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.
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.
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