496 Philippine Journal of Science 1919 
of the other forty-eight cases are, as a whole, obscure with 
respect to the history of nutritional disease, still they indicate 
that the majority of the patients were undernourished and un- 
derdeveloped. It is probable that among these forty-eight cases, 
there were many, besides the two, who were beriberic either 
in active or latent form, as the symptoms of beriberi were not 
especially looked for in preparation of their clinical histories 
from a purely surgical standpoint. 
The cases studied have been classified into four groups; (1) 
eleven cases, nine of which were my own, giving positive his- 
tory or signs of beriberi; (II) eighteen cases with an unreliable 
history of beriberi, but undernourished and from the poorer 
class; (III) twenty-three well-nourished and well-developed in- 
dividuals; and (IV) six cases of uncertain nutritional condition. 
The percentage of primary phosphatic calculi (nuclei), as de- 
termined by qualitative tests, is greatest in the individuals 
belonging to groups I and II, being 45.4 and 72.2, respectively. 
Primary urate calculi were most frequently found in the well- 
nourished cases (group III), occurring in 43.5 per cent of these 
cases. 
Of the one hundred eighty-nine layers from fifty-eight stones 
examined, one hundred four layers or 55.03 per cent were phos- 
phatic in composition; fifty-four or 28.57 per cent, uratic; 
nineteen or 10.05 per cent, oxalates; seven or 3.70 per cent, 
carbonates; five or 2.65 per cent, mixed phosphate and urate, 
phosphate and oxalate, and phosphate and carbonate. 
A majority of the cases occurred in children and young adults. 
Uric acid or urate nuclei were found in six out of eight cases 
over 50 years of age, while phosphates predominated in the 
earlier decades. 
The classification of the cases as regards occupation indicates 
the prevalence of stone formation chiefly among laborers and 
farmers. The provincial distribution of the cases is as follows: 
Bulacan, 10; Batangas, 9; Pampanga, 8; Rizal, 6; Manila, 6; 
Nueva Ecija, 5; Cavite, 4; other provinces, 10. Phosphate cor- 
tices predominated in all occupations and in all the provinces 
except Pampanga. : 
Among ,forty-nine cases the chief constituent of the cortices 
was phosphate in twenty-four cases, with a neutral or alkaline 
urine, and in nine cases with an acid urine. The reaction of 
Filipino urine is normally acid, but to a less degree than in the 
United States and Europe because of the low protein intake. 
It is apparent, therefore, that the inadequate dietetic conditions 
