300

INDIAN MEDICAL GAZETTE.

[SEPT. 1893.

(iii) A certain number o f * mea should be carried for the sole duty ot' cleauaing the decks, latrines, etc., one of whom might, should the necessity arise, be deputed to take charge of the sickbay or hospital. (iv) A native apothecary should be carried to aid the surgeon. (v) More cubic space than at present should be allowed to each pilgrim. These are matters of the first importance, and I might mention many minor ones. It would be much better if food were included and charged for in the passage - money. This would prevent the possibility of semi-starvation, and be an actual saving to both owners and pilgrims. Much trouble would be saved iu serving out wood, and chopping it, meals would be uuiform, and the nuisance of the penetrating smoke from the fires on deck would be obviated. Further, I do not think that pregnant women or very young children should be allowed to undertake such a journey.

better drained than surrounding ones." The water-supply is from one good, pucca well and is pure. The inhabitants have for the past 18 months subsisted almost entirely on tera, the grain in question. This is on account of their regular food-crops having failed the last two years. The better-off inhabitants eat it mixed with wheat, gram, or red masuri dl, whilst the poorer class subsist on it unmixed. These griud it into flour to make bread, aud also eat it in the
form of dl. latter class. Ail the affected men belong to this

LATHYRISM.
BY SUBGEON-CAPTAIN A. G. HENDLEY,

Civil Surgeon, Seoni.

the above heading I venture to send an account of a suddeu, localised outbreak of a peculiar form of paraplegia, affecting some ten per cent, of the male population of a certain village iu this district, which outbreak, I think, is clearly traceable to the use of" tera " or "kliasari dl" {Lathyrus satious) as sole article of diet. When it is considered () how vast an area of those, the Central Provinces, are under this Lathyrus cultivatiou (the returns of 1887-88 give 357,883 acres ; Sind coming next with 72,876 acres); and (b) its extraordinary cheapness (nearly a maund to the rupee) ; one can readily understand how disastrous might be the effects of a few years of scarcity ; in forcing people to resort to this grain as a principal article of diet. The circumstances of the outbreak are as follows:During the past six weeks, or thereabouts, 12.males of one village have become paralysed more or less severely in the lower limbs; and one man also.in the hands and arms.. Some of these men had not been ailiug in auy way up to the date of the onset of the disease, which was so sudden and progresa of which waa so rapid that iu 8 to 10 days the sufferers could with difficulty get about. With this paralysis there is no sense of illuess. No females of this village or auy persons in any of the neighbouring villages have been attacked. The affected village is situated (as nearly all the villages of this part i are) on high ground, on a ridge between two nullahs, with good, natural drainage. ! I noticed this village in my sanitary notes, some few weeks ago, as being "much cleaner aud
UNDER

Practically, all the cultivation immediately around this village is Lathyrus, whilst near neighbouring villages not nearly so large a proportion is grown, aud in none of these villages could I find people who eut it unmixed. Many of the villagers know that indulging largely aud for lengthy periods iu this grain is likely to induce "weakness of the legs"; and some (a minority) say cattle are sometimes affected. A few villagers told me that, some 16 years ago, there was a similar outbreak hereabouts, when two or three males from every village were affected; noue of these men, they say, ever recovered the use of their limbs, and yet they can shew me uoue living now who were then affected. This is rather a significant fact as shewing a tendency toshorten life, as most of the men affected were, I understand, young aud strong. A native theory is that Ci good kora hurts no man," and that the present outbreak is due to the fact that much of the grain is blackened and diseased by rain. Certainly, there was a large amouut of blackened grain in the samples shewn me in the village ; but the blackening seemed ouly skin deep, aud on husking it I could didcern no difference from the healthy grain, which is externally of a silver-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, with his symptoms, &c, in detail, as his account is clear and typical. The cases are giveu iu the order in which they were attacked. CASE NO. I.Dasru (Ahir), 50 years, labourer, states that, some 1^ mouths ago, I woke one morning to find my legs stiff, weak and trembling, when I rose up to walk. They felt very heavy to lift. I was quite well up to this time and have had no illneas worth mentioning for years. This weakness and trembling increased so rapidly that in about 10 days I could scarcely walk about even with a stick. I even now feel quite well, have a good appetite, and sleep soundly. There is no actual pain,^ ouly the sense of heaviness aud weariness of the legs, chiefly the calves aud outer thigh muscles; Both lega were affected simultaneoualy, first the calves, then thighs aud hips. Lately I have lost all sexual desire and power. (All the adults affected complain of this.) Since my legs be? came affected some dozen other.ineii aud boys

SEPT-

1393.]

HENDLEY ON LATHYRI8M,

SOI

of my village have been similarly attacked. CASE N O . VI.Bam Lai (Mehra), 19 None of our women folk or men from other years, labourer. A big, robust youth. Both legs affected, but less than any of the preceding villages are affected. Examined, 21st July 1893.Is a strong, heal- cases. thy-looking man of 50 years. "Walked in fouiCASE N O . VII. Thoonu (Pardhan), 25 miles from his village with the aid of a stick. years, labourer. Similarly affected but unsymHis rate of progression is under two miles au metrically, his right leg being more affected hour, aud his gait very peculiar. The body than the left. This gives him a limping gait. above the hips sways from side to side in walkCASE N O . VIII.Khurm Mai (Ahir), 45 ing, while the legs seem to be lifted with diffi- years. Healthy, strong-looking man. Both legs culty and tremble when the weight of the body equally affected. An average case and typical. is put on them. The general effect is an imCASE N O . IX. Baghchan (Ahir), 20 years, pression of instability, aud reminds one of the son of No. VIII. Eobust youth. Both legs efforts of a man "drunk in the legs " to walk affected, principally below knees, so gait is not straight and erect. There is nothing "spastic " typical. about the gait, nor are the legs flung about as CASE NO. X.Ram Bakhsh (Pardhan), 8 in inco-ordination. years, sou of No. I I . A mild case of only ten There is- evident muscular weakness of the days' duration, both legs weak and clearly aflower limbs and hips, but no wasting; and the fected. muscular tone seems normal. No loss of power CASE N O XI,Parman (Mehra), 45 years. over the rectum and bladder. Bowels are reguKtwar of village. Both legs slightly affected lar and natural. There are no true tremors; the trembling which occurs in walking seems to below knees, as yet only has weakness aud be due to the excessive weakness, and there is " wabbles " in his gait. Only affected since no 1088 of "muscular sense." Sensation is un- eight days. I have only been able to induce two of these affected. No rigidity or spasms. The tendon men to remain in hospital, viz., Nos. I I and I I I ; reflexes are very exaggerated, both " kneejerk " and "ankle clonus; " and the slightest stimulus treated with good nourishing diet ; and medicinstarts the latter phenomenon goiug for a long ally with Iodide of potassium, belladonna and time. Arms, trunk, head, and neck are un- ergot. No. I l l has recovered greatly as to his affected. The mind is clear, speech natural, hands and arms, but otherwise is the same as on pupils normal and act both to light and accom- admission. His condition varies with the weather modation. Urine is: Sp. gr. 1030; acid high- being much aggravated by continued rainfall. Case No. II has not benefitted from treatcoloured (urates), no albumen or sugar. ment. CASE N O . II.Jarri (Pardhan), 35 years, The following points naturally now present labourer. A precisely similar history and symp- themselves for elucidation, viz: toms identical with No. I. 1. In what does the poisonous property of CASE N O . III.Birju (Baghri), 30 years, la- the grain consist, and why should its effects be so bourer. Gives a similar history except that in capricious, selecting robust males as victims his case the disease begiuninor in his calves, whilst the decrepit and females seem immune? spread to thighs and hips, and then he noticed his 2. What is the true pathology and morbid hands began to tremble when he grasped any- anatomy of the disease? thing, and his arms have become very weak the In Watt's " Dictionary of the Economic Prolast few days. This mau looks pinched and ill, ducts of ludia," from which work much of the but beyond the paralysis has no complaint. His subsequent information has been derived. The leg symptoms are very marked, and are the same following is the chemical composition of the grain as noted for No. I. His hands tremble when as determined by Church:"Water 10*1, alextended, and the grasp is very feeble- Lips also buminoids 31*9, starch aud fibre 53*9, oil 0*9, tremble and face muscles twitch when he is talk- ash 3-2," and it is said that " the oil expressed ing. Nerves of special sense unaffected. Latter- from the seeds is a powerful and dangerous ly he lias complained of paiu in lower dorsal aud cathartic." lumbar regions, and also in masseter muscles Also that " a recent analysis by Aatier has and around muscles of larynx. revealed the presence in the grain of a volatile CASE No. IV.Kanhai (Mehra), 10 years, liquid alkaloid, probably produced by some prolabourer. A healthy boy. Same history and teid ferment, which exhibits the toxic effects of symptoms : very marked in legs. Has rather a the seeds and the action of which is destroyed "spastic" gait, but no tremors, rigidity or by heat." spasms. Now if this analysis is to be depended on and CASE N O . V.Umer Lai (Mehra), 8 years, the isolation of the " toxic volatile liquid alkalabourer. Healthy boy. History and symptoms loid " a settled fact, much of the capriciousness of the effects of a diet of this grain on different the same, but gait is less uotioeable.
38

individuals is explained by possible variations iu the method of cooking it, viz., at high and low TEE EVOLUTION OF ANTISEPTIC SURGERY; temperatures. A RETROSPECT. Also, if the alkaloid is a product of proteid BY ERNEST P. NEVE, M.D., F.B.O.S. ED., fermentation (Astier), the native idea that Surgeon to the Kashmir Mission Hospital. " only the grain blackened by rain is poisonous" may be correct, as I take it, this grain would be (Concluded from page 262.) more liable to fermentation processes than sound A T the International Medical Congress at grain. Berlin m 1890 Sir Joseph Lister referred apDr. Irvine, who in 1868 wrote or the subject preciatively to the extension of our knowledge of a similar outbreak in Bengal, where u earl y resulting from Koch's new method of cultivatfour per cent, of the population of one district ing microbes upon solid media. He also mensuffered, also noted that "the ill effects were tioned the interesting work of Metschnikoff in more apt to occur in the rainy season." He, connection with leucocytesa subject which has moreover, states that some females were affected, an important bearing on antiseptic surgery " the proportion being 6*11 males to 0*59 fe- Speaking of the success of Lawsou Tait and males. As to the true pathology and morbid Bautock which was supposed to be achieved anatomy of the disease, I can naturally ouly without autiseptics, he.pointed out that both conjecture, having had no opportunity of investi- these surgeons were scrupulously careful about gating after death the conditions of the nervous the cleaning of their sponges and both observed the strictest cleanlinesswashing the peritoneum system and other parts of the body. w!th water-and Bautock boiling the water before The nature of the well-marked symptoms and use. their many poiuts of resemblance to cases of Lister at this time was using irrigation-with cerebro-spinal sclerosis would lead me to surmise that the disease is a form of sclerosis, pro- sublimate lotion in two strengths. He employed bably characterised by nodules of sclerotic atro- jhr for washing a wound after the arrest of all as an ordinary lotion. phy and degeneration of the proper nerve ele- hasmorrhage and ^ ments of the- white matter of the spinal cord or The stronger solution was not used iu joint cases brain or both ; the motor tract only being affect- le seat of operation was surrounded by towels ed and in the form of an ascending degeneration. wrung out of an antiseptic solution. Speaking of the spray, which he had abanThe only evidence I can find recorded on the doned for some years, Lister remarked that it pathology of the disease is a statement iu Watts' was wonderful what good results had been obDictionary that ained when it was in use when it is considered " Cantarini of Naples has published a number that the particles of carbolic ac$ were widely of cases in which he has carefully observed the separated, and these particles cannot have beeff conditions after death ; the muscles of the face, in more than instantaneous contact with much neck and trunk, were found nut to be affected ; of the dust which was drawn into the vortex those of the lower extremities, especially the He thought that this tended to indicate that the' abductors, were found to have undergone a fatty floating partiales of the air were not usually degeneration, the transverse strias being dimi- dangerous and that antiseptic washiu* and irri nished and the ultimate fibres containing little gatiou of wounds might be dispensed 'with if the drops of oil. No affection of the spinal cord operator and his assistants could be trusted to was discovered." In the face of this definite avoid the introduction into the wound of septic result of post-mortem inquiry, my conjectures defilement from other than atmospheric sources naturally fall to the ground ; but I confess I do not understand how a fatty degeneration of the If this could be aocomplished Lister thought muscles of the lower extremities could, per se, that, perhaps, his early dream could be fulfilled paralyse a man in some 10 to 15 days and cause and that as in subcutaneous wounds so a wound such symptoms as loss of sexual desire and made under antiseptic precautions might forthwith be closed completely with the liu?of union power. perhaps sealed hermetically with some antisan I have instituted experiments on pigeons with tic varnish. If the application of an antiseptic" a view to clearing up the following points : to cut surfaces could be discarded and the spouses 1. Whether the healthy or diseased seed be wrung out in a liquid that is aseptic but unirritating, such as j ^ sublimate lotion, perfrom the affected village contains the poison. haps such an ideal might be attained 2. Whether seed brought from a different Iu this direction there had been ste'ady move part of the district is equally poisonous, 3. Whether subjecting the grain to great ment. The spray had been got rid of Th heat drives off the " volatile liquid alkaloid," less irritating sublimate had been substituted for and so renders the grain a harmless article of carbolic acid. Less drainage was required on account of diminished irritation. Still there was diet. a limit to this progress. As a dressing f o r