12-6 SELECTION FIIOM THE 11ECOIIDS OF THE MEDICAL COLLEGE LCI.

Hence resulted the secondary abscess in the leg, which was not as usual bounded by a .definite wall, but extended itself among the surrounding- tissues, causing- them to slough, till it came in contact with the posterior .libial artery, which then also became in a sloughing slate, and at last burst.

H'xTTf
'REPORT ON A SPECIES OF PALSY PREVALENT IN PERGUNNAH KHYRAGHUR, IN ZILLAH, ALLAHABAD PROM THE USE OF LATIIYP,US SATIYUS OR KESSAREE DAL.. AS AN ARTICLE OF FOOD;
BY JAMES IRVING, M. D..

CIVIL SUP.GI-GX or ALLAHAB.UI.

!.:< a R.eport-- dated 30th March 1S57, I drew attention to the prevalence of what I considered to be a- species ot Palsy that prevailed in liarra, Perg-unnah oi' the Allahabad District, and winch was supposed to be caused by the people livingon Ivessaree Dal, a vetch known to botanists as LathyTiis sativus. Tiie ]M-esent Report refers to the same disease as it appears in Ivhyratrhnr, a Pero-unna-h of Alialuibad situated on the other side of the Tons river, adjoining Barm. On the 2-1-th January - oi' this yea,r, I joined the camp of Mr. Court at Kntka., on the banks of the Tons, and the same day we marched to Mejnh, where the Tehseeklaree of Khyrairbur is situated. Hitherto, we had passed throug-h a tine country, with rich soil and bearing- abundant crops. At Mejah. on enqnirinir for cases of Gutteea., which is the name applied by the natives, to this kind of Palsy,I was told thai there were a few examples ; but the only one brought to me was a case of the ordinary Palsy. Leaving" Mejah next morning, we passed over a low rana-e of rocky hills and came to Koraon. On the march, we observed much
* The present Report was recently presented to the Government of iheKonh WeslPrnvinees, and if here reprinted bv permission of the Honorable the Lieutenant Governor.

128

DU. TRYING ON A FORM OF

PA1ULYSIS OF THE LOWEIt EXTREMITIES.

129

black mar] soil,, and found Kessaree Dul growing in profusion. The ground, m many places round Koraon, is swampy ; tanks abound, and the water of these, the people drink. On the surface of the soil, m man)' places, tn efflorescence of nitre was noticed. The following morning, we came to Lurreearee. The soil, as before, was of dark marl: Kessaree was plentiful as a, crop, and cripples were noticed in most of the villaa'es we passed. . In proceeding next day, a distance of six miles, to Keeree, we traversed a poorer looking part of the country than we had hitherto done. The soil,.as before, was marly, and there seemed to be hardly an)" other crop at this season, than the poisonous vetch. In many places there were large tracts of uncultivated land covered with low jungle bushes. We observed ma.ny cripples. Next day, we crossed the. Tons and, in doing so, entered Perg-unnah Barra. Bad as the soil of Khyratrhur had gradually become, as we were approaching- Barr;1.. the change for the worse was very evident on emering- the latter Pergunnah. The black marl soil crumbled in ibe band, and the around was everywhere split into dee]:) iissnres, -and large hollows, as if so much of the subjacent soil had sunk down from the action of water. Cultivation was carried on to a trifling- extent, "bur. the crops seemed seantr and consisted chiefly of Kessa-ree Dal. "We passed no village of any size. On the 30th of January, we arrived at Barva. Ou the road thither, we passed many ruined and deserted villages, and observed the usual black, ci.v era.s-ked suiithe eounrrv abounding in tanks, kessaree, and iame villagers. 2\:ext ci;iy we proceeded to Kurma in Pergvinnah Araii and found tiiu sod and crops steadily improving as we advanced ; and we saw so panuyties. The crops were not. as in Barra at this season, confined almost exclusively to kessaree a.nd <j-rnm, but- were varied bv a plentiful admixture of barley and wheat. Such is a sketch of the extent of my marches in Khyrarrhur and Barra during the nine days that I was out in crimp with j S J r. Court iii the past cold season. The appearance of the soil alone was sufficient to indicate what crops one might expect, and if" it- were, of dark marl, one mi^ht be equally certain that kessaree or as it is otherwise called Chupiooa Muiiu-r, would, at this season, be the prevailin"' crop ; and that when one found this soil .a.nd this crop, one might look with a certainty of finding men crippled in their legs, in the surrounding villages, or in their neighbourhood. The people of Khyrag-bur and Barra, appear to drink tank water. These tanks are ver\'

numerous all over this part of the country ; so numerous, indeed, thai they cannot be intended for holding drinking water only, but are probably intended to drain particular pieces of land, and also for purposes .of irrigation in the hot weather. W ells appear to be comparatively rare, and, in such as existed, the water was found close to the surfacethat is to say within eight or nine feet of it. In some parts of the country that we passed through, there is a stratum of stone, a short distance beneath the soil which would render well-sinking, difficult and expensive; but this cannot -be the only reason- that wells are so scarce, for, in places where there is no substratum of stone and where the water is close to the surface, we only met with tanks. From what has been said, of the soil and water oi" Khyragbur, it may be inferred that, in the rainy season, the country must be almost entirely covered with water; and this I believe is the case. The Kbureef crop in the portions of Rkyraghnr in which paralytics are found, consists of Cotton, which is produced in considerable quantity; Koodoo is also largely cultiva.ted ; while J awar, and Bujra are produced in comparatively small quantities. The principal crop, at tins season, is a coarse, but very productive kind of rice called Sal/iee. The R.ubbee crop consists of Wheat and Barley in small quantity. They do DOT. come to perfection. In all parts of Kyrachur and Barra m which I have seen these grains trrowmo-on the marl soil, they seemed to be stinted in the growth of the stalkthe heads were unproductiveand the grains were dark colored, and small in size. As Rubee crops we have also Gram, Linseed, Arhur Da], and lastly, and chiefly Kessaree Dal. In my former Report it was stated, that Kessaree formed the principal food of the people of Barra for A great part of the year being the. cheapest-; that it required little or no cultivationno labour or trouble to produce it; and that it grows on damp, swampy soil that would bear no other crops. The. ground merely requires to be lightly ploughed once, and the seed is then thrown in, when it speedily germinates, and comes to perfection wit.bout farther interference on the part of the cultivator. Mr. Court, in the letter which forwarded my former Report to Government, has stated that Kessaree grows in all seasons, varying in luxuriousness of growth only according, to the season, aud a.n"ordin- the only certain provision of ln'e in Barra. .All this applies with equal force m the case of those part- oi' Khyrachur in which cases of Paraplegia occur.

ISO

DR. TOVTSG OK A

PAlLiLTSIE OP THE XffWEE EXTREMITIES.

331

When out in the District every opportunity was taken to enquire into the amount of lameness in 'the various villages, and to ascertain from those affected, the history of their cases, as well as the prevalent notions of the people generally, as to the nature of a malady which disables so many, otherwise healthy men. The following Table, compiled from returns, which Mr. Court very kindly directed the Teh seel da.r to draw out, exhibits the extent to which Palsy prevails in Kbyragkur. TABLE.
C

if'

, -;

TALOOKAH.
c~

Chowrassee Barokhur Kohra-r Dyah Mara Ivhurkee .... Total

C760 9194 10120 15722 207SP 8215 7OSO0

31 ' 0-43 140 , ]-5S 100 . 1-07 251 i 1-59 102 i 0-4S 250 \ 3-04 SS9 ; 1-25
:

The disease is thus much less prevalent than in Barra., in which Pergunnah out of a population of 56,64-0 as <nven by the Teh seel dar in January of this year, 2,22-1 were paralvze'd .or 3-92 per cent. The table a.bove shows clearly too that all the Talookahs of Khyraghur do not suffer in equal proportions : and, in fact, it would be found, that cases of Palsy in particular places are in exact, proportion to the quantity of Kessa-ree Dul cultivated. My impression, from what I saw. is that, in -the Table, the amount of Palsy in Khyraghur, is

understated.

At Jvoraon I spoke witli some forty or fifty cripples who had been assembled there from all the surrounding1 villages. many of them called their complaint Rheumatism, and appeared to imagine thai- it was occasioned by a- noxious wind {k'hral kawa) that Wows in the rains. Others spoke, of deleterious properties of the water during the rains, as the cause, or at all events, a cause of the affection. Every one who has spoken to natives about the on arm or cause of any obscure disease, knows how prominent are the parts, that bad wind and bad water play. By means of them and of heat, {gv.rmtc) they appear to account for all manner of diseases. Others spoke of their feeding on Kessa.ree as the ca.use of their Palsy. Their ideas were not at aJi clear as t.o the agency -of bad wind, bad water, and Kessaree Dal respectively, in producing- the disease m a.ny case ; nor could I discover whether they considered that bad wind, or bad water alone, would give rise to palsy m one. who did not use the poisonous crrain. One man said one thing, and another the reverse. Here as at Barra, many spoke of the suddenness of their seizure : and several said how thev had been working in the fields during1 the rains, when thev all at once felt pain in the loins, as if rheumatism had seized them. An old man asserted, and many others told me the same thineviz.. thai the disease is onlv produced ;.n particular years : the theory beincr that u is onlv in those years.. tha.T the " kbra.b ha.\va''; prevails. There won Id appear, however, to lie no foundation for fins statement ; for of the cripples I examined at Koraon, the year that they stated they had become lairsc, was too various, to ad mil of the idea alluded to beinc true. The following are given as examples of the cases seen at Koraon. 1, Dussortalee, Churnar. aged 35 inhabitant of Furrureea : has been lame five months. He was working in a rice kait during last rainy season; and had sa.t down, when suddenly lie found that he. was unable to raise himself. He fe.lt no actual pain at the time, but now his kaees and loins, ache when he rises from a sitting position to the erect posture. He used to eat. and still eats kessaree. 2. Jowhair, kocmbee a^-ed 50, an inhabitant of Chokun<lee village, has been lame for three years. He was working 3n the fields, durine- the rains where he became lame. He had no fever or other illness, before lie became so. This all the paralytics that 1 have examined, assert likewise, lie used. he eat kessaree. and still does so.

132

DU. IRVING-OK A FORM

or

lURAl/YSlS OF TUX LOVEf. EXTREMITIES. T..AJ3UE.

133

3. Em am Bux, Mussulman aged 40, inhabitant of Ivornon. states, that he was labouring in the field during the rains, about three years ago when he became lame, all of a sudden, and has so remained. He used to live on kessaree, and still does so. 4. Shewnundiin, aged 10 years, has been lame since last rains. He was herding cattle m the rains, when he became so. He too, has always lived-on kessaree. 5. Biron Lall, Brahmin, aged 60, has been lame for two years. He has always lived principally on kessaree. and still does so. This man stated that since he became paralysed, lie has felt pain hi the loixis, but no where else. These short- histories correspond exactly with those given in my previous Report. The characteristics of the affection appear to bethe generally sudden seizure of the patient; the time of seizure, the rainy season ; the absence of any accompanying fever or other acute disease ; the absence of pain except in the knees and-loinsand that, only when they attempt to walk. The affected do not appear to fall oil' much, if at ail, in condition in consequence of the disease ; nor, so far as I could judge, did the legs fall away, as one would have expected. There seems to be no blunting of sensation. I pinched equally hard an arm, and an affected leg of the same personin- many different instances : but all said that they felt as much in the leg as in the arm. Biron Lall, whose case is given above, as well as several others, have told me that they feel cold from the loins downwards more acutely now than they did before they became lame. Others complained of a tingling sensation in the legs. A peculiarity of the disease is thai it affects men. more commonly than women. Thus, it appears, from ;\ liet.nrn kindly furnished me by Mr. Court that.m Barra. at. the bc-Q-inninn1 of this vear, of a population of 33,951 Males,2.US7 are paralyzed or ( H I per cent.: -while of 22.C5-S Females, onlv 134 or 0"59 per cent, are a-iiected. According to tins li.etnrn, the total population of Barra m January was 50,64-'.'), of whom 2.221 were paralyzed or 3'92 per' cent.* The same fact is apparent in the following Return from Ivhyragliur.

P(MTLAIIOS.
TALOOEAH. ! Males. Femaics.! Toial.
i

PAHALTXI os.

R I T I O r El: CENT or 1' ULv LYTICS TC Pu-

i -i
j

i.

Chowrussie Bnrokliur Kolirar

3533 3S55 6171 8973

3227 5339 4-949 G749 10123 . 4117

i C76O

26

31 10-73 Cr]5 0-43

j 91S4- 139 110120 107 il57

i
!

-.'. 1-1-0 13-GO 10-13 VIS. 2 109 12.00 :0-04- 1-07

1 '59

Mara
Kiluri

100 CO

1-207 89

93 | 4' 107

4085

! S215 239 i l l : 250 :5-S3 10-20 3-01

l

"'^

3G29P

2504-

J70S00 S-i2 i-12 SSi j-2-3 JO-IS ;-25

Mr.-C. B. Tliornliill was good enough to obtain for ixie a return of the paralytics in Chowkee Burgah, Perg-unna.li Mow. Zillah Banda. From tliis ,it ajipears that there arc: m tins part Qn that district.- 2964 men. of whom 109 or 6 71 are paralyzed : and tliat of 2502 women 11, or only 0'4-3 are affected. Oi' this complaint I have found various traces in other parts of India, ' besides those given in mv former Report. In the pan of Pergunnah Rurehnnnah of the Allahabad district, winch joins on to Barra and possesses the same soil we have a few cases."'7 1 had hoped to give some interesting details, regarding the prevalence of Palsy in oilier parts of Banda. But after waiting a long time for a translation of .papers ordered for me through Messrs Tliornliill and M.avne, 1 found them so evidently erroneous, that I do no! produce
" There is not. R fa-ace of the disease to be found indirrenous. in any other p.-m. of the Allahahad District. Mr. Conn, made Ail! enquiries oil tii!.- suuieci.. and found it unknown in the Jjcw.h. or across i.iie Gam.ro=. Several 'i'ehs.-eluars said. t,hat they had seen cases, bui t-hat f-hev were iiiHons.- men. w-hu Lad conic iioiii Ban-;:. Jiliyraijiiur or Banda.

: : '- In a I\el-\ii'ii triveii in my nrsi Tiepnrt.. tin: Population of Barra in 1S57. v.-as staled In hc-'jUales. 32.82" Fnuale't 30,003. Total 6o.-i'J0. Ali'ected with Palsy 2028 or ii'10 nor cent.

13-1-

UnrT>vG

ON A FOltM

OF

PARi.LTSTS OF THE LOWER EXTREMITIES.

135

them here. For example, in a vernacular ta.ble which was furnished by a native official, there was a column in which to insert the usual food of the various villages. This was almost, invariably stated to be Wheat, Barley. Ba.jra. Kodoo : and Kessa.ree was ven r seldom mentioned under the name of Peas ; although it was shown, m another column that Paralytics were common. Thinking this very strange, and suspecting that the whole of the Return, was a mere effort of imagination on the part of the official in question. I wrote to Peearee Mohun Bannerjee, Deputy Collector of Ba.nda, on the subject, and found as .1 anticipated I should do, that " t h e Dal of K.essaree is extensively xrown in the Pern-uriahs affected bv the disease, but the people call it by the name of Chotee Mutiur." He adds " i t is much used by the poor man, and grows abundantly in the hilly tracts of the Pertrunahs Cbeeboo and Tirohan." The disease would appear to prevail in the Mirzapore district also. But. I have failed to obtain any information regarding it, through officials, although 1 tried to do so.* Captain F. Chapman of the Allahabad Military Police who has lived in the interior of that district, told me that."cases of Paralysis .from Kessaree Dill in the Mirzapore District are few, but I have never seen a case, in which the slightest doubt was expressed as to its use having been the cause. Women, however, are never to my knowledge affected, only the males." He also states, that in the .Mirzapore District, the vetch is named " Karou: Dul.'! The same kind of Palsy is also said to prevail in the neighbourhood of Pa.tna a,nd G-ya-h. Dr. Allen the Civil Surgeon of the latter station informs me. thai '"'it is verv common m the villages of the district." He-had not seen the. disease himself, but was told by one of his Native Doctors, that " a ir,an sleeping near Kessaree Dal, which lias been cut and collected in a heap m the' time of harvest, rna.y become affected with Palsy in consequence.'" Tins is probably an oriental delusion, but it shows, that the. natives of thru, part of India are aware of some connection, between palsy, and kessaree as a, cause thereof.
* Since this was written. I have received a valuable communication from Mr. C. B. Dennison, Collector' of Mirzapore, showing tha; liit disease prevails to a j;rea.t extent in v.liai district. ] ' hope soon io uiaki". known the information above alluded u>.

I have been informed, that the sepoy part ol' the Army, which accompanied General Elphmstone^ in the first expedition to Cabuk sufferea much in consequence of-eating Kessaree Dal. They welJ knew the- deleterious effects produced by its constant use, but. as tbev were often reduced to a pound of

term is probably indicated the same symptoms as are observed in Khyraohur and Barra. I have asked several intelligent and educated Baboos as to the. existence of the disease in Bengal, but as far as 1 can learn, it is not known. Kessaree Dal is found extensively in Bengal but it is not employed as food to the almost total exclusion of all other grams, as in Barra and" Khyrao-hux. Itseems to be very generally eaten by way of a change as it is also in the Punjab. There is a disease m the horse known in Ben<ral and other parts of India., which affects the spine in the loins, and appears to be of a paralytic nature. A horse so afi'ected is said to be " gone in the loins." Now, it seems by no means improbable, as suggested by a writer in the hiigluii'irum Newspaper, m speaking of the disease among the natives of Barra, that this affection in trie horse is similar, and that it is produced m the same way, namely, by the horse feeding on gram largely adulterated with Kessaree Dal. ] do not know the appearance of the -ram usually sold in Bena'al. but there is hardlv a sample of it to be procured in mainparts of the North W est Provinces, which does not. exhibit a considerable admixture of Kessaree. As to the-nature of this affection, I believe it to be paralytic. Others, however, have thousrht that it wa; of the nature of rheumatism. Assistant Surgeon Abbott, of Rewah, who has seen cases of the disease, informs me, that he inclines to this opinion, which is also not uncommon among the natives. The examination of a few bodies after death, mii;'ht probably enable one to give better reasons than can a"i present be assigned, for maintaining either one side or the other. Hitherto, however, I have failed to obta.m any cases for dissection. There can be no doubt, that if what has been stated, above on the authority of affected natives, as to the historv of the disease, is true, there are circumstances that would appear at first sight, to point to rheumatism as the essential part of the disease. For exampleit is g-enerally. if not always, contracted in the rainy season; and ao-ain men

srs or who are more exposed to damp and other causes of rheumatism, are much more liable to the disease than women who are less exposed. This, however, does not bear investigation. We have fche rains over the whole country, and men equally exposed to their influence every where, but the affection is not, universalbeing confined to certain parts, in which the Kessaree Dal is cultivated. There are. besides, other arguments, against the supposition that the affection is rheumatic. ]f it, were so, we misrht expect to find other parts occasionally affected, and not invariably the lower extremities only. -Again the only uneasiness complained ofit does not amount to painis in"the loins as one would expect in palsy of the lower limbs. But what seems to me to be the strongest, argument in favour of the lameness of Khyrag'hur and Barra- being of a paralytic, and not of a rheumatic nature is, that a similar affection lias long been known in various parts of .Europe, as well as in India, to result from the use of Kessaree Dal, as well as of some other members of the Natural Order of Plants to which the Kessaree belongsviz.. the Fabiacece. In these cases, the disease has been regarded as paralytic. The affection, m fact, simply seems to be, an instance of what is termed chronic poisoningthat is to say, injurious effects produced by fre- ' quently repeated doses of a poison. Other substances, m frequently repeated small doses, produce palsy. Of this we have familiar instances in the case of Mercury and Lead ; although m the latter instances the affection is more curableas these poisons admit of elimination. As to the treatment of palsy produced by the use of Kessaree, I have nothing satisfactory to add. Five cases were recently under treatment in the Government Dispensary, and to a certain extent improved on being well led, but- when remedies were administered, they took fright and all left. Situated as the people of Khyraghur and Barra are at present, if any were cured in Allahabad, and were sent bade to their homes, they would again be exposed to the action of the exciting- cause of their malady, as they would be compelled to live on Kessaree, and would again, in all probability, become affected. The form of Paraplegia to which I have drawn attention, is one of great interest. As yet, our information regarding it, is meagre, although the subject seems well worthy of farther and fuller investigation, with a view of mitigating the evil. I t is indeed remarkable, that thousands of people, who know that a particular grain may render them lame, yet continue

TFE

EXTREMITIES

137

i-o use it as food. Is this-because they must either eat the poison or starve? Will, no other gram grow a.nd be productive m the affected parts of KhyraH'bur and Barra., except Kessaree? If not at presentwill drainage or other means not render the soil capable of bearing other and less deleterious crops? Are there no means, in fact, of inducing the people to give up the use of the poisonous food? These are practical questions well worthv of solution.