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.
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’.
During my Dracula researches in Dublin a helpful cathedral guide found me the plaque to the psychiatrist who was Thornley Stoker’s best friend – Dr Conolly Norman. So human eyes can flash too under the right circumstances…