No. of experiment. or neutral salt has been taken. The quantity of oxalic acid passing into the urine is not different, if oxalic acid be taken as such, or in combination with alkalies. But if taken in combination with lime, only a small per centage of the oxalic acid reappears in the urine, because the greater part of the oxalate of lime passes unchanged through the intestines, and is discharged with the fæces, as was proved by Magawley and Buchheim in two experiments. In two experiments with oxalate of magnesia, this salt seemed to be decomposed in the intestinal canal in larger quantity than the lime salt. The quantity of lime in the urine after ingestion into the stomach of oxalic acid, or its salts, is neither increased nor diminished. The following table perspicuously exhibits the results of the above observations: Form in which Oxalic Acid Quantity of Oxalic Per centage in the Spontaneous pre- Lime from spon- The presence in the urine of any considerable quantity of oxalic acid, in any form, for a longer period of time, during which the ingestion of oxalic acid, in any form, into the stomach was excluded, indicates the existence of a disorder, the nature of which is, at present, entirely unknown. This disorder, to which the names of oxalic acid diathesis and oxaluria have been applied by systematic ontologists, has a great tendency to the production of oxalate of lime concretions in the urinary passages. It is not ascertained whether the oxalic acid in these cases is formed in the circulation, or only in the urinary passages, by a peculiar kind of fermentation of some normal or abnormal ingredient of the urine. Loc. cit., p. 240. See further on this subject, Orfila, Toxicologie gén,' 1843, i, 187. Oxalate of lime is frequently found, in not very small amounts, in the urine of patients recovering from severe diseases.1 Thus, Kletzinsky2 examined the first urine, after the attack, of three cholera patients, and every specimen contained oxalate of lime. Its quantity was ascertained by collecting the deposit of oxalate and any precipitate produced by a lime-salt on a filter, and, after washing, dissolving it in hydrochloric acid. To the solution chloride of gold was added, and the mixture boiled, until no further reduction took place. From the weight of the brownish-violet, dicroic precipitate of metallic gold, the quantity of oxalic acid present in solution was calculated upon the basis of 31Au 30 (C2O2+HO). = The first urine of the first patient measured 457 cub. cent., and contained 278 milligrammes, or 0.6 per mille, of oxalic acid. The first urine of the second patient measured 460 cub. cent., and yielded 58 milligrammes of oxalic acid, or 0.125 per mille. Thirteen ounces of urine contained three quarters of a grain of oxalic acid. The first urine of the third patient, 463 cub. cent., yielded 117 milligrammes, or 0.25 per mille, of oxalic acid. Thirteen ounces contained a grain and a half of the acid. The presence in urine of such small microscopical traces of oxalate of lime, that their quantity cannot be estimated by quantitative analysis, is of no practical or pathological importance. The question after their origin is one of the greatest difficulty and the smallest use, and therefore I do not propose here to discuss it. The presence of oxalate of lime in the urine may indicate disease of the kidney, with which it is not rarely associated. The relations between the oxalate and the kidney disease are, however, most uncertain. For, whereas the experiment of Wöhler shows that large quantities of oxalic acid passing the kidneys may so irritate them as to produce the appearance of albumen in the excretion, it is not unreasonable to think that, in some cases of disease or poisoning, a similar relation might exist. But these investigations are surrounded with many difficulties, which make speculation more than ordinarily dangerous. The following case is one in which considerable quantities of oxalate of lime were present in albuminous urine of a patient, who succumbed to disease of the kidneys. 1 Walsh, Month. Journ. of Med. Science.,' Jan., 1849. 2 S. H. Flamm, Cholera und Vergiftung,' Wien, 1856, p. 4. R. D, æt. 30, the wife of a policeman. She had been for some time under the treatment of Dr. Smiles, and improved considerably. Her illness she dates from the time of her last confinement, which was very severe, and caused prolapsus uteri. About six weeks ago, the urine became turbid, and she got very weak and thin; her feet swelled, her body emaciated, and the emaciation was the more apparent as she was pregnant in the sixth month. She had an abscess at the outer side of the middle of her left thigh. Her tongue was very foul, covered with a thick, white fur, and yellowish-brown in the middle. She had little appetite, and could not fancy anything. Her bowels were regular. She was very thin indeed; abdomen very prominent; ber feet were excessively swollen, particularly so over the instep. The urine was turbid on making, and became still more so on standing. She said it was dark, and like blood sometimes. The abscess discharged a thin pus. Urine of May 15th.-Loaded with the urate of ammonia. Reaction decidedly acid. Specific gravity, at the temperature of the body, 1017. It did not become clear, but made a sediment, which became more apparent, and subsided more readily to the bottom when the urine was mixed with twice its bulk of warm water, and allowed to stand in warm water. The deposit, when examined under a power of 400 diameters, consisted of an immense number of small crystals of octahedral oxalate of lime, with which there was a certain proportion of small and large dumb-bell-shaped crystals or bodies mixed up. Epithelial scales and granular casts of the tubules of the kidneys were present in numbers. (See Plate V, fig. 6.) A part of the urine was then filtered and warmed, whereupon it became perfectly clear. On being now heated, it became slightly turbid, and on the addition of a few drops of nitric acid, the fluid became of a dark colour, and the turbidity assumed the appearance of flakes. R Mist. Ferri c. Quinin., ter die. She states the quantity of urine to have been very small a few weeks ago, only one or two table-spoonfuls having been passed at a time, and that not very frequently. May 19th. I was summoned this morning to the patient, who during the night had been attacked by sickness and vomiting. I found her perfectly prostrate. crouched up in her bed, throwing her clothes about in a restless manner. She complained of pain at the back of her head and neck, of pain in her stomach, and particularly across her loins. She was incoherent in her replies, grasping the hand which was approached to feel her pulse. The latter was excessively weak, respiration frequent, evidently blood-hunger, viz., there was more air in the lungs than the heart could drive blood into them to absorb. The vomiting had been very severe, and the retching had continued for several hours from two o'clock last night. I saw the colour of bile on her night-gown. In the afternoon she had got worse, being apparently unconscious, and only at intervals recognising her relatives. Her limbs were in a constant spasmodic action, like severe fidgets, and the levatores angulorum oris were in that peculiar spasmodic action, which constitutes a feature of the sardonic grin, or of incipient tetanus. Pulse weak, irregular; extremities cold. She had twice made water that day. Both specimens intensely acid, contained abundance of octahedra and dumb-bell crystals, casts, and albumen. She died in the evening. Post-mortem examination, May 20th, afternoon.-I was assisted by Mr. J. Paul, the resident medical officer of the St. Pancras Royal General Dispensary. The emaciation of the body was extreme, a skeleton covered with parchment. Abdomen very prominent; dry sore at the outer side of the middle of left thigh; feet somewhat oedematous, particularly over instep. Slight rigor mortis. The pericardium, which contained some serum, was then opened. All the blood-vessels going from or to the heart were then ligatured twice. The heart was then removed, and both sides were emptied of their contents in such a manner as to keep venous and arterial blood separate. Both were fluid, and of a dark crimson-lake colour. There were some fibrinous coagula in the cavities of the heart, having the appearance and colour of the yellow fat of hot roast-beef. The heart itself was excessively thin and flabby, brownish-red, and the tissue in a sort of broken-up condition, a degeneration in which the muscular fibres divide into the elementary fibrils, which appear at the broken end of a fibre like the hair on the end of a painting brush. There was some fatty and some other granular matter, besides numerous nuclei deposited in the substance of the fibres; the heart was very tearable. The lungs were then taken out, after the blood from their veins and that from the upper cava had been collected separately, being taken with spoons out of the pericardium. This too was very thin, and perfectly fluid. The lungs appeared sound in structure, with the exception of a few hard nodes on the tops, particularly the left top, which appeared like contracted scars of healed-up cavities. Some few small tubercles were present. With these exceptions, the lungs themselves were sound in structure; but they adhered to the thorax. The thoracic aorta was somewhat filled with fluid blood. The stomach contained some medicine, port wine, and mucous matter; the small and large intestines presented nothing peculiar. The liver was large, and showed signs of hepatic venous congestion (nutmeg liver). It was taken out with all its vessels ligatured, to retain the blood in the organ. The spleen and pancreas showed nothing particular. The kidneys were of ordinary size, perhaps, a little thicker than usual. In the pelvis, they contained a smeary mass, covering the pyramids and lining, consisting of tubular epithelium and casts, fatty matter, and softened epithelium of the calyces. But no trace of oxalate of lime crystals, either in dumb-bells or octahedra, could be discovered. On a section of the kidneys being made, they exhibited several of their pyramids in fatty degeneration and atrophy, an appearance which was verified by the microscope. The tubular epithelium was fatty. The Malpighian corpuscles were normal in size and condition, and their numbers did not seem to be diminished, except, perhaps, over the fibrous parts, where they could not be detected. The womb contained a foetus of four months. collected, as also some of the blood of the fœtus. Some of the liquor amnii was There was no stone in the bladder, of which also there had been no symptoms during life. The blood showed a degree of leukocythosis, a large excess of white bloodcorpuscles being present. After two days' standing in the corked bottles it coagulated, and permitted the clear serum to be decanted from the cake. This fact deserves attention, for the cases in which fluid blood is found in thé great vessels (heart included) not being rare, and there being frequently no opportunity for letting a sample of the blood stand for a day or two, in order to test it upon its coagulability, the blood may easily be put down as absolutely not coagulable, while the coagulation is only delayed by the peculiar condition of the fluid, and takes place much as usual, only after a certain lapse of time. The decanted serum was dried in the water-bath, and preserved in a wellcorked bottle for future examination. Another quantity of blood, that contained in the ascending cava, the hepatic veins, and the portal vein, was mixed with water before it had time to coagulate; this contained fibrine, serum, and bloodcorpuscles in solution. This was immediately subjected to chemical analysis. The bile, gall-bladder, or its mucus and mucous membrane, showed no traces of oxalate crystals, even after several days' standing, and repeated examinations. There were no crystals in the liquor amnii, nor in the mucus from the surface of the child, the inner surface of the womb, nor in the meconium, which had passed into the liquor amnii. In short, in no part of the body (bladder unexamined) were any crystals detected. I was induced to this examination by u statement of C. Schmidt, who found the oxalate octahedra in the womb and gall-bladder of certain cases. The analysis of the blood, which was conducted with great care, and which it would serve no purpose here to detail, yielded no evidence of the presence of oxalic acid. Concretions of Oxalate of Lime. Sand and gravel.-Small concretions of oxalate of lime of the size of uric acid sand (see p. 110), are rarely, if ever met with. But there is a variety of oxalate of lime concretions, of small size, pale colour, and smooth surface, and usually containing some urate of soda. They are most frequently found in the calyces of the kidneys, and being many in number they exhibit the effects of prolonged attrition. These concretions, termed hemp-seed calculi, or gravel, are not seldom passed by elderly persons after severe nephritic attacks characterising the passage through the ureters of concretions. Renal concretions of oxalate of lime are frequently of a very large size, particularly when uric acid has supervened. According to Prout, the pain and derangement caused by oxalate concretions in the kidneys usually assume different characters from the pain and derangement attending lithic acid concretions. The pain is generally of a more acute character; and though principally referred to a particular spot over the region of the kidney, is often discursive, and shoots in the direction of the ureter, epigastrium, or shoulder. The same author observed, that renal hæmorrhage, referable to concretions, had become very much more frequent after two epidemics of cholera in London. It remains to be ascertained, whether the occurrence of oxalate of lime in the urine of cholera patients had any share in the production of these concretions. Calculi of Oxalate of Lime. The purest concretions of oxalate of lime are the white. crystallized variety, of which I have already noticed three specimens preserved in the Museum of the Royal College of Surgeons. Such a calculus is represented by Prout, on Plate V, fig. 7*. The mode in which the large crystals are deposited on these calculi, leaves no doubt of their having been formed in the bladder from a solution of oxalic acid and lime. On a section, these and the crystalline calculi exhibit peculiar crystalline fibres, running from the centre in irregular curved lines towards the periphery, and mostly ending in the projections which give these calculi their peculiar uneven surface. Though layers may be distinguished, |