lathyrism cause, symptoms et treatment jacoby 1947 par miles

7/29/2019 Lathyrism Cause, Symptoms Et Treatment Jacoby 1947 Par Miles

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Sm :| g > F EB. ' , 1947] C A U SE , S Y M P T O M S A N D T R E A T M E N T O F L A T H Y R I S M : J AC O B Y 5 3 -quiet, no wound of entry seen. Corn ea "dear,pupil dilated and regular, lens clear. Thevitreous was full of blood and no fundus detailscould be seen. Th e left eye was normal .~X.-ray localization.One foreign body about2 mm. in diameter was seen to be 13 mm. to thenas al side, 13 mm . posterior an d 1 mm . belowthe horizontal. The foreign body was thuslocalized to be on the sclera under the internalrectus muscle just behind the equator.Operation was performed and the foreign bodywas found on the sclera under the muscle.The case demonstrated that this method oflocalization can be a ccura te to 1 mm .Another case is as follows :W. D., male, aged 27, was injured by aJapanese grenade about 70 days before beingseen by us.Examination: Right eye.Vision 5/60.Cornea clear. No wound of entry seen. E yequiet. Pupil dilated, lens clear. A yellow masswas seen on the retina at the equator in the4 o'clock meridian. Left eye nor m a l .X-ray localization with the ring.The foreignbody (abo ut 2 mm . in diameter) was m easuredto be 14 mm. posterior, 6 mm. nasal and 12 mm.below.This corresponds with the mass of scar tissueseen ophthalm oscopically. No operation was per-formed in this case as the ophthalmoscopic andradiological evidence showed that the foreignbody was in the scleral wall well sealed off infibrous tissue and hence siderosis bulbi was notlikely to supervene.Comment. X-ray of a 12 mm . silver ring sewnon the lirabus is a very simple, yet very accurate,method of localizing intra-ocular and orbitalforeign bodies. No co mp licated, appar& tus orelaborate calculations are necessary and theaccuracy of the centering at the time of x-ray isapparent from the resulting pictures.

SummaryA description of the method of the localiza-tion of intra-ocular and orbital foreign bodies bymeans of the lirnbal ring is given and its accuracyshown by illustrative cases.

R E F E R E N C E SRoss (1945) . . . . Brit. J. Ophihalmol, 29, 545.STALLAKD, H . B . (1942). - Brit. Med. J., ii] 629.C A US E , S Y M P T O M S A ND T R E A T M E N T. OF LATHYRISM

A SPECIFIC NUTRITIONAL NEUROPATHY

B y H . JACOBY, M . D .Chiej Physician, Prince oj Wales Hospital, Bhopal,Bhopal Slate' Introduction,There is con siderab le differencein the descriptiorrof symptoms in lathyrism by

d i f f e r e n t a u t h o r s , - r / r v , -' -.-,. -'-'"'.'/ ) , , ; / .- Shah (1939) an d . Minchin _ ( 1940) , : report ,besides spastic paralysis'-of the legs, also involve-ment ' of- the arms :. an d. sensory impairm ent as

I well. Min chin also noted affection of th eI bladde r. Ruge and his co-workers (1925) andJ Ran jan (1944) described' incontinence of urineand faces as well as sexual imp airme nt. It hasbeen postulated that the disease is never pro-gressive after a few days or weeks beyond theinitial par alys is (B ickncll and Prescot 't, 1942):R an jan (1944), however, notes rapid progressof the disease. The published accounts ofthe reflexes in lathyrism are equally puzzling.M inchin (1940) observed norm al cremastericand abdominal reflexes along with spastic legsand extensor plantar responses. Trabaud andMouharram (1932) found completely normalreflexes, including the plantar responses, thoughthere was spa sticity and clonus of th e legs. Acommon symptom associated with lathyrism isnight-blindness according to McCombie Young(1928) , and- Ran jan (1944) ' reports ma rkeddimness of vision.E ven th e diseases which can experimentally beproduced in animals by feeding them on certain speciesof legumes of t-he genus Lathyrus have also been willedlathyrism, although they do not show the characteristicsym ptom s of the hum an lathyrism. Geigei- ct al. (1933)fed rats with a diet consisting of Lathyrus odoralvs,the flowering sweet pea (at levels of 80, 50 and 25 percent of the diet) . Charac teristic sym ptom s were lame -ness, paralysis and contracture of the spine and sternum.In other experiments on white rats also fed with aLathyrus odoratus diet, carried out by Lewis aud E sterer(1943). these authors produced a disease which they calllathyrism showing the following symp toms : Inco n-tinence, lameness, paralysis of limbs, spinal curvatureof the thoracic region. Another nutritiona l disease byfeeding sheep with a certain species of legumes, viz,cull beans, has experimentally been produced by-Willman and his co-workers. The y call the resultingdisease ' Th e Stiff L amb D isea se' , which shows thefollowing s ym pto ms : The an ima l concerned h as diffi-culty in -walking and rising. It gets tired very soonafter walking and tries to lie down whenever permittedto do so. On standin g and walking there is disturbanceof keeping the balance; later on, inability to rise at all,not even -with help.

Since the author is working in an area wherelathyrism patients are a common sight and sinceall of them show a uniform symptomatology, itappears advisable to establish first of all arecord of the symptoms of this disease, whichwe regard in this area of Central India as indis-pensable for the diagnosis of lathyrism.Symptoms.The following trail of sym ptom s ,is in our experience found in every lathyrismpatien t : . ' . . . . : . .1. Spastic and painful rigidity in.the musclesof the lower extrem ity, including .loin"m uscles.From this results a typical spastic-ataxic gait ,frequently associated with a so-called scissor-gait . . ' .

2. E xag gera ted deep reflexes in the legs,gen erally clonus. . . . ' '.". . ', . [_' 3. The complete absence 'of disease-symptomsin other" pa rts of th e bod y, especially in theupper extremity and the head. ''.''".'' ":".;-r : '.1. ' Th e"i flexor-- and i- frequently'. ' al so y the::;;adductor .muscles of: 'calf and thigh; part icularly^ 'the M / gastrocnemius, feel hard and are . te nd er ^on squeezing.-;: All thes e m uscle3 are i nva r i a bl y^


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T H E I N D I A N M E D I C A L ' G A Z E T T E [ F E B . , 1947well devploped and never flabby or atrophic.The patients complain of permanent pnin inthese muscles which is increased on standingand walking . In more adv anc ed eases even thesleep is disturbed due to the pains. Theexamination of passive movements shows per-manent muscle resistance to flexion and extensionat the knee- and hip-jo ints. Th e degree of thisresistance runs parallel to the advancement ofthe disease. In very far advanc ed cases theresistance is such that it is not possible at allto achieve these passive movements by force.In this late stage all such movements are possibleonly by the patients themselves actively, veryslowly and with the help of their own hands.

Most characteristic is the gait of the patients.The onlooker gets the impression as though thesepatients walk against the obstacle of their ownmuscles. They generally walk with a slight,apparently voluntary flexion at the knee-joints ,which is associated or caused by a foot-drop,in an involuntary attempt to compensate forthe latter, resembling the so-called Striimpellphenomenon. Or another way of involuntarycompensation is achieved by swinging the leg ina convex arch instead of lifting the foot (circum-duc tion). Th e patients seem to walk on theirtoes only. Ano ther group of patie nts who do notshow the abo ve flexion at th e knees will dragthe feet on the ground, as though their soles arepaste d to it . The se pa tien ts describe their gaitthemselves as ' scratching the gro un d' . Allthese symp toms which appea r on walking are' associated movem ents, as the y are known tooccur in pyramidal lesions, but are not en-countered in extra-pyramidal motor lesions norin the norm al individual . The se modes of walk-ing rather belong to the advanced stages of thedisease. In the initial stages only the slightmuscle resistance and the slightly bent knees onwa lking pre vail. In ma ny cases of all stages,in whom the spasm of the adductor muscles ofthe thigh dominates, the so-called scissor-gaitresu lts. T he p atie nts walk; with crossed legs,resembling the somewhat opened blades ofscissors. Th e movem ents of the arms, normallyaccompanying the gait of healthy persons, arealways unimpaired in lathyrism . W a lking andin more advanced stages standing of thesepatients is complicated by a peculiar kind ofswaying (a tax ia) . This goes frequently alongwith fibrillary twitchingsof the muscles of thelower extremity, which in combination with thecontractures result in inco-ordinated movements.This disturbance of inco-ordinatio'n of differentmuscle, groups is certainly the cause of thisparticular kind of ataxia of lathyrism patients.It is not due to cerebellar lesions, because thefollowing tests exclude this type of ataxia :

(a) The re ' is no ' dec om position' in thesequence of complicated single mo vem ents. ..' (6) T he t est of moving the .leg and big toeaway from and back to the examiner's finger asa ' target , wi th : ; eyes shut, does not show- a'

deviation in any direction (B aran y's P ointimT e s t ) . '(c) If the patient is made to walk forward;and backwards with his eyes shut, he will noi present the p ecu liar dev iation of the so-called; compass g ai t ' (K rolm, 1938).2. The following reflex reactions are alsosignificant of py ram ida l lesion. W itho ut excep-tion a greatly exaggerated knee-jerk is elicited,the ankle-jerks often being diminished or absent. .In some cases, however, also the ankle-jerks areexaggerated. Almost always ankle-clonus ispresent and frequently also ' danc ing of th epatella ' . F ar adv ance d cases show on sudden. 'brisk passive dorsiflexion of the foot to elicitankle-clonusan involuntary complex reflexmovem ent consisting of flexion at the hip-jointand flexion at the knee-joint . F requ ently this

' flexion reflex' occurs alrea dy by a gentlestimulus, like deep pressure or pinching of theskin of the distal par t of the lower limb. E ithe rreflex, i.e. the flexion reflex as well as theincreased deep reflexes, is indicative of hyper-irritability of pyram idal origin. So is. theflexion reflex a pr om ine nt fe ature of " th eusual flexor contracture (the tendon reflexesbeing frequently decreased) and exaggerateddeep reflexes are an equallj1 characteristicfeature of extensor co ntra ctur e. Th e latter formis indicative of a less severe lesion than theflexor contracture (B abinsk i) . B abinski ' s signby stroking the sole along the lateral borderrather tha n the med ian border is as a ruleextensor and signifies a less severe pyramidalaffection t ha n does an extensor respons e elicitedfrom the median border as well as from the lateralborder of the sole (K rolm , 1938). Th ere is elec-trically no reaction of degen eration. Th e sensesof position and of movement are always anddefinitely unimpaired as well as the temperatureand touch senses. Th e Rom berg sign, if positive, "is of little significance on account of the abovedescribed inco-ordination of muscle movements.The superficial reflexes va ry : All or some of theabdominal reflexes as well as the cremastericreflexes a re in less adv anc ed, stages norm allyelicitable, but are missing in far advanced cases;This pathological abdominal reflex is generallyassociated with the ' flexion reflex ' and theextensor pla nta r 'r esp on se all belonging to theorder of ' reflexes of spina l au tom atism ' and a re 'signs of pyra mid al involvement. An yho w, "re-appearance of the previously absent superficialreflexes and of a normal plantar response and. the disappea rance of the ' .flexion r efle x' areamong the signs denoting improvement undersuccessful tre atm e nt. -. . . . . : - .

3. There are definitely no abnormal nervoussigns whatsoever in any other part of the :body. Never was any disturbance of sensa-:tion encountered, n or. of the functions of t h ebladder, of the bowels, of the sex and of thementality. - . . } . ^ : v - ; ; . f - ; : ; ; ^ \ / ; ;E xam ination of the cerebrospinal ' fluid-as'-to:-pressure,-cell count, albumin content and' Kahti;


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S Y M P T OM S . A N D . T R E A T M E N T O F L A T H Y R I S M : J A C O B Y 55'"test shows no abn orm alities . Th ere arc also no"pathological findings in urine rind blood. B loodpressure is norm al. Radioiogically, lungs andshape of the heart are always found normal.'Differential diagnosis and cctioluyy. B y t h eell defined signs, as described above, lathyrism( in be diagnosed with full certain ty. The re isonh one other disease, th e signs of which arcidentical with lathyrism. that is spastic spinal-CICIOMS of E rb (B eaum ont. 1942) or the pure-pi^tic type of amyotrophic lateral sclerosis ofother autho rs (P rice, 1941). B oth diseases arecaused by lesions in the upper motor neurone ofthe p yra m ida l tra ct. Th e lesion of ' spastic,spinal sclerosis' is confirmed by post-mortemexam inations. Records of post-mortem examina-tions of the spinal cord and the cerebrum oflathyrism patients appear not to be in theliterature . B ut the difference between these two nervou sdiseases does not lie in a divergence of theirsigns. Their only difference is the a'tiology.Whereas we are not aware of the cause of spasticspinal sclerosis, the cause of lathyrism is wellknow n, viz, consumption of certain species oflegumes of the genus Lathyrus for a period ofusually not less than abo ut a month, This con-sumption is, therefore, to be regarded as indis-pensable for the. diag no sis of lathyrism: We inthis area of Central India found invariably thatit was only Lathyrus sativus (teora or khesariclal) th at was consumed by our patien ts. T othe same conclusion comes also Shourie (1945)in his comprehensive review of lathyrism inCe ntra l Ind ia. Th is experience does, however,not exclude the po ssib ility th at other species ofLathyrus may also cause nutritional diseaseswhich may more or less resemble the diseasewhich is our subject.

R uge a nd hi s c o- w or ke r s s l a i e l ha t be s i de s Lathyrussativus, Lathyrus ciccra an d Lathyrus dymenum alsocan cause lathyrism. B ut they associate with thedisease disturbance of sensation, urine incontinence andimp otency . E pidem ics in Trance in 1770 and inE nglan d in 17S5 were thou ght to be caused by ea tingvetches of the species Lathyrus ciccra. This or Lathy-rus dymenum was held responsible for an outbreak inSyria (Trab aud and M ouharram , 1932), but Shah (1939),investigating an outbreak in a Punjab village in 1939,found that seeds of Vicia sativa and not of Lathyrushad been eaten mixed with corn. McCombie Young(1928), however, reports that his cases had eatenLathyrus but little or no Vicia sativa and Minchin(1940) describes ' lathyrism without La thy rus ' . . Th elatter 's diagnosis appea rs rather doubtful in the lightof our abov e sta ted experience. In connection w ithMcCombie .Yo ung's report on Vicia sativa being thecause of., lathyrism ,-ex am inations of Lathyrus sativus-stocks, as" consumed by lathyrism patients, in M hoImperial Agricultural Research Institute, New Delhi,failed to . reveal t he presence of Vicia sativa seeds(quoted by Shourie, 1945). The above quoted experi-ments on animals also show that legumes other thanLathyrus sativus are a pt to cause" nutritio nal diseasessomewhat similar to lathyrisrn (Geiger el al:; 1933;, Lewis and E stcrer, 1943)-.. . . . . .

"}fr Course^of". lathyrism. With, regard to theonset of- the ' di sea se we- entirely. depen d' on thepatien ts',- ' own- rep orts .- Ab out 30 per centof

them state that before the occurrence of thefirst symptoms there was fever with shivering,r e se m b l i ng m a l a r i a / F r e q u e n t l y , t h is s t a te m e n twas confirmed by malaria relapses taking placein our presence in the hospital. A m ino rity ofall lathyrism patientsless than 20 per centremember to have had diarrhoea previous to theirfalling sick from lathy rism . A ctua lly, we foundocc asio nall y am cob a- in their sto ols. I t is. the re-fore, quite possible that the latter diseases actedin these cases as a conditioning cause for thedeterioration of a latent background disease, viz.vita m in B deficiency state , on which the toxicinfluence of La th yr us was grafted. On the otherhand, the majority of oiir patients did not giveany history of a previous disease. All ourpatients are , however, unanimous in their state-m ent th at the ' disease, generally during or afterthe rainy season, started slowly, at first onlywith heaviness in their legs, followed bygradually increasing pains in the loin, thigh andcalf muscles. These symptoms deteriorate tothe cripple stage, unless consumption of teora isdiscontinued . E ven if i t is continued in amixture with wheat, containing about 50 per centof teora, the condition goes on deteriorating.B ut if consumption of teora is completelystopped, the condition remains steady, showingneither improvement nor further deterioration.The latter statement of the patients could beconfirmed by our own observation in thehospital; there was in a batch of eight patientsneither improvement nor deterioration for aperiod of a month, in which no treatment wasgiven. W e mu st, however, mention in this con-nection th at .during this time of observation thehospital diet itself was deficient, consistingmainly of chapattis about 8 oz. and of dalab ou t 2 oz. and occas ionally of ghee 1 oz. andof milk 6 oz. per day.

Nutritional background.B esides the con-sumption of a special variety of Lathyrus, veryimpor ta nt f or the type of symptoms a ppe a r ingin different parts in the world, is in our view thenutr i t io na l ba c kgr ound of la thyr ism. A lthoughwe have not had the facility to prove thisexperimentally, by giving the same amount ofteora to one volunteer with normal nutritionalba c k gr ou nd" a nd to- . - a nothe r vo lunte e r w ithdeficient nutritional background, clinical experi-ence shows that outbreaks of lathyrism occurat all . t imes and in all countries only among thepoor and ill-fed classes of people.Special observations ori the particular ingredient defi-cient in the diet are reported by McCombie Young

(1928). He stresses a vitam in A deficiency am ong hislathyrism pa tients . He not only found night-blindnesscommon in a village suffering from lathyrism, but alsonoticed that the disease did not occur in neighbouringvillages, where the diet contained as much Lathyrus butmore v itam in A, fish and m eat; w hile Shah (1939) hasreported great improvement in patients, when vitaminsA and D were given. '1 Apart from night-blindness no.ap pa ren t, , deficiency; diseases have been :. reported;; aa- :.occurring^' wi th : ou tbre ak s-, of: lathyrism.; \ A . y . l a t e n t ; "vitamin B ! ' .deficiency..however is suspected as ' a -result.."of the investigations on serum phosphatase of lathyrisrrr. .


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T H E I N D I A N M E D I C A L G A Z E T T E [ F E B . , 1947pa tien ts by Rud ra and B liatiachary a (1SM6) in. F ain a.They found a high .serum phosphatase and a consequentpossib le cocarboxylase deficiency in lathyrism andrelated these findings to the jetiology of the disease.They consider it, however, also possible that the highserum phosphatasc is the effect and not the cause oflathy rism . B ut, of course, lack of other substances inthe diet, apart from vitamins, may be important, assuggested by B asil ct al. (1037), who found that theseeds of Laihyrus antivus, .which, often form the staplefood in famine villages, are a very poor source ofprotein, being especially deficient in tryptophaue.

The author (Jacoby, 1946) has found in thisarea here that the nutritional background of avast proportion of (lie population is a vitamin Bcomplex deficiency. Although symp toms of thisdeficiency are visible in only ab ou t 14 per c entof our lathyrism patients, the result of thetherapeutic test {see under treatment) suggeststh a t a late nt vitam in B complex deficiency existsin a far greater proportion. I t is a hitherto un-explained fact that in lathyrism villages thedisease attacks generally only one or twomembers of a family, but leaves the others un-touched who eat the same food and live underthe same conditions.- Children arc affectedroughly in the same proportion and manner asadults, but the female sex to a much smallerproportion as compared with the male sex. InSho urie's (1945) sta tistics only ab ou t 13 per centwere females.Treatment. This present description of thecurative influence of prostigmin in lathyrismis based on the analysis of 50 patients treatedwith prostigmin.There has been no effective treatment oflathyrism unti l now. . Jacoby (1946a), how-ever, discovered that lathyrism responds wellto prostigmin tre atm en t. Th is response differsin degree in the different stages of the disease.The first stage in our classification comprisesall those patients who can walk with slightlybent knees and only some active and passiveresis tan ce in their m uscles as' well as with th e

. ju st noticeable scissor-gait and slight m usclepa in. Th eir deep reflexes are, of course, gre atlyexaggerated, the superficial reflexes as a rulebeing normal and plantar response extensor,elicrtablc from the lateral border, of the sole.N o ' flexion refl ex ' is present. In this stagean apparently complete clinical cure is achievedthrough and during the treatment with pros-tigmin injection; in the beginning about 10intramuscular injections of 2 c.c. are givendaily, after which a course of another ten dailyinjectio ns with 1 c.c. only follows. Afterw ards,injections on alternate days may be sufficient tokeep the achieved condition unaltered . If thetreatment is discontinued, we invariably founda re-occurren ce of the former symptom s. It wasnot possible to substitute, either for the short-term or the long-term treatment , the injectionsby tablets of prostigmin. The tablets haveproved to be ineffective in lathyrism. -

The required duration of the treatment oflathy rism with prostigmin .is thus the sa m e' asin.-. Myasthenia gravis... Discontinuance of/ the/

treatment causes re-occurrence of symptoms ineither disease.The second stage in our classification oflathyrism comprises the more advanced caseswith marked painful muscle spasm and a clearlyvisible spastic ataxic scissor-gait . M uscularfibrillations are present. These patients arestill in a position to walk, although with con-siderable difficulty and discomfort, either justwithout or preferably with one or two sticks,.according to the advancement of the case.The treatment of this stage with prostigmininjections does not achieve the same result asin the first stage. Th e symptom s are only con-siderably relieved, but it is generally onlypossible to reac h an imp rovem ent whichresembles the earlier first stage in our classifica-tion. Tho se who were previously able to walkwith tiie described obstacles, but without a stick,can under the influence of the prostigmin treat-ment walk like untreated first-stage patients,and those who requ ired the stick are enabledto walk without it .The third-stage patients are those who areperm anen tly confined to bed. Th e m usclespasm and contractures are so extreme tha t .they prevent practically any movement withthe legs. Th e pains in the muscles of the lowerextremity, of the calves, thighs and loins areperm anent and severe. These patien ts have thusbecome cripples. A t the same time all otherfunctions of the body are unimpaired, the vegeta-'tive as well as the m ental functions. Th ereflexes are such as we have described under' s y m p t o m s ' fo r t h e far ad van ced s t ag es . T h eprostigmin-injection treatment in this thirdstage achieves little with regard to the crippledstate of these patients, but succeeds in so faras the pains almost disappear and the musclerigidity becomes less. Th is results som etimes inan ability of these patients to leave their bed,slowly crawling on the floor for short distances.These third-stage patients are, of course, not ina position to work. Th e patien ts, however, whobelong to the first and second stage, are by thetreatment with prostigmin enabled to do almostev ery k in d of w o rk. . . .

The achievements under prostigmin treatmentcan in every case an d stage be" acc urate lychecked and even measured in the followingway : The exaggeration of the knee - and arikle-jerks becomes less and in early cases practicallynormal so that also the clonus may disappear;the extensor B abinsk i response in the early caseswill equally approach the normal. If in themore advanced stages the superficial reflexeswere not to be elicited before, they will reappearin the course of th e trea tm en t and the ' flexorreflex ' disappear. Th e most accurate evidenceof imp rove m ent is th e gait,-, which ' can bemeasured as follows : Th e pat ien t is asked towa lk in his usua l m ann er with we tted feet on ',the dry floor. The heel-to-heel distance - ismeas ured w i th a; . t ap e . . T h i s , d i s t an ce , s h ow sunder prostigmin treatment a marked diminution


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t 1947] CAUSE, SYMPTOMS AND TRE ATM E NT OF LATHYRISM : JACOB Y 57^aboiit 3 to 6 inches. Vice versa, if theinjections a r e . discontinued, the length of stepsslowly increases again till after about a month the original length is regained. The symptomK vhich shows improvement last is the ataxia. Itfit-Aak cs abou t 20 daily injections before theW - patients can for instance stand quietly on one P leg or are able to stop walking imm ediately onfe i:: sudden order. B efore the treatmen t they were| t f not able to do so bu t had to proceed one or twoi t steps further in order to keep their balance.fe The improvement of ataxia can generally not beft--' achieved in late stages. We tried to enhanceI* the effect of th e prostigmin trea tm en t byjE-f administering at the same time massage, lightl|v or electric trea tm ent to the lower extremities of| . lathyrism patien ts. We did not, however, find'.. any response to these methods.

S.'" . Vitamins.Several authors report improve-ii ment of the disease by the administration of;v certain vitam ins. Ranjan advises, plenty of'


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58 T H E I N D I A N M E D I C A L G A Z E T T E [FEB., 1947charge of the villages concerned. Th ey poin t toan increase in the incidence of lathyrism thereduring the ye a r 1946.Whatever significance might be given to suchreports in view of the absence of official data,the writer has actually come across and treatedpat ien ts whose disease represe nts new outbreaksin 1946. If this fact of new out br e a ks iu 194Gor of an increase in the incidence of lathyrismin general is recognized and appreciated by theauthorit ies, the third task should be a legislative.one. This should not prove too difficult, sincethis district (B hopal) is a grain surplus area.The awareness of the villagers to the fearfulconsequences of teora consumption had a ppa r -ently not the effect of inducing them to leaveteora voluntari ly to cattle only instead of usingit for their consumption. Th ey should, there-fore, be prevented by law from consuming teorathemselves. This ought to be a hum a ni t a r i a nd u t y and should not be governed by any otherconsideration. Such a step was in fact takeni n N ove m be r 1945 hy the D e p a r t m e n t Com-missioner of Jubbul por e , ba nni ng the sale ofteora in the Sihora telisil.

Along with the legal prohibition of teora con-sumption should go the scientific research with aview to investigating a mixture of teora mixedwith other grains, i.e. m a i nl y of wheat , in whichthe proportion of teora is too small to exerciseits toxic effect on men. Such research, whichthe writer had no facilities to carry out, wouldbe of greatest importance in view of the present-world food scarcity, because it would assist inovercoming this scarcity by stretching the avail-able food resources with thehelp of teora, whichgrows abundantly even on rocky soil in spiteof hailstorm, blight, excess of r a i n , etc.

SummaryL a t h y r i s m is a specific disease of the. pyr a m i da l t r a c t , due to theconsumption of teora ,a species of the ge nus L a t hyr us . in this area ofCe nt r a l I ndi a . " A full account of its m a ni f e st a -t ions and a description of the t r e a t m e nt w i t hprostigmin injections is given. Th e. role , whichvi t a m i ns , if deficient in the diet , play inthe causation and t r e a t m e n t of thedisease inm enand experimental animals, is discussed. Sugges-tions for the prevention of the disease arem a de .

AcknowledgmentThe author desires to express his thanks to Sir Colin

C. Garbe tt, former Revenue M inister, B hopal State, forhis keen interest and kind encouragement throughoutthe work. Thank s are also due to Messrs. Hoffmann-LaRoche, Switzerland, B ranch B ombay, for the liberalsupply of prostigmin. R E F E R E N C E S

A H M A D , S. K. (1944) . . Antiseptic, 41, 514.BAETJ, K. P., N A T H , Indian J. Med. Res., 24, 1027.M. C, G H A U T , M. 0., ; .and M U K H E R J E B , R- : .(1937). ' ' . . . . .B A E U , K. P., N A T H / .. - Ibid^ . . v 24 , .1001;M. C, and,- M C K H E R - . ' ' . J E E , R. (1937). ' " . ; L " '."_'.'

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lathyrism cause, symptoms et treatment jacoby 1947 par miles

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