In 1951, an epidemic of madness (and some very real physical effects) swept through the village of Pont-St-Esprit, France. Several hundred people were affected, and though most survived the immediate onslaught, they did not all completely recover. Unfortunately, medicine of the time could not accurately diagnose the problem, much less treat it once they had. Fuller, the author of this book, came to this incident nearly 20 years after it took place, so many of the original details were lost, although court procedure being what it is, the lawsuits had come to a close only a few years previously.
One hot day in August, a significant percentage of the residents of Pont-St-Esprit, both human and animal, developed a mysterious malady. The rapid onset and widespread nature of the epidemic suggested a food-borne contamination of some sort, and the doctors and officials quickly narrowed the probable source to bread, as it was the only thing eaten by all the people and the animals who presented with the disease. The symptoms, however, didn’t match anything known to modern medicine: digestive upset, fever/hypothermia, nausea, and rashes are typical of several common problems, but the persistent insomnia and hallucinations to the point of raving mania didn’t match anything the doctors practicing in Pont-St-Esprit at the time had seen. It took someone with a penchant for historical medicine to make the connection with ergot poisoning, aka St. Anthony’s Fire. (A modern doctor might more easily make the leap to an LSD overdose–not surprisingly, as that drug is derived from ergot.)
How did the bread in the area, normally made entirely from wheat, become contaminated with ergot? Rye was not a significant source of bread flour in France at the time, but the damp summer had resulted in a lower than usual wheat harvest and a spread of the contaminant in rye included in the flour distributed to this particular area.
Even once the doctors had tentatively identified the cause of this epidemic, there was very little they could do to cure their patients or even mitigate the symptoms with palliative care. The worst affected of the patients had to be physically restrained in mental hospitals–often requiring multiple straitjackets–until whatever was causing the hallucinations and convulsions had worked out of their systems.
Both ergotism from consumption of bread containing contaminated rye flour, or mercury poisoning from a mercury-based fungicide, Panogen, were suggested at the time of the outbreak. The mercury theory is not implausible, as people have been so poisoned in just this manner, and indeed the defendants’ court case was based upon this theory. The symptoms of ergot and mercury poisoning are similar: gastrointestinal distress, mental disturbances, neurological difficulties, and so on. The caveats are, however, that the onset of mercury poisoning tends to be slower than the Pont-St-Esprit outbreak and the amount required for this dramatic a demonstration of toxicity is high; in the Pont-St-Esprit outbreak, patients were exhibiting symptoms, and quite dramatic ones at that, within hours of ingesting the contaminated bread. (Fuller contends that the amount of mercury based fungicide required would have rendered the bread noticeably different than usual, and while the bakers noticed a difference in the dough, the consumers did not see anything objectionable after the bread had been baked.)
The book, written in 1968, is showing its age in that the writing style of the author is decidedly dated. His dramatization and fictionalization of the outbreak and the ensuing government action and lawsuits shifts the text a bit further from a purely scientific analysis standpoint than many physicians and public health officials might appreciate these days. However, as a description of what is, sixty years after the fact, something of a footnote in medical investigation, it makes for an intriguing read, and the central idea–that historical medical outbreaks may return in new guises–is still sound if the medical world dismisses them as from the dead past. Would I suggest a library owning this book keep it? yes, as a description of a historical event and how to investigate the sources of an epidemic. It’s no use as a description of modern medical techniques, if indeed it ever was, but as part of a history of medicine collection, it’s valuable.
What to read next? I’d suggest Berton Roueche’s works; he wrote articles for the New Yorker about unusual individual medical cases and the city health department’s tracking down various outbreaks. These have been collected into various shorter works, though the (more or less) complete collection is The Medical Detectives.