17,1 Guerrero and Concepcion: Xerophthalmia 101 
narrow cages that prevent all movements except those of the 
head and neck. Fowls so confined fatten quickly if fed liberally 
on unhulled rice or corn. 
The discovery of fat soluble A is of practical importance, 
because it elucidates certain clinical manifestations which until 
now have remained unexplained, or have been attributed to 
other causes. 
Mori, in 1904, published his observation on a disease found 
in Japan and known in that country by the name of hikan, 
characterized principally by diarrhea, bulimia, cachexia, marked 
dryness of the skin and hair, and xerophthalmia. The course 
of this malady is chronic; it is rarely fatal. Death is usually 
due to septicemia, following the cachexia or the eye complications. 
Hikan is a disease of second infancy, generally occurring in 
the dry season, in children between the ages of 2 and 5 years, 
and rarely in breast-fed children or in adults. 
During a period of about three and a half years, Mori was 
able to study 1,511 cases among 45,162 patients. He claims 
that hikan is not found among the fishermen, but usually among 
the poor who live chiefly on vegetable diet. He believes that 
this ailment is caused mainly by deficient absorption of fats, 
and that cod liver oil, chicken livers, eel fat, and the oil of 
sesame possess unusual curative properties which bring about 
rapid disappearance of the symptoms. 
Very recently Bloch reported from Copenhagen forty cases of 
necrosis of the cornea with ulceration, in children fed with 
skimmed milk. Of these cases, only five presented xerosis; 
twenty-seven, keratomalacia of both eyes; and seven, kerato- 
malacia of only one eye. The patients, all of them children 
varying in age from a few months to 1 year, showed evidence 
of atrophy and dystrophy; the tissues appeared soft and oedem- 
atous, the emaciation was sometimes masked by the oedema, 
and in a few cases only weakness and pallor were observed; 
but in all the cases, there were marked evidences of retarded 
growth, and the skin was dry and was covered with a fur- 
furaceous desquamation. The little patients lay, quiet, in pro- 
found apathy. They objected when disturbed, but remained 
quiet if let alone. He attributes the cause of this syndrome 
to insufficient intake of fats. 
The majority of his cases occurred during the war; twenty- 
eight came from rural districts, and only eleven were from the 
city. The serious cases from the rural districts were fed on 
centrifuged milk, and this class of cases has been progressively 
