Lathyrism

LATHYRISM, a disease arising from poisoning by a special type of chickling pea Lathyrus, in Russian called 'china' (L. sativus, L. cicera and L. silvestris). The harmful effects of consuming china as food were already known to Hippocrates, who described the occurrence of prolonged weakness of the lower extremities in the inhabitants of Ainos who ate beans. In the 17th century in Württemberg there were so many cases of poisoning from china that a special edict was issued prohibiting its consumption. Throughout the 18th-19th centuries there are numerous mentions of both sporadic and endemic cases of L. During a mass poisoning in India in 1856, thousands of victims were counted, in Kabidia in 1883, 1,200 people fell ill. In Russia only one mass poisoning is described in the Saratov province during the hungry year of 1891, where about 140 workers were affected. The bread eaten by these workers consisted of 1/3 china and 2/3 rye flour. In addition, porridge made from china was consumed. Patho-anatomically only one case was examined (Filimonov). The main changes were observed in the spinal cord, and among them, the degeneration of the lateral pyramidal tracts was prominent. To a much lesser degree, sclerosis of the direct cerebellar pathway and Goll's pathway was expressed. Significant changes were found in the cells of the cerebral cortex, mainly in Betz cells (decrease in number, wrinkling, expansion of pericellular spaces). The literature is much richer with experimental material. In the experiments of Mingazzini and Buglioni on rabbits, feeding the animals china for just 1 month led to the development of spastic paraplegia. Anatomical examination of the nervous system, however, gave a negative result. Mirt fed rabbits and guinea pigs with china and achieved in them the development of acute poisoning phenomena and anatomically discovered severe changes both in the cells of the cerebral cortex and especially in the cells of the anterior horns of the spinal cord (perinuclear chromatolysis, atrophy of dendrites). In addition, the author also found changes in the white matter of the spinal cord, namely, a systemic disease of the lateral pyramidal and Goll's bundles. Spir experimented with dogs using various types of china and found that all species of Lathyrus can cause paralysis phenomena and most quickly L. silvestris. The latter affects the cells of the cerebral cortex most, while L. sativus affects the gray matter of the spinal cord most. The clinical picture of the disease is very stereotypical. As already observed by Hippocrates, the main features are those of spastic paraplegia of the lower extremities. In the initial stages, paresis phenomena are sometimes observed also in the muscles of the trunk, upper extremities and even the neck. Further, in the initial stage, disturbances are observed from the side of urination: increased and painful urges, which patients must immediately follow, as otherwise they lose urine. Sometimes incontinence of feces is also observed. And finally, the third symptom consists of circulatory disturbances in the lower extremities—constant sensation of cold, sometimes also a distressing sensation of burning, cyanosis, decrease in skin temperature. The course is subacute. Already after a few months the disease phenomena reach their maximum development, to then (of course, if china is excluded from food) go into decline until certain stable phenomena remain. Disturbances from the side of the pelvic organs as a rule are transient in nature, and as the only symptom of past poisoning, the typical spastic paraplegia of the lower extremities remains—paralysis or paresis with increased muscle tone and tendon reflexes, with pathological reflexes, without significant atrophy and without reaction of degeneration. The diagnosis of the disease presents no difficulties if anamnestic data are known. On the contrary, it is extremely difficult if diagnosis has to be made only on the basis of the clinical picture in the residual stage, since the latter does not present any differences from the usual picture of lateral sclerosis. The prognosis in cases where acute phenomena have passed is favorable for life and very unfavorable for the disappearance of symptoms. Treatment by the usual methods of therapy for spastic paraplegia gives in general only very modest results. Prevention consists in the complete elimination of Lathyrus from food.