Before Renfield could die of his probable GPI (General Paralysis of the Insane) he unwisely lets Dracula into Dr Seward’s asylum, only to be knocked unconscious by him. Professor Van Helsing discovers ‘a depressed fracture of the skull, extending right up through the motor area’, and says:
“The rapidity of the suffusion shows the terrible nature of his injury. The whole motor area seems affected. The suffusion of the brain will increase quickly, so we must trephine at once or it may be too late.”
Bram Stoker’s surgeon brother Thornley Stoker had advised on this, being proud of his own success in trephination of a patient taken into the Dublin Richmond Asylum. This man, however, survived, whereas Renfield is abandoned by the medics as soon as he has revived enough to speak a bit.
Although this case is more neurologically advanced in description, as a plot point it was preceded by Sheridan Le Fanu, another Dublin author, in The House by the Churchyard (1863). His trepan (or trephine) is gothicly described as:
resembling the homely bit-and-brace, but slender, sinister, and quaint, with a murderous sort of elegance.
I think the trephine in the picture may not have been produced in time for Dr Seward, but the name of the maker seems very apt.
‘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).
Dr Seward, the asylum superintendent in ‘Dracula’, decided to invent a new diagnosis for his pet patient Renfield – ‘zoophagy’ (animal-or life-eating).
However, Renfield wanted to go beyond his usual flies, spiders and birds, and attacked Dr Seward himself, explaining that ‘the blood is the life’ as mentioned in the Bible and in the advertisement shown above. (In fact this Mixture’s chief active ingredient was potassium iodide.)
The real psychiatrist Dr George Savage had in 1888 described a case with similar self-proclaimed motivation:
He visited the city abattoir, obtained and drank blood hot from the slaughtered animals. This was after a few days stopped, but fortunately he was watched, for he was seen to try to decoy children to his rooms, and he owned to me that he wished to have their blood, as blood was his life, and his life was that of a genius.
Dr Savage was considering the psychopathology of Jack the Ripper.
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’.