3. In vitro digestibility experiments showed that the digestibility of tapioca proteins was not inferior to that of rice protein.

. . . 4. The chief defect of tapioca as a source of protein appears to lie in its low total protein content rather than in the quality of the protein present. 5. The^digestibility of the carbohydrates of tapioca by two enzymes has been studied and found to be 48'3 per cent in raw state and 77-9 per cent after cooking. The starch is digested to a greater extent by taka diastase than by pancreatic amylase.
REFERENCES.
AYKROYD, W. E., and KEISHSTAN, B. G. (1939)

Ind. Jour. Med.'Res., 33, 2, October, 1945.

AN OUTBREAK OF LATHYRISM IN CENTRAL INDIA.

K. L. SHOUBIB, M.B., ir.sc. (Nutrition Research Laboratories, Coonoor, South India.)
[Received for publication, July 24, 1945.]

BAS0, K. P., and MUKHEBJEE, S. (1936)

BEAZELL, J . II., SCHMIDT, C. E-, and I V Y , A. C.

Ind. Jour. Med. Res., 27, p. 139. Ibid., . 23, p. 777. Jour. Nutr., 17, p. 77. Biochem. Jour., 29, p. 209. Jour. Biol. Chem., 94, p . 013. Jour. Nutr., 2, p. 91.

(1939).
BHAOVAT, K., and SEEENIVASAYA, M. (1935) CALVEEY, H. 0 . (1931) CABMAN, J . S., SMITH, H. G-, HAVENS, G. C , MITRTIN, J. E. (1930). FOLIN 0 . , and MABENZI, A. D. (1929) and

Jour. Biol. Chem., 8 3 , p. 89. Ibid., 8 3 , p. 103. Chinese Jour. Phi/siol., 9, p. 141. Jour. Biol. Chem., 42, p. 27. Ibid., 52, p . 251. .Idem (1922) ' Chemistry of flesh foods and their MCCASCE, R. A., and Smpp, H. L. (1933) losses on cooking ', M. R. C. Report, No. 187. ; Biochem. Jour., 36, p. 662. NEUBEEOER, A., and SANOEE, F . (1942) RAYMOND, W. D., JOJO, W., and NICODEMTJS, Z. East Afr. Agric. Jour., January, p. 1. (1941). ' Comptes Rendus Du Dixieme ConEOSEDALE, J . L. (1939). "... . .... gres ' {Far Eastern Association of Tropical Medicine), p. 489. 'Chemistry of food and nutrition', SHEBMAN, H. C. (1942) ... . ... 1942 ed. Ind. Jour. Med. Res., 25, p. 847. SWAMTNATHAN, M. (1938) . . . .:. Geneeskund. Tijdschr. Nederland VAN V E E N , A. G. (1938) . . . ' Indies. 7 8 , p. 254S. Jour. Biol. Chem., 8 6 , p. 217. . WEBER, C. J . (1930) WILLSTATTER, R., WALDSCHVMIDT-LEITZ, E., and Jour. Physiol. CT!em.,12S, p. 143. Idem (1929a)
KAO, H. C , ADOLPH, W. H., and Lro, H. C. (1935) LANGWOBTHY, C. F., and DEVEL, H. J., J R . (1920) HESSE, A. R. F . (1923).

LATHYRISM is an ancient disease. According to Chopra (1935) ' in the old Hindu literature, Bhavaprokasa. it is written that " the triputa pulse " causes a man to become lame and crippled and it irritates the nerves '. Hippocrates observed that the prolonged use of certain peas as food was liable to cause paralysis. In the seventeenth and eighteenth centuries outbreaks of disease which were ascribed to the eating of lathyms occurred in France, Germany, Italy and Algiers. The first account of lathyrism was written by a layman, General Sleeman, over 100 years ago. Sleeman (1844) encountered a.n outbreak in a number of villages near Saugor in the Central Provinces in 1834-36 and described it in his ' Rambles and Recollections of an Indian Official', published in 1844. His account, which is clear and vivid and could scarcely be bettered to-day, may with advantage be quoted in full:
' I n 1829 the wheat and other spring crops in Saugor and surrounding villages were destroyed by severe hailstorms and rains and in 1831 they were destroyed by blight. During these three years the " teori " or what in other parts of India is called " kesari " {Lathyrus sativus), a kind of wild vetch which, though not sown itself, is left carelessly to grow among the wheat and other grains and given in the green and dry state t o cattle, remained uninjured and thrived with great luxuriance. I n 1S31 they reaped a rich crop of it from the blighted wheat fields and subsisted upon its grain during that and the following years, giving the stalks and leaves only to their cattle. In 1S33 the sad effects of this food began t o manifest themselves. The younger part of the population of this and the surrounding villages, from t h e age of thirty downwards, began to be deprived of the use of their limbs below the waist by paralytic strokes, in ail cases sudden, but in some cases more severe than others. About half the youth of this village of both sexes became affected during the year 1S33-34 and many of them have lost the use of their lower limbs entirety and are unable t o move. The youth of the surrounding villages in which the " t e o r i " from the same causes formed the chief article of diet during the years 1831-32 have suffered to an equal degree. Since the year 1834 no new case has occurred but no person once attacked had been found to recover the use of limbs affected and my tent was surrounded by great numbers of the youth, in different stages of the disease, imploring my advice and assistance under the dreadful visitation. Some of them were very fine young men of good caste and respectable families and all stated t h a t their pains and infirmities were confined entirelv t o the part below the waist. Thev described the attack as coming on suddenly, often while the person "was asleep, and without any warning symptoms whatever and stated., that a greater portion of young men were attacked than of the young women. I t is the prevailing opinion of the natives throughout the country t h a t both horses and bullocks, which have been much fed upon " t e o r i " , are liable to lose, tho use of their limbs, but if the poisonous quantities abound more in grain than the stalk or leaves, a- man who eats nothing but the grain must be more liable to suffer from the use of the food than beasts, which eat it merely'as they eat grass or hay.'

( 238

In more recent times lathyrism has occurred in India in epidemic form in the Central Provinces (Buchanan, -1904), in Rewa. Central India- Agency (Acton, 1922 ; McCombie Youne. 1927). in Gilsifc (McCarrison. 1926; Mackenzie, 1927), in the Um'te'd Provinces (Stott",. 1930) and in the Punjab (Shah.. 1939). Megaw and Gupta (1927) concluded from information supplied by civil surgeons in response to a questionnaire that the disease is mainly confined to a belt which runs across the Central Provinces, the east of the United Provinces and the north of Bihar. It also occurs in certain restricted areas in the Punjab and the United Provinces outside this belt. Lathyrism appears to be unknown in South India. Minchin (1940) reported a series of cases of spastic paralysis of the lower limbs in the Madras General, Hospital which he considered to be clinically indistinguishable from lathyrism, but there was no evidence that lathyrus seeds, had formed part of the diet of the patients. > . The epidemic described in this paper occurred in Bhopal State in Central India in 194445. At the Fifth All-India Food Conference held in Delhi at the end of January 1945, an official of that state consulted Dr. W. R. Aykroyd, Director of Nutrition Research, then serving on the Famine Inquiry Commission, about an outbreak of disease which the people affected ascribed to the consumption of a certain kind of pulse. The account given obviously suggested lathyrism. A few days later the author was sent to Bhopal to investigate the outbreak. ( 239 )

?-

I
e)

~_

"Z.

_ THE"BACKCROUND OF*"THE "EPIDEMIC

Z^:
J

~ P_P i f the_ conclusions reached in the investigation is that lathyrism, as its name implies, " T t " \ _isdue to eating lathyrus There have been other theories of origin which will be referred ~ -i~"L ^"-jojater ^A^j^egards^he_immediate_cause _of the disease, nothing has been discove ed -i. >i~4 ~ which does not conform to the observations of Sleeman and the classical conception of ^j ^& >. setiologv An attempt has, however, been made to studv the social, economic and agricultural ~^^g^ ** background of the outbreakto discover, in fact uhy the victims of the disease were forced to 1 1, ,* . ",^.felv on lathyrus as their staple food .Accordingly, before the clinical features of the epidemic?^ * are described, an account will be given of the environment in which it occurred /^ _Bhopal State which has an area of 6 902 square miles and a population (1941) of ~j"* 785,000, is divided for administrative purposes into two districts, eastern and western I t ~* ""V"L. * was m the eastern district that lathyrism made its appearance. This district is ab upland ^ t* area, partially covered with forests, about 1,000 to 1,500 feet above sea-level, and less fertile II" * ^1" than the western district The population is mainly Hindu. Malaria is prevalent and the spleen rate is high '. _ '| ; Except m Bhopal City and certain smaller towns, the entire population is engaged in agriculture and lives on food produced in the area. There.are three types of worker in ^ the villages " ---7-'. ,' .'- . :"'Vj - 1 . '." (a) t land ownmg cultivators"
.' - J (6) sub-tenants of the above ,

the country. -Howard a n d ' K h a n .(1928) described in detail the Indian types* of lathyis alnui. It is an important crop in the eastern district o r Bhopal for the following reasons ' , . .;-. .':.'. i .'.....:' . . . . 1. It is used,as a fodder crop._ . _.__... ' . . " . . 2. It gives a good yield" with minimum labour. I t is a hardy plant and thrives well in unfavourable circumstances. ' .' . ' ~ ~ . ' .3. It is a stand-by to the cultivator should there be a failure of wheat supplies ]f wheat is in short supply ' teora ' grains are consumed in greater quantities - Vegetables are grown in only a.few villages and on a very limited scale. Vegetable sellers called ' kachhis ' may come once or twice a month to sell vegetables to those who can afford them. The following vegetables are grown in the district: Spinach Onion Brinjal Cucumber Bitter gourd Carrots Tomatoes Radish ' , -

:.'~~ ' " .

..

. ."' ..
'>.<, .::-

"Hi
"*

- w , . r . - : . > . . . < : - ; - - > : v.-- -. .

- - ;V. -.-, v

t_^-

_ (c) labourersthese do various kinds,,of work' as "well as cultivation. , Labourers J""^ are usually paid in kind and "very rarely in cash. . " . There are no modern means of ; irrigation! I n bad seasons, rust, blight, hailstorms, excess of ram, etc , may lead t o dariger'of scarcity anil food shortage. The diet change ^'f to some extent with the season, following the succession of harvests. .. -""" The principal food crops and seasons of sowing and harvesting are as follows :
Crop. Time of sowing. Time of harvesting.

t-^

Bengal gram leaves ... These are eaten frequently. ' Rajgra ' leaves . .' ...1 These are wild plants, taken occasionally but not .' Bathua ' leaves . . . . / relished by the villagers. Fruits.There are very few fruit gardens in the districts and the poor rural community cannot afford to buy imported fruits. 'Mangoes, papaya, ' ber ' (plumsZizyphvs jo,nba) ' mohwa ' and ' achar ' are consumed to some small extent -in the district. ' Milk and milk products.Milk is obtained both from cows and buffaloes. The cattle are small and degenerate though grazing , grounds, are abundant in the area. The average cow in the'area yields' about 1 lb. to 1J lb. of milk per day. and an average buffalo 3 ID to 5 lb. In Table I the population of human beings and the number of milch cattle in two villages in the area are shown : . . .
TABLE I. . . '' ''; -

."*,'

NVime of v
Rice Maize ' Jowar ' Sawan ' Kodon (Sor hum vul are) (Pamcum frumantnceum) (Paspalum toloniferum) October June October December Birpur Uuiarkhoe

Population.

Number of

Number of

040 431

110
Vi2

Black gr m (Phaseolus mungo)

%

Red gram (Cajanvs tndicus) Wheat

vie *,J* j. -=-^

October-November
^
anetinum)

March

\l~jf*. f ,."**
e>

*" * v Barley (Hordeum vulgare)

r^ B e n g a l g r a m (Gtcer

October February March

P f p - * " * Jl

^3,%^^-s %,

^ * ^T

^ l e o r a ' (Latfarus sattvus) ^

~~

- 5 ^ i~w.y, . . is known* as '.teo*ra ' or ' teon ' in this part of India Vanousname m v '""^cludingV matra {, ' matri',' ' batra ', ' khes>ari', ' garash ', etc , are used in other parts of
'-$;*^ \ ' \ ~
s

' -

- ' * (

240')

'

- . v *j

Even the small quantity of available milk is not usually consumed by those who 1 etjr cattle. The milk is converted into curds and the milk fat is remover]. The ahee is sold ind the buttermilk is consumed. . Meat and eggs.Tradition . and taboo prevent the eating of these foeds. The tie i t majority of the population is Hindu and does not take'.meat at, all. while the few Mohammedans take meat very rarelv. " 1 Sugar.Little sugarcane is grown in this area and the consumption of sugar is almost * % negligible. The preparation and cooking of food.The whole grains, (both cereals and pulses) are ground into flour (' atta ') and this flour is usually made into ' chapatties '. Whole or coarseH crushed pulses'are boiled with water and consumed as porridge ' after the addition of s a l t ' and condiments. " ", " . ,,' " Conditions prevailing in the area at the time of the outbreak of lathyrism .During the last* 2 to 3 years, crops < specially wheat, in this arei have been damaged by rust, blight hailstorms, etc The hardy teora', however," thrived While wheat forms the staple*diet of the* population, the poor-mix cheaper grains with wheat Failure of the wheat crop had t h e ' . J, ME - ,;-*( 241* ) - - f - -6 - \"

tfiJ ,.

'

result that the poor consumed cheaper grains in increasing quantity. The prices of food grains have risen to 2 to 3 times the pre-war level. In Table II the market rates of differant food graina for the period 1939 to 1945 are shown :
TABLE II.

Market rates at which different food grains were available, in the period from 1939 . to 1945 (per 5 maunds).
Name of foodstuff. 1039.
1940.

The disease is not a mysterious unfamiliar malady to the inhabitants of this area. Every year, or every second or third year., a few persons contract it. Villagers are familiar with it .and know that it is associated with famine and ppverty, and that it is not an infectious disease. It may be added that the present outbreak of lathyrism was not confined to Bhopal State. There were reports of cases occurring in adjacent areas outside the state boundaries. Age.The villagers cannot give their age with any degree of exactness. Table III shows approximately the incidence of the disease by age groups:
TABLE Ace trroup. years. ' III. T, , Percentage.

1941.

1942.

1043.

1944.

1945.

Rs.

Its.
](i

Rs.

Rs. 20 13 IS

Rs.

Rs. 30 20
;>;

Rs 30 20 25 25

Number of eases.

"Wheat 'Teora' ...

12 S 10 12 8

n >
12 14 10 13

24 to 30
20 25 25

12 14 IS 12

4-10 11-20 21-30 31-40 41-50 51-60

13 19 21 11 7 1

1S-0 2S-4 29-1 15'2 o-i 1-3

Bengal gram Lentil ' B a t l a ' * ...

20 '
15

25 20

20

20

* ' Batla ' is a pulse whioh resembles a pea. Its consumption is being encouraged as an alternative to ' teora '.

In 1944 the state authorities introduced the rationing of wheat into the urban areas. To meet the demand of the towns the cultivators were asked to give on payment certain quantities of wheat- per acre sown. In areas where the wheat, crop was poor, the cultivator was left with limited supplies of wheat. The position of agricultural labourers was also - afieoted for the following reasons : (a) The labourers are paid in kind. Cultivators did not have enough wheat and the labourers were given ' teora ' (Lathyrvs sativus) instead of wheat. (b) The landowning cultivators found a ready excuse for refusing demands for wheat on the part of their employees by saying that practically all their wheat had been taken by the state and that nothing was left. The net result of the crop failure and the procurement operations waa that the poorer section of community was reduced to living almost entirely on ' teora '. Visits to houses in villages at the time of preparing meals confirmed the above statement. It was found that poor villagers generally consumed ' chapatties ' made of ' teora '. In some cases ' teora ' was mixed with Bengal gram, barley or wheat. State of nutrition.One hundred children in a villager -were: examined for the incidence of clinical signs of deficiency diseases. The results obtained are as follows : Number of children showing phrynoderma7 per cent. ., ,, Bitot's spotsNil. . angular stomatitis2 per cent. :, Practically all the children showed discoloration of the conjunctivas. The general impression gained from this survey was that the state of nutrition was very similar to that of village children in many other parts of the country. This is a point of importance, since suggestions have been made that vitamin deficiency plays a part in the causation of lathyrism.
THE OUTBREAK.

Buchanan (loc. cit.}, McCombie Young (loc. cit.) and Shah (loc. cit.) all observed that the majority of cases were in the age groups 11-20 and 21-30. This agrees with the observed age incidence in the present investigation. Season.Table IV gives the number of cases and the percentage of cases occurring in different months :
TABLE IV. Number of cases.

Month of onset.

Percentage.

January February March April May Tune ... ... 1

.'0

1-5

July ... August ... September October November December

11 23 22 9 1

Preliminary inquiries revealed that at least 1,200 oases had occurred in the district. Fifteen villagea in three tahsils in which a high incidence was reported were visited and about 150 people showing evidence of the disease were examined. A full history of 75. cases of recent onset during the second half of 1944 or early in 1945 was obtained. It was felt that cases ocourring earlier might not be able to recollect details about the onset of the disease and attention 'was focused on more recent cases. ( 242 )

15'9 33-9 31-S 13-0

1-5

TOTAL

69

243 )

-a I

The above figures show that most of the cases occurred in the' months of August.. .September and October, the highest number being in the month of September. Shah (lot--, cit.) recorded that most of his" cases occurred in August and McCombie Young (loc. pit.) observed a peak in October. It is during or just after the rainy season that the paralysis of lathyrism tends to appear. Sex incidence.The percentage of cases occurring in the population of two villages and the sex incidence are shown in Table V :
TABLE- V. Number of persons suffering from iathvrism.

(b) Gait.In mild cases there was only a little berdirg cf the trees ard patients felt difficulty only on running or on goiiig downhill. In n.ore seveie cases tie patients waited with bent knees, the knees being approximated and the feet more widely separated than normal. In this stage the heels leave the ground earlier than the toes and there is some swaying of the hips. In more advanced cases the ' scissors ' gait (crossing of the legs on walking) developed, with a tendency on the part of the patient to walk on the toes and swaying of the hips was more marked. Such patients required the use of one or two sticks, according to the severity of the paralysis. Very severely affected patients were reduced to crawling in a sitting position. In all the above stages instability was increased by running, jumping, crossing a small drain, going down a hill, etc. There was a frequent tendency on the part of patients to fall down. (c) Musculature.There was no marked change in the appearance of the muscles of the lower extremities. Muscular tone was, in most cases, in excess of normal. Spasm of the calf and thigh muscles occurred on slight exertion or in the absence of exertion in some cases. No case complained of any weakness in the upper extremities. ((/) Reflexes.In 63 cases the- epigastric and abdominal reflexes were exaggerated. The plantar reflex was extensor in type in those in which it could be elicited. The knee-jerks were exaggerated in all cases. Ankle-clonus was present in 62 cases. The sphincters of the rectum and the bladder were unaffected. (e) Sensation was normal in all cases. There was no change in the functioning of the cranial nerves. Speech, sight, smell, hearing, etc., were normal. Mental symptoms and psychological disturbances were not observed. It is apparent that the paralysis of lathyrism is an upper motor neuron lesion. Presumably the pyramidal tracts are involved. No post-mortem histological examination of the spinal cord in cases of lathyrism appears to be on record in the literature.
^ETIOLOGY.

of vi]!ae.

Total population.

Number of persons.

Percentage.

Birpur

I
I

J1

513 427.

Uumrkkoh

207

i-u

The above shows that males suffer more than females. Out of the 69 persons suffering from the disease in these villages, only 9 were females. This is in conformity with the findings of the earlier workers previously referred to. Economic status.The victims of lathyrisrn belonged to the poorest section of the community, usually labourers in villages owning no land. Out of the 73 persons afflicted whose history was taken only i were cultivators owning some small parcel of land, and there was one ' Bania ' (grocer). The others were all labourers. ' Chamars ' (shoe-makers) contributed the largest number of victims.
Incidence of signs of diet-deficiency diseases .All the cases were examined for clinical

signs of dietary-deficiency diseases. None showed angular stomatitis. There were 3 cases of phrynoderma among" the 73 cases. A history of night-blindness was given by 2 cases. The general impression'was gained that the affected persons were not badly nourished. [ , Clinical findings, (a) Onset.In all the patients examined, no premonitory symptoms such as an attack of nausea, vomiting after meals, or diarrhoea, were complained of. McCarrison (1926) noted that constipation tended to occur in his cases, but this was not a prominent feature in the present series. Of the 73 persons examined, only 10 gave a history of mild or severe constipation. Inquiries revealed that 15 cases suffered, previous to the onset of the disease, from fever which was most probably malaria. .In 33 patients the onset of the disease was sudden. Some gave a history of sleeping normally and awakening with stiffness of the muscles and partial loss of control of the lower limbs. Others fell down while working (ploughing, etc.), and found themselves unable to get up and walk back to their houses. ' In the remaining 40 cases the onset of the disease was slower. In one case the patient did not know that he was a sufferer until others pointed it out to him after seeing him walking with bent knees. A few days later he found himself paralysed. In cases in which the "onset was slow the patients first suffered from backache and stiffness of the lower extremities with some difficulty in dorsiflexion of the knees. Severer signs and symptoms followed slowly. Some patients reported that in the early stages contraction of the muscles of the calves had occurred. A ' lump would form ' in the morning when the patient was getting out of bed. These ' lumps ' of contracted muscles would prevent the straightening of the lower extremities. The patients would massage these out and for the rest of the day could walk without much difficulty. Then slowly severer symptoms would set in. ( 244 )

Villagers in the area affected by the outbreak and the victims of the disease have no doubt that the paralysis is caused by consuming lathyrus seeds in large quantities for several months. This is the traditional view of the cause of the disease : hence, in fact, its name. The observations of Sleeman have already been quoted. A number of those who have studied the disease in India (Buchanan, loc. cit. ; McCarrison, 1928 : McCombie Young, loc. cit., and others) have adopted the traditional standpoint. Anderson, Howard and Simonsen (1925) and Shah (loc. cit.). however, consider that another pulse, Vicia saliva, may be the cause of the disease. The feeding of Lathyrus sativus or Vicia sativa to rats by McCarrison (1928) and to ponies by Stott (he. cit.) did not result in the production of lathyrism or of any lesions of the nervous system. During the present investigation it was found that those who developed lathyrism had usually consumed Lathyrus sativus in large quantities for six months or more! It was impossible to obtain exact information about the proportion of Lathyrus mtivvs in their diet. It appears, however, that it formed the great bulk of the diet. The victims of the disease were mostly labourers, and were paid in kind. They ate what they could get, and this was mainly lathyras seeds. It was said by the villagers that those who mixed Lathyrvs sativvs grains with equal amounts of wheat did not contract lathyrism. Anderson et al. (loc. cit.) stated that samples of ' khesari dhal' or lathyrus obtained from localities in India in which outbreaks of; lathyrism had occurred were contaminated with the vetch Vicia sativa, popularly known as akta '. They reported that ' akta ' was poisonous to ducks and monkeys whereas lathyrus was not. The toxic signs produced in these species by the feeding of diets containing ' akta ' did not, however, closely resemble human lathyrism. In the present inquiry the question whether the lathyrus seeds which were being consumed in the affected district were contaminated with ' a k t a ' was investigated. A pure san sample of 'Vicia sativa was obtained from Dr. B. P. Pal f the Imperial Agricultural Research Institute, New Delhi, and was shown to stockists villages and towns, and to intelligent cultivators ( .245 )

in various villages. In not a single case did they recognize the Vicia sativa seeds and all were sure that such seeds were not to be found in Lathyrus salivas stocks. About 50 samples of Lathyrus sativus were collected from various "families and in various villages. Some of those were from stocks actually consumed by people who developed lathyrisni. Careful examination of these samples in the Imperial Agricultural Research Institute, New Delhi., failed to reveal the presence of Vicia saliva seeds. At three places about 200 lb. of Lathyrus sativus were sifted through a sieve with a mesh smaller than normal Lathyrus sativus grain. A search was made in the sieved material for ' akta' seeds, which are smaller than lathyrus seeds. No ' akta ' could, however, be sieved out in this way. It was thought.that ' akta ' seeds, being lighter and smaller than Lathyrus sativus seeds, might be separated with the chaff in the process of winnowing. A sample was taken from the latest crop in the field which was ready for separation. The husk was carefully removed. The resultant seeds were examined for ' akta ' seeds but" none could be found. This shows that Lathyrus sativus stocks were not contaminated witli Vicia saliva. Mellanby (1934) has put forward the theory that ' lathyrism is due to an active neurotoxin in the food whose detrimental effects can be prevented by protective foods containing vitamin A and carotene, such as milk, eggs and green vegetables, even when much of the toxic agent "in the lathyrus peas is consumed. I t may therefore be classed among the deficiency diseases'. McConibie Young (he. dt.) was also of the opinion that vitamin A deficiency was concerned in causation. Lesions of the nervous system have, however, been more frequently observed in experimental animals as a result of deficiency of various members of the vitamin B2 group than as a result of deficiency of vitamin A. The present investigation has not thrown any further light on the problem,whether ;lack of vitamins is associated with a toxic factor in producing the paralysis. Lathyrism is a famine disease and the circumstances which lead to an increased intake of-lathyrus will at the same time lead to a decreased .intake o f other foods, including protective foods. None of the facts revealed is incompatible with Mellanby's hypothesis, but in view of the low incidence of vitamin deficiency states in the affected area, the author is of the opinion that lathyrisni should be regarded as a disease due to a toxin of unknown nature rather than as a deficiency disease. Until, however, lathyrism has been satisfactorily reproduced in experimental animals, the question as to what part vitamin deficiency may" play in causation cannot be finally answered. The higher incidence of the disease amongst men than women can probably be explained by the greater intake of lathyrus on the part of the former. During the rainy season and just after, agricultural labourers work hard at ploughing and other agricultural operations. Their calorie requirements are correspondingly increased and when only lathyrus is available to fulfil these they eat it in large quantities.
TREATMENT AND PREVENTION.

Procurement operations to supply wheat to towns under rationing schemes should not be allowed to deprive rural areas, in which lathyrus is a stand-by, o f excessive amounts of wheat.
' SUMMARY.

1. An outbreak of lathyrism in Central India has been investigated. This was associated with the consumption of Lathyrus sativus in large quantities for a period of six months or more. Some 1,200 cases occurred in the district. Of these, 150 were seen, and full notes of 73 cases were taken. 2. Villagers in the area in question and patients who contracted the disease' realized that it was due to the consumption of this pulse. They also realized that it is not an infectious disease and understood its association with poverty. 3. The chief sufferers from lathyrism were young adult males belonging to the poorest classes. September and October were the months of greatest prevalence. i. Clinically the disease manifests itself as a spastic paralysis of the lower limbs. The sphincters of the bladder and the rectum are not affected. No mental or sensory disturbances were observed. . 5. No Vicia sativa seeds were found in the stocks of lathyrus seeds consumed in the villages in which the outbreak occurred. The investigation points to the existence in Lathyrus sativus of a toxin affecting the pyramidal tracts. 6. Preventive measures are discussed.
ACKNOWLEDGMENTS.

Grateful thanks are due to Sir Colin Garbett, K.C.I.E., C.S.I.. C.M.C, Revenue Minister, Bhopal State, and to Lieut.-Colonel M. L. R. Siddiqui, F.R.C.S., Chief Medical Officer, Bhopal State, for assistance in the investigation.
REFERENCES. ... Ind. Med. (laz., 57, p. 241.
A., and SIMONSZS, Ind. Jour. Med. Ees., 12, p. 613.

ACTON, H. W. (1922)

A2IDEBS0S, L. A. P., HOWABD, J. L. (1925).

BUCHANAN (1904) CHOPSA, R. N. (1935)

HOWAKD, A., and KHAN, A. K. (19i-'S) MCCARRISON, K. (1920)

Idem

(1928)

MACKENZIE, L. H. L. (1927) MCCOMBIE YOUNO, T. C. (1927) MEOA-W, J. W. D., and GUPTA, J . C. (1927) MELLANBY, E. (1834) MINCHIN, R. L. H. (1D40) SHAH, S. K. A. (1939) SLEBHAN, W. H. (1S44) ...

As far as at present known, the nervous lesions are permanent and the disease, incurable. No social study has been made of the fate of the victims of lathyrism ; many no 'doubt remain in their villages and contribute to the work of the village as far as their crippled state permits ; others swell the ranks of beggars in cities. I t has been stated that many of the paralysed beggars who obstruct the pavements of Calcutta and other large cities are victims of lathyrism. ' Prevention is a social, economic, administrative and agricultural problem. Lathyrus seeds can apparently be safely consumed in small quantities, but when they form the bulk of the diet the disease makes its appearance. The circumstances in which this tends to occur, have been described in this paper. Satisfactory preventive measures include encouraging the production of suitable alternative crops to lathyrus, the improvement of the economic status of agricultural labourers., and the importation of other foods such as wheat into endemic areas when an outbreak threatens. A watch should be kept by public health authorities for the . appearance of the disease in such areas in Central India and elsewhere in the country.
( .246 )

STOTT, H. (11)30)

Nuypiir Civil Administration Report. ' The British encyclopedia of medical practice', Lond., 7, p. 651. Memoirs of the Department of Agriculture in India. 15, p. 31. Intl. Jour. Med. lies., 14, p. 37U. Ibid., 15, p. 707. Ind. Med. Gaz.. 62, p. 201. Ind. Jour. Med. lies., 15, p. 453. Ind. Med. Gaz., 62, p. 299. ' Nutrition and disease.' Oliver it Boyd, Lond. Brit. Med. Jour.. 1, p. 253. Ind. Med. Gaz.. 7<J, p. 385. 1 Rambles and recollection? of an Indian official', 1, Hatcbard and Sons, Lond. Ind. Jour. Mc'l. Urn., 18, p. 51.

247