Over the past two decades, the study of disease has become an important subfield within the medical history of modern Japan. Smallpox, malaria, tuberculosis, leprosy, and plague, to name but a few conditions, have served as the focus of numerous books and articles. Beriberi (kakkebyō), too, has elicited some attention, mostly among Japanese scholars. As the first English-language monograph on the subject, Alexander R. Bay's Beriberi in Modern Japan: The Making of a National Disease offers new insights not only (or even primarily) on the history of this particular pathology, but also on the larger process of creating scientific knowledge in the context of late nineteenth- and early twentieth-century state-building.

During the Meiji period (1868–1912), as increasing numbers of Japanese gratified their preference for tasty yet nutritionally poor white rice, beriberi, now understood as a thiamin deficiency, emerged as a major scourge. At the turn of the century, the condition was said to account for 8.2 percent of all deaths from disease in Japan. Annually, beriberi struck about 265,000 Japanese, or approximately six persons per thousand. It was particularly prevalent in the urban population, from the imperial family to industrial laborers (who lost an estimated six to ten million workdays to beriberi each year from 1899 to 1901). The disease also ravaged the Japanese military, supplied with nutritionally meager rations primarily composed of white rice, vegetables, and tofu.

As Bay argues, the threat of beriberi to the core institutions and expansionist aspirations of the Meiji state prompted its construction as a “national disease” (kokuminbyō) demanding resolution. Given this significance, the fight against beriberi mobilized a wide assortment of medical practitioners, including army and navy physicians, private and public university faculty, practitioners of traditional Chinese medicine (kanpō), and others. In the Tokugawa period (1600–1868), doctors viewed the disease as an affliction of geography, associated with damp, low-lying urban environments. Nonetheless, by observing patients, they came to recognize the effectiveness of treatment through diet, particularly barley. In the 1880s, however, elite physicians associated with the newly founded Tokyo Imperial University Medical College (Teidai) consolidated their authority over the profession by promoting scientific medicine at the expense of early modern practices and knowledge. Bay draws heavily on the literature of colonial medicine to discuss this process as an imperialist “occupation” (p. 6) of the Japanese medical world, paralleling the larger narrative of state-building in Meiji Japan. A small cohort of mostly German-trained physicians who prioritized discovery in the laboratory over experience in the clinic ignored the effectiveness of diet therapies associated with “backward” kanpō and spent several decades fruitlessly pursuing a beriberi bacillus. The particular “villain” of beriberi history, Army Medical Bureau Chief Ishiguro Tadanori (a perennial figure in scholarship on health and sanitation in modern Japan), even manipulated data to downplay the effectiveness of treatment through barley consumption while implementing sanitary measures to prevent “contagion” of the disease among troops.

Whereas the Japanese navy eliminated beriberi by reforming rations prior to the Sino-Japanese War of 1894–95, Ishiguro and his successors continued to provide only thiamin-poor white rice to soldiers. Nothing less than the catastrophe of the Russo-Japanese War of 1904–5, during which a staggering 90 percent of the army (more than 250,000 troops) fell ill with beriberi, finally induced a humiliating reversal of the anti-barley stance. Even when forced to acknowledge the link between beriberi and nutrition, however, Teidai doctors remained determined to use the laboratory to establish the etiology of the disease. In 1908, the state and army collaborated in founding the Beriberi Research Council, where elite scientists camouflaged their retreat from the germ hypothesis by continuing to manufacture controversy over causality.

With the outbreak of the disease controlled through preventive measures, and no professional incentive to disprove contagion, the confirmation of beriberi as a vitamin deficiency in 1921 was but a muted triumph. The objective of scientific research subsequently shifted to the production of a thiamin-rich yet palatable and aesthetic rice grain capable of nourishing a mobilizing nation. In this quest, however, the imperialist power of the Teidai medical establishment at last confronted an implacable foe: a diverse rice crop that “resisted” the standardized “discipline” of science (p. 10). In 1939, with total war imminent and Japan's food supply of increasing concern, the government overrode Teidai's recommendations for optimizing the grain by selecting a pragmatic over nutritionally ideal standard for milling.

Bay's use of the “national disease” framework to discuss beriberi implies a public response beyond the medical profession, glimpsed through references to the suicides of stricken, impoverished laborers who despaired of recovery, episodes of sailors secretly discarding nutritious but unfamiliar supplementary rations of bread and meat, and housewives pounding “black” rice into cakes for the new year. Yet the author's focus remains firmly on physicians: not a single beriberi sufferer speaks in the text. The inanimate rice grain enjoys greater agency than the human victim. While depicting beriberi prevention as a “tool of empire” (p. 9), moreover, Bay does not consider the significance of nonmilitary encounters with the disease in colonies and territories beyond the Japanese metropole.

These limitations aside, Beriberi in Modern Japan offers an insightful and detailed account of the workings of power in the Japanese medical profession at the turn of the century. Whereas the fight against disease is often narrated as a triumph of scientific enlightenment over medieval superstition, Bay powerfully shows that the “constructed ignorance” of modern times may pose greater danger to human welfare than the unfeigned ignorance of the past.