Diagnosing Dracula’s Renfield: Sanguine

Dr Seward described his strange patient Renfield as ‘sanguine’ – but what did he mean?

Lavater Sanguine
Lavater: Sanguine Physiognomy Wellcome Collection

‘Sanguine’ was the name of the ancient medical ‘humour’ supposedly related to an excess of blood. The associated temperament was active and cheerful, while the appearance or ‘physiognomy’ was as above.

Now Renfield was not always cheerful, although he could be, but he was certainly keen on consuming blood to maintain his liveliness.

Looking through the old Journals of Mental Science, it seems that when the doctors were describing one of their own brethren as ‘sanguine’ it meant ‘calmly optimistic’. When the term is used about a patient, it is usually someone with ‘General Paralysis of the Insane (GPI), presumably because of ‘grandiose delusions’.

Diagnosing Dracula’s Renfield: Lunacy

Hogarth’s Rakewell ends up in Bethlem

‘Lunacy’ was a term the medico-psychologists of the late nineteenth century were trying to change, as their studies seemed not to indicate an effect of the moon. The public, however, were not receptive. Dr Seward of ‘Dracula’ thought that somehow his pet patient Renfield was affected, although in a different way.

Three nights has the same thing happened, violent all day then quiet from moonrise to sunrise.

Seward did not realise at first that a vampire was involved…

Tom Rakewell, of Hogarth’s painting series ‘The Rake’s Progress’, had had too much nightlife (judging from his sinisterly syphilitic acquaintances) and his ensuing lunacy was thus probably General Paralysis of the Insane (GPI).

 

Bitten by a Bat, 5

real vampire-bat

The real blood-sucking (or blood-lapping) vampire bats, are found in the Americas. The common vampire bat (Desmodus rotundus) feeds solely on blood, a trait known as ‘haematophagy’. (Compare this with Renfield’s so-called ‘zoophagy’.) These bats are quite small, even cute-looking, but rabies is still a possibility.

For a dental note: it is the two sharp front teeth which open up the blood vessel, then the long tongue takes over. Note that in the ‘Dracula’ novel and most movies it is the canine teeth that cause the damage but Count Orlok in ‘Nosferatu’ has teeth like this, as do rats.

 

Bitten by a Bat, 3.

Daubenton reset
Daubenton Bat

Rabies can be caused by a bite from a British bat, the Daubenton. It is caused by the European Bat Lyssavirus – EBLV, which was first found in a bat in Florida in 1953. While in the UK there has only been one case of human rabies acquired from a native bat, in 2002, this was fatal. An infected bat was found as recently as October 2019.

In humans symptoms of the disease include:

  • anxiety, headaches and fever in the early stages
  • spasms of the swallowing muscles making it difficult or impossible to drink (hence ‘hydrophobia’)
  • breathing difficulties.

Post-exposure treatment (PET) using rabies vaccine with or without human rabies immunoglobulin (HRIG) is highly effective in preventing disease if given correctly and promptly after exposure. For  advice see: www.gov.uk/government/publications/rabies

While Count Dracula seems to have had mild hydrophobia, his swallowing seems to have remained intact.

Bitten by a Bat, 1.

Wellcome bat 2019 1 crd

Coloured engraving by Josiah Wood Whymper (1813 -1903) from the Wellcome Collection. The accompanying text comments:

Sleeping during the day in the most retired places, in the hollow of trees, or hanging by its claws from the bark, or concealing itself in ruined buildings, or in the roofs of ancient churches, it avoids the glare of daylight; but when the shades of evening come on, and hunger tempts the timid animal from its lurking-place, it is brisk and lively enough.

In ‘Dracula’, Mina noted:

Between me and the moonlight flitted a great bat, coming and going in great whirling circles. Once or twice it came quite close, but was, I suppose, frightened at seeing me, and flitted away across the harbour towards the abbey.

We are in Whitby here, but it is not until Lucy is back home in Hampstead that the bites in her neck are noticed by Professor Van Helsing. He starts to suspect a diagnosis of Vampirism.

 

 

 

Treating Beri-beri in Ireland

Guinness factory Dublin 1910
Guinness factory Dublin 1910

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.

Garlic is a good source of thiamine too.

 

 

Dr Norman and Beri-beri

Conolly Norman pic

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.