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’.

Childish Psychiatry Horror, 1. Frederick

Cruel Frederick pic

The author of this horrid warning rhyme was Heinrich Hoffmann, a German psychiatrist, in his book ‘Struwwelpeter’, published in 1845, and written to entertain his little son.

This sort of animal cruelty has been attributed to the lunatic Renfield in ‘Dracula’, but I think he had different motives. On the other hand, the real life ‘Jack the Ripper’ may have had such a childhood background according to Dr George Savage  writing on  ‘Homicidal Insanity’ for The Fortnightly Review in 1881.

I have known such children kick cats and dogs to death, or set light to them, or pour boiling water over them, the fiendish pleasure being increased if the young of the animals were thus reduced to starvation. The morally undeveloped child has been pointed out to me by several devout friends as a proof of the existence of the devil.

Savage and other ‘medico-psychologists’ of his time regarded this as a type of ‘moral insanity’, which is perhaps more apt than the modern ‘conduct disorder’ or, in adulthood, ‘severe antisocial personality disorder’ or ‘psychopathy’.


‘Dracula’ and Diet: Renfield, 3

Wain Gothic Cat
Louis Wain: Gothic Cat (Wellcome Collection)

In his paper ‘On some of the Varieties of Morbid Impulse and Perverted Instinct’ (1866) Dr Mclntosh reported:

Dr Elliotson narrates in his lectures that a patient has longed for raw flesh, and even for live flesh, so that some have eaten live kittens and rats (!).

In ‘Dracula’, Dr Seward tempts his patient Renfield with the possibility of a kitten, but lets him down. The Count offers rats to get Renfield to let him into the asylum:

A dark mass spread over the grass, coming on like the shape of a flame of fire […]  and I could see that there were thousands of rats with their eyes blazing red, like His only smaller.

But Renfield is deceived again, and dies.

‘Dracula’ and Diet: Renfield, 2


Moth by Rae
Death’s Head Moth: photo by Alastair Rae

Secret treats to ingest were sent by Count Dracula to Renfield: “Big moths, in the night, with skull and cross-bones on their backs.” The all-knowing Dr Van Helsing explains: “The Acherontia Atropos of the Sphinges, what you call the ‘Death’s-head Moth’?”

Curious eating habits of various kinds had long been observed in asylums, and were discussed by W. C. McIntosh, superintendent of Perth asylum, in 1866:

The morbid desires, longings, or impulses for various substances generally regarded with loathing and disgust have been grouped under the head of Pica. 

Although these alien substances were often chalk, charcoal or earth, there is one mention of an insect-eater:

Remaining during winter in a kind of torpid state in the chimney corner, but in summer hunting all day long for honey-bees, humble-bees, and wasps.

While the unfortunate patients may partly have been trying to improve their wretched diets, these days, eating insects is very trendy, and earth will clearly be next.

‘Dracula’ and Diet: Renfield, 1

2019 Blood is lifeImages from Wellcome Collection

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.



Pellagra and Polenta

2019 mamaliga

I had for breakfast more paprika, and a sort of porridge of maize flour which they said was ‘mamaliga’. (Jonathan Harker)

When the use of maize (corn) was introduced into Europe from the Americas it became a main dietary carbohydrate source for poor people – as ‘polenta’ in Italy and ‘mamaliga’ for the Romanians. Without the original method of preparing the corn by soaking it in lime, niacin (also known as Vitamin B3) and tryptophan (its precursor) have poor bioavailability. The ensuing deficiency disease is pellagra, a chronic and finally fatal condition, whose mechanism was not understood until well into the twentieth century. It was endemic in many poverty-stricken regions at the end of the nineteenth century, especially Transylvania.

Count Dracula would not have suffered from this – nor Renfield – as their diets were less vegetarian.


Horrid Hands for Halloween 7

Plague hand pic

A giant hand (representing bubonic plague) roams through the dark streets of London, as people and rats try to escape its grasp.

Watercolour by Richard Tennant Cooper. Source: Wellcome Collection.

‘Dracula’ can be understood as a story of a disease such as the plague and the Count certainly deploys rats. The lunatic Renfield reported that:

A dark mass spread over the grass … I could see that there were thousands of rats with their eyes blazing red, like His only smaller.

He was hoping Dracula would allow him to eat them.