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The Causation of Epidemic Dropsy

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The Causation of Epidemic Dropsy THE CAUSATION OF EPIDEMIC DROPSY. By HUGH W. ACTON, Major, i.m.s., Professor of Pathology, School of Tropical Medicine and Hygiene, Calcutta. In a previous paper on the causation of lathyrism. (I. M. G.,Jufy, 1922.) I pointed out the possibility of this disease being- due to an amine in kesari dal. Since then we have progressed still further in our knowledge. We found that the large grain kesari with thin husks known as lakh germinated in twenty-four hours, whilst the small grain with thick husks, did not sprout after four days' soaking .in water. During the germina- tion process, more than twice the amount of amine was produced in the large grained variety as in the smaller non-germinating dal. This explains why the large grained lakh is popularly regarded as being more poisonous than the smaller lakhari dal, whilst the high incidence of the disease during the months of July to September is due to the heat and humidity of these monsoon months causing the grain to germinate more readily. Further the toxic amine isolated from germina- ting grain caused paralysis in mice. Lathyrism is therefore a chronic amine poisoning similar to ergotism; in the former the toxic amine is produced during germinating, and in the latter produced by Claviceps purpurea. Both diseases are conditioned by economic stress because people will not eat either of the grains, unless compelled to do so by famine. Epidemic dropsy is a disease characterised by localised oedemas chiefly affecting the lower extremities and not associated wjth signs of peripheral neuritis, thus differentiat- ing it from beri-beri. Col. Megaw, I. M. S Director of this School, has for many year's been interested in this disease and commenced an investigation into its causation. Before going to England on leave he deputed me to carry on the investigation. Owing to the generosity of F. M. Kanga, Esq., of Bombay who gave the school a donation towards these researches we were able to employ a part time medical officer to collect certain etiological data:?an excellent example of disinterested generosity, as Mr. Kanga allowed us to utilise his grant to investigate a disease that is almost peculiar to Bengal. The School gratefully recognises the value of his example, and looks to the numerous wealthy Indians that live in this city to help with grants to solve the pre- vention and treatment of the many diseases 332 THE INDIAN MEDICAL GAZETTE. [Sept., 1922. that decimate the inhabitants of this (b) The disease is commonest between the province. ages of 20 to 35, when the consumption of food is My previous study on lathyrism largest. (1922), The incidence showed the importance of these toxic ami- (c) high amongst Bengali widows. The of rice eaten an nes in the production of disease. I next con- quantity by individual is not the sidered epidemic dropsy from a similar point although important only factor, because show that the of view. The disease is almost peculiar to Greig's figures mean amount of rice consumed the infected Bengal and Madras, the great rice-eating provinces by was over three c'hittacks a of India. In Bengal it occurs amongst the community just day. The classes consume a Hindus, and more particularly affects the mid- poorer larger quantity of rice a whilst there is a dle class, the great eaters of old rice day, fairly large of chattris who consume (Desi or Balami). The disease commonly community up-country about 8 chittacks of new rice a and both occurs during the months of July to Septem- day communities are free from the disease. ber. the hot humid months of the year, when The the rice. changes are likely to occur in the rice as the (3) quality of Greig pointed out the disease affects the middle with result of fungus growth. The disease occurs classes fixed in epidemics that are associated with rises in incomes, viz., clerks, artisans, students, the price of food-stuffs for two consecutive petty traders of the Bengali Hindu community, and considered that the disease was due to a years, when grain is likely to be hoarded up, and further changes occurs in this old rice. one-sided diet. If his view was correct we would ?those There is no need to give the ^etiological data, expect the. poorer classes, earning Rs. 15 a month and to be as these were very carefully collected by Col. under, mainly affected, but these are immune E. D. Greig, c.i.K., i.m.s., Director of Medi- poor people practically from the disease. When I into cal Research, India, and these I will use for enquired this fact, I found that the classes in- the purpose of this paper. It is with regard to poorer his interpretation of the data that I differ from variably eat the new indigenous rice (Dcsi) as it is in The him:, I believe he was led astray by the vita- considerably cheaper price. middle to eat well-seasoned mine theory, then recently published by Fraser classes prefer and Stanton. rice (old Dcsi or Salami) as it is sweeter in flavour, more digested, and consequent- The are the main factors in the easily following ly more expensive. The seasoning of the rice causation of Dropsy in Bengal :? Epidemic by age shows that the vegetable proteids and The association with a rice diet. (1) Greig carbohydrates are split up by slow bacterial showed that the distribution of this disease or enzyme action into the more soluble digest- was wards of peculiar in the different Calcutta. ible proteids, proteoses and peptones; and who eat Patna The European community rice sugars. Here we have an economic factor and very little of ,it, wholly escaped from the but one which is diametrically opposite to that as as Marwari commu- disease, well the large causing lathyrism which is due to famine con- who lived on hand-made a nity mainly bread, ditions. In epidemic dropsy the poorer classes new His little rice and pulses. figures next live on the cheapest indigenous new rice and showed that the disease mainly affects the do not suffer from the disease, the middle Hindu whose main article Bengali community classes who can afford the more digestible of diet consists of rice with a little addition of seasoned rice suffer, whilst the wealthy The incidence fish, sweets, etc.. high amongst escape as they can afford a richer protein diet Hindu widows was also noticed by him, who and thereby diminish the amount of rice. for caste reasons were hot allowed to take (4) The production of the amine. Our meat of be it fish or fowl. The any kind, flesh, figures show that the disease is most pre- interpretation I place on Greig's findings is valent in September and extends into the that the disease is one closely associated with winter months. Tt is caused by the old an exclusive or almost exclusive rice diet. seasoned rice which has been subjected to the heat Greig thought that the absence of meat in and moisture of the monsoon months. This a factor in the diet played large the disease, was also the case with lathyrism, which was but this is one of these spurious correlations due to the production of an amine produced that have led many astray in their deductions. by the grain germinating during these months. The amount of meat eaten by an individual The germinating power of the rice is destroy- must the invariably restrict quantity of rice ed during the husking and polishing processes, consumed by him. to which it is subjected during milling. are kinds on (2) The amount of rice consumed is the There three main of rice the second factor. This is borne out by the follow- Calcutta market, Dcsi or country rice, Balarni, ing facts.? and Rangoon rice. The rice that is eaten bv is seasoned Balarni rice (a) The disease is extremely common the middle classes amongst the Bengali Hindu community. which is par-boiled. The Marwari communitv Greig showed that out of 630 cases of epide- eat a special kind of rice, Chini Suckur, which and these are washed mic dropsy investigated by him. 538 cases were is preserved by lime gravel, Hindus. away, the rice boiled with milk and eaten as Sept. 1922.] SURGICAL ASPECTS OF AMCEBIASIS: CHATTERJI. 333 The cause and Khcr. The Hindu widows cannot eat any causing epidemic dropsy. are so not of the disease Obvious, the food cooked by other hands, the rice is prevention viz., rice of seasoned rice from the diet. par-boiled. The final polishing of the elimination reason for this is removes almost the whole of the aleurone The preliminary publication cases have been with some of the neighbouring starch the fact that several recently layer and the in cells, and most of the germ. This exposes reported already, practitioners to know what advice the fruit to invasion by bacteria and fungi, and this city require they as treat- hastens the seasoning of the rice. Seasoning should give to their patients regards as to the is not the only factor, as old rice is eaten all ment and prevention. Speculations a cases occur etc., are but the year round and yet only few nature of the toxin, premature, is definite that it is found in in non-epidemic years. the evidence (5) The economic factor. Greig showed over-seasoned rice. that epidemics were likely to occur when food prices had been at a high level for two years as fell consecutively. As soon food prices as the fall the epidemic subsided result of the is in prices.
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