Historical setting and neuropathology of lathyrism: Insights from the neglected 1944 report by Oliveras de la Riva.

Lathyrism is a central motor system disorder recognized since antiquity resulting from prolonged dietary dependence on the grasspea (Lathyrus sativus). The neuropathology underlying the characteristic spastic paraparesis of lathyrism is sketchy. Described here is a landmark but little-known Spanish-language neuropathological study of two patients with lathyrism of recent onset. Due to erroneous interpretations of Filimonov's influential work in 1926, it was assumed that spastic paraparesis of lathyrism was explained by destruction of Betz's pyramidal cells in the motor cortex. Contrary to present understanding, Betz cells and anterior horn cells were preserved, and pathological findings dominated by myelin loss were largely limited to pyramidal tracts in the lumbar cord. Thickening of the adventitia of capillaries and arterioles, together with proliferation of perivascular astrocytes, was found along the length of the spinal cord. Oliveras de la Riva proposed that the segmental spinal pathology arose because distal regions of elongate pyramidal tract axons are distant from their trophic center in the motor cortex, a view not far from the current distal axonopathy concept of lathyrism. In addition, we review the historical circumstances of Filimonov's work in Russia, a summary of the epidemic of lathyrism in Spain following its Civil War (1936-1939), and some historical aspects of the Cajal Institute in Madrid, where Oliveras de la Riva's work was carried out under the supervision of Fernando de Castro, one of Cajal's favorite students.

Azañón's disease. A 19th century epidemic of neurolathyrism in Spain.

The cultivation and consumption of grasspea (Lathyrus sativus) in Spain probably dates back centuries, especially during times of famine when the neurotoxic potential of this legume was expressed in the form of a spastic paraparesis known as neurolathyrism. Little known outside the country, the epidemic of neurolathyrism in the years following the Spanish Civil War (1936-1939) came to affect more than a thousand people. In late 1872, during the Six Years Revolutionary Term, young Alejandro San Martín Satrústegui (1847-1908), then editor of the popular weekly El Siglo Médico, travelled to Azañón, a remote village in the province of Guadalajara, to clarify a so-far unknown disease. We analysed the original article published in 1873 by San Martin, as well as communications sent by El Siglo Médico readers reporting similar cases in many other Castilian provinces. San Martín's neurological findings in seven personally examined cases were astonishingly accurate; he concluded the subjects' neurological deficits resulted from injury to the lateral columns in the lower portion of the spinal cord. Description of the clinical findings provided both by San Martín, and by the readers of El Siglo Médico, leave no doubt as to the diagnosis of neurolathyrism. However, none suspected the patient's staple food was the determinant cause of the disease. San Martín proposed the eponym Azañón's disease for lack of a better name the same year (1873) in which Cantani in Italy introduced the term lathyrism. The epidemic of neurolathyrism that affected many Castilian towns represents one of the best-documented in Europe during the last third of the 19th century.

[Describing neurolathyrism. Physicians and the lathyrism epidemic in post-civil war Spain]. / Describiendo el neurolatirismo. Los clinicos ante la epidemia de latirismo en la Espana de la posguerra.

INTRODUCTION: Lathyrism is a chronic disease involving spastic paralysis of the lower limbs caused by the prolonged consumption of large amounts of flour made from grass pea, or almorta as it is known in Spain. In Spain it became an epidemic in the early post-civil war years, and this gave rise to a series of studies and clinical descriptions of unquestionable medical and historical interest. DEVELOPMENT: This paper analyses the clinical reports of patients with lathyrism during the above-mentioned epidemic in order to stress the importance of the symptoms and the neurological examination in identifying new cases and in controlling them. One interesting feature that stands out is how uniform these descriptions are, except in the initial phase of the disease, where certain differences have been reported depending on the epidemic area. Likewise, the (typical and atypical) prodromal symptoms, the classic symptoms of the disease and the so-called residual symptoms are all described. CONCLUSIONS: The lathyrism epidemic that occurred in Spain in the years 1941-1943 resulted in a series of clinical descriptions with very detailed accounts of the signs and symptoms written by the Spanish physicians who treated those patients. These reports constitute a valuable historical and clinical contribution on the subject of a disease that has been eradicated in west but is still endemic in other parts of the world.

Describiendo el neurolatirismo. Los clínicos ante la epidemia de latirismo en la España de la posguerra / Describing neurolathyrism. Physicians and the lathyrism epidemic in post-civil war spain

Summary. Introduction. Lathyrism is a chronic disease involving spastic paralysis of the lower limbs caused by the prolonged consumption of large amounts of flour made from grass pea, or almorta as it is known in Spain. In Spain it became an epidemic in the early post-civil war years, and this gave rise to a series of studies and clinical descriptions of unquestionable medical and historical interest. Development. This paper analyses the clinical reports of patients with lathyrism during the above-mentioned epidemic in order to stress the importance of the symptoms and the neurological examination in identifying new cases and in controlling them. One interesting feature that stands out is how uniform these descriptions are, except in the initial phase of the disease, where certain differences have been reported depending on the epidemic area. Likewise, the (typical and atypical) prodromal symptoms, the classic symptoms of the disease and the so-called residual symptoms are all described. Conclusions. The lathyrism epidemic that occurred in Spain in the years 1941-1943 resulted in a series of clinical descriptions with very detailed accounts of the signs and symptoms written by the Spanish physicians who treated those patients. These reports constitute a valuable historical and clinical contribution on the subject of a disease that has been eradicated in west but is still endemic in other parts of the world (AU)

Resumen. Introducción. El latirismo es una enfermedad crónica producida por el consumo excesivo y continuo de harina de almorta (Lathirus sativus), que cursa con parálisis espástica de los miembros inferiores. En España adquirió un carácter epidémico en los primeros años de la posguerra, lo que dio lugar a una serie de investigaciones y descripciones clínicas de indudable interés histórico-médico. Desarrollo. Se analizan las descripciones clínicas realizadas sobre los pacientes con latirismo durante la mencionada epidemia con el fin de destacar la importancia de los síntomas y de la exploración neurológica en la identificación de nuevos casos y en el control de éstos. Se destaca la uniformidad de dichas descripciones, salvo en la fase de inicio de la enfermedad, respecto a la cual se han comunicado algunas diferencias en función de la zona epidémica. Se identifican, asimismo, los síntomas prodrómicos (típicos y atípicos), los síntomas clásicos de la enfermedad y los denominados síntomas residuales. Conclusiones. La epidemia de latirismo que tuvo lugar en la España de los años 1941-1943 dio lugar a una serie de descripciones clínicas de una gran ‘finura’ semiológica por parte de los médicos españoles que trataron a estos pacientes, lo que constituye una aportación de relevancia histórica y clínica en torno a una enfermedad erradicada en el mundo occidental, pero endémica en otras zonas del planeta (AU)

[Two epidemic diseases in Blois region in the 19th century]. / Deux epidemies en Blesois au XIX siecle et leur traitement pharmacologique.

Lathyrism is an ancient neurological disorder caused in human by food contamination with seeds of Lathyrus species. Based on new documents, this paper describes the exact sanitary actions done in the discrict of Blois in 1829. Official reports due to Dr. Desparanches, M.D., describe clinical cases, causes of the disease and its extension in the population. A bacterial dysentry occured mostly in children and poor families in the summer of 1858 in the same district. An official report due to Dr. Monneau, M.D., describes the extension and possible causes of the diseases. In the two reports, sucessful pharmaceutical treatments and public sanitary measures are described.