Lithogenesis and hypovitaminosis.

In earlier times, prior to one hundred years ago, lithiasis, particularly of renal origin, was much more prevalent than today. It was in fact the major cause of surgical intervention at that time. As evidence of the former medical prominence of this subject there are some eighty words with the prefik "lith" in medical dictionaries. During the last century, however, there has been in most countries a general decline in the incidence of urinary calculi, which has been noted clinically by some of our older urologists even in the span of their own experience. In America, where calculous disease has always been less prevalent than in Europe, the decline in incidence has been particularly noticeable. The incidence of lithiasis is still known to be unusually high in certain countries, notably India and Egypt, which would seem to suggest a nutritional etiology. Additional "stone areas" have been reported in southern China (Kwangsi Province), Indo-China, Siam, Palestine, Dalmatia, Mesopotamia, and the valley of the Volga in Russia. Clinicians in these areas have attributed the high "stone" incidence to impoverished diets. Kwangsi Province is the poorest part of China. The diet there consists mostly of boiled rice (polished) ; whereas fruit, vegetables, milk and 'meat are only occasionally inincluded. It is significant that most of these areas are districts where a form of civilization has existed since remotest historical time, and where antiquated sanitation, faulty personal hygiene and poor nutrition are still the rule. Recently, in a nutritional survey of Newfoundland (1), the prevalence of renal stone is ref erred to as possibly related to faulty diet. During the previous century urinary lithiasis was a disease of infants and young children mostly ; whereas now the generally lessened incidence involves mostly the older age groups. A possible explanation for these features of incidence will be offered later. Joly (2) states "I believe the hypothesis that stone is a deficiency disease is the most plausible and probable that has yet been advanced. It explains not only all the principal features of the condition today, but also the changes in incidence during the past years. I believe that vitamin starvation acts primarily on the renal epithelium and through it on the colloidal mechanism of the urine ; also that once this mechanism is deranged, stone formation must follow as a direct result of the laws of physical chemistry." Aside from clinical observations, experimental work on laboratory animals suggests a relationship between urinary calculi and dietary deficiency. Osborne and Mendel (3), in 1917, found that urinary calculi, both vesical and renal, could be produced in rats on a diet deficient in vitamin A. (It should be recognized, however, that vitamin A was the principal vitamin known at that time.) In 1926, Fujimaki (4) found that rats on a vitamin A deficient diet developed phosphate stones in the urin-