resume intermittently and without appreciable cause their first vigor and expansion. It seems that they want to acclimatize in the places they have invaded and perpetuate themselves in an endemic state. Thus it was feared that the fire of St. Anthony would be fixed forever in the theaters of its ravages; in this respect leprosy, its contemporary, can be compared to it.

In spite of the uncertainties and the obscurities which remain on this point, M. Fallot concludes with the probable identity of the sacred fire and the gangrenous ergotism. The only difference would be in substituting a name specifying the cause for a name that indicates one of the main symptoms.

In this hypothesis, it would be easy to explain the return of these epidemics, at a time when the cultivation of cereals was completely neglected, or compromised by the incessant succession of meteorological troubles. Mr. Fuchs has counted twenty-eight, spaced in a period of five hundred years, since 857, which he believes to be the date of the first invasion, until 1347. Ozanam mentions only sixteen, probably because his calculation does not rise as high.

Some of these stories expressly mention the alteration of the grains. In 1096, the bread was red with blood, which Mezeray attributes to a kind of fake wheat .

It may be contrasted with M. Fallot that, under the reign of the sacred fire, rye entered the diet only for a very small proportion.

This honorable colleague mitigates the objection by saying that ergotism is not the exclusive effect of rye ( secale cornutum ); but still, mixing with some grasses.

The ergot proper ( Sclerotium clavus ) also attacks other cereals, barley in particular. However, before the introduction of rye in the daily diet of the people, barley figured in the making of bread and soups.

Mr. Fallot could have added that wheat is also subject to parasite invasion. Dr. Mialhe did some research that showed him the chemical identity of the rye wheat and rye. Like the latter, wheat contains an abundant fat, a particular fat, albuminous and gummy matter, crystallizable salts, and finally a sui generis extractive material , ergotine .

According to this similarity of composition, M. Mialhe has presumed that the same must be true of physiological and therapeutic properties. Clinical experience seems to have verified its predictions .

Be that as it may, it is certain that the evil of ardents betrays the prior action of a powerful and general influence which has been exerted on populations fatally predisposed. This is the fact that gives us the observation. The hypothesis begins when it is claimed that this cause is unique, and that the disease is only poisoning by the ergot of rye. Whence logically it would have been sufficient to exclude this cereal from public consumption, to suppress at the same time its formidable effects, and to put an end to the epidemic. Sublatâ causâ …

Does not M. Fallot hazard this conjecture when he asks whether the cures which took place after a more or less prolonged stay in churches or convents, would not be concerned with the wholesomeness of the food provided by these religious establishments, which stored up in the years of abundance, to ward off possible shortages?

To which one could answer that most of the patients did, so to speak, only pass into these asylums, if it is true, as is asserted, that those who did not die, recovered in seven or nine days, which can be accepted from a pathological point of view without any miraculous intervention.

Messrs. Trousseau and Pidoux, whose testimony is of such great weight, can not consent to put on the account of the ergoted rye, the terrible epidemics described under the name of ergotism , ergot , epidemic convulsion grainetc. When acrodynia reigned in Paris, the first idea that was offered was to report it to a cereal intoxication; but it soon became evident that this explanation must be abandoned, since the inhabitants of Paris never use rye as food. On the other hand, if we take a critical look at these so-called epidemics of ergotism, we recognize, with the eminent collaborators whose opinion I reproduce, that those who develop in France do not show themselves in the various places, the same years. Thus, while Artois is infected with it, Sologne feels nothing, and vice versa. The very wet years in Sologne are also very good in Artois, and consequently the production of ergot must be the same. It would be very singular when the influence of the same cause did not determine the same epidemic accidents. When a common cause exists in two localities, and one disease develops in one, without showing itself in the other, it is necessary, of necessity, to resort to another etiological explanation.

During the years 1816 and 1817, the wettest there may have been, perhaps, for more than a century, although the rye have been infected with ergot, it was not heard that, in Sologne and in many other parts of France, where one feeds on rye flour, there has been an epidemic of ergotism.

It is also an irrefragable fact that entire populations feed on this altered cereal; in six or seven departments the peasants have no other food. During cold, wet summers, rye ears contain a huge amount of ergot. When the grain has been beaten, the peasants, before grinding it, remove only the largest stubs, and the rest goes to the mill with the good grain. The bread, all year round, is then made with rye, and it is the food which enters for the greatest proportion, in the food of the inhabitants of the country. At times when the alteration of the cereal has greatly exceeded its usual degree, those who make use of it feel a sort of ebriation which is not painful; but when there is little ergot, no noticeable accident is observed,

It seems to me that it is difficult to answer these arguments if we persist in defending, without concession, the cereal etiology of the disease of the Middle Ages.

Dr. Marchal (of Calvi), touching this question, is astonished, rightly, that a pathological fact, so common formerly, has ceased to occur. He has read, like me, the passage I have just extracted from the book of MM. Trousseau and Pidoux, and he agrees that there would be something incomprehensible there, if, he says, we were not authorized to think that the peasants of our days do perhaps better than to remove only the largest spurs; while probably, and this is important to note, their predecessors left large and small in the grain to grind .

The conjecture of the learned doctor of Paris is rendered rather improbable by the well-known negligence of the people of the country; but even if it were so, the facts quoted by MM. Trousseau and Pidoux would not be less inexplicable for those who support, in an absolute way, the toxic intervention of the ergot. In this case, I think rather that our peasants, to whom M. Marchal lends so much prudence, would be all the less likely to prune all the bad grains, that the intoxication which follows the use of rye bread, strongly quirky, is not without approval for them. They know perfectly well the origin of this impression, and far from being repugnant, they make it a habit, like the smokers and the opium-eaters.

The special effects of ergot rye are formally denied in the name of experience by some German authors. It is known that it grows in large quantities in the canton of Basel. It is ground with good quality grains, and bread is made to eat without the slightest inconvenience .

After this, it is no longer surprising that the wheat, which has been badly altered, may have been used without disturbing public health.

Ramazzini says that in 1691, rust invaded this grain abundantly in Italy, without any unpleasant consequences.

It is certain that many physicians, who are not interested in the success of a system, hardly believe in ergotism.

Shark, who makes this remark, has consulted, to enlighten him, Dr. Arnal , who has made a special study of the therapeutic and toxic effects of ergot. The answer of this confrere was categorical: he had tried every way to determine on animals, gangrenous or convulsive ergotism, and he had never been able to reach it .

I have carefully read the account of the experiments made by Tessier on some animal species to clarify the pathological action of ergot . The author has neglected no precaution to avoid any cause of error; but I am obliged to add that his conclusion, very affirmative, does not seem to me entirely applicable to man. He supposes that the experimenters who obtained contrary results, employed only an insufficient proportion of ergot. I find it hard to believe that men as practiced as Model and Parmentier did not prevent such a reproach.

I therefore think, like Shark, that many of the epidemics of which this poison was entirely innocent have often been thrown on account of ergot, and that this etiology has been invoked most freely in the world. This does not prevent me from accepting the facts that are based on the positive testimonies of Salerno, Réad and a few others. It is important to never forget that medical causality is repugnant to exclusive interpretations that do not take into account the contingencies of observation.

Of all the foregoing, I draw, to the contrary, the following conclusion:

The low proportion of ergoted rye in the diet of the populations struck by the Saint-Antoine fire; the extension of this epidemic in localities where this cereal was not cultivated; its duration several times secular, with intermissions which the continuity of action of its pretended cause would render incomprehensible, unless the arbitrary suppositions are heaped up; the gradual diminution and permanent disappearance of the plague, which can not be attributed to the suppression of the suspicious influence; the symptomatic strangeness of the disease which excludes its vulgar origin; the contradictory meaning of the observations of ergotism, after their careful revision: all these considerations, in a word, ruin the hypothesis which has rallied the opinion of physicians on the common basis of grain intoxication. The Saint-Antoine fire remains, for me,

An attempt has been made to establish an intimate relationship between her and the coal; but the comparison does not stand before the nosographic parallel. The circumscribed tumor that characterizes the anthrax, and the gangrene that rapidly radiates from its center to the adjacent parts, differs radically from the sphacele, which attacks a whole limb and devours it secretly, as by the slow action of an internal fire. .

Practitioners also can not assimilate the fire Saint-Antoine, as we chronicle the chronicles, to these gangrenous malignant fevers, the march of which is most acute, and which are accompanied by a great disorder of the circulation and a deep depression, a sign of the resolution of the forces.

The question thus posed brings another:

The St. Anthony fire he was known to the ancients, or must his accession date of the first clues that denounce the X th century?

Hippocrates has left us the relation of an epidemic of erysipelas, accompanied by gangrene very extensive. The lighter causes gave birth to them. The flesh, ligaments, bones and even whole limbs were destroyed. The author of the story points out that these accidents were more frightening than dangerous, because most of those in which they occurred, escaped death. Those, on the other hand, whose illness did not take this direction, were carried away .

In this description, M. Littré finds many features of resemblance to the formidable epidemics which, under the name of the late Saint-Antoine , of ardent evil , etc., were the terror of the populations of the Middle Ages. But he sees the essential difference that gangrene, beneficial in the old epidemic was exceedingly unfortunate that in the X th century .

I must press another distinctive character; It is because the action of any occasional cause causes erysipelas to erupt on the simplest lesions, on very small wounds, whatever their siege. This observation is renewed in most erysipelatical constitutions well drawn. Hospital surgeons must, in such a case, renounce the use of the cutting instrument, even the lancet, on pain of the appearance of an erysipelas whose severity, too often mortal, can not be measured in advance. . We do not see anything like it in the history of the evil of the ardents. The epidemic of antiquity is nothing but an epidemic of erysipelas, aggravated by the indefinable influence of a gangrenous and putrid constitution.

China Rifampicin