Ogai went to war in April of 1904. The Russo-Japanese war has been called ‘the first great war of the twentieth century’, and its pattern of rival empires failing to come to a peaceful resolution over territory which both saw as within their sphere of influence would become depressingly familiar over the following decades. In the Russo-Japanese war, the territory first argued and then fought over was Manchuria. Russia had been a major player in the region since leasing Port Arthur (modern Lushun) from Qing dynasty China. The port was of great strategic importance to Russia as their only warm water port on the Pacific, and they followed up on this development of infrastructure by building a railway from Port Arthur to Mukden, Harbin and on to join the newly built Trans-Siberian railway. After the Boxer Rebellion in 1900, as part of the eight member international delegation to relieve the imperiled foreign troops trapped in Beijing, Russia sent troops into the imperial capital. At the same time they stationed 177,000 troops in Manchuria, ostensibly as a temporary measure to protect their railroad to Lushun, though as this would have given them an excessive one soldier for every 5 metres of railroad track, it was clearly an invading army disguised as the world’s largest transport police. As expected Russian plans for evacuation of their troops from Manchuria were delayed and postponed until they dropped any pretence and announced their intention to stay in 1903. Japan`s prime minister, Ito Hirobumi, tried to negotiate with the Russians, but the Russian government did not believe that the Japanese would go to war against a power so much larger than itself. Japan, meanwhile, felt strengthened by an alliance with Britain that would bring Britain into the war on Japan`s side if any other power allied with Russia. Diplomacy had failed. Japan attacked Port Arthur on the 8th February 1904, three hours before formally declaring war on Russia. The war was fought on land and sea, with Japanese supremacy at sea in the battles of the Yellow Sea and Tsushima (largely due to weaponry with a marginally greater range than the Russian naval guns, allowing them to bombard the Russian fleet while staying just out of harm`s way) backing up victories on land in the Battle of Mukden and the Siege of Port Arthur. The Japanese victory, and place at the top table of world powers was enshrined at the Treaty of Portsmouth in 1905.
But, we must return to the role of Mori Ogai before he disappears into the mass of humanity that fought in the conflict. He was the chief medical officer in the second division of the Japanese army, sent to the Liaodong peninsula in April 1904. The great controversy of Ogai`s conduct in the war revolves around his handling of beriberi, which was rife among the troops in the army. Ogai is strongly criticized for sticking to his theory that beriberi was a bacterial infection, rather than a deficiency of vitamin B12, or thiamine, leading to the deaths of thousands of soldiers in the Russo-Japanese war when a simple change in diet could have saved the majority. I will not attempt to revive Ogai’s reputation here, as science has proved him to be entirely mistaken. However, I would like to put Ogai`s actions in some context; he was not a lone voice arguing for the bacterial cause of beriberi while the rest of the scientific community had come to their senses and realized its true nature. As late as the 1920s, professors such as Hayashi Haruo at Tokyo University, one of the highest centres of learning in the land, were still performing experiments to try and show that diet and beriberi were not causally related.
However, the link between beriberi and diet had been postulated as early as the 1880s by Takaki Kanehiro, a naval doctor. In 1880 he began to search for reasons behind the high incidence of beriberi in the navy. He had just returned from five years of medical training in St. Thomas’s Hospital, London, and had been schooled in British traditions of social medicine. He began to look for the cause of the disease in diet, housing, bedding, and conditions on board ship. He noticed that officers, with a varied diet of meat and vegetables, rarely developed beriberi whereas the common sailors, with a diet primarily consisting of white rice, were much more susceptible. He concluded that a protein deficiency was a possible cause, and stipulated a more western-style diet of bread, meat and vegetables. However the sailors were not impressed by what they say as a forced adoption of western ways, and there were many cases of sailors hurling their rations overboard en masse. So Takaki used a technique known to parents of fussy children everywhere; he kept the white rice favoured by the sailors, but secretly added barley to it to increase its protein content. This was by no means a novel treatment; adzuki beans and barley in place of white rice had been prescribed as a remedy for beriberi by Chinese herbalists of the Sui dynasty in the 6th century. Indeed, it was the very age of the technique which caused doctors like Ogai and his contemporaries to reject it.
Takaki recorded incidence of beriberi in the navy before and after his diet was introduced. In 1878, 1485 out of 4528 navy personnel contracted beriberi, with 32 dying from it. Just six years later, the figures were 3 beriberi cases among 8472 personnel, and not a single death. All this was more than a decade before Christian Eijkman made a similar proposal in the Dutch East Indies, though he would get a Nobel Prize for his work. Takaki got no such recognition, though he does have an Antarctic peninsula named after him, which is more than most of us can claim.
You may well wonder how it was that fully 20 years after the conclusion of Takaki`s experiment, Mori Ogai was still fiercely resisting the theory that beriberi was a dietary disease even as the army`s soldiers were falling down around his ears. There are a number of reasons, but all revolve around various rivalries within Japanese medical circles. Firstly, his work was criticized roundly by army doctors, rivalry between army and navy being as old as armies and navies themselves. Ishiguro Tadanori, surgeon-general of the Japanese Imperial Army, rounded on Takaki, saying that his statistics were unreliable and that beriberi was a contagious disease which flourished in damp and insanitary conditions. Four weeks after Takaki`s results were published, Dr Masanori Ogata of Tokyo Imperial University released a paper in which he claimed to have found the bacillus which caused beriberi, and his research was much more widely promulgated in the popular press than Takaki`s.
There was also rivalry between the British and German schools of medical thought. German medicine emphasized the importance of laboratory work in proving scientific theories. British medicine was more social in outlook, and relied more heavily on epidemiology and statistical research, perhaps as a result of Florence Nightingale`s pioneering work in using statistics and data to show the role hygiene played in army health in the Crimean war. Thus Takaki saw his statistics on beriberi and diet in the navy as proof of the causal relationship. The German-trained Ogai, along with his superior Ishiguro and many others, strongly disagreed, commenting in print that `Experimental knowledge, using microscope and microtome, is the highest art for producing scientific knowledge`. Statistical data did not constitute scientific fact for these men, and Takaki`s tables would not convince them otherwise.
There was a third rivalry in play, which split the medical authorities along similar lines to the second but was nevertheless separate; between those who believed that traditional medicine was a relic of the past, and those who believed it still had something to offer alongside newer Western techniques. For those in the former camp, the idea of using barley to treat beriberi was old fashioned, dangerous, and based on nothing more than superstition and guesswork from a prior age. For those in the latter, western and traditional medicine were more like two approaches to the same problem, which could complement each other in certain cases.
Finally, there was a social factor at work. White rice, highly polished to remove the entirety of the husk from the grain, is much more expensive than barley or brown rice, and thus was seen as a reward to the armed forces for their sacrifice and struggle. The family of an ordinary soldier back in the civilian world would most certainly not have been able to afford such a luxury. It was thought by many in the armed forces that any attempt to replace white rice with other foods would merely be seen as a cost-cutting exercise by the troops, leading to dissatisfaction at best and full scale revolt at worst.
While this puts into context Ogai`s refusal to countenance barley as a remedy for beriberi, it cannot excuse it. The Russo-Japanese war was the first overseas war Japan fought in where more soldiers were lost to enemy action than disease. This was in no small part due to Ogai’s work on improving army medicine and hygiene. However we must stand against this the 27000 deaths from beriberi in the army, compared to well under 1000 in the navy.
In 1905, one of the most celebrated Meiji era chroniclers of Japan, the writer Basil Hall Chamberlain, wrote `Things Japanese`, a kind of encyclopedia of Japan for the curious Western world. In the section on beriberi, he states that recent scientific advances have proven the disease to be dietary. He notes the example of “the peasantry, who often cannot afford either rice or fish, and have to eat barley or millet instead, suffer much less than the people” A foreign scholar with no medical training had realized the true nature of the disease while Ogai still stuck to his outdated theories; the final proof, if any were needed, that Ogai made the biggest mistake of his career with regard to the transmission of beriberi, one that caused hundreds if not thousands of preventable deaths.
Next time, we will look at Ogai as he furthered his writing career with a burst of creativity in the last years of the first decade of the 20th century.