The Fungus that Hung Us: Did Ergotism Lead to the Salem Witch Trials?

Image credit to the  US Library of Congress
Image credit to the US Library of Congress

By Judith Lavelle
BU News Service

The Witch Trials of 1692 remain Salem’s darkest and most infamous historical moment. Legend (and record) holds that ten adolescent girls accused some Salem residents of practicing witchcraft. The town leaders believed them, given their convulsions and “spectral visions,” and the consequent trials led to the hanging of nineteen “witches” from June to September of that year. Historians have since proposed several explanations for the girls’ “bewitched” behaviors, including youthful mischievousness and mental illness. Still, some people maintain that the culprit was a hallucinogenic fungus lurking in the villagers’ rye crop. Could the girls have confused the effects of the fungus—a disease called ergotism—with witchcraft?

Probably not.

Behavioral psychologist Linnda Caporeal proposed the “ergotism theory” in 1976, speculating that the girls “bewitched” in Salem actually fell victim to Claviceps purpurea, or ergot—a fungus that infests wild rye, a crop the settlers ate. The theory is a compelling explanation for the colonial community’s horrific experience. Proponents argue that ergotism “bewitched” the girls in Salem experienced seizure-like symptoms and hallucinations. Furthermore, records suggest that the weather was humid enough that year for the growth of ergot-infested rye. However, historians largely agree that the evidence leaves the fungus as innocent as those poor “witches.”

Upon closer consideration, the symptoms of witchcraft in 1692 Salem are missing a few key characteristics seen in documented cases of ergotism outbreaks (one occurred in France in 1927). Ergotism patients normally suffer the effects of several toxic substances produced by Claviceps purpurea. While these include chemical precursors to the hallucinogen lysergic acid diethylamide (LSD), which may have caused the victims’ “visions,” other ergot poisons have more grisly symptoms not seen in Salem: vomiting, infertility and constricted blood vessels that can ultimately lead to the loss of limbs.

But if ergotism didn’t spur the panic of 1692, what did? The problem was likely in the town’s culture rather than its agriculture. In a true ergotism outbreak, the disease afflicts the youngest and most vulnerable in the population—not the relatively healthy teens who levied the accusations. According to historical records, the only individuals who seemed to be affected by the twitching curses and visions were those old enough to understand what witchcraft was.

In fact, most of the accusers were the wealthy children of town leaders. Some of the “witches” who swung had less-than-Puritan reputations or had stopped attending church—in other words, easy targets for prosecution by the powerful theocrats in colonial Massachusetts’s justice system.

It is tempting to defer the blame to a disease rather than the early societies that make up our national heritage, but the ergotism theory seems only to provide a poor rationale for humans behaving badly.

Special thanks to Marilynne K. Roach, historian and author of Six Women of Salem: The Untold Story of the Accused and Their Accusers in the Salem Witch Trials, and to Barry Yaremcio, beef and forage specialist at the Alberta Ministry of Agriculture and Rural Development.

Tonsillectomies: No Longer a Routine Solution

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Desperately seeking a cure: how treatments for chronic sore throats have shifted with medical developments. Image credit: Malcom

 

By Judith Lavelle
BU News Service

At the start of her college career in 2009, Mimi Raver’s tonsils swelled so severely that she struggled to swallow and even to breathe. “At that point,” she says, “I wanted them out right then.”

But it would take three years, two consulting surgeons and several cases of tonsillitis before the University of Miami voice major and her troublesome tonsils would finally part ways. Mimi recalls that her surgeon was hesitant at first. “[He] didn’t recommend it,” she says, “and I literally begged him. I told him, ‘No. You have to take them out.’”

As recently as a generation ago, Mimi’s story could have been much different. Tonsillectomy—the removal of the lymph glands at the back of the throat—was the most common surgical procedure in the United States for a good chunk of the twentieth century. By their heyday in 1965, over 1.2 million tonsillectomies were performed in the United States.

Tonsillectomies gained popularity just after the turn of the century, when surgery in general—prompted by better sterilization techniques and improved methods to induce anesthesia—became increasingly accepted as a legitimate medical practice. Removing the tonsils particularly appealed to surgeons because the organs were relatively easy to access and seemed to serve no other purpose than offering bacteria a place to colonize and cause infection.

But when antibiotics entered the public sphere in the 1940s, physicians could turn to a relatively cheaper, more immediate and essentially more effective solution to sore throats. But tonsillectomies did not immediately decline; their reputation as a useful, relatively low-risk and almost rite-of-passage procedure managed to stick. From the 40s to the early 80s, elite physicians challenged the wisdom of tonsillectomies in medical journals while parents requested the treatment in exam rooms. As a result, the likelihood of a child having his tonsils removed frequently depended more on his doctor’s preference for the procedure and his parents’ insistence than on his medical history.

In this way, the procedure’s history fits into a much larger revolution in medical practice in the United States. Tonsillectomies performed on the basis of infection didn’t start fading out until physicians began to embrace “evidence-based medicine”—the idea of using the results of peer-reviewed research to support medical decisions at the patient level. By the mid-1980s, physicians used clinical data to set national guidelines and standardize the indication for a tonsillectomy: three cases of tonsillitis per year for three years, five infections per year for two years, or seven infections in a single year.

It didn’t take long for the procedure to decline. By 1986, surgeons removed tonsils only 281,000 times, less than a quarter of the number in the mid-1960s. But that doesn’t mean that, even now, tonsillectomies have shed their reputation among parents. “I’ve definitely had patients’ families where parents have had their tonsils out,” says Dr. Jessica Levi, a pediatric surgeon at Boston Medical Center. “They’ll come with their child and want their child’s tonsils out, but they don’t have a great indication for it.”

Like Mimi, patients who may not fit the criteria to receive a tonsillectomy are often frustrated to be denied a once-common procedure. “There are real symptoms for people who suffer from chronic tonsillitis,” says Dennis Scanlon, professor of health policy and administration at Penn State University, “so lots of people want the surgical intervention or some magic bullet that’s going to make them feel better.”

Scanlon observes that this scenario is an opportunity for shared decision making between the physician and her patient. Dr. Nina Shapiro, the director of pediatric otolaryngology at UCLA, explains that many questions can be considered before performing a tonsillectomy. “What’s the evidence?” she says. “What’s the benefit of doing tonsillectomies in otherwise healthy children? Versus the risk?”

While physicians no longer recommend tonsillectomies lightly, many believe that the removal of the tonsils does cause far more benefits than risks for children with a condition called sleep apnea. A growing problem among children in the United States, sleep apnea is a nighttime breathing disorder in which obstruction of the airway (often because of enlarged tonsils) leads to snoring, oxygen deprivation and eventually, daytime exhaustion. According to Dr. Levi, the disorder affects about 90% of her tonsillectomy patients.

Adults get sleep apnea too, but the disease is usually relieved by wearing a CPAP mask to ensure a steady flow of oxygen. Young children, however, will pull the device off and eventually sleep just as restlessly. This is a big problem, as studies have shown that children with sleep apnea may struggle in school because of their fatigue. According to Levi, tonsillectomy is then the first line of treatment—allowing surgeons to reduce the risk of obstruction by removing the bulky organs from a child’s airway.

Dr. Shapiro agrees that sleep apnea is by far a more common reason to remove the tonsils, citing that only about 5% of her tonsillectomy patients come in after multiple cases of sore throat. But for the few who do have the procedure done for the old-fashioned reasons, the relief can be palpable. “It’s been so much better,” says Mimi Raver, now a studio singer based in Los Angeles. “I’m so happy that I had it done.”

So you want to be a stool donor? – Infographic

By Judith Lavelle
BU News Service

In recent years, clostridium difficile—an antibiotic-resistant bacteria that causes severe diarrhea—has become an growing health concern in the United States. (It caused nearly 15,000 deaths in 2007, the last year for which statistics are available.) While doctors treat most clostridium difficile gut infections with repeat rounds of antibiotics, stubborn cases call for unconventional treatment. A fecal matter transplant helps populate an ill person’s gut with healthy bacteria, which can help clear up dangerous levels of clostridium difficile.

Family members or friends usually provide the transplantable stool. But OpenBiome of Medford, Mass, is collecting stool donations from prescreened donors and sending them to hospitals across the country. Donors receive $40 for each donation, but not everyone qualifies to donate. Below, we’ve created an infographic to explore what factors commonly disqualify those interested in joining the registry.

Stool Donor Infographic - Lavelle - EDITS2
Infographic by Judith Lavelle