xiv,s Padua: Cystolithiasis with Dietetic Deficiency 491 
An inference might be drawn from comparison of my findings 
among Filipinos with those among Caucasians. The association 
of phosphatic calculi in the cases here classified as undernourished 
(with an unbalanced diet), and the frequency of urate stones 
among a class of people with nourishment sufficient for normal 
physiological processes are points that strongly agree with the 
incidental findings of Osborne and Mendel(19) in their experi- 
ments upon animals. As a whole, the total phosphatic estimates 
give an incidence of more than half of the total number of calculi 
among Filipinos. It is possible that quite a number of the cases 
at hand, although suffering from the so-called latent form of 
beriberi or other nutritional-deficiency disease, did not give any 
history nor present any suspicious sign of the disease at the 
time of admission, and in many instances the malady may have 
been entirely overlooked (Manalang,(17) Saleeby(21)). All but 
one of my cases (cases 49 to 58, Group I) gave a positive his- 
tory of having had beriberi, and in this particular case the stone 
was essentially oxalate in composition. In only two of the beri- 
beri cases were the calculi made up mainly of urates, and there- 
fore the percentage of phosphatic stone formations in association 
with this disease is greatest. : 
The character of the stone deposit is partly dependent upon 
the influence of the urine reaction. Thus Ballenger and Elder, (3) 
in speaking of the cementing substance that holds the crystals 
together to form the calculus, say: 
This doubtless varies with different stones according to the acidity or 
alkalinity of the urine. Stones composed of uric acid, urates, calcium 
_ Oxalate, cystin and xanthin develop in acid urine while those consisting 
of calcium carbonate and acid phosphate of calcium arise in alkaline 
urine. Stones of ammonium or magnesium phosphate are precipitated 
from stagnant urine with local infection and inflammation. 
Spiegel, in his series of chemical analyses, has corroborated 
this fact. Kahn and Rosenbloom, however, slightly differ from 
this view. These authors state: 
While uric acid and acid salts are soluble in alkaline medium and 
_ insoluble in acids, the exact opposite holds good for calcium oxalate and 
calcium phosphate, which are deposited in alkaline medium and dissolved 
in acids. 
Blatherwick(4) says: 
High urinary acidity favors the formation of uric acid calculi, which 
comprise from 60 to 81 per cent of all urinary concrements. 
Wells states that: 
“Phosphate calculi are formed as a result of decomposition of the urine, 
with the formation of ammonia from the urea. In the ammoniacal solution 
165559 —3 
