Oxalates

From Doctor Pearson, Physiclan to St. George s Hospital, Lecturer on the Practice of Physic and Chemistry, &c. London.

CASE III. 

July, 1798. 

A Gentleman, aged about 56 years, who had lived rather in a fedentarv manner, was troubled for five succeffive winters with a cough, attended by a copious spitting. In the Summer he was almost free from these ailments. During the two last of these winters symptoms appeared, which, it was apprehended were those produced by pulmonary tubercles and vomicae. In the early part of the Summer succeeding the fifth Winter, namely, in May 1797, when the patient was considered as labouring under the chronic kind of pulmonary phthisis, besides taking the usual medicines in such disorders, he began to breathe hydrocarbonate gas; which was administered to him by Dr. Thornton. Soon after the use of this medicine, he experienced a very decisive amendment of his pulmonary disorder ; and continued almost entirely free from cough, spitting, and difficulty of breathing the whole of the Summer ; nor did these complaints return in October following, as they had constantly done for several preceding years. In October last it was observed that, notwithstanding the amendment of the disorder of the chest, a gradual wasting of the flesh had taken place ; so that instead of being, as in health, muscular, and rather corpulent, his body was become thin, and his limbs were emaciated. The appetite continued to be as great, and was frequently greater than in health. The pulse at the wrifl was most commonly about 80 in a minute, and never exceeded that number. The tongue had a healthy appearance, and there was pretty constant thirst. The patient had sweat profusely for the whole preceding year. 

I now learnt that he had been accustomed, for five or six years past, to drink to the amount of from five to eight pints of liquids, such as tea, capillaire, fmall beer, wine, water, coffee, &c. in the space of every twenty-four hours. A proportional quantity of urine was discharged ; that is, as much urine, or thereabouts, as he had taken of drink. As will be expected, the nightrest was difturbed by riling to pass urine. The quantity of urine being at first attended to without reckoning the quantity of drink ; and being perceived by the attendants to be sometimes sweet to the taste, the patient was pronounced to labour under the Diabetes. 

The urine also having been tasted by a person of unquestionable accuracy, it was discovered to be saccharine. A parcel which I examined was not decisively sweet, but I was struck with a smell which I had never perceived on any former occafton, namely, that of stale beer. Half a pint of this urine, on evaporation, yielded 400 grains of extract-like matter, which contained no sugar perceivable by the taste. Another parcel of the same urine, on standing ten days in a warm room, in a three pint bottle, which was half full, and closed with a glass stopper, became covered with a white scum, and a deposit took place of seemingly the same fort of matter ; but the urine itself, which was quite clear, smelled strongly of vinegar, and tasted sourish. On distillation, this sour urine afforded three-fourths of an ounce of liquid acetous acid, of nearly the strength of weak distilled vinegar. It may be useful to notice that the patient had lived principally on animal food for several months, and had drunk a pint of wine daily, instead of a larger quantity, as was his custom before his illness. During my attendance occasionally for three months, the urine generally had the beer smell, and on standing became sour. Two or three different times it had however, undoubtedly, the saccharine taste. Some parcels of this patient's urine, which had a fleshy and beerish smell, happening to stand in a closed vessel, in a warm room, from November, 1797, to May following, not one of them had the usual smell of urine of persons in health, nor of putrid urine ; but either smelled sourish, or musty ; and they deposited less, and were covered with white scum. The urine of the patient, however, sometimes smelt like ordinary urine ; but on keeping it did not grow ascetic, nor acquire an animal odour ; nor did it ferment, and became four. It was also found that this last mentioned sort of urine retained the usual acescency of urine of healthy persons, as betrayed by the test of turnsole, even after keeping in a warm room fix months.

The patient was directed to live four days entirely on vegetable food. The urine during this time proved fo irritating to the urethra and glans penis, as to inflame them, and a little of it was even paffed involuntarily. It was observed that the urine excreted during the ufe of this kind of food, contained none of the uric oxide, which is the usual basis of urinary concretions. According to my observation the urine voided, when the food was entirely animal matter, was equally acescent, and fermentable into vinegar, as when it was entirely vegetable matter.

The quantity of urine, in October and November last, never exceeded, according to eflimation, the quantity of drink ; and the quantity of urine seemed to vary proportionally, or nearly so, as the quantity of liquor varied. Except for some slight incidental colds, the patient was quite free from pulmonic complaints the whole of the last Winter, as well as during the prefent Summer. The thirst has abated a little ; the appetite for food has been of late about the fame as it was in health, instead of being greater than formerly. The pulse at the wrift has varied between 70 and 80 in a minute. The wasting of the flesh has scarce continued to go on of late, and the strength has decreased very little for several months past. The urine, however, does not appear to have diminished in quantity; nor to have been altered in its properties, in proportion to the general amendment. The amount of this excretion has been for fome months, at least, five to six pints in the face of twenty-four hours. It flill commonly has a beerifh fmell, and on Handing in a warm room does not ordinarily fmell urinous, and putrefy like common urine, but becomes acefcent, and deposits lees, and throws up fcum as malt liquor does, on growing four. There is no room to suppofe that the quantity of urine exceeds the quantity of drink.

The patient has continued to live almost entirely on animal food, even breakfasting usually on what is called beef-tea, in place of the vegetable matter commonly taken at this meal. When vegetable substances were occasionally taken as food, the urine was increased in quantity, but no effects were otherwise experienced different from those during the ufe of animal food. It was thought advisable to continue, however, the animal food, as it agreed very well with the patient, and as the urine was less in quantity than when vegetable food was taken.

Remarks.

Saccharine matter is not the immediate cause of Diabetes, but the effect of this disease ; and if animal food is beneficial, and vegetable food is detrimental, it cannot, I think, be shown, that it is because the former does not afford sugar and the latter does. In support of your theory, that the Diabetes is not seated in the kidneys, it may be asserted that the kidneys do not appear to be secretory organs, or organs which compound matters of a different kind from those which enter into them from the blood ; for excepting, perhaps, the secreted mucus from the urinary passages, there is nothing in urine that does not exist in the same state of composition in the blood itself.

It has been attested by persons whose abatements cannot be doubted, that the blood has, in some instances of Diabetes, tasted sweet, and that it had other properties denoting sugar. A single positive evidence of this sort ought not to rejected by any number of negative ones. But, in short, blood and urine to most persons taste is commonly somewhat sweet ; and therefore, it seems not improbable, that there is in general, sugar both in the blood and urine of all animals at certain times. It is not doubted that the sweetness of chyle, and of milk, is from sugar. It seems also that the digestive and assimilating organs of animals compound sugar from merely animal, as well as vegetable aliment ; as appears on examining the chyle and milk of animals which live entirely on animal food ; namely, either those which are purposely fed or which are naturally carnivorous. It does not seem that the fluids of animals which feed on saccharine matters, contain more sugar than those which feed on animal substances. Vegetables manured with merely animal matter contain as much sugar in their fluids as when manured with vegetable matter, or probably with sugar itself. But fugar can also be compounded by fermentation, without the aid of live powers, from dead animal matter and tasteless farina. These facts, it may be proper to notice, seem to justify the observation above made, that, on a theoretical ground, we might conclude that animal food was not likely to be either more beneficial, or less hurtful, than vegetable. In this place it will be proper to point out that fermentation is a more delicate criterion of the preference of sugar in urine than the taste ; for the urine of the above patient did not taste sweet, but it fermented into acetous acid.

5. If the Diabetes be essentially an organic disease of the kidneys, one might expect to see air-ways such a diseased state on dissection ; which, however, could not be perceived in Laurie's cafe above related. There are also deflections published by various persons, in a few of which only was any disease {etn in the kidneys ; nor are there, in general, any complaints of the loins, urinary passages, hips, &c. in diabetic cases. Wherefore if organic affection takes place, it should be considered as an accidental attendant, or consequence ; and in this light mould be regarded the diseased state of the liver, spleen, lungs, &c. observed in some instances. At the most, such organic disease can only be confidered as productive of one species of Diabetes, in which, on examination, it is probable the urine will be found to be very different from that in the other species of this disease. The state of the mesentery should be more accurately attended to on diffection of diabetic patients. In Laurie's cafe above described, it was observed to be diseased, but I was not prepared at that time for examination of this part with a view to any theory. The urine ought also to be examined after the death of the patient, as well as while alive. In fome cafes, as the appetite fails the urine diminishes in quantity, and loses its sweetness a short time before death. The theory that Diabetes is a diseased state of the assimilatory organs, accounts for fome of its molt characteristic symptoms ; namely, for the urine containing fugar and other nutritious matters, the walling of the flesh, frequent discharges of urine, thirst, hunger, weakness of the organs of voluntary action, &c* but it does not account for the quantity of urine much exceeding the quantity of drink.

W. Rhubarb was given, by Doctor Wittman, to a patient for four days; a portion of blood was then taken from the arm, and the serum was, as well as the urine, evidently tinged with its yellow

colour, staining linen.

(Rhubard is high in oxalates)

An Experimental Inquiry on Poisoning by Oxalic Acid - 1823

Dr Robert Christison experimented on dogs by giving them 50 grams of pure oxalic acid, which generally causes vomiting, so in order to observe what happens, he sutured the stomach to prevent vomiting. 

He makes observations at different minute marks below:

2’ He began to make violent efforts to vomit, which were frequently repeated, till
12’, when they ceased; and the breathing became full and frequent; sensibility unimpaired; great restlessness,
16’ 30”. Breathing short, and at times suspended for a few seconds; he then hung the head in a peculiar manner, looked very dull, lay down on the side, and would not rise when stirred; at last, when he was set on his legs, he walked easily across the room; suddenly the breathing became very quick and short, and then ceased, although the chest was quite relaxed ; he staggered a few paces, and sank down on the side at
20’, motionless and senseless; the body was now spasmodically extended for a second or two, after which he made a few convulsive gasps; no pulsation could be felt in the region of the heart after the 20th minute.
21’. Death being complete, the body was opened without delay. The heart was distended in its pulmonary cavities, and not contractile; the blood in those cavities was dark, in the aortal florid, in both fluid, and coagulated almost immediately in loose clots.

There are 15 pages of further experiments recorded.

VII. Oxaluria. 

Oxalic acid occurs in the urine, in combination with lime, forming an oxalate which is held in solution by the acid phosphate of soda. About .01 to .03 gramme is excreted in the day. It never forms a heavy deposit, but the crystals— usually octahedra, rarely dumb-bell-shaped— collect in the mucus-cloud and on the sides of the vessel. The amount varies extremely with the diet, and it is increased largely when such fruits and vegetables as tomatoes and rhubarb are taken. It is also a product of incomplete oxidation of the organic substances in the body, and in conditions of increased metabolism the amount in the urine becomes larger. It is stated also to result from the acid fermentation of the mucus in the urinary passages and the crystals are usually abundant in spermatorrhoea. When in excess and present for any considerable time, the condition is known as oxaluria, the chief interest of which is in the fact that the crystals may be deposited before the urine is voided, and form a calculus. It is held by many that there is a special diathesis associated with this state and manifested clinically by dyspepsia, particularly the nervous form, irritability, depression of spirits, lassitude, and sometimes marked hypochondriasis. There may be in addition neuralgic pains and the general symptoms of neurasthenia. The local and general symptoms are probably dependent upon some disturbance of metabolism of which the oxaluria is one of the manifestations. It is a feature also in many gouty persons, and in the condition called lithaemia.