July, 1922.) CAUSATION OF LATHYRISM IN MAN: ACTON. 241

is eaten as a In times1 of plenty it dal, with * Y wheat hand-bread, or rice, or as puris, but in to the Articles. ' times of famine owing high price iaf wheat Original forced to consist of and rice, their diet is only are unobtainable kesari dal. Vegetables, etc.,

the drought. _ during Ihe dwarf AN INVESTIGATION INTO THE (2) Lathvrus ciccra.? chickling and and is CAUSATION OF LATHYRISM IN MAN. is crown in France, Italy, Algeria, for cattle. When wheat is dear, HUGH W. ACTON, i.m.s., used as fodder By Major to make bread it is used instead of flour Pathology and Bacteriology, School of Ihe Professor of (3) lathvrus clymenum.? Spanish Tropical Mcdicinc and Hygiene, Calcutta. North Africa and the vetch, is grown in Spain, H. August 1921, Major W. Pierpoint, In we are concerned with the to Sutna to the India, only i m s invited me up investigate Lein Some believe that sativns or kesari dal. a type of spastic paraplegia, disease lathyrism, not but that the seeds the inhabitants of North the ddl itself is poisonous, common amongst takes place, decompose, or some paras,tic growth is in this way ; snudar by the as due and the produced The paralysis is regarded people of ergot. Others consider diet of kcsari ddl to the production to an exclusive are due to the eating that the symptoms Agrostemma sativus). or to the Lolntm (Lathyrus me corn-cockle), Major Pierpoint assured that the disease githago (the in this part of the State and tcmulcntum (the darnal). was very prevalent ^stier isolated an alkaloid which he the few I had ai my 1 ought In 1883 dnring days disposal, but gave no experimental in at least a as the poison, to have no (difficulty examining regarded of his view In 917, cases. He wanted to know evidence in support couple of hundred an alkaloid, but m take to prevent this terrible Stockman also isolated only what measures to and he was unable to ob- for life so of the very minute quantities, affliction which .crippled m;any large amount to analyse this State. tain a sufficiently subjects of formula. Furthermore Dr. Suda- I was to but Pier- its molecular anxious collaborate, Major been on M.sc., has working the point requested me to conduct my own investiga- moy Ghosc, of the subject and has isolated tions on this disease, for he was too to chemical aspect only glad which gives most of the have given me the lead. I am therefore indebted a non-toxic amine to him, not only for having this re- alkaloMal tests. . . instigated the amine m the but also for his The chemistry of produced search, help during the clinical will be dealt with examination of these cases, and furthermore for ?Train during germination the research is still not complete. the necessary information from the separately, a?s obtaining live on an exclusive diet of officials about the will not various State harwar system people to famine, and I so or vetch unless compelled by and other factors that play large a part in the dal that the of the prevention of causatiion of this disease. will show problem rus is enough by my finding Three of lathy are as latbyrism simple species regarded is water soluble i.e., it can be and endemic in m;an that the poison causing epidemic the gram m three of are: removed by soaking changes and animals. They hours Yet When we are in water the 24 (1) sativus.?Generally known during illiterate Lathyrus a half starved ddl, teora, or buttorah ka ddl. dealing with population India as kcsari circumstances to live on a the as who are forced by The are of two sizes, larger known of this the soak- peas or diet vetch, on wheat land, and the smaller nartial exclusive lakh is grown dry even if it were carried out, on wet rice fields. incr of the grain, lakhari is cultivated with the making of flour the grain lakh which is would interfere In Rewah, larger is therefore a sociological one, is as more The solution from Bhagalpur, regarded I will m the aboli- imported and should consist-as show, than the smaller indigenous vetch. the of poisonous in tion of the harwar system, controlling ddl is taken various ways by the The kcsari and relief during famine years and It be into flour, food prices common people. may ground the which at lof wealth, # raw flour is moistened with the utilisation and eafen raw ; the unworked as concessions added, and the mash is present is practically water salt and chillies to are companies. or the flour may be made up rarely granted known as sutto; The disease is very common in and baked on an Aetiology. into hand-bread or chappaties, India and the United some oartsi of Central iron , 1857, in the North-West Pro- plate. in and Provinces. Irving, The vetch is also boiled water with salt now the United Provinces, considered that soup is known as ddl, and vince, onions, the thick pea as many as 6 per cent, of the or the boiled vetch in some districts eaten with the hand-bread; whilst A. in were affected Buchanan, be made into small thick cakes, fried population may up that about 7,600 persons were or oil and called 1904, estimated clarified butter puns. district alone. "(ghee), as in the both as a food for cattle, affected Saugor The vetch is used a to its From Sutna to Rewah distance of 30 miles, as for and owing cheap price, well man, of we met these I count of the number persons it is eaten all the year round by people. kept 242 THE INDIAN MEDICAL GAZETTE. [July, 1922.

walking on the road side. We saw 94 individuals lowest Sudra class, and both men and women of whom 8 were suffering- from lathyrism, twio work in the quarries as stone breakers. An of these cases we were returning home after had explanation that was given to me by the more examined them at This the hospital. would intelligent men employed as overseers, was that to 6 and correspond Irving'si per cent., would during famine years, the women eat less in .order mean that there were about 60,000 lathyrism to save the food for their husbands and children, cases in North Rewah. and consequently m.any die from starvation. I carefully examined 204 individuals, who The women that survive by eating less kesari dal were chosen at random, in order to ascertain the get less of the poison. various factors that a part in the causa- played Occupation.?All these cases, with the excep- tion of this disease. Some of the cases were tion of two poor Brahmin were of the collected but the beggars, by Major Bierpoint, majority lowest Sudra class, Teli, Kachi, Koals, etc., and were seen at the Sutna lime works and I am practically everyone of them had been bondmen indebted to Mr. Holden the for all the Manager (luguwars). Their wage as harwars (literally help he me in these indivi- gave getting together is two annas a day, and during duals. ploughmen), famine years they are paid in kind (kesari dal). In the lime works, two or three hundred of If they become affected with lathyrism and can- these men and women are employed in breaking not plough, or be of use on the land, they are up the lime stone, before it is burnt in the kiln. turned 'out by their masters (Kasans), and have The large boulders of lime stone are placed to earn their living by begging, stone breaking, before them in heaps, artd they smash them into etc. Many of them migrate to the larger cities, smjall pieces, the crushed stone isi taken away in Patna, Benares, Bombay and Calcutta, and small baskets by the able bodied men and form a large percentage of the beggar population. women. Relation to famine years.?The last hundred Each was individual examined separately, in cases were m;ore examined on this order to in their carefully prevent any errors answers. point and they invariably stated that when they These are to be ignorant people apt very suspici- became paralysed there was a famine in their ous of any examination, and to save themselves district. from -thinking or to possibly avoid trouble later, The rainfall in Rewah is not distributed would merely repeat the answer they had heard evenly over the State and the (official of famine given -by the person in front of them. years are when a over the whole of For this were collected in a court- drought prevailed reason, they the State. The Home Member, Rewah State, yard and examined one at a time, and then allow- informed me that the famine years were ed to so that there was no communica- go away, 1896-97, 1918-19, 1919-20, tion between the examined and those 1899-1900, 1907-08, persons whilst Major Colvin, i.A., Acting Regent in his waiting their turn. D. O. No. 7464, d., 29th September, 1921. gave is in 5 Age.?The age interval given yearly the famine years since 1890 as 1896-97, intervals for the first thirty years of life, be- 1908-09, 1918-19, 1919-20. These illiterate cause these when usuallv estimate people young people were usually very hazy about the actual their in 5 intervals. After 30 years of age year year in which they got the disease. The usual the is reckoned in ten age, age generally year answers were, about 2?3 years ago, 10?12 intervals. The table the of following gives age years, 20?25 and so on. The following table onset of .Wthvrism fheir statement. according (table 2.) gives the year of onset according to Table 1 the patients' statements. The official famine are shown with an Age and years Onset. Total. asterisk. This table does not show (that marked association with famine years which one would No. of have expected from the patients' statements, and Oases 10 34 46 52 38 20! is due to their faultv reckoning of the year of onset. They invariably stated that a famine was in their and that in famine The earliest age at which the disease wa9 present village, years a number of cases occurred in the district. stated to have occurred was three years of age, large and fifty-eight the oldest age. The majority of Thus a fairly intelligent overseer stated that cases, i.e., 170 out of 204 occurred between the in his village, Kermani in North Rewah, during 15th and 30th year, when the individual is most the famine of 1907, in the month of July, the active, and after marriage has to leave his wind suddenly changed and came down from parents in order to earn a living wage for him- the hills. On that day all the men in the village self and family in a poor country. were stricken with lathvrism including: himjself, Se.r.?Amongst the 204 cases examined, 181 and those women who were working in the were men, and 23 women. This difference is not fields. due to any difficulty in getting the women to The month of onset.?The majority of cases come for examination, as they were all of the stated that the disease came on during the rains ACTON. July, 1922.] CAUSATION OF LATHYRISM IN MAN: 243

Table 2.

I No. of years 9 ;10 12 13 |14 ! IS 16 17 18 19 21 22 23 24 25 26 27

No. cases of I 1 I 16 I 10 32 26 39 204

The asterisk denotes the famine years as reported by the state officials.

of The in small in especially in the month (Asar), July. the is only present quantities distribution was as follows:?See table 3. with chills-In many of the Table 3. ^^association definite that cold or rases the people are quite disease. 1 hav<~ chill predispose to the already evidence that the disease of Total. the overseer's Month >? ! M quoted Onset cold wind from the "5 1 3 was caused by the blowing were at work in < hills Other state that they wet, when they came back 10 19 122 21 10 j 12 201 cases. the'fields and got were unable to home they noticed that they walk me that in most cause of is The tehsildar informed PrThe1 great predisposing lathyrism in Rewah are exhausted or I years the local crops the hanvar system system of bondage. kesari a of bow the by March or April, and dal is imported will therefore give brief descnption as the food becomes out in t le State from Bhagalpur supply system was carried . common there- are Brahmins scarce by July. The people have The owners (Kasanah), generally to caste are fore to subsist on the cheapest article of diet, nr Thakurs who owing prejudices the monsoon fails in own land The bondmen viz., kesari dal, if June, unable to plough their on the month of then all the fresh food supplies, e.g., vegetables, (lugmmrs) are taken during are at advanced for and etc., unobtainable except very high prices, Mav Rs 8?10 are boys, have to subsist on an men. Should want to be and the people entirely Rs "30 jp for adult they to the owner about vetch diet. freemen, they have pay of to them. The bond- When the local crops' rice and wheat have Rs j 5 more than advanced, a bad dal is are lent the failed owing to monsoon, kesari men, if not married, Purchase in October. The absence of a wife Rs. 20-30, and whilst planted and ripens money for they months of to March the children of the cases during the December are in bondage marriage one of two of the master The is very suggestive of factors. become the property can sell these children as (1) The indigenous small grained kesari dcil Kasanah if he wishes, or the old to wtork in the is not poisonous, (2) diet is sufficiently soon as they are enough varied with other articles, e.g., local grasses, etc., of a British the so that the amount lof kesari dal is kept below the regime Regent, ^During as poisonous limits. has been suspended far as the law practice the Both factors play a part in preventing lathy- is concerned, but previously court could issue as I will show later. the bondman to return to rism during these months, an order compelling With the advent of April the first f ew cases his owner. over 50 niot in are seen, whilst in July per cent, of the These bondmen are usually paid money, month. In times of cases occur during the The evidence but given their food. famine the this table shows 19 :? owners themselves have barely sufficient to live must be fed in order That the disease is associated with upon and the bondmen (1) the eating imported dal (Bhagalpur dal) as the inci- to work, so they are given cheapest food, vis., the dence coincides with importation of this kesari dal...... these is vetch in March and April and is maintained The helplessness of poor people piti- of them until October and November when the local able: on questioning one^ why he per- for sisted in eatino- kesari dal when he knew it was kesari dal is gathered consumption. " (2) The incidence of the disease in bad for him, lie replied, Sahib, one has to high the dal is July is probably associated with the production of eat to live, even though poisonous and poisonous amines during germination. The produces paralysis." to find this large Bhagalpur vetch germinates more readily I was astonished blind spiot in the than the local small grain which sprouts with all seeing eve that ever watches to suppress difficulty. slavery in civilized countries. wiith an (3) The association exclusive diet, Symptoms and Signs?The onset of the dis- which occurs famine that comes on 'during years, suggests ease practically always suddenly. The 244 THE INDIAN MEDICAL GAZETTE. [July, 1922. men state that they were working in the field, knees are acutely flexed, and owing to the marked ploughing, cutting grass or wood, mending the adductor spasm the knees are drawn one in front roofs of their houses, and even whilst at stool. of the other (scissors progression). At this A few state that the onset came on gradually, stage these patients usually walk with the foot they got ill with fever, and when they got up well inverted, caused by the spasm of the pos- and tried to walk, they found that they were terior-peroneal group, so that the outer toes and paralysed in the lower limbs. the extreme end of the outer part of the sole As far as I am aware the actual onset of the only touch the ground. Occasionally the foiot disease has never been observed by any com- may be everted instead of inverted. is a petent investigator. The following typical In the last stage (fig. 4), the knees are flexed account an loverseer. almost on to back of the so that " by intelligent thighs, progres- of During the famine year 1908-09, whilst sion is only possible by crawling on the hands ploughing, I suddenly noticed that my legs were and knees, or by using wiooden shoes for the weak, there was no pain, but I had difficulty in hands. down and from a sitting getting up squatting There is never any loss of consciousness, nor I did not I was until position. know paralysed, is there any involvement of the bladder or rec- friends told me that I had On m;y lathyrism. tum. On examination of the legs, there are no that 15?20 men of also became day my village sensory disturbances present, on pressing the I realised that 1 was from paralysed. suffering muscles of the calf and thigh no tenderness is down when I tried to lathyrism because I fell elicited although the patients complain of muscular run a in ; few days later I felt pain the calf pain. muscles." On their with the feet in on cliosing eyes together The gait is very and depends the typical the erect no a'.axia is seen. The knee- of involvement of tracts, a posture, degree spinal single are ankle clonus is well attack leaves the as is jerks increased, marked, patient paralysed depicted and when the skin of the soles of the feet is not in Plate I, figs. 1 or 2, the worst cases, figs. too thick and an extensor response of the 3 or 4, have suffered from two or more horny, usually toe is on the sole. attacks. great given stroking out to me that on For descriptive purposes I have described the Major Pierpoint pointed tap- the adductor of the a marked gait as seen in this disease, in four stages:? ping muscles thigh see Plate I. figs. 1 to 4. In the eailiest stage reflex contraction occurs. I found this adductor (Plate I. fig. 1.) the patient can walk without reflex present in every case I examined, and con- sider it a characteristic in this disease. any aid, or only requires a short walking stick. sign The knees are flexed; with each step the shoulder There is ruo paralysis, but a spastic condition is thrown forward; as he rises from the ground involves the following muscle groups, quadriceps on his toes, the movement ends with a peculiar extensor, adductors, gastrocnemii and posterior spring owing to the spastic condition of the peroneals. The trunk and upper limbs are un- gastrocnemius. The feet are kept apart, and as affected, and the chest and arm muscles are the spasm; of this muscle still persists, the heel usually well developed owing to the extra work is well raised off the ground, so that when the that is thrown on them. foot is advanced for the next step, the toes just Pathological Anatomy.?These cases rarely die clear or drag across the ground. There is no during the acute stages, and post mortem exami- stamping-as is seen in locomotor ataxia, nor is nations are impossible to obtain owing to religi- the fioot swung round as in the flaccid paralysis ous prejudices. The nature of the lesion has of a hemiplegia. therefore largely to be surm;ised from the signs The characteristic point about the gait is its and symptoms. peculiar hesitating springy character as the As the knee jerks are increased, ankle clonus patient walks on tip toes. Progression is very bad and Babinski's sign are present, the lesion is an when the patient starts walking, but improves upper neuron lesion. somewhat after he has gone a little distance. The posterior columns of Goll and Bardack, In the second stage (fig. 2), a long stick has and the posterior root ganglia are not involved to be used as a support. The body and the as is shown by the absence of hyperesthesia, shoulder on the same side are thrown forward girdle pain, stamping gait, etc. with each step. The knees are more flexed, and There is no ataxia so the cerebellar tracts are they walk more on their toes; the foot is slightly intact. turned in, and owing to the adductor spasm, one The absence of any bladder or rectal trouble, foot is brought in front of the other. The gait either at the onset or in the advanced stages of becomes much more hesitating owing to the mark- the disease shows that the. lesion is outside or ed spasm of the gastrocnemius and post-perianeal below these centres. The involvement of the group of muscles. quadriceps extensor, adductor, gastrocnemius and In the third stage (fig. 3), two long sticks post-peroneal group indicates that the lesion is have to be used to enable themj to walk at all. below the second lumbar root. There is no loss The body is thrown well forward, and the muscles of consciousness during any stage of the disease, of the arm and chest are well developed as they confirming the lopinion that the site of the lesion have to support the weight of the body. The is not in the cranium. ...i ACTON. 245 July, 1922.] CAUSATION OF LATHYRISM IN MAN:

that the lesion is an the blood in this is a vSo far we have deduced supply region predisposing situated below the second cause of The upper neuron lesion lathyrism. anterior-spinal artery motor as evi- below the lower thoracic lumbar root, involving the tracts is region becomes extreme- in arc and ly fine and and is denced by the increase the reflex attenuated, only preserved in its course Babinki's sign. downward by fine reinforcements molor of from the dorsal and lumbar Now the upper neuron path ,consists arteries. Plate 2, fig. a shows a section of the main conducts (see Plate 2, fig. b). spinal cord of a rabbit with (1). The cortico spinal motor system.?Con- the capillaries injected with a gelatine- sisting of the crossed and direct pyramidal tracts, carmine mass. One sees that the grey matter of the cord anterior and lesions cf which are associated with flaccid para- viz., the posterior horns lysis followed by tonic rigidity, and increased are richly supplied with numerous capillaries. reflexes. The white matter consisting of the various motor motor and tracts is not so (2). The strio-spinal system.?Con- sensory well supplied as the the various sisting of Monakow's bundle, the tectospinal and crrey matter. Of columns-of the lesions are columns are more vestibule-spinal bundles, of which cord* the'posterior richly sup- of than the associated with no loss of movement, rigidity plied with blood lateral columns, and is to voluntary muscles, no alteration in reflexes. the poorest supply given the anterior reflexes show that the columns. (See Plate 2, fig. a). The increased pyramidal _ the Thrombosis if it occurs in this tracts are 'damaged, but absence of paralysis region of the not to indicates that the lesion is only partial, and cord is imore likely select the avascular re- complete. This is further exemplified by the gions rather than those more richly supplied with a whio after walking short distance begins blood vis. the antero and antero-lateral tracts. patient, In _ to improve in his gait. The rigidity of the volun- these two areas of the cord are found the that the motor two motor tary muscles indicates1 strio-spinal systems?the cortico-spinal and strio- In the of The direct system; is also involved. early stages spinal systems. pyramidal tract at the disease the rigidity of these muscles is only the second lumbar root has practically disappeared movement hence as a tract. The lesion is observed during voluntary and probably due to a off the damage is only partial. In the advanced thrombosis cutting the blood supply of the 1, the antero and antero-lateral tracts and stage of the disease (Plate fig. 4) rigidity causing dege- is constantly present showing that the whole nerative changes which only partially affect the has as strio-spinal motor system been destroyed crossed pyramidal tract, and partially or We have wholly the result of disease. therefore deduced the strio-spinal system. From experimental that the from clinical signs, lesion of the cortico- evidence on animals, Stockman and myself did spinal system is always partial, and, never com- not find any microscopic lesions such as embolism plete, but that the strio-spinal motor system may or haemorrhages. The thrombosis is in the due to an of probably be completely destroyed, advanced cases of arterial spasm these vessels as the disease, and that the lesion is belozv the second paralysis in animals comes on suddenly, and if the it lumbar root. diet is changed, disappears within a few The nature of the lesion.?\Ye have already days leaving no permanent damage of the cord. comes on often in we have seen that the disease suddenly, Clinically man, the evidence that whilst at work. nersons only* suffer from the disease in The sudden onset suggests that the cause may times of famine, i.e., semi-starvation with low the blood that vvet or be due to one of following: embolism, pressure, and clnll precipitates the haemorrhage or thrombosis. disease by inducing arterial spasm, which at to is ?-tie toxin Embolism can be dismissed once, owing directly caused by in kcsci) i ddl, of such a as ddl the invariable selection minute vessel Evidence that kesari is the cause x)f the there is in the heart disease \? a spinal vessel, and nothing disease. first sounds to suggest valvular (A).' Clinically-?The thing that one had one would to exclude in this On an analogy with ergot poisoning, investigation was the possibility at first expect that haemorrhage would be a very of any other food causing the disease. The fol- but the likely cause of this lesion, patients give lowing grasses and pulses are eaten by these from other end of no history of bleeding any vessels, people "fnom the August, when the im- and to conceive why the fine branches kesari dal it is difficult ported gets scarce, until the ripening of the anterior-spinal vessels should be selected of their crops in October. as than vessels in other Plate a site of rupture rather (1). Samai (See 3, fig. 1) a wild which end of grass parts of the body. ripens at the August Id the left for Consideration and of and begin- Thrombosis is finally ning September, lasts for about a as I will show that there is a good deal of evi- fortnight's food supply- dence in lof this view. We know that (2). Samah (See Plate 3, support fig. 2) is generally a bilateral can occur in this sown and about the end of spastic paraplegia ripens or of August Sep- situation of the cord in certain grave forms tember, and gives about two months' food and toxic conditions. The lesions are or Narwal supply. anaemia, (3).' Luptowah (See Plate 3, fig. 3) considered to be due to thrombosis caused by end- a small grass seed which in ripens September; the or a low state of the blood women collect it arteritis, very pressure. by brushing the seeds into I consider that the anatomical arrangement of this lasts for about baskets, three weeks or so. 246 THE INDIAN MEDICAL GAZETTE. [July, 1922.

These grass seeds are ground into flour and grain was washed in three changes of water dur- are used to make hand-bread. The difference ing the 24 hours. None of these ducks showed is marked between the yield of the cultivated the slightest symptoms of paralysis. and wild as heads of these grasses is seen in (3) The third group of three ducks were fed Plate 3. on washed grain as in group (2) but they were (4) Puchchoar (See Plate 3, fig. 4) a wild given some chopped vegetables in addition. They which over pulse grows all the place, and ripens were quite well up to the 60th day of the experi- in September. The seeds are generally spoken ment, and I considered the experiment practi- of as jungly mungh. It is used as a dal, and cally finished. On the 80th day one duck showed lasts for about three weeks. symptoms of paralysis which may have been due B'~ jides these articles of diet, in famine-strick- to the fact that I was not then supervising the en years, the mowah fruit various roots, washing of the grain. etc., are eaten by the people. July is the This experiment shows that the poison is month that has the greatest incidence of lathyr- water soluble, and the paralysis is not due to any ismi, and these food stuffs are not available until deficiency in vitamines caused by living on the end of August or September. They there- an exclusive vetch diet, because all the ducks in fore cannot play any part in the production of group 2 remained perfectly well during the this paralysis. experiment. The question of adulterants had next to be Stockman considered the poison to be an considered. Three other seeds are sometimes alkaloid in nature, as it gave all the chemical tests present. (1) The ordinary dried pea. (Pisum and the crude alkaloid produced paralysis in .sativus. etc.,) and (2) gram or chunnar, (Circer. animals. The following points may be advanced Arietinum) both of which we know to be non- against this view :? poisonous. A third (3), a small black grain called (1) Most alkaloids are not very soluble in Akri which wild water. (Withania coagulans) grows , and ripens in October, is a slight adulterant, but if (2) In a plant the alkaloid is fairly evenly seen, is always removed during the cleaning and distributed in the leaves1, etc. We know that the fanning of the dal. So we can exclude the leaves, are not poisonous to cattle. possibility of an adulterant of kesari dal causing (3) Pew alkaloids have a cumulative effect lathyrism. in the system. To explain the high incidence The possibility that this vetch m;ay be attacked during the month of July we would have to as- by a fungus at once suggests itself to the mind sume a cumulative effect. I am, in favour of owing to the analogy with ergot. The follow- the toxin being an amine for the following ing evidence may be quoted against this reasons:? view::? (1) Am,ines give all or most of the alkaloidal (1) Stockman found that all the samples of tests. kesari dal he tested contained the poison, but in (2) They are all water soluble. varying amounts. (3) The amount of amines in the seed is (2) One specimen of the large grained increased during germination, e.g., Hordenine in kesari (lakh)' contained a large quantity of this barley. poison compared with the other samples tested. (4) The high incidence of lathyrism in July He does not mention having noticed any would correspond to the conditions necessary for obvious signs of disease in any of his samples germination, viz., temperature and humidity. of this vetch. (5) The of the large grain kesari (B) Experimental Evidence.?Stockman has dal (lakh) could be explained similarly, as the conclusively shown that if susceptible animals, large grain germinates in 24?48 hours in the are of moisture at 37 C. The small e.g., monkeys fed on an exclusive diet of presence degrees kesari dal, they develop paralysis at varying in- grain even at the end of four days shows no tervals depending on the toxicity of the grain on signs of sprouting. which they are fed. On my return from Sutna (6) Many (of these amines cause a marked of I placed nine ducks on a diet of kesari dcil. contraction involuntary muscle and blood vessels. (1) First group of three ducks were given Dr. Ghose is at the the crushed grain soaked for 24 hours in a Sudhamoy working sufficient quantity of water to make it soft, chemistry of this poison. For several months he otherwise the ducks could not masticate it. followed Stockman's technique and practically On the 18th day the first duck showed signs got no yield from large quantities of this vetch. Of paralysis, which increased in intensity ; ion From grain that was not germinating he got a the 22nd day it could not rise from the ground. fair amount of a non-toxic amine in a pure It was killed and there were no signs of state. Thirty mgrms. of this amine had no effect hsemorrhage in the cord. The second duck showed on the guinea-pig. We are now attempting to from as symptoms on the 20th day and the third duck on isolate the toxic amine germinating seed, tfie 22nd day. Neither of these ducks were so well as commencing feeding experiments on ducks. badly affected as the first one. Differential Diagnosis.?Most medical men in that the is a (2) The second group of three ducks were Calcutta have been taught disease fed on an exclusive diet of kesari dal, but the primary lateral sclerosis of unknown origin, PLATE I.

The character of the gait in the different stages of Lathyrism.

1st Stage. 2nd Stage.

3rd Stage. Final Stage. (a) Microscopical drawing of a section of the cord of a rabbit, to show the arrangement of the blood vessels and finer capillaries.

fasciculus gracilis fasciculus cu.7ieat.us I Fasciculus septorn.cx.ryin+tlis I \ I I ***** fe

Fasciculus spin ocere&/?2Lz.ris /^V:':y' / ' (??*>?) mg ; /; / Fa,acuU, ccr.bro.s^nati, mCJQJ .%/>-. lateralis

Fattciciiluajovetarior fjroprin/s.

'ta&cccytus ruirospinulis

Fasciculus a.nteroia,tei'uiie ~~ " 3u.perZicia.lz4 (ijencrj)

- fasciculus leclosfiinalu Fasciculus spino?/iuiamicuJy (posterior) .'

, Fancichij> / spinat/ctaj.is \ \ ^-cicuk,, SuUcspinaluf^l olu-cspinali,) * ' hamulus ^ _/ Fasciculus spinotk.a.Ca.rriicziSspinotka.lcx.rn.icus ^ \ anterior ^ fasciculus ^/ ^ ^estiiuioepinalis fix-icicuZzcs ante p"tfpriue

(b) Diagrammatic section of the spinal cord showing the arrangement of the different tracts. PLATE III. Grasses.Grasses.

(fr) Fig.Fig. 1.1. (a) Fig.Fig. 2.2. Samai.Samai. Samah-Samah- ramosum Linn. PanicumPanicum Crus-galliCrus-galli L?L? var.var. ff rumentaceum.rumentaceum. PanicumPanicum ramo sum Linn, (b)(b) PanicumPanicum colonumcolonum L?L-

Fig. 3. LiliptowahLuptowah or Narwal. $4tariataria glauca Beauv?Be any.

Fig. 4. Jungly Mungh. Phaseolus trilobus Ait. July, 1922.] CAUSATION OF LATHYRISM IN MAN : ACTON. 247 possibly syphilitic in nature. The peculiar hesitat- order to catch the monsoon rain. When water ing springy gait, the throwing forward of the body is required for the fields, the embankment is ,cut with each step, the increase in the reflex arc and and ithe water allowed to run into the field. If a marked adductor reflex, are however character- the monsoon fails, no water is available and the istic and peculiar to this type of paralysis. crops fail. The people are then compelled to Prognosis.?The degree of paralysis that is live ion kesari dal and hence lathyrism is very produced by the original attack remains perma- common in North Rewah. In the South, the nent for the rest of their lives. In a very small Gonds do all their cultivation by forest clearing, percentage of cases some improvement occurs in and irrigation from streams, with the result that the gait after a few months lor years, but the lathyrism is rare in this portion of the State, as people are very definite in their statement that the crops (of rice, wheat, etc., rarely fail. The complete recovery is> impossible. The first attack State is rich in mineral wealth, if this source of produces the degree of paralysis shown in revenue was allowed to be opened up, it would the gait by Plate 1, figs. 1 and 2. Two or more afford an occupation which is independent of attacks cause an extension of tlhe injury to the rainfall, and so largely prevent lathyrism in North cord and produce the gait shown in Plate 1, figs. Rewah. 3 and A This research has been a most fascinating Prevention of the disease.?In 1907 the la'e one from every point of view. An investiga- Maharajah of Rewah attempted to prevent this tion carried out amongst a poor illiterate disease in his- State. He issued an order dated population is impossible without a good com- the 29th November, 1907, in Hindi and it was mand of their language. The backwardness was well read out to me by -the Home Member. The gist of this state exemplified by the barouche with its two of the order was as follows :?The paralysis antique high sprung a chiefly affected the labouring.classes, more parti- horses, accompanied by bevy of four red- cularly those of small caste and especially those coated, brass belted attendants who drove me back to the station. The who were given their wages in food (harwars). statistical It was due to the eating of kesari ddl ithere enquiry made clear the relationship during spoken of as butturah, which was cheap in famine times of famine between an exclusive kesari times. He forbade the cultivation lof this vetch, dal diet and the harwaf system : whilst an for the and placed import and export duties on the it demanded explanation high grain. As the vetch was the staple food of (the incidence of the disease during the month of of the population, it was impossible to prevent its culti- July, the suddenness onset, and the distribution of the cord The vation in out-lying villages. In a year or sio the peculiar lesions. order was forgotten, and now the ddl is cultivated water soluble nature of the toxin is a most from the of view of without any restraint. The preventive measures satisfactory result point should consist in.? the prevention of the disease. The surmount- of in makes the (1) The abolition( of the harwaf system, ing difficulties any problem more than that are because in times of famine the bondmen are com- solution precious those won. For months Dr. pelled to subsist on a diet composed entirely of easily Sudhamoy kesari dal. Ghose, M.sc., laboriously worked to obtain of (2) To decrease the amount of kesari dal a sufficient quantity the alkaloid that to be the consumed by the population by instituting Stockman considered toxin in kesari on the nature of famine reliefs during the years of a bad m;onsioon, dal. Whilst working Shiga was able to isolate an as well as controlling the price of wheat, rice, and toxin, Major Boyd so amine for me similar to histamine in its effect ddl, that the poor can afford to buy these articles of food. on isolated guinea-pig's uterus. Since then able to a (3 ) To increase the popular knowledge re- Dr. Chatterji has been isolate similar of garding the toxicity of this grain, (a) The amine from a broth culture the cholera vibrio. poison is water soluble so that soaking the grain This am;ine also causes a very marked contrac- The an for twenty-four hours in ithree changes lof wa'er tion of uterine muscle. production of amine the of removes the poison, and the grain can be used (Hordenine) during gerjninatiion barley, once itself as a in itfhe for making ddl or purist (b). .The small grain- at suggested possibility ed kesari is less toxic than the large grained case of kesari dal and lathyrism, anid I have in favour of this view. The Bhagalpur ddl, so that every effort should be given the evidences isolation of the toxic amine from the other non- made to grow a sufficient quantity of the indigen- still a ous grain to meet local requirements. (c) toxic amines in the grain requires good the hot months of July and August, deal of labour before the pnoblem can be solved. During damp results the grain should be stored in a dry place to In India one publishes and waits patiently for to see them carried out into prevent germination. years practice. be the of know- (4) By improvements in the agricultural Ultimately there will satisfaction that work has been the means lof methods now employed. The system of cultivation ing the saving a life- differs considerably in North and Siouth Rewah. many of these poor oppressed people from if harwar In the North, the inhabitants largely rely on long paralysis. Even only the system can it alone will do deal the bund system, i.e., an embankment 4?5 feet be abolished, great the of this high is thrown up to enclose a square afea in towards prevention paralysis,