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that Winsbury-White found an increased incidence of upper urinary
tract lithiasis at older ages among the 866 cases investigated and an
incidence of two cases of urinary stone in males to one case in females,
and that both renal and ureteric stones are more common on the right
than the left side.
He refers to McCarrison's work in India on rats to whose diets
deficient amongst other things in vitamin A, calcium was added, and
states: "McCarrion's experiments have made it clear that it is in
the presence of vitamin deficiency that excess of lime in the water is
a factor." The full extent of the pathological processes which take
place in the body as a result of lack of vitamin A and which lead
ultimately to urinary lithiasis have yet to be defined. One consequence
is that degenerative changes in epithelial structure involve the urinary
tract to a marked degree. There seems no doubt that desquamated
epithelium often forms the nucleus of the stone but whether infection
always precedes stone-formation is a point yet to be settled.
Experiments of Bliss, Livermore and Prather (1933) appear to
substantiate the generally accepted conclusions that deficiency of
vitamin A alone can induce the formation of urinary calculi in the
rat.
These experiments throw light on the incidence of vesical calculus
in Great Britain in former days ; it was in fact in the counties where
the best pasture land was found that stone was not prevalent ; for in
these districts milk and butter both rich in vitamin A and absorbable
calcium were commonly available.
In some parts of the East children develop vesical calculus while
still at the breast. In the dry belts of the world such as Northern
Africa, Arabia, Persia, Mesopotamia and Northern Italy stone abounds.
Because vegetation is scarce, meat, milk and butter are scanty but
the animals which do exist depend on green fodder for vitamin A.
Moreover, the dry food on which they so largely live is rich in calcium
and phosphates. It is not surprising that lithiasis is common even
amongst the animals themselves.
In 1828 William England quoted by Thomas commented on the
following facts :—
(1) The rarity of stone in Ireland where the people lived on
vegetables, potatoes and milk.
(2) The scarcity of stone in Scotland where the diet consisted
of oatmeal, milk, cheese, vegetables and fish.
(3) Its prevalence in Norfolk where the diet consisted of bread,
water, tea and very little milk—the last because pasture land
was poor.
Switzerland and Normandy are two places where the inhabitants
have access to plenty of milk and its by-products and where lithiasis
is rare.
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