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ON THE DISTRIBUTION OF LATHYRISM IN THE UNITED PROVINCES ANT) ON ITS CAUSE, WITH A DESCRIPTION OF A -(:; MONTHS FEEDING EXPERIMENT

ON TONGA PONTES WITH BOTANIC ALLY PURE CULTURES OF LATHYBUS SATIVUS AND OF VICIA SATIYA.

LIEX.-T.-COI.OXEL H.

STOTT, M.D., M.R.C.P., D.P.H., I.M.S.,

Principal awl I'/nirxsnr nl Ptdliology, King George's Medical College, Lucktum:


I Kwoived for publication, December 12, 1929.]

1.

DlriTHIBUTIOX OF LATHYRISM IN THE UNITED PROVINCES.

LATHYTUSM (endemic spastic paralysis) is not a very rare disease in certain area? of the United Provinces. During a recent period of 3 years, 22 cases of primary spastic paraplegia (i.e., excluding all cases with a positive W. R. and those secondary to tubercle or growth) where lathyrism was suspected were admitted to the medical wards of King George's Hospital. These cases resided ss follows:Lueknow (5. Punjab 3, Bareilly 2, Pilibhit 2, Unao 2, Kheri 2, Baraioh, Basti, Sitapur, Iiardoi and Rampur State 1 each. Dr. Hargovind Salmi with his many years' experience as physician in-charge of medical outpatients at King George's Hospital informed me that most cases he had seen came from the eastern districts of the province where the rainfall is high and the hmd low-lying; and that the disease was almost unknown in the western districts. His experience was that Gorakhpur, Azamgarh, Ballia, Lakhimpur and Sitapur provided most cases, whilst he had also seen an occasional case from Hardoi and Lucknow. The Inspector-General of Civil Hospitals, United Provinces, was good enough to address 51 Civil Surgeons as to the frequency of latliyrism in the United Provinces.' Their replies indicated that there were two areas in the United Provinces (Ballia and Allahabad) where lathyrism was not uncommon and one area along the Himalayan foot-hills (Gorakhpur, Gonda, fasti, Baraich, Sitapur. Pilibhit) where the disease was recognized. The ( 51 )

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Lathyrism in U. P. and Its Cause.


3.

H. Stott.
T H E DISEASE AMONGST MAN AND ANIMALS.

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remaining districts of the province especially those in the western half were so far as was known practically free of the disease. As the frequency of the disease increased so definitely towards the eastern districts, culminating in Ballia, the most easternly situated of all, I asked the Inspector-General of Civil Hospitals of Bihar and Orissa for information as to its distribution in Bihar and Orissa. The Civil Surgeons of this province were good enough to reply indicating that lathyrism was comparatively not uncommon in northern Bihar and practically did not exist south of the Ganges.' The main Allahabad focus is around Shankergarh, where the people eat peas and rice. This area is not far from Rewar State, where lathyrism is very common. Obviously then lathyrism exists in the United Provinces to a greater extent than was formerly generally believed and I determined to have the home conditions of my next case more fully investigated. The opportunity soon presented itself when one Baldeo, aged 40, was admitted into my ward from Kheri district with spastic paraplegia of 11 months' duration. Baldeo stated that hie- father, uncle and only son had the same disease, whereas his wife and daughter were healthy. (It is remarkable how frequently the women of the family seem to escape.) His wheat crop had been damaged to the extent of 75 per centand his diet and that of his son had consequently consisted of gram 50 per cent and of lathyrus pea 50 per cent with a little barley. At my request my house physician Dr. R. Chandra, M.B., B.S., Lucknow, was good enough to visit this area for a few days. Dr. Chandra furnished a most interesting report and found that 10 persons were affected with spastic paraplegia out of approximately 1,000 in this patient's village. In the next village there were about 12 afflicted amongst 1,000 persons. Similarly amongst other villages he visited the proportion with spastic paraplegia approximated 0-5 to 1 per cent. The diet of these poorer labourers approximated lathyrus 50 per cent, barley 33 per cent, wheat 17 per cent. Dr. Chandra found several interesting examples of many cases_of the disease in one family. It was somewhat unexpected to find on investigation so definite, a percentage of lathyrus cases in this area.

Lathynsm inflicts cruel hardships on the afflicted. It is usually the poor cultivator in debt, the bread-winner of a family, who with his intellect clear is ~inittcn down in his prime with this incapacitating stiff paralysis of the legs. The four stages, of cramps, of spastic paralysis, of bladder and rectal trouble, ;ii'd finally of inability to progress except by crawling, follow each other in the worst cases with rescntless sequence. How apt are Shakespeare's words:
Famine is in thy cheeks, Xreri and oppression starteth in thine eye, Contempt and beggary hang upon thy back, The world is not. thy friend, nor the world's law.'

Animals do not escape. Fowls, pigeons and partridges eat the lathyrus pea freely and with apparent immunity. Ducks are readily poisoned. Of all animals the horse is especially susceptible. Many outbreaks amongst horses i-:i'iinji lathyrus in feeding cakes have been reported and some such outbreaks have formed the subject of subsequent legal proceedings. As long ago as 1820, the Paris Veterinary School warned farmers against using lathyrus peas for horses as. it caused them to become roarers and to die if worked. The main symptoms of equine lathyrism are (i) weak lumbar muscles (' gone in the loins'), lii) Roaring (from recurrent laryngeal palsy). (Hi) Dyspnoea and sudden death on exertion, (iv) Rapid and weak pulse, (v) Debility, tremor and stiffness of the legs. At rest the horse might appear quite well, but cm exertion attacks of the above symptoms might appear and disappear equally suddenly. The first signs in some horses is stumbling and staggering whilst at work so that, if pushed, they might stagger and even fall to the ground.
4. T H E CAUSE OF LATHYRISM.

2.

DISTRIBUTION or LATHYBUS CULTIVATION IN THE U. P.

I applied to the Director of Agriculture for information as to the areas in the United Provinces under lathyrus cultivation. The figures perhaps are not very accurate as to the actual areas sown by the villagers, and I am not inclined to attach much importance to them. On the whole they indicated that more areas existed under lathyrus cultivation in the sub-Himalayan areas and in the eastern districts. The actual figures in areas were Gonda 3,036, Badaun 1,454, Shahjahanpur 381, Moradabad 320, Bulandshahr 258, Farrukhabad 192, Etah 171, Bareilly 99, Baraich 82, Hardoi 19, Bara Banki 18, Kheri 11, Sitapur 2. . . . .

Throughout the centuries in diverse countries from the time of Hippocrates, the disease has been attributed to the consumption of the lathyrus pea in sufficient quantity over a sufficient period of time. What is the factor in mixture of peas from a lathyrus crop that causes lathyrism? From experimental work Acton and Chopra indicated that the cause was a water soluble nmine which was increased during germination and which could be removed nun the l.ithyrus by soaking the grain for 24 hours in three changes of water i/mi. Mai. Caz., Nov. 1922). But some crops of lathyrus will apparently produce lathyrism whilst other crops will not and the experimental work of many workers give discordant results as to the poisoning properties of lathyrus. Anderson. Howard and Simonsen, a team combination of a medical research worker with a botanist and a chemist, by a well-planned research spread over many months, showed that a bazar specimen of lathyrus contained several li.-tinct varieties of peas from which they separated amongst others two of lTial importance, Lnthyrus sativus and Vicia sativa, which they cultivated m botanically pure culture. They concluded that lathyrus was chemically

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Laihyrism in U. P. and Its Cause.

H. Stott.

free from alkaloids and that controlled feeding experiments over long periods with ducks and monkeys showed that the grains are harmless and even nourishing to these animals. They found that Yicia saliva, a weed commonly contaminating a lathyrus crop, possessed alkaloidal bases. One, divicine, produced a characteristic and fatal disease when innoculated into guinea-pigs. Vicia saliva when fed to ducks caused death, and in monkeys produced characteristic nervous and muscular symptoms. Though some of these symptoms have been described in human latbyrism they were not yet prepared to state that Akta is the cause of lathyrism in man (Ind. Jour. Med. Res., XII, 4, 1925).
5. T H E LUCKNOW TONGA PONY EXPERIMENTS.

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owing to the exhaustion of botanically pure strains of the grain At the end of this period, all ponies were in equal and excellent condition and had put on weight. At no time did they show any evidence of disease either at ie,t o,during or after exercise.
6. A PLEA FOE FURTHER RESEARCH.

I conclude therefore that the experimental proof of the factor in a lathyru, crop winch causes lathyrism is not yet complete and I urge that f u X research may be devoted to the solution of this important problem

Was the cause of lathyrism residual in Lathyrus sativus, or in the contaminating weed Vicia saliva f It is of the utmost importance to decide this point for in famine periods, when vast outbreaks.of lathyrism arc apt to occur, the effective preventative steps to be advised differ according to which pea is actually responsible. Therefore I devised the following experiment and, in consultation with Major L. A. P. Anderson, I.-M.S., of the Central Research Institute, Kasauli, J. T. Edwards, Esq., of the Imperial Institute of Veterinary Research, Muktesar and Captain Hickey of the Civil Veterinary Department, "United Provinces, put it into effect. Three healthy tonga ponies were purchased in the bazaar and kept for a period in quarantine. Their age (2 years 3 months), sex (male), height (10 feet 3 inches), girth (48 inches), shank (6 inches), weight (50 seers) and condition (fair) were approximately the same and the ponies were seen at fortnightly intervals by Captain Hickey who recorded their progress. I saw the ponies daily at one feed and weekly at trotting and cantering exercise. To each pony the same basic diet was given, namely, three pounds of barley with salt, a handful of lucerne when available and grass feeding ad lib. To No. 1 pony, a chestnut, named ' Vicia,' three pounds of Vicia saliva daily were given mixed in the basic diet. To No. 2 pony, a roan named ' Lathyrus,' three pounds of Lathyrus sativus daily were given mixed in the basic diet. To No. 3 . pony, a starred chestnut named ' Control,' the basic diet only was given. The lathyrus and vicia were grown in botanically pure culture at the Institute of Plant Industry, Indore, Central India, and these pure strains I was able to obtain through the courtesy of the Director, A. Howard, Esq., C.I.E. A daily register was maintained of each pony's feeds, exercise and condition. Each feed was mixed and given in the presence of Dr. R. S. Lai, demonstrator in pathology at the King George's Medical College, to whom I am indebted for this considerable help. The amount of any feed left by the animal was entered in the register. It was expected from the experience of previous outbreaks of lathyrism in horses, that with this dosage of the pea symptoms of lathyrism would appear in one or at the most 2 months. The experiment started on 12th November, 1928, and was continued until 6th April, 1929, that is for 4 months 24 days, when it was forced to stop

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