Photo/Illutration The fifth line on the right page in the “Shincho Koki” chronicle refers to the “besieged battle at Tottori Castle on Oct. 25,” while the first row on the left page reads “more than half of the people were intoxicated by food and died abruptly,” according to the Tottori Prefectural Museum’s accounts. (Provided by the Okayama University Libraries)

Japanese researchers trying to get a handle on a phenomenon known as refeeding syndrome discovered that starving soldiers who survived the siege of Tottori Castle in 1581 died en masse after surrendering and being fed.

The episode represents the earliest recorded instance of the medical condition in Japan.

The researchers said they used the historical event to illustrate how malnourished individuals can quickly perish after a sudden supply of nutrients and published their findings in the international medical journal American Journal of the Medical Sciences.

Records from the time vividly report what transpired, which bolstered the research effort.

“This historic episode will help spread awareness that those starved in wars or natural disasters can become victims of refeeding syndrome,” said internist Yasuhiro Kano.

The study involved not only Kano, who is attached to a medical center in Tokyo, but also Sayaka Aoyama, an internist at a hospital in Ibaraki Prefecture, and Ryuichiro Yamamoto, 35, a curator at the Tottori Prefectural Museum.

The three examined the 1581 battle where Hashiba Hideyoshi (1537-1598) employed starvation tactics to take control of Tottori Castle at the request of his lord, Oda Nobunaga (1534-1582).

Hideyoshi, who later changed his name to Toyotomi Hideyoshi, forced his enemy forces to take refuge in Tottori Castle for upward of three months. The defense capability of the impregnable fortress was considered so exceptional that it was referred to by Nobunaga as “a great fortress with strength.”

After many lives were lost through starvation, castle lord Kikkawa Tsuneie (1547-1581) is believed to have committed ritual seppuku suicide to save the remaining personnel in his fortress.

Hideyoshi distributed porridge to the starving survivors but more than half of them perished soon after consuming the gruel.

According to Kano’s accounts, this page of history regarding the massive post-siege death toll at Tottori Castle was conventionally linked to refeeding syndrome in the medical community in Japan. But no papers have ever been released to support the theory.

Refeeding syndrome is a metabolic complication that is said to lead occasionally to heart failure, respiratory difficulties and other severe conditions associated with vitamin deficiency. It occurs when patients with chronic nutritional disorders are given nutrients abruptly.

Working with Yamamoto at the museum in Tottori, Kano and Aoyama gathered historical documents two years ago on the “large-scale calamity.”

The chronicle of Nobunaga titled “Shincho Koki” shows that most of the starving soldiers were “intoxicated by food” and died as soon as they had consumed porridge provided by Hideyoshi after the castle lord’s surrender.

The “Toyokagami” biography of Hideyoshi says those who ingested large amounts of porridge died swiftly but no problems were detected among soldiers who ate slowly.

Kano and Aoyama surmised that the survivors’ state of extreme starvation, not the porridge itself, was responsible for the fatalities.

They concluded the widespread deaths were likely due to refeeding syndrome as a result of the victims ingesting carbohydrates immediately following the end of a prolonged period of excessive hunger.

Related News