Beriberi in Modern Japan: The Making of a National Disease by Alexander R. Bay (review)

The struggle between army and navy doctors over how to prevent and treat beriberi (kakke), a disease now known to result from vitamin B₁ deficiency, is well known among those familiar with Japan’s modern medical history, and it has been the subject of several monographs and many articles. In the 1880s, alarmed over skyrocketing rates of the disease among soldiers and sailors, the medical corps of both branches of Japan’s military sought a means to prevent and control it. Although laboratory evidence had not yet confirmed the cause of the disease, the navy experimented with and successfully adopted dietary reform. Meanwhile, physicians in the Army Medical Bureau aligned themselves with the civil medical elite of Tokyo Imperial University’s Faculty of Medicine and embraced the theory that beriberi was an infectious disease spread by a yet-to-be-identified microbe. They refused to follow the navy’s lead and condone the addition of barley or bread to the white rice rations of their troops until the 1920s, with devastating results.

In Beriberi in Modern Japan, Alexander Bay retells this story in considerable detail with the aim of illuminating larger questions about the production of medical knowledge in modern Japan. Chapter 1 examines early modern theories of the disease, which linked it to urban sites and a lifestyle of ease and sexual and dietary excess. Chapters 2–5 examine the struggle between proponents and critics of the dietary theory of the disease. The sixth and final chapter examines the debates that culminated in the 1939 Rice Milling Regulation Law, which required millers to retain 30 percent of the B₁-rich rice germ. Bay argues that the intransigence of doctors who refused to accept the dietary explanation of the disease can be traced to the imperial relations of power that shaped the production of medical and scientific knowledge in the late-nineteenth and early-twentieth centuries. According to Bay, the medical faculty at Tokyo Imperial University, whose prestige and claim to authority rested upon their mastery of Western medicine and the procedures of laboratory science, rejected the dietary solution for beriberi because the use of barley as both prophylaxis and treatment originated in Sino-Japanese medicine (kanpō)—whose disestablishment was a central aim of the modern medical elite—and was based upon insights gained from clinical practice rather than laboratory research.

Bay does a fine job of demonstrating the formation and influence of medical networks across institutional boundaries and revealing the divisiveness that shaped the process of medical modernization, and certainly he is correct about the central place of Tokyo Imperial University’s Faculty of Medicine in modern medical culture. Like many of his contemporaries in science studies, he is a fan of sociologist Bruno Latour, whose Pasteurization of France (Harvard University Press, 1993; translated by Alan Sheridan) is something of a subtext for the book under review. Following Latour, Bay seeks to explicate the social, political, and ideological factors that shaped the acceptance or rejection of a scientific discovery. However, although he announces early on that he “is not interested in showing how the Faculty of Medicine maintained a wrongheaded stance” (p. 8), he proceeds to do just that. The book suffers from the author’s one-dimensional portrayal of those he terms “the anti-barley faction” as arrogant, intellectually dishonest, and concerned primarily with establishing their own authority. Indeed, he explicitly likens those who rejected the dietary theory of beriberi to the scientists in the employ of the U.S. tobacco industry who repeatedly denied any link between cancer and tobacco. Both, Bay argues, used the purposeful “construction of ignorance” to counter their critics and maintain a position that had real health consequences (p. 127).

A better analogy might be the debates that surrounded the disease pellagra in the United States in the early twentieth century.¹ A disease caused by vitamin B₃ (niacin) deficiency, pellagra results...