Epidemic dropsy in India

Epidemic dropsy results from ingestion of edible oil adulterated with Argemone mexicana (Mexican Poppy) oil. The outbreak of epidemic dropsy in the Indian capital, New Delhi, during the rainy season of 1998 was of one of the most severe forms and had repercussions in both health and political circles. Some 2552 cases were reported and 65 deaths occurred between 5 August and 12 October, causing untold misery and economic loss to the affected families. The actual figures are likely to be much higher due to nonreporting of milder cases to the hospitals. The aim of this article is to consolidate and update the available information on clinical aspects of epidemic dropsy.

The condition was first reported by Lyon in 1877 from Calcutta 1 and has since occurred in other countries including the Fiji Islands, Mauritius, Madagascar, South Africa and Burma (Myanmar). 2 In India, it has been reported from time to time from the States of West Bengal, Bihar, Orissa, Madhya Pradesh, Uttar Pradesh, Gujarat, Maharashtra and Delhi, 3-13 generally sparing South Indian States where the predominant cooking fat is coconut oil.

The word Argemone is derived from the Greekargema meaning cataract in the eye, as the juice of the plant was used as a remedy in diseases of the eye. In India the plant has numerous vernacular names of whichSatyanashi meaning devastating seems most appropriate. 14 The Prickly Poppy has been used as a medicinal plant in several cultures.

Aetiology

Based upon numerous epidemiological and clinical studies and human and animal feeding trials, it has been firmly established thatArgemone oil is responsible for epidemic dropsy. 5 15-19 It occurs due to the use of contaminated mustard oil (with which Argemone oil is completely miscible) 20 for cooking and massage. 21 Adulteration of other types of oils (linseed, rapeseed, groundnut, and other vegetable oils) has also been reported. 22-24 In South Africa, an epidemic occurred due to contamination of wheat flour. Other contributory factors are the consumption of a diet rich in carbohydrates and low in proteins, as well as poor premorbid nutritional status. It has been observed that those consuming a protein-rich diet tend to develop a relatively mild form of dropsy. 25 The active toxic principle ofArgemone oil,...