Great Disease Enemy, Kak'ke (Beriberi) and the Imperial Japanese Army, The

Military Medicine, Apr 2006 by Hawk, Alan

The supreme test of an army's medical organization comes, of course, in time of battle. The severer the clash of arms, the greater is the strain made upon the medical organization. In no great battle in history has the medical organization proven adequate to the demands made upon it; but the best record ever made in that direction, embodying as it did an approach to perfection, was that of the Japanese in the war with Russia.16

Seaman's praise, intended to push reforms of the U.S. Army Medical Department, overlooked the reasons for the apparent success by the Japanese Medical Department.

Seaman noted that although wartime soldiers throughout the 19th century were generally more likely to die from disease than from combat trauma, 8% of the Japanese army died from enemy fire while less than 2% died from disease. However, he attributed the success to Japanese efficiency and did not consider other factors that may have affected the statistics. As the Japanese assaulted Russian positions, they discovered, as European armies would during the Great War a decade later, that assaulting a dug-in enemy in the age of modern artillery and automatic weapons was virtually suicidal. Japanese forces sustained significant casualties. Approximately 20,000 Japanese soldiers were killed during frontal assaults on Port Arthur during 1 week of fighting; many died before receiving medical care. After the battle, General Maresuke Nogo contemplating the 60,000 casualties sustained to take Port Arthur, wrote:

The feeling 1 have at this moment is solely one of anguish and humiliation that I have expended so many lives, so much ammunition, and such a long time upon an unaccomplished task. . . . I have no excuse to offer my sovereign and to my countrymen for this unscientific, unstrategical combat of brute force."17

Although Japanese soldiers confronted ferocious firepower on the battlefield, there were few endemic diseases in the area of operations. The army emphasized providing their soldiers with a clean water supply. Since these soldiers preferred hot tea, the water they drank had been sterilized, preventing the spread of cholera, typhoid fever, and diarrheal diseases. Mosquito-borne illnesses, such as malaria, were virtually nonexistent.

Another factor was the soldiers' belief that to become sick was shameful, which was part of the army's indoctrination on the proper methods of sanitation. A soldier was taught that preserving his health was as important as maintaining his rifle. Although this attitude imbued the soldier with the notion that, for example, taking his creosote pills to prevent diarrhea was his patriotic duty, it also discouraged him from reporting to sick call when he became ill and further skewed the statistics.18

However, one disease took a disproportionate toll on the army. As the American physician, Dr. Anita Newcomb McGee, noted, ". . . There is more dysentery than typhoid, but (the army's) great disease-enemy is beriberi . . ."19 It caused almost half of the sickness in the army during the campaign and, as McGee noted, almost 70% of one unit returning from the front was afflicted with beriberi. During the siege of Port Arthur, 20,000 to 25,000 men were sent home from the 80,000-man Third Army because of the disease. As Takaki noted, ". . . Owing to circumstances, only rice was given to the men as the principal food, and consequently cases of beriberi increased greatly."20 The soldier's ration during the siege was 5 ounces of meat and 30 ounces of rice, which they were expected to cook themselves. In contrast, sailors of the Naval Brigade participating in the siege were given 1 pound of meat, 10 ounces of barley, and 20 ounces of rice per day and sustained few cases of beriberi.