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Having answered the Count’s salutation, I turned to the glass again to see how I had been mistaken. This time there could be no error, for the man was close to me, and I could see him over my shoulder. But there was no reflection of him in the mirror! The whole room behind me was displayed, but there was no sign of a man in it, except myself.3

While many of these tropes came from the mind of Stoker, as well as the centuries-old legends of Romania, there is a real medical condition that mimics vampirism, and perhaps informs some of these vampiric idiosyncrasies. Is it possible that medical afflictions inspired the authors and filmmakers who have brought vampires to life? Or even the Eastern European legends which Stoker studied?

One theory of the origin of the vampire is the rare disease called porphyria. Known as “vampire disease,” porphyria causes irregularities in the production of heme, a chemical in blood. Some forms of this condition can lead to deposition of toxins in the skin. Sufferers are often sensitive to light as it activates these toxins. While they don’t burst into flames like Count Dracula, those afflicted can suffer from disfigurement, including lip and gum erosion. These factors could have led to the corpse-like, fanged appearance that we associate with vampires and their dislike of sunlight. “Porphyrias” also have an intolerance to foods that have a high sulphur content such as garlic.4 This could have led to the popular myth that vampires are repelled by the stinky vegetable.

One famous case of porphyria was King George III who had acute intermittent porphyria. As portrayed in the film The Madness of King George (1994), the most notable symptoms of this type are neurological attacks, such as trances, seizures, and hallucinations, which often persist over days or even weeks. Other famous people who were said to have porphyria include Vlad III, fueling the rumors of him being a vampire, and Vincent Van Gogh.

Another rare type of porphyria, congenital erythropoietic porphyria (CEP), can cause appalling mutilations from the light-activated porphyrins, including loss of facial features and fingers, scarring of the cornea, and blindness. The condition may have been less rare in the past, especially in Transylvania, perhaps giving rise to tales of vampires. While porphyria is a genetic condition, in some cases it can also be caused by environmental contaminants. The most famous episode happened in Turkey in the 1950s, when four thousand people developed a form of porphyria after eating wheat seeds that had been sprayed with a fungicide. Hundreds died, and use of the fungicide was later banned.

This leads us to ask, can porphyria be treated? Studies have shown that spleen removal and bone marrow transplants can be effective. Modern medicine has also found that blood transfusions can help. Interesting to note, the heme pigment is robust enough to survive digestion, and is absorbed from the intestine. This means that, technically, it is possible to relieve the symptoms of porphyria by drinking blood! Who knew Count Dracula was so advanced in medical science?

Heme is strong enough to survive digestion.

Another medical explanation for vampires is tuberculosis (TB). This lung disease has been around for centuries and throughout history was spread easily among those living in close, unsanitary conditions. Victims of TB turn very pale, often avoid sunlight, and cough up blood due to the breakdown of lung tissue. Seeing a sick person with blood on their lips and in their mouth was often misinterpreted as them drinking blood rather than coughing it up. TB spreads rapidly and easily from person to person and may have led to the belief that vampires rise from the dead. As multiple family members succumbed to the infectious disease, some believed the undead were visiting at night to drink blood and create more vampires. Nineteenth century New England was gripped by its own “vampire panic” resulting in members of the community exhuming bodies and burning internal organs in order to stop the “vampire” outbreak.

Many famous people throughout history either suffered from TB or knew someone who did, including Edgar Allan Poe, Charlotte Brontë, and Anton Chekhov. Because so many artists had TB it became known as “the romantic disease” and was thought to help its sufferer see life more clearly. TB is still an active disease but much less common due to vaccines and treatment options. Currently, less than two hundred thousand people a year are infected with TB in the US. In the early 1800s it was the leading cause of death afflicting more than 25 percent of the population.

Another theory for the vampire myth is the condition called catalepsy. This disease of the central nervous system leads to a slowing of the heart and breathing rate, with sufferers often appearing to be dead. This condition is portrayed in popular fiction including Edgar Allan Poe’s The Premature Burial (1844) and The Fall of the House of Usher (1839). When a person is afflicted with catalepsy, they are unresponsive to stimuli, may have rigidness, and pale skin. The subject is paralyzed and has no vital signs, which, to most people, would seem like they were dead. This disorder usually lasts a few minutes or hours, but can last up to days in the most extreme cases.

Although Bram Stoker may have started the phenomenon of vampires in literature, the creatures live on in media today. From popular series True Blood (2008–2014) to Twilight (2008) people continue to be fascinated with the mysterious blood suckers well into the twenty-first century.

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CHAPTER EIGHT

NOSFERATU

Year of Release: 1922

Director: F. W. Murnau

Writer: Henrik Galeen

Starring: Max Schreck, Greta Schroeder

Budget: Unknown

Box Office: Unknown

While the 1931 version of Dracula was made with the blessing of Bram Stoker’s heirs, the 1922 silent German film Nosferatu was a blatant rip-off. So obvious, in fact, that Stoker’s family and estate sued Prana Film over the copyright infringement. They won, leading to the destruction of almost every copy of Nosferatu. The vital word is almost, as Nosferatu, like its inspiration Count Dracula, is seemingly immortal. Thankfully, the F. W. Murnau picture survived and has gone on to entertain audiences for nearly a century.

Count Orlok, with his pale eyes and spindly fingers, is yet another take on Dracula. The story of Nosferatu is strikingly similar to Stoker’s novel, complete with its own versions of Jonathan and Mina Harker. And while the film is an admitted copycat, it deviates from the novel in that Count Orlok kills his victims, giving them no chance at eternal life. Nosferatu is even credited with first depicting the notion of vampires succumbing to sunlight, which has been inculcated in our modern day understanding of vampires.

F. W. Murnau is, of course, not the first creative to take perhaps a little too much inspiration from another. It is true that Nosferatu mirrors itself after Stoker’s novel, yet vampires were not a new concept. Stoker stitched together Dracula with the before-mentioned Vlad the Impaler. Like all monsters, vampires have a touch of realism, a humanity that anchors them to the natural world. Nearly every movie monster has roots in reality. The consumption of blood has been dated back to ancient civilizations. From Asia, Africa, and beyond there are examples of blood rituals long before Stoker, or Romania, came to be. In Christianity there is even the symbolic drinking of Jesus Christ’s blood.