Further Research on Epidemic Dropsy · FURTHER research on epidemic DROPSY ,n we devoteu uui just...
Transcript of Further Research on Epidemic Dropsy · FURTHER research on epidemic DROPSY ,n we devoteu uui just...
_^T-> 1937] EDITORIAL nJ7
Indian Medical Gazette
OCTOBER
FURTHER research on epidemic DROPSY
,n we devoteu uui
just over two years ago .
dropsy, but editorial to the subject of epi
.
n0 means
as our readers are aware this ^ sjnce its first
an unusual departure becaus -
01U- first recognition in Calcutta in 18( '
ently formed reference to it in 1880, it has
,-+orjai columns
the subject of discussion in our in the intervening thirty-five
'rYt for so
Our excuse, if excuse be n
^ubiect is that, frequently returning to the sami ^ WOrk that
in spite of the immense amo .
0f names ?*
has been done and the long .Lcparch workers, distinguished physicians and -with these principally in Calcutta, associ
tiie aetiology ?* investigations the final proof oi : *
In our
this serious disease is still u
(Ty|any theories last note on the subject we sai
formulated, regarding the disease have
history and have lived their day, and be
sentence is
have been revived again ?
events of the more than ever justified by past two years.
0pPnt work faulty As a result of the most recex
upon
or infected rice, which has jia(j proof
for a good many years, an
establish after proof added from time t
production it, as the fundamental
Pfi in its pride of
epidemic dropsy, is tinea ^ade to Set
of place and an attempt has appears that
up mustard oil in its '
ewer mustard oil the rice
supporters and the respect and
advocates are in agreement i pre_formec
that is that a toxic body, ^ acterial or other
in the food or produced by probably the
action in the intestine, is m .
keen isolated cause of the disease. A t?xm
^ liarmfu , from
specimens of rice judg ^aS failed to i
but up to now chemical analysis gubstance, |
reveal in mustard oil any m]
t liave been ;
and samples of oil from sitoch have appeared
connected with recent outbre*, an kno\\n
to be fit for human consump methods of examination. ,
GCCasion upon This is by no means the
entjoned as the :
which mustard oil has been
-^ernic dropsy, possible or probable cause o
it waS first because
nearly thirty year-n?e then the idea :
suggested as such and ever these adherents
has had its adherents. }ay public
have been among those of
Qr jiaci sufferec Were in intimate contact wi
0f the from the disease, but this ca
^ arc highly latest recruits to this theory
e carried ou trained
research workers w i ^Qg^ approved
their investigations on 11 modern lines of research.
They have considered the subject from several angles and have produced epidemiologic* evidence based on the careful analysis of
numerous factors that there appears to bo o
correlation between the factors considered am
/the use of special stocks of mustard oil Theso opinions have been strengthened by production of the symptoms of the disease in volunteer* fed on the oil. There are some criticisms that may be levelled against the conclusions arrived at. For instance five of the six positive experi mental cases had casts (some hyaline and some granular) in the urine. Nevertheless a fairlv good case has been made bv Dr. Lai and his associates for mustard oil, at least as the vehicle of the causative agent if not the actual causp itself. But an equally good and in some res! pects a better case was formerly made in favour of rice being the root of the trouble so
mustard oil cannot yet be looked upon as the
proven cause of epidemic dropsy although this research indicates it should perhaps have further attention paid to it from this point of view In our opinion one of the most valuable products of this investigation is that it has supplied fresh evidence that epidemic dropsy can occur in persons who have not used rice at all so it should stimulate further search for the causa- tive factor on wider lines than have hitherto been employed. It is possible that the substance causing the disease is carried by but is not an intrinsic constituent of any one food Another small but important paper' has been
published recently by Bt.-Colonel Chopra and other workers in which evidence of a toiic body m the blood plasma of epidemic dropsy cases
has been demonstrated by the effect of such plasma on cell growth j? tissue Clllt especially on those of the embryo heart Burins this part of the investigation it was noticed that some of the degenerate cells showed cyto- plasmic granules and attempts were made to
propagate a possible virus on the chorio-allantoic membrane of the egg. A few suspicious lesions were produced and it is claimed that the same
type of lesions were caused in five successive
generations of eggs by passage, but the infect- ing agent was lost after that. This work is
suggestive but cannot be considered definite
enough to establish the presence of a filterable virus in epidemic dropsy. The conclusion of these workers, that the presence of a
' toxic
agent' has been demonstrated in the plasma of epidemic dropsy patients, must be accepted,'but whether this unknown body is a primary toxic agent or a secondary one arising from cell
damage by the real causative factor or yet may be of the nature of a virus must be left for further research to determine.
The baffling nature of the aetiology 0f this disease naturally leads to speculation and wo crave the permission of our readers to embark' upon a small speculation of our own and to
suggest the revival of still another theory that may be worth while inquiring into more fully
618 THE INDIAN MEDICAL GAZETTE [Oct., 1937
than has been done hitherto. It is the theory that the fundamental cause of epidemic dropsy is a dietary deficiency, which permits of the establishment of an otherwise innocuous infec- tion and the production of toxins with all the attendant signs, symptoms and pathological changes. When one reads the histories of beri- beri and pellagra one cannot help comparing them with the investigations into epidemic dropsy, and when this has been done one must be impressed by the fact that these diseases, whose aetiology is now firmly established, went through practically all the stages of theorizing through which epidemic dropsy is now passing, and they were successively ascribed to similar
causes before they were removed from that once large but ever diminishing group of diseases of
unknown aetiology. This editorial should serve to show that the
difficulties in finding the cause of epidemic dropsy are not disheartening to the workers
engaged upon it, but rather do they seem to be
stimulating them to greater efforts, and at the
same time attracting new recruits to this in"
triguing field of research. To the worker ?r
group of workers who finally discovers the cause of this serious and important disease the honour will be great in proportion to the difficulties that have to be surmounted, a fact whicn should add still further impetus to the work.