Cystinuria A Review of Some Recent Investigations *

The older literature concerned with cystinuria has been reviewed in detail frequently", 21, 38 44. It is, therefore, the purpose of this review to discuss the more recent literature only, and we have chosen to discuss mainly the literature of the past ten years, the period which hlas elapsed since the most recent revision of Garrod's able presentation of the subject"3. Cystinuria, discovered in 1810 by Wollaston, has usually been considered a rare condition. Thus Kretschmer22, reviewing the cases of cystine calculi and cystinuria in 1916, was able to find only 107 cases of cystine calculi reported in the period of more than a century after Wollaston's original observation. With the renewed interest in this peculiar "error of metabolism", the number of cases reported since 1920 has been large. In our own search of the literature covering the period beginning with 1921, we have been able to find reports of 71 cases of cystinuria, although calculus formation has not been observed in all of these. In addition, the author, through the courtesy of Drs. Reed M. Nesbit and A. R. Klopfenstein of the Department of Surgery, has been able to study a case of cystinuria accompanied by formation of calculi. Furthermore, we have also had under observation, for the past two years, four healthy individuals, all of whom present the classical picture of cystinuria, i.e., frequent occurrence of cystine crystals in the urine, although in no instance has the condition given rise to any of the difficulties usually associated with cystinuria, such as calculus formation, etc. A list of these more recent studies is presented in the bibliography. Comment may be made on a few of these cases. Cystinuria had not been reported from the Orient until Misawa34 in 1927 reported the first observation of the condition in Japan. M5rner87 in 1926 ably summarized all the cases reported in Sweden. After the first report in 1 870, no further occurrence was observed till 1901 and only six cases had been discovered up to 1920. In the six-year period from 1920 to 1925, 16 additional cases were recorded, a total of 22 reported in the Swedish medical literature. Of these only four