lathyrism india field study mccombie young 1927

7/29/2019 Lathyrism India Field Study McCombie Young 1927

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452 A Study of Renal (Edema.2. In two cases primary retention of water seems to have been the cause ofthe oedema.3. In the remaining cases it is probable that the dropsy was of pre-renalorigin, due to abnormal capillary permeability to wa t e r and salt.4. Of the latter, onepatient exhibited the features of pure lipoid nephrosis,and three those of nephrosis complicated by inflammatory renal changes. Incom-

plete investigations on another case pointed to a condition of pure nephrosis.In the remainder the findings indicated degenerative and inflammatorychanges but the cholestrol content of the blood was not raised.5. In a case of pure nephrosis and in one of nephrosis with very earlynephritic changes considerable improvement was effected by a high protein diet andlarge doses of thyroid extract.Our thanks are due to Major V. R. Mirajkar, F.R.C.S. , I .M.S. , Professorof Physiology, King Edward Medical Col lege, Lahore, for allowing us tomake use of his laboratory, to Dr, Raghbir Singh, Clinical Pathologist to theMayo Hospi ta l , for making the blood urea estimations, and to Drs. MohammadYusaf and Fakharud Din for assistance during the investigation.

BENNET, I., DAVHVS. D. T. andDODDS, E. C. (1927).DYKE, S. C. (1924)ELWYN, H. (1926)EPPENGER, H. and STEINER(1917).EPSTEIN, A. A. (1926)KENDALL, E. C. (1919)LEIBOFF, S. L. (1924)LOEB, L. (1923) . .MACLEAN, H. (1924)MCNEE, J. W. (1922)MA-YRS, E. B. (1926)STRAUSS and GRUNWAI.D(1927).VOLHARD and F AH R (1914) :.DE WESSELOW, O. L. V. (1925)WHITEHORN, J. C. (1921) ..WIDAL, A M BARD and WEII.L(1912).

REFERENCES.Lancet, I, p. 3.Quart. Jour. Med., XVIII, p. 77.Arch. hit. Med., XXXVIII, p. 346.Wein Klin. Woch., XXX, p. 77. Quoted by deWesselow (1925).Jour. Amer. Med. Assoc, LXXXVII, p. 913 (contains

references to previous work) .Endocrinology, III , p. 156.Jour. Biol. Chem., LXVI, p. 177.Medicine, II, p. 171.Modern Methods in the Diagnosis and Treatment f

Renal Disease, London.Jour. Path, and Bad., XXV, p. 425.Quart. Jour. Med., XIX, p. 273.Quoted by Beaumont G. E. and Dodds, E. C. (1927).

Recent Advances in Medicine, London.Die Brightioche Nierenkrankheit, Berlin. Quoted byde Wesselow (1925).Quart. Jour. Med., XIX, p. 53.Jour. Biol. Clvem., XLV, p. 449.Sem. M ed., XXXII, p. 361. Quoted by de Wesselow(1924). The Chemistry of the Blood in Clinic!

Medicine, London.

/ .XHA.

A FIELD STUDY OF LATHYRISM.BY

LiEUT.-CoLONEL T. C. McCOMBIE YOUNG, M.D., D.P .HV I . M. S .[Received for publication, May 26, 1927.]

' Karya matra, pir pisanUske khae, gor nisanHale chandi, matke kulYe dekho matra ke shut/Translation :' The black pea, with its yellow flourFrom eating it comes trouble in the legs,Flapping topknot and swaying hips ;Behold the ill effects of eating matra.'

INTRODUCTORY.TH E writer was deputed under the Indian Research Fund Association inNovember, 1926, to examine in the field the epidemiological and clinical aspectsof lathyrism.Bundelkhand and Baghelkand in Central India, being areas in which akrge number of cases had been located, were selected as the venue of the investi-gation, with Rewa, and later, Sutna, as its headquarters. The investigation waspursued by daily visits to all likely villages within five to ten miles of a motoringroad.

REWA, General .Rewa vState, the scene of the greater part of these observations, is a treatySlate in the Baghelkand Political Charge of the Central India Agency, of whichdwrge it is the largest and most westerly State. It has an area of about 13,000quare miles, about the size of Bulgaria. A range of hills divides it into two't Batural areas. One, the northern area, consists for the most part of an upland^lluvial plain, the ' Uparihar, ' about 1,000 feet above sea-level, which is continuousthe main Central Indian plateau ; it is open cultivated country, with ai^Pukt ion of 176 per square mile.' southern area consists of hills which culminate in the peaks in whichSone and the Nerbudda rivers. It is forest-clad, has a population of( 453 )


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454 A Field Study of Lathyrism. T. C. McCombie Young. 45572 per square mile, and is less fertile than the northern area, cultivation l)e jnfor the most part confined to the valleys of streams.In the plateau, 85 per cent of the population are HindusBaghels, Uahnii,and lower castes, while in the hills the population are chiefly animist hillnienthe Gonds.The average rainfall in the 'U pa rih ar' is 42-2 inches: a maximum of64 inches was recorded in 1894, and a minimum of 26-34 inches in 1905, wlijc], jwas a year of shortage of crop s and of famine.W ith the exception of coal mines at Umaria and B urhan in the hill countryand of the lime kilns at Sutna, the sole occupation of the State is agriculture. -In the years of normal rainfall it is self-supporting as to cereals, and exports lgrain in considerable quantities, and only in a year following a failure of themonsoon rains is the normal outflow of grain exports replaced by an inflow ofimported cereals. Sutn a, on the G. I. P. Railway, is the distributing centre andcommercial emporium of the S tate. A metalled road, 31 miles long, connects itwith Rewa, the capital, from which radiate other metalled roads whose mileageaggregates 100 miles only. Apa rt" from these, unmetalled roads and village1cart tracks are conspicuously lacking, and owing to this lack of communicationthe villagers of the interior live in the circumstances and under the economicconditions which have prevailed since time immemorial. They are dependantfor their food supply on their own resource s, and the shortage of food-grainwhich follows a failure of the monsoon rains in a country depending for rainfall jon its crops, is not capable of relief by imported grain, and is a vital feature athe subject under consideration. t

The land owners are Brahmins, Baghels, Rajputs and others. The field:work is done by labourers, the harwahas, who belong to the lower castes, Ko!* .Cham ars, etc. W ith the field labour is associated a form of economic bondage,the ' harwaha' or ' lugwa' system, which is relevant to our subject. ;A 'lugwa' is a low caste labourer who having incurred a debt of someR s. 60 to Rs. 80 by extravagant expenditure on a marriage ceremony, or suchlike, has pledged the services of himself and his family to a landowner until sadtime as he has paid off his debt. His m aster, in return for these services .guarantee*his bondm an's food and clothing. Th e food is a ' khatvai 'a payment in kind ofa daily ration of such foodstuffs as are available from the ' kharif ' and raw ,crops and as may be expected u nder these circumstances, the ' lugwa's ' rationconsists of the cheapest grains . It is unvaried and monotonous and they are thefirst to feel the stress of scarcity.Grazing grounds are abundant in area, although poor in quality, and the catare small and degenera te. In a Hindu State none are killed for food, andeffort is made to control their reproduction or to eliminate the unfit. The averafc-|village cow yields only about ^ seer of milk per day. On ly the better classes dru*lmilk or consume dairy products, and little enough at that ; and such of the p o o j ^classes as have cattle collect their milk for the preparation of ghee, which, bcieasily portable, is sold to obtain the money which pays the land revenue of tlState. The^ only milk pro duct which is consumed by them is ' matha 'buttamilk. There is a noteworthy scarcity of fruit and of the leafy vegetables wt

ar e cultivated and used in other parts of India, and only the better class villagefamilv obtains at rare intervals and on feast days some green vegetables, whichar c tnown and hawked by itinerant ' Kachhis ' or vegetable-sellers. Mang orrnvc- abound, and the mango in its season as the green or ripe fruit, as a decoc-tioii called ' panna,' or a dried and powdered condiment' amchtir,' is largelyH st - , 1 . Mahua flowers are also used to a small extent in the ' Uparihar,' but theirVl l,ruc fresh, fermented, or sun-dried,is greater among the Gonds of the hilltract.-, who live on a variety of other jungle products which include the leafyvenab les. The Gond, unlike the orthodox Hindu of ' Uparihar, ' does not growanv ai'iirecaWle- qiiaiitity of Lathyrus {Rexva State Gazetter, 1907), and lathyrism- unknown among these hillmen.

Agriculture in Rewa.As lias been noted, the Rewan crops are entirely dependant on rainfall.There are no irrigation canals. A primitive water lift, the ' Dhenk uri,' isused m irrigate from small kutcha wells the exiguous patches of green vegetables,tobacco, or sugar-cane, raised by the ' Kachhis,' but of the agricultural irrigationof the cereal crops from wells, as practised elsewhere, there is none. To conservethe rainfall and keep the fields moist enough to yield a ' rabi ' crop, earthen banksstyled ' bandhs ' are throw n ac ross the lower ends of sloping fields to retain inthem as much moisture as possible. The Rew an farmer recognises several kinds, o soil, to which frequent references were met in one's wandering s. Thu s, thereis the ' Mair,' a rich dark loamy soil, retentive of moisture and fertile in the* autumn. ' Sigma ' is a lighter soil more suitable for the ' kharif ' crops and forfs rice. ' Dumat ' soil contains the properties of both and may be ' Dufasli 'suit-able tor both ' rabi ' and ' kharif ' crops, while there are other poorer soils, suitableonly for 'kharif ' crops and after years of rest. Th ere are two harvests, in the|/ spring and summer, the ' kharif,' watered by the monsoon rains, and the autumn-a* winter crops, the ' rabi,' dependan t on the residual mo isture in the soil. The

real ' kharif ' crops are as follows:Ri ce . . . . . . Oryza sativa.Sa ma n . . . . . . Panicum frumentaceutn.Jowar . . . . . . Jorghum vulgre.Ka kun . . . . . . Sitara itlica.Ba j ra . . . . . . Pencillaria spicata.Kodon . . . . . . Paspalum stol&niferum.i, I Ura d . . . . . . Phaseolus radiiatus.| . the pulses I Mung .. .. .. Phaseolus mungo.\ Arhar . . . . . . Cajanus indiens.i de s non-cereals, such as cotton and oil-seeds. Of the above list, the poorer usscs use Jowa r, B ajra, Kodo n, S aman and Kaku n, and the rice is for the most| pan appropriated for the use of the well-to-do.' k f ir eS e C ro P s a r e s o w n during the rains; much ploughing is done while rain\ . a "?* a " d t n e wettings and exertion the ploughman then experiences often!etenmne the onset of lathyrism, as we shall see later.J * * 13


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456 A Field Study of Lathyrism. T. C. McCombie Young. 457The pulses ripen in August and September, and the cereals, Kakun andSaman, ripen first about September or October, followed by Kodon, Bajra, rice,-!and last of all, Jowar in Novem ber. The method of preparation of these cereals!for food is relevant to this enquiry.Kodon is husked w ith the ' chakara ' a soft grind stone m ade of sun-driediclay held together by rice husks . It is the n cleaned in the ' supa ' or winnovvi

basket and pounded with the Musal (the pestle) in the ' kari ' or mortar, andhusk' kanna 'is given to a nimal s or may be eaten by poorer classes,resulting gra m is known as ' Kod ai.' This is washed and boiled, like rice, fceating as ' Kodo ka bhat ' and the thick rice-water in which it is boiled, is fed ijcattle.Saman and Kakun are similarly treated, Jowar and Bajra, after betrodden by oxen, and winnow ed, are ground in a hard stone Chakki and .1resulting whole meal is cooked over a g irdle ( ' Taw a ') into a girdle cake' roti. ' Rice is reaped in October, trodden in the ' Kalihan ' and winnowedthe ' supa.' The gram is husked in the ' chakara,' shaken in the ' supa '^separate the outer husk, which is used to consolidate clay for bricks. Theat this stage is know n as ' Bag ri.' It is now pounded in the ' musal '' kari ' to remove part of the pericarp . It is now ' Chawal,' and the br'kann a,' is given to animals. It is not polished or parboiled. It is eatboiled, in the usual man ner. It will be seen that a very varied selectioncereals is available from t he ' kharif ' crop for the use of the lower classes,that its method of preparation is not such as seriously to lower its vitamin conteAt this time of year, the poorer classes use small quantities of green lea?of a wild plant, ' Chakaora,' which grows in the rains and is gathered and used)August and Septem ber while still soft. It is eaten with salt, condimentsvegetable oils.

No other green vegetable food is available until ' Chuna ki bhaji ' comes isgeneral, use in December. Thi s consists of the green shoots of the youngplant, gathered when it is big enough to admit of the young shoots being ' praby being nipped off by the finger and thumb. This prevents the plantstalky and induces a branching which improves its yield. These pruningseaten raw with salt, or cooked, or dried for storage, and appear to be a valuasource of vitamin A, see later.Common salt is used by all, as required. The vegetable oil, mustardand linseed, are used occasionally in small quantities by the poorer classes,these vegetable dishes, on the rare occasions when they are available,inability to supply fat soluble A is the reflection with which one regardsas a dietary ingredient.- The ' rabi ' cereal crops consist of the following :W h e a t . . . . . . Triticum aestivum.Barley . . . . . . Hordum vulgre.Matr a . . . . . . Lathyrus sativus.Ch u na . . . . . . Cicer arietinum.Masu ri . . . . . . Brvum lens.

These are sown in September and October and ripen in March and April.Double or treble sowing is practised, thus wheat is sown with gram and with roatra,' in drills, the seed being fed thr ough a tube (' nali ') attached to theplough, through which the seed is dropped into the furrow. It is thus easy todistinguish what is sown intentionally and what is self-sown ( 'la me r '). Matra(LaJlixnts sativus) is sown with the wheat, as a precaution against the wheat(ailing to germinate in a dry year, in which case only the mat ra comes up. It isalso very largely self-sown. The re sulting crop of such an yield of mixed sowingis known as ' berra ' and consists of a mixture of barley and matra(jao berra)or wheat and matra, or wheat, gram and m atra. The wheat and barley havingbeen trodden and winnowed at the 'Kalihan,' is-ground in the hard stone:Chakki. The coarser parts of the peric arp are removed by sieving through a' Chhahni,' the bran being known as ' Cho kar,' but m uch of the pe ricarp remainsin the flour which is eaten as a ' roti,' and the vitamin value of the seed doesnot appear to have been much impaired in the process of preparation of the flour.

Lathyrus sativusstyled matra and batra in Rewa, and variously known inIndia as ' kesari,' ' teora,' etc., has now to be considered.The ' karya m atra,' or black p ea, which is the only va riety of L. sativusgrown in Rewa, is the large-seeded dark-coloured variety which grows on uplandwheat land. If the seeds are small, the diminutive ' matri ' is applied to themvariation in colour yields another distinction, ' Bhura matra 'which is of slightlypaler hue, and if the seeds are much flattened, it is called " chipta matra.' Allippear to be substantially the same stuff. ' Goliya matra ' is the seed of anotherlegume which I have not been able to identify but it is a close relative of ourgarden pea. It is grown in the Cen tral Provinces in Damoh and Saugor, whereit is called ' batra.' and there is used as a ' dhal ' but not as a ' roti.' ' Bagalpurimatra ' is the name given in Re wa to the sm all-seeded pale-coloured Lathyrussath-us grown on rice lands of the Gangetic plain, which is imported duringfamine years. It is not grown in R ewa, and is not seen there in normal years.Matra is in Rewa the staff of life of the working classes at all times, and,owing to its ability to grow in a soil which is too dry for th e other ' rabi 'cereals,of the general population in years of sc arcity. The labouring manHkes it ; he considers ' matra roti ' to be ' filling at the price ' and thinks its energy-yielding value to be considerable. An Abair (R ewa ) kahaw at exemplifies thisview :

Matra .ki dhal men dal de hing,To reng chale Sambhar ke sing.Translation : ' Only put a dash of asaftida in the dhal of matra, and even adried sambhar's horn will (come to life and) walk.'It is considered to be ' humble fairin ' and a Brahmin patient will not readily*>wn, ' coram pub lico,'. to its e xtensive use in his own household. W hen ques-^ boned as to his diet preceding an attack of lathy rism, he will commonly give*>aginary accounts of a sumptuous and varied fare whose accuracy one learnedto discount by observing the grins on the faces of the listening audience, and from

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458 A Field Study of Lathyrism. T. C. McCombie Young. 459a knowJedge of the paucity of such fare in the famine year in which, perchancethe case had devel oped.

Those who can afford to be more fastidious in their feeding consider tht-' mat ra roti ' to be hard, difficult to masticate, and indigestible, while they knowits proneness to produce lathyrism. Ordinari ly the better class household usesit as a ' dhal / t aken with' rice in the evening meal, and under such circumstanctiit never reaches one-thir d to one-half proport ion of the diet, which Buchanan andother observers agr ee to be dangerous. There ar e areas, however, where itspredominance in the crops entails its being eaten in large quantities mixedwith wheat or barley as a ' roti ' (see notes on Kotar, where the amount omatra eaten is large, and the number of cases is considerable) . For eating,matra is gr ound , unhusked, in the ' Chakki,' to form a yellow flour which isbaked into a ' roti,' eaten without sieving by the lower classes. Better classpeople may remove the husk from the flour before preparing the ' roti .' As a' dhal ' it is like the other pulses, husked in the ' Chakra,' which breaks the slidland turns out the yellow hemispher ical endosperm, which is separated from thehusk by shaking in the ' supa/ and boiled and eaten with rice.

Thus matra, and now for its ill effects. . CLINICAL. V

The clinical manifestations of the disease have been recorded in great detailby earlier observers, who had, moreover, t he opportuni ty in famine years, of sseeing large numbers of cases, of recent ori gin. Continued search has, in the'jcourse of this invest igat ion, revealed only 13 cases which occurred in 1926.*!Examination of old cases might have been multiplied ad lib, but it was foundJthe water pour s over this cause way th e refuse is carried away and spread l>vthese waters over the fields which they flood, and thus their fertility is effectivelymaintained. An inspection of the fields suggested a predominance of legume*,especially lathyrus, in the crops tha t they yield. An examination of the foodgrains used in the village and the accounts given by the villagers as to their dietconfirm th is. The heaps of ' rabi ' grain crops given in barter in the bazar andin the bania's shops show a large and predominant proportion of lathyrus, whichis of the large-seeded variety, the ' karya matra ' of the wheat uplands of Rewa,with a small admixture of ' goliya matra/ another legume.Th e commonest mixtu re is the ' jao ber ra/ of barley and lathyrus, theproportions vary ing, but in all cases lathyrus forms the larger portion. Themixture of lathyrus and wheat is less commonly seen, as the amount of wheatgrown locally is small. As it is a valuable grain, for which there is a demandelsewhere, it is sifted out from the mixed crop and sold to raise money andthe lathyrus is retained for consumption and for the wages of the field labourers.In both wheat and barley berra, there is a certain amount of gram.In none of the numerous samples examined by me could the seeds of Akri(Vicia sativa) be detected, despite the plentitude of this weed in some of the fields.Mango trees ar e numero us, and mango ' panna ' is much drunk during themango season, in May and Jun e. Usually even the poorest obtain it, and it isused to wash down the dry and unpalatable ' roti ' of matra, when no ' matha ' orbuttermilk is obtainable by -them. Ma hua trees are likewise abundant. Theflowers are sun-dried and stored and parched for immediate Consumption, form-ing a sweetmeat which is not unpalatable to European taste.A wild plant yields a leafy vegetable known as ' Chorai/ which is gatheredin Chait-Baisakh (Apr il-May- June) by the Kachhis and is bartered in thevillage by them. It is generally eaten d uring these months, at ten or twelveclays' interval, but the poorer classes who have little food grain to spare for barter,cannot get it, and in a year of g rain shortage, no one can afford to obtain it.

The staple diet of a b etter class B rahmin household, while the ' kharifcrop lasts, is, in the morning, a ' roti ' made of barley and matra, the latter pre-dominating, washed down with panna (mango decoction) or matha (buttermilk)according to the time of the year; and in the evening, rice, with a dhal of matra,cooked whole.On this diet four mild cases of lathyrism occurred in 1926. The proportionof lathyrus in the diet varies in inverse ratio to the affluence of the family, a n"the poorer classes live for eight months of the year on an exclusive diet oflathyrus (nichela matra) and four months on Kodon, with a little dhan andsome matra.Families in comfortable circumstances can supplement this diet with son*milk or ghee, and a little green vegetables, the poorer labouring classes have

&% .

none of the former, and little, of the latter, except for such small amount ofchuna shoots, ' chuna ki bhaji ' which they obtain in the cold weather. Fleshmeat is hardly ever eaten, even by those castes who indulge in it, except on therare events on which it is obtainable as game.According to the village school master, malarial fever is very prevalent inOctober, as might be expected from the amount of the low-lying land whichsurrounds the village.The population of the village in the last census was 1,774. all Hindus exceptthree, who were Mohamm edans, The re were 369 houses, 856 Hindu males and918 Hindu females.A rough census of the number of cases of lathyrism in the village wasobtained by summoning a prominent man from each Moholla and getting him ioname those in his quarter afflicted with lameness. The figures thus obtained w ere11C males and 26 females, total 136.On these figures it would appear that 7-6 per cent of the total population,or 12 S per cent of the male population, and 2-8 per cent of the female populationare affected with lathyrism, and it is probable that these numb ers ar an u nder-estimate.It appears, therefore, that the description ' lame Ko tar ' currently applied tothis village, is justified by the condition of a population, 12-8 per cent of whoseadult males are crippled by lathyrism.On the supposition that lathyrus diet is the primary cause of this calamity,the state of affairs in this village is readily explainable. Fro m the foregoing notesas to crops and diet, it will be seen that the population lives very largely on a.lathyrus diet, which is the predominating food grain in this area. A local kahawalexpresses this dpendance on lathyrus in rhyme:' Matra ki roti, matra ki dhal,Matra hi pati rakhan har!which may be translated as follows :' Bread of matra and matra as dhalMatra indeed is the guardian of all/Possibly the barley-lathyrus ' berra ' which they u se is a more dangerousdiet than the wheat-lathyrus more common in other Mouzas of the Rewan' Uparihar ' and the lack of variety and the comparative shortage of the ' kharif 'rops of Kotar may also be an unfavourable factor.The villagers say that in former years they grew much more matra thanthey do now, and that this was the cause of the excessive lameness and of thepithet ' lame Kot ar/ and they recall that in the famine years, to which all the olderod more seriously affected cases refer the onset of their complaint, nothing butatra grew.Under present-day conditions, a small annual crop of mild cases is occurring.cases were reported to have occurred in 1926, of these 6 cases were seen andas lathyrism. O ne was absent from the village, one was not a case^..Jin but of injury, and a third was of doubtful causation and may havesyphilitic, 5 cases of 1925 were seen.

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468 A Field Study of Lathyrism. T. C. McCombie Young. 469Owing to the discouragement by the State of the growth if lathyrus, and thfact that the last few years have had good monsoon rains, and good grain is ajpresent fairly plentiful, the 1925 and 1926 cases were comparatively few, andtheir symptoms light. Nevertheles s the amount of lathyru s in the diet of thUcommunity is unusually large and to this fact coupled with the poverty an* accomplished, and the lathyrism cases begin to appear.Moreover, in a year of deficient rainfall and famine, when such cases are"^oas, the ' kharif ' crops, normally varied in kind and plentiful in quantity,1 *hich the poorer classes depend for their nourishment, have been inadequate,


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470 A Field Study of Lathyrism. T. C. McCombie Young. 47 1and the population, especially the poorer classes, who suffer most from lathvr'has been exposed to privation, malnutrition, and vitamin depletion, and art icondition of grave nutritional instability, caused by a diet deficient in fat-soluhle ASome evidenc e in regard to the existence of an avitam inosis of A is afford-i by certain facts that came to light regarding night blindness in association with =>the prevalence of lathyrism.

McCollum (1925) states that 't his is a condition which seems related to ^deficiency of fat-soluble A in the diet of man.' He rega rds it as 'a specific!syndrome of dietary origin' and suggests that 'a diet derived too largely from!cereal products, tubers, and other foods having similar deficiencies, indi*lowered vitality which becomes manifested, among other ways, in faulty visicMy observations indicate that this condition is very common in Rewa.Major C. H. Smith , I .M.S., Superi ntende nt of the* medical departmentRewa State tells me that it is common in the jail, mostly in the hot weather}months when vegetables from the jail garden are lacking and in this connectioofit is noteworthy that the fat element of the jail is derived from vegetable!oils, not ghee.The Sub-Assistant Surgeon in charge of the Nagod State Dispensary tefls*}me that he sees a number of cases in the hot weather months and that he connects^its occurrence with a lack of fat in the diet.Mr. J ardine , the Manager of the Sutna Lime W orks, sees cases of this]disorder of vision among his labour force and he first drew my attention to the|belief in the efficacy of chuna leaves' chuna ki bhaji,' as a remedy.For this complaint, known as Rataondhi, the traditional Indian remedy of a 3diet of goat's liver (a source of fat-soluble A ), wit h a poultice of goat's liver te;the eyes, is well-known.Ghee is also esteemed as a remedy and is used as such by those who can]obtain it.A Brahmin cultivator expressed to me the unprom pted opinion that those who!eat ghee do not get Ratao ndhi and t hat the first milk of a newly calved cow i$-also efficacious as a cure.' Chuna ki bhaji,' the green prunings of the young chuna plant is, however,^the most universal remedy among the vegetarian poorer classes. Thus in the family of a lathyrism case No. 5 1, the story was told me that the young wife o fj|the patient had, in August of the year in which the husband developed lathyrisnyjsuffered for six days from night blindness. He r old mother-in-law produced!some dried ' chuna ki bhaji ' which was kept in the house, soaked it in water, put]it up on the roof of the house overnight, and fed the patient on this, who foundjherself cured in two days.

It is significant that in one family the man developed lathyrism and thenight blindness in the same month and on the same diet.That the association is not fortuitous is suggested by the observation thatKotar village where, as we have seen, 12 per cent of the male population arcjafflicted with lathyrism, night blindness is extraordinarily prevalent.

m

This is embodied in a local kahawat, a jibe against Kotar, which runs asfollows : ' Bkai andltar, ekai lui,Ekai chale matkawat kul,Ye dekho Kotar ke shul.'' One is blind, another halt, and another lame with swaying hips; behold thetroubles of Kotar ! 'Inquiries showed that the particular form of ' And har ' zvas night blindness,while i lie tilting and wriggling movem ent of the pelvis in la thyrism ' matkawatjjul "_i s considered a diagnostic feature of that disease.My case notes show that in the diet of lathyrism cases in particular, as inthe diet of the population in general, there is a conspicuous absence of the leafyvegetables, and of whole milk, ghee or dairy products containing butter fat, whichare believed to be the most plentiful sources in a well balanced vegetarian diet offat soluble A, while in regard to Kotar it is seen that this community whichsuffers severely from lathyrism, also suffers from night blindness, an evidence ofthe lack of fat-soluble A in its diet. W ith this may be contrasted the state ofaffairs in the ' control ' village of A miriti, w hose inhab itants grow and eat asmuch matra as the average Hindu villagers do, but being Mohammedans they

supplement their cereal ration with fish and flesh meat and substances containinga modicum of fat-soluble A. This village has no lathyrism cases.In Sind, which the writer subsequently visited on another inquiry, it appearsthat Lathyrus satiznts is grown and eaten, but cases of lathyrismknown as' matar mandai ' are very rare, and occur under exceptional conditions of scarcity.The Sind villager grows and eats Lathyrus sativus, but he also keeps herds o?fine upstanding cattle and buffaloes, which give a plentiful yield of milk, which isconsumed by the owners, and they also grow and eat green vegetables in con-siderable quantities. The conditions which, with a lathy rus diet, are in Rewaassociated with the occurrence of lathyrism are absent in Sin d. I am indebtedto Dr. Shiveshwarkar. Assistant Director of Public Health, Sind RegistrationDistrict, for the opportunity of perusing his report on an outbreak of scurvyin a Sind jail where, in addition to the lack of vitam in C in the diet, thesubstitution of lathyrus dhal for the other more expensive legumes from whichit had been previously prepared, was associated with the appearance of symptomsof lathyrism. This observation would also appear to mark an association oflathyrism with nutritional instability and avitaminosis, in this case of C.

\ A C T O N ' S A M I N E T H E O R Y . It is now for consideration what bearing the observatio ns have on the twotheories of causation which it has been the work of the writer to investigate in" : field.In regard to Acton's theory of the formation of a poisonous amine byitrmination, it may be noted that his investigations (Acton, 1922) were made inAugust 1921, i.e., in a period following the year 1920 when the rains and the"harif ' crops had failed and the people were subsisting after eleven months ofJ, MR - 14


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472 A Field Study of Lathyrism. T. C. McCombie Young. 473

rhapflI j V l

privation, on the inadequate ' rabi ' crop of 1920-21, supplemented byimported grains.It has been shown that in a normal year, no importation of grain occurs andthat the ' Bagalpu ri ma tra ' whose germination he sugg ests to be the causethe disease, is never used. He suggests that the indigenous vetch is per]non-poisonous, but of the 13 recent cases seen by me all had been eating ligrown matra and of the eight samples of such grain that were obtainablewere of the large-seeded variety, the ' karya matra ' of the wheat uplands'1Rewa.From this it would appear that the locally grown matra is as potent to plathyrism as is the imported ' Bagalpuri matra ' whose consumption in a f;year has earned it an undeservedly evil reputation in Rewa,a disrepute produe to the circumstances of its use rather than to any inherent and special toxiiHe noted that the majority of cases seen by him gave the month of Julythe time of onset, and he suggested that this indicated the possibility that ge:tion of the grain occurs during the rains, which produces the poisonousto the ingestion of which he considers the symptoms of lathyrism are due.Buchanan (1904) paras 52 and 64 to 67 of his report, has shown that threemonths of lathyrus diet at any time of the year will determine the onsetlathyrism, and it would appear that the facts which he cites afford a credible1explanation of the appearance of the cases in July when three months of pre-ponderating lathyrus diet since the harvesting of the ' rabi ' crops in April, hadbeen accomplished, without assu ming germ ination and a poisonous amine to bethe explanation.The possibility of the occurrence of such germination was, however, cart;fully investigated. In none of the specimens of Lathyrus stivus whichformed the staple diet of eight cases before the onset of their disease, was anysign of germination detectable, and this was confirmed by the Director of theInstitute of Plant Industry, Indore, A. Howard, Esq., C.I.E., to whom sampleswere sent for examination.It does not appear likely that such can occur. The g rain is harvested in;the hot dry month of April. It is stored in the houses in a large sun-bakedearthen jar called the Kutu li. *Grain which is to be used for seed is mixed with wood ashes to prevent theinroads of weevils, while that required for use is kept in the Kutuli and takenout and spread in the sun at frequent intervals to keep off weevils. It is unhusked,''and the pericarp is thick and resistant and unlikely to permit of the germ beingactivated by an increase of atmospheric humidity. iI was informed by all whom I questioned, that only such grain as has beensoaked in water will germinate, and that if it does, it is rejected as unfit forfood. INo field evidence can therefore be discovered which suggests that an importedgrain is the offender or that germination of the grain occurs, while the Julyincidence seems more credibly explained by the completion in that month of-*,period of three months' diet of lathyrus. rather than by the occurrence ofhypothetical germination.

had]

AKTA CONTAMINATION THEORY.It will be recalled that Anderson , Howa rd and S imonsen (1925 ) observedin 30 specimens of Kesari obtained from different parts of India, the onlyapi constituent common to all was the narrow leaved vetch, Vicia sativa var.ustifolia, known in the vernacular as ' Akta. 'Their chemical investigations showed that the seeds of L. sativus containedalkaloid but the seeds of V. sativa var. angustifolia, were found to containR n co of two bases showing alkaloidal properties, viz., vicine and divicine, and annn oge tic glucoside, vicianin. Divicine produced by inoculation of guinea-pigscharacteristic fatal disease, and a series of animal experiments indicated thatducks and monkeys fed on Akta the majority showed a definite syndromegwhat resembling human lathyrism, although by no means entirely similar tosymptoms which were absent in ' controls ' fed only on Kesari.The possibility that lathyrism is due to the presence in commercial Kesari of>eeds of this contaminating weed was, therefore, examined in great detail incourse of this investigation.This weed which is known in Rewa as ' Akri ' is a wild vetch which growsmoist soils. It is to be found in most fields which surroun d a tank. SomeL say be found in a moist corner of a wheat field at its lower end where a bndh

[bas been thrown up to retain in it the monsoon rains. It is sometimes fairlyF plentiful in ' dumat ' fields which grow rice during the ' kharif,' and wheat, etc.,[ doring the ' rabi ' season.It is a true weed, and it is never seen in the drills in which the seed hasi sown through the ' nali,' but in the soil between the furrows.I 1 the seed were a constantly present contamination of the harvested crop, it would be found also in the sowings, as no special pains are taken to purify the^ted which is sown, which is identical with th at consum ed.? Us absence from the drills, which I was at pains to verify by a carefulstudy of a large number of growing wheat fields, shows its absence from the' sown seed and seems to affcrd a reasonable presumption of its absence from thecrop as it is eaten.Everywhere the villagers were emphatic that it is bitter unpalatable stuffwhich is never eaten by man and that it is always weeded out and used as cattleiodder. They say that if a field contains an appreciable quantity of it, it mustbe carefully weeded out, else it will damage the crop and reduce its yield.During Feb ruary . I was everyw here able to see this work in- progress andto nark the bundles of Akri being brought home as cattle fodder (Plate XL V I,figs. 8 and 9).The villagers point out that the Akri pods ripen before the matra pods andtkat they burst and scatter their seeds on the ground before the matra isi "*n"ested, and that little or none of the Akri which has not already been[.gathered for cattle fodder is mixed with a 'b er ra ' or a matra harvest. Matra*s usually grown as a mixed cropa ber ra, and this m ixed crop is usually passedthrough a sieve to separate the more valuable wheat or barley from the cheaperoatra . The ma tra seeds being the larger, are retained by the mesh through whichwheat passes, and this explains why a very occasional seed of the minute


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474 A Field Study of Lathyrism. T. C. McCombie Young. 475seeds of Akri may be found in a handful of wheat from the bottom of a pThe large-grained ' Karya matra, ' the cheap grain w hich is fed to ' lugwas ' andwhose consumption causes lathyrism, ordinarily contains no Akri.The "only crop in which a very small percentage of A kri may be found is n' berra ' produced in a somewhat moist field which in the previous year had beensown with wheat and matra, etc., and for some reason is being allowed to liefallow u nder a self-sown, unweded crop, consisting chiefly of matra and alittle wheat, with some wild vetch in places.Such a crop is given to the ' lugwas ' and may admittedly contain ' one pice inthe rupee ' of Akri, but such slovenly methods of farming are very rare, I onlysaw one such field in four months' wanderings. .None of the many samples of matra in current use which I collectedcontained any Akri seeds, which are easily distinguished from the large andcharacteristic seeds of the upland wheat lands, although it may be more difficultto distinguish them from the smaller seeds of the grain grown on rice lands.Six specimens of grain which had been eaten by lathyrism cases were sent to

BarleyWheatRiceLinseedGram lentils,etc.KesariAktaEarthWeevils* ..

SAMPLE I.250

28139

22

48954

A greatdeal.Weevilledbut no liveweevils.

SAMPLE II.18

891149

6570

Very little.Many liveweevils.

SAMPLE III.293

36307

30315

None.Fewweevils.

SAMPLE IV.3

807

16

4970

' None.Veryweevilled, many liveweevils.

SAMPLE V.2

32

60

6570

None.Very fewweevils.

SAMPLSVI.286417

8640

A greatdeal.No weevils.

*The weevils which infest matra were sent to Mr. Bainbrigge Fletcher, ImperialEntomologist, Pusa, for favour of examination.He reported ' that they are not real weevils, but are a species of Bruchus (Bruchidx) ofwhich several species attack pulses in India.' He advises that they occur practically throughoutthe world in various species of peas and beans and that it is therefore unlikely that they areconcerned in cases of lathyrism.'

Mr Howard for examination as to the presence in them of Akri contamination,in specimen No. 1, which was the leavings at the bottom of a grain bin, totbc lxirtom of which the small seeds of Akta and grains of earth, and otherthris had found their way, 54 seeds suspected to be those of Akri werecparated from a total of 489 of Kesari, not including seeds of other foodains . T" e a v e r a e weight of Kesari seeds to Akta seeds is about 5-5 to 1 and{be proportions by weight of Ke sari and Akta were therefore about 50 to 1,while the percentage by weight of Akta in the mixture, which also containedbarley and other food grain s, was still lower. In specimen N o. 3, also one ofleavings, the proportion by weight of Akta to Kesari was about 111 to 1 andas considerably less in the total m ixture .It has been remarked that the weed is more abund ant in ' dumat ' f ieldswhich grow rice in the ' kharif ' and are more moist than the wheat lands. W erethis contamination the cause of lathyrism, one would exp ect the disease, withibe weed, to be more common in rice lands than in wheat lands. In Rewa could find no evidence that this is the case, nor does it appear that the diseaseb more prevalent in the rice lands of the Gangetic plain than it is in the uplandwheat lands of Rewa, where the weed is rare and the disease is common.The villagers are emphatic in rejecting the suggestion that Akri is evermixed with matra or that it is eaten in any appreciable quantity, and the opinion

of those who sow, grow, weed, reap, harvest, grind, bake, and eat their ownjrain is worthy of credence.They clench the m atter by po inting out that ' Akri grows only in moistfields and that in a famine year w hen lathyrism cases occur in great numbe rs,the fields are all dry and no A kri gro ws: how then can it produce la thyr ism'?Taking everything into consideration, therefore, I can find no confirmationof the theory that lathyrism is caused by a contamination of Lathyrus sativtts bvihe weed of Vicia sativa. D I S C U S S I O N .Having failed to find evidence that lathyrism is due to an amine formed byCtrmination or to contamination of the grain by a poisonous weed, it remains todiscuss what other possibilities of causation are suggested by this investigation.Lathyrism is pre-eminently a famine year phenomenon, it is one of thepain.s and penalties of poverty and malnutrition, and the mechanism of itsproduction is as follows :In a year when m onsoon ra ins fail, the ' kharif ' crops on which the po orerclasses depend for a varied and cheap variety of cereals are in defect, and thePeople are now ill-fed and half-st arved . Th e wheat an d barley of t he ' rabi 'crops fail to germinate in the dry soil, only the lathyrus grows, which is harvestedm April, and the bulk of the population has to live chiefly on that and on^*ch imported grains as they can obtain, of which lathyrus, being the cheapest the most used.Three months of such a diet brings on an abundant crop of lathyrism cases,J*ginning in July and continuing until the resumption of a better balanced diet September and October when the ' k h a r i f ' crops become available if themonsoon rains have been more bountiful. In a year of normal rainfall


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476 A Field Study of Lathyrism. T. C. McCombie Young. 477only those whose circums tances of life app roxima te to famine condition*acquire lathyrism and the striking feature of a pre-lathyrism diet, apart fromthe preponderance of lathynis, is the absence from it of the protective foodsubstances of M cCollum. The notes on Kotar village show that where one ofthe recognised effects of a diet which lacks in fat-soluble A viz.. night blindness, jis very prevalent, lathyrism is rife; whereas the 'control' Mohammedan villa 1of Amiriti, also using lathyrus as a foodstuff, but adding to its diet other'articles as eggs, fowls, fish and flesh meat, is entirely free from lathyrism. These]indications seem to point to the possibility that lathyrism is allied to the defidediseases in the mechanism of its causation.Further examination of the available data seems t show that sudhypothesis supplies some explanation of the epidemiological and aetiologicalalready noted. In regard to the greater incidence in the years of greatest, physici]activity, the ages 10 to 20, and 20 to 30, an analogy with the deficiency disberi-beri and pellagra, may be noted, the incidence of which is highest among thosljwhose work is hardest (M cCar rison, 1 921 ). The influence of excessive physicexertion in determining the attack of deficiency diseases has been notedMcC arrison who re cords th at ' the onset of hu man beri-beri is often rendeacute, or that of hunger oedema sudden by excessive physical exertion ' andquotes others in support of the view that 'exposure to cold favours theof scurvy, malnutritional cedemas and pellagra.' As we have seen, exertionwettings are often the immediate antecedents of lathyrism. ' ;slIn regard to sex incidence, which is from 5 to 10 times greater inthan in females, apparently only an essential sex difference can explain it, forwomen share equally in the work of the fields and their diet differs in nofrom that of the men. -'McCarrison notes a different sex incidence in the deficiency diseases, beri-and war oedema, and in experimental polyneuritis columbarum, and attributthis in part to ' different metabolism and endocrine action in the twoNo other explanation seems applicable to" the markedly different sex incidein lathyrism and the analog y is perh aps significant.It has been shown in these notes that a common antecedent of lath)an attack of malarial fever (which is often treated by ten days' star' Upas ') or by dysentery, smallpox, or pneumonia.

W hile such may be regarded as conditions tending to lowering of the viniand as such sufficiently explained, from the point of view of dietary stthey may perhaps be regarded as periods of vitamin depletion which wouldthe appearance of a deficiency disease . The six months of starvation afinsufficient ' kharif ' crop, which precedes the mass outbreak of lathyrism 1famine year, may perhaps be similarly construed.In regard to a preponderance of the legume Lathyrus sativus in the dietcommunity suffering from lathyrism and its bearing on the subjectcussion, we may recall views of recent workers in dietetics.McCollum (1923) states that 'the protein molecule is a chain-like stof amino acids ' and points out t hat ' the nu tritive value of a protein deon its yield of the indispensable amino acids and the extent to which

oroportions correspond to those existing in the body proteins into which they aretran* a prolonged ingestion of a legume, the amino acids of whose proteins areUnsuitable as a diet and perhaps specially harmful, which is itself deficient infat-soluble A.!- In regard to such experimental work it may be noted that while epidemio-, ">|pcal observations point to a prolon ged period of avitaminos is being an esse ntialk or in the production of lathyrism, experimental workers, Stockman (1917),^Anderson, Howard and Simonsen (1925), were at some pains to eliminate^** far as possible, the influence of avitaminosis on their experimental animals.^ , l li e observations cited in this report suggest that this failure to reproduce: >e conditions which attend the o nset of lathyrism in man may have been the^ause of their lack of success in reproducing the disease in animals.


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478 A Field Study of Laihyrisrn.Further experimental work, reproducing as far as possible in animals th*pre-lathyrism avitaminosis as seen inmen, would, therefore, seem to be desiraUfIf successful, the results of such work would yield deductions of considerablepractical value. -Pending such confirmation, some practical preventive inferences seem

now, to bewarranted. AsActon has pointed out (Acton, 1922), the ultimate!causes of lathyrism areeconomic. Its prevention turns on administrauWjimprovements aimed at reducing poverty, providing a better balanced dietpreventing the exclusive use of lathyrus inyears of deficient rainfall.In Rewa, irrigation would prevent this dependence on rainfall, but aswhether a system of ' flow irrigation, utilising the waters of the river Scis a practical engineering proposition and onewhich is within the financresources of the State, the writer is not competent to offer any opinion.4 Lift ' irrigation from wells, using a water lift operated by bullocksispossibility which would similarly require technical consideration. Itsintrodution would presumably require capital for initial expenditure and maintewhich the ' rayat ' has not got, and the State would presumably have to finait by loans.An obvious requirement is an increase inthe village roads and cart tracThis would make it worth while for the villager togrow more and l>grain, which he could getaway, and sell, and thus provide himself withfood and with some financial reserves totide over a period of stress. It wealso enable the State tosupply him with a grain not liable toproduce lathyriswhen, inthe absence of irrigation, famine relief measures are required in a yfollowing a bad monsoon.If the writer's views are well founded that avitaminosis dueto lack ofuse of dairy products and green vegetables, isan essential factor inthe prodiition of lathyrism, then measures aimed at increasing the yield of milkimproving the breed of cattle and at encouraging the growth and use ofvegetabwould be valuable in its prevention.The prohibition of the cultivation of Lathyrus sativas hasbeen triedState administrators in Bundelkhand, andBaghelkhand, following the exaof European rulers of the 17th century (Stockman, 1917).It has been shown that this vetch isnormally sown as a mixture with wror barley, etc.,as an insurance against famine, and effective prohibition weleave the cultivator with nothing toeat indry year when his wheat failed,order is usually evaded bya mixed sowing in which, it isclaimed, the lathyrusself-sown, as indeed much of it undoubtedly is.Furthermore, this hardy and universally cultivated legume, some of whicis present inevery wheat-field inRewa, doubtless serves a useful functionconserving the nitrogen of the soil in fields which are notmanured andcontinuously cropped, and it almost certainly serves a useful purpose forreason ifno other.If not used in undue proportions, it is a valuable food crop and >nopinion of the writer, efforts should rather be made to obviate, by the measur

T.G. McCombie Young. 479ta involuntary misuse by over-use, inpreference to endeavouring, l e g i o n w hi ch c a nn ot in the nature of thmgs, be obeyed.

(1922)ox, H O W A R D and S I M O N S E N(1925)IAK. A. (1904) ..IAN. R. (1917) . .oN, R. (1921) ..

Lvu, E. V. (1923). C. and MACLEOD, A. L. (1922)

C E. and PANDIT JANKI, PAUHAD (1907).

R E F E R E NC E S .Causation of Lathyrism inMan. Ind. Med. Gaz., July.Studies onLathyrism. Ind. Jour. Med. Res., Vol. XII ,No. 4, April.Report on Lathyrism intheCentral Provinces, 18961902. Nagpore Civil and Administration Report.Edin. Med. Gaz., November.Studies in Deficiency Diseases. London. HenryFroude and Hodder & Stoughton.The Newer Knowledge of Nutrition. NewYork.McMillan & Co.Vital Factors of Food. New York. D. Van NorlandCoy.Central India State Gazetteer Scries, Rewa State.


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E XP L AN ATION OF P L ATE XLJII.Fig. 1. Sepaiya, a crawler. 2. Chida, much adductor spasm and spastic equinus.

PLATE XLIII.

Fig. I-

Fig. 2.


16/18

F*.E XP L AN ATION OF P L ATE XLIV.

3. Lall Mun, marked spastic equinus.4. Spastic equinus and adductor spasm.


17/18

EXPLANATION OF PLATE XLV.Fig. 5. Adductor spasm and spastic equinus. 6. Cross legged scissor.gait due to adductor spasm.


18/18

E XP L AN ATION OF P L ATE XL/VI.;. 7. Progression with bent knees due to flexor spasm.8 and 9. Akri gatherers .

lathyrism india field study mccombie young 1927

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