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3. Invitro digestibility experiments showed that the digestibility of tapioca proteinswas not inferior to that of rice protein. . . .4. The chief defect of tapioca as a source of protein appears tolie inits low totalprotein content rather than in the quality of the protein present.5. The^digestibility of the carbohydrates of tapioca by two enzymes has been studiedand found tobe 48'3 per cent in raw state and 77-9 per cent after cooking. The starchis digested to a greater extent by taka diastase than by pancreatic amylase.

REFERENCES.AYKROYD, W. E., and KEISHSTAN, B. G. (1939)BAS0, K. P., and M U K H E B J E E , S. (1936)BEAZELL, J. II., SCHMIDT, C. E-, and IVY, A. C.(1939).BHAOVAT, K., and SEEENIVASAYA, M (1935)CALVEEY, H. 0. (1931)CABMAN, J. S., SMITH, H. G-, HAVENS, G. C, and

MITRTIN, J. E. (1930).FOLIN 0., and MABENZI, A. D. (1929)Idem (1929a)K A O , H. C, ADOLPH, W H., and Lro, H. C. (1935)LANGWOBTHY, C F., andDEVEL, H. J., JR. (1920).Idem (1922)M C C A S C E , R. A., andSmpp, H. L. (1933)

NEUBEEOER, A., and SANOEE, F. (1942)RAYMOND, W. D., JOJO, W., and NICODEMTJS, Z.

(1941).EOSEDALE, J. L. (1939). "... . .. ..

SHEBMAN, H. C (1942) .. . . .. .SWAMTNATHAN, M (1938) ... .:.VAN VEEN, A. G (1938) . . . '

WEBER, C. J. (1930)WILLSTATTER, R., WALDSCHVMIDT-LEITZ, E., andHESSE, A. R. F. (1923).

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.Jour. Biol. Chem., 83, p. 89.Ibid., 83, p. 103.Chinese Jour. Phi/siol., 9, p. 141.Jour. Biol. Chem., 42, p. 27.Ibid., 52, p. 251.' Chemistry of flesh foods and their losses oncooking ', M. R.C. Report,No . 187. ;Biochem. Jour., 36, p. 662.East Afr. Agric. Jour., January, p. 1.' Comptes Rendus DuDixieme Con-gres ' {Far Eastern Association ofTropical Medicine), p. 489.'Chemistry of food and nutrition',1942 ed.Ind. Jour. Med. Res., 25, p. 847.Geneeskund. Tijdschr. NederlandIndies. 78, p. 254S.Jour. Biol. Chem., 86, p. 217. .Jour. Physiol. CT!em.,12S, p. 143.

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* ?-

Ind. Jour. Med.'Res., 33, 2,October, 1945.AN OUTBREAK OF LATHYRISM IN CENTR AL INDIA.

K . L. SHOUBIB, M.B. , i r . sc .(Nutrition Research Laboratories, Coonoor, South India.)

[Received for publication, July 24, 1945.]LATHYRISM is an ancient disease. According to Chopra (1935) ' in the old Hinduliterature, Bhavaprokasa. it iswritten that " the triputa pulse " causes a man to becomelame and crippled and it irritates the nerves '. Hippocrates observed that theprolongeduse of certain peas as food was liable to cause paralysis. Inthe seventeenth and eighteenthcenturies outbreaks of disease which were ascribed to the eating of lathym s 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 numberof villages near Saugor in the Central Provinces in 1834-36 and described it in his ' Ramblesand R ecollections of an Indian Official', published in 1844. His account, which is clear andvivid and could scarcely be bettered to-day, may with advantage be quoted in full:' In 1829 thewheat andother spring crops in Saugor andsurrou nding villages were destroyed byseverehailstorms and rains and in1831 they were destroyed by blight. During these t hree ye ars the " teori " or whatin other parts ofIndia iscalled " kesari " {Lathyrus sativus), a kind ofwild vetch which, though not sown itself,is left carelessly to grow among thewheat andother grains and given in the green and drystate to cattle,remained uninjured and thrived with great luxuriance. In 1S31 they reaped a rich crop of it from the blightedwheat fields andsubsisted upon itsgrain during that and the following years, giving the stalks and leavesonly to their cattle. In1S33 the sad effects ofthis food began tomanifest themselves. The younger part ofthepopulation ofthis and thesurrounding villages, from the age of thirty downwards, began to bedeprived oftheuse oftheir limbs below thewaist byparalytic strokes, in ailcases sudden, but in some cases more severe thanothers. About half the youth ofthis village ofboth sexes became affected during the yea r 1S33-34 and man y ofthem have lost the use of their lower limbs entirety and areunable to move. Theyouth of the surroundingvillages in which the "teori " from thesame causes formed the chief article of diet du ring the years 1831-32have suffered to an equal degree. Since theyear 1834 no new case has occurred but no person once attacke dhad been found torecover the use of limbs affected and my te nt was surroun ded bygreat numbers of the youth,in different stages of thedisease, imploring my advice andassistance under thedreadful visitation. Someofthem were very fine young men ofgood caste and respectable families and all stated t hat their pains and infirmi-ties were confined entirelv to thepart below the waist. Thev described the attack ascoming on suddenly , oftenwhile theperson "was asleep , andwithout anywarning symptoms whatever andstated., that a greater portionof young men were attacked than of the young women. It is the prevailing opinion ofthe natives throughout thecountry that both horses andbullocks, which have been much fed upon " teori", are liable to lose, tho use oftheir limbs, but ifthe poisonous quantities abound more ingrain than the stalk orleaves, a- man who eats nothingbut the grain must bemore liable to suffer from the use of the food than beasts, which eat it merely'as theyeat grass or hay.'In more recent times lathyrism has occurred in India inepidemic form in the CentralProvinces (Buchanan, -1904), inR ewa. C entral India- Agency (Acton, 1922 ; McCombie Y oune. 1927). in Gilsifc (M cCa rrison. 1926; M ackenzie, 1927), inthe Um'te'd Provinces(Stott",. 1930) and inthe Punjab (Shah.. 1939). Megaw and Gupta (1927) concluded frominformation supplied by civil surgeons inresponse to a questionnaire that the disease ismainly confined to a belt which runs across the Central Provinces, the east of the UnitedProvinces and the north ofBihar. It also occurs in certain restricted areas in the Punjaband theUnited Provinces outside this belt. L athyrism appears to be unknown in SouthIndia . M inchin (1940) reported a series of cases of spastic paralysis of the lower limbs in th eM adras General, H ospital which he considered to be clinically indistinguishable from

lathyrism, but there was no evidence that lathyrus seeds, had formed part ofthe diet ofthe patients. > .The epidemic described in this paper occurred in Bhopal State in Central India in 1944-45 . At the Fifth All-India Food Conference held inDelhi atthe end ofJanuary 1945,an official of that state consulted Dr. W. R. Aykroyd, Director ofNutrition R esearch,then serving on the Famine Inquiry Commission, about anoutbreak of disease which thepeople affected ascribed to the consumption of a certain kind ofpulse. The account givenobviously suggested lathyrism. A fewdays later the author was sent toBhopal toinvestigate the outbreak.

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I . ~_ "Z. _ THE"BACKCROUND OF*"THE "EPIDEMIC ~ Z^:~ P_Pei)f the_ conclusions reached in the investigation is that lathyrism, as its name implies, " Tt" J\_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 Anattempt has, however, been made to studv the social, economic and agricultural ~^^g^ **background ofthe 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 Sta te which has an area of 6 902 square miles and a population (1941) of ~ j " * 785,000, is divided foradministrative purposes into two districts, eastern and western It ~* ""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 thespleen 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" :.'~~ ' " . .. . ."' .. . . "Hi

.' - J ( 6 ) s u b - t e n a n t s o f t h e a b o v e , - 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 ; i r r iga t ion ! In bad seasons, rust, blight, ha i l s to rm s ,excess of ram, etc , may lead to dariger'of scarcity anil food shortage. The diet changeto some extent with the season, following the succession of ha rves t s . .. - " " "

T he principal food crops and seasons of sowing and harvesting are as follows :^ ' f

Crop. Time of sowing. Time of harvesting.

RiceMaize' Jowar (Sor hum vul are)

' Sawan (Pamcum frumantnceum)' Kodon (Paspalum toloniferum)Black gr m (Phaseolus mungo)

% Red gram (Cajanvs tndicus) Wheat

* ve * , J * j. -=-^\l~jf*. f ,"** *" *v Barley (Hordeum vulgare) ^

e> Pfp -** Jl r ^ Bengal gram (Gtcer anetinum)

^3,%^^-s %, ^ 1* ^T ^ l e o r a ' (Latfarus sattvus) ^ ~~

June OctoberDecember

October

October-NovemberOctober

March

February March

- 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 ' - - ' * ( 2 4 0 ' ) ' - - . v * j

t -^

. " * , '

the country. -Howard and 'Khan .(1928) described in detail the Indian types* of lathyisalnui. It is an important crop in the eastern district or Bhopal for the followingreasons ' , . .;-. .':.'. i .'.....:' . . ., . 1. It is used,as a fodder crop._ . _.__... ' . . " . .

- 2. It gives a good yield" with mi nimum labour. It is a hardy plant and thrives wellin unfavourable circumstances. ' .' . ' ~~. .3. It is a stand-by to the cultivator should there be a failure of wheat supplies ]fwheat 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 sellerscalled ' kachhis ' may come once or twice a month to sell vegetables to those who canafford them. The following vegetables are grown in the district:Spinach Bitter gourdOnion Carrots 'Brinjal TomatoesCucumber Radish

Bengal gram leaves' Rajgra ' leaves

.' Bathua ' leaves.. . These are eaten frequently.

. . ...1 These are wild plants, taken occasionally but not

. . . . / relished by the villagers.Fruits.There are very few fruit gardens in the districts and the poor rural communitycannot 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 aresmall and degenerate though grazing , grounds, are abundant in the area. The averagecow in the'area yields' about 1 lb. t o 1J lb. of milk per day. and an average buffalo 3 IDto 5 lb. In Table I the population of human beings and the number of milch cattle in twovillages in the area are shown : . . .

T A B L E I. . . ' ' ''; -

NVime of v Popula t ion. Number of Numberof

BirpurUuiarkhoe

04 0

4 3 1

110Vi2

tfiJ ,.

Even the small quantity of available milk is not usually consumed by those who 1 etjrcattle. Themilk is converted into curds and the milk fat is remover]. The ahee is sold indthe buttermilk is consumed. .Meat and eggs.Tradition . and taboo prevent the eating of these foeds. The ti e itmajority of the population is Hindu and does not take'.meat at, all. while the fewMohammedans 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) areground into flour (' atta ') and this flour is usually made into ' chapatties '. Whole or coarseHcrushed pulses'are boiled with water and consumed as porridge ' after the addition of salt'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 a rei have been damaged by rust, blight hailstorms,etc The hardy teor a', however," thri ved While wheat forms the staple*diet of the*population, the poor-mix cheaper grains with wheat Failure of the wheat crop had th e' .- J, ME - - , ; - * - ( 241* ) - - - - - 6 - \ "

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resu lt th at the poor consumed cheaper grains in increasing quant ity. The prices of foodgrains have risen to 2 to 3 times the pre-wa r leve l. In Table II the market rates ofdifferan t food graina for the period 1939 to 194 5 are shown :TA B LE I I .

Market rates at which different food grains were available, in the period from 1939. to 1945 (per 5 maunds).Name of foodstuff. 1039. 1940. 1941. 1942. 1043. 1944. 1945.

"Wheat ' Te o r a ' . . .Bengal gramLe n t i l' B a t l a ' * . ..

R s.12

S1012

8

Its.]( i1214IS12

R s.n>12141013

R s.2013IS20 '15

R s.24 to 30

20252520

R s.3020 ; > ;

2520

R s3020252520

* ' Batla ' is a pulse whioh resembles a pea. Its consump tion is being encouraged as an alternative to' teora ' .In 1944 the state authorities introduced the rationing of w heat into the urban areas. Tomee t th e demand of the towns the cultiva tors were asked to give on payment certainqua ntitie s of wheat- per acre sown. In areas where the wheat, crop was poor, the cultivatorwas left w ith limited supplies of wheat. The position of agricultural labourers was also- afieoted for the following reasons : (a) The labourers a re pai d in kind. Cultivators did nothave 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 thepart of their employees by saying that practically all their wheat had been taken by the stateand th at nothing was left. The net result of the crop failure and the procurement operationswaa 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 ' cha pattie s ' made of ' teora '. In somecases ' teora ' was mixed with Bengal gram, barley or wh eat.

State of nutrition.One hundred children in a villager -were: examined for the incidence ofclinical signs of deficiency diseases. The results obtain ed are as follows :Number of children showing phrynoderma7 per cent. . , , , Bitot 's spotsNil. . :, angular stomatitis2 per cent.Prac tically all the children showed discoloration of the conjunctivas. The general impressiongained from this survey was that the state of nutrition was very similar to that of villagechildre n in many other parts of the country. This is a point of importance, since suggestionshave been made that vitamin deficiency plays a part in the causation of lathyrism.

THE O UTB R EA K.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 about150 people showing evidence of the disease w ere exa mine d. A full history of 75. cases ofrecen t onset during the second half of 1944 or early in 1945 was obtained. It was felt thatcases ocourring earlier might not be able to recollect details about the onset of the disease andattention 'was focused on more recent cases.

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The disease is not a mysterious unfamiliar malady to the inhabitants of this area.Eve ry yea r, or every second or third year., a few persons contract it. Villagers are familiarwith it .and know that it is associated w ith famine and ppverty, and that it is not aninfectious disease. It may be added that the present outbre ak of lathyrism was not confinedto Bhopa l State. There were reports of cases occurring in adjacent areas outside thestate boundaries.Age.Th e villagers cannot give their age with a ny degree of exactness. Table IIIshows approximately the incidence of the disease by age groups:

TA B LE I I I .

Ace trroup. Numbe r of T, ,years. ' eases. Percentage.

4-1011-2021-3031-4041-5051-60

13192111

71

1S-02S-429-115'2o-i1-3

Buchanan (loc. cit.}, McCombie Y oung (loc. cit.) and Shah (loc. cit.) all observed thatthe majority of cases were in the age groups 11-20 and 21-30 . This agrees with the observedage incidence in the present investigation.Season.Ta ble IV gives the number of cases and the percentage of cases occurringin different month s :

TA B LE I V .

Month of onset.

JanuaryFebruaryMarchApril .. .May . . .TuneJuly ...August ...SeptemberOctoberNovemberDecember

TOTAL

Number ofcases.

1

1123229

1

69

Percentage.

. ' 01-5

15'933-931-S13-0

1-5

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The above figures show th at most of the cases occurred in the ' months of August...September and October, the highest number being in the month of Septem ber. Shah (lot--,cit.) recorded th at m ost of his" cases occurred in August and M cCombie Young (loc. pit.)observed a peak in October. It is during or just after the rainy season that the paralysis oflathyrism tends to appear.Sex incidence.The percentage of cases occurring in t he population of two villages andthe se x incidence are shown in Table V :

TABLE- V.

of vi]!ae.Total

population.Number ofNum ber of persons suffer-

persons . ing fromiathvrism.Percentage.

Birpur

Uumrkkoh

I J1

I F

513427.

207 i-u

The above shows tha t males suffer m ore than fem ales. Out of the 69 persons sufferingfrom th e disease in these villages, only 9 were females. This is in conformity with the findingsof the earlier workers previously referred to.Economic status.T he victims of lathyrisrn belonged to the poorest section of thecom mun ity, usually labourers in villages owning no land. Out of the 73 persons afflictedwhose history was taken only i were cultivators owning some small parcel of land, and therewas one ' Bania ' (grocer). The others were all labourers. ' Chamars ' (shoe-makers) con-

tributed the largest number of victims.Incidence of signs of diet-deficiency diseases .All th e cases were examined for clinicalsigns of dietary-deficiency diseases. None showed angular stomatitis. There were 3 casesof p hrynoderm a among" the 73 cases. A history of night-blindness was given by 2 cases.The genera l impression'was gained tha t the affected persons were not badly nourished. [ ,Clinical findings, (a) Onset.In all the patients examined, no premonitory symptomssuch as an attack of nausea, vomiting after meals, or diarrhoea, were complained of.M cCarrison (1926) noted that constipation tend ed to occur in his cases, but this was not aprom inent fea ture in the present series. Of the 73 persons examined, only 10 gave a historyof mild or severe constipation. Inquiries revealed th at 15 cases suffered, previous to the on-set 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 sleepingnormally and awakening with stiffness of the muscles and partial loss of control of the lowerlimbs. Others fell down while working (ploughing, etc.), and found themselves unable to getup and w alk back to their houses. ' In the remaining 40 cases the onset of the disease wasslower. In one case the patien t did not know tha t he was a sufferer until otherspointe d it out to him after seeing him walking with bent knees. A few days laterhe found himself pa ralysed. In cases in which the "onset was slow the patients first sufferedfrom backache and stiffness of the lower extremities with some difficulty in dorsiflexion of theknees. Severer signs and symptoms followed slowly. Some patien ts reported that in theearly stages contraction of the muscles of the calves had occurred. A ' lump would form ' inthe m orning when the patient was getting out of bed. These ' lumps ' of contracted m uscleswould prevent the straighte ning of the lower extremities. The patients would massage theseout an d for the rest of the day could walk without much difficulty. Then slowly severersymptoms would set in.

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(b) Gait.In mild cases there was only a little berdirg cf the trees ard patients feltdifficulty only on running or on goiiig downhill. In n.ore seveie cases tie patien ts waitedwith bent knees, the knees being approxim ated and the feet m ore widely separated thannormal. In this stag e the heels leave the ground earlier than the toes and there is someswaying of the hip s. In more advance d cases the ' scissors ' gait (crossing of the legs onwalking) developed, with a tendency on the part of the patient to walk on the toes andswaying of the hips was more mark ed. Such patien ts required the use of one or two sticks,according to the seve rity of the paralysis. Very severely affected patie nts were reduced tocrawling 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 tenden cy onthe part of patients to fall down.(c) Musculature.There was no marked change in the appearance of the muscles of thelower extremities. M uscular 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 abdom inal reflexes were exaggerated. Theplantar reflex was extensor in typ e in those in which it could be elicited. The knee-jerkswere exaggerated in all cases. Ankle-clonus was present in 62 cases. The sphincters ofthe rectum and the bladder were unaffected.(e) Sensation was normal in a ll cases. There was no change in the functioning of thecranial nerves. Speech, sight, smell, hearing, etc., were normal. M ental symptoms andpsychological disturbances were not observed.It is apparent th at the paralysis of lathyrism is an upper motor neuron lesion. Presum-ably the pyramidal trac ts are involved. No post-mortem histological examination of thespinal cord in cases of lathyrism appears to be on record in the literature.

^ETIOLOGY.Villagers in the area affected by the outbrea k and the victims of the disease have nodoubt that the paralysis is caused by consuming lathyrus seeds in large quantities for several

months. This is the tradi tional view of the cause of the disease : hence, in fact, its na me.The observations of S leeman have already been quoted. A number of those who have studiedthe disease in India (Buchanan, loc. cit. ; McC arrison, 1928 : McCombie Y oung, loc. cit., andothers) have adopted the traditiona l standpoint. Anderson, Howard and Simonsen (1925)and Shah (loc. cit.). however, consider that another pulse, Vicia saliva, may be the cause ofthe disease.The feeding of Lathyrus sativus or Vicia sativa to rats by M cCarrison (1928) and to poniesby Stott (he. cit.) did not re sult in the production of lathyrism or of any lesions of thenervous system.During the present investigation it was found that those who developed lathyrism hadusually consumed Lathyrus sativus in large quantities for six months or more! It wasimpossible 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 diseasewere mostly labourers, an d were paid in kind. They ate what they could get, and this wasmainly lathyras seeds. It was said by the villagers that those who mixed Lathyrvs sativvsgrains with equal amounts of wheat did not contract lathyrism.Anderson et al. (loc. cit.) stated that samples of ' khesari dha l' or lathyrus obtained from

localities in India in which outbreaks of lathyrism had occurred were contaminated with thevetch Vicia sativa, popularly known as ; akta '. They reported that ' akta ' was poisonous toducks and monkeys whereas lathy rus was not. The toxic signs produced in these species bythe feeding of diets containing akta ' did not, however, closely resemble human lathyrism . Inthe present inquiry the question whether the lathyrus seeds which were being consumed in theaffected district were contamina ted with 'a kt a ' was investigated. A pure sansativa was obtained from D r. B. P . PalDelhi, and was shown to stockistssample of 'Viciaf the Imperial Agricultural Resea rch Ins titute , Newvillages and towns, and to intelligent cultivators( .245 )

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in various villages. In not a single case did they recognize the Vicia sativa seeds and allweresure that such seeds were not to be found inLathyrus salivas stocks. About 50 samples ofLathyrus sativus were collected from v arious "families and in various villages. Some of thosewere from stocks actually consumed by people who developed lathyrisni. Careful examinationof these samples inthe Imperial Agricultural R esearch Institute, New Delhi., failed to revealthe presence of Vicia saliva seeds.At three places about 200 lb. of Lathyrus sativus were sifted through a sieve with a meshsmaller than normal Lathyrus sativus grain. Asearch was made in the sieved material for' ak ta ' seeds, which are smaller than lathyrus seeds. No ' akta ' could, however, be sievedou t 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 thelatest crop inthe 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 showsthat Lathyrus sativus stocks were not contaminated witli Vicia saliva.

M ellanby (1934) has put forward the theory that ' lathyrism is due to an active neuro-toxin in the food whose detrimental effects can be prevented by protective foods containingvitamin A and carotene, such as milk, eggs and green vegetables, even when much of thetoxic agent "in the lathyrus peas is consumed. It may therefore beclassed among thedeficiency diseases'. McC onibie Y oung (he. dt.)was also of the opinion that vitamin Adeficiency was concerned in causation. Lesions of the nervous system have, however, beenmore frequently observed in experimental animals as a result of deficiency of various membersof the vitamin B2 group than as a result of deficiency of vitamin A. The present investiga-tion has not thrown any further light on the problem,whether ;lack of vitamins is associatedwith a toxic factor inproducing the paralysis. L athyrism is a famine disease and thecircumstances which lead to an increased intake of-lathyrus will at the same time lead to adecreased .intake of other foods, including protec tive foods. None of the facts revealedis incompatible with Mellanby's hypothe sis, but inview of the low incidence of vitamindeficiency states in the affected area, the author is of the opinion that lathyrisni should beregarded as a disease due to a toxin of unknown nature rather than as a deficiency disease.U ntil, however, lathyrism has been satisfactorily reproduced inexperimental animals, thequestion as to what part vitamin deficiency may " play incausation cannot be finallyanswered.The higher incidence of the disease amongst men than women can probably be explainedby the greater intake of lathyrus on the part of the former. During therainy season and justafter, agricultural labourers work hard at ploughing and other agricultural operations. Theircalorie requirements are correspondingly increased and when only lathyrus is available tofulfil these they eat it inlarge quantities.

TREATMENT AND PREVENTION.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 rem ainin their villages and contribute to the work of the village as far as their crippled state pe rmits ;others swell the ranks of beggars incities. It has been stated that many of the paralysedbeggars who obstruct the pavements of Calcu t ta and other large cities are victims oflathyrism. - 'Prevention is a social, economic, administrative and agricultural problem. L athyru sseeds can apparently be safely consumed in small quantities, but when they form the bulk ofthe diet the disease makes its appearance. Thecircumstances in which this tends to occur,have been described in this paper. Satis factory pre ventive measures include encouraging theproduction of suitable alternative crops to lathyrus, the improvement of the economic statusof agricultural labourers., and the importation of other foods such as wheat into endemic areaswhen an outbreak threatens. A watch should be kept by public health authorities for the .appearance of the disease in such areas inCentral India and elsewhere in the country.

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Procurement operations to supply wheat to towns under rationing schemes should not beallowed to deprive rural areas, in which lathyrus is a stand-by, of excessive amountsof wheat.' S U M M A R Y .1. Anoutbreak of lathyrism in Central India has been investigated. This wasassociated with the consumption ofLathyrus sativus in large quantities for a period of sixmonths ormore. Some 1,200 cases occurred in the district. Of these, 150 were seen, and fullnotes of73 cases were taken.2. Villagers in the area in question andpatients who contracted the disease' realized thatit was due to the consumption of this pulse. They also realized that itis not an infectiousdisease and understood its association with poverty.3. The chief sufferers from l ath yris m w ere young adul t 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. Thesphincters of the bladder and the rectum are not affected. No mental or sensory disturbanceswere observed. . 5. No Vicia sativa seeds were found in the stocks of lathyrus seeds consumed in thevillages inwhich the outbreak occurred. The investigation points to the existence in Lathyrussativus 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 M inister,Bhopal State, and to Lieut.-Colonel M. L. R. Siddiqui, F.R.C.S., Chief Medical Officer, B hopa lState, for assistance in the investigation.

ACTON, H. W (1922)A2IDEBS0S, L. A. P.,HOWABDJ. 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) .. .

STOTT, H. (11)30)

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