DEC. 1904.

LATHYRISM IN THE CENTRAL PROVINCES.

THE

461

Jndian
DECEMBER, 1904. THE LATHYRISM INQUIRY. ^ I T may be remembered that in February 1003 we announced that the Government of ''india had determined to hold an inquiry into the prevalence of lathyrism in the Central Pro, v in ces, and that Major Andrew Buchanan, I.M.S.I 3T.D., had been appointed to conduct the inquiry. The Report is now before us and we may at once say that it forms a complete and valuable monograph on this disease. The Report announces no new discovery in -the causation'of this disease, but proves, to our minds, conclusively that the common belief which -connects the prevalence of lathyrism known Tvith the long and excessive use of the vetch botanically as Lathy rus sativus (vernacular deora C. P., Kesari, Northern India) is correct. The Report gives an interesting sketch of the history of the disease in India, and in other countries. The best known accounts of the disease in India is that in Sleeman's Rambles and Recollections, where he describes whole villages of paralytics in the Saugor District tind in the neighbouring districts of what are now 4,he United Provinces. Sleeman wrote in 1833 "The next important account is by Dr. Kinlock iKirke in 1845, who described a serious outbreak in Sinde in that year. Next comes the very full and valuable report by Dr. Irving, then a Civil Surgeon of Allahabad, in 1857 and following years. Dr. Irving's account is of -great interest, and his descriptions are so accurate that the}7 cannot be surpassed. They will be found in volumes 6, 7, 12, and 23 of the long extinct Annals of Indian Medical Science, and some interesting extracts are printed from them by Major A. Buchanan in an appendix to his report. There is a strong popular opinion in favour of -the connection between the consumption of kesari -and the spastic paraplegia S3rmptoms of lathyrism. Of course persons are found to tell one that they know of cases where the patients hardly ever or never ate kesari, but on investigation i t is found, if the.case is one of lathyrism at all, that the patient ate some inferior mixed grains, which on examination prove to. be lathy rus.

The essential conditions are as follows : (1) a large quantity, i.e., a large proportion, of -the daily fo* must have consisted of this grain, (2) this use of it must have continued for at least two or three months. It is probable that when kesari is eaten as bread with the husk, it is more deleterious. We have been told by men in Bengal that they could see no reason for the prohibition of the use of kesari in Bengal jails, they usually stated that they had seen it used and without harm. Quite true, but in Bengal it is rarely used, and it is used in small quantity and as a dav ; hence the two essential conditions are not fulfilled, and the argument falls to the grouud. These two conditions, viz., large quantity and longtime mu3t always be borne in mind when one is investigating any cases of this unfortunate complaint. Cases of lathyrism are always connected with times of scarcity or famine, because this grain often survives, when wheat and other food crops fail and because it is cheap. The people well know that its continued use will produce paralysis, but they always hope to be able to leave off before serious symptoms have supervened. The Report deals fully with the symptoms of this paraplegia. Women are much less affected than men, a fact of which no wholly satisfactory explanation is forthcoming. Children often suffer. The severity varies according to the length of time and the quantity of the grain consumed. If a man eats pure teora (kesari) for about two months he gets cramps in his legs; if he then stops he may recover entirely; but even then will be noticed "an up and down movement of the shoulders," the patient's toes may drag slightly on the ground, and if he attempts to run he will very likely fall. If the patient continues to eat teora, he may experience a sudden attack of paralysis, but if at last warned, he gives up the use of the grain, he will slowly recover, and soon be able to walk about with the aid of a stick, his toes will scrape the ground, and the muscles of the back of his leg will be rigid.* If in spite of warnings or from dire necessity the patient continues the use of the grain he will loose control over his bladder aud rectum sphincters. Even at this stage the disease is capable of arrest and improvement if the supply of teora is stopped ; but the utmost that can be expected is an ability to hobble along with the aid of two sticks. A further
* We saw dozens of men in this stage in Shahabad District in 1897-8 after the scarcity.ED., / . M. G.

462

THE INDIAN MEDICAL GAZETTE.

1904.

stag is described in the Report as that of the " crawlers." These unfortunates have eaten kesari fora long time, and have become unable to do more than crawl. It will thus be seen that if only the patient will remove the cause, i.e., stop eating lathyrus. he can toa considerable extent, recover the partial use of his limbs.* The characteristic gait and "stance" of a lathyrus patient is well known, the dragging of the toes is a marked symptom, there is usually a tendency to crossed-legged progression. Major Andrew Buchanan's Report deals with the geographical, agricultural and famine influences which affect the prevalence of this serious complaint. As regards the degree of prevalence, the Chief Commissioner ordered a Census of the cases of lathyrism in the five districts, Hoshangabad, Narsingpur, Jubbulpore, Datnoh, and Saugor, and there was found a total of 7,78G, consisting of 5,775 males, 759 females and 958 children. This shows the very marked difference in the number of females affected. The epidemic, as it may be called, lasted in the Central Provincs from 1896 till 1902. The evidence in favour of regarding lathyrus as the cause is considered under three heads(I ) the evidence of those who ate the grain, and all who were paral\\sed admitted that they had eaten lathyrus in large quantity and for a long time ; (2) the fiict that none were paralysed who had not eaten lathyrus, and (3.) that others who on finding they had some unusual sensations, ha<l ceased to eat lathyrus, and had escaped from the disease. It is not possible to say much that i,s of value as regards the therapeutics of this form of paraplegia. Dr. Quinn treated some 400 cases with strychnine and considered it of no value, on the other hand Major W. D. Sutherland, I.MS., thought strychnine beneficial. There remains the important questionCan the disease be prevented ? The cultivation of Jathyrns has been prohibited in Europe in 1671, and in 1829, in Algeria in 1881 and at Allahabad in 1870, but at present in the Central Provinces this is nofc a practical polic\7, though, where the grain is not grown for feeding cattle, but only for issue
* It may. be worth noting that the patient whose case was reported by the present writer in Journal of Tropical Medicine, May 1899, and whose portrait now appears in Scheube's Diseases of Warm Climates (2nd Ed.) was recently seen and was found to have almost c< mpletely recovered the use of hia limbs, after 5 years regular feeding in jail. This photograph will show the "crossed-legged progression,"mentioned above.Eli., / . M. G.

to farm servants, some sort of restriction is probably advisable. Major A. Buchanan, however, is inclined to educate the people to thednger of continuing to eat this grain. This admirable report is concluded as follows : " I t has been shown that lathyrism is due to the consumption of lathyrus, that the disease, when it occurs in big epidemics, follows famines or scarcity ; that it is chiefly confined to wheatarowiiiij areas; that failure of wheat is an important factor in its causation ; that thedisease is found chiefly among the poor, and that debt is an important factor in causation. Under certain circumstances lathyrus is a good article of diet, and it is only when the proportion reaches or exceeds one-half of the whole ration that paraljsis is likely to occur. The numerous theories which have been advanced to account for the curious distribution of lathyrism owe their origin mainly to the fact that the 'time'' and the ' quantity ' factors had not received, due consideration. There is no proof that roasting or washing removes the poison; there is no proof that the poison lies in the husk, or that the poison H of th^ nature of an ergot, or that one kind of lathyrus is poisonous whileanother kind is not. The mixtures are special sources of danger. The grain is specially injurious to horses." *

ANTI-MALARIAL SANITATION IX INDIA. THE discussion on the prophylaxis of malaria at the recent Meeting of the British MedicalAssociation at Oxford, as reported in full in the Journal of September 1901, is of exceptional interest and importance. We would direct the special attention of our readers to the paper by Dr. J. W. W. Stephens, and to those by Major R. Ross, Captain James and Lieutenant Christophers i.Jvr.S., on the results of the anti-malarial campaign at Mian Mir. The first point emphasised by Stephens is that all the anophelines do not transmit malaria, but oidy certain species, hence in India if we could only differentate them it would oidy be necessary (according to our present knowledge) to wage war against three species, viz., A. listoni, A. culicifacies andprobably ,A. maculipalpis. It i? admittedly
* How many cases of that somewhat vague disease of horses known as knmri or " gone in the loins is due to the use of this grain by horses, owing to tricks of the syces, and how few horse owners would recognise kesari when they see it ?- E D . , / . M. G.