Museum of Health Care Blog

Ex Crypta: Special Halloween Edition

“. . . Then I guess, Jack Seward, that that poor pretty creature that we all love has had put into her veins within that time the blood of four strong men. Man alive, her whole body wouldn’t hold it.” Then, coming close to me, he spoke in a fierce half-whisper: “What took it out?”

Dracula by Bram Stoker, published 1897

The answer to that question, of course, is the vampire Dracula. But here at the Museum of Health Care, we are much more interested in how the blood got into poor Lucy Westenra in the first place.

To summarize for those of you who haven’t read Dracula, young maiden Lucy is an early victim when the vampire comes to London. Although she is eventually drained and turned into a vampire herself, her (un)death is briefly staved off by donations of blood from four of the male leads (Arthur Holmwood, Quincey Morris, Dr. John Seward, and Dr. Abraham Van Helsing). It’s one of the earliest depictions of blood transfusion in literature.

Dracula was published in 1897. What was the state of blood transfusion back then?

Bram Stoker was no great medical innovator, although he came from a family of doctors and was probably well-versed in medicine of the time period. Blood transfusion as a concept was fairly well established by 1897. The idea of consuming blood to gain power is an ancient one, but vein to vein transfusion has its roots in the 17^th century, spawned from a new understanding of blood circulation. After demonstrating successful transfusion in 1667, French doctor Jean-Baptiste Denis was hoping to usher in a new era of medical treatment. Unfortunately, most French physicians were against the practice and when one of his patients died, it provided a good excuse to squash blood transfusion for more than a century (Denis was in fact put on trial for murder, but was acquitted due to the likelihood that the patient had, in fact, been poisoned by his wife).

Interest in blood transfusion picked up again in the 19^th century with the work of Dr. James Blundell (himself inspired by the work of Dr. John Henry Leacock). In 1818, Blundell would perform the first recorded human to human blood transfusion. His work popularized blood transfusion as a treatment; although still controversial, other physicians would also begin to perform transfusions. By the 1897 publication of Dracula, then, blood transfusion was known as a possible, though still fraught, treatment.

Stoker doesn’t describe in detail how the blood was transferred, but attending physician Dr. Van Helsing had options. The earliest experiments in transfusion were done with quills and pipes. Van Helsing could also have borrowed Blundell’s earliest method for transfusion using a syringe: stick a syringe into the donor’s vein, snag some blood, and then put it into the patient’s vein. Easy!

However, though the method is not named, Stoker does describe the donor watching their blood revive Lucy as it is drawn, which suggests that some kind of apparatus was used. Certainly the doctors in Dracula could have had access to one. Blundell himself had a device in which the donor stood to direct blood into a funnel which then went into the patient. Experiments in the latter half of the nineteenth century would involve rubber tubing connected to a small bulb to perform the pumping action.

Lucy was also dependent on having a willing donor right next to her. 1897 was years before blood banks would be developed. This was because at the time, there was no way to keep blood viable. As soon as it was removed, it would begin to coagulate (get sticky and eventually solidify). Thus, blood had to be transferred immediately from vein to vein. The addition of sodium citrate to prevent blood clotting was first experimented with in 1914; this and World War One would lead to the creation of blood banks.  In Dracula’s time, the only way to try to prevent coagulation would have been to defibrinate the blood (remove the fibrin). Stoker was familiar with this concept, although perhaps not the motivation behind it – the first donor’s blood is referred to as “too pure” to be worth defibrination.

There are more complications to blood transfusion than simply getting it out of one body and into the other. You may have heard of blood typing (the Red Cross has a charming interactive covering the basics here). But Bram Stoker had not. Karl Landsteiner would not publish his discovery that red blood cells come in different varieties until 1901; his initial work identified only 3, naming them A, B, and C (now known as O). The discovery that blood types further divided into RH+ and RH- varieties wouldn’t come until 1940.

Stoker did have some idea that some blood was better, but he put it down to strength, youth, and masculinity – qualities that have little to do with blood compatibility. However, Lucy wouldn’t necessarily have died from receiving the wrong blood. Death was only one possible side effect of receiving the wrong blood. Others included fever, aches, and blood in the urine (“dark urine” in the lingo of the time).

(So what was Lucy’s blood type? She had no reaction, so she may been an AB+, but if we factor in demographic data, she was probably an A+).

However, although Lucy didn’t have her blood tested, she was lucky to receive human blood at all. Early experiments with blood transfusion in the 17^th and 18^th centuries didn’t stick to one species. Denis did several transfusions from a lamb or calf to a person with mixed results. In fact, sometimes animal transfusions were considered preferable. Animals were pure because they didn’t engage in human sin and it was thought that animal blood could transfer properties over. For example, the blood of a lamb could make someone calmer and gentler.

Leacock and Blundell eventually established that transfusing between human and animal was dangerous, although part of Blundell’s protests were practical. In his opinion, it was generally easier to get a willing human donor into the bedroom than it was to drag a protesting farm animal. Of course, given that blood donation is compared to marriage in Dracula, everyone in the story is probably extra relieved that no livestock was involved!

Dracula was written at the tail end of a century full of medical innovation (you can find a good introduction to it in our galleries), innovation that Stoker knew about and applied in his books. Jekyll and Hyde and Frankenstein, those other two horror classics, are consumed with a fear of unchecked science. But in Dracula, modern medicine was a force for good. There have been plenty of attempts to modernize Dracula, but perhaps we’re missing one of them. Perhaps a modern Dracula isn’t about doing battle with a vampire at all. Perhaps the story of Dracula as Stoker might have told it today is about Lucy Westenra spending a few hours in the emergency room and then moving on with her life.