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Discussion of Results with Reference to Identity or otherwise of the Tico Parasites.

The above inoculation (primary) experiments show a distinct difference between the diseases produced, in animals, by the human and the horse trypanosomes. The horse parasite is the more pathogenic, and after death obvious post-mortem lesions, namely, enlargement of spleen and glands, the latter usally hsemorrhagic, are found. The " disease " caused by the human trypanosome is very chronic, the animal's health does not seam to be affected, and in the only deaths which hav?. occurred in animals infected with this parasite no macroscopic lesions were perceived. In the early stages of both diseases the continued presence of the parasites in the peripheral blood is far from the rule. This tendency to disappear from the peripheral circulation is much more marked in the human parasite. In the later stages of the horse disease (a week before death) the presence of parasites is constant, and their numbers gradually increase until death takes place. The morphology of the two parasites presents, so far, no characteristic differences. There are, it is true, a few minor points in winch they differ, but before anything definite can be said a careful study of stained specimens will be necessary. From a consideration of the above facts it is impossible to decide whether the parasites found originally in horse and man are the same or different. The one clear distinction we can draw at present is the marked dissimilarity of the disease produced by inoculation in lower animals.
Transmitters of the Diseases.

to the Congo to publish as far as possible a complete account of the animal experiments up to date, and to give a description of about six species of trypanosomes found in frogs, birds, tortoise, and mice.

LATHYRISM.
By Major A. G. HENDLEY, I.M.S.

Here, unfortunately, we have to disappoint you as much as we ourselves have been disappointed, by saying that our results are negative. We tried many times in vain to transfer both parasites by biting flies to healthy rats from either naturally-infected horses or artificially-inoculated animals. Two species offlies,Stomoxys and Glossina were used. If the method of transmission of this disease were, as is maintained, simply a mere mechanical transference of parasites from one animal to another by means of the insect's proboscis, we think we should have obtained some results in our experiments. Perhaps, however, it may be'that the parasite cannot live for even a few hours in the insect's proboscis during the dry season owing to the excessive lack of moisture in the atmosphere. At McCarthy Island, where some of our experiments were undertaken, there was a daily difference of from 15 to 20 between the wet and the dry thermometer bulbs. Mr. Hewby, a travelling commissioner in Northern Nigeria, has told us of an observation, based on a very careful study, which seems to be interesting in this connection. He noticed that his ponies after passing through a certain bit of bush in the wet season often became ill and died of fly disease. Ponies sent through the same bush in the dry season, however, escaped, although the flies, which he says are the same as the Glossinae, which we showed to him, were always present in great numbers. We should have liked to have given you our results in a more detailed way, but it is impossible, as our notes are not yet completely arranged or our animal experiments completed or fully worked out. We hope before we return

THE best definition of this affection is Scheube's, which not only sums up in a few words pievalent opinions as to its causation, but at once recalls the nature of a too narrowly-known disease of importance. He says : " Lathyrism is a disease of the nature of an intoxication with a spastic spinal paralytic course, which is attributable to poisoning with various^ kinds of the family of Papilionace lathyrus (chick-pea or common pulse). Dr. Watts, in his " Dictionary of the Economic Products of India," says : " Lathyrus, a genus of annual or perennial plant of the natural order Leguminosa;, which comprises some 170 species, seven of which are natives of India." The specimens I have here are of the commonest cultivated Indian variety, Lathyrus sativus, known in different parts of India under various vernacular names, as hhesdri dull, tera, lkh, or lkhri. To quote Dr. Watts again : " Lathyrus sativus (jarosse or gesse) is indigenous from the Southern Caucasus to Northern India ; it has spread as a weed of cultivation from its original home, and is now cultivated all over India." In the Central Provinces some 358,000 acres are under lathyrus cultivation ; and it is in these provinces that the disease has of late years become so increasingly prevalent as to call for Government inquiry, which inquiry has been entrusted to Major Andrew Buchanan, I.M.S., who has for the past six months ox more been devoting his entire attention to this subject. h istory. Lathyrism is no newly-discoveied affection. Its history dates from very early times, being, according to Huber, alluded to in the Hippocratic writings, where mention is made of the fact that " At Ainos those men and women who continually fed on pulse were attacked by a weakness in the legs, which remained permanent." In Don's " System of Gardening," again, it is recorded, in describing Lathyrus sativus, that : " In several parts of the Continent a white pleasant bread is made om the flour of this pulse, but it produced such dreadful effects in the seventeenth century that the use of it was forbidden by an edict of George, Duke of Wurtemberg, in 1G71, which was enforced by two other edicts under his successor Leopold in 1705 and 1714." In Italy and France the disease was also observed during the seventeenth and eighteenth centuries, and in the earlier half of the nineteenth century, large numbers of persons becoming affected in France, British India, and Algiers, attracted apparently some considerable attention. From the years 1857-68, when Dr. James Irvingthen Civil Surgeon of Allahabad contributed five very interesting and exhaustive papers
to the Indian Annals of Medical Science on the subject

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of an epidemic of lathyrism then prevailing in the North-West Provinces, down to 1893, when I described in the Indian Medical Gazette a localised outbreak I had met with in the Central Provinces, the disease seems to have attracted no notice, save at the hands of a few veterinary surgeons, who noted its effects on cattle, and may in consequence be assumed as practically non-existent. The circumstances under which I first made acquaintance with the affection were as follows : Towards the end of July, 1893,1 came across a village where quite suddenly some 10 per cent, of the male population had during the previous five or six weeks (that is, since the commencement of the rainy season) become paralysed, more or less severely, in the lower limbs. At that time I had never heard of such an affection as lathyrism, but careful investigation and inquiry into the circumstances of the outbreak soon convinced me that they owed their condition to poisoning with Lathyrus sativus, a pulse on which all the affected, poor hand-to-mouth labourers had Wgely subsisted for some eighteen months on account of the failure of their more regular crops, in consequence of which the village landlord had paid his labourers in kind with the cheapest gvuin available, namely, Lathyrus salivus. For some years I saw no further case of this disease ; but with years of scarcity, culminating in the terrible famine of 18%-7, the local conditions artificially produced by the village landlord in 1893 became general ; the poorer agricultural labourers were driven to resort extensively to the cheapest foodstuffs procurable (lathyrus), and with most disastrous consequences. In the average village a dozen or more victims would be found, whilst in a famine relief camp of some 4,000 persons it became easy to pick out one or two hundred of such cases. The disease has. in the Central Provinces and adjoining native States, gone on spreading ever since, helped by the second severe famine of 1899-1900 ; until at the present time Major Buchanan writes to me that he has an incomplete census of 2,700 cases in one district and 1,400 cases in another ; and in a recent letter says, " I have seen 190 cases this morning." Symptoms. I will now pass on to a description of the symptoms and mode of onset of the disease. For reasons, given above, it will be seen that only the pooiest classes are liable to this disease ; those who are forced to subsist on the grain unmixed or diluted only slightly with other grain. All the affected will be found to belong to this class. They eat it either ground into flour as bread, cooked as porridge, or boiled with or without oil as lentils, much as we eat haricot beans. Practically all are field labourers, and the wonderful unanimity with which all agree as to the onset of the disease is most striking. A man will say : " I went to sleep perfectly well and very tired after a day's ploughing or other field work in the rain " (it is always in the rainy season) " and awoke in the morning to find my legs stiff, weak, trembling, and very heavy to lift when I rose to walk." (I have never been able to elicit any history of premonitory symptoms.) This weakness and trembling, you will be told, increased so rapidly -that within ten days progression became difficult, evfen with the aid of sticks. Still the patients have no sense of illness and

no pain : they have good appetites, sound digestions and natural sleep at night. Both legs are usually affected simultaneously, first the calves, then the thighs, and soon after this all sexual appetite and power was lost. All complain bitterly of this. On examination of any typical case, of some six weeks' duiation, you will find that the gait is very peculiar. Aided with a long two-handed staff walking is possible, the rate of progression being undei two miles an hour. The body above the hips sways from side to side, whilst the feet, which seem clogged with invisible weights, are lifted with evident difficulty and dragged forward, the toes scratching along or barely clearing the ground. The leg bearing the weight of the body is bent at the knee and trembles, whilst the advancing leg, dragged wearily forward strongly adducted, is planted unsteadily directly in front of its fellow, the toes reaching the ground first. In short, a kind of paralytic goosestep, The general effect is one of laboured unsteadiness, due to great weakness. The evident spasm of the thigh adductors ceases to be very apparent when the patient reclines on his back, when the thighs can be separated, usually without resistance, to a normal extent. There is no wasting, no loss of muscular tone, no true tremors, only tremblings of the entire limbs when weight is put on them. Sensation seems quite unaffected. The tendon reflexes are much exaggerated, both knee jerk v and ankle clonus ; the slightest stimulus starting the latter phenomenon going for a long time. There is no loss of power or undue excitability in bladder or rectum. The arms, trunk, head and neck muscles are unaffected. The mind is clear, speech natural, pupils normal and reacting naturally, to light and accommodation. The urine is often of rather high specific gravity (1030), acid, and contains abundant urates. Such are the symptoms as I have found them. I am aware that some writers state that digestive disturbances, colicky pains, and diarrhoea are usually precursors of the paralytic state ; and that sensory disturbances, such a hypersesthesia, anaesthesia, and formication, with bladder troubles, such as incontinence and retention of urine, are common. I have never met with a case in my experience of many hundreds where the slightest history or evidence of any -such complications could be traced.
Etiology.

As regards the etiology of the disease, it is, I think, generally conceded now that the paralysis is in some way due to lathyTUS poisoning. Other main theories of causation are : (1) That lathyrus eating has nothing to do with it. (2) That if it has, it is only diseased grain which is capable of poisonous effects. (3) That exposure to sun or some local hot wind is the true cause. (4) That the paralysis is due entirely to cold and damp. (5) One eminent authority on tropical medicine (Manson) has thrown out the suggestion that, like alcoholism and probably beriberi, the disease may be due to the entrance into the body of a toxin generate( by germs whose habitat is outside the body. (fi) Lastly, I am quite prepared to hear some charm

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pion of parasitism arise and suggest that some organism, so minute as to have hitherto escaped observation, is really the author of all the mischief. In the time at my disposal I cannot fully discuss these and other theories, and can only say that the occurrence of the disease in epidemic form among lathyrus eaters and among no others, seems to me very strong evidence that a lathyrus diet B primarily responsible. The idea that diseased grain only is injurious i an argument probably borrowed from the analogy of ergotism. I know of no facts to support the idea. That exposure to sun or some local hot wind can be held responsible is at once disproved by the undoubted fact that the disease has occurred (amongst lathyrus eaters) equally disastrously in India, Italy, France, Algiers, and Wthtemberg, countries with vastly dissimilar meteorological conditions. Also, if exposure to cold and wet alone could induce lathyTism, England surely should be full of such cases. As regards Manson's suggestion that the affection, like beriberi, may be a " place disease," one has only to remember that the paralysis is incurable, and that removal from the locality where the person was attacked is in no sense beneficial. As to what the actual poison is, and how it acts, that is a matter still left for our eminent physiologists and chemists to decide. Church has stated the chemical composition of the grain as : Water, 10*1 ; albuminoids, 31*9 ; starch and fibre, 53*9 ; oil, 0*9 ; ash. 3'2 ; and has further observed that " the oil expressed is a powerful and dangerous cathartic." Astier says, " There is present in the grain a volatile liquid alkaloid, probably produced by some proteid ferment, which exhibits the toxic action of the seeds, and the action of which, is destroyed by heat." On this volatility and destruction by heat notion has been based much speculation as to the possible variations in methods of cooking, explaining the capriciousness of the effects of a diet of this grain on different individuals. Scheube says, " Several poisonous alkaloids have been extracted, but further investigations are necessary ; " also, " that by the administration of preparations made from the grain, a disease giving rise to symptoms similar to lathyrism has been produced in animals.51 Professor Dunstan, of the Indian Institute, is now working at this subject. So far his investigations and experiments on animals are inconclusive, but go to show : (1) That only certain samples of lathyrus are poisonous ; (2) there are some reasons to think that poison is contained in the skin or husk of the seed, but no fungus has been discovered ; (3) that poultry are immune, but that rabbits and guinea-pigs are sometimes affected. Professor Dunstan also tells me that in Canada lathyrus is largely grown and freely used as poultry food, so probably birds are immune. My own pigeon feeding experiments in India were all negative, and so support this view. There remain two points of interest in connection with the causation of lathyrism, namely, its marked preference for males and its seasonal incidence, that is, during the rainy season. Dr. Irving found that the proportion of females to males attacked was about one in twelve. Major A. Buchanan, I.M.S., with a recent very large experience, tells me he finds it one in

ten. I personally have only seen three female cases against many hundreds of males. Major Buchanan accepts the comparative immunity of females as an unexplainable fact, but says that the reason for the seasonal incidence of the disease is very simple, namely, that " he finds that the ordinary grain pits or granaries are closed in June, and that lathyrus grain is only issued to labourers in the rains." The difficulty in the way of accepting this explanation is that (1)1 do not believe the custom he alludes to is generalthat of .only eating lathyrus during the rains it certainly was not during the recent famines ; and (2) the fact that according to this idea cases occurring quite early in the rains must have been caused by a very few days' dietary of the poison ; and this is opposed to all my experience of histories given me by patients. I prefer an even simpler solution of both difficulties. As long ago as 1858 Dr. Irving quoted the prevalent opinion amongst intelligent educated natives as being that, " the lameness produced by eating lathyrus was really a mixture of palsy and rheumatism," and added, " they seem to think that living on this particular grain is the predisposing cause, and exposure to cold, rain, and damp weather the exciting cause." I believe the native idea is the coir cet one. I believe that lathyrus, whilst it may possibly cause paralysis by itself, ordinarily only predisposes to it, that it makes the subject ready or ripe for the attack of paralysis, but that exposure to severe wet and cold is requhed actually to excite the sudden seizure. This seems to me to explain the unvarying history of the sudden unexpected attack during the wet season only ; for nearly always the attack occurs after an unusually thorough wetting whilst ploughing, watching crops at night, or other field work that ordinarily falls to man's lot and not to woman's. To their greater protection from severe and prolonged exposure alone, I believe, women owe their comparative, immunity. I have suggested to Major Buchanan that the respective shares which exposmre and a lathyrus dietary have in producing the paralysis might well be tested during the extensive animal-feeding experiments which are to be carried out at the Bombay Eesearch Laboratory.
Morbid Anatomy and Pathology.

Satisfactory observations on the morbid anatomy and pathology of the disease are wanting. From the clinical symptoms one would be justified in assuming it to be a form of lateral sclerosis, but in Watts' " Dictionary " I find a statement that " Cantarri, of Naples, has published a number of cases in which he has carefully observed the condition after death. No affection of the spinal cord was discovered. The muscles of the lower extremities, especially the abductors, were found to have undergone a fatty degeneration, &c." Scheube mentions one published necropsy (where death resulted from malarial cachexia) where " a softening of the spinal cord above the lumbar enlargement was found." AUbutt refers to two examinations of horses which had died of lathyrus poisoning. In these the symptoms were apparently mainly those of cardiac and respiratory oppression, and after death " the mischief was found mainly in the cells of the anterior horns of the

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cord, which were diminished in number and atrophied, Castellani is about to proceed to Ceylon to take up There was also thrombosis of small arteries, which were the duties of Professor of Pathology and Bacteriology also thickened. There was, too, fatty degeneration of in the College of Medicine at Columbo. the heart and intrinsic muscles of thu larynx." From this he suggests that the nerve mischief may be secondary to the vascular lesions, which would suggest a similarity to ergotism. The prognosis of this disease as regards life is favourable. It does not seem to cause m torrent literature. death directly, but the paralysis is incurable. Treatment, I believe, is quite futile. A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in any branch of tropical literature mentioned in these lists
the Editors of the JODBNAL OP TBOPICAL MEDICINE will

be pleased, when possible, to send, on application, the medical journals in which the articles appear.

totes mxh
A SOLUTION of formaldehydeone drachmfcoa pint, applied to the chief seats of perspiration in the body axillae, perineum, or the soles of the feet, will remove the odour of the perspiration.

Malaria.

WE congratulate Mr. J. G. Craggs upon the knighthood that has been bestowed upon him. All interested in tropical medicine have good reason to respect his name and to rejoice at the honour he has received. The London School of Tropical Medicine benefited by his liberality and wise forethought, inasmuch as he placed a travelling scholarship at the disposal of the School authorities, amounting to a sum of no less than .300 yearly for three years. The work done by Dr. C. W. Daniels and Dr. G. C. Low, the successive holders of the scholarship, must have amply repaid the generous donor, for by their investigations several important problems in tropical medicine have been elucidated and our general knowledge advanced. Mr. Craggs' latest encouragement to the study of tropical diseases is the prize he has instituted for original work, so brilliantly gained by Dr. Castellani.

this title Dr. J. L. Porteous (Med. Record, July 25th, 1903) describes a disease, resembling typhoid, but presenting some of the characters of malaria. He states that the blood did not give., Widal's test and concludes therefore that the disease; was not typhoid. The assumption that malaria played: a part in the disease he describes is based solely uponf the benefit ascribed to a few doses of Warburg's tinctures and not to an examination of the blood for malarial: parasites. In the face of such negative evidence itj is impossible to decide the etiology of the so-called\ hybrid malaria.
HYBRID MALARIA.Under

Jkaie of CImrps far gJib-erttsentents.

SPECIAL POSITIONS. Front half page 3 Front quarter page . . .. ' 2 Back page .. . . 5 Page facing first matter 3 Page facing last matter .. ,. . . 3 ORDINARY POSITIONS. Page Half page 2 2 0 150 3 2 0 3 3 0 0 0 0 0

One-third page Quarter page

..

0 17 6 ..0140

THJE CRAGGS' PRIZE.The authorities of the London POST FREE. School of Tropical Medicine have bestowed the Craggs' One year 0 18 0 Six months 0 10 0 Prize for the year 1902-1903 upon Dr. A. Castellani, Single copies .. . . 0 1 0 a former student of the School, for his original work in which may commence at any time, are connection with the investigation of sleeping sickness in Subscriptions, advance. and the important discovery of trypanosomata in the crbro-spinal fluid of persons suffering from that disease. In November, 1902, Castellani first observed to Correspondents. ,,, trypanosomes in the cerebrospinal fluid of sleeping sickness patients, and so persistently did the disease 1.Manuscripts sent in cannot be returned. 2.As our contributors are for the most part resident i and the parasite occur together that he came to the conclusion " that the sleeping sickness is due to the proofs will not be submitted to those dwelling outside the j unless specially desired and arranged for. trypanosome I had found." Castellani's discovery has Kingdom, 3.To ensure accuracy in printing it is specially stimulated investigation in regards to this parasite that all communications should be written clearly. in many directions and in many countries, and the 4.Authors desiring reprints of their communication! authorities of the London School of Tropical Medicine JOUBITAII OP TBOPICAII MEDICINE should communicate ,, are to be congratulated upon the bestowal of the prize Editors. should look for replies under the^hf upon one so deservedly entitled to receive it. Dr. " 5.Correspondents Answers to Correspondents."

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