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Original and Review Articles 70 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. I, NO.2 87 Romer FK. Sarcoidosis and Cancer: A critical review. In: Jones 100 Eisenberg H, Terasaki P, Sharma OP. HLA association studies in Williams W, Davis BH (eds), Eighth International Conference on black patients with sarcoidosis. Tissue Antigens 1978;11:484. Sarcoidosis and Other Granulomatous Diseases. Alpha Omega 101 Newill CA, John CJ, Cohen BH, et al. Sarcoidosis, HLA and im- Publishing Ltd, Cardiff, UK, 1980;567-71. munoglobulin markers in Baltimore Blacks. In: Chretien 1, Mar- 88 James DG. Is sarcoidosis a precursor of lung cancer? Cancer Con- sac J, Saltiel JC (eds), Sarcoidosis and Other Granulomatous Dis- sultation 1985;1(2):19. orders. Pergamon Press, Paris, 1981;253-6. 89 Kyle RA, Bayrd ED. Amyloidosis: Review of236 cases. Medicine 102 Tachibana T, Shirakura R, Yamazaki Y. HLA-DR antigens in sar- (Baltimore) 1975;54:271. coidosis. Sarcoidosis 1985;2:83. 90 Gordonson JS, Sargent J, Jacobson G, et al. Roentgenographic 103 Thunell M, Soundell K, Stjerberg N. HLA-antigens in patients manifestations of pulmonary amyloidosis. J Can Assoc Radiol with sarcoidosis from Northern Sweden. Sarcoidosis 1985;2:48. 1972;23:269. 104 Nowack D, Goebel K. Genetic Aspects of Sarcoidosis: Class II his- 91 Cole SR, McCormick, Sulavik SB. Granulomatous lymph node in- tocompatibility antigens and family study. Arch Intern Med volvement in amyloidosis. Sarcoidosis 1985;2:78. 1987;147:481. 92 Fresko D, Lazarus SS. Reactive systemic amyloidosis complicating 105 Crystal R, Roberts WC, Hunninghake GW, et at.' Pulmonary sar- longstanding sarcoidosis. NY State J Med 1982;82:232. coidosis: A disease characterized and perpetuated by activated 93 Sharma OP, Koss M, Buck F. Sarcoidosis and Amyloidosis: Is the lung T lymphocytes. Ann Intern Med 1980;94:73. association casual or co-incidental? Sarcoidosis 1987;4:139. 106 Crystal R, Gadek JK, Ferrans VJ, et al. Interstitial lung disease: 94 Sack GH Jr, Lease 11. Human amyloid-A gene isolation and struc- Current concepts of pathogenesis, staging and therapy. Am J Med tive studies. Sarcoidosis 1985;2:68. 1981;70:542. 95 Harf RA, Ethevenaux C, Gleize J, Perrin-Fayolle M, Geurin JC, 107 Lem VM, Lipscomb MF, Weissler lC, et al. Bronchoalveolar cells Ollagnier C. Reduced prevalence of smokers in sarcoidosis. Re- from sarcoid patients demonstrate antigen presentation. J Im- sults of a case control study. Ann NY Acad Sci 1986;465:625-31. munoI1985;135:1766. 96 Lawrence EC, Fox TB, Teague RB, Bloom K, Wilson RK. 108 Daniele RP, McMillan LJ, Dauber lH. Immune complexes in sar- Cigarette smoking and bronchoalveolar T-cell populations in sar- coidosis: A correlation with activity and duration of disease. Chest coidosis. Ann NY Acad Sci 1986;465:657-64. 1978;74:261. 97 Moilers E, Hedfors E, Wiman LG. HLA genotypes and MLR in 109 Quismorio F, Sharma OP, Chandor SB. Immunopathological familial sarcoidosis. Tissue Antigens 1974;4:299. studies on the cutaneous lesions in sarcoidosis. Br J Dermatol 98 Kueppers F, Mueller-Eckhardt G, Heinrich D. HLA Antigens of 1977;97:635. patients with sarcoidosis. Tissue Antigens 1974;4:56. 110 Okabe T, Suzuki A, Ishikawa H, Watanabe I, Takaku F. 99 Brewerton D, Cockburn G, James DG. HLA antigens in sar- Chromosomal aneuploidy in sarcoid granuloma cells. Am Rev coidosis. Clin Exp ImmunoI1977;27:277. Respir Dis 1986;134:300-4. The neurotoxic disease lathyrism DWIJENDRAN. ROY INTRODUCTION ditions, when L. sativus constitutes approximately two- Human lathyrism, or neurolathyrism, is caused by the in- thirds of the daily diet, humans and domestic animals de- gestion of certain Lathyrus species, namely L. sativus velop lathyrism. 1-7 (chickling vetch), L. cicera (flat-podded vetch) and L. The search for a causative factor or group of factors in clymenum (Spanish vetchling). Lathyrus presumed to be responsible for the onset of the In certain areas of the world, L. sativus provides a com- disease has resulted in the identification of various chemi- paratively nutritious and inexpensive diet among poor cals having potential toxic properties, all of which have people. During natural calamities such as flood and been generally termed 'lathyrogens'. drought, when other general food crops are damaged or destroyed, the hardy crop, L. sativus becomes a survival THE DISEASE LATHYRISM food for humans and domestic animals. Under these con- Historical and General Background The ancient Hindu treatise, Bhavaprakasa, mentions that Institute of Neurotoxicology, Department of Neuroscience, 'the triputa pulse causes a man to become lame and it crip- Albert Einstein College of Medicine, Bronx, New York, USA ples and irritates nerves.s Hippocrates (460-377 B.C.) © The National Medical Journal of India, 1988 ROY: THE NEUROTOXIC DISEASE LATHYRISM 71 noted that certain peas were found to be toxic to human documented by General Sleeman, of an epidemic of beings. In the seventeenth century, the Duke of Wurtem- lathyrism in India which took place between 1829 and berg prohibited the use of Lathyrus flour in the making of 1831:6 bread, recognizing its paralysing effects upon the legs." In 1829 the wheat and other spring crops in Saugor and sur- Contani, in Italy, first coined the term 'lathyrism' in 1873 rounding villages were destroyed by severe hailstorms and rains to identify the unique neurological disorder which re- and in 1831 they were destroyed by blight. During these three sulted from ingestion of Lathyrus seeds.? years the 'teori' or what in other parts of India is called Khesari Throughout the eighteenth and twentieth centuries, (L. sativus), a kind of wild vetch which, though not sown itself, outbreaks of lathyrism occurred in certain parts of is left carelessly to grow among the wheat and other grains and given in the green and dry state to cattle, remained uninjured Europe, Central India, North Africa, Middle East, Af- I and thrived with great luxuriance. In 1831 they reaped a rich ghanistan and Russia. ,4.5.IOMajor epidemics were re- crop of it from the blighted wheat fields and subsisted on its grain ported in France (1700-1; 1836) and Spain (1940s).6.IO.11 during that and the following years giving the stalks and leaves Lathyrism has been reported in many districts of India in- only to the cattle. In 1833, the sad effects of this food began to cluding Jammu and Kashmir, the Punjab, Bihar and West manifest themselves. The younger part of the population of this Bengal. Madhya Pradesh experienced a high incidence of and the surrounding villages, from the age of thirty downwards, lathyrism with about 60 000 cases reported in 1922. A sur- began to be deprived of the use of their limbs below the waist by paralytic strokes, in all cases sudden, but in some cases more se- vey carried out between 1956 and 1961 revealed 25000 vere than others. About half of the youths of this village of both cases in Rewa and 7000 cases in Satna districts. The oc- sexes became affected during the year 1833-34 and many of currence of lathyrism was also reported in Orissa and them have lost the use of their lower limbs entirely and are un- Maharashtra. able to move. The youth of the surrounding villages in which the In India, the pulse of L. sativus is known by various teori from the same sources formed the chief article of diet dur- names including khesari (in Hindi, Bengali, Nepali, ing the years 1831-32 have suffered to an equal degree. Since the year 1834 no new case has occurred but no person once at- Oriya), teora, batra and teora-dal (in Hindi), gharas(in tacked has been found to recover the use of limbs affected, and Kashmiri), vattu-parippu and khesari (in Malayalam), my tent was surrounded by great numbers of youth, in different lakh (in Marathi), khesari-chural (in Punjabi), lamka- stages of the disease, imploring my advice and assistance against pappu (in Telugu) and khesari-parappu (in Tamil). the dreadful visitations. Some of them were very fine young men The pulse, known to be a native of Southern Europe of good caste and respectable families and all stated that their and West Asia, is grown in India, Bangladesh and pains and infirmities were confined entirely to the part below the Ethiopia. In India, four per cent of the land used for pulse waist. They described the attack as coming on suddenly, often while the person was asleep, and without any warning symptoms cultivation is occupied by L. sativus, and its production whatever, and stated that a greater portion of young men were constitutes about three per cent of the total pulse pro- attacked than of young women. It is the prevailing opinion of duced. The Lathyrus growing states are Madhya Pradesh, natives throughout the country that both horses and bullocks, Uttar Pradesh, Bihar, West Bengal and Assam. which have been fed on teori, are liable to lose the use of their L. sativus (Fig. 1) belongs to the botanical family of limbs, but if the poisonous qualities abound more in grain than leguminosae. It is an annual herb, with creepers 45-60 em the-stalk of leaves, a man who eats nothing but the grain must be long which produce hairy pods. The seeds are greyish- more liable to suffer from the use of food than beasts, which eat it merely as they eat grass or hay. brown and black in colour. The following was taken from the first description, Epidemics of neurolathyrism were reported in Europe and Asia in the eighteenth and nineteenth centuries and were associated with famine and the consequent use of certain Lathyrus species in the preparation of flours and cereals.8.12.13A clinically similar disease, thought to be potentiated by vitamin deficiency, occurred in concentra- tion and prisoner-of-war camps during World War 11.12.15 Based on observations reported in Israel and Asia, it is concluded that lathyrism is a stereotyped, self-limiting neurotoxic disorder found in nourished and under- nourished individuals who consume 200-400g per day of L.
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