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the health of the Japanese navy ever since Dr. Takagi, late Surgeon-General, introduced a meat and bread diet for the seamen.[1] Dr. Scriba, Emeritus Professor of Surgery at the Imperial University of Tōkyō, traverses both these opinions.[2] 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 Wm. Anderson, F.R.C.S., printed in Vol. VI. Part I. of the "Asiatic Transactions" (also published in pamphlet form).—Infections-krankhciten 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.

  1. In 1883 the ratio of kakke patients was 231 per mil. of the entire naval force, and 49 of the cases ended in death. In 1898 the ratio had sunk to 0.87 per mil, and there was but a single death; in other words, the disease had been practically stamped out. The daily rations of the Japanese seaman, as revised, consist of ½ lb of bread,25 lb. of meat, ⅔ lb. of rice, and 516 lb. of vegetables, besides small quantities of fresh fish, tinned meat and fish, various cereals, beans, tea, sugar, and soy. It is claimed that under this system, not only has kakke ceased to be a scourge, but the average weight of the men has increased.
  2. In a private communication to the present writer.