A forgotten plague: making sense of dancing mania.

624 www.thelancet.com Vol 373 February 21, 2009 On Christmas Eve in 1021, 18 people gathered outside a church in the German town of Kölbigk and danced with wild abandon. The priest, unable to perform Mass because of the irreverent din from outside, ordered them to stop. Ignoring him, they held hands and danced a “ring dance of sin”, clapping, leaping, and chanting in unison. The enraged priest, recorded a local chronicler, cursed them to dance for an entire year as a punishment for their outrageous levity. It worked. Not until the following Christmas did the dancers regain control of their limbs. Exhausted and repentant, they fell into a deep sleep. Some of them never awoke. It might seem improbable to us, but there was nothing in this story that mediaeval people found hard to believe. Compulsive dancing joined that litany of natural and human disasters to be explained in terms of celestial or supernatural forces. But even if much of the chronicler’s account is clearly the stuff of legend, we should not dismiss it as purely invention. Plenty of sources indicate that this obscure chronicler may have embellished a real event. The Kölbigk incident is a contender for the fi rst of the dancing plagues. Later chronicles speak of a bout of unstoppable, and sometimes fatal, dancing in the German town of Erfurt in 1247. Shortly after, 200 people are said to have danced impiously on a bridge over the Moselle River in Maastricht until it collapsed, drowning them all. Likewise, dozens of mediaeval authors recount the terrible compulsion to dance that, in 1374, swept across western Germany, the Low Countries, and northeastern France. Chronicles agree that thousands of people danced in agony for days or weeks, screaming of terrible visions and imploring priests and monks to save their souls. A few decades later, the abbot of a monastery near the city of Trier recalled “an amazing epidemic” in which a collection of hallucinating dancers hopped and leapt for as long as 6 months, some of them dying after breaking “ribs or loins”. On a far larger scale was the outbreak that struck the city of Strasbourg in 1518, consuming as many as 400 people. One chronicle states that it claimed, for a brief period at least, about 15 lives a day as men, women, and children danced in the punishing summer heat. There were also several isolated cases during the 1500s and 1600s, from Switzerland and the Holy Roman Empire, of the mania gripping an individual or entire family. The dancing plagues are little remembered today, in part because they seem so unbelievable. But while the incidents at Kölbigk, Erfurt, and Maastricht might be apocryphal, there is no question that the 1374 and 1518 epidemics occurred. Dozens of reliable chronicles from several towns and cities describe the events of 1374. And the course of the 1518 epidemic can be minutely detailed with the help of municipal orders, sermons, and vivid descriptions left behind by the brilliant Renaissance physician, Paracelsus. These outbreaks represent a real and fascinating enigma. On one thing contemporary and modern writers have agreed: those who danced did so involuntarily. They writhed in pain, screamed for help, and begged for mercy. So what could have impelled them to dance against their will? One theory is that they had ingested ergot, a mould that grew on stalks of ripening rye and can cause hallucinations, spasms, and tremors. Epidemics of ergotism certainly occurred in mediaeval Europe when people ate contaminated fl our. But this theory does not seem tenable, since it is unlikely that those poisoned by ergot could have danced for days at a time. Nor would so many people have reacted to its psychotropic chemicals in the same way. The ergotism theory also fails to explain why virtually every outbreak occurred somewhere along the Rhine and Moselle Rivers, areas linked by water but with quite diff erent climates and crops. We do know, however, that the victims of dancing epidemics were experiencing altered states of consciousness. This is indicated by their extraordinary levels of endurance. In a trance state, they would have been far less conscious of their physical exhaustion and the pain of sore, swollen, and lacerated feet. Onlookers in 1374 also spoke of the affl icted as The Dancing Mania by Hendrick Hondius (1642) after Pieter Brueghel The art of medicine A forgotten plague: making sense of dancing mania