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ON THE DISTRIBUTION OF LATHYR ISM IN THE UNITEDPROVINCES ANT) ON ITS CAUSE, WITH A DESCRIPTIONOF A -(:; MONTHS FEEDING EXPERIMENT ONTONGA PONTES W IT H BOTANIC ALLY P URECULTURES OF LATHYBUS SATIVUSAND OF VICIA SATIYA.

LIEX.-T.-COI.OXEL H. STOTT, M.D., M.R.C.P., D.P.H., I.M.S.,

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52: Lathyrism in U. P. and Its Cause.remaining districts of the province especially those in the western half wereso far as was known practically free of the disease.As the frequency of the disease increased so definitely towards the easterndistricts, culminating in Ballia, the most easternly situated of all, I asked theInspector-General of Civil Hospitals of Bihar and Orissa for information asto its distrib ution in Bihar and O rissa. The Civil Surgeons of this provincewere good enough to reply indicating that lathyrism was comparatively notuncomm on in no rthe rn Bih ar and practically did not exist south of theGanges. '

The main Allahabad focus is around Shankergarh, where the people eatpeas and rice. Thi s area is not far from Rewar Sta te, where lathyris m is verycommon. Obviously then lath yrism exists in the United Provinces to a greaterextent than was formerly generally believed and I determined to have the homeconditions of my next case more fully investigated.The opportunity soon presented itself when one Baldeo, aged 40, wasadmitted into my ward from Kheri district with spastic paraplegia of 11mon ths' duratio n. Balde o stated tha t hie- father, uncle and only son had thesame disease, whe reas his wife and daughter were health y. (It is rema rkablehow frequently the women of the family seem to escape.) His wheat crop hadbeen damaged to the extent of 75 per centand his diet and that of his sonhad consequently consisted of gram 50 per cent and of lathyrus pea 50 per centwith a little barley. At my request my house physician Dr. R. Chandra , M.B.,B.S., Luckno w, was good enough to visit this area for a few day s. Dr. Chan drafurnished a most interestin g report and found th at 10 persons were affectedwith spastic paraplegia out of approximately 1,000 in this patient's village.In the next village there were about 12 afflicted amon gst 1,000 persons.Similarly amongst other villages he visited the proportion with spastic paraplegiaapproxim ated 0-5 to 1 per cent. The diet of these poorer labourers approxim atedlathy rus 50 per cent, barley 33 per cent, wheat 17 per cent. Dr. Ch andra foundseveral interesting exam ples of many cases_of the disease in one family. Itwas somewhat unexpected to find on investigation so definite, a percentage oflathyrus 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 inthe United Provinces under lathyrus cultivation. The figures perhaps are notvery accurate as to the actual areas sown by the villagers, and I am not in-clined to attach m uch importance to them. On the whole they indicated thatmore areas existed under lathyrus cultivation in the sub-Himalayan areas andin the eastern distr icts. The actua l figures in areas were Gonda 3,036, Badaun1,454, Shahjaha npur 381, Morad abad 320, Bulandshahr 258, Farru khab ad 192,Etah 171, Bareilly 99, Baraich 82, Hardoi 19, Bara Banki 18, Kheri 11,Sitapur 2. . . . .

H. Stott. 533 . T H E DISEASE AMONGST MAN AND ANIMALS.

Lath ynsm inflicts cruel hardship s on the afflicted. It is usual ly the poorcultivator in debt, the bread-winner of a family, who with his intellect clearis ~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 theworst cases with rescntless sequence. How apt are Shak espea re's wor ds:

Famine is in thy cheeks,Xreri and oppression starteth in thine eye,Contempt and beggary hang upon thy back,The world is not. thy friend, nor the world's law.'

Animals do not escape. Fowls, pigeons and partridges eat the lathyruspea freely and with app aren t immun ity. Du cks are readi ly poisoned. Of allanimals the horse is especially susceptible. M any o utbr eaks am ongst horsesi-:i'iinji lathyrus in feeding cakes have been reported and some such outbreakshave formed the subject of subsequ ent legal proceedings. As long ago as 1820,the Paris Veterinary School warned farmers against using lathyrus peas forhorses as. it caused them to become roare rs and to die if worked. The m ainsymptoms of equine lathyrism are (i) weak lum bar muscles (' gone in theloins ') , lii) Roaring (from recurrent laryngeal palsy). (Hi) Dyspnoea andsudden death on exertion, (iv) Rapid and weak pulse, (v) Debil i ty , t remorand stiffness of the legs. At rest th e horse might a ppe ar qu ite well, but cmexertion attacks of the above symptoms might appear and disappear equallysuddenly. The first signs in some horses is stumbling and staggering whilstat work so that, if pushed, they might stagger and even fall to the ground.4 . T H E CAUSE OF LATHYRISM.

Throughout the centuries in diverse countries from the time of Hippo-crates, the disease has been att ributed to the consumption of the lathyrus peain sufficient q uan tity ov er a sufficient period of time . W ha t is th e factor in mixture of peas from a lath yru s crop th at causes lathy rism ? From ex peri-mental work Acton and Chopra indicated that the cause was a water solublenmine which was increased during germination and which could be removed nun the l.ithyrus by soaking t he gra in for 24 hours in three changes of w ateri/mi. Mai. Caz., Nov. 1922). But some crops of lathyrus will appare ntlyproduce lathyrism whilst other crops will not and the experimental work ofmany workers give discordant results as to the poisoning properties of lathyrus.Anderson. Howard and Simonsen, a team combination of a medical researchworker with a botanist and a chemist, by a well-planned research spread overmany months, showed that a bazar specimen of lathyrus contained severalli.-tinct varieties of peas from which they separated amongst others two oflTial importance, Lnthyrus sativus an d Vicia sativa, which they cultivatedm botanically pure culture. They concluded that lathyr us was chemically

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54 Laihyrism in U. P. and Its Cause.free from alkaloids and that controlled feeding experiments over long periodswith ducks and monkeys showed that the grains are harmless and even nourish-ing to these animals. They found tha t Yicia saliva, a weed commonly con-tamina ting a lathy rus crop, possessed alkaloidal bases. One, divicine, produceda characteristic and fatal disease when innoculated into guinea-pigs. Viciasaliva when fed to ducks caused death, and in monkeys produced characteristicnervous and muscular symptoms. Though some of these symptoms have beendescribed in human latbyrism they were not yet prepared to state that Aktais the cause of lathyrism in man (Ind. Jour. Med. Res., XII, 4, 1925).

5. TH E 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 thispoint for in famine periods, when vast outbreaks.of lathyrism arc apt to occur,the effective preventative steps to be advised differ according to which peais actually responsible. Therefore I devised the following experiment and, inconsultation with Major L. A. P. Anderson, I.-M.S., of the Central ResearchInstitute, Kasauli, J. T. Edwards, Esq., of the Imperial Institute of VeterinaryResearch, Muktesar and Captain Hickey of the Civil Veterinary Department,"United Provinces, pu t it into effect. Three healthy tonga ponies were pur-chased in the bazaa r and kept for a period in quarantine. Their age (2 years3 months), sex (m ale), height (10 feet 3 inches), girth (48 inches), shank (6inches), weight (50 seers) and condition (fair) were approximately the sameand the po nies were seen a t fortnightly intervals by Captain Hickey whorecorded their progress. I saw the ponies daily at one feed and weekly attrotting and cantering exercise. To each pony the same basic diet was given,namely, three pounds of barley with salt, a handful of lucerne when availableand grass feeding ad lib. To No. 1 pony, a chestnut, named ' Vicia,' threepounds of Vicia saliva daily were given mixed in the basic diet. To No. 2pony, a roan named ' Lathyrus,' three pounds of Lathyrus sativus daily weregiven 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 grownin botanically pure culture at the Institute of Plant Industry, Indore, CentralIndia, and these pure strains I was able to obtain through the courtesy of theDirector, A. Howard, Esq., C.I.E. A daily register was maintained of eachpon y's feeds, exercise and condition . Each feed was mixed and given in thepresence of Dr. R . S. Lai, dem onstrator in pathology at the King George'sMedical College, to whom I am indebted for this considerable help. Theamount of any feed left by the animal was entered in the register. It wasexpected from the experience of previous outbreaks of lathyrism in horses, thatwith this dosage of the pea symptoms of lathyrism would appear in one or atthe most 2 months.

The experiment started on 12th November, 1928, and was continued until6th April, 1929, tha t is for 4 m onths 24 d ays, when it was forced to stop

H. Stott. 55owing to the exhaustion of botanically pu re strains of the grain At the endof this period, all ponies were in equal and excellent condition and had put onweight. 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 tha t f u Xresearch may be devoted to the solution of this important problem