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JULY, 19391 EDITORIAL 42 1

Indian Medical GazetteJ U L Y

L A T H Y R I S MIT is an everyday experience to encountervictims of lathyrisra in the streets of Calcutta.These people usually come from North Bihar orthe United Provinces and are beggars by occupa-tion. M ost of them have been cultiv ators orlabourer.=; and the usual account they give ofthe onset of their disability is that during someyears of scarc ity they had to live ma inly onchick peas and that the disease then began, in-

sidiously in some cases, sudde nly in oth ers. T hedisability gradually increased until they couldwalk only with the help of stick s, the ir legsstiff, weak and trembling and their gait spasticand scissors-like. In advanced cases p rogre s-sion is effected by crawling on the balls of thefeet and on the hands.Lathyrism was first recognised in Europe overtwo hundred and fifty years ago, and it isobvious that even in those early and unscientifictimes it was ascribed to the ingestion of th eseeds of various species of the genus Lathyrus,because as early as 1671 the Duke of Wurtum-berg issued an edict forbidding the use of theseseeds. La ter, it was observed in Ita ly , Fran ce,Algeria and certa in easter n countries . It is nowrarely seen in Europe and the chief interest inthis disease at present centres in India where it-is shown to have been pre va len t for a t leas t aslong as written records of Indian history existand where it is still one of the most importantcauses of paralysis and deformity among thepoorer sections of the population in certain partsof the country . Du ring the last hund red yea rsit has been frequently reported upon by writerson medical matters of local interest and import-ance, and a great deal of the most recentresearch' on the still-d ispu ted aetiology of la th y-rism has emanated from workers in India.Th e disease is regarde d as a form of foo'dpoisoning by most authorities and, as the' nameimplies, sub stanc es in the seeds of th e genusLathyrus have usually been considered to be itscause. In Indi a, the species held respo nsible isLathyrus sativus. Stockman and Dill ing bothlent support to this theory because they inde-pendently isolated from the seeds of this plantalkaloidal substances which when inoculatedinto animals produced symptoms suggestive oflathyrism. Acton and Chopra also held theopinion that the seeds of L. sativus contained atoxic substance, but the toxin they isolated, andwhich caused lathy rism -like signs in m onk eysand ducks, was a water-so luble amine. So th at ,although these workers are all in agreement asto the seeds being the cause, they are at variance

us to the actual offending subs tance. Fu rth erevidence adduced by still other workers, as aresult of animal experiments, are also conflicting,probably because samples of seeds of L. sativusare very frequently conta min ated by seeds ofvariou s unidentified weeds, w hich mo st likelyplay some part in the production of these vary-ing results recorded. Ho wa rd, Simonsen andAnderson showed that botanical' ly pure lathyrusseeds could not produce any toxic effect, but acontaminant of the lathyrus seed, Vicia saliva{akta), contained bases having alkaloidal prop-erties, which produced definite signs of poison-ing with involvem ent of th e cen tral nervoussystem in laboratory animals such as guinea-pigs. Mc Com bie Young was of the opinion tha tdeficiency of vitamins, particularly vitamin A,was a factor in the production of the disease.Stockman later reported that watery extract oflathyrus contained a salt of phytic acid whichwas toxic to the brain and spinal cord. Stott.could not reproduce the symptoms in horses byfeeding them on L. sativus or V. saliva.The above brief outline shows that there aretwo m ain views, regarding the causa tion of th edisease, viz. fa) that it is due to food intoxica-tion, either by Lathyrus sativus or by Viciasativa and (b) that it may be to some extent adeficiency disease.In this issue of the journal there is a papersetting forth the details, of an outbreak of lathy-rism in a Punjab village, this village is in anarea where there have never been cases oflathy rism before. The paper brings out severalfeatu res of inter est. Th e disease affected theSikh agriculturists mainly, and three males toevery two females suffered. Th e pea Lathyrussativus was definitely not the cause of the disease,as this was not cultivated in the locality, nordid it occur as a contaminant of other cereals.It was finally found to be caused by ingestion offlour made from wheat that contained seeds ofVicia sativa. This vetch seems to have occurredas a weed in the wheat fields and was harvestedalong with the wh eat. Inspection of the wheatshowed the presence of these seeds and theidentification of them as V. sativa was definitelyestablished, as plants grown from the seeds werefound to be the same specimens as of V. sativaplants supplied by a botanist.The symptoms of the disease became aggra-vated whenever the people took bread made fromthe old stock of wheat that was contaminatedwith vicia seeds; wheat from other sources hadno such effect. Th ese findings ha ve lent supp ortto the V. sativa (akta) contamination theoryof Ho wa rd, Simonsen an d And erson and ha:ruled out the possibility of L. sativus being th*noxious agent. Avitam inosis cann ot be dismmissed completely as a possibility in view of th*pov erty of the people, but avitam inosis, i$present, must have been there for years whil*-the epidemic of lathyrism followed the harvest-ing of the wheat " crop contaminated witLV. sativa seeds.

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422 T H E I N D I A N M E D I C A L G A Z E T T E [ J U L Y , 1939Th e disease us a rule runs a very chroniccourse and there is little possibility of cure inthe sense of restoration of function of the limbs;therefore prevention should be aimed at.From the above discussion it seems clear thatlathyrism might be greatly reduced, if notaltogether stamped out, in India, by education

of the agricultural population so that they migappreciate the danger of akta seeds mixed wcereals. Th ey migh t also be given instructichow to recognize the plant V. sativa in its youstages before seeds are formed so that it coibe removed from among wheat cropsweeding.

Special ArticleSNAKE BITES AND THEIR TREATMENTIN INDIA

PART IIT H E MANAGEMENT OF SEQUEL S AND COMPLICA-

TIONSBy R. N. CHOPRA, C.I.E., M.\., J O , SC.D. (Cantab.),F.H.C.P. (Lond . )BRE V E T - CO LO N E L , I . M . S .

Honorary Physician to the Kingand

J. S. C H O W H A N , CAPTAIN, M.B., B.S., A.I.R.O.(School oj Tropical Medicine and Hygiene, Calcutta)Introduction

THERE are about 15.000 species of snakes inthe world and about 110 varieties exist in India.Out of these only 69 species are poisonous (40land and 29 sea snak es) . Excluding th epoisonous sea snakes it is apparent that one isexposed, taking India as a whole, to the bitesof 81 species out of which only 40 (50 per cent)are poisonous. The commonest poisonous snakesare the cob ra, k ra it, d aboia, echis and pit-vipers.Of the persons bitten by poisonous snakes ,about half may not receive a fatal dose; thebite may have been through thick clothes, thefangs may have simply grazed the skin, or theattack has been unsuccessful and the venomhas only been spilled on the surface of the intact-skin and so does not find its way into the tissuesand get absorb ed. Th e fangs may have hit abony portion of the limb or the bite may be onfingers or toes from which absorption into thegeneral circulation takes place slowly. Und erthese circumstan ces the usua l procedure ofincision, ligature , suction, ca uterization, etc.,m ay be effective. The refor e even of the 50 percent of cases bitten by poisonous snakes, onlyhalf the nu m be r (20 to 25 per cent) are inreality in a serious condition and need immediateat tention and prompt treatment in order to savetheir lives. Cla rk (1928) reported on 46 casesof sna ke bite. In half th e cases the snakes werenot indentified or caught and 10 per cent werefatal and these were from the bite of L. atrox.and L. mutans (Bush master) . The bi tesrecorded there were on hands and fingers in 20cases, wr ist and forearm in 6, shoulder in 1,foot or toes in 10, leg in 1 and thigh in 1. Basu

(1938) reported on 27 cases of snake bite amitted into the M edical College Ho spitaCa lcutta , for tre atm en t. Out of these 74 \cent were viperin e and 26 per cent colubribites. The death rate was 60 per cent. Inthe cases local infiltration with gold chloride aintravenous injections of Kasauli mixed anvenene were adm iniste red . H e is of opinithat the present treatment of both the scorpiand snake bites is unsatisfactory and a bet-form of treatment should be worked out.Th e above figures show tha t ha rdly 25 r.cent of all persons bitten are in real dangerlosing their lives and if adequate and prommeasures are taken we may be able to savegood, nu m be r of the se lives also. Our effort-this paper is to outline the present situatiregarding snake bite poisoning and to point rwhat treatments should be carried out in diffien t stag es of po isoning and for the differcsequelae. Ke eping in view the fact th at speciantivenene and expert medical aid is not readavailable in the places where snake bites usuaoccur, the following mea sures ma y be fouuseful : In persons w ho are bad ly b itten, where ivenom has found a direct passage into a laivessel, and if more than half an hour has elaptbetween the bite and the availability of pro]medical aid, so much harm has probably bedone that there is not much chance of savilife. Frequently such cases occur in out-of-tlway places and jungles where medical aid aantivenene are not available.

Acton and Know les (1914 ), Ba nne rm an (19Jand Chopra and Chowhan (1935a) have reporith at almos t all the poisonous snakes , wl:giving a good and sa tisfa ctor y bite , inject a d