_^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.