More from #Draculafordoctors: Dr Seward, the love-lorn Medical Superintendent, says:
My homicidal maniac is of a peculiar kind. I shall have to invent a new classification for him, and call him a zoophagous (life-eating) maniac. What he desires is to absorb as many lives as he can, and he has laid himself out to achieve it in a cumulative way.
He gave many flies to one spider and many spiders to one bird, and then wanted a cat to eat the many birds. What would have been his later steps?
Peculiar eating habits were not uncommon in the nineteenth century asylums, the technical terminology being ‘pica’. I dare say there were various ways of trying to supplement the poor diet of the institutions.
As for an excellent sensation of horror – ‘disgust’ is most effective, just watch ‘I’m a Celebrity, Get Me Out of Here’!
Secret treats to ingest were sent by Count Dracula to Renfield: “Big moths, in the night, with skull and cross-bones on their backs.” The all-knowing Dr Van Helsing explains: “The Acherontia Atropos of the Sphinges, what you call the ‘Death’s-head Moth’?”
Curious eating habits of various kinds had long been observed in asylums, and were discussed by W. C. McIntosh, superintendent of Perth asylum, in 1866:
The morbid desires, longings, or impulses for various substances generally regarded with loathing and disgust have been grouped under the head of Pica.
Although these alien substances were often chalk, charcoal or earth, there is one mention of an insect-eater:
Remaining during winter in a kind of torpid state in the chimney corner, but in summer hunting all day long for honey-bees, humble-bees, and wasps.
While the unfortunate patients may partly have been trying to improve their wretched diets, these days, eating insects is very trendy, and earth will clearly be next.
Dr Norman thought that as the diet in the Richmond Asylum in Dublin was better than elsewhere, the beri-beri like disease could not have a nutritional basis. However, evidence for a dietary connection, especially with polished white rice, had emerged, and a precedent for a deficiency disorder – scurvy – was known if not fully understood. It was not until Casimir Funk in 1912 published ‘The etiology of the deficiency diseases’ that this concept began to take hold, and was the start of ‘vitamin theory’.
The deficiency in beriberi is of Vitamin B1, also known as thiamine, which is found more in brown rice and bread than the ‘white’ versions. Beriberi is less common in complete starvation than when extra but refined carbohydrate such as sugar is introduced. White bread may have been used in the asylum, and thiamine’s absorption is impaired with dysentery, in alcoholism, and even by tea drinking. There were no cases among the medical staff.
Unbeknownst to Dr Norman, a remedy akin to Marmite was at hand along the River Liffey at the Guinness Factory. The Brewery’s Chief Chemist, Dr Millar, developed the popular and tasty savoury spread, Guinness Yeast Extract or GYE, from the surplus yeast generated in the fermentation process. It was launched in Ireland in 1936 and was discontinued in 1968.
Dr Conolly Norman reviewed the issue of beri-beri in asylums in 1899. He pointed out that following the outbreak in the Richmond Asylum, others had occurred in Suffolk, England, Alabama and Arkansas in the USA, and at St. Gemmes-sur-Loire in France. Norman remained puzzled as to the possible causes: sometimes there seemed to be an association with nutrition but he thought that the Richmond diet was quite as good as in other asylums.
He wondered about a ‘miasmatic poison’ especially in conditions where the ground was damp and marshy, and subject to frequent excavation as was common with asylums. (He is probably thinking here of the frequent building works, probably on top of human waste and, indeed, buried corpses.)
He decided that ‘infective peripheral neuritis’ would be an appropriate term, and that at least asylum doctors needed to be aware of the problem even if the cause and treatment were unknown.
The British Medical Journal reported on a ‘supposed outbreak of beri-beri’ in the Richmond Asylum, Dublin in 1894. This was remarkable, because previously such a disease had mainly been seen in the East.
The first noticeable symptom was oedema of the legs, which tended to spread rapidly. This was followed by weakness of the heart and breathing difficulties. Mentally, the sufferers became dull and sleepy. Sometimes there were symptoms of hyperaesthesia or paralysis. At this point there had been 110 cases under treatment, and 13 deaths.
Dr Conolly Norman, the medical superintendent, called for outside help, and the eminent Dublin surgeon Dr Thornley Stoker (Bram Stoker’s brother) led an investigation and provided a report to the governors. The disease appeared to resemble the beri-beri known in tropical and sub-tropical regions but the cause was unknown, although it seemed as if the cause must lie within the boundaries of the asylum. They concluded:
Bad ventilation and bad blood appear to be promoters, but the bacillary origin does not appear to be yet established.
The BMJ noted later that ‘blood’ had been a misprint for ‘food’.