ON PORPHYRIA AND THE AETIOLOGY OF WERWOLVES.
Article: PORPHYRIA CUTANEA TARDAInvestigation of a Case, Including Isolation of Some Hitherto Undescribed Porphyrins[show abstract] [hide abstract]
ABSTRACT: WALDENSTRÖM1 has divided the porphyrias into the following groups:Porphyria congenita, a familial disease, probably recessive in character, present at birth and characterized by sensitivity to light, pigmented bones and teeth, and greatly increased coproporphyrin and uroporphyrin excretion, mainly of Series I.Porphyria cutanea tarda, a disease in which the porphyrinuria and sensitivity to light develop later in life and a sclerodermic tendency is noticeable. The occurrence of colic and the occasional excretion in the urine of uroporphyrin suggest a relationship with the group next to be described. Severe nervous symptoms have not yet been reported.2Porphyria acuta, a familial disease, dominant in character, accompanied with the excretion of coproporphyrin and uroporphyrin mainly of Series III. The following clinical forms have been recognized: (a) Latent porphyria in which there is increased uroporphyrin excretion without any clinical manifestations of porphyria; such patients as have been encountered have always beenA.M.A. archives of internal medicine 11/1952; 90(4):483-504.
Volume 57January 1964
Section of the
History of Medicine
PresidentW H McMenemey MD
Meeting October 2 1963
On Porphyria and the
zEtiology of Werwolves
by L Illis MB MRCP
(Guy's Hospital, London)
'And yet I know no more than the mahogany
That forms this desk, ofwhat they mean;
I comprehend, for without transfornation
Men become wolves on any slight occasion.'
Byron: 'Don Juan'
The term 'werwolf' is probably derived from the
Anglo-Saxon 'wer' meaning man, and 'wolf'. In
the history of alleged metamorphosis, the trans-
formation ofman into wolf is the most prominent
form of the myth, though the further south one
goes the more common becomes the myth of
wer-tigers, and further north wer-bears become
I believe that the so-called werwolves of the
past may, at least in the majority of instances,
have been suffering from congenital porphyria.
The evidence for this lies in the remarkable
relation between the symptoms of this
disease and the many accounts of werwolves that
have come down to us.
Werwolves were familiar to Pliny, Herodotus,
and Virgil. Probably the earliest account of
changed into a wolf by Jupiter as a punishment
for eating human flesh. Since the time of the
Greeks, up to the present day,
legends of werwolves have been common in all
countries of South America, Asia, Africa and
Europe. The belief reached its height at the time
of the witch-hunts of the Middle Ages, but
probably survives today only in a few isolated
The transformation into a wolf is not exclusive
Armenian and Abyssinian
clearly implicate women, and Boguet, a sixteenth
century judge who was responsible for the burn-
ing of about 600 witches and werwolves,
is that of Lycaon who
counts the story of a farmer's wife who changed
into a wolf and attacked a neighbour: during the
ensuing struggle she (the wolf) lost a paw. When
she turned back into a woman, one of her hands
was missing (Boguet 1590). However, most of the
stories are of men making the transformation.
Occasionally children make the change and this
may be linked with the innumerable stories of
wolf-children. These stories probably owe more
to the writer's imagination than to actual myth or
legend, though there are apparently authentic
tales of children reared by wolves or living as
wild animals (Lang 1895).
There are several ways of accomplishing the
metamorphosis. Broadly speaking these are by
personal intent, by the witchcraft of others, by
the instigation ofthe devil or evil spirits, and even
by the dispensations of saints or a more direct
divine agency. Metamorphosis by personal intent
may be brought about merely by the removal of
clothing or the putting on of the skin of the
animal into which it is desired to be transformed.
Usually, however, it is by incantation (Ralston
1872) or by anointing with an ointment (Ver-
stegan 1605). The witchcraft ofothers may change
an innocent person into a wolf: see, for example,
the poem 'Bisclaveret' by Marie de France, circa
1200 (Costello 1835), and the numerous instances
of royal and noble personages changed into
wolves by witchcraft or some unhappy fate. As
regards saints and divine agency: the King of
Wales, Veretricius, was changed into a wolf by
St Patrick, and St Thomas Aquinas says: 'Omnes
angeli, boni et mali, ex virtute naturali habent
potestatem transmutandi corpora nostra'
angels good and bad by some natural virtue have
the ability to transmute our bodies).
Not all transformations were complete: there
are many instances of partial changes such as
those recorded by Jean Bodin, a French priest
who wrote a book about witches and was a
sixteenth century authority on the various forms
of witchcraft. Nearly all these partial transforma-
tions involved only the hands and teeth (Bodin
Proceedings ofthe Royal Society ofMedicine
There are several examples of a number of
werwolves occurring in the same family. A parti-
cular example is that of Gamier, a name which
crops up several times in the writings of de
Lancre (1613). Either sex may be involved but
usually the male.
As a general rule, up to the beginning of the
seventeenth century werwolves were regarded as
heretics. There were exceptions to the general
denigration of wolves and werwolves: the head of
St Edmund the Martyr was guarded by a wolf,
and the life of St Oddo of Cluny was saved by a
wolf (Gubernatis 1872). At the time that wer-
wolves were considered heretics on the Continent,
in England they were regarded
delusion brought on by an excessive melancholy
persecuted at that time), but to the fact that
wolves were extinct. Throughout the world, the
most common or feared animal is the one to
animals were extinct, the myth tended to die out.
Transformations, we have
thought to occur throughout history. They have
been reported from Japan to South America.
The actual descriptions are difficult to come by
but Marcellus of Sidal describes werwolves as
frequenting the tombs of Athens at night, with
yellow complexions, hollow
tongue. In an Abyssinian legend, a woman went
into a trance with her fingers clenched, her eyes
glazed and nostrils distended. When she came to
she laughed hideously and ran on all fours. She
was thought to be a werwolf and the exorcist was
called in. He held garlic to her noseand questioned
the evil spirits.
A Borussian werwolf was brought before the
Duke of Prussia and John Frederic Wolfeshusius
of Leipzig University (1591) describes him: 'He
was an evil favoured man, not much unlike a
beast, and he had many scars on his face
although he was long and vigilantly watched, this
Werwolf never cast what little he possessed of
Amongst the Toradja natives ofCelebes (Dutch
East Indies), werwolves are described as having
unsteady eyes with dark green shadows under
them. They do not sleep soundly. They have a long
tongue with red lips and teeth which remain red in
spite of chewing betel nuts. Their hair stands on
Boguet describes werwolves as having a pale
skin with numerous excoriations from frequenting
as victims of
I, 'Demonologie'). This was not due to
were being obsessionally and cruelly
seen, have been
'Marcellus of Sida lived about A.D. 117-161. He was a physician
who wrote a long medical tract of which only fragnents remain.
In this tract Marcellus wrote of lycanthropy as a disease rather
than a manifestation ofevil possession
with wolves or perhaps as a consequence of their
attacks on human beings. One, he writes, was so
disfigured as to be scarcely recognizable as a
human being and people could not regard him
Physicians, on the whole, were rather more
humane in their attitude to werwolves than were
Oribas, physician to the
Emperor Julian, says the disease was manifested
by a going out of doors at night; the patient was
pale with dry, dull and hollow eyes, and his legs
covered with sores from frequent stumbling. He
recommended treatment by venesection and eva-
cuation, followed by a generous diet and sleep
(Encyclopedia Metropolitana 1845). Donatus de
Altomani stated '. . . there is a wonderful altera-
tion ofthe braine especially in the imagination and
thought' (Encyclopedia Metropolitana 1845).
It is difficult to build up a picture of a werwolf,
but the most consistent one would be of a man, or
occasionally a woman or child, who wanders
about at night. The skin is pale with a yellowishor
greenish tint, with numerous excoriations, and
with a red mouth. The eyes are unsteady. Occa-
sionally werwolves are described as being hairy.
They show (to say the least) disordered behaviour.
Their distribution is virtually world wide but with
particular pockets of strong belief in their exist-
ence, such as South Germany. They date back at
least to Greek times.
A belief as widespread both in time and place
as that of the werwolf must have some basis in
fact. Either werwolves exist or some phenomenon
must exist or have existed on which, by the play
of fear, superstition and chance, a legend was
built and grew.
Tracing the origins of the werwolf myth is a
difficult exercise. One is continually met with
conflicting evidence. There would seem to be two
suggestions for the origin of this myth. One is that
it is a result of fear and an invocation of evil
spirits, 'or near witchcraft, to account for some
strange happenings which could not be explained
by the contemporary philosophies.This is attrac-
tive but, by itself, carries us no further. It cannot
explain the widespread belief and it makes no
contribution to the exact oetiology of the fear. My
isolated areas in various parts of the world,as a
result of some rare, but widespread, happenings,
and spread into the common consciousness.
It is of interest that in pre-Christian days the
insane were kept in beautiful gardens and tran-
quillized with music, With Christianity and the
dreadful doctrines of heresy, the insane were
thought to be possessed by evil spirits and were
treated with appropriate inhumanity. It is true
that earlier civilizations thought that some mental
or nervous disorders were due to possession (e.g.
is that the myth arose in several
Section ofthe History ofMedicine
the word epilepsy comes from the Greek bri=
upon, andAapp&vszv= to seize, i.e. the person
was seized by some spirit) but none of -these
peoples practised the savage cruelty of the Early
and Middle Ages. It was at this time that the belief
in werwolves was rife, and it must have been
heightened by the climate of fear and by the
convenience of disposing of one's enemies by
denouncing them as witches or werwolves. This
was helped by the incredible readiness of the
accused to confess; a feature which marks all
stories of witch-hunting. Although essentially a
pre-Christian belief based on the need to externa-
lize fear, once a story of a werwolf, of sufficient
credibility, was established, it would persist for
several generations and become the focus for ex-
plaining other dreadful and otherwise inexplicable
happenings. Indirect help would come from the
religious teachings of the time which played
strongly upon the ignorance and credulity of the
Congenital porphyria is a rare disease, due to a.
recessive gene, in which there is an inability to
convert porphobilinogen to porphyrin in the bone
marrow. The condition is characterized by:
(1) Severe photosensitivity in which a vesicular
erythema is produced by the action of light. This
may be especially noticeable during the summer
or in a mountainous region (Vannotti 1954).
(2) The urine is often reddish-brown as a result of
the presence oflarge quantities ofporphyrins.
(3) There is a tendency for the skin lesions to
ulcerate, and these ulcers may attack cartilage and
bone. Over a period of years structures such as
nose, ears, eyelids, and fingers, undergo pro-
(4) On the photosensitive areas hypertrichosis and
pigmentation may develop.
(5) The teeth may be red or reddish-brown due to
the deposition ofporphyrins.
(6) The bone marrow is hyperplastic, usually in
association with splenomegaly and hrmolytic
Porphyria cutanea tarda ('mixed porphyria') is
another manifestation of disturbed porphyrin
metabolism (Fig 1).
genetic trait. The age ofonset of its manifestations
is later and there is a marked sex difference in
favour of males. Photosensitivity is less marked
but does occur, and skin lesions are not so severe
and do not usually progres
mutilation. A brownish pigmentation is common
and the face may present a peculiar violaceous
colour and show injection of the conjunctivr
(Brunsting et al 1951). Exposure to heat or light
may be followed by pruritus in which case the
affected parts may show excoriation. Hirsuties
occurs but is less common than in the congenital
form. Jaundice, related to hepatic dysfunction,
may be present (MacGregor et al. 1952).
Nervous manifestations are most common in
the acute intermittent variety of porphyria. They
do, however, occur in porphyria cutanea tarda
(MacGregor et al 1952) or the 'mixed' type of
hepatic porphyria. Although congenital and idio-
pathic porphyrias are separable on clinical and
genetic grounds, Vannotti (1954) is ofthe opinion
that there are 'points of contact [which] could
give rise to these mixed forms'.
is familial, but of a dominant
to scarring and
Fig 1 Patient with severe cutaneous hepatic porphyria with facial lesions and mutilation ofthe hands.
(Reproduced with kindpermissionfrom Goldberg & Rimington 1962)
Proceedings ofthe Royal Society ofMedicine
Fig 2 Congenital porphyria showing photosensitization,
scarring andmutilation (Hausmann 1923)
The nervous manifestations may be referable to
any part of the nervous system, and include
mental disorders ranging from mild hysteria to
manic-depressive psychoses and delirium. Epi-
lepsy may occur.
Both Waldenstrom (1937) and Vannotti have
shown that, at least in idiopathic porphyria, there
is an important geographic factor, and these
cases often occur, in Sweden and in Switzerland,
'in certain districts and especially along certain
valleys' (Vannotti 1954). This also reflects the
hereditary factor inthedevelopment ofthe disease.
It is possible, then, to paint a picture of a
porphyric which, though not necessarily charac-
teristic or typical, will fit with all the available
evidence in the literature of porphyria: such a
person, because of photosensitivity and the resul-
tant disfigurement, may choose only to wander
about at night. The pale, yellowish, excoriated
skin may be explained by the hemolytic aniemia,
jaundice, and pruritus. These features, together
with hypertrichosis and pigmentation, fit well with
the descriptions, in older literature, ofwerwolves.
The unhappy person may be mentally disturbed,
and show some type or degree of abnormal
behaviour. In ancient times this would be accen-
tuated by the physical and social treatment he
received from the other villagers, whose instincts
would be to explain the apparition in terms of
witchcraft or Satanic possession.
The red teeth, the passage of red urine, the
nocturnal wanderings, the mutilation of face and
hands, the deranged behaviour: what could these
suggest to a primitive, fear-ridden, and relatively
isolated community? Fig 2 gives an obvious
Acknowledgments: I would like to thank Mr A H
Wesencraft, Harry Price Librarian at London
University Senate House, and the Curator of the
British Museum ReadingRoom for their help.
Bodin J (1580) De la D6monomanie des Sorciers.
Boguet H (1590) Discours des Sorciers. Lyons
Brunsting LA, Mason H L& Aldrich RA
(1951)J. Amer. med. Ass. 146, 1207
Costello L S (1835) Specimens of the Early Poetry of France.
Encyclopedia Metropolitana (1845) London
Goldberg A & Rimington C
(1962) Diseases of Porphyrin Metabolism.
Gubernatis A de (1872) Zoological Mythology. London, Vol. 2
Hausmann W (1923) Strahlentheraple Suppl. 8
Lancre P de (1613) Tableau de l'Inconstance des mauvais Anges.
Lang A (1895) Illustrated London News, Jan. 26
MacGregor A G, Nicholas RE H, & Rimington C
(1952) Arch. intern. Med. 90, 483
RalstonWR S (1872) The Songs ofthe Russian People. London
Vannotti A (1954) Porphyrins. Trans. C Rimington. London
Verstegan R (1605) A Restitution of Decayed Inteligence.
Waldenstrom J (1937) Acta med. scand. Suppl. 82
Wolfeshusius JF (1591) De Lycanthropis. Leipzig
The following papers were also read:
The History ofSt John's Hospitalfor
Diseises ofthe Skin
DrBrian Russell (London)
This paper consisted ofextracts from the
book 'St John's Hospital forDiseases of
the Skin 1863-1963', edited byBrian Russell
(1963, Edinburgh & London).