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V T I960] LATHYRISM : RUD RA.& KANT 415j ; ..: . . " A graphical picture of lathyrism cases indifferent age groups is.s ho w n'in figure IV ' :

is

IS 20 25 Jo $3 40 45" 50 55 60

Statistical analysis oj the observationsEstim ated variance 7.03, standa rd deviation2.65. !Sampling variance0.053. standard error

0 . 2 3 . . '

T A B L E IAge distribution of 133. lathyrism cases

-, ' ' Age grp up 0-5 5-10 10-15 .1 5-2 0 20-25 25-30 30^35 "35-40 . 40-45 "45-50 50-55 55 -6 0'' ' * ; Nu m be r . . 4 25 . 12 16 19 24 7 11 . 8 . 2 " . . 1 4

i P e r c e n t . . 3.0 18.8 9-0 12.0 14.3 1S.0 5'.3 8.3 6.0 1.5 0.S '". 3.0

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416 T H E I N D I A N M E D I C A L G A Z E T T E [S:'Er ror , of random sampling0.025.. It is surprising to note that the largest numberof incidence occurs in the very voung age groupof 5 to 10 ye ars (18.8 per cent)" T h at the nexthighest incidence (18.0 per cent) is in the agegroup of 25 to 30 years is not surprising becauseapparently healthy young persons are easilyand readily affected. I t is also noticed ' th atthe number of cases among the older age groups45 to 60 are much fewer. I t is surprising th ateven a. pa rtia lly breast-fed child of 2 years onlywas found affected. It s m othe r also ' sufferedfrom t he same disability. T he significance ofthi s obser vation has been discussed later. Sixtywas found to be the maximum declared age ofthe examined persons. Th is does not necessarilymean th at older persons are immune. Certainlyit cannot be expected that illiterate andignorant people would or could keep a correct

cou nt of the ir respectiA'e ages. Th ree score isindeed a very high and serviceable figure to themand might represent any age of 60 or higher.Sex distribution. In tab les I.I and II I thedis trib utio n of the cases by sex is given. Itwill be seen that 18 of the cases, i.e. 13.5 per centof them , were women. Th is observation is inagreement with the reports of earlier observersthat females were usually found to be lessaffected. W heth er females are actua lly lesssusceptible to lat hyr ism -or this observed lower

rate of incidence is due to the natural shynessof Indian women to come forward for examina-tion ca nnot be settled at, the m ome nt.T A B L E . I I

Distribution of 133 lathyrism cases by sexSex N um ber Per cent REMARKS

MaleFemale

115IS

S6.5 Distribution indifferent.13.5 age group.In table I I I .

com mu nity is more susceptible -to thealthough we are inclined to think, afteci^ing all the known . facts ab ou t ; ia thy ri iMusl ims, as meat-eaters , would be-mbrSl .But taking into account the fact that the!usually occurs among the people in.tnejfincome group of the society, it is not.surfth at the. ra te of incidence is a fair in de x!propo rtional distrib ution of the two.; eduin the popula tion. It is also import""remember that the Hindus (including Bra_of this locality are usually fish and meat!TABLE IV ^

Distribution by religion of 133 lathyri&rr&iReligion Num ber Per cent E.EMAB

Hindus

Muslims

102 76.7

23.3

Proportional?tribution -Wfair indexfcommunity!ia. pqpulatio

Rate of incidence to overall population total population of the villages frompatients had collected at the examination cjis estimated at about 14,000. Even ifassumed th a t all person.? suffering from lath;had gathered, though this contingency >happens, the percentage of lathyrismbecomes nea rly 1.0. On the assumption^only a half of the cases assembled, the rajincidence comes to about 2 per cent,indeed a very disturbing and distressingRemembering the fact that most of the exa:and affected perso ns (80 per cent) wereattacks of the year and that lathyrism mipractically total disabili ty (as far as man-is concerned), an incidence of 1 or 2 pereach year represents a loss of man-powerwill be continually on the upgrade a s n ofrom lathyrism has been discovered yet.c e n | |w h pInde

TAB LE I I IAge distribution of 18 female lathyrism cases

Age groupNumber . .Per cent ..

0-500.0

5-106

33.3

10-156

33.3

15-2000.0

20-2500.0

25-30 30-351 35.6 16.7

It is interesting to note that not one casebetwe en the ages 15 and 25 was found. One ofthe explanations may be the unwillingness of theyoung married girls to come for examination.Distribution by religion.From table IV wesee that out of 133 affected persons 102 wereHindus and 31 Muslims. This gives a per-centage ratio of 76.7 to 23.3 respectively whichis in close agreement with the proportional dis-tribution of the two communities in the popula-tion. There is thus no evidence that either

35-4000.0

40-452

U .I

45-50 50-550 ' 00.0 0.0

o3o o 3

Buchanan found as many as 13 per cent ofvillages affected with epidemic spastic paralyswhich is not surprising and which can be expect*in other affected villages if a census is tak en . , |Discussion

Lathyrism is clinically diagnosed byspastici'ty in the lower limbs, exaggeratereflexes, ankle clonus and BabinskrsIncontinence of urine and impotence are u;not in evidence although these symptoms

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LATHYRISM. : RUDRA & KANT 417in some cases. The disease iE- i ' ^ e d l y of nu t r i tiona l o r ig in and i s;- a s~~% ' tt before,.essentially an economic one.ieories about the aetiology of lathyrismeen advanced but none are entirely sa-tis-or convincing.

, ' t t f fo(1922) , Anderson et'al. (1925)", Dilling4801 Geiser et al. (1933), Jimenez Diaz" A . |(1943)~ Howard et al: (1923) , McCarr ison-rf i t rishnaii (1934) , M ellanby (1930), Ru draf l lfo at tach arya (1946) , Shah (1939), Stock-Jji 'f ' (1934) , Stockman and Johnston (1933) ,Gtt (19 30) , 'Tra land and M oh arra m (1932) an drj&uj r, (1927) ha ve all ad va nc ed hy pot hes esSir. [ing the aetiology or refuted those of .others."jfaTiin A deficiency can produce nervousgp sration but so can vitamins B t and Eicfii >ncies. In fac t, Ei nh ar so n and Rin gst ed5V d escribed mo tor nerve degeneratio n from1 5 !iicy of vi ta m in E . T he deg ene ratio n oflip,' :entral nervous- system by vitam in B1cl" ;ncy and its cure bj ' vitamin B t alone iso* * ill kno w n as to need no reference here .lbach has therefore cautioned against theafieptance of Mellanby's \utamin A deficiencyslbry, asnot only can deficiencies of vitamins A.jfe.E an d of other- vitam ins b ut su ndry otherjauses also may bring about the degeneration.texample, Zimmerman and Burack (1934)rved nervous lesions in animals given

jfeicient vitamin A but deficient in the black""ague factor (hicotin ic acid ). Th e inves tiga-ihs of Profes sor Jim enez D iaz et al. (loc. tit.)ye focused the importance of animal foods. _ : t h e - die t for preventing la thyr ism . Bh atta - efiarya working in the laboratory of RudraJBplated an albuminose-like substance from the\esari grains but i t is unfor tunate that thevestigation could not be purs ued further owing\\ itf iits sudden termination.' ^?^ i n o w agreed that lathj 'r ism can be and is, -produced by t he exclusive or pred om ina nt use of^ khesari in the di et Th is fact does not excludef. the possibility of other grains producing th eI flisease. Stockman (loc. cit.) claims that it can1 f>5 prod uced by oth er pulses a nd even cereals.II ^siger ep^tt. (loc. cit.) repor ted that la thyr ismten induced in the white rat by feeding^2t \ : 'pea (Lathyrus odoratus). Recently,^ewis et al.. (1948). hav e produced experimentalp p^ j in ra t s by feeding them swee t pea and.- lertain species of La th yr us peas other th anLathyrus sativus. Minchin (1940) reported casesv , ' i i - the Madras Genera l Hospi ta l which he con-

:r-" eluded were lathyrism "but doubted if these'infected persons had had any hhesari in their"diets, .as this pea is usu ally no t grown in the. area,,-from which the patients, came.\ -On. inte rrog atio n a l l . th e. affected persons^eta m ined replied th at the y h ad. been subsis t ing.* on : Jchesari for some tim e p ast. ' I t should be~ remem'bered that when these people start taking'kii s pea, they, hav e exhau sted:.their stock of all- other grains an d. the y consume practically only

this sub stan ce. "They either cook .the peas -liker ice or make. them into chapatii-s with the .peameal and eat the rice or chapattis : with ' dalmade from the sam e gra in. '" Th ere " is ' ' .usual lynone of other foods tuffs.. Mo re than" 80 "per-cent of the exam ined an d affected p erson s :wererecent and fresh cases of from' fifteen days.vtothree mo nths ' dur a t ion . I t is evident that 'm ostof the chronic cases had stayed at "home althoughwe ha d one or two of ab ou t ten ye ars ' duration.::Minchin {loc. cit.) quoting Basu et al. (1937)thinks it may be due to tryptophane deficiency.But Basu et al. have given ho.data or proof thatkhesari. is deficient or how mu ch deficient .int ryp tophane . S tockman {loc. cit.) thinks."thatlathyrism is caused by the toxic action of phyticacid and possibly other substances. JimenezDiaz et al. (loc. cit.) repor ts that the khesari

lacks in some v itam in-lik e substance which, ispresent in foods of ani m al origin. Th is observa-tion fits in very well with the results of.investiga-tions now being conducted in the senior 'author 'slabo ratory. I t has been found (Rudra andChowdhury. 1950). that- khesari is. very -poor-inmethionine content, having only about a quarterof the methionine content of most other dais.It is very probable that the methioninedeficiency with other multiple deficiencies presentis really the aet-iological factor of lathyrism.

In the absence of .adequate m ethio nine ' in ' thediet a dis tu rb an ce ' in the c reatine metabolismmay follow which may result in the degenerationof the nervous system specially-of the pyramidaltrac t . The exper iments of Bodian a nd M ello rs(1947) in experimental neurone regeneration isinteres ting in this respe ct. T he possibility ofsome toxic substance abetting the action ofmethionine deficiency is not altogether excluded.We have already mentioned that a child of 2years and practically breast-fed was also affected

with lathyrism. The pertinent question thenar is es : Is . the toxic principle transm itted-fromthe mother to the child if the disease is of toxicorigin ? T hi s is ve ry m uch .unlikely. ..Fo rexample, we cannot visualize the phytic acidtaken by the mother being transm it ted to . thechild thro ug h the m ilk. On the other hand," ifthe disease is actually a deficiency one likemethionine deficiency, the child's illness canV-beexplain ed. Since th e m oth er's diet was Iv.erypoor in.m ethi on ine content, her milk, would.alsobe poor in m eth ion ine and , althou gh' the childwas taking milk, it was continually beingdeprived of this essential amino acid.W e. ha ve - also o bserved th a t fewer femalecases ar e "usually lo.und." A re females "less "sus-ceptible ? W e canno t settle this question-hereand now. B ut if a distu rban ce in the creatinem etab olis m is, th e rea l .cause o'f lathyrisrn,we will not be surprised if females areactua lly found more res istan t to ' the . disease

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418 THE INDIAN MEDICAL .GAZETTE [ S E EMcCarr ison and Kr ishnan {loc; cit.) found nofemale cases in the Gilgit agency. It is probablethat his investigation was not exhaustive.

Cr uic ksh ank (1947) described a similarspastic syndrome among European prisoners ofwar in the military camp at Singapore occurringfirst in Septem ber 1942. Th is mo st probab lyhappened on account of the very poor diet ofthe prisoners lacking in calories, proteins, fats,minerals and vi tam ins. Trea tme nt with good,nutritious and balanced diet and adequatevitaminizat ion gradually al tered the pat ients 'conditions but ' ther e w as no tota l cure as. inlathy rism . Jac oby (1947) reports that inBhopal lathyrism usually occurs during or afterthe rainy season and once the disease hasaffected,, the con dition of the patie nt continuesto deteriorate even if the diet consists of50 per cent of wh eat . He further suggests th atthe disease may be due to fungus growth on theLathyrus grains because of bad storage conditionduring the rainy season.

SuggestionsThe best t reatment that we can recommendfrom our pre sen t know ledge, .is an all-roundimp rovem ent in diet rath er th an medication. Weappreciate that this is rather a tall order andextremely difficult of realization in the present

economic st ate and food s up ply . position of theco un try . Ja co by (1946),,. .we th ink , was first inintroducing prostigmin in the treatment ofl a t h y r i s m . .- . - .::. v : _.-. :_-.'..':.'...

W ith a :. generous gif t: from -'the m anu factu rers,the'Roche firm, one of \is- (M'"N. R:}-rwith H. C.G h o s h , had- the.. . opp ortu nity , of . testing theefficacy of this dru g in' lathy rism .; -We mustconfess that in our experience .prostigmirf. doesnot promise to be & remedy for lathyrism.There have been some improvements in somecases, no doubt, and in our opinion it can beused for relieving.some of the signs and symp-toms. The biochemistry of , lathyrism is nowbeing inve stigate d in the lab ora tor y of one ofus (M, N . R . ) . . :We must also emphasize the role that theplant geneticist has to play in this connection.An alternative crop must be evolved which willbe as hardy and cheap as khesari and still havea nutritive value equal to that of the best ofour pulses.We offer our best thanks to Lieufc.-Colonel H. J.Curran, I.M.S., lately Principal and Superintendent,Darbhanga Medical College and Hospital, for his keeninterest in this investigation.

REFER ENCE S . . . .ACTON, H rW ;. (1922) ... Indian Me d., Gaz.,.G7,\2il.ANDERSON, ' .L. A... P., . Indian J. Med. Res., 12,613.HOWARD, . A., andS I M O N S E N , J . L . (1925).BASU, K. .P. , NA TH, Ibid., 24. 1027.M. -C, GH AN I, M. 0. , and MU KHER JEE, R .(1937).

;BASU, K. -P. , ' NA TH, Indian J .Med. Rei1 M . C , a n d M U K H E R - - .."'1 J E E , R . ( 19 3 7) . . . . ' :%.

BODIAN, D., and MELLORS,.R . C. (1947).C B U I C K S H A N K , E. K.(1947).DILLING, W. J. (1920) . .GEIGER, B. J.. STEENBOCK.H., and PARSONS, H. T .(1933).HOWARD, A., SIMONSE N, '

J L.. and ANDERSON. I. A- P- (1923).JACOBY, H . (1946)' Hem; (1947)- . .J IME NE Z DIAZ , C ORTIZ. DE LANDAZXTRI. E., .and

RODA.. E . (1943).| L E W I S . H. B. . F A J A K S .R. S., ESTERER, M. B. .SHE N. CHAO-AVE N, and.OLIPHANT, M . (1948)..! MCCARRISON, R.. and| K E I S H N A N . B. G.(1934).. '. .

MELLANBT, E . (1930)' . .M I N C H I N . R. L. H .(1940).

IjRuDii1., M. N.. andf BHATTACHAHYA. K. P .(1946).RODRA, M. N.. andC H O W D H U B V . L. M.j (1950).

I SHAH, S. R. A. (1939).! } S T O C K M A N , R . (1934) . .

J STOCKMAN, R.. and J O H N -' STON, J . M. (1933).

STOTT.. H . (1930)TRALAND. J.. and MOHAR-RAM (1932).YouNfi, T. C. M. (1927).Z I M M E R M A N . L., andBTJRACK, E . (1934).

J. Biol. Chem,,'rProc. Nutrition'SiJ. Pharm. and Expt14, 359./ . Nutrition, 6, 42

" lIndian J. Med. ResIndian Med. Gaz., Ibid:,an d 122.Sev. Clhi. Espanola

J. Nutrition, 38, 53Indian J. Med. Res..Brit. Med. J., i, 677.Ibid., i, 253;Lancet, i, 68S. '''

Proc. o7Lli Indiar.Congress, part. 111,-n -A.Indian Med. Gaz., -74

J. Hyg., 3 4 , 1 4 4 ' . Ibid., 3 3 , 204. 'Indian I: Mod. Res.,]'--Rev. Med. France, 1.3.Indian J. Med. Res-, '1J/ . Expcr. Med., 59,"V2

THE RISK OF POLLUTION OF GROjLW A T E R FR O M B O R E H O L E L A T R I N

By K. SUBRAHMANYAN ; ^an d -i t

T. R. BHASKARAN -0(All-India Institute oj Hygien e an d Public .BeCalcutta) !;