Introduction It is well known that the cholelithiasis of the Japanese differs remarkably from that of Europeans or Americans. A difference also is noted in respect to such common diseases as pulmonary tuberculosis, diabetes mellitus, chronic pancreatitis, some malignant tumors, and other states, as they affect the Japanese and as they affect other peoples. However, the differences between cholelithiasis in the Japanese and the same disease in other peoples are most noticeable. Since the time of the late H. Miyake1 in Kyushu and I. Matsuo2 in Kyoto, the cardinal differences between the type and location of gallstones in the Japanese and the type and location of these lesions in Western peoples have been pointed out thus: 1. Most gallstones of Western peoples are cholesterol stones, whereas, in Japan, pigmented calcium stones, including stones of parasitic origin, account for nearly 60% to 80% of all such concretions; 2. Most