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route the specific poison, whatever it may be, enters the body. It is a 
well-known fact that, given certain conditions, no ordinary means of 
hygiene and sanitation will prevent the outbreak and the spreading of 
beri-beri. Such conditions are encountered in a particularly susceptible 
race, partictilarly when they are crowded together, and in certain localities. 
When these factors are present, nothing less than the abandonment of the 
locality which is apparently infected and the dispersion of the susceptible 
individuals will prevent the continual spreading of the disease. Of 
course, such measures as these could not very well be resorted to in the 
case of an army in the field and in the presence of the enemy. To repeat, 
given certain environments and certain compulsory conditions, kakke, in 
the present state of our knowledge, can not be considered to be a prevent- 
able disease. 
The author was ordered to Japan to study beri-beri some time after the report 
concerning the presence of the disease in the military hospitals of Japan, and the 
information that two Japanese military surgeons claimed to have discovered its 
specific organism, had reached Manila. He was provided with letters of introduc- 
tion from Mr. Goro Narita, Japanese consul at Manila, and he is greatly indebted 
to this gentleman as well as to Mr. Ishi, director of the Bureau of Commerce, 
Foreign Office, Tokyo, for securing permission, through the Japanese War Office, 
for him to pursue his studies in the military reserve hospitals at Hiroshima and 
Tokyo. He was also greatly assisted in the preliminary steps taken in arranging 
this matter by Mr. Griscom, American minister at the court of Tokyo; Mr. 
Huntington Wilson, first secretary of the legation, and Mr. Charles B. Harris, 
American consul at Nagasaki. 
The author left Manila on August 15, 1905, reached Nagasaki on Aug- 
ust 20, and arrived in Hiroshima on the 24th of the same month. At this 
place, situated not far from the Inland Sea, there had been a number of 
military reserve hospitals in operation during the war, with an aggregate 
capacity of 12,000 or more patients, the Japanese having transported all 
of their sick and wounded who could at all be moved, from the front to the 
home country. Hiroshima was one of the principal places for the recep- 
tion of such invalids, and at that place, during the greater part of the war, 
there had been in operation one hospital devoted exclusively to the care 
of kakke patients. After the Japanese war office had given its permission 
for the pursuance of this work, the writer, through Colonel Onishi, chief 
medical executive officer at Hiroshima, was assigned to the kakke hospital 
to take up his studies under the direction of Surgeon Major Kokubo, 
who, before the outbreak of hostilities, had been professor of infectious 
diseases in the Military Medical School at Tokyo" and who was in charge 
of the hospital. In this institution of about 1,000 beds, there were remain- 
ing approximately 700 subacute or chronic cases of beri-beri. Connected 
with the hospital and situated in a separate building there was a small, 
though well-equipped laboratory for all ordinary bacteriologic work. Here 
‘This school was closed temporarily during the war, all of its teachers having 
been assigned to duty with the army. 
