So-called ‘Saharanpur encephalitis,’ with high case fatality, used to occur annually, post-monsoon, in Western districts of Uttar Pradesh (UP). Over 2 decades, Indian Council of Medical Research (ICMR) and National Centre for Disease Control (NCDC) staff failed to diagnose it. A team of volunteer investigators (T Jacob John, virologist; VM Vashishtha, pediatrician; NC Nayak, pathologist; Amod Kumar, epidemiologist; and Mukul Das, toxicologist) diagnosed this encephalopathy with focal liver and muscle necrosis (hepatomyoencephalopathy) to be caused by phytotoxins of Cassia occidentals [1].

History repeats in Bihar, as pointed out by IAP President [2]. The ‘mystery disease’ recurred annually for decades in the North-Western districts, during pre-monsoon months; it was called ‘Muzaffarpur encephalitis’ first and later Acute encephalitis syndrome, as ICMR/NCDC failed to find viral etiology. Again, a volunteer team (T Jacob John, Arun Shah and Mukul Das facilitated by NK Sinha and guided by Maya Thomas) investigated the problem. We diagnosed hypoglycemic encephalopathy and have advised Bihar Health Ministry how to investigate etiology and to mitigate the risk factor of undernutrition [3]. These non-infectious encephalo-pathy cases can be prevented or treated. In UP, public education that Cassia occidentalis is poisonous was enough to prevent the disease [4]. In Bihar, early infusion of 10% dextrose saved lives [3].

In healthcare, incorrect diagnosis or treatment is medical negligence. In public health, incorrect management is public health negligence – consequent deaths amount to homicide by public health negligence [5]. State officials believe that outbreak investigation is the responsibility of the Central Government. In Delhi, the view is that health is State subject; States are responsible for diagnosis and prevention. The unfortunate victims are people without voice.

India’s health management system lacks organization with clear lines of command and is in need of review and repair. IAP can serve as advocate, advisor and guide in this regard.

1. Vashishtha VM, Kumar A, John TJ, Nayak NC.　Cassia occidentalis　poisoning causes fatal coma in children in western Uttar Pradesh.　Indian Pediatr.　2007;44:522-5.

2. Yewale VN. Misery of mystery of Muzaffarpur. Indian Pediatr. 2014;51:605-6.

3. Shah A, John TJ. Recurrent outbreaks of hypoglycaemic encephalopathy in Muzaffarpur, Bihar. Curr Sci. 2014;107:570-1.

4. Panwar RS. Disappearance of a deadly disease, acute hepatomyoencephalopathy syndrome, from Saharanpur. Indian J Med Res. 2012;135:131-2.