Alexandre Dumas père was inspired to write The Count of Monte Cristo by the experiences of his father, Thomas-Alexandre Dumas, son of a minor French nobleman and an enslaved Caribbean woman. Thomas-Alexandre was the first black general in the French army and accompanied Napoleon on his campaign to Egypt. On his return, his ship was waylaid by storms into the Italian port of Taranto. He was imprisoned and kept in solitary confinement for nearly two years, was possibly poisoned with arsenic, and returned to France with his health effectively destroyed, dying of stomach cancer in 1806.1,2
The Count of Monte Cristo has been translated into nearly 100 languages and, since its original serialization in the French newspaper Journal des Débats from 1844–1846, has inspired numerous film and television adaptations. The story is set in France and Italy, beginning with Napoleon’s escape from Elba in 1815. Edmond Dantès, a nineteen-year-old sailor about to be promoted to ship captain and marry his sweetheart, is denounced as a Bonapartist agent by Danglars, who desires his job, and Fernand, who desires his fiancée. Imprisoned by the decision of the monarchist prosecutor, Villefort, Dantès is sent without trial to the Château d’If near Marseilles, where he spends fourteen years in solitary confinement in a dark subterranean cell.
Dantès becomes terribly depressed and wants to die. Then one day, there is a knock on the wall of his cell. It is Abbé Faria, who had mistakenly dug fifteen feet into the castle’s thick wall but, alas, in the wrong direction. He turns out to be a man of immense culture and wisdom. He educates Dantès, teaching him foreign languages and everything else known at that time. Like a supreme diagnostician, he helps Dantès solve the mystery of why he was imprisoned. He also tells Dantès about an enormous treasure hidden on a deserted island in the Mediterranean called Monte Cristo.
After Faria dies, his body is sewn into a sack to be thrown into the sea. Dantès takes his place and is cast overboard with his feet tied to a 36-pound weight. He cuts himself free, swims to a nearby island, and is rescued by Genovese smugglers. He takes possession of the treasure on Monte Cristo and becomes immensely rich. When he returns to Marseille, he finds out that his father had died of starvation, and his sweetheart had married Fernand. Swearing vengeance on the three men who had caused his imprisonment, he first goes to Italy, then appears in Parisian society as the Count of Monte Cristo, intent on avenging himself.
Of medical interest is Dumas’s depiction of what later would be termed “locked-in syndrome.”3 The condition affects Villefort’s father, Monsieur Noirtier, an aging Bonapartist who cannot move or speak because nearly all his voluntary muscles are paralyzed. His intellect remains intact, however, and he communicates through his eye movements, using a system developed by his devoted granddaughter, Valentine. This syndrome was not described in the medical literature until 1875, and it was formally termed locked-in syndrome in 1966. It results from lesions of the brainstem (pons), usually due to a stroke, but may also follow trauma, tumors, or diseases such as multiple sclerosis. Incomplete forms may allow partial recovery.
Also of medical interest is the fictional hereditary disease described in the book as “catalepsy.” It is predicted to affect the Abbé Faria in three attacks. The first and second attacks are successfully treated with a red fluid that he secretly smuggles into his cell, but the second leaves him partially paralyzed, destroying his hopes of ever escaping from his prison. He dies after the third attack of what most likely would have been cerebrovascular disease manifested as transient ischemic attacks followed by a major fatal stroke.
Psychiatric symptoms also abound in the book, including Dantès’ initial profound despair and depression from being imprisoned in complete isolation. Other mental symptoms are well described, such as the mental disintegration of the three men who had caused his incarceration.
The Count is presented as having a profound knowledge of medicine and therapeutics. Disguised as a physician, he cures one patient’s jaundice by administering the correct medicine. He is well acquainted with the use of poisons and particularly with mithridatism, the administration of poison in small, incremental doses that will later confer immunity to higher, fatal doses. This practice is named after Mithridates VI, the ancient king of Pontus, who became immune to its toxic effects by taking increasingly high doses to avoid assassination.
The Count is also adept at using various tranquilizing medicines, which in his time were legally available in pharmacies. He mixes in equal doses what he calls the best brand of opium, which he personally brought from Canton, with the best formulation of hashish, a concentrated form of cannabis that he obtained from Alexandria or from the “area between the Tigris and the Euphrates.” He has learned to make these ingredients into pills by having become “a tolerable chemist” and carries them around in a small container made of precious stones “to manage his intense emotions, enhance his experiences, … escape reality, and let dreams rule.”
Dumas weaves the nineteenth-century fear of premature burial into the plot. With no reliable way to confirm death, people worried about being buried alive. He underscores the era’s crude methods by describing how guards tested for death by pressing a burning ember to Faria’s feet. The fear was widespread enough that some German and French cities experimented with “waiting mortuaries,” where bodies could be observed before burial. The theme also appears in chapter 43, when a premature infant presumed dead is buried in a garden box but is revived with mouth-to-mouth resuscitation. In chapter 105, Valentine is declared dead after poisoning and placed in the family vault, but she survives because earlier exposure through mithridatism has made her immune.
The Count indeed has a sophisticated knowledge of poisons and antidotes, which he claims to have acquired in the Orient, and he knows how to administer substances that mimic death without causing permanent harm. He tells Villefort’s second wife, Heloise, about brucine, a powerful, bitter, colorless strychnine derivative, which she will use to poison several family members for her son’s inheritance. Brucine had been isolated and named in 1819, and its bitter, convulsive properties were of significant medical interest. It had become so popular that the physician in the novel was quite familiar with it and could recognize its presence by observing a color change when another substance was added.
The physician treats the incapacitated Monsieur Noirtier with progressive doses of brucine, ostensibly as a palliative for his paralysis. This detail is medically plausible: small doses of strychnine-family alkaloids were sometimes prescribed in nineteenth-century therapeutics as tonics and for various nervous complaints. In the story, however, it becomes a secret prophylactic in that Valentine is exposed to brucine by always being near her grandfather and thus developing a degree of immunity to the very poison that her stepmother intends to use against her.
Monsieur d’Avrigny, the Villeforts’ family physician, is the first to recognize that the sudden deaths at their home are due to murder rather than illness. To protect the family’s reputation and avoid a public scandal, he at first keeps his suspicions secret. Finally, he refuses to treat the family any further, declaring he will no longer be a silent accomplice to the “crimes and grief” growing in their house. Valentine survives several poisoning attempts by her stepmother, Héloïse. The Count fakes her death using a potion to protect her, allows her to be buried, and then reunites her with her lover. Eventually, he gives them part of his fortune and leaves France for the Orient, having encompassed, in what he believes is all human wisdom, to “wait and hope.”
End notes
- a. The sufferings of Thomas-Alexandre Dumas, the Black Count, gave his son, the writer, an interest in medicine and poisoning. He also acquired his medical knowledge through his friendship with a physician, visits to the Hôpital de la Charité, and an upbringing in the shadow of a father whose history he would later dramatize so vividly.
- b. The third person remembered in the Dumas family is Alexandre Dumas fils (son), author of La Dame aux Camélias, the story immortalized by Giuseppe Verdi in his opera La traviata.
References
- Dunea G. The real Monte Cristo. Hektoen International, Summer 2013. https://hekint.org/2017/02/01/the-real-monte-cristo/
- Tom Reiss. The Black Count. Random House, 2012.
- JMS Pearce. The locked-in syndrome in fiction. Hektoen International, Fall 2024. https://hekint.org/2024/10/07/the-locked-in-syndrome-in-fiction/