lathyrism ind hendley 1903 par miles

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Nov. 16, 1903.1 THE JOUKNAL OP TEOPICAL ME DICIN E. 359Discussion of Results with Reference to Identity orotherwise of the Two 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 afterdeath obvious post-mortem lesions, namely, enlargement

of spleen and glands, the latter usally heemorrhagic, arefound. The " dis eas e" caused by the human try -panosome is very chronic, the animal's health does notseam to be affected, and in the only deaths which haveoccurred in animals infected with this parasite nomacroscopic lesions were perceived. In the early stagesof both dissases the continued presence of the parasitesin the periph eral blood is far from the rule. Thistendency to disappear from the peripheral circulationis much more marked in the hum an 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, nochara cteristic differences. There are, it is true, a fewminor points in wliich 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 atpresent is the marked dissimilarity of the disease pro-duced by inoculation in lower animals.

Transmitters of the Diseases.Here, unfortunately, we have to disappoint you asmuch as we ourselves have been disappointed, by sayingthat our results are negative. We tried many times in

vain to transfer both parasites by biting flies to healthyrats from either naturally-infected horses or artifi-cially-inoculated an imals. Two species offlies,Stomoxysand Glossina were used. If the metho d 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 b e' th at the parasite cannotlive for even a few hours in the insect's proboscis duringthe dry season owing to the excessive lack of moisturein the atmosph ere. At McCarthy Island, where someof our experiments were undertaken, there was a dailydifference of from 15 to 20 between the wet and thedry thermometer bulb s. Mr. Hewby, a travelling com-missioner in No rthe rn 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 lie saysare the same as the Glossinae, which we showed to him,were always present in great numbers. We should haveliked to have given you our results in a more detailedway, but it is impossible, asp our notes are not yetcompletely arranged or our animal experiments com-pleted or. fully worked out. We hope before we retu rn

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

LATHYRISM.By Major A. G. HENDLEY, I.M.S.

THE best definition of this affection is Scheube's,which not only sums up in a few words pievale nt opinionsas to its causation, b ut at once recalls the nature ofa too narrowly-known disease of importance. He says :" Lathyrism is a disease of the nature of an intoxica-tion with a spastic spinal paralytic course, which isattributable to poisoning with various ~-t kinds of thefamily of Papilionacece lathyrus (chick-pea or commonpulse).Dr. W atts, in his " Dictionary of the EconomicProducts of India," says : " Lathyrus, a genus of annualor perennial plant of the natural order LeguminoscE,which comprises some 170 species, seven of which arenativ es of Ind ia. " The specimens I have here are ofthe commonest cultivated Indian variety, Lathyrussativus, know n in different par ts of India under variousvernacular names, as khesdri dull, tedra, lakh, or Idkhori.To quote Dr. Watts again : " Lathyrus sativus (jarosseor gesse) is indigen ous from the Southern Caucasusto Northern India ; it has spread as a weed of culti-vation from its original home, and is now cultivatedall over In di a." 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 or more been devoting his entire attention tothis subject.

h istory.Lat hy rism is no newly-discoveied affection. Its his-tory dates from very early times, being, according toHuber, alluded to in the Hippocratic writings, wheremention 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, t h a t :" In several p arts of the Continent a white pleasant

bread is made from 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,Du ke of Wur tem berg , in 1671, which was enforced bytwo other edicts under his successor Leopold in 1705and 1 714." In Ita ly an d 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 attenti on . From the years 1857-68, whenDr. James Irvingthen Civil Surgeon of Allahabadcontributed five very interesting and exhaustive papersto the Indian Annals of Medical Science on the subject


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Nov. iG, 1; THE JOUENAL OF TEOPICAL MEDICINE. 36 1pion 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 fuDy 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 is primarilyresponsib le. The idea tha t diseased grain only isinjurious is an argument probably borrowed from theanalogy of ergotism. I know of no facts to supportthe 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 Wuitemberg, countrieswith vas tly dissimilar meteorological conditions. Also,if exposure to cold and wet alone could induce lathyrism,Englan d surely should be full of such cases. As regardsManson's suggestion that the affection, like beriberi,may be a " place disease," one has only to remembeithat the paralysis is incurable, and that removal fromthe locality where the person was attacked is in no sensebeneficial. As to wh at the actu al poison is, and howit acts, that is a matter still left for our eminent physio-logists and chemists to decide. Church has stated th echemical composition of the grain as : W ater, 10'1 ;album inoids , 31'9 ; starch and fibre, 53'9 ; oil, O'D ;ash, .'3'2 ; and has 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 a.ction of the seeds,and th e action of which, is destroyed by heat." Onthis volcttility 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 savs, " Several poisonous alkaloids have beenextrac ted, bu t 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."Professor Dunstan, of the Indian Institute, is nowworking at this subject. So far his investigations andexperiments on animals are inconclusive, but go toshow : (1) Tha t only certain samples of lathyrus arepoisonous ; (2) there are some reasons to think th atpoison is contained in the skin or husk of the seed,bu t no fungus has been discovered ; (3) th at pou ltryare immune, but that rabbits and guinea-pigs aresometimes affected. Professor Du nsta n also tells methat in Canada lathyrus is largely grown and freely usedas poultry food, so probab ly birds are immune. 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 that 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 persona lly have only seen thre e female casesagainst m any hund reds 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 that lathyrus grain is only issuedto labourers in the rains."The difficulty in the way of accepting this explanationis that (1).I do not believe the custom he alludes to isgen eral that of .only, eating lathy rus during the rainsit certainly was not during the recent famines ; and(2) the fact that according to this idea cases occurringquite early in the rains must have been caused by avery few days' dietary 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 beingtha t, " the lameness produced by eating lathyrus wasreally a. mix ture of palsy and rheu ma tism." and added," they seem to think that living on this particular grainis the predisposing cause, and exposuie to cold, rain,and damp weather the exciting cause."I believe the native idea is the coircct one. I believethat lathyrus, whilst it may possibly cause paialysis byitself, ordinarily only predisposes to it, that it makes thesubject readj' or ripe for the attack of paralysis, butthat exposure to severe wet and cold is requhed actuallyto excite t he sudd en 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 whichexposure 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 Research Laboratory.

Morbid Anatoimj and Pathology.Satisfactory observations on the morbid anatomy and

pathology of the disease are wanting. From theclinical symptoms one would be justified in assumingit to be a form of latera l sclerosis, bu t in Wa tts' " Dic-tionary " I find a statement that " Cantarri, of Naples,has published a number of cases in which he has care-fully observed the condition after dea th. No affectionof the sp inal cord was discovered. The muscles of thelower extremities, especially the abductors, were foundto have undergone a fatty d egeneration. &c." Scheubementions one published necropsy (where death resultedfrom mala rial cachexia) where " a softening of thespinal cord above the lumbar enlargement was found."Allbutt refers to two examinations, of horses which haddied of lath yrus poisoning. In these the symptomswere apparently mainly those of cardiac and respira-tory oppression, and after . dea th " the mischief wasfound mainly in' the cells of th e a nterior horns of. the


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THE JOUENAL OF TSOFICAL MEDICINE. [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 thi, la rynx ." Fro mthis he suggests that the nerve mischief may be secon-dary to the vascular lesions, which would suggest asimilarity to ergotism. 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 * m x hA SOLUTION of formaldehydeone drachm to a pint,

applied to the chief seats of perspiration in the bodyaxillae, perineum, or the soles of the feet, will removethe odour of the perspiration.

WE 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 to rejoice at the honour he has received.The London School of Tropical Medicine benefited byhis liberality and wise forethought, inasmuch as heplaced a travelling scholarship at the disposal of theSchool authorities, amounting to a sum 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 elucidatedand our general knowledge advanced. Mr. Craggs'latest encouragement to the study of tropical diseasesis the prize he has instituted for original work, sobrilliantly gained byDr. Castellani.

THB 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 sicknessand the important discovery of trypanosomata in thecerebro-spinaj fluid of persons suffering from thatdisease. In November, 19012, Castellani first observedtrypanosomes in the cerebrospinal fluid of sleepingsickness patients, and so persistently did the diseaseand the parasite occur together that he came to theconclusion " that the sleeping sickness is due to thetrypanosome I had found." Castellani's discovery hasstimulated investigation in regards to this parasitein many directions and in many countries, and theauthorities of the London School of Tropical Medicineare to be congratulated upon the bestowal of the prizeupon one so deservedly entitled to receive it. Dr.

Castellani is about to proceed to Ceylon to take upthe duties of Professor of Pathology and B ctenologvin the College of Medicine at Columbo.

leant m\h Current literatureA tabulated list of recent publications and article bearing ontropical diseases is given below. To readers xnteie ted many branch of tropical literature mentione d in the e h ttlie Editors of the JOURNAL OF TROPICAL MEDICINE willbe pleased, when possible, to send, on application the medicaljournals in which the articles appear.

Malaria.HYBRID MALAHIA.Under this title Dr. J. L. Por- *teous (Med. Rxord, July 25th, 1903) describe a di easeresembling typhoid, but presenting some of the charac

te.rs of malaria. He states that the blood did not giveWidal's test and concludes therefore that the disease *was not typhoid. The assumption tha t malaria playeda part in the disease he describes is based olely uponthe benefit ascribed to afew doses of W arburg tinctu reand not to an examination of the blood tor malarialparasites. In the face of such negative evidence it[is impossible to decide the etiology of the o called)"hvbrid malaria. i

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lathyrism ind hendley 1903 par miles

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