In March 1892, the inhabitants of Exeter, Rhode Island, dug up Mercy Brown’s grave because both her mother and her sister had died before her. Since her brother Edwin at that time had consumption, the old term for tuberculosis, it must have been a member of the family who was killing him.
Because Mercy had survived through the harsh winter, her body showed less decay than the others when they opened her grave. The villagers removed her heart and liver and burned them, believing this would help Edwin recover. According to the records, they even gave him the ashes to drink as a remedy.
He died in May.
Bram Stoker did not publish Dracula until five years later, and although newspapers reported on Mercy’s exhumation, there is still no definite evidence that Stoker knew about it; the only link between the two is that the dates are close.
As more members of the Brown family in Exeter fell ill, the community turned to exhuming graves, guided by the local beliefs of the late nineteenth century. People thought that those who had recently died could somehow drain the life force from their living relatives, causing the sickness to linger in the family.
A bat keeps the wound open
Unlike the stories, a real vampire bat does not tear open wounds. Instead, it simply licks the blood from a small cut.
Its saliva contains a protein called draculin, which interferes with blood clotting. In fact, blood-feeding animals have evolved different compounds in their saliva—some keep the blood flowing, others widen blood vessels or even reduce pain. Each species has its own unique mix.
A minor cut might go unnoticed; for example, a real blood-feeding animal like the vampire bat bites to get blood, but in the Exeter case, the so-called ‘vampire’ never did anything of the sort. This difference shows how far the folklore strays from what actually happens in nature, compared to the biological phenomenon. Tuberculosis slowly took its toll on the Brown family. The disease could cause someone to cough up blood, grow pale, and waste away over months. First Mercy’s mother died, then her sister, and finally Mercy herself, all while Edwin was still struggling with the illness. Then her sister died as well, and afterward Mercy died when Edwin was ill.
As each member of the Brown family fell ill in turn, people began to wonder if the disease was somehow spreading from the grave itself.
When tuberculosis is active in the lungs or throat, bacteria enter the air when the ill person coughs, talks, or sings, and other people can then inhale them. As those who live in the same house are exposed to each other’s air for long periods, it is impossible to determine who infected Edwin or when the infection took place. This is why the illness continued after Mercy was buried.
The period in question might be extremely long; those infected with Mycobacterium tuberculosis can develop active disease only after a latent tuberculosis infection, where the bacteria live in the body without causing symptoms, and the individual cannot transmit tuberculosis. Active disease may then appear later, particularly when the body’s immune defenses diminish. In other situations, it never does.
Someone could easily catch tuberculosis by breathing in bacteria from a sick family member while they were still alive, even if the illness only appeared after that person had died. So, while people believed the disease came from the grave, the real moment of infection had already passed, unnoticed, while the loved one was still there.
The werewolf learned to bite later
In 1603 the French court dealt with the case of Jean Grenier; the boy’s explanation of how he had become a wolf was based on ideas concerning pacts, transformation, and mental illness. The record illustrates the sorts of arguments that judges and physicians were willing to advance. Nevertheless, it does not allow us to conclude that he suffered from a disease that can nowadays be diagnosed.
In older werewolf tales, becoming a werewolf did not require being bitten. Instead, curses, bargains, or even special ointments could trigger the change. The idea that a bite could spread the condition only became popular in twentieth-century films. In a way, we ended up giving an ancient monster the same method of transmission as a modern disease.
Rabies spreads through saliva, usually after a bite from an infected animal. At first, there are no symptoms, but then the disease can bring on agitation, strange behaviors, and a heightened sensitivity to touch, sound, or even moving air. Watching someone with rabies, it is easy to see how these symptoms could remind people of werewolf legends.
The symptom known as hydrophobia is the one most often misinterpreted; people do not avoid water because they believe it is dangerous. Trying to swallow it can cause painful spasms in the throat, and both seeing and hearing water may also trigger it; swallowing saliva becomes difficult, and as a result it oozes from the mouth. A thirsty person might pull away from a cup.
It by no means happens that all patients have that type of rabies, for some of them suffer from paralysis. As the article published last week made clear, a human case does not usually carry on the chain of transmission.
Werewolf was not caused by rabies; it was in fact one of a number of different kinds of suffering grouped under that heading. The trial record does not allow a single medical diagnosis.
Neither weapon reached the patient
In Exeter, the men set fire to Mercy.
In Exeter, the villagers burned Mercy’s organs, not using a stake as is often told in vampire stories. Their attention stayed fixed on the body in the grave, hoping this old ritual would stop the illness. Yet, from a scientific point of view, Edwin was suffering from tuberculosis—a bacterial infection in his lungs—not from anything that lingered in the cemetery.The rule in old werewolf legends was later adopted as stories became case studies of someone with rabies. Effective treatment has to match the symptoms; this involves thoroughly cleaning the wound, giving the vaccine, and, if necessary, giving rabies immunoglobulin. A bullet fired at a body that is already suffering from the illness would arrive too late.
Silver was not chosen at random.
Silver ions can kill microbes, and silver sulfadiazine is still used today on burn wounds for its surface effects. But silver cannot reach tuberculosis deep in the lungs or rabies in the nervous system. Taking silver for too long can even turn the skin a permanent blue-grey, a condition called argyria. So while silver has its uses for wounds, it is not a cure for infections inside the body.
The first shot came from soil
It was not until 1943 that scientists isolated streptomycin from a soil bacterium. This was the first antibiotic that could actually fight tuberculosis. For the first time, something made by one microorganism could stop the bacterium that had once devastated families like the Browns.
But streptomycin alone was not enough. When only the sensitive TB bacteria were killed, the resistant ones survived and multiplied. Over time, the treatment would end up favoring the very bacteria it could not destroy.
It has always been the prThat is why doctors have always used more than one drug to treat tuberculosis. Multidrug-resistant TB can withstand both isoniazid and rifampicin, two of the main medicines. New combinations, like the Bedaquiline-pretomanid-linezolid (BPaL) regimen, have been developed for some drug-resistant cases and can help certain patients. Still, the key is to find out which drugs will actually work against each person’s infection. They have not been of any use in the case of a person with rabies since antibiotics have no effect on viruses and only work against bacteria, and so the two cases referred to in the monster stories required different clinical methods.
Other than in the case of tuberculosis, hospitals Outside of tuberculosis, hospitals turn to carbapenems for some of the most serious bacterial infections, especially when nothing else works. These are called ‘last-line’ drugs because they are used when all other treatments have failed. Sometimes another drug might help, depending on the bacteria, but there is never a guarantee that the next option will succeed. Production of carbapenemases, enzymes that render these drugs ineffective. A gene may be found on a plasmid, which is a piece of DNA that can be transferred from one bacterium to another, including from a bacterium of one species to a bacterium of another species. It is not necessary for resistance to occur only after the descendants of a single bacterium have taken over a ward; resistance can be passed on in this manner, even though this does not account for all cases of resistant infection.
The next patient is not in the room
Imagine a patient in intensive care, growing sicker by the hour. The doctors suspect a bacterial infection, but they cannot rule out resistance. The lab results are not back yet, so they decide to start a carbapenem right away. Later, when the results arrive, they can adjust or stop the treatment. But for now, the patient cannot wait for absolute certainty.
Right now, the patient benefits from getting the drug. But the value of keeping that drug effective will only be felt in the future, by people none of us in the room have ever met.
One course of treatment does not directly lead to a single instance of future resistance. One patient’s treatment does not directly cause resistance in just one future case. Even people who have never taken the antibiotic can end up with resistant infections. Testing, infection prevention, and careful antibiotic use are all crucial. Still, every time we use these drugs, even responsibly, we add to the pressure that makes them less effective for others. Stewardship is about how we share this limited resource.
Decades after streptomycin, we still have no way of knowing how much longer our antibiotics will last.
“If you use penicillin, use enough.”
Alexander Fleming, Nobel Lecture, 1945
Fleming was warning against giving too little penicillin to treat an infection. He was speaking about a dose, not permission to prescribe without limit.
The Browns opened a grave while tuberculosis was passing among the living. Rabies could put a different suffering body inside a werewolf story.
Stakes and silver reached neither patient. Streptomycin gave doctors a way to treat tuberculosis, but resistant bacteria survived what the first drugs could kill.
A carbapenem may now be the right choice for the patient in the bed. Its remaining usefulness belongs to patients who have not arrived.
No vial shows the number left.