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

Military Medicine, Apr 2006 by Hawk, Alan

Vitamin B1

Takaki, as a naval officer, had the authority to implement his diet within the navy. However, his results were treated with skepticism throughout the Japanese medical community. Although army surgeons recognized the navy's success, they argued that changing the ration would not yield the same benefits because sailors enjoyed better living conditions than troops in the field. A battleship was easier to disinfect than the battlefield. Army surgeons noted that the disease was more common on the coast and seemed to be influenced by relative humidity and fluctuation in temperature. They noted that soldiers who endured poor sanitation, overexerted themselves, dug holes, and slept on the ground were likely to get beriberi.21

Part of the problem was the different service cultures and orientation of their medical services. Unlike most Japanese medical schools established according to the German system, the navy appointed British surgeon William Anderson as the first director of the Naval Medical College in Tokyo in 1873.22 Takaki, who attended Anderson's alma mater, St. Thomas's Medical School in London, was one of the few Japanese physicians to receive medical training in England. In addition to his anecdotal experience through his father, Takaki, as a naval surgeon trained by the British whose tradition included James Lind's success against scurvy, would be more open to the concept that diet was the culprit. In contrast, army surgeons trained in Germany during the era of Robert Koch would be more inclined to look for an infectious cause. Interservice rivalry also exacerbated the problem, as illustrated by the conclusion written by Shigemichi Suzuki, Surgeon General of the Navy:

If the Army authorities had tried to prevent the occurrence of Kak'ke among the soldiers as the Japanese naval authorities did many years ago (in the Navy there was practically no Kak'ke during the whole wa? [author's italics], the sanitary record of the Army would have been better than that shown above.23

Finally in February 1905, General Terauchi, the Minister of War, forced the Army to change the ration, substituting barley for a portion of the rice, ostensibly as an economic measure. Soldiers did not care for the mixture, which they called "black rice" because of the dark specks. The fact that it was also the prison ration did not help its popularity. However, it dramatically reduced the incidence of beriberi among Japan's fighting force.

Early 20th century research on "accessory food factors" began to make Takaki's conclusions seem more plausible. In 1897, Christian Eijkman in the Netherlands East Indies (now Indonesia) discovered that chickens fed a diet of polished rice quickly developed beriberi-like symptoms, which quickly disappeared when the rice hulls were added to the diet. Elmer McCollum isolated a growth-promoting factor, which he called "fat-soluble A" in 1915. He called Eijkman's discovery "water-soluble B," which later became known as vitamin B1. In 1934, Robert Williams, an American chemist, isolated thiamin, the molecule for vitamin B1. As a consequence, many prewar middle- and upperclass Japanese families purchased syringes and injected themselves with vitamin B to prevent beriberi (Fig. 3).24