THE LAST WORD

     Way back in 1970, when my headmaster, Mr. Anantha Rama Rao Verkady summoned me to his room, I was surprised. It was to tell me that I was one of the reciepients of the National Merit Scholarship for having figured in the list of first 100 ranks in the state SSLC examination. My joy knew no bounds. He gave me a letter to that effect and another accompanying letter to be signed by my father, a physician,  and indicated where my father had to sign it. The scholarship was a prestigious one and would look after my education till my Phd if ever I chose to do it! When I proudly gave the letter to my father he was extremely happy. He went through the contents of the letter very carefully and appreciated my achievement but flatly refused to sign it. 

     He pointed out to me that an income limit was prescribed and that his income exceeded that limit marginally. I tried to convince him by saying that by signing this he would be absolved of all responsibilities of my entire education. I however failed miserably in my efforts.

     I then put forth my last argument saying that if he did not sign the letter for his son, the next in line would sign it for his own even if  his income exceeded the prescribed limit. To this my father coldly replied "hat is the difference between hid father and your father!"Needless to say I never received the said scholarship but rt only Rs. 100 as a token and a certificate instead. This action of his reflected his honesty, transparency and descipline. 

     The day before his demise, when he was unable to swallow, I politely suggested that he may be admitted into a hospital and be given intravenous fluids. I felt that I was doing what was best for him as he always did for me. But he refused the suggestion immediately. The speed of decision and the finality of his voice reminded me of the incidence  in school. 

     The voice however had become feeble, but the spirit had not diminished. Needless to add, as usual, he had the final say in the matter!

FOOTPATH IN MANGALORE - A MYTH OR REALITY? - IS THERE ANY FOOTPATH LEFT?

     Footpath is a self explanatory term - a passage specially created for the safety and convenience of the pedestrians. I vividly remember walking on quiet and the safe footpaths of Mangalore as a young boy accompanying my mother to the  market.
     What has happened now? Many roads just do not have footpath. The basics insist that when a road is created, road, drains and footpath have to be constructed as a unit. Earlier there was not much of technology - but there was robust common sense. Now there is modern technology and no sense common or uncommon!
     If by chance the road you chose to walk on does have a FOOTPATH what has happened to it? Food vendors occupy it in the plum places parking their carts - making it a FOODPATH. People crowd round it effectively blocking what is left of it!
     Many ladies walk on the road and therefore the flower vendors are sure to occupy a corner making it a FLOWERPATH .Many varieties will be available in a small space!
     Vendors of footwear are ubiquitous and there is no better place than the footpath to sell them - they convert  the footpath into the FOOTWEARPATH!
      Autos and 2 wheelers and sometimes 4 wheelers are parked on it as if the owners of these vehicles also own the footpath making it a FOOTPARK!
     Some self respecting people are upset and try to tell the vendors that they are blocking the path and being an obstacle. If looks they give could kill, these guys would surely be dead - making it a MURDERPATH!
     Come elections, or festivals the footpaths now will be occupied by the poles and banners - usually holes are dug into the footpath to stabilize the banners - a sure way to destroy it permanently!
     Once I remember reaching the venue at Bangalore late when I was an invited faculty for a lecture for a Post Graduate Medical Education Programme because the road was blocked for some drama festival!
     Is there any remedy for this problem? Probably the change has to come from within. Common sense and civic sense have to be rediscovered. After all the footpath is primarily meant for the pedestrians.
     I only hope that these people who usurp the footpath realize their fallacy and vacate the same it will again be a pleasure to walk safely on the footpath. Let us rediscover the joy of using the footpath properly

THE STORY OF ASCLEPIUS - THE MAN WHO COULD BRING THE DEAD MEN BACK TO LIFE - WHY WAS HE NOT IMMORTAL?

     According to the Greek mythology, Asclepius could bring the dead back to life! This was probably his undoing. What is known about his life history makes an incredible story.
     His birth was indeed controversial and interesting. His mother was Coronis from Trikala of Thessaly. She had a secret affair with Ischys. When Apollo learnt of this, he wanted to kill her. On his command, his sister Artemis killed her on the funeral pyre. While watching this, Apollo felt guilty of killing the unborn innocent baby and rescued it by splitting open the womb - probably the first recorded caesarean section in he history of mankind! He adopted this baby as his own and brought it up under the mentorship of half human half horse Chiron a famous for his medical skills. Thus Asclepius learnt his medical skills from Chiron. He bacme a very successful healer with exceptional medical skills. He mastered the art of surgery and the art of medicine including the use of drugs and aprodisiacs. He is supposed to have given Gorgon blood with magical properties to Athena. Gorgons were Gorgons had snakes for hair, bronze claws, wings and eyes that could turn humans into stones. The blood from left side of Gorgon would kill a man and that from the right side would bring back a man from death.
     Ascalpions were built in his honor and memory after his death. The famous Hippocrates  studied medicine from one such Asclepion on the Kos island and started his medical career there. One should also note that the original Hippocratic oath mentions the names of  Asclapius and his daughter Hygea (goddess of hygeine) and Panacea (goddess of universal remedies). His 2 sons were Machaon and Podalarius who were great surgeons. They healed a 10 year old wound of an archer Philoctetes who later raised the bow to kill Peris to end the decade long Trojan war.
     However, the Asclepion, a rod with a single serpent wound around it is more famous than Asclepius. This signifies his exceptional skills in treating snake bites. It became the symbol of doctors and modern medicine should not be confused with Caducius a staff with 2 snakes intertwined  which is more a symbol of occult art carried by Hermis when he carried the souls from the land of living to the land of the dead.
     Because of the indredible powers of Aesclepius, many who were supposed to die did not die. Hades, the god of dead complained to Zeus the god of skies  who in turn struck Asclepius with a thunderbolt and killed him. Asclepius, his staff and the serpent became a constellation in the sky.
     Even Bible mentions that Moses during the exodus out of Egypt wandering in wilderness in search ofthe Promised Land raised a serpent made of copper on his staff like the rod of Asclapius, called Nehushtan. Mere looking upon it was supposed to heal people with snakebite! Snakes were regarded to have great healing powers and non poisonous ones  were left free in the dormitories where the sick lived. The snakes were believed to rejuvinate themselves by shedding their skin and therefore were believed to cure the sick!

JEAN MARTIN CHARCOT - PIONEER IN NEUROLOGY- ALSO A PATHOLOGIST AND A RHEUMATOLOGIST- BEST KNOWN FOR HIS 18 EPONYMOUS CONTRIBUTIONS TO MEDICINE

     Jean Martin Charcot is considered the father of Neurology. But he was much more than that. He was also a trained Pathologist. He was also interested in Rheumatology. He is considered to be one of the most influential physicians of all times.
     He was born on 29 November 1825. His father was a cottage builder. Being better than his brothers, his father supported only him to persue the higher education in Medicine. A keen observer, a good painter, he had a good visual memory. He was good in German, Italian and English languages.
     He graduated from the medical school of Paris at the age of 23. He was an intern at Salpetriere hospital, Paris. He held various positions at that hospital  including Chef de Clinique(1853), Physician t the hospital of Paris (1856), Professor of Pathological Anatomy at the University of Paris (1872). A position of Professor of the diseases of the nervous system was specially created for him. He established the neurology clinic in 1882. Classical French Neurology was founded by him.
     He would work uninterruptedly into the night and was a prolific writer. He articles regularly appeared in Lancet and BMJ. He also authored many books. He was a popular teacher and his students came from all over Europe. He  adopted theatrical techniques and lectures to teach the students. His famous students included Babinski, Bechterew, Pierre Marie, Freud, and Bouchard, Bornville.
     Bouchard was one of his good students. Bouchard being egoistic felt that he should get equal glory if not more for their joint activities - Charcot- Bouchard aneurysms was an example of this. Bouchard felt very neglected because his name came after that of Charcot!
     He was the teacher of Babinski. Babinski was thought to succeed him. Unfortunately for the crucial selection examination, Charcot could not come and Bouchard replaced him as the chairman. Babinski was not selected and it cahnged his life completely. He became very famous but never became a teacher officially.
     His contribution to the understanding of Multiple Sclerosis and differentiating it from Paralysis Agitans was then considered outstanding. He was a clinical wizard and was variously nicknamed as the 'Napoleon of the Neurosis' and 'Caesar of Salpetriere'.
     His 18  eponymous contributions include - Charcot -Leyden crystals seen in the stools of patients with Amoebiasis and the sputum of patients with asthma; Charcot's (Neuropathic ) joint seen in leprosy, diabetes, Tabes dorsalis, syringomyelia - a non inflammatory hypermobile painless joint; Charcot - Neumann crystals in semen; Charcot's (cerebral ) triad - Nystagmus, Intention tremor, staccato speech seen in Multiple sclerosis; Charcot's( Biliary) triad - Right upper quadrant pain, Jaundice, intermittant fever in cholangitis. Charcot's artery of cerebral Haemorrhage - Lenticulo striate branch of MCA; Charcot - Buochard aneurysms - aneurysms of the perforating branches of MCA  which can result in cerebral haemorrhage.;
Charcot's edemma - a painful edema seen in hysterical paralysis; Charcot's disease or Charcot's sclerosis -Lou Gehrig's disease a rare disease from which the baseball player of that name died; Charcot - Marie - Tooth disease - Peroneal muscular atrophy;  Charcot's hysterogenic zones; Charcot - Wilbrand syndrome - Visual agnosia due to PCA occlusion; Erb - Charcot paralysis - a rare from of spinal syphilis; Charcot's angina cruris - Intermittent claudication; Charcot - Joffroy syndrome of epidural ascending spinal paralysis.
     His pastime was music and Beethoven was his favorite composer. In 1882, University of Wurzberg honored him with a doctorate. He started to get attacks of angina pectoris and his health deteriorated. He died in 1893 of pulmonary edema at Morvan in France.His famous quote inclded " symtoms then ,are in reality nothing but cry from suffering organs". and "to learn how to treat a disease one must learn how to recognize it. The diagnosis is the best trump in the scheme of treatment".  So true!

THE STORY OF HIPPOCRATES - DID HIPPOCRATES REALLY WRITE THE HIPPOCRATIC OATH?

     Hippocrates known as the Father of Medicine epitomizes the Greek Medicine. His teachings in philosophy and medicine have influenced the practice of medicine through the ages.
     He was born in 460 BC in the island of Cos. His father was Heraclides a physician, mother, Praxitela, daughter of Tizane. He had 2 sons - Thesallus and Draco and son in law Polybus. Polybus was his true successor. Hippocrates learnt medicine from his father and his grand father
     He is known well for some of his views. He was the first to say that the disease was due to natural causes and not due to God's wrath. The focus was on patient care and prognosis and not diagnosis which was general. Another concept in the treatment of the disease was "crisis" the point at which the disease would abate or the patient would succumb to it. His therapeutic principles were humble and passive based on the nature's ability to cure.
     He was known for his strict professionalism, discipline and rigorous practice He would always trim his fingernails and had a primitive operating room where he did splinting and minor surgery.
     He contributed many things to Medicine. He is supposed to have written 79 books and 52 treatises - no body is sure how many of these were really written by him. He was the first to describe clubbing of fingers - sometimes called Hippocratic fingers. He described Hippocratic facies He gave very good descriptions of various diseases but did not name any syndromes. He gave the first description of Empyema. He devised a primitive speculum to study piles which must have been the first application of endoscopy He emphasized the importance of diet and exercise. He had the concepts of acute and chronic; endemic and epidemic; exacerbation, resolution, relapse and crisis.
     The most famous contribution to medicine by him was the Hippocratic oath. which is a seminal document on ethics in medicine. It entails good medical practices and morals. It is controversial whether he wrote it at all!
     Soranus of Ephisus, a Greek Gynaecologist of the 2 nd century was his first biographer. After him the famous physician was Galen who lived between 129 to 200 AD Thomas Sydenham, William Heberden, Charcot, William Osler followed his methods.
     Hippocrates is also well known for some of his aphorisms - Gout never develops before puberty on men; before menopause in women and never seen in the eunuchs. - almost true even today. He probably described Behcet's disease and Crohn's disease without naming them  He never spoke of a disease resembling rheumatoid arthritis and so the disease must have been more recent!
     Coins bearing his name and his profile were unearthed from Cos. He is supposed to have died in Thessaly. A sculpted head was found in the cemetary of Ostia which bears a close resemblance to what is now accepted to be his appearance
     It is indeed unbelievable that a sigle person has contributed so much to Medicine. No wonder he is liked, loved, adored and admired. He definitely qualifies to be called the "father of Medicine"
     

WHAT IS MUNCHHUASEN SYNDROME? WHO WAS MUNCHHAUSEN?

Every doctor has experienced patients who create symptoms or exaggerate them mainly seeking attention. They hop from doctor to doctor, hospital to hospital, producing thick charts, undergoing unnecessary admissions and even surgeries supposedly from a mental illness. This disorder has a name - Munchhausen's syndrome
    Karl Frederic Munchhausen was a minor nobleman, a country gentleman with a large estate. He was born in 1720 and joined the Russian army and served there till 1750.
     He returned to his home in Badenwerder. He has an extraordinary skill of story telling. He would tell terrific stories about his pole in wars and his other adventures mostly from his fertile imagination. Most of the events never happened or were greatly exaggerated. Rudlf Raspe in 1771 collected some of these cleverly put stories and published a book.  He had to persue a series of lawsuits to protect  his name.
     The stories included some of these - An effect of storm in Ceylon; how he flogged a wolf( which had attacked him) till its skin turned inside out; Story of an extraordinary horse presented by Count Prozobossy with which he performs extraordinary feats and continues to do so even when the horse has been sevbered into 2 parts; A brass cannon travelling to the moon; building a bridge from Africa to Great Britain; How he sieged Seringapatam; His combat with Tippu Sultan and such other spooky tales
     This condition differs from hypochondriasis and other somatoform disorders in that the patient does not intentionally produce the somatic symptoms. Emotional trauma during childhood or adolescence may be the contributing factors. In Arrhythmogenic Munchhausen, the arrhythmias are simulated. Munchhausen syndrome  by proxy is a condition where the parent will ensure that the child will experience some medical affliction compelling the child to suffer the treatment and to spend a significant portion of the youth hospital hopping and doctor shopping. Some of them even undergo repeated surgeries simulating surgical illnesses.
     In 1951, Richard Ashner published a paper in Lancet and titled it as Munchhausen's syndrome after this person. This was to give medical attention to this condition.
     One has to suspect Munchhausen's syndrome when new symptoms keep cropping up every time a negative report comes. They are eager to undergo new tests, may have multiple surgical scars, history of visiting many doctors and many hospitals.
     Baron Munchhausen became very famous. Books were written about him. Plays, and movies were made about his life. Illustrated comics were produced about his exploits. A puzzle/ hidden object game was produced which was named after him in 2012. In Russia, there is a club named "Munchhausen's grandchildren". Germany has arranged international tourism including the places visited by him. A museum was opened in his name where he had stayed with his wife. A commemorative coin was released by Latvian Central bank. In 1994 a main belt asteroid was named 14014 Munchhausen in honor of the Baron. 

THE STORY OF ROBERT KOCH - HIS FACE OFF WITH PASTEUR - DID KOCH REALLY DESERVE TO BE FAMOUS?

     The disease Tuberculosis is as old as the mankind. It has been demonstrated in ancient Egyptian mummies (100 BC)  and has found a mention in very old literature. Hippocrates called it Pthisis. It was a great killer rightly called the "captain among these men f death".
     The possible infectious nature of the disease was speculated for many centuries. Hippocrates and Galen had suspected its contagious nature. Laennec was convinced that the tubercle was the common factor of all forms of tuberculosis. Schonlein gave it the name  "tuberculosis" in 1839. Pasteur's germ theory in 1862 gave impetus to the research. Jean Antonie Villermin in 1862 proved that animals can get the disease from man by inoculation. Only demonstration of the causative agent remained. There was virtually a race among researchers to do this and finally in 1882, Robert Koch won the race!
     On the 24 th day of March 1882, in the monthly meeting of the Berlin Physiological Society the formal announcement about the discovery of the tubercle bacillus was made.The meeting was chaired by DuBois Reymond and Helmholtz, Leoffler, Ehrlich and other medical luminaries were also present.  There was no applause for the presentation though the audience must have sensed that this was going to be an important invention in the history of Medicine.The reason why it was not announced in the meeting of the Pathological society was because of the poor vibes Robert Koch shared with Rudolf Virchow, (Professor of Pathology), then a dominant figure in the Berlin Medicine. Robert Koch went on to further research in the field. He believed that the Tuberculin was the treatment of tuberculosis. Though he was proved wrong later, it became an important as a diagnostic tool in the management of tuberculosis.
     Koch used Methylene blue as the stain. Culture proved to be difficult. Prof. John Tyndall of Londin used the term "Koch,s bacillus" which was widely accepted all over the world. Erlich developed a method of staining which proved to be superior. In 1887, Ehlich tested his own sputum and found it to be positive! In a paper in 1884, he described what was later came to be known as Koch's postulates. Much earlier, in 1876 he had already described very virulent, spore forming Anthrax bacillus. He visited India in 1883 and identified Vibrio cholerae. During the second visit at the behest of teh British government, he carried out important work on Bubonic Plague , proving that it was transmitted to the humans by the rat flea.
     Robert Koch married his childhood friend Emily Fraaz in 1876. It was a happy mariage in the beginning and they had a daughter in 1878. However after 20 years of he married life, the relationship broke down and ended in a divorce in 1897. 2 months after the divorce, at the age of 50, he married  a young actress Fraulein Freiburg who was only 21. The second marriage was followed by a social boycott and was forced to spend much time abroad.
     In 1883, a controversy arose when Pastuer, calling himself 'second Jenner' tried to use methods of inoculation with the hope of preventing certain diseases. He used nasal discharge from horses who had supposedly died from horse typhoid and inoculated the rabbits with it.  He used saliva from children with hydrophobia and inoculated the rabbits with it. When the findings were presented and discussed, Robert Koch took serious objections - the causative organism was not conclusively proved and the whole experiment was unsatisfactory. He claimed that the death of rabbits in both instances was due to septicemia. Despite all these shortcomings, Pasteur was considered a genuine "path breaker"
     For all his discoveries concerning tuberculosis, Robert Koch was considered the father of scientific study of tuberculosis. In 1905, he was awarded the Nobel Prize in Medicine. 

HEIMLICH MANEUVER - LIFE SAVER FOR THOSE WHO CHOKE - DID HENRY JAY HEIMLICH REALLY DISCOVER IT?

     Henry Jay Heimlich was born in 1920. He was a trained cardiothoracic surgeon He realized that choking was an important cause of death in the USA. He wanted t do something to save lives of those who had choked.
     He was a keen observer. He had observed that abdominal thrusts helped the dogs to get rid of the material on which they had choked - that would dislodge from the throat and come to the stomach. He therefore attempted to try the same thing in the human beings - apply pressure on the chest and see whether the material blocking the throat would come to the stomach. Soon he realized that it was the pressure to the diaphragm that was really needed.
     Heimlich suggested the use of a fist - placing the thumb against the patient's upper abdomen and grasping it with the other hand from the back with quick upward thrusts. He published the technique and its advantages in Emergency Medicine in June 1974. The article was titled "Pop goes the Cafe Coronary" Within weeks, he started receiving reports as to how the technique was saving lives. JAMA was so impressed with this technique that they renamed it as Heimlich Maneuver.
     From 1976 to 1985, the American Heart Association and the Red Cross recommended guidelines on choking nicknamed as "the five and five"- 5 back slaps and if that failed 5 Heimlich Maneuvers. However in 2006 the term Heimlich maneuver was replaced by 'abdominal thrusts'. The drowning rescue guidelines regarded it as not only not useless but also as potentially harmful because it could facilitate vomiting and choking on the vomit. There is no doubt that Heimlich Maneuver saved millions of lives.
     Heimlich was not a one trick pony. He has contributed many other inventions to Medicine. In 1960 s he devised a simple inexpensive unidirectional valve in the Vietnam war which helped to remove blood from the chest of injured soldiers and saved thousands of lives.
     In 1950 s he devised a surgery wherein he replaced the damaged part of the esophagus with a portion of the normal stomach in patients whose esophagus was damaged and resulted in the difficulty for the patient to swallow. He claimed that they were happy and could enjoy normal meals with the family.
     In 1980 s he devised a Micro-trach transtracheal catheter to deliver oxygen more efficiently
     Heimlich went on to claim that his technique would even help the patients with severe asthma. His adversaries however argued that though it helped remove blocked secretions, it did not help relief from the asthma in any other way.
     His unusual experiment in China where he tried to induce Malaria  -Malariotherapy- to therapeutically benefit patients with Lyme disease and AIDS by allegedly 'strengthening the immune system' was severely criticized and he was even labelled as a fraud by some .
     His worst critic was his own son  Philip Heimlich who later became the county commissioner of  Hamilton County, Ohio, always held the view that the real discoverer of the maneuver was a doctor by name Henry Patrick and Henry Jay Heimlih only stole the idea fro him!
     Whatever the controversy may be, there is no doubt that the maneuver saved millions of lives. In 2002, George Bush, then the President of USA survived choking. Tennessee William, a Pulitzer prize winner who choked on the cap if an eye drop bottle and Marshall Subrato Mukherjee , India's first chief Air Marshall who choked on fod in a Tokyo restaurant were not so lucky. Both died of choking!

THE CASE OF THE" FROZEN ADDICTS" - WHY DID THE ADDICTS FREEZE? WHAT HAPPENED TO THEM?

     Drug addiction is a serious thing. The extent to which an addict would go is decided by the desire, craving, knowledge and intelligence of the individual. He would go any length to procure the drug or even to manufacture it! This is the story of such 'committed ' addicts!
     Barry from Maryland spent some time in India with his family He initially bought the medicines from the street. One day in 1976, he took the drug manufactured by him intravenously. He felt severe burning at the site of injection and a sense of euphoria. Within three days he became immobile and mute. He was admitted to a hospital with a diagnosis of catatonic schizophrenia and was given phenothiazines to which he did not respond. He was promptly shifted to NIH where he was evaluated.Though the symptoms and signs closely mimicked Parkinson's disease,  the suddenness of symptoms made them suspect a toxic etiology. Their research showed that he had tried to synthesize a chemical called MPPP ( related to Meperidine). He inadvertently overheated the mixture and synthesizes MPTP instead. They had come very close to the answer. The next step was to try the hypothesis in the rats. They injected the rats with the same compound. Rats are not as susceptible to the toxic effects of MPTP and the catatonic phase seen was temporary. This resulted in a setback and the  further research did not get priority. The issue became dormant.
     In 1979, Barry's case was published. L Dopa was tried. He improved significantly and the speech returned. In 1978, he died of cocaine overdose. In 1982, George was found to have similar syndrome. He was also having extrapyramidal syndrome - Diphenhydramine did not work. He rapidly worsened and became stiff and immobile. He was later evaluated at Stanford.
     William Langston tried to find a connection. MPTP seemed to damage the mitochondria of dopaminergic neurons. Dopamine reuptake blockers could prevent this damage. L Dopa gave temporary relief . Drug holidays prolonged the response but eventually the drug stopped working. Eventually a steriotactic implantnation of fetal tissue was done in Lund, Sweden. This was tried in 2 patients George and Juanita and both did well.
     The research showed that the compound, MPTP was like a bullet to substantia nigra resulting in immediate and long lasting damage. This compound gave an insight into the the role of environmental causes in the genesis of Parkinson's disease.
     The addicts had a very bad outcome. They became immobile and mute - truly " frozen addicts". Only some fortunate ones recovered. Others remained so for long periods.
     The the case of the "frozen addicts" opened up a new chapter in the study of environmental  toxins in the causation of PD. It also gave an insight into the animal studies in PD which is otherwise almost impossible due to the insidious onset of the disease! Thus the "frozen addicts" came as invaluable research tools!

THE EPIDEMIC OF THE WITCHES' CURSE - WHY WERE HUNDREDS OF "WITCHES" IMPRISONED AND EXECUTED?

     The place was Salem. The date 1692. The event - a tragic community event leading to the death of 20 innocent Puritans
     In 1691, 8 teenage girls presented with altered behavior, gesturing, posturing, speech disorders, convulsive seizures - then known as "unknown distempers". A possibility of witch craft causing this was seriously considered. and this was even testified by the sufferers. 20 residents were tried and hanged for the offense. 150 more were incarcerated.
     Some sought alternative expanation for these phenomena - mass hysteria, fraud, politics, social devisiveness were considered. It was noticed that the symptoms started after cold winters. This phenomenon was observed to have 2 presentations - Acute neurologic presentation - hallucinations, convulsions,  paranoia, mania, sweating, spasms, jerks what we today refer to as acute Serotonin Syndrome. Chronic form was associated with Gangrenes of various parts of the body - Intense burning pain in limbs leading to (in severe cases )dry gangrene, black and mummified limbs which sometimes dropped off. Some women suffered spontaneous miscarriage.
     Finally the phenomenon was traced to contaminated rye - the disease was Ergotism  When this view was accepted, the new incoming Governor ordered the unconditional release of 150 incarcerated suspects.
       Ergot thrived in cold winters followed by damp spring. Acute phenomena observed was really acute ergotism called by some neurologists as St. Vitus' dance ( reserved by some only for Rheumatic Huntington Chorea). Chronic gangrenous ergotism  was referred to as St. Antony's fire St Antony was a pious ascetic who lived in Egypt near Red sea. He fasted for long periods and used to have hallucinations. An order founded in Fance in 1100, took his name. They developed some treatment for the ergotism which seemed to work though the real improvement was probably due to consumption of a diet free of the contaminated grain. Sometimes the amputated limbs were left at the shrine as symbols of appreciation for cured patients.
     Slowly the people noticed the vasoconstrictive and hallucinogenic properties of Ergot. Its use in labour was started in  1600 s though the acceptance came in 1900 s. The active substance useful in labor was isolated by Dudley and Moir in 1935 to be usewd IM or IV in PPH.
     Though useful, the derivatives of Ergot Ergotamine and Dihydroergotamine have side effets - nausea, vomiting, abdominal pain, diarrhea, tingling and numbness, peripheral and coronary artery vasoconstriction. So Ergot derivatives should not be used in peripheral arterial disease, coronary artery disease, severe hypertension, stroke, pregnancy.
     These drugs are metabolized in the liver by the enzyme cytochrome P 450 system .. Any substance leading to a delay in its metabolism could precipitate r enhance the side effects. Macrolide antibiotics like Erythromycin, antifungals like ketoconazole, protease inhibitors used for HIV infections, antidepressants like fluoxitine can all result in this.
     The experience with Ergot should have taught us to be more careful. Unfortunately it has not. We still find humans continuing to be victims of neurotoxins coming in from their own environment usually polluted by humans for the purpose of greed. - tainted products, drugs of abuse, contaminated bread, contaminated water and the like. Despite our knowledge, many of the suffers and the causes must be going unnoticed and the perpetrators unpunished.