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300 INDIAN MEDICAL GAZETTE. [SEPT. 1893.( ii i) A certaiu number of men should be car-ried for the sole duty ot cleansing the decks, hit- jr ines, etc. , one of whom might, should the neces-sity arise, be deputed to take charge of the sick-bay or hospital. ( iv) A nativ e apothecary should be carried toaid the surgeon.(v) M ore cubic space than at presen t shouldbe allowed to each pilgrim.These are matters of the f irst importance, andI m igh t me ntion many minor ones. I t would bem uc h be tte r if food were included and charg edfor iu the passage - mon ey. Th is would prev entthe possibili ty of semi-starvation, and be an ac-tu al 3aviug to both owners and pilgrims. Mu chtrouble would be saved in serviug out wood, andcho pping it , meals w ould be uniform, and theuuisauce of the penetrating smoke from the fires

ou deck would be obviated.Is, F ur th er , I do not th ink that pregn ant womenor ve ry y ou ng children should be allowed to un-der take such a jouruey.

LATHYEISM.B y SUHGEON-CAPTAIN A. G. HENDLEY,

Civil Surgeon, Seoni.UNDER the above he ading I ven ture to sendau acc oun t of a sudd en, localised o utb reak of a

pe cu lia r form of para pleg ia, affecting some tenpe r cent, of the male population of a certa in vil-lage iu this distr ict , which outbreak, I think, isclea rly traceable to the use of" teora " or " k h a -sar i dal" {Lathyrus satious) as sole article of diet.When it is considered () how vast an area ofthose, the Cen tral Provinc es , are unde r th isLathyrus cultivation ( the returns of 1887-88 give357,883 acres; Sind coming next with 72,876acres) ; and (b) i ts extrao rdinary cheapness (near-ly a miiuud to the ru p ee ); one can read ily un-de rst an d how disastro us m ight be the effects ofa few ye ar s of scarcity ; in forcing people to re-sort, to.t his grain as a princip al article of diet.The circumstances of the outbreak are as fol-lows:During the past six weeks, or thereabouts,12.m ales of one village have become paralysedmo re or less severely in the lower lim bs ; andone m an also .in the hands and arm s..Some of these men had not been ailing in anyway up to th e: date of the onset of the disease,which was soisudden and progress of which was sora pid th at iu 8 to 10 day s the sufferers could withdiff iculty get about. W ith this paralysis thereis.n o se nse of illness . . N o females, of this v illag eor any persons in any of the neighbouring vill-ag es have been atta ck ed . T he affected villageis situated (as nearly all the villages of this partare) on high groun d, on a r idge between twonullahs , with good, natural draiuage.

I noticed this village in my san itary notes ,some few weeks ago, as being "much cleaner and

bet ter drained than surro und ing ones." Th ewater-supply is from one good, pucca well and ispure . The inhabitants have for the past 18months subsisted almost entirely on teora, thegrain in question . Th is is on acc ount of theirregular food-crops having failed the last twoyears. The better-off inhab itant s eat i t mixedwith wheat, gram, or red masuri dal, whilst thepoorer class subsist on it unm ixed . The se griudit into flour to ma ke bre ad, an d also eat it in theform of dal. All the affected men belong to tinslatter class.

Practically, all the cultivation immediatelyaround this v i l lage is L at hy ru s, w hils t nearneighbouring villages not nearly so large a pro-portion is gro wn , and in none of these villagescould I find people w ho eat it unm ixed. M an yof the villagers know that indulging largely andfor len gthy periods in this g rain is likely to in-duce "weakness of the legs"; and some (am inority ) say cattle are som etimes affected. Afew villagers told me tha t, some 16 yea rs ago,there was a similar outb reak hereabou ts, whentwo or three males from every village wereaffected ; noue of these men, they say, ever re-covered the use of the ir limb s, and ye t they canshew me none living now who were then affected.This is rather a significant fact as shewing aten de nc y to sho rten life, as most of (he men af-fected were, I und erstan d, you ng and strong. A

native theory is that "good kora hurts no man,"and that the present outbreak is due to the facttha t much of the grai n is blacke ned and diseasedby rain. Ce rtain ly, there was a large amoun t ofblackened grain in the samples shewn me in thevillag e; but the blacken ing seemed ouly skin deep ,and on husking it I could discern no differencefrom the healthy grain, which is externally of asilv er-g rey colour faintly stre ak ed with black.Below is a list of the eases seen by me.I have given the history of case No. I, withhis symptom s, & c , in d etail , as his account isclear and typical. Th e cusea are given iu theorder in which they were attacked.CASE N O . I .D asru (Al i i r ), 50 year s, l a -bou rer, states t ha t, some l i mouths ago, Iwoke one morning to find my legs stiff, weakand trem blin g, when I rose up to walk. Th eyfelt very heav y to lift. I was qu ite well upto this time and have had no illness worth men-tioning for years. Th is weakness and tremblingincreased so rapid ly that iu abo ut 10 day s Icould scarcely walk abo ut even with a stick. I

even now feel quite well, have a good appetite,and sleep soundly. Th ere is no actual p nin ,-^only the sense of heaviness aud weariuesa of thelegs, chiefly the calves aud outer thigh muscles.Botli legs were affected simultaneously, first thecalv es, then thighs aud hips. La tel y I have lostall sexu al desire and power. (A ll the adultaaffected co m plain of this.) Sin ce m y legs be-rcam e affected some dozen o th e r, ineu aud boy a

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SEPT- 1893.] HENDLEY ON LATHYRIS1T, SOI: of my village have been similarly attacke d.None of our women folk or men from othervillages are affected.Exam ined, 21st July 1893.la a strong, heal-thy-looking man of 50 years. W alke d in fourmiles from his village with the aid of a stick.His rate of progression is under two miles auhour, and his gait very peculiar. The bodyabove the hips sways from side to side in w alk-ing , while the legs seem to be lifted with diffi-culty and tremble when the weight of the bodyis put on them. The general effect is an im-pression of instability, aud reminds oue of theefforts of a man "d ru nk in the legs " to walkstraight and erect. There is nothing "sp ast ic "about the gait, nor are the legs flaug about asin inco-ordination.

Th ere is- evident muscular weakness of thelower limbs aud hips, but no wasting; and themuscular tone seems normal. No loss of powerover the rectum and bladder. Bowels are regu -lar and natural. There are no true trem ors;the trembling which occurs in walking seems tobe due to the excessive weakness, and there isno lossof " mu scula r sense .' ' Sensation is un-affected. No rigidity or spasms. Th e tendonreflexes are very exaggerated, both "kneejerk"and " an kl e clonus ; " and the slightest stimulusstarts the latter phenomenon going for a longtime. Arms, trunk, head, and neck are un-

"affected. Th e mind is clear, speech na tur al,pupils normal and act both to light aud accom-modation. U rine is : Sp. gr. 1030; acid high-coloured (urates), no albumen or sugar.C A S E N O . II.Jarri (Pardhan), 35 years,labo urer . A precisely similar history and symp-toms identical with No. I.C A S E N O . III.Birju (Baghri), 30years, la-bou rer. Gives a similar history except that inhis case the disease beginning \w his calves,spread to thighs and hips, and then he noticed hishands began to tremble when he grasped any-

thing, and his arms have become very weak thelast few days. This man looks pinched and il l,,bu t beyond the paralysis has no complaint. Hisleg symptoms are very marked, and are the sameas noted for No . I. H is hands tremble whenextende d, and the grasp is very feeb le. Lips alsotremble and face muscles twitch when he is talk-ing. Ne rves of special sense unaffected. L at te r-ly he lias complained of pain in lower doraal audlumbar regions, and also in masseter musclesand around muscles of larynx.\ C A S E No. IV. Ka nha i(M ehra ) , 10 years,labou rer. A healthy boy. Same history audsym ptom s: very marked in legs. Has rather a"spastic" gait, but no tremors, rigidity orspasms.

C A S E N O . V.Umer Lai (Mehra), 8 years,labourer. He althy boy. History and symptomsthe same, but gait is less noticeable.

C A S E N O . VI.Earn Lai (Mehra), 19years, labourer. A big, robust youth. Bothlegs affected, but less than any of. the precedingcases.C A S E N O . VII.Thoonu (Pardhan), 25years, labo urer. Similarly affected but unsym-

metrically, his right leg being more affectedthan the left. Th is gives him a limping gait.C A S E N O . VIII.Khurm Mai (Ahir) , 45years. He althy, strong-lo oking man. Both legsequally affected. Au av era ge case and typical.C A S E N O . IX . Baghchan (Ahir), 20 years,son of No. V I I I . Robust youth. Both legsaffected, principally below knees , so gait is nottypical.C A S E N O . X. Ram Bakhsh (Pardh an), 8years, sou of No. I I . A mild case of only tendays' duration, both legs weak and clearly af-fected.C A S E No XI .P arman (Mehra), 45 years.KS twar of village. Both legs slightly affectedbelow knees, as yet only has weakness aud"w a b b le s" in his gait. O nly affected sinceeight days.I have only been able to induce two of thesemen to remain in hospital, viz., Nos. II and I I I ;treated with good nourishing d ie t; and medicin-ally with Iodide of potassium, belladonna andergot. No. I l l has recovered greatly as to hishands and arms, but otherwise is the same as onadm ission. His condition varies with the weatherbeing much aggravated by continued rainfall.Case N. I I has not benefitted from trea t-ment.The following points naturally now presentthemselves for elucidation, viz :1. In what does the poisonous property ofthe grain consist, aud why should its effects be socapricious, selecting robust males as victimswhilst the decrepit and females seem immune?2. What is the true pathology and morbidanatomy of the disease?In W att's "Dic tiona ry of the Economic P ro-ducts of India," from which work much of thesubsequent information has been derived. Thefollowing is the chemical composition of the grainas determined by C hu rch : "W ate r 10*1, al-buminoids 3l'9> starch aud fibre 53-9, oil 0'9,ash 3 -2," aud it is said that " the oil expressedfrom the seeds is a powerful and dangerouscathartic."Also that " a recent analysis by Astier hasrevealed the presence in the grain of a volatileliquid alkaloid, probably produced by some pro-teid ferment, which exhibits the toxic effects ofthe seeds and the action of which is destroyedby heat."Now if this analysis is to be depended on andthe isolation of the " toxic volatile liquid alka-loid " a settled fact, much of the capriciousnesaof the effects of a diet of this gra in on different

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302 INDIAN MEDICAL "GAZETTE. [SEPT. 1893.individuals is explained by possible variationshi.'the method of cooking it, viz., at high and lowtemperatures.Also, if the alkaloid is a product of proteidfermentation (A stie r), the. native idea that" only the grain blackened ty raiu is poisonous"may be correct, as I take it, this grain would bemore liable to fermentation processes than soundgrain.

Dr. Irvine, who in 1868 wrote or the subjectof a similar o utbreak in Be ngal, where nearlyfour per cent, of the population of one districtsuffered, also noted that "the ill effects weremore apt to occur in the rainy senson." H e,moreover, states that some females were affected," tiie proportion being 6"ll males to O -59 fe-males. As to the true pathology and morbidanatomy of the disease, I can na turally onlyconjecture, having had no opportunity of investi-gating after death the conditions of the nervoussystem and other parts of the body.The nature of the well-marked symptoms andtheir many points of resemblance to cases ofcerebro-spinal sclerosis would lead me to sur-mise that the disease is a form of sclerosis, pro-bably characterised by nodules of sclerotic atro-phy and degeneration of the proper nerve ele-ments of the-white matter of the spinal cord orbrain or both ; the motor tract only being affect-ed and in the form of an ascending degeneration.The only evidence I can find recorded on thepathology of the disease is a statement in Watts'Dictionary that" Cantarini of Naple3 has published a numberof cases in which he has carefully observed theconditions after death ; the muscles of the face,neck and trun k, were found not to be affected ;those of the lower extremities, especially theabductors, were found to have undergone a fatty

degeneration, the transverse strife being dimi-nished and the ultimate fibres containing littledrops of oil. No affection of the spinal cordwas discovered." In the face of this definiteresult of post-mortem inquiry , my conjecturesna tura lly fail to the ground ; but I confess I donot understand how a fatty degeneration of the' muscles of the lower extremities could, per se,para lyse a man in some 10 to 15 days and c;msesuch symptoms as loss of sexual desire andpower.I have instituted experiments on pigeons witha view to clearing up the following points :1. "Whether the healthy or diseased seedfrom the affected village con tains the poison.2. "Whether seed brought from a differentpart of the district is equally poisonous.3. Whether subjecting the grain to greatheat drives off the "volatile liquid alkaloid,and ao renders the grain a harmless article ofdiet.

THE EVOLUTION OF ANTISEPTIC SURGERY:A EETEOSPECT.

. BY EBNEST P. HE VE, JI .D., p.H.a.s. ED. ,Surgeon to the Kashm ir Mission Hospital.

(Concluded from page 262.)A T the International Medical Congress atBerlin in 1890 Sir Joseph Lister referred ap-preciatively to the extension of our kuowledgeresulting from Koch's new method of cultivat-ng microbes upou soljd media. H e also men-tioned the intere sting work of Metscbuikoff inounectiou with leucocytesa subject which hasan important bearing on antiseptic surgery.Sp eaking of the success of Law sou Tait- andBa utock which was supposed to be achieved 'withou t autisep tics, lie . pointed out that boththese surgeons were scrupulously careful aboutthe cleauing of their sponges and both observedthe strictest cleanlinessw ashing the peritoneumwith w ater audB antock boiling the w ater beforeuse.Lister at this time was using irrigation withsublimate lotion in two streng ths. H e employed-j -g- for washing a wound after the arrest of allhaemorrhage and $&(,$ as an ordinary lotion.The strong er solution was not used in join t casesThe seat of operation was surrounded by towelswrung out of an antiseptic solution.Speaking of the spray, which he had abau-doned for some yea rs, Lister rem arked that itwas wouderful what good results had been ob-tained when it was in use, when it is consideredthat the particles of carbolic ac$i were widelyseparated, and these particles cannot have beeifin more than instantaneous contact with muchof the dust which was drawn into the vortex.He thought that this tended to indicate that thefloating partiales of the air were not usuallydangerous and that antiseptic washing and irri-gation of wounds might be dispensed with if theoperator and his assistants could be trusted toavoid the introduction into the wound of septicdefilement from other than atmospheric sources.If this could be aocomplished Lis ter thou ghttha t, perhaps, his early dream could be fulfilled,and that as in subcutaneous wounds so a woundmade under antiseptic precautions might forth-with be closed completely with the line of unionperhaps sealed hermetically with some antisep-tic varn ish. If the application of an antisepticto cut surfaces could be discarded and the spongesbe wrung out in a liquid that is aseptic but un-irrifcating, such as TTr^nr sublimate lotion, per-haps such an'ideal might be attained..In this direction there had been steady move-ment. Th e spray had been got rid of. Th eless irritating sublimate had been substituted forcarbolic acid. Less drainage was required onaccount of diminished irritatio n. Still there wasa limit to this progress. As a dressing for in