OXALURIA.
Excess of oxalates in the urine is determined by various causes, the appreciation and detection of which will afford indications for their removal.
Temporary oxaluria sometimes of a severe type is well known to follow the ingestion of certain vegetables and fruits, as rhubarb, sorrel, straw berries, tomatoes and spinach. Such oxaluria is promptly arrested by discontinuing the offending article of diet.
Oxalates constantly appear in the urine when no article of diet contain ing oxalic acid has been ingested. This type often requires prolonged and rigid dietetic treatment. The formation of oxalic, like that of uric, acid is believed to be derived from the oxidation of the purin bases of the food. Hence the diet should be as free from purin bases as possible, and milk, cheese, eggs, butter and rice, with a limited amount of red meat, fish or poultry, constitute a suitable regimen. Milk is especially valuable as a staple food, since it contains no oxalic acid.
The mere selection upon chemical principles of a dietary does not, however, meet all the difficulties of the case. Rose Bradford drew attention to the fact that the origin of the oxalates in many cases is due to fermentation of the food in the stomach usually caused by diminished production of hydrochloric acid, the carbohydrates, especially sugar, being the most prolific factor. In this connection arises the consideration of the intimate relationship of oxaluria with several neuroses of the neurasthenic, hypochondriacal, dyspeptic, neuralgic and spermatorrhceic types. Whether these are the cause or the result of the perverted meta bolism still requires investigation. In either case the indications for treat ment are equally clear; the underlying neurotic condition will demand suitable treatment.
As the stomach suffers in all such depressed conditions of the nervous system, the digestive process should be hastened, and Hydrochloric Acid or Nitrohydrochloric Acid administered in conjunction with Pepsin. Where organic acidity is a prominent symptom this may be aggravated by mineral acids, in which case Alkalies—Sodm Bicarb. or Magnesia— should be administered with 5-gr. doses of Papain 2 hours after eating. At the same time any violation of the established health laws, as irregu larity in the hours of meals, curtailment of sleep, mental pressure, absence of physical exercise, &c., will require correction.
Not only will it be necessary, therefore, to rearrange the dietary on the scale already mentioned, but the eating habits of the patient should also be changed. Thus the heavy dinner indulged in after partially fasting all day may be the cause of oxaluria, and by getting the patient to dine in the middle of the day, and to take a light meal in the evening, the oxalates rapidly diminish. Large eaters should take simple carbonated or aerated water instead of tea or coffee ; concentrated soups are not to be recom mended.
Free open-air exercise is a powerful corrective of the perversion of metabolism, and a change of life in this respect may lead to the speedy disappearance of oxaluria when the ill-ventilated office or workroom is abandoned for the fresh breezes of mountain or seaside resorts. Sleeping room ventilation should be looked after, and the bedroom window left open all night. For the anxious, over-worked city clerk who drives to his small office in the morning, and drives home again in the evening to spend the hours till bed-time in the close atmosphere of a gas-heated room, cycling is a good practice. Sleep should he sound and natural, and all conditions interfering with this must be attended to, neuralgia, insomnia, overwork, or high pressure being remedied as far as this is possible.
Sea-bathing and the Turkish bath, or a good shampooing after perspira tion has been induced by brisk or even violent exercises, are of use. The morning shower bath is to be recommended, and the clothing should be warm and light.
Bicarbonate of Potassium should be prescribed when the signs point to gastric irritation, and the Mineral Acids when atonic dyspepsia is present. A combination of these methods is more rational, the acid with a little pepsin being administered immediately after meals and the alkali given when symptoms of acidity follow from fermentation owing to delay in the digestive function. Ilagge advises that plenty of water should be taken in the morning fasting, and he extols Urotropine as the best of all drugs.