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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 out-

patients 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

)

52:

Lathyrism

in

U. P.

and Its

Cause.

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 to its distribution

of Civil Hospitals of Bihar and Orissa

for

information

as

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

same disease, whereas his wife and daughter were healthy.

only

son had

the

(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 cent—and 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

with

spastic

In

the next

paraplegia

out

village

there

of

approximately

1,000

were

about

12

afflicted

10 persons were

in

this

patient's

affected

village.

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.

  • 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 in-

clined 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.

.

..

.

H.

Stott.

53

3.

THE DISEASE AMONGST MAN AND ANIMALS.

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

Contempt

The

world

oppression starteth

in

thine eye,

and

beggary hang upon thy

back,

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.

animals the horse is especially

susceptible.

Many

outbreaks

amongst

Of

all

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).

sudden death on exertion,

(iv)

Rapid and weak pulse,

(Hi) Dyspnoea

and

(v)

Debility, tremor

and stiffness

of

the

legs.

At rest

the

horse might

appear

exertion attacks of the above symptoms might appear

and

quite

well, but cm

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. THE

CAUSE OF LATHYRISM.

Throughout the centuries in diverse countries from the time of Hippo-

crates, 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 experi-

mental 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

»l«Tial importance, Lnthyrus

sativus

and

Vicia sativa,

which they cultivated

m botanically pure culture. They concluded that lathyrus was chemically

  • 54 Laihyrism

in

U. P.

and Its

Cause.

free from alkaloids and that controlled feeding experiments over long periods

with ducks and monkeys showed that the grains are harmless and even nourish- ing to these animals. They found that Yicia saliva, a weed commonly con- taminating 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. THE

LUCKNOW

TONGA

PONY

EXPERIMENTS.

• Was

the

cause of

lathyrism

residual in Lathyrus

sativus, or

in

the

con-

taminating 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 pur-

chased in the bazaar

and kept for a period in quarantine.

Their age

(2 years

(male), height (10 feet 3 inches), girth

(48 inches), shank

(6

3 months), sex 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 the most 2 months.

in

one or

at

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

 

H.

Stott.

55

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

fu X

research may be devoted to the solution of this important problem

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