is the same disease as that known in India and the Malay peninsula under the name of beri-beri, and may be defined in popular language as a sort of paralysis, as it is characterised by loss of motive power and by numbness, especially in the extremities. It is often accompanied by dropsy. All these symptoms are due to a degeneration of the nerves, which is the main anatomical feature of the complaint. In severe cases it affects the heart, and may then become rapidly fatal, though the usual course of the disease extends over several months, and mostly ends in recovery. But he who has had one attack may expect another after an interval of a year or two. Some persons have had as many as ten or even twenty attacks, all setting in with the warm weather and disappearing in the autumn. Kakke attacks with special frequency and virulence young and otherwise healthy men,-women much less often, scarcely ever indeed except during pregnancy and after childbirth. Children of both sexes enjoy almost absolute immunity. The disease springs, in the opinion of some medical authorities, not from actual malaria, as was formerly imagined, but from a climatic influence resembling. malaria. Others have sought its origin in the national diet,- some in rice, some in fish. In favour of this latter view is to be set the consideration that the peasantry, who often cannot afford either rice or fish, and have to eat barley or millet instead, suffer much less than the townsfolk, and the further fact that an extraordinary improvement in this respect has been observed in the health of the Japanese navy ever since Dr. Takagi, late Surgeon-General, introduced a meat and bread diet for the seamen. Dr. Scriba, Emeritus Professor of Surgery at the Imperial University of Tōkyō, traverses both these opinions. According to him, it is the crowding together of men in spaces imperfectly ventilated, especially when these spaces are covered with mats which are rarely taken up or renewed, that favours the development of the germs of the malady. The change of diet has had no direct influence in ridding the navy of kakke. What has done so is the increased attention paid of recent years to cleanliness and ventilation, combined with the general open-air life of the seamen. He compares the suppression of kakke in the navy to the suppression of hyæmia, erysipelas, etc., in hospitals since the introduction of hygienic and antiseptic precautions. This opinion gains weight from the notorious fact of the influence of crowding in propagating the disease, and from its comparative frequency in low alluvial situations.
Whether kakke is indigenous or imported, is a question that cannot yet be answered; but the latter alternative seems the more probable, as the first mention of it occurs only two hundred years ago. Then, and till about fifty years ago, it was confined to a few ports on the Pacific coast of Japan and to some large cities in constant communication with those ports, such as Kyōto and in all these localities, barracks, schools, and prisons were the places most affected. The construction of railways, steamers, and carriage roads has converted kakke from a local into a national scourge. Restricting itself no longer to low-lying situations, it has invaded almost the entire country, the visitation being in some cases mysterious, in others clearly traceable to the residence of kakke patients, who, having been sent to the hills for change of air, have left a legacy of their disease to the inhabitants.
Books recommended - Kak'ke, by Win. Anderson, F.R.C.S., printed in Vol. VI. Part I. of the "Asiatic Transactions" (also published in pamphlet form).-Infectionskrankheiten in Japan, by Dr. E. Baelz, in the "German Asiatic Transactions," Vol. III. p. 301.-Die Japanische Kak-ke, by Dr. B. Scheube-Geographisch-medicinische Studien, by Dr. Wernich; and others in European languages, besides reports in Japanese by Drs. Takagi and Miura.