JOURNAL Of THEINDIAN MEDICAL ASSOCIATION

CALCUTTA, AUGUST 16, 1963

LATHYRISM

yathyrism, a crippling disease, has been known

Ücenturies among the peasants in India, and the

í'Hindu literature in medicine has a mention of

s disorder. In the 17th century, it was attri-

to eating of the vetch, lathyrus and this

is yet generally held. It is mostly prevalent

|:India, though outbreaks have been reported

>m several European continental countries.ice the beginning of this century one finds fre-

lt reports of the disease, Having occurred in

lie or .epidemic form in several provinces,

tícularly Bihar, Madhya Pradesh and Uttar

idesh.1'10 Except for a few sporadic cases, the

ïse has not been encountered in West Bengal.11

:ent outbreak in this State investigated in

[ail by Chaudhuri et al.12 the report of which

irs elsewhere in this issue will, therefore, be

eiterest.

if, A. G.—Brit. Med. J., 2 : 707, 1903.^BUCHANAN, A.—Report of Lathyrism in the Central

ices in 1896-1902, 1904, Nagpur.toy, D. M.—Indian Med. Gaz., 8 6 : 263, 1951.LCTON, H. W.—Ibid., 57 : 241, 1922.

|HCCOMBIE YOUNG, T. C—Indian J. Med. Res., 15 :

£1927.

ÏANAPATHY, K. T. AND DwiVEDi, M. P.—Studies onEpidemiology of Lathyrism, Lathyrism Enquiry

i. Unit, Gandhi Memorial Hospital, 1961, Rewa

r, H.—Indian J. Med. Res., 18 : 51, 1930.

r JÎD, S. K.—Antiseptic, 41 : 514, 1944.¿RANJAN, N. P.—Ibid., 41 : 652, 1944.

glrfAI,, s . B.—Indian Med. Gaz., 84 : 468, 1949.FCHAUDHURI, R. N.—Annual Rep. Calcutta School

"Med., 1959-60, 1961, Supdt. Govt. Printing, WestGovt. Press, Alipore, p. 34.

AUDHURI, R. N., CHHETRI, M. K., SAHA, T. K.

P. P.—/. Indian M. A., 41 : 169, 1963.

The disease usually affects people belong-

ing to the lower income group who happen

to live principally on khesari dal. Human

lathyrism, also called neurolathyrism is charac-

terised by weakness, spasticity and rigidity of

the leg muscles with increased deep reflexes.

The higher functions, cranial nerves, trunk and

upper extremities escape so that the morbid ana-

tomy is confined to the lower dorsilumbar region

of the spinal cord. While most workers blamed

Lathyrus sativus seed itself for its neurotoxi-

city,13' 14> 15 other investigators16 incriminated

Vicia sativus seeds as the real offender, the toxic

principle being divicine. In any case the precise

causative agent has, however, not been identified.

Surprisingly enough and contrary to the popular

belief, patients with features of lathyrism have

been reported from South India in nonlathyrus

eating population.17"18 On theother hand, several

workers19'21 considered that deficiency of certain

factors in the diet, e.g., vitamin A or carotene,

tryptophane and methionine are in some way

related to the disorder. Metallic poisoning (sele-

nium, manganese, etc.) has also been incriminated

for the neurological features of the disease on the

basis of high selenium or manganese content of the

1 3 ACTON, H. W. AND CHOPRA, R. N.—Indian Med.

Gaz., 57 : 432, 1922.14 MEGAW, J. W. D. AND GUPTA, J. C.—Ibid., 62 : 299,

1927.15 JACOBY, H.—Ibid., 81 : 246, 1946.1 6 ANDERSON, I/. A. P., HOWARD, A. AND SIMONSEN, J.

L.—Indian J. Med. Res., 12 : 613, 1925.17 MINCHIN, R. L. K.—Brit. Med. J., 1 : 253, 1940.18 GOPALAN, C.—Trans. Roy. Soc. Trop. Med. Hyg.,

44 : 333, 1950.19 MEIVLANBY, E.—Nutrition and Disease, 1934, Oliver &

Boyd, London, p. 136.2 0 BASU, K. P., NATH, M. C , GHANI, M. O. AND

MUKHERJEE, R.—Indian J. Med. Res., 24 : 1027, 1937.3 1 RUDRA, M. N., CHOWDHURY, L. M. AND SINHA, S.

P.—Indian Med. Gaz., 87 : 89, 1952.

207

2Ô8 ]. INDIAN M. A., VOL. 41, NO. 4, AUGUST 16, 1963

Lathy rus sativus seeds.22"23 This is comparable to

hepatolenticular degeneration due to copper

poisoning.

It is thus obvious that there is still many gaps

in our knowledge regarding the aetiological back-

ground of the disease. The recent reported out-

breaks have been studied by Chaudhuri et al.11

clinically, epidemiologically and biochemically.

Floods and poverty had driven many inmates of

the particular rural area to cultivate khesari and

live exclusively on the cheap product seasonally

for 4-5 years during which period the disease

appeared in the community. Some members of the

affected family and many others in the area con-

suming similar food, however, escaped. The

authors suggest that the disease in some of these

individuals might have been subclinical or at bio-

chemical level only. In fact, slighter forms are

rarely ever recognised clinically or reported. Bas-

ing their conclusions on biochemical and haemato-

logical investigations the authors for the first time

point out that the disease may be the result of

antigen-antibody reactions, the auto-antigen being

related to the khesari protein and nervous tissue

complex. The hyperglobulinaemia, particularly

increased gammaglobulin, elevated ESR and posi-

tive thymol turbidity test all may be no doubt to

some such mechanism and, therefore, the present

work opens up a new field for investigation which

should ultimately establish or deny the suggested

view.

Autoimmune diseases, i.e., diseases resulting

from antigen-antibody reactions, the antibody

being produced against one's own cells are being

M RUDRA, M. N.—Nature, 170 : 124, 1952.23 SADASIVAN, T. S., SULOCHANA, C. B., JOHN, V. T.,

SUBBARAM, M. R. AND GOPAUN, C—Curr. Sei., 29 : 86,I960.

increasingly recognised. Collagen diseases occur',

ring in relation to the connective tissue, dissemi-

nated sclerosis occurring in relation to the myelin

sheaths of the central nervous system, Hashimoto's

disease occurring in relation to the thyroid gland

have been attributed to the same mechanism. It may

be that the antigen-antibody reaction in lathyrism

occurs in relation to the nervous tissue of the spinal

cord, the injurious effect depending upon prolonged

consumption of khesari and the activity of the auto-

immune mechanism, the site of predilection being

the most vulnerable part of the spinal cord, viz,,

dorsilumbar region.

The authors found that the subjects were tak-

ing khesari for 3-5 months every year during the

said period, and they think such periodical stimula-

tion of the antigen-antibody reaction important

for finally bringing about the overt clinical syn-

drome. Persons in whom the reactions are mild

may only show biochemical abnormality and herein

lies the slender possibility for the prophylaxis of

the disease. At this stage, besides elimination of

the sensitising agent from the diet, use of steroids

may halt the progress of the reactions which may

ultimately culminate in the disease. This no doubt

entails costly and comprehensive biochemical

survey of the inhabitants in the lathyrus growing

regions but is worth consideration, in view of the

fact that the end stage of the disease is crippling

to the sufferer and burdensome to the family and

the State. In any case, all measures to discourage

the use of lathyrus as the staple diet should be

taken,> and replacement of the poor cultivators'

lathyrus crops by paddy, especially during periods

of scarcity, will go a long way to prevent the

disease, as is borne out by the experiences gained

in the reported outbreak of West Bengal.