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300 IN D IA N M ED ICA L G A ZETTE. [SEPT. 1893.(iii) A certain number of* mea should be car-ried for the sole duty ot' cleauaing the decks, lat-rines, etc. , one of whom might, should the neces-sity arise, be deputed to take charge of the sick-bay or hospital.(iv) A nativ e apothecary should be carried toaid the surgeon.(v) Mo re cubic space than at present should

be allowed to each pilgrim.These are matters of the first importance, andI m ight mention many minor ones. It would bemuch bette r if food were included and chargedfor in the passage - money. Th is would preventthe possibility of semi-starvation, and be an ac-tua l saving to both owners and pilgrims. Muchtrouble would be saved iu serving out wood, andchopping it, meals would be uuiform, and thenuisance of the penetrating smoke from the fireson deck would be obviated. Fu rth er , I do not think that pregn ant womenor very young children should be allowed to un-dertake such a journey.

LATHYRISM.B Y SUBGEON-CAPTAIN A. G. HENDLEY,

Civil Surgeon, Seoni.U N D E R the above heading I venture to sendan account of a suddeu, localised outbrea k of apeculiar form of paraplegia, affecting some tenper cen t, of the male population of a certa in vil-lage iu this district, which outb reak, I think, isclearly traceable to the use of" tera " or "k lia-sari dl" {Lathyrus satious) as sole article of diet.When it is considered () how vast an area ofthose, the Cen tral Province s, are under thisLathyrus cultivatiou (the returns of 1887-88 give357,883 acres ; Sind coming n ext with 72,876acres); and (b) its extraordinary cheapness (near-ly a maund to the rupee) ; one can readily un-der stan d how disastrous might be the effects ofa few yea rs of scarcity ; in forcing people to re-sort to this grain as a principal article of diet.The circumstances of the outbreak are as fol-lows:During the past six weeks, or thereabouts,12.males of one village have become paralysedmore or less severely in the lower limbs; andone man also.in the hands and arms..Some of these men had not been ailiug in auyway up to the date of the onset of the disease,

which was so sudden and progresa of which waa sorapid that iu 8 to 10 days the sufferers could withdifficulty get about. W ith this paralysis thereis no sense of illuess. No females of this villageor auy persons in any of the neighbouring vill-age s have been attacked . Th e affected villageis situated (as nearly all the villages of this part iare) on high ground , on a ridge between two nullahs , with good, natura l drainage. !I noticed this village in my sanitary notes,some few weeks ago, as being "m uch cleaner aud

better drained than surro und ing ones." Thewater-supply is from one good, pucca well and ispure. The inhabitants have for the past 18months subsisted almost entirely on tera, thegrain in question. This is on account of theirregular food-crops having failed the last twoyears. The better-off inhabitants eat it mixedwith wheat, gram, or red masuri dl, whilst thepoorer class subsist on it unm ixed. These griudit into flour to make bread, aud also eat it in theform of dl. Ail the affected men belong to thislatter class.Practically, all the cultivation immediatelyaround this village is La th yr us , whilst nearneighbo uring villages not nearly so large a pro-portion is grown, aud in none of these villagescould I find people who eut it unmixed. Manyof the villagers know that indulging largely audfor lengthy periods iu this grain is likely to in-duce "weakness of the legs"; and some (amin ority) say cattle are sometimes affected. Afew villagers told me that, some 16 years ago,there was a similar outbreak hereabouts, whentwo or three males from every village wereaffected; noue of these men, they say, ever re-covered the use of their limbs, and yet they canshew me uoue living now who were then affected.This is rather a significant fact as shewing atendency tosho rten life, as most of the men af-fected were, I understand , young aud strong. Anative theory is that Ci good kora hurts no man,"and that the present outbreak is due to the facttha t much of the grain is blackened and diseasedby rain. Cer tainly, there was a large amouut ofblackened grain in the samples shewn me in thevillage ; but the blacken ing seemed ouly skin deep,aud on husking it I could didcern no differencefrom the healthy grain, which is externally of asilver-grey colour faintly streaked with black.Below is a list of the cases seen by me.I have given the history of case No. I, withhis symptoms, &c, in detail, as his account isclear and typical. The cases are giveu iu theorder in which they were attacked.C A S E N O . I.D asru (Ah ir), 50 years, la-bourer, states that, some 1^ mouths ago, Iwoke one morning to find my legs stiff, weakand tremb ling, when I rose up to walk. Theyfelt very heavy to lift. I was quite well upto this time and have had no illneas worth men-tioning for years. This weakness and tremblingincreased so rapidly that in about 10 days Icould scarcely walk abou t even with a stick. Ieven now feel quite well, have a good appetite,and sleep soundly. There is no actual pain,^ouly the sense of heaviness aud weariness of thelegs, chiefly the calves aud outer thigh muscles;Both lega were affected simultaneoualy, first thecalves, then thighs aud hips. La tely I have lostall sexual desire and power. (A ll the adultsaffected complain of this.) Since my legs be?came affected some dozen other.ineii aud boys

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SEPT- 1393.] HENDLEY ON LATHYRI8M, SOIof my village have been similarly attacked.None of our women folk or men from othervillages are affected.Examined, 21st July 1893.Is a strong, heal-thy-lo okin g man of 50 ye ars . "Walked in foui-miles from his village with the aid of a stick.His rate of progression is under two miles auhou r, aud his gait very peculiar. The bodyabove the hips sways from side to side in walk-in g, while the legs seem to be lifted with diffi-culty and tremble when the weight of the bodyis put on them. The general effect is an im -pression of instability, aud reminds one of theefforts of a man "d ru n k in the legs " to w alkstraight and erect. There is nothing "sp ast ic "about the gai t, nor are the legs flung abo ut asin inco-ordination.The re is- evident muscular weakness of thelower limbs and hips, but no wasting; and themuscu lar tone seems normal. No loss of powerover the rectum and bladder. Bow els are reg u-lar and natu ral. There are no true trem ors;the trembling which occurs in walking seems tobe due to the excessive weakness, and there isno 1088 of "mu sc ula r sen se. " Sensation is un-affected. N o rigidity or spasms. Th e tendonreflexes are very exaggerated, both " kneejerk "and "a nk le clonus; " and the slightest stimulusstarts the latter phenomenon goiug for a longtime. Arm s, trunk, head, and neck are un-affected. The mind is clear, speech na tur al,pupils normal and act both to light and accom-modation. Urin e is : Sp. gr. 1030; acid high-coloured (urates), no albumen or sugar.

C A S E N O . II.Jarri (Pardhan), 35 years,labou rer. A precisely similar history and sym p-toms identical with No. I.C A S E N O . III .Birju (Baghri) , 30 years, la-bour er. Gives a similar history except tha t inhis case the disease begiuninor in his calves,spread to thighs and hips, and then he noticed hishands began to tremble when he grasped any-thing, and his arms have become very weak thelast few days. This mau looks pinched and ill,but beyond the paralysis has no complaint. Hi sleg symptoms are very marked, and are the sameas noted for No . I. H is hands tremble whenextended, and the grasp is very feeble- Lips alsotrem ble and face muscles twitch when he is tal k-ing. Ne rves of special sense unaffected. L at te r-ly he lias complained of paiu in lower dorsal aud

lumbar regions, and also in masseter musclesand around muscles of larynx.C A S E No . IV. Kanhai (Mehra) , 10 years ,labourer. A healthy boy. Same history andsymptoms : very marked in legs. Ha s rather a"s pa st ic " gait, but no tremors, rigidity orspasms.C A S E N O . V.Umer Lai (Mehra), 8 years,labourer. He althy boy. Histo ry and symptomsthe same, but gait is less uotioeable.

C A S E N O . VI.Bam Lai (Mehra), 19years, labourer. A big, robust youth. Bo thlegs affected, but less than any of the precedingcases.C A S E N O . V I I . Thoonu (Pardhan), 25yea rs, labourer. Sim ilarly affected but unsym -metrically, his right leg being more affectedthan the left. Th is gives him a limping gait.C A S E N O . VIII .Khurm Mai (Ahi r ) , 45years. H ealthy, strong-loo king man. Both legsequally affected. An av era ge case and typical.C A S E N O . I X . B aghchan (Ah ir), 20 years,son of No. V II I. Eobust youth. Both legsaffected, principally below knees, so gait is nottypical.C A S E N O . X.R am Bakhsh (Pardhan) , 8years, sou of No. I I . A mild case of only tendays' duration, both legs weak and clearly af-fected.C A S E N O XI,Parman (Mehra ) , 45 years.K tw ar of village. Both legs slightly affectedbelow knees, as yet only has weakness aud

" wabbles " in his gait. On ly affected sinceeight days.I have only been able to induce two of thesemen to remain in hospital, viz., Nos. I I and I I I ;treated with good nourishing diet ; and medicin-ally with Iodide of potassium, belladonna andergot. No. I l l has recovered greatly as to hishands and arms, but otherwise is the same as onadm ission. H is condition varies with the weatherbeing much aggravated by continued rainfall.Case No. II has not benefitted from treat-ment.The following points naturally now presentthemselves for elucidation, viz:1. In w hat does the poisonous prop erty ofthe grain consist, and why should its effects be socapricious, selecting robust males as victimswhilst the decrepit and females seem immune?2. What is the true pathology and morbidanatomy of the disease?In W att's " Dictionary of the Economic P ro -ducts of ludia," from which work much of thesubsequent information has been derived. Thefollowing is the chemical composition of the grainas determined by C hur ch: "W ater 10*1, al-bum inoids 31*9, starch aud fibre 53*9, oil 0*9,ash 3-2," and it is said that " the oil expressedfrom the seeds is a powerful and dang erouscathartic."Also that " a recent analysis by Aatier hasrevealed the presence in the grain of a volatileliquid alkaloid, probab ly produced by some pro -teid ferment, which exhibits the toxic effects ofthe seeds and the action of which is destroyedby heat."Now if this analysis is to be depended on andthe isolation of the " toxic volatile liquid alka-loid " a settled fact, much of the capriciousnessof the effects of a diet of this grain on different

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individuals is explained by possible variationsiu the method of cooking it, viz., at high and lowtemperatures.Also, if the alkaloid is a prod uct of proteidfermentation (A stier ), the native idea that" only the grain blackened by rain is poisonous"may be correct, as I take it, this grain would be

more liable to fermentation processes than soundgrain.Dr . Irvi ne , who in 1868 wrote or the subjectof a similar outb reak in Be ng al, where u earl yfour per cent, of th e population of one districtsuffered, also noted that "the ill effects weremore apt to occur in the rainy season." H e,moreover, states that some females were affected," the proportion being 6*11 males to 0*59 fe-males. As to the tr ue pathology and morbidanatomy of the disease, I can natura lly oulyconjecture, having had no opportunity of investi-gating after death the conditions of the nervoussystem and other parts of the body.The nature of the well-marked symptoms andtheir many poiuts of resemblance to cases ofcerebro-spinal sclerosis would lead me to sur-mise that the disease is a form of sclerosis, pro-bably characterised by nodules of sclerotic atro-phy and deg eneration of the proper nerve ele-men ts of the- white ma tter of th e spinal cord orbrain or both ; the motor tract only being affect-ed and in the form of an ascending degeneration.The only evidence I can find recorded on thepathology of the disease is a statement iu Watts'Dictionary that

" Cantarini of Naples has published a num berof cases in which he has carefully observed theconditions after death ; the muscles of the face,neck and trunk, were found nut to be affected ;those of the lower extremities, especially theabductors, were found to have undergone a fattydegeneration, the transverse strias being dimi-nished and the ultimate fibres containing littledrops of oil. No affection of the spinal cordwas discovered." In the face of this definiteresult of post-mortem inquiry , my conjecturesnatu rally fall to the ground ; but I confess I donot understand how a fatty degeneration of themuscles of the lower extremities could, per se,paralyse a man in some 10 to 15 days and cause

such symptoms as loss of sexual desire andpower.I have instituted experiments on pigeons witha view to clearing up the following points :1. Whether the healthy or diseased seedfrom the affected village contains the poison.2. Whether seed brought from a differentpart of the district is equally poisonous,3. Whether subjecting the grain to greatheat drives off the " volatile liquid alkaloid,"and so renders the g rain a harmless article ofdiet.

TEE EVOLUTION OF ANTISEPTIC SURGERY;A RETROSPECT.

B Y ERNE ST P. NE VE , M.D., F.B.O.S. ED.,Surgeon to the Kashmir Mission Hospital.

(Concluded from page 262.)A T the International Medical Congress atBerlin m 1890 Sir Joseph Lister referred ap-preciatively to the extension of our knowledgeresulting from Koch's new method of cultivat-ing microbes upon solid media. H e also men -tioned the interesting work of Metschnikoff inconnection with leucocytesa subject which hasan important bearing on antiseptic surgerySpe akin g of the success of Law sou T ait andBautock which was supposed to be achievedwithout autiseptics, he.pointed out that boththese surgeons were scrupulously careful aboutthe cleaning of their sponges and both observedthe strictest cleanlinesswashing the peritoneumw!th w at er -a n d B autock boiling the water beforeuse.

Lister at this time was using irrigation-withsublim ate lotion in two streng ths. H e employedjhr for washing a wound after the arrest of allhasmorrhage and ^ as an ordina ry lotion.Th e stron ger solution was not used iu joint casesle seat of operation was surrounded by towelswrung out of an antiseptic solution.Speak ing of the sp ray, which he had aban-doned for some yea rs, Liste r remarked that itwas wonderful what good results had been ob-ained when it was in use when it is consideredthat the particles of carbolic ac$ were widelyseparated, and these particles cannot have beeffin more than instantaneous contact with muchof the dust which was drawn into the vortexHe thought that this tended to indicate that the'floating partiales of the air were not usuallydangerous and that antiseptic washiu* and irrigatiou of wounds might be dispensed 'with if theope rator and his assistants could be trusted toavoid the introduction into the wound of septicdefilement from other than atmospheric sourcesIf this could be aocomplished List er thoug httha t, pe rhap s, his early dream could be fulfilledand that as in subcutaneous wounds so a woundmade under antiseptic precautions might forth-with be closed completely with the liu?of unionperhaps sealed hermetically with some antisantic varnish . If the application of an antiseptic"to cut surfaces could be discarded and the spo usesbe wrung out in a liquid that is aseptic but un-irritating, such as j ^ sublimate lotion, per-haps such an ideal might be attainedIu this direction there had been ste'ady movemen t. The spray had been got rid of T h less irri tati ng sublimate had been sub stituted forcarbolic acid. Les s drainage was requ ired onaccount of diminished irritation . Still there wasa limit to this progress. As a dressing f o r