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’.