Lathyrism India Bihar Lal 1949

7/29/2019 Lathyrism India Bihar Lal 1949

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OCT., 1949] LATHYRISM IN BIHAR : LAL 469engaged as labourers in the fields of the villagelandlords and were getting wages in the formof grains of t he cheapest type.. ' Khesa ri ' alwaysformed a major percentage of the wages becauseit was cheap a nd easy to grow. The number ofpersons affected together with sex incidence isgiven in table I.

TABLE INumber of persons affected together with sexincidenceDistrict

P a t n aMonghyrDarbhangaTOTAL

T o t a lnumberofaffectedpersons. ! 1432749. | 219

i

M a l e

13S2746211

Female

53

i S

PERCENTAGEM a l e96.5 :100.093.9 ;96.2

F emal e3.56.13.S

It is very difficult to assess the age of thepeople in villages, and an approximate ageincidence of the affected persons is given in tableII. TABLE II

121825

Age groups

to 16 years . .to 20 yea rs . .and above

Male

: iss188

F e m a l e

35

PERCENTAGEM a l e

6.843.6585.83

F e m a l e1.362.28

Table III gives thedifferent types of food. intake of calories and

Types of food consumedDiet surveys were carried on all the affectedfamilies. . All the food taken was weighed twicea day, before cooking, for a to ta l period of10 consecutive days on the lines suggested byAykroyd and Krishna n (1937). Altogether, thefood intake of 150 families consisting of 857,per-sons was investigated. Diet surveys of theunaffected families were also carried on. Forbrevity the relevant figures only of theunaffected families are given in table IV.Of the cereals consumed, maize, ragi andbarley were the most important items, while riceand wheat were in a very small quantity.' Khesari ' wa s t he most import a nt pulse con-sumed. The consumpt ion of other articles offoods too was below the standard suggested bythe Nut rition Advisory Com mitt ee (1944-). Theonly source of fats was mustard oil. Ripemangoes and ripe jackfruits were the fruitsconsumed by the families in Monghyr whilethose in Patna were found to take onlv greenmangoes.Analysis of _ the diets of the affected andunaffected families for vitamins made with theuse of the tables in Health Bulletin No. 23(1946) is given in table IV.The affected families of Monghyr were con-suming ripe mangoes and ripe jackfruits whichhave a high carotene cont ent. It is because ofthis that though the consumption of leafyvegetables, fruits and milk was lower than thatof Patna, s ti l l the figures for vi tamin A arenearlv the same.

The intake of vitamin A was below thestandard laid down by the Nutrition AdvisoryTABLE II IAverage intake oj calories and types o f food in oz. per consumption unit/day{affected families)

Name of , C e r e a l s p u i s e gdistrict : ;P a t n aM onghyrD a r b h a n g a

16.06 132712.66 ' 10.7425.57 ' 329

L e a f yveget ables1.150.560.59

Non- l e a fy \ F a t s and ! Fl'eshveget a bles; oi ls foodsi1.49 0.33 ! 1.060.93 i 0.10 ! 0.441.61 0.07 0.99

Milk a n dmi l kpr oduc t s1.160.170.30

F r u i t sa ndn u t s0.790.60ni l

Condi -men t s' 1.180.710.13

Calories32212,4212.904

TABLE IVIntake of vitam in and percen tage of ' Khesa ri ' in the diet of affected and unaffected familiesper consumption unit/day - - .

P a t n a .MonghyrD a r b h a n s a

FamiliessurveyedAffected . .UnaffectedAffectedUnaffectedAffectedUnaffected

! Percenta ge of' Khesari 'ii . . . .. i' ' ' 74.1. 1 2.0542. i 2.5. ! 79.63-5

Vi t ami n ,I.U. .2.8344,8482,8794,0121,8304,142

V i t am in Bi,m g.3 21.8.1.6.1.92 .5 1.6

Vitamin C, .. m S -. 24213.6/: : - 37 S10 242 A3.0


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L70 THE INDIAN MEDICAL GAZETTE | OCT.. 149Committee (1944) aneigne same was true forvitamin C as well.

State of nutritionIn order to assess the state of nutrition, allthe children available were examined clinicallyon the lines described by Mitra (1940) and rated

a s ' good ', ' fa ir ' or ' poor '. Ta ble V gives t heresults of clinical rating by naked-eye examina-tion.

whether it is a deficiency disease. The low-intake of vitamin A by families of Darbhanga'Jdistrict does not reflect the incidence of it sr"deficiency in the children of the place, which'"may be due to the fact that the children while-playing in gardens and orchards consume fruits'which could not possibly be recorded in thesurvey. There does not appea r to be significantdifference in the incidence of the diseasessupposed to be due t o deficiency of somenutrients, between the children of affected andunaffected families.TABLE VIncidence of state of nutrition amongst children of families affected and unaffected withlathyrism

R A T I N G

District Familiessurveveci Good Fa ir Poor

PATN'A Affected

Una f fec t f

M O N G H Y R Affeded

U n a f f e c t e d

DAR B HAXGA ; Affected

U n a f f e c t e d

B o y sGi r l sT O T A L

j B o y si G i r l s.TO TA L

( B o y ?) G ir l sT O T A L .

. B o y s! G i r l sT O T A L .

Boys\ GirlsTOTAL

\ Boys1 GirlsTOTAL

Actual!

Percentage ; Actual Percenta ge j Actual Percentage434083231740

403070

302050

5126

312 556

14.422.3

18.2

1S.419.2

20.422.4

16.117.6

30.418.2

151942457450

1249876

1769070

160180S 3263

9085-175

51.52.1

51.353.7

45.14S.7

50.058.2

57.156.4

58.463.1

1034G1494726

79501296040

1008438

12241950

34.625.5

32.629.S

36.432.1

29.619.9

26.625.8

10.91S.6

Deficiency diseasesAykroyd and Rajagopal (1936) have stressedthe value of the presence of deficiency diseasesand their correlation with the state of nutrition.The children of the unaffected families werein a better s ta te of nutri tion than those of theaff ected fa milies. The incidence of phrynoderm aand xerophthalmia which are supposed to beassociated with the deficiency of vitamin A wasnot so high as compared with angular stomatitisa nd ca ries. There is yet no agreed opinion bydifferent nutrition workers on malocclusion and

Clinical findingsHistory of sudden onset of the disease waselicited from a large majority of the patients.They sta ted that usually on getting up in themorning they felt weakness in legs, whichprogressed on to th eir present condition. Ina few cases the onset was after an attack offever. The fever mostly was malaria. Theother findings were those of upper motor neuronlesion.Table VI gives the findings of the survev.


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OCT.. 1U49J LATHYRISM IN BIHAR t i l1ABLE VI

Percentage incidence of diseases supposed to be associated with malnutritionPercentage found to be suffering from

District Famil ies ; To ta l ; ;: number p h r y n 0 _ ! X eroph- Angularderma thalmia s tomat i t is c . i r j p c

P A T N A AffectedUnaffected

M O N O H T R Affected

BoysGirlsBovsB o y sGir ls

Unaffected j GirlsDARBHANGA ; Affected

U na f f e c t e d

B o v sGi r l sB o y sGi r l s

297ISO14493217156180130315147162119

S .610.47.613.9S .78.97.06.95.14.S0.72.1

DiscussionLathyrus sativus is mostly mixed with Viciasativa and is consumed along with the l a t ter .Every villager in the affected localities believest h a t the disease is caused by eating ' Khesari '(Lathyrus sativus) ; but so far experimentscarried on animals in various laboratories haveyielded conflicting results. McCarrison (1928)could not produce the clinical picture of la thyrismin rats even when they were fed on pureLathyrus sativa or on Vicia sativa. Snook(1948) observed no ill effects when a wetherand two cockerels were fed on Vicia sativa.Bhagvat (1946) working on guinea-pigs couldnot produce any paralysis in them. Lewis et al.(1948) fed Lathyrus sativus at 50 per cent levelto ra ts wi th no symptoms of la thyrism.Mellanby (1930) could produce experimentallathyrism in dogs by a diet composed of varie tyof pea, Vicia sativa, and deficient in vi tamin A.Further suggestion that this vitamin mayfurnish protection against lathyrism is supportedby the experiments of Geiger, Steenbock andParsons (1933). Mellanby (1930, 1934) hasput forward the theory tha t l a thyrism was dueto an active neurotoxin, the effects of which couldbe prevented by protective foods containingvi tamin A and carotene even when much of thetoxic agent in Lathyrus sativus is consumed.McCombie Young (1927) also was of the sameopinion. The present investigation showed thatthe in take of Lathyrus sativus was high with avery low or almost negligible consumption ofsuch protective foods which would be sources ofvi tamin A and carotene. The in take of caroteneand vi tamin A too was very low and all of thishad been derived from leafy vegetables and

7.08.86.211.8S.I2.51.51.9

2 2? , ' . 4ni lni l

15.71S.714.524.712.412.112.413.5

4.16.15.22. 0

14.814.715.918.211.713.410.714.5

3 46.87.12.6

M a l -occhis ion5.66.54.S9.65.97.1nil-ni l1.92.0nilni l

T o t a lpercentagesufferingfrom oneor otherdisease41.42S.349.328.509 ^23/7

30.224.5

16.123.117.312.6

fruits. The value of vitamin A has been calcu-lated from carotene of which only a very smallpercentage, from 1 to 2 per cent, can be utilizedby the system (Moore, 1933).A review of the literature mentioned hereshows that the exact aetiology of the disease isstill obscure. The present survey revealed thatthe diet of the affected families was deficient inqual i ty and quan t i ty and contained a high per-centage of ' Khesari '. Surveys carried out inthis province have revealed a similar state ofintake except that nil or very little of ' Khesari 'was in their diet. It appears tha t l ack ofadequate nutr ients in the diet lowers the generalbody resistance and concomitantly to t h a t ofthe lower segments of the spinal cord too, tothis toxic agent. The low in take of vitamin Afor a long time coupled with the high intake of' Khesari ' for a length of time possibly leads tothe development of the disease. This is furthersupported by the fact that families in the sameaffected areas with adequate vitamin A (tableIV ) and low ' Khesari ' in take did not reveal anysymptom of the disease. Considering all thefacts it appears reasonable to conclude that poordiet with low vi tamin A in take and high con-sumption of ' Khesari ' {Lathyrus sativus) for alength of time allows the toxin or toxins presentin the pulse to act and damage the nerve cells,already devitalized by the individual living on apoor diet, till a time comes when the paralysismanifests itself. The evidence collected and thesuggestions put forward are in consonance withthe theory of Mellanby and McCombie Young(loc. cit.).Jacoby (1947) too, from the study of a seriesof cases, found tha t 'Khesari ' or ' Teora '


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472 THE INDIAN MEDICAL GAZETTE [OCT., 1949(Lathyrus sativus) was invariably associatedwith lath yrism. Furt her, hisfindingswith regardto a poor nutritional background are the sameas those reported in this paper. He is also of asimilar opinion, that deficiency of vitamins mayform the clinical background upon which thetoxic agent of '' Khe sa ri ' exercises its effect. Theincidence of B complex deficiency amongst the

patients were 15.5 per cent, as against 14 percent reported by Jacoby {loc. cit.).y,o reason could be elicited from the surveyfor the high incidence of the- disease inmales. The suggestion put forth by Shourie(loc. cit.) t h a t the high incidence was due togreater intake oi Lathyrus by males couldnot. be corroborated in the present investigation.It has been noticed that both males and femalesof the families surveyed worked for the samehours in the field, and hence the other suggestionthat since the males only work in fields, theircalorie requirements, and so their intake ofLathyrus sativus would also increase, has notbeen borne OUT.Summary1. An outbreak of lathyrism in three districtsof this province has been described.2. Diet surveys of the affected familiesrevealed high consumption of Lathyrus sativusand low intake of vitamin A.3. The s t a t e of nutrition was commensuratewith the calorie intake.4. A suggestion based on the field studiesregarding the cause of the disease has been ma de.

AcknowledgmentI am grateful to my assistant Dr. A. Bose for helpingme in collecting and analysing the data.

REFERENCESAYKROYD, W. R.. and Indian ./. Med. Res.. 24, 667.

KRISHNA^, B. G.(1937).AYKROYD. W. R.. and Ibid., 24, 419.

RAJAGOPAL, K. (1936).BHAGVAT, K. (1946) . . Ibid., 34, S7.CHOPRA. R. X. (1938) . . The British Encyclopaedia ojMedical Practice, 7, 651.Butterworth and Co., Ltd..London.GEIOEB, B. J., STEENBOCK. ./ . Nutrition, 6, 427.

H., and PARSONS. H. T.(1933).HEALTH BULLETIN X O . 23 The Manager of Publica-(1946). tions, Government of India"'"" Press, Delhi.

JACOBY, H. (1947) . . Indian Med. Gaz., 82, 53.L E W I S , H. B.. et ai J. Nutrition, 36, 537.(1948).

MCCABRISON, R. (1928). Indian J. Med. Res., 15, 797.M C C O M B I B " Y O U N G , T. C. Ibid., 15 , 453.

(1927).MEGAW, J. W. D., and Indian Med. Gaz., 62, 299.GUPTA, J. C. (1927).

i MEU,A>-BY. E. (1930) . .Idem (1934) . .

MITKA. Iv. (1940)MOORE. T. (1933)XUTRITIOX A D V I S O R YCOMMITTEE (1944).

j .SHOUHI, K. L. (1945) . .X .. W. H. (1S44).

?XOOK. L. C. (1948)

Brit. Med. ,/., i, 677.Nutrition and Disease.

Oliver and Boyd, London.Indian J. Med. Res., 27, 887.Biochem. J., 27, 898.Report of Sub-Committee onA utrition-al Requirements.Indian Research FundAssociation. Xew Deihi.Indian J. Med. Res., 33, 239.Rambles and Recollectionsof an Indian Official.Hatchard and Sons,London./. Agrie. We t Australia. 2S,47 .

a b e 3noa n riDebca ta s

INSANITY IN INDIA(From the Indian Medical Gazette. October1899, Vol. 34, p. 373)THE following tables, compiled from thereports upon the Lunatic Asylums of Bengal,Madras and the Punjab, show the relativenumbers of lunatics in the asvlums at the endor the year 1898 :

Idiocy . .Mania(a) Epileptic(6) Other formsMelancholia(a) Epileptic(b) Other forms

1 Dementia(a) Epileptic(6) Other forms . . Mental stuporGeneral paralysisDelusional insanityN"ot 3ret diagnosed or re-covered.

TOTAL TREATED : . :

Bengal

2539

626

4167

3126..2

335S

l.OSo

Madras

3343453

431124

0141

714

Punjab

34

335

S 2: 424

51i13

55S

>

'i1

1%

# 1

From this table it will be seen that in all threeprovinces the vast majori ty of lunatics sufferfrom acute or chronic mania. Idiocy isapparently least found in Bengal asylums andmost in the Punjab. The proportion of insanitydue to epilepsy is somewhat greater in Madra sand Punjab than in Bengal. Forms of dementiaappear much less common in the Punjab.

Lathyrism India Bihar Lal 1949

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