Climate and Diseases 
OF 
JAPAN, 
BY J. C. BERRY, M. D„ 
* 
OF KOBE, JAPAN. 
[Reprinted from the Transactions of the Maine Medical Association, 1879.] 
PORTLAND: 
STEPHEN BERRY, PRINTER. 
1879, Climate and Diseases 
OF 
JAPAN, 
BY J. C. BERRY, M. D„ 
OF KOBE, JAPAN. 
I Reprinted from the Transactions of the Maine Medical Association^ 1879. | 
PORTLAND: 
STEPHEN BERRY, PRINTER. 
1879. Climate and Diseases of Japan. 
Dr. S. H. Weeks, Corresponding Secretary Maine Medical 
Association. 
My dear Doctor :-In complying with your request to furnish 
your committee with information concerning matters of profes- 
sional interest in Japan, with especial reference to disease and 
treatment, and the modification of either by climatic conditions, 
social habits and other influences operating here, allow me to sub- 
mit the following as introductory to further reports, if desired by 
your society, on the subjects in question. The consideration of the 
meteorology of a country, and other causes operating in the pro- 
duction or modification of disease, naturally precedes a study of 
the diseases existing therein; hence in the present paper I confine 
myself to these, and defer, for the present, reference to the more 
interesting objects of your inquiry. 
While sensible that, in the present state of meteorological and 
sanitary science, climatic influences upon the constitution are in 
the highest degree complex, and impossible to trace to their ulti- 
mate results, yet in the study of disease these influences cannot be 
ignored. Besides, the most casual observations in a country so 
unknown and yet so distinctive as Japan may afford one of the 
necessary stepping stones to a more satisfactory consideration of 
the important question, viz: The Relation of Climate to Disease. 
Iler relation to important ocean currents; the mountainous char- 
acter of the country, with ranges varying from 4,000 to 7,000 feet, 4 
and with isolated peaks from 10,000 to 14,000 feet in altitude; 
her numerous alluvial plains of low and (in summer, during the 
rice-growing season) saturated soil; her immediate relation to the 
largest ocean of the globe on the east, and to the greatest conti- 
nent on the globe on the west; her situation in the region of 
variable winds, and extending through 14° of latitude and 16° of 
longitude; these, together with her relation to islands and groups 
of islands, both north and south, constituting a chain extending 
from near Kamtschatka by the Kuriles, through Formosa and the 
Philippines to the East Indies, all contribute to make the meteor- 
ology of Japan, in its relation to disease, of peculiar and exceptional 
interest. 
And here I will remark, parenthetically, that I have not, during 
my residence in the East, and in my professional relations with a 
wide circle of American and European residents therein, witnessed 
the deadly effect of warmer climate upon the health of Northerners 
which the popular mind so generally attributes thereto ; but rather, 
in proportion to the supply of proper food, pure air and sun-light, 
good water and a proper observation of sanitary laws, these sup- 
posed effects, barring, of course, the influence of malaria, have not, 
except in some cases with children, been manifest; and the system 
has, with impunity, accommodated itself to its surroundings. It 
is true there is lessened activity of the lungs, increased activity of 
the skin, and diminished force of circulation-modified functions 
which, perhaps, would influence the development of certain struc- 
tures in succeeding generations : but these changes take place grad- 
ually, even in the individual, and never with the rapidity incident 
to the supposed process of "acclimatization." There is, it is true, 
a gradually lowered tone of the system following a prolonged resi- 
dence in such a climate, and with it a corresponding disinclination 
to great exertion, either mental or physical; but, as indicated 
above, these changes are gradual, not immediate. Northerners, even 
in Japan, which cannot be said to have a tropical climate, notice 
this gradual relaxation of the skin in their growing susceptibility 
to cold-the first winter seldom requiring extra-thick clothing, 
while, by the third winter, obliged to dress as for a climate colder 
by 20° or 30°. This condition of the skin should, I think, be 5 
borne in mind as influencing, especially with natives, an impor- 
tant class of diseases. 
Japan, or "Dai Nippon," is an empire lying off the East coast of 
Northern Asia, between lat. 31° and 45° N., and long. 128° and 144° 
E. The Loo Choo (Lin Kien) Islands, a dependency of Japan, 
lie on the south, extending down to lat. 23° N. The entire num- 
ber of islands composing the group is said to approach four thou- 
sand, but many of them are scarcely more than ledges without 
foliage or human occupants. The four principal, however, Yezo, 
Nippon, Shikoku and Kushd, contain an area of about 132,000 
square miles, are densely populated, excepting the first named, and 
present a variety in scenery, geological structure and meteorological 
conditions. The country is of volcanic origin, the surface consist- 
ing either of hills, mountains and valleys, or terraced plains at the 
outlets of rivers and mountain torrents. The soil is largely dilu- 
vium and disintegrated lava, though a great variety exists. In 
general, that of the plains may be said to be alluvial soil, brought 
down by the rivers and mountain torrents which, during the rainy 
season, are swollen to rapid rivers, carrying to their mouths large 
quantities of sand, gravel, and decayed vegetable matter washed 
down from the steep mountain sides and adjacent ravines. A very 
large proportion of the inhabited portion of Japan, probably one- 
third, perhaps more, is composed of this alluvium. It is, it is true, 
chiefly silicious; but with it, in many places, there is so large an 
amount of vegetable matter, and under it, in many localities, a 
stratum of clay, as to render it unsuitable for healthy occupation ; 
and yet all the large cities of Japan stand in such plains. Built 
for defence rather than for commerce, the Castle towns are, with 
very few unimportant exceptions, located near the mouths of rivers 
and heads of shallow bays sufficiently far from the sea to prevent 
ships of draught from approaching them ; while around these towns, 
on every side, the plain is devoted to the cultivation of rice, thus 
saturating the soil during the heat of summer and throwing off 
malaria when the rice is harvested and the soil again broken for 
wheat in autumn. It is thus that Japan, though mountainous, 
yet is malarious, and the diseases of a vast proportion of her people, 
and resident foreigners as well, are modified by this influence. 6 
The silicious character of the soil, too, renders the reflected light 
from the unshaded streets* extremely trying to the eyes, while 
over such portions as are not covered by vegetation, the air is 
heated by radiation to a degree far in excess of what happens in 
other localities. 
Temperature. A great variety of temperature exists-greater, 
perhaps, than is found in any other country within corresponding 
degrees of latitude. Along the south-eastern coast it is usually 
mild and equable, the amplitude of yearly fluctuation seldom ex- 
ceeding 45°, while on the northern coast this frequently amounts to 
65° or 70°. Indeed, it is estimated that, in going north one de- 
gree of latitude in Japan, as great a difference of temperature is 
experienced as in going north three degrees of latitude in the 
United States. The reason for this is obvious: Along the south- 
east coasts runs the Kuro-Shrivo (Black Stream) which, coming 
from the Southern Pacific tropics, brings with it the warmer 
waters of that region, attaining a temperature of 85° during the 
summer months, and preserving, to a considerable extent, its 
elevated temperature in winterf : while along the north-west coast 
comes down, in counter current, the cold waters of the North, pro- 
ducing its corresponding depression of temperature, especially in 
winter, when this is aided by the cold northerly winds from Man- 
churia and Yakoutsk. 
On the south-east coast the influence of the ocean winds are not 
greatly felt in lowering the temperature in summer, as is usual in 
*The highways of the Empire,-the roads formerly traveled by the Daim- 
ios, or former Princes, are beautifully shaded with grand old pines; but this 
is not true about the cities and plains, where the sub-soil is so damp as to 
prevent the growth of coniferte. 
t The temperature of this stream, in its course between Satonornisaki 
(southern point of Kiushu) and Oo-sima, at the mouth of Yedo Bay, and 
given by Capt. Brown in a paper read before the Asiatic Society of Japan, 
is as follows : 
January, (Fah.) 65° 
March, 62° to 68° 
April 70° 
May, 74° to 78° 
July, 82° 
August 80° to 84° 
October, 80° to 85° 
December, 64° to 72° 7 
such cases; while, owing to the mountain ranges, the land breezes 
do not elevate the temperature as in many countries. 
While the influence of the elevated temperature of the ocean cur- 
rent tends, of course, to produce a corresponding elevation of tem- 
perature on land, yet this is, doubtless, more than compensated for 
by the vapor screen in the air which its exhalations afford, and by 
which radiation of heat from the soil, and the severity of the sun's 
rays in summer, are essentially checked and modified. 
Mean temperature in shade of some of the larger cities. 
Months. 
Nagasaki-Lat. 32° 
43' North. Long. 
129° 46' East. 
Kobe (*)-Lat. 34° 
41' North, Long. 
135° 11' East. 
Osaka-at the head 
of Osaka Bay, 20 
miles E. of Kobe. 
Yokohama Golf 
of Yedo. 
Tokio Gulf of 
Yedo. 
Hakoda to - Is. of 
Yezo. 
Niigata -N. West 
Coast. 
J anuary, 
47.5° 
40.3° 
39.7° 
41.2° 
36.8° 
30.2° 
F ebruary, 
48.7 
40.4 
38.9 
42.1 
38.0 
33.5 
c 
March, 
April, 
55.7 
46.3 
44.1 
49.1 
43.8 
34.9 
o 
64.7 
54.2 
55.8 
58.1 
55.1 
44.1 
g 
Q 
May, 
73.3 
66.7 
65.7 
65.9 
62.3 
55.1 
June, 
79.3 
73.5 
72.5 
70.8 
69.2 
62.7 
c 
July, 
86.6 
81.1 
80.9 
78.2 
76.3 
68.9 
<x> 
August, 
85.7 
83.2 
79.3 
80.6 
79.2 
74.3 
S< ptember, 
80.6 
76.6 
72.3 
72.8 
70.3- 
68.5 
October, 
72.3 
63.7 
59.9 
65.1 
60.1 
57.1 
November, 
61.2 
52.6 
49.6 
56.0 
48.7 
45.9 
o 
December, 
54.5 
44.5 
44.8 
46.8 
41.9 
36.5 
<4 
Mean of Year, 
67.5 
60.3 
58.6 
60.6 
60.6 
50.9 
Amplitude of) 
fluctuation, J 
39.1 
42.9 
42.0 
39.4 
42.4 
44.1 
Humidity. Unfortunately the hygrometric readings are obtain- 
able only for Kobe and Tokio. These give the following results : 
*The observations for Kobe were kindly furnished me by Capt. John 
Marshall, H. I. J. M.'s service, whose experience in meteorology and the 
perfection of instruments employed are a guarantee that the observations 
are correct. 8 
Humidity. Saturation-100. 
Kobe. 
Tokio. 
Months. 
* 
• 1 
S >< 
O £ 
s s 
s 
1 ' 
January, 
70.2 92 
52 
o 
February, 
70.8 87 
52 
C 
March, 
68.1 93 
51 
r3 
April, 
77.3 Sat. 
56 
May, 
76.2 Sat. 
52 
o nJ 
June, 
70.5 94 
61 
Q Q 
Cm > 
J uly, 
83.1 Sat. 
72 
*8 
August, 
74.9 95 
58 
fl 
o 
September, 
81.1 94 
60 
October, 
72.5 95 
58 
♦g 
November, 
71.1 88 
54 
.o 
December, 
70.1 86 
51 
Mean daily aver- 
73 8 
age for year, \ 
Rain. The amount of rain varies with different times of the 
year, depending both upon the summer winds, which are chiefly 
from south and east, and upon the condensation of the vapor given 
off from the Kuro-Shrivo. When these winds, loaded with moisture 
from the adjacent ocean current, strike the mountainous coast, or 
when the heated vapor from this ocean stream, which, as has been 
seen, attains a temperature in summer of 85°, and from which 
evaporation must be rapid, causes an ascending current, and 
which, on reaching a certain altitude, becomes condensed - in 
either case a copious rain-fall is the result. From obvious causes, 
then, the rainy season occurs in summer, as will be seen by refer- 
ence to the following table, f 
* Arithmetical mean of daily readings at 9 a. m. 
t These tables I have compiled chiefly from information given in Staff- 
Commander Tizard's contribution to the Meteorology of Japan. 9 
Monthly Rain-fall. 
Months. 
Nagasaki. 
Kobe. 
Osako. 
Yokohama. 
Tokio. 
Hakodato. 
Niigata. 
Ins. 
Ins 
Ins. 
Ins. 
Ins. 
Ins. 
Ins. 
January, 
1.00 
1.49 
1.48 
2.29 
2.40 
February, 
0.V9 
1.18 
.93 
2.26 
2.07 
March, 
2.85 
2.19 
2.54 
6.75 
5.21 
April, 
2.75 
2.15 
3.34 
7.23 
4.18 
o 
o 
May, 
4.03 
3.96 
6.01 
6.24 
4.25 
le 
June, 
4.95 
2.18 
3.11 
11.62 
10.52 
72 co 
J uly, 
3.24 
6.95 
7.17 
7.78 
4.18 
fl 
o 
August, 
10.76 
2.31 
2.11 
9.43 
5.78 
■fl « 
fl 
September, 
4.86 
8.15 
6.25 
10.56 
14.21 
o 
hr 
October, 
2.09 
4.88 
4.70 
13.03 
9.17 
November, 
1.04 
1.56 
1.14 
5.59 
5.68 
o 
December, 
2.08 
1.61 
2.68 
2.49 
2.27 
Total, 
40.64 
38.61 
41.46 
85.27 
69.92 
Winds. Southerly winds prevail in summer, and northerly and 
westerly winds in winter; and, as in most countries of similar 
latitude, it will be noticed that the barometric column rises with 
northerly and falls with southerly winds. 
For Yokohama.-Wind. 
Months. 
Number of days from 
lays 
lies. 1 
* 
N. E. 
E. 
S.E. 
s. 
s. w. 
W. 
NW 
Calm 
a jo 
•ON 
January, 
17 
3 
0 
0 
1 
2 
0 
1 
7 
0 
February, 
20 
2 
0 
0 
0 
0 
0 
1 
5 
0 
March, 
13 
6 
1 
2 
1 
1 
0 
0 
7 
1 
April, 
8 
6 
1 
0 
5 
2 
1 
0 
7 
1 
May, 
5 
5 
2 
1 
7 
3 
0 
0 
8 
1 
June, 
5 
6 
3 
0 
6 
4 
0 
0 
6 
1 
July, 
1 
4 
1 
2 
5 
8 
0 
0 
10 
1 
August, 
2 
4 
1 
1 
7 
8 
0 
0 
8 
1 
September, 
11 
6 
2 
0 
1 
4 
0 
1 
5 
1 
October, 
18 
5 
0 
0 
1 
2 
0 
0 
5 
0 
November, 
13 
3 
2 
0 
1 
2 
1 
1 
7 
1 
December, 
16 
4 
0 
0 
0 
0 
1 
2 
8 
0 
Total, 
129 
54 
13 
6 
35 
36 
3 
6 
83 
8 10 
Pressure of air. The barometer is usually steady. The oscilla- 
tions are regular and caused, it would seem, by alterations in 
humidity, though possibly, at times, by electric influence. On 
this latter point, however, I am not aware that any experiments 
have yet been made in Japan. 
Mean Barometric Pressure. 
Months. 
Nagasaki. 
Kobe. 
Yokohama. 
Hakodato. 
January, 
30.28 
30.18 
30.09 
29.98 
February, 
30.27 
30.18 
30.12 
29.97 
March, 
30.24 
30.11 
30.07 
30.00 
April, 
30.14 
30.12 
29.97 
29.79 
May, 
30.03 
30.04 
29.83 
29.82 
June, 
29.96 
30.03 
29.79 
29.78 
July, 
29.92 
30.02 
29.70 
29.76 
August, 
29.92 
29.34 
29.67 
29.77 
September, 
30.04 
30.11 
29.79 
29.82 
October, 
30.27 
30.14 
29.88 
29.93 
November, 
30.38 
30.16 
30.06 
29.86 
December, 
30.39 
30.18 
30.00 
29.96 
Mean, 
30.16 
30.05 
29.91 
29.87 
Food. As in most Asiatic countries, the food of the Japanese 
is chiefly vegetable, rice being the chief, though the farmers use 
largely of wheat. Beef has, until recently, been rarely eaten, 
while venison and game, which abound on the mountains, are sel- 
dom used. Fish, of which a great variety is found, is largely eaten 
by those who can afford their purchase, but, owing to the high 
price, their use is confined to the upper classes. The people eat 
largely, endeavoring, by quantity, to make up for the lack of nitro- 
gen which a much less amount of animal food would afford; and, 
as a rule, it is improperly cooked and very indigestible. This gives 
rise to large and weak stomachs, and to dyspepsias of every con- 
ceivable variety. The tone of the system is lower, the muscular 
strength weaker, and the nervous system, as a rule, less susceptible 
to morbid impressions than with Americans or Europeans. Their 
inordinate susceptibility to the action of certain medicines, and 
their immunity from shock in surgical operations have, it would 11 
seem, a direct relation to the food employed. Indeed, one cannot 
but be impressed with the fact, as he mingles with the people, that 
they are under-stimulated by food and over-stimulated by bodily 
and mental exercise. This leads to a natural result, viz : the very 
general use of tea, tobacco and alcohol-the latter in the form of a 
rice beer, Sa-ke, containing a large amount of sugar and about fif- 
teen per cent, of alcohol. In proportion as a more nutritious and 
stimulating diet comes into use, it is hoped that the need for, and 
use of, stimulants and agents calculated to supplement their insuffi- 
cient diet by preventing disintegration of nitrogenous tissue, will 
be less apparent. One of the duties of the social reformer in 
Japan is to replace the use of Sa-ke and tobacco with good nutri- 
tious beef, of which Japan affords an abundant supply. 
This strong rice-beer is now inordinately used by both sexes, 
and at times by children as well, giving rise to drunkenness, misery 
and disease to a most appalling extent. The liver and stomach 
are the organs most affected, supporting the already generally ac- 
cepted theory that the injurious effect of an alcoholic beverage 
upon the liver is in direct proportion to the amount of sugar plus 
the amount of alcohol which it may contain. Its effect in this 
direction is doubtless aggravated by the elevated temperature of 
the climate. This beer intoxicates quickly, the effect soon passing 
off and producing less disturbance of the brain than in the case of 
our stronger liquors, or even with wines containing no more alcohol. 
In spite of the inordinate use of this intoxicant, many men 
taking, habitually, as much as three pints to two quarts a day, 
one very seldom meets with a-case of delirium tremens. Dementia, 
however, and at times acute mania, is frequently met with; but 
whether this arises from the alcoholic intoxicant or from the sexual 
dissipation which so very commonly accompanies the debauch, it 
is difficult to determine. 
Tobacco, though originally an exotic, is now produced naturally, 
and is largely used by both sexes. Many diseases of a nervous 
character follow its improper use. In smoking, the smoke is deeply 
inhaled and then ejected through the nostrils, thus bringing it in 
contact with the largest possible amount of mucous membrane. 
The water, except in the mountainous districts, is bad being 12 
largely impregnated with vegetable matter from surface drainage. 
Fortunately, however, this is seldom taken in an uncooked state,, 
a simple infusion of tea being the beverage of the people. To this, 
perhaps, is largely due their immunity from cholera in summer, in 
spite of stagnant drains, over-crowded localities, eating of unripe 
fruit, &c. 
Though cows abound, they are only used as beasts of burden, 
milk seldom being used except as a medicine. The diet of the 
sick is usually soft-boiled rice and tea I 
The women marry early (fifteen to sixteen years) and bear chil- 
dren before reaching the age of seventeen. Menstruation usually 
occurs at the age of thirteen years and ceases at about forty-seven. 
Nursing is encouraged as long as the mammary gland affords any 
secretion, usually until the child is about two and a half or three 
years old. Large families are uncommon, the children seldom 
numbering more than three; and yet the women, at an early age, 
appear prematurely old. Abortions are frequent, in spite of the 
efforts of the civil authorities to the contrary, and are always pro- 
duced by mechanical means. Uterine disease is prevalent, arising 
partly from the above mentioned cause, partly from the heat and 
constriction of the abdomen, with embarrassed pelvic circulation, 
from the use of the wide and heavy girdle* about the waist, and 
partly from injudicious management during the lying-in state,-a 
cause, unhappily, far too slowly becoming a thing of the past. 
Syphilis is very prevalent among all classes, and constitutes a 
prominent element in the aetiology of a large proportion of diseases 
affecting the people. Its relation to scrofula is painfully apparent 
-the children and even the grand-children of syphilitic parents 
suffering from cellular hyperplasia of the glands, scrofulous ulcers 
of the cornea, scrofulous diseases of the skin, a disposition, in adult 
life, to pulmonary inflammations, followed by caseous infiltration 
and the production of tubercle, weakening of the coats of the blood- 
vessels and thus predisposing to aneurism, and so forth. That it 
* These girdles (obi), which are wound many times around the body and 
tied in a huge knot behind, are about ten inches wide and ten feet in length. 
They are usually made of satin and stuffed with floss-silk. 13 
acts, too, in harmony with certain conditions of soil and climate 
existing here in the production of leprosy, by lowering the vital 
powers of the system, there can, I think, be little doubt. Brothels 
are now licensed and their occupants subjected to the usual medical 
supervision; but as yet the expected (on their part) relief has not 
been realized. 
The social and gregarious habits of the people should also be 
noted as influencing diseases of a contagious character, especially 
the public bath*, usually taken daily, and their disposition to con- 
gregate in villages in the country districts, rather than to occupy 
isolated houses, as in farming localities in Western countries. 
The mode of heating the houses is by open braziers in which 
charcoal is used, the gas escaping into the room ; while, for cooking, 
a fire-place-like arrangement is made in which wood is burned, the 
smoke escaping from the kitchen through a hole in the roof. This 
latter should be borne in mind in its relation to diseases of the 
eyes, from which the people suffer greatly, as also should the custom 
of allowing the children to sleep on the backs of their nurses with 
their faces upturned to the sun-light. The injurious effects of the 
former are doubtless lessened by the porous character of the walls 
of the bamboo-plaster houses, through which considerable ven- 
tilation must take place. In spite of this, however, and the 
helpful influence of habit as well, patients confined to their rooms 
suffer much from the noxious fumes of the burning charcoal. I 
have many unpleasant recollections of headaches occasioned during 
calls upon the sick confined in rooms heated in this manner. The 
houses, however, are cold in winter, and, as there is no other mode 
* The public bath-houses have a large box-like bath in the centre, about 
eighteen feet long, nine feet wide and two and a half feet deep. Across this 
a partition is thrown, which serves to separate the sexes while bathing. This 
is filled with water and elevated to a temperature of about 105°. At an early 
hour the bathing commences, and by ten o'clock at night, from one hundred 
to two hundred persons have been accommodated. The water is not changed 
in the meantime, except as cold water may be added to reduce the temper- 
ature when too hot, an equal amount escaping from the over-flow. Price per 
head-half a cent. The use of soap not allowed in the bath. Those who 
can afford it, of course, have a bathing room in their own house. 14 
of heating accessible to the majority of the people, much suffering 
and injury to health is the result. 
I deeply regret my inability to touch upon many other points of 
interest, from lack of time to make, at present, the necessary in- 
vestigations ; but enough has been said, I think, to show that 
disease and its treatment in Japan are subject to modifying influ- 
ences at once numerous and peculiar.