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Nov. 16, 1903.1 THE JOURNAL OF TROPICAL MED ICINE. 359Discussion of Results with Referen ce to Identity orotherwise of the Tico Parasites.The above inoculation (primary) experiments showa distinct difference between the diseases produced, inanimals, by the human and the horse trypanosomes.The horse parasite is the more pathogenic, and after

death obvious post-mortem lesions, namely, enlargementof spleen and glands, the latter usally hsemorrhagic, arefound. The " disease " caused by th e hum an try-panosome is very chronic, the animal's health does notseam to be affected, and in the only deaths which hav?.occurred in animals infected with this parasite nomacroscopic lesions were perceived. In the early stagesof both diseases the continued presence of the parasitesin the peripheral blood is far from th e rule. Thistendency to disappear from the peripheral circulationis much more marked in the human parasite. In thelater stages of the horse disease (a week before death)the presence of parasites is constant, and their num-bers gradually increase until death takes place. Themorphology of the two parasites presents, so far, nocha racte ristic differences. There are, it is true , a fewminor points in winch they differ, but before anythingdefinite can be said a careful study of stained specimenswill be necessary. From a consideration of the abovefacts it is impossible to decide whether the parasitesfound originally in horse and man are the same ordifferent. The one clear distinction we can draw a tpresent is the marked dissimilarity of the disease pro-duced by inoculation in lower animals.

Transm itters of the Diseases.Here, unfortunately, we have to disappoint you asmuch as we ourselves have been disappointed, by sayingth at our results are negative. We tried many times invain to transfer both parasites by biting flies to healthyrats from either naturally-infected horses or artifi-cially-inocu lated anima ls. Two species offlies,Stomoxysand Glossina were used. If the method of transmissionof this disease were, as is maintained, simply a meremechanical transference of parasites from one animal toanother by means of the insect's proboscis, we think weshould have obtained some results in our experiments.Perhaps, however, it may be'that the parasite cannotlive for even a few hours in the insect's proboscis duringthe dry season owing to the excessive lack of moisturein the atmosphere. At McCarthy Island, where someof our experiments were undertaken, there was a dailydifference of from 15 to 20 between the wet and thedry thermo mete r bulbs. Mr. Hew by, a travelling com-missioner in Northern Nigeria, has told us of an observ-ation, based on a very careful study, which seems tobe interesting in this connection. He noticed th at hisponies after passing through a certain bit of bush inthe wet season often became ill and died of fly disease.Ponies sent through the same bush in the dry season,however, escaped, although the flies, which he saysare the same as the Glossinae, which we showed to him,were always present in great numb ers. We should haveliked to have given you our results in a more detailedway, but it is impossible, as our notes are not yetcompletely arranged or our animal experiments com-pleted or fully w orked out. We hope before we retu rn

to the Congo to publish as far as possible a completeaccount of the animal experiments up to date, and togive a description of about six species of trypanosomesfound in frogs, birds, tortoise, and mice.

LATHYRISM.By Major A. G. HENDLEY, I .M.S.TH E best definition of this affection is Scheube's,which no t only sums up in a few w ords piev alen t opinionsas to its causation, b ut a t once recalls the nature ofa too narrowly-kn own disease of importanc e. He says :" Lathyrism is a disease of the nature of an intoxica-tion with a spastic spinal paralytic course, which isattr ibu tab le to poisoning with various^ kinds of th efamily of Papilionace lathyrus (chick-pea or commonpulse).Dr. W atts , in his " Dictionary of the E conomicProdu cts of India," says : " Lathyrus, a genus of annualor perennial plant of the natural order Leguminosa;,which comprises some 170 species, seven of which arenative s of Indi a." The specimens I have here are ofthe commonest cultivated Indian variety, Lathyrussativus, known in different parts of India under variousvernacular names, as hhesdri dull, tera, lkh, or lkhri.To quote Dr. Watts again : " Lathyrus sativus (jarosseor gesse) is indigenous from the Southern Caucasusto Northern India ; it has spread as a weed of culti-vation from its original home, and is now cultivatedall over Ind ia. " In the Central Provinces some 358,000acres are under lathyrus cultivation ; and it is in theseprovinces that the disease has of late years become soincreasingly prevalent as to call for Government in-quiry, which inquiry has been entrusted to MajorAndrew Buchanan, I.M.S., who has for the past sixmonths ox more been devoting his entire attention tothis subject.

h istory.Lat hyris m is no newly-discoveied affection. Its his-tory dates from very early times, being, according toHuber, alluded to in the Hippocratic writings, wheremen tion is made of the fact tha t " At Ainos thosemen and women who continually fed on pulse wereattacked by a weakness in the legs, which remainedperm anen t." In Don's " System of Gardening," again,it is recorded, in describing Lathyrus sativus, that :" In several parts of the Continent a white pleasantbread is made om the flour of this pulse, but it pro-duced such dreadful effects in the seventeenth centurythat the use of it was forbidden by an edict of George,Duk e of W urtem berg , in 1G71, which was enforced bytwo other edicts under his successor Leopold in 1705and 1 714." In Ita ly and France the disease was alsoobserved during the seventeenth and eighteenth cen-turies, and in the earlier half of the nineteenth century,large numbers of persons becoming affected in France,British India, and Algiers, attracted apparently someconsiderable attent ion . From the years 1857-68, whenDr. James Irvingthen Civil Surgeon of Allahabadcontributed five very interesting and exhaustive paperst o th e Indian Annals of Medical Science on the subject

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360 T H E J O U R N A L O F T E O P I C A L M E D I C I N E . [Nov. 16, 1903.of an epidemic of lathyrism then prevailing in theNorth-West Provinces, down to 1893, when I describedin the Indian Medical Gazette a localised outbreak I hadmet with in the Central Provinces, the disease seems tohave attracted no notice, save at the hands of a fewveterinary surgeons, who noted its effects on cattle,and may in consequence be assumed as practicallynon-existent. The circumstances under which I firstmade acquaintance with the affection were as follows :Towards th e end of July , 1893,1 came across a villagewhere quite suddenly some 10 per cent, of the malepopulation had during the previous five or six weeks(that is, since the commencement of the rainy season)become paralysed, more or less severely, in the lowerlimbs. At th at time I had never heard of such anaffection as lathyrism, but careful investigation andinquiry into the circumstances of the outbreak soon con-vinced me that they owed their condition to poisoningwith Lathyrus sativus, a pulse on which all the affected,poor hand-to-mouth labourers had Wgely subsisted forsome eighteen months on account of the failure of theirmore regular crops, in consequence of which the villagelandlord had paid his labourers in kind with the cheape stgvuin available, namely, Lathyrus salivus. For someyears I saw no further case of this disease ; but withyears of scarcity, culminating in the terrible famine of18%-7, the local conditions artificially produced by thevillage landlo rd in 1893 becam e general ; th e pooreragricultural labourers were driven to resort extensivelyto the cheapest foodstuffs procurable (lathyrus), andwith most disastrous consequences. In the ave ragevillage a dozen or more victims would be found, whilstin a famine relief camp of some 4,000 persons it becameeasy to pick out one or two hundred of such cases.The disease has. in the Central Provinces and adjoin-ing native States, gone on spreading ever since, helpedby th e second severe famine of 1899-1900 ; until atthe present time Major Buchanan writes to me thathe has an incomplete census of 2,700 cases in one dis-trict and 1,400 cases in another ; and in a recent lettersays, " I have seen 190 cases this morning."

Symptoms.I will now pass on to a description of the symptomsand m ode of onset of the disease. For reason s, givenabove, it will be seen that only the pooiest classes areliable to this disease ; those who are forced to subsiston the grain unmixed or diluted only slightly with othergrain. All the affected will be found to belong to thisclass. They eat it either ground into flour as bread,cooked as porridge, or boiled with or without oil aslentils, much as we eat haricot beans. Prac tically allare field labourers, and the wonderful unanimity withwhich all agree as to the onset of the disease is moststriking. A man will say : " I wen t to sleep perfectlywell and very tired after a day's ploughing or otherfield work in the rain " (it is always in the rain y season)" and awoke in the morning to find my legs stiff, weak,trembling, and very heavy to lift when I rose to walk."(I have never been able to elicit any history of pre-monitory symptoms.) This weakness and trem bling,you will be told, increased so rapidly -that within tendays progression became difficult, evfen with the aid ofsticks. Still the pa tients have no sense of illness and

no pain : they have good appetites, sound digestionsand natu ral sleep at night. Both legs are usuallyaffected simultaneously, first the calves, then the thighs,and soon after this all sexual appetite and power waslost. All com plain bitte rly of this.On examination of any typical case, of some six weeks'duiation, you will find that the gait is very peculiar.Aided with a long two-handed staff walking is possible,the rate of progression being undei two miles an hour.The body above the hips sways from side to side, whilstthe feet, which seem clogged with invisible weights,are lifted with evident difficulty and dragged forward,the toes scratching along or barely clearing the ground.The leg bearing the weight of the body is bent at theknee and trembles, whilst the advancing leg, draggedwearily forward strongly addu cted, is planted unsteadilydirectly in front of its fellow, the toes reaching theground first. In short, a kind of paralytic goosestep,The general effect is one of laboured unsteadiness, dueto great weakness. The evident spasm of the thighadductors ceases to be very apparent when the patientreclines on his back, when the thighs can be separated,usually without resistance, to a normal extent. Thereis no wasting, no loss of muscular tone, no true tremors,only tremblings of the entire limbs when weight is puton them . S ensation seems quite unaffected. Thetendon reflexes are much exaggerated, both knee jerk vand ankle clonus ; the slightest stimulus s tarting thelatter phenom enon going for a long time. There is noloss of power or undue excitability in bladder or rectum.The arms, trunk, head and neck muscles are unaffected.The mind is clear, speech natural, pupils normal andreacting naturally, to light and accommodation. Theurine is often of rather high specific gravity (1030),acid, and contains abu nda nt urates. Such are thesymptoms as I have found them. I am aware thatsome writers state that digestive disturbances, colickypains, and diarrhoea are usually precursors of the para-lytic state ; and th at sensory disturbances, such ahypersesthesia, anaesthesia, and formication, with bladdertroubles, such as incontinence and retention of urine,are common. I have never met with a case in myexperience of many hundreds where the slightest his-tory or evidence of any -such complications could betraced.

Etiology.As regards the etiology of the disease, it is, I think,generally conceded now that the paralysis is in someway due to lathyTUS poisoning. Other ma in theoriesof causation are :(1) That lathyrus eating has nothing to do with it.(2) That if it has, it is only diseased grain which iscapable of poisonous effects.(3) That exposure to sun or some local hot wind isthe true cause.(4) That the paralysis is due entirely to cold anddamp.(5) One em inent a uthor ity on tropical m edicine(Manson) has thrown out the suggestion that, like alco-holism and probably beriberi, the disease may bedue to the entrance into the body of a toxin generate(by germs whose habitat is outside the body.(fi) Lastly, I am quite prepared to hear some charm

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Nov. 16, 1303.] T H E JO E N A L O F T R O P I C A L M E D I C I N E . 361pion of parasitism arise and suggest that some organism,so minute as to have hitherto escaped observation, isreally the author of all the mischief.In the time at my disposal I cannot fully discussthese and other theories, and can only say that theoccurrence of the disease in epidemic form amonglathyrus eaters and among no others, seems to mevery strong evidence that a lathyrus diet B primarilyresponsible. The idea that diseased grain only isinjurious i an argument probably borrowed from theanalogy of ergotism . I know of no facts to supp ortthe idea. Th at exposure to sun or some local hotwind can be held responsible is at once disproved bythe undoubted fact that the disease has occurred(amongst lathyrus eaters) equally disastrously in India,Italy, France, Algiers, and Wthtemberg, countrieswith vas tly dissimilar meteorological conditions. Also,if exposure to cold and wet alone could induce lathyTism,En glan d surely should be full of such cases. As regard sManson's suggestion that the affection, like beriberi,may be a " place disease," one has only to rememberthat the paralysis is incurable, and that removal fromthe locality where the person was attacked is in no sensebeneficial. As to wh at the ac tual poison is, and howit acts, that is a matter still left for our eminent physio-logists and chemists to decide. Church has stated thechemical com position of th e grain as : W ater, 10*1 ;albu min oids , 31*9 ; sta rch an d f ibre , 53*9 ; oil, 0*9 ;ash. 3'2 ; and h as further observed th at " the oil ex-pressed is a powerful and dangerous cathartic."Astier says, " There is present in the grain a volatileliquid alkaloid, probably produced by some proteidferment, which exhibits the toxic action of the seeds,and the action of which, is destroyed by he at." Onthis volatility and destruction by heat notion has beenbased much speculation as to the possible variationsin methods of cooking, explaining the capriciousness ofthe effects of a diet of this grain on different individuals.Scheube says, " Several poisonous alkaloids have beenextracted , b ut further investigations are necessary ; "also, " that by the administration of preparations madefrom the grain, a disease giving rise to symptomssimilar to lathyrism has been produced in animals. 51Professor Dunstan, of the Indian Institute, is nowworking at this subject. So far his investigations andexperiments on animals are inconclusive, but go toshow : (1) That only certain samples of lathyrus arepoisonous ; (2) there are som e reasons to think th atpoison is contained in the skin or husk of the seed,bu t no fungus ha s been discovered ; (3) that pou ltryare immune, but that rabbits and guinea-pigs aresome times affected. Professor Duns tan also tells methat in Canada lathyrus is largely grown and freely usedas poultry food, so probably birds are imm une. Myown pigeon feeding experiments in India were allnegative, and so support this view.There remain two points of interest in connectionwith the causation of lathyrism, namely, its markedpreference for males and its seasonal incidence, thatis, during the rainy season. Dr. Irving found th at theproportion of females to males attacked was aboutone in twelve. Major A. Bucha nan, I.M.S., with arecent very large experience, tells me he finds it one in

ten . I personally ha ve only seen thre e female casesagainst many hundreds of males. Major Buchananaccepts the comparative immunity of females as anunexplainable fact, but says that the reason for theseasonal incidence of the disease is very simple, namely,that " he finds that the ordinary grain pits or granariesare closed in June , and th at lathyrus grain is only issuedto labourers in the rains."The difficulty in the way of accepting this explanationis that (1)1 do not believe the custom he alludes to isgene ral that of .only eating la thyrus during the rainsit ce rtainly w as not during the rec ent famines ; and(2) the fact that according to this idea cases occurringquite early in the rains must have been caused by avery few day s' die tary of the poison ; and this is opposedto all my experience of histories given me by patients.I prefer an even simpler solution of both difficulties.As long ago as 1858 Dr. Irving quoted the prevalentopinion amongst intelligent educated natives as beingthat, " the lameness produced by eating lathyrus wasreally a mixture of palsy and rheumatism," and added," they seem to think that living on this particular grainis the predisposing cause, and exposure to cold, rain,and damp weather the exciting cause."I believ e the na tive idea is the coir cet one. I believethat lathyrus, whilst it may possibly cause paralysis byitself, ordinarily only predisposes to it, tha t it makes thesubject ready or ripe for the attack of paralysis, butthat exposure to severe wet and cold is requhed actuallyto excite t he sudden seizure. This seems to me toexplain the unvarying history of the sudden unexpectedatta ck during th e wet season only ; for nearly alwaysthe attack occurs after an unusually thorough wettingwhilst ploughing, watching crops at night, or otherfield work that ordinarily falls to man's lot and notto wom an's. To their greater protection from severeand prolonged exposure alone, I believe, women owetheir comparative, immunity. I have suggested toMajor Buchanan that the respective shares which

exposmre and a lathyrus dietary have in producingthe paralysis might well be tested during the extensiveanimal-feeding experiments which are to be carriedout at the Bombay Eesearch Laboratory.Morbid Anatomy and Pathology.Satisfactory observations on the morbid anatomy andpathology of the disease are wanting. From theclinical symptoms one would be justified in assumingit to be a form of lateral sclerosis, but in Watts' " Dic-tionary " I find a statement that " Cantarri, of Naples,has published a number of cases in which he has care-fully observ ed the condition after dea th. No affectionof the sp inal cord was discovered. The muscles of thelower extremities, especially the abductors, were found

to have undergone a fatty degeneration, &c." Scheubementions one published necropsy (where death resultedfrom ma larial cachexia) w here " a softening of thespinal cord above the lumbar enlargement was found."AUbutt refers to two examinations of horses which haddied of lathyrus poisoning. In these the symptomswere apparently mainly those of cardiac and respira-tor y opp ression, an d after death " the mischief wasfound mainly in the cells of the anterior horns of the

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36 2 T H E J O U E N A L OF T E O F I C A L M E D I C I N E . [Nov. 16, 1903.cord, which were diminished in number and atrophied,There was also thrombosis of small arteries, which werealso thickened. There was, too, fatty degeneration ofthe heart and intrinsic muscles of thu larynx." Fromthis he suggests that the nerve mischief may be secon-dary tothe vascular lesions, which would suggest asimilarity toergotism. The prognosis of this diseaseas regards life is favourable. It does not seem to causedeath directly, but the paralysis is incurable. Treat-ment, I believe, is quite futile.

t o t e s m x hA SOLUTION of formaldehydeone drachmfcoa pint,applied to the chief seats of perspiration in the bodyaxillae, perineum, or the soles of the feet, will removethe odour of the perspiration.

W E congratulate Mr. J. G. Craggs upon the knight-hood that has been bestowed upon him. All interestedin tropical medicine have good reason to respect hisname and torejoice at the honour he has received.The London School ofTropical Medicine benefited byhis liberality and wise forethought, inasmuch as heplaced a travelling scholarship at the disposal of theSchool authorities, amounting to asum of no less than.300 yearly for three years. The work done by Dr.C. W. Daniels and Dr. G. C. Low, the successive holdersof the scholarship, must have amply repaid the generousdonor, for by their investigations several importantproblems in tropical medicine have been elucidatedan d ourgeneral knowledge advanced. Mr. Craggs'latest encouragement to the study of tropical diseasesis the prize hehas instituted for original work, sobrilliantly gained by Dr. Castellani.

THJE CRAGGS' PRIZE.The authorities of the LondonSchool of Tropical Medicine have bestowed the Craggs'Prize for the year 1902-1903 upon Dr. A. Castellani,a former student of the School, for his original work inconnection with the investigation of sleeping sicknessan d the important discovery of trypanosomata in thecrbro-spinal fluid of persons suffering from thatdisease. In November, 1902, Castellani first observedtrypanosomes in the cerebrospinal fluid of sleepingsickness patients, and sopersistently did the diseasean d the parasite occur together that he came to theconclusion " t ha t the sleeping sickness is due to thetrypanosome I had found ." Castellani's discovery hasstimulated investigation in regards tothis parasitein many directions and inmany countries, and theauthorities of the London School of Tropical Medicinear e to be congratulated upon the bestowal of the prizeupon one sodeservedly entitled to receive it. Dr.

Castellani is about toproceed toCeylon totake upthe duties ofProfessor ofPathology and Bacteriologyin the College of Medicine at Columbo.

m torrent literature.A tabulated list of recent publications andarticles bearing ontropical diseases is given below. To readers interested inany branch of tropical literature mentioned in these liststhe Editors of the JODBNAL OP TBOPICAL MEDICINE willbe pleased, when possible, to send, on application, the medicaljournals in which the articles appear.

Malaria.HYBRID MALARIA.Under this title Dr. J.L. Por-teous (Med. Record, July 25th, 1903) describes a disease,resembling typhoid, butpresenting some of the charac-ters of malaria. He states that the blood did not give.,Widal's test and concludes therefore that the disease;was not typhoid. The assumption tha t malaria played:a part in the disease he describes isbased solely uponfthe benefit ascribed to a few doses of Warburg's tinctures

an d not toan examination of the blood for malarial:parasites. Inthe face of such negative evidence itjis impossible todecide theetiology of the so-called\hybrid malaria.J k a i e of C I m r p s far g J i b - e r t t s e n t e n t s .

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