- Beriberi in Modern Japan: The Making of a National Disease by Alexander Bay
imperialism, nutritional deficiency, public health, diet
In Beriberi in Modern Japan, Alexander Bay examines how beriberi, a nutritional deficiency illness caused by a dearth of vitamin B1 and often associated with the consumption of white rice, came to be defined as a “national disease” in Japan. This work begins with conceptions of beriberi in Japan’s early modern period and ends with the debate regarding the partial milling of rice in 1939 that resulted in the Rice Milling Regulation Law. This law transformed Japan’s staple from a causative pathogen to a source of nutrition. Bay places beriberi within the context of Japanese modernization and focuses on how Western medicine perpetuated the disease. The central thesis of Beriberi in Modern Japan argues that physicians of Western medicine in [End Page 333] Japan’s elite institutions exerted power and authority over Japan’s medical community, thus constituting a form of internal imperialism.
In examining the nexus between institutions, medical knowledge, authority, and beriberi, Bay employs a sophisticated array of theoretical frameworks that provide the book’s intellectual scaffolding. The most significant are Michel Foucault’s “production of discourses of truth” and Edward Said’s understanding of imperialism. Foucault’s writings on the “production of discourses of truth” assert that truth and power are intimately linked concepts; the production of truth is based on its relation to power and the exercise of power is largely dependent on its association with truth. For Bay, this axiomatic relationship between truth and power is evident in the persistent view held by many Western trained Japanese physicians in Japan’s preeminent medical institutions that beriberi was a contagious illness while ignoring or marginalizing nutritional theories of disease causation. Bay also employs Said’s flexible understanding of imperialism to characterize Tokyo Imperial University as an authoritative imperial center that dominated other domestic medical institutions by controlling the means of academic and scholarly production related to beriberi.
Beriberi in Modern Japan finds common ground with writings that position early modern and modern Japan within the context of the twin processes of state-building and internal colonization. Here Bay specifically points to Herman Ooms’s Tokugawa Village Practice, which views the early Tokugawa regime as domestically colonial in nature and Mark Ravina’s Land and Lordship, which describes the formation of Meiji Japan as a type of internal imperialism. Bay’s monograph is also closely linked both conceptually and thematically with works in Japanese history that focus on the broader social and institutional implications of a single illness on Japanese society such as William Johnston’s The Modern Epidemic: A History of Tuberculosis in Japan and Ann Jannetta’s The Vaccinators: Smallpox, Medical Knowledge, and the “Opening” of Japan.
Beriberi in Modern Japan is organized chronologically, as well as thematically in six chapters. The first chapter focuses on Tokugawa understandings of beriberi that linked the disease to urban spaces like Edo (today’s Tokyo), Osaka, and Kyoto, as well as environmental conditions. At this time, most Japanese physicians were trained in Chinese medicine and used dietary therapies to effectively treat beriberi. Chapter 2 examines the rise of the primacy of the laboratory in the Faculty of Medicine at Tokyo Imperial University and the concomitant emphasis placed on the field of bacteriology and the search for a microbial explanation favored by Western trained researchers. In the third chapter, Bay discusses beriberi during the Sino-Japanese War (1894–95) and the Russo-Japanese War (1904–5). The author convincingly shows the devastating impact of the Japanese army’s insistence [End Page 334] on basing their diet on white rice in contrast to the Japanese navy’s successful prevention of the disease by employing barley-rice instead. Chapter 4 is the intellectual pinnacle of Beriberi in Modern Japan. Here Bay demonstrates how beriberi became Japan’s national disease “by aligning strategies for disease prevention with the aims of national defense” (88). In chapter five, the author focuses...