17,1 Guerrero and Concepcion: Xerophthalmia 103 
that xerophthalmia, when allowed to run its natural course 
without treatment, always termjnates fatally. However, he 
has never seen a rapidly fatal case of carbohydrate-dyspepsia 
without xerophthalmia. He believes that the immediate cause 
of death is the loss of the resistance of the patient, and that 
there are evidences to sustain the theory that both the carbo- 
hydrate-dyspepsia and the avitaminosis contribute to the fatal 
termination of these cases. According to him, xerophthalmia is 
often, but not always, of dietetic origin. It is also found in 
tuberculous patients where the xerophthalmia appears to be 
due not to defective diet but rather to the inability to assimilate 
the accessory elements found in the food. There seems to be 
individual power of assimilation, as there are children who 
apparently do very well on a diet that in others would bring 
about serious xerophthalmia. 
Before closing, we wish to call the attention of medical 
practitioners, and especially pediatricians and ophthalmologists, 
to the possibility of meeting in their practice similar cases, 
especially among the children of the poor, who are weaned 
early and placed on a rich carbohydrate diet. We should look 
for these cases in Manila, where the use of skimmed milk 
in the treatment of gastrointestinal troubles is becoming 
generalized. 
