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DE C . 1904.] LATHYRISM IN THE C E NTRAL PROVINC E S. 461

T H EJ n d i a n

DECEMBER, 1904.THE LATHYRISM INQUIRY.

^ I T may be remembered tha t in F ebrua ry1003 we announced that the Government of' ' i n d i a had d e termined to hold an i nqu i ry i n tothe prevalence of lathyrism in the C en tral Pro-, v in ces, and that Major Andrew Buchanan, I.M.S.I3T.D., had been appoin ted to conduct the inquiry.The Report is now before us an d we may a tonce say tha t it forms a complete an d valua blemonograph on this disease.The Report announces no new discovery in-the ca usa tion 'of this disease, but proves, to ourminds, conclusively tha t the common belief which-connects the prevalence of lathyrism knownTvith the lon g a n d excessive use of the vetchbotan ically as La thy rus sativus (verna culardeora C . P . , Kesari, Northern In d ia ) is correct.The Report gives an in terestin g sketch of thehistory of the disease in India, and in othercoun tries. The best know n accoun ts of thedisease in Ind ia i s that in Sleeman 's Ramblesand Recollections, where he d escribes w holevillages of para lytics in the Saugor D istrictt ind in the n eighbourin g d istricts of what a re now4,he Un ited Provin ces. Sleeman w rote in 1833"The n ext im portan t account is by D r. KinlockiKirke in 1845, who described a serious outbreakin Sind e in tha t yea r. Next comes the veryfull an d valuable report by D r. Irvin g, thena C ivil Surgeon of Allaha bad , in 1857 an dfollowing yea rs. D r. Irvin g's accou n t is of-great in terest, an d his descriptions are soaccurate that the}7 can not be surpassed. Theywill be found in volumes 6, 7, 12, an d 23 of thelong ext inct Annals of Indian MedicalScience, an d some in terestin g extracts areprin ted from them by Major A. Buchan an in anappendix to his report.There is a strong popular opinion in favour of-the conn ection between the consumption of kesari-and the spast ic paraplegia S3rmptoms of la thy -rism . Of course persons are found to tell onethat they know of cases where the patients hard-ly ever or never ate kesari, but on invest igat ioni t is found, if the.case is one of lathy rism a t all,tha t the pa t ien t a te some infer ior mixed gra ins ,whi ch on examin at ion prove to . be la thy rus.

The essential conditions are as follows : (1) a largequan t i ty , i.e., a large proportion , of -the d ai lyfo* must have consisted of thi s gra in , (2) th isuse of it must ha ve contin ued for a t least two orthree months. It is probable that when kesari iseaten as bread with the husk, it is more dele-terious. We have been told by men in Bengalthat they could see no reason for the prohibitionof the use of kesari in Bengal ja i ls, theyusually stated tha t they had seen i t used an dwithout ha rm. Quite true, but in Bengal i t israrely used, and i t is used in small quantity andas a dav ; hence the two essential cond itions aren ot fulfilled, an d the argum en t falls to the grouud .

These two cond itions, viz., large quant i ty andlongtim e mu3t alwa ys be borne in mind whenone is in vestigating an y cases of this un fortuna tecomplaint . C ases of lathyrism are alwa ysconnected with times of scarcity or fam ine,because this gra in often survives, when whea tand other food crops fail and because it is cheap.The people well know tha t its con tinued usewill produce paralysis, but they always hope tobe able to leave off before serious symptoms havesupervened.The Report deals fully with the symptoms ofthis para plegia. Women a re much less affectedthan men, a fact of which no wholly satisfactoryexplan ation is forthcoming. C hildren oftensuffer. The severity varies accordin g to thelength of t ime an d the qua n tity of the grainconsumed. If a ma n eats pure teora (kesari)for about two mon ths he gets cram ps in hislegs; if he then stops he may recover entirely;but even then will be n oticed "an up an d d ownmovement of the should ers," the pa tien t's toesmay d rag slightly on the ground, an d if hea ttemp ts to run he will very likely fall. If thepatien t continues to eat teora, he may experiencea sudden a ttac k of para lysis, but if at la stwarned, he gives up the use of the grain, he willslowly recover, an d soon be able to wa lk aboutwith the aid of a stick, his toes will scrape theground , an d the muscles of the back of his legwill be rigid.* If in spite of warn in gs or fromd ire necessity the pa tie n t con tin ues the use ofthe grain he will loose con trol over his blad deraud rectum sphin cters. E ven a t this stage thedisease is capable of arrest an d improvement ifthe supply of teora is stopped ; but the utmosttha t can be expected is an abi li ty to hobblealong with the aid of two sticks. A further

* We saw dozens of men in this stage in Shahabad Districtin 1897-8 after the sca rc i ty .ED . , / . M. G.

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46 2 THE INDIAN MEDICAL GAZETTE. 1904.stag is described in the Report as that of the" crawlers." These unfortunates have eatenkesari fora long time, and have become unable todo more than crawl. It will thus be seen that ifonly the patient will remove the cause, i.e., stopeating lathyrus. he can toa considerable extent,recover the partial use of his limbs.*

The characteristic gait and "stance" of alathyrus patient is well known, the dragging ofthe toes is a marked symptom, there is usuallya tendency to crossed-legged progression.

Major Andrew Buchanan's Report deals withthe geographical, agricultural and famine influ-ences which affect the prevalence of this seriouscomplaint. As regards the degree of prevalence,the Chief Commissioner ordered a Census of thecases of lathyrism in the five districts, Hoshanga-bad, Narsingpur, Jubbulpore, Datnoh, and Sau-gor, and there was found a total of 7,78G, consist-ing of 5,775 males, 759 females and 958 children.This shows the very marked difference in thenumber of females affected. The epidemic, asit may be called, lasted in the Central Provincsfrom 1896 till 1902.

The evidence in favour of regarding lathyrusas the cause is considered under three heads(I )the evidence of those who ate the grain, and allwho were paral\\sed admitted that they hadeaten lathyrus in large quantity and for a longtime ; (2) the fiict that none were paralysedwho had not eaten lathyrus, and (3.) that otherswho on finding they had some unusual sensa-tions, ha