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BMJ No 7123 Volume 315 The muses Saturday 20/27 December Christmas 1997 issue
Illnesses and creativityByron's appetites, James Joyce's gut, and Melba's meals and mésalliancesJeremy Hugh Baron
Even for amateurs the retrospective rediagnosis of the famous is one of the lowest forms of medical history, but I hope this three course dinner with its appetiser (Byron), main course (Joyce), and dessert (Melba) will prove worthy of Christmas 1997. Byron's appetitesGeorge Gordon Byron(1-9) was born in 1788 and was unfortunate in his ancestors. On his father's side were psychopathic noblemen. His great uncle, the 5th "wicked" lord, killed his cousin in 1765 in a duel over the best way to hang game, and after his wife left him begat a bastard by one of his servants, "Lady Betty." (5) Byron's admiral grandfather, "Foulweather Jack", was an irresponsible rake, as was his father, "Mad Jack", who degraded, impoverished and deserted Byron's mother, had an incestuous affair with his own sister Frances,(7) and died in 1792. Catherine Gordon, Byron's mother, boasted descent from James I of Scotland, but her ancestors were brigands and melancholics, with her grandfather in 1760 and her father in 1779 both drowning, presumed to be suicidal.
Byron's widowed mother abused him for his father's vices. Byron claimed his nursemaid beat and seduced him.(9) In 1798 the 5th lord died, and at the age of 10 Byron inherited the title and moved with his mother from Aberdeen to Newstead Abbey, given to the family by Henry VIII. He lived there on and off until he left England in 1816, never to return. It would be presumptuous to extol the glories of Byron's poetry or his role as the exemplar of the Romantic hero. His general medical history is well known, especially his lameness, usually thought to be a club foot, for which he wore a brace and boot "which haunted him like a curse."(2) It was probably a simple dysplasia(10) for which John Hunter alone correctly predicted "it will do very well in time." Byron also suffered from biliousness, catarrh, chilblains, convulsions, constipation, faintness, giddiness, gonorrhoea, haemorrhoids, kidney stone, liver complaints, rheumatism, scarlet fever, sunburn, tertian fever, and warts. In 1823 Byron went to fight for the liberty of Greece against the Turks. There he caught a fever after a sudden downpour while riding. His doctors bled him with leeches and lancets, gave him blisters and clysters, purgatives, antimony, laudanum, and ether. After a painful, pathetic illness, probably malaria, he died at Missolonghi on 19 April 1824. He was only 36.
Byron's body image
Byron had appetite problems which were not simply sexual, and Wilma Paterson has developed the hypothesis that he had a bulimia or anorexia eating disorder.(13,14) Byron was a miserable, fat, and bashful boy, scurrilously and violently abused by his ungainly, obese mother.(3)(6) He was wretched at leaving Harrow in 1805, and wretched at going to Cambridge instead of Oxford. When he went up to Trinity College he was miserable and untoward. However, he soon became less diffident: "I took my gradations in the vices with great promptitude, but they were not to my taste ... I could not share in the common place libertinism of the place and time without disgust. ... College is not the place to improve either morals or income. ... Since I left Harrow I have become idle and conceited, from scribbling rhyme and making love to women."(2)(6) Thomas Moore claimed that Byron's singularities were chiefly to be ascribed to his college associates, but Hobhouse did not accept this: "Certainly Byron had nothing to learn in depravity when he came from Harrow."(15) By the age of 18 Byron was 5 feet 8 This crash diet brought him down to 9 stone 11 1/2 pounds (61 kg). He
later became a "leguminous-eating Ascetic." (6) "I
have long left off Wine entirely ... my meal is
generally at ye Alfred, where I munch my vegetables in place.
... For a long time I have been restricted to an
entire vegetable diet, neither fish or flesh coming within my regimen,
so I expect a powerful stock of potatoes, greens, & biscuit, I drink no
wine." (6) Nothing gratifies him so much as being told
that he grows thin: "Don't you think I get thinner? Did you ever see
any person so thin as I am, who was not ill?"(3)
"Webster ... found me thinner even than in 1813,
for ... I have subsided into my former more meagre
outline. ... I am as thin as a skeleton - thinner than
you saw me at my first arrival in Venice and thinner than
yourself there is a climax!" (6) Byron's
accounts reveal payments for all his food and drink, and in 1811 he
bought a treatise on corpulence.(7) This treatise was
probably William Wadd's Cursory Remarks on Corpulence,
published anonymously in 1810. Wadd cited Coelius Aurelianus's triad
of diet, exercise, and sweating. "His food is to be chiefly bread
made with bran, vegetables of all kinds; a very small quantity of
animal food, which should be dry and free from fat. He advises very
little sleep, and positively forbids it after meals."(16)
When Byron dined with Samel Rogers in November 1811 he asked for just
"hard biscuits and soda water." These were not available, so he
dined on bruised potatoes drenched with vinegar.(17)
Rogers's anecdote that Byron later went to his club "and eaten a
hearty meat-supper" is probably a fiction. In 1821 his breakfast
"consisted of a cup of strong green tea, without milk or sugar, and
an egg, of which he ate the yolk raw. ... My
digestion is weak; I am too bilious ... to eat more
than once a-day, and generally live on vegetables. To be sure, I drink
two bottles of wine at dinner, but they form only a vegetable diet.
Just now, I live on claret and soda water."(1)
In spite of his cult of thinness he remained a passionate gourmet
and giver of famous dinner parties. One menu does survive from a Byron
dinner, on 2 January 1822 in Pisa, with just three main courses, but 18
dishes.(7) For each course all the dishes would have been
served at once and laid on the table for the guests to help themselves.
The first course was thick dark vegetable soup, or herb soup é2 la
sant|fe, with fried sweetbreads or cream cheese; a salami of pork with
lentils, spinach, and ham; boiled capons; beef garnished with potatoes;
and a fish stew. That course would then have been removed and in came
the grand set piece, which the host carved. There was veal, roast
capons, roast woodcocks, baked fish, a fricasee of poultry, and another
stew. The dessert was blanched and plain almonds with pears, oranges,
and chestnuts. With dinner they would have drunk claret and hock, and
afterwards coffee and tea. (This was a modest dinner compared with what
the Prince Regent was serving in Brighton about the same time, when in
1817 the kitchens of his Royal Pavilion produced 36 courses of 112
dishes.(18))
Yet Byron was almost never seen, and did not like to see others,
eating. "I don't know how I shall manage this same wooing
... I am sadly out of practice lately, except for a
few sighs to a Gentlewoman at supper who was too much occupied with ye
fourth wing of her second chicken to mind
anything that was not material. ... I only wish she
did not swallow so much supper, chicken
wings - sweetbreads - custards - peaches and Port wine - a
woman should never be seen eating or drinking, unless it be
lobster sallad & champagne, the only true feminine &
becoming viands. ... I have prejudice about women: I
do not like to see them eat." (1) "He disliked seeing
women eat, or to have their company at dinner, from a wish to believe
if possible, in their more ethereal nature ... his
chief dislike ... arose from the fact of their being
helped first, and consequently getting all the wings of the chickens,
whilst men had to be content with legs or other parts."
(11) He rarely dined with his wife, Annabella, who remarked,
"For four or five months before my confinement, he objected unkindly
to dine with me, though I was willing to conform to his hours, and once
when his dinner was accidentally served at the same table with mine, he
desired his dish to be taken into another room."(19,20)
Nor did he sit and eat with his devoted mistress, Teresa
Guiccioli.(5)
Probably he dined alone to gorge in secret, and then perhaps make
himself sick. His sister Augusta wrote, "I am quite convinced that if
he would condescend to eat & drink & sleep like other
people he would feel ye good effects - but you know his way is
to fast till he is famished & then devour more than his
stomach in that weak state can bear - & so
on."(19) "Stuffed myself with sturgeon, and exceeded in
champagne and wine in general, but not to confusion of head. When
I do dine I gorge like an Arab or a Boa snake; on fish
and vegetables, but no meat. I am always better, however, on my tea and
biscuit than any other regimens and even that sparingly.
... To dine today ... for which I
have some appetite, not having tasted food for the preceding
forty-eight hours. I wish I could leave off eating
altogether."(6)
Byron refused most dinner invitations. "I dare not venture to
dine with you tomorrow - nor indeed any day this
week - for three days of dinners during the last seven
days - have made me so head-achy and sulky. ... I hope
you will not take my not dining with you again after so
many dinners - ill - but the truth is - that your banquets were too
luxurious for my habits." (6) When he did dine with the
Blessingtons in 1823 in Genoa he took two helpings of plum pudding é2
l'Anglaise: "for several months I have been following a most
abstemious regime, living almost entirely on vegetables; and now that I
see a good dinner, I cannot resist temptation though tomorrow I shall
suffer for my gourmandise, as I always do when I indulge in
luxuries."(3) "Forgot there was a plum-pudding, (I have
added, lately, eating to my 'family of vices').
... Mrs Ingram has promised me a
minced pie, a dainty I have not seen these seven
years." (6)
"Last night I supped with Lewis; - and, as usual, though I neither
exceeded in solids nor fluids, have been half dead ever since. My
stomach is entirely destroyed by long abstinence. ...
That confounded supper at Lewis's has spoiled my digestion and my
philanthropy. I have no more charity than a cruet of vinegar. Would I
were an ostrich, and dieted on fire-irons, - or any thing that my
gizzard could get the better of. ... I am in the most
robust health - have been eating and drinking - & fallen upon illfortune.
... I began very early and very violently - and
alternate extremes of excess and abstinence have utterly destroyed - oh!
unsentimental world! - my stomach - and as Lady Oxford used
seriously to say a broken heart means
nothing but bad digestion. I am one day in high
health - and the next on fire or ice - in short I shall turn
hypochondriacal - or
dropsical - whimsical I am
already - but don't let me get tragical
... three days of dinners during the
last seven days - have made me so head-achy and sulky - that it will take
me a whole Lent to subside again into anything like independence of
sensation from the pressure of materialism."(6)
George Gordon Byron, 6th Baron Byron,
He feared being dominated by animal appetites
"the wear and tear of the vulture passions."(6) Byron
knew his sexual excesses came when he was at his fattest. He avoided
meat for the curious p "I am better than ever - and in importunate health - growing (if not
grown) large & ruddy - & congratulated by impertinent persons on my
robustious appearance - when I ought to be pale and
interesting."(6) He would then boast of intolerable
leaness, a meagre outline, "nearly transparent."(6) Yet
to Hunt in 1822, "Upon seeing Lord Byron, I hardly knew him, he was
grown so fat."(21) Byron's friends confirmed his eating
disorder. Trelawny wrote: "Byron had not damaged his body
by strong drinks, but his terror of getting fat was so great that he
reduced his diet to the point of absolute starvation. He was of that
soft, lymphatic temperament which it is almost impossible to keep
within a moderate compass, particularly as in his case his lameness
prevented his taking exercise. When he added to his weight; even
standing was painful, so he resolved to keep down to eleven stone, or
shoot himself. He said everything he swallowed was instantly converted
to tallow and deposited on his ribs. He was the only human being I ever
met with who had sufficient self-restraint and resolution to resist
this proneness to fatten: he did so; and at Genoa, where he was last
weighed, he was ten stone and nine pounds, and looked much less. This
was not from vanity about his personal appearance, but from a better
motive; and as, like Justice Greedy, he was always hungry, his merit
was the greater. Occasionally he relaxed his vigilance, when he swelled
apace. I remember one of his old friends saying: 'Byron, how well you
are looking! ... You are getting fat,' Byron's brow
reddened and his eyes flashed - 'Do you call getting fat looking well,
as if I were a hog?' Byron said he had tried all sorts of experiments
to stay his hunger, without adding to his bulk. 'I swelled,' he said,
'at one time to fourteen stone, so I clapped the muzzle on my jaws,
and like the hybernating animals, consumed my own fat'
... his brain was always working at high pressure.
... By starving his body Byron kept his brains clear.
He would exist on biscuits and soda-water for days together, then, to
allay the eternal hunger gnawing at his vitals, he would make up a
horrid mess of cold potatoes, rice, fish or greens, deluged in vinegar,
and gobble it up like a famished dog."(22)
He took quantities of vinegar to lessen his appetite, dosed himself
with Epsom salts, magnesia, and strong laxatives, and always had the
highest spirits when he had emptied himself at one or both ends, that
is after the purgatives had acted, or he had vomited. He also used
tobacco "to take off the pinguify propensities of the
appetite."(23) In Athens he had Turkish baths daily and a
diet of vinegar, water and rice.(9) He drove himself to
excess exercise and perhaps would be classified today as also having
exercise bulimia. "I am in tolerable leanness, which I promote by
exercise and abstinence."(6) He swam the Hellespont, in
imitation of Leander, enjoyed being tossed by the sea for days on end
in a boat(6) and his last fatal illness followed being
drenched during a long ride in Greece. James Joyce,(24-26) perhaps the greatest of the
many famous Irish writers, was born in Dublin in 1882. Both he and his
father became medical students, his father at Cork from 1867 to 1869:
"He was enrolled in the school of medicine for three years
... studied as little as possible, and instead made a
big name in sport and dramatics, and by his wild life while a student
... many human lives were saved by his giving up the
study of medicine."(24)
10.30 am Ham, bread and butter, coffee -1.30 pm Soup, roast lamb, potatoes, bread, wine -4.00 pm Beef-stew, bread, wine -6.00 pm Roast veal, bread, gorgonzola cheese -8.30 pm Roast veal, bread, grapes with vermouth -9.30 pm Veal cutlets, bread, salad, grapes, wine Joyce entered medical school in University College Dublin in October
1902. By December he had transferred to the Sorbonne in Paris. ("Of
all the wild youths I have ever met he is the
wildest."(24)) He came home the following Easter because
of the fatal illness of his mother. He could not have spent much time
studying medicine, but he did spend his evenings frequenting the
doctors' quarters of Dublin hospitals for the social life. Joyce was a
close friend of many Dublin medical students, especially Oliver St John
Gogarty, the Buck Milligan of Ulysses, physician, journalist, senator,
and poet - but bizarrely fated to be best known anonymously as the
author of a limerick: There was a young man of St
John'sWho wanted to bugger the swansOh no! said the
porterOblige with my daughterFor the swans are reserved for the
dons.
Joyce had a profound knowledge of human disease, and
diseases and doctors and hospitals are continually referred to in his
Portrait of the Artist as a Young Man, in
Dubliners, and in Ulysses. He met his
wife to be, Nora Barnacle, on 16 June 1904 - the famous Bloomsday.
James Joyce, painted in 1935 His friends with similar symptoms told him that he had an ulcer,
but his French doctors made other diagnoses. In 1928 it was
inflammation of the intestine. In 1933, after a night of acute soreness
of all his inside, leaving him helpless and strengthless, he was seen
by Dr Debray's assistant, Dr Fontaine. (24)
She had a particular interest
in contemporary literature in English and looked after other expatriate
authors such as Ernest Hemingway and Samuel Beckett. Dr Fontaine
discounted the diagnosis of colitis and attributed the spasms to a
"disequilibrium of the system of the sympathetic nerve with the focus
of the dislocation in the epigastric part of the stomach": she
advised absolute and complete calm.
Joyce was then well for some months, but the pains returned with a loss
of 7 kg in weight. The pains lasted up to eight hours and were
attributed by Dr Debray to "nerves" from his worries over so many
years; Debray treated him with laudanum compresses. His friends and
family still considered that he had a peptic ulcer, which made Debray
even crosser - "une interpretation trop facile." In 1934 Jung
described Joyce's "psychological style" as "definitely
schizophrenic." (24)
He continued to be ill over the next four years, with similar symptoms.
In 1939, with constant stomach cramps and indigestion, he was described
as abnormally pale. In 1940 he and his family fled Paris from the
Germans; on arrival in Switzerland he was described as so
undernourished as to look like an angular figure in a Picasso drawing.
At 4 am on Friday 10 January 1941 at his home in Zurich, he was woken
by severe abdominal pain. His usual doctor was away and another came,
made no diagnosis, and gave an injection of morphine. Joyce did not
improve and in the evening was seen by the surgeon Heinrich Freysz, who
had studied in Lausanne, Munich, and Zurich under Kocher, Kré-nlein,
and Sauerbruch (who had dismissed him) and then worked in Strasbourg,
Berne, Geneva, and Vallence before returning to Zurich.
Freysz found Joyce with a rapid pulse and a tender distended abdomen,
but without rebound tenderness, presumably because of the morphia.
Joyce was admitted to the Schwesterhaus vom Roten Kreuz, where the next
morning gastric aspiration gave positive results on a benzidine test
and x ray films showed air below the diaphragm. It was
32 hours after the perforation when, at midday on Saturday 11 January,
Freysz opened the abdomen under local anaesthesia and found and sutured
a 2 mm perforated indurated duodenal ulcer near the pylorus, and then
covered it with a patch of omentum. Joyce was given intravenous fluids
but later that afternoon collapsed from an internal haemorrhage.
Blood donors were summoned, and Joyce thought it a good omen that one
of them came from Neuchatel because of Joyce's liking of the wine of
that area; indeed, he had drunk a considerable amount of it the evening
before the ulcer perforated. The transfusion was given by William
Léffler (famous for Léffler's syndrome), later director of the
medical clinic and policlinic of Zurich University. Paralytic ileus
developed, and at 1 am on 13 January Joyce asked the nurses for his
wife and son before he died. "Lonely in me loneness. For all their
faults. I'm passing out. O bitter ending. I'll slip away before
they're up."(24)
The necropsy showed enormously dilated loops of intestine
with a fibrinous exudative peritonitis. Freysz's patchwork on the
perforated ulcer was intact, but there was a second shallow ulcer
containing blood clots in the duodenum. The pancreas had a r My third course, the dessert, must be Dame Nellie Melba, who was
born Helen Mitchell in Melbourne, Australia, in
1861.(27-30) She was determined to be a singer and trained
as such. In 1882, however, when she was 21, she met the first of the
many men in her life on a visit to Queensland: Charles Nesbitt
Armstrong, the youngest son of an English baronet. She married him but
was soon unhappy with him and with both the cultural desert of
Queensland and its tropical climate, which made mouldy her clothes,
music, and piano. In 1884 she had a son, but she left her husband two
months later.
Her father took her to Europe, where she studied with Mathilde Marchesi
in Paris before her debuts, in Brussels in 1887 and the next year in
Covent Garden, where she sang almost every season until she retired in
1926. She had a wide repertoire, and she sang frequently at the
Metropolitan Opera in New York, where in 1896 she had her only failure
as Wagner's Brünnhilde.
The chef at the Savoy was Escoffier, who had worked for Emperor
Napoleon III and for the Kaiser, who had entitled him the Emperor of
Cooks. Escoffier was the son of a blacksmith and he was 14 before he
could read or write, and he never mastered more than a few words of
English.
Dame Nellie Melba, photographed by Baron Adolf de Meyer in 1926
He explained that if he spoke English he might also learn to
cook like an Englishman. He had two nightmares, the English and
the Americans: the English because they gorged tea and cakes, ruining
their palates for his divine di In 1890 Melba, aged 31, met the second and last great love of her life,
a méesalliance destined to be one of the royal love scandals of the
1890s. Louis Philippe Robert, 14th Duke of Orléeans, was the eldest
son and heir of the Comte de Paris, the Bourbon Pretender to the throne
of republican France. He was eight years younger than Melba, lean,
handsome, 6' 2" (188 cm), highly educated, and an entertaining
companion. He had been educated at the Royal Military College,
Sandhurst, and then spent a year with a British regiment in India. The
Bourbon family had been exiled from France in 1886, but the duke went
back to Paris demanding as a Frenchman to do his military service. He
was arrested and sentenced to two years in jail. Released after a few
months, he returned to England and fell in love with Melba.
He followed her to St Petersburg, where she sang Juliette. At the end
he of course applauded, which was against court etiquette: no one must
applaud before the Tsar. Melba's duke was promptly expelled from
Russia. Melba and the duke lived and travelled together throughout her
performances at the opera houses of Europe. To achieve his ambition to
return to France, however briefly, Melba "hired a carriage, dressed
him in livery, and made him act as her coachman." They crossed the
frontier from Germany, "lunched in France and returned without the
slightest contretemps."(27)
Escoffier, Savoy chef Melba had one last attempt to keep her duke. At Covent Garden in 1894
she sang Else in Wagner's Lohengrin, with Jean de Reszke as the swan
prince. The next evening she gave an intimate supper for the duke and
asked Escoffier for pérches flamb|fees.
Escoffier was determined to
excel even himself on such a critical evening and wheeled in as dessert
a swan carved out of ice in tribute to Lohengrin. Escoffier had made a
nest of spun sugar and strawberry leaves with a superb peach resting on
a vanilla flavoured ice, coated lightly with raspberry jam.
Then Melba, like so many opera singers, went to seed and put on much
weight. She developed erratic eating habits, gorging and fasting on
alternate days. Again Escoffier was called to the rescue. For her to
lose weight, he created the crisp austerity of the thin Melba toast,
and at one stroke he doubled Melba's gastronomic immortality. Today's doctors, and indeed any British or American
gastroenterologist in the 1930s or 1940s, would have diagnosed and
treated James Joyce's chronic duodenal ulcer. We have all struggled
with patients with anorexia or bulimia, or both. A good read is
Byron's fantastic Don Juan, with its clear associations
of sexual and gastric preoccupations. The next time you gorge or diet,
think of Byron, James Joyce, and Melba and then recall the refrain of
every waiter in New York: "Enjoy your meal!"
I am grateful to Wilma Paterson for allowing me to explore
f
Gastroenterology Division,
Correspondence to: Dr J H Baron, References
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