IDIOPATHIC OXALURIA - OXALURIA NERVOSA.
Putting aside what may be termed the physiological, accidental, and vicarious causes just mentioned for the production of oxalate of lime crystals in the urine, there remains a class of cases in which a constant supply of this salt appears in the urine, and it is to this class that the terms oxaluria, idiopathic oxaluria, oxalic diathesis, oxaluria nervosa have been applied. It must be acknowledged that we know very little concerning the causes of this condition, and though the literature is as abundant as it is theoretical, it is at the same time confusingly polemic.
Sir William Roberts is strongly convinced that oxaluria is only one of a long list of symptoms, and one having the least significance, and many well-known authorities support him in this view. On the other hand, the opinions expressed by Prout, Bird, and Begbie are in dorsed by many, such as Cautani, v. Jaksch, Peyer, Ultzmann, and Oberlander. This view is, that there are certain complaints char acterized by pains in the back and loins attended by rapid emaciation in which the only other subjective symptom is an excessive elimina tion of oxalic acid in the urine.
Dr. Bird (" Urinary Deposits," 5th ed., p. 251) gives the following account of the symptoms which accompany oxaluria: " They" (the patients) " are generally much emaciated excepting in slight cases, extremely nervous, painfully susceptible to external impressions, often hypochondriacal to an extreme degree, and in very many cases labor under the impression that they are about to fall victims to consumption. They complain bitterly of incapacity of exerting themselves, the slightest exertion bringing on fatigue. Some feverish excitement with parching of the palms of the hands and soles of the feet, especially in the evening, is often present in severe cases. In temper they are irritable and excitable, in men the sexual power is generally deficient and often absent. A severe and constant pain, or sense of weight across the loins, is generally a prominent symptom, with often some amount of irritability of the bladder. The mental
faculties are generally but slightly affected, loss of memory being sometimes more or less present." Cantani distinguishes two forms of oxaluria nervosa, in both of which the presence of oxalate of lime in the urine is pronounced. In the first the patients are emaciated and complain of a feeling of general discomfort and of digestive disturbances—dyspepsia, flatulence, and constipation; of sleeplessness, hypochondriasis, melancholia, capri ciousness, bodily weakness, loss of energy, diminution of mental power, rheumatic pains. Often there are progressive emaciation, pain in the kidney region, eczema, and psoriasis. The urine is very acid and concentrated and dark, similar to that passed in febrile diseases. It is of a high specific gravity, and it is often also heavily charged with solids, uric acid, and urates. The second class includes obese patients who are troubled with the usual loin pains, but also complain of characteristic neuralgic lancinating pain along the whole length of the backbone, and along the extremities. 'Gastralgia is also present. Small purulent collections, such as furunculosis, car buncle, and abscess, which perhaps result from the blockage of the capillaries with oxalate of lime, are suffered from. Nervous symptoms and great weakness are marked, but the patient does not emaciate. After an absolute flesh diet for some days not only does the oxalate of lime disappear from the urine, according to Cantani, but also the nervous feelings gradually abate. If neglected or badly handled such patients invariably form calculi in the bladder or kidney.
Beneke,* who has subjected this question to an elaborate exam ination, in the way of both experiment and observation, has formu lated the following propositions : 1. Oxaluria, a condition which accompanies the lighter or severer forms of illness, has its proximate cause in an impeded metamorpho sis, that is, in an insufficient activity of that stage of oxidation which changes oxalic acid into carbonic acid.