If you’re a Metallica fan like me, then you probably started singing their song "Welcome Home (Sanitarium)" upon seeing the title of this episode -- “Sanguinarium … leave me be.” I was very apprehensive about this episode because of what a sanguinarium sounds like it would be. No, it’s not an aquarium where you go to watch bloodthirsty people locked up in glass cages. If it’s another “vampire” tale then are we looking at a sequel to "3" (Season 2, Episode 7)? Bite your tongue! (Or your neck, whatever.) 
We begin the episode in Vancouver’s version of Chicago, Illinois. Plastic surgeon Harrison Lloyd preps for surgery by scrubbing his hands so badly they bleed. He performs the most disturbing liposuction procedure ever. Nurse Rebecca Waite tries to intervene, but she’s too late. For once I’m glad to be doing this blog late at night so I’m not eating at the same time because that was extremely repulsive.Sculder meet with Dr. Lloyd and his attorney in the light of day. The doc seems cooperative at first, but is clearly following his lawyer's lead. Scully learns Lloyd has been taking sleeping pills for five years, so she thinks he’s addicted to the medication. Upon investigation of the crime scene, Mulder finds five marks burned into the floor. He uses the impressions to form a pentagram, leading Dana to deliver the obvious line, “If you want to connect the dots here, you should look at the facts.” (Hey, I’ll take an X-Files witchcraft tale over an X-Files vampire story any day of the week.) Mulder leads Scully out of Operating Room Three ("3?" No!!!) Nurse Waite suggests possession allegations are cheaper than malpractice insurance. Dr. Shannon wants the nurse to stop talking to the agents and gives her the move along.
Meanwhile hospital board members, led by Dr. Jack Franklyn (Richard Beymer of West Side Story and Twin Peaks fame), discuss Dr. Lloyd’s situation and clearly know what's going on. Nurse Waite is prepping the next patient – with leeches – but claims she is going to protect her. In surveillance video of Lloyd’s last procedure, Sculder sees the markings on the floor. Fox tells Dana a pentagram is a sign of protection. You’d think he would have led with that when he first suggested the spots were points on a pentagram. Scully learns Lloyd’s medication contains belladonna, which Mulder says can be used for hexing rituals. Dr. Shannon gets ready for her next surgical procedure while colleague Dr. Eric Ilaqua acts peculiar and possessed while scrubbing his hands. He begins the laser peel procedure on the patient without Shannon’s permission and burns a hole through the woman's cheek. Anyone having surgical procedures in the near future might want to stop watching this episode.Scully learns Dr. Ilaqua is taking the same sleep medication as Dr. Lloyd. She updates Mulder, who seems to be considering rhinoplasty. He reviews the latest videotape and notices the marks made by the leeches on the victim’s stomach. The agents meet with the hospital board and Dr. Franklyn mentions similar incidents from 10 years earlier in which the deaths were listed as accidental. Franklyn implicates Nurse Waite, since she is the only person who had contact with the involved patients then and now.
At home, Rebecca is performing a ritual. She sits around naked and cuts off her hair. Sculder go to her house and see a pentagram … and a broom. Witch! They gain entry and locate remnants of her last spell. Meanwhile, Dr. Franklyn finds a bathtub full of blood at his abode. When turning off the faucet, Rebecca emerges from the tub and attacks him, but Franklyn gets the upper hand. Man, I would hate to be his cleaning woman. Police take Waite into custody, but when our heroes arrive the nurse starts coughing up straight pins … hundreds of them. Mulder picks up one without wearing gloves. Ew …gross. Fox checks on Franklyn, whose head wound is being stitched up by Dr. Shannon. Franklyn guesses that Rebecca attacked him because he accused her. After all, how would she know? Franklyn sends them away and relaxes by levitating over his bed. Rebecca dies after hemorrhaging from the hundreds of pins in her stomach. Mulder’s theory of allotriophagy -- the act of vomiting or disgorging foreign and foul objects, usually associated with a possessed person -- seems more plausible than Scully’s theory of pica -- a psychiatric disorder regarding the eating of non-food items with no nutritional value. Fox, who continues to silently and comically mull over his facial imperfections, tells Dana he found a book on his theory in Rebecca’s house. He also draws a correlation between the victims’ birth dates and the witches’ four Sabbaths. They call Dr. Shannon about the birth dates, so she warns Doctors Franklyn and Kaplan.
Since Franklyn professes to be tired, Kaplan takes over his procedure and promptly burns off the victim’s face with acid. Shannon, who is finally affected by the horrible things happening to their patients, tells Sculder about former physician Dr. Cox. By tweaking the computer program and they figure out Doctors Cox and Franklyn are the same person. Mulder thinks witchcraft gave Cox the ability to transform his features beyond surgery’s capabilities. When Shannon finds Franklyn first, he magically inserts several scalpels inside her. That’s gotta hurt. 
It’s pretty far-fetched that the correlating birth dates worked out so well for Franklyn in such a short period of time, but don’t you think after making the connection between the victims’ birth dates and the witches’ holy days, Mulder should have had someone check the birth dates for all patients scheduled for surgery that day? One quick phone call – hey, are any of your surgical patients born on Halloween? – and that would have been the end of Franklyn. I guess technically it is the end of Franklyn since they never address this again. Fun fact: In 1996, the year this episode aired, Richard Beymer also had a TV movie called A Face to Die For. Interesting trend. Sestra Professional:
Good lord, that was gross. This certainly could be the grisliest episode of the entire run, at least that's how I remembered it before starting this particular rewatch. And it more than lived up to that unlofty recollection.
It's certainly an interesting story choice after last week's cerebral "The Field Where I Died" and ahead of an interesting quartet of episodes that will mess with the mythology in a few different ways. It was penned by sisters Vivian and Valerie Mayhew, who don't work for The X-Files again, but go on to co-produce and write for Charmed. It's directed without restraint by stand-alone standout Kim Manners, who reportedly gave network standards and practices fits on the heels of the controversial "Home" earlier this season. This place is a factory: "Sanguinarium" does have a lot to say on the practice of cosmetic surgery. "There's magic here. Only it's being done with silicone, collagen and a well-placed scalpel," Scully says. In fact, people seem to want it so badly that they won't cancel their procedures. Two deaths at the facility in a couple days should scare off even the most vainglorious of patients.
I'll give the scripting sestras -- or Chris Carter, John Shiban, Vince Gilligan, Glen Morgan and/or James Wong, who contributed to ironing out the episode according to the official fourth-season episode guide -- credit for leading us to believe that Nurse Waite was the piece's villain before revealing she was just trying to protect the patients with her pentagrams. And also props to props and production designer Graeme Murray for some sharp-looking hospital sets with five-sided operating rooms.
My favorite touch of the episode was Mulder using the broom at Waite's door as probable cause for entering the house. Although even then, I'd have to take issue with the fact that Dana doesn't argue that notion at all. She seems to complain all the time in the face of stronger evidence from Fox.I'm also kind of glad Dr. Shannon got a taste of Franklyn's medicine. She was so one-note, maybe that enabled her to grow and get some character. Perhaps she would be a better physician because of it. She wasn't winning any points as a doctor or a human being before that happened.
Meta mania: Gillian Anderson wasn't a huge fan of this one. "This was one of the most repulsive scripts that I've done," she said in the episode guide. But David Duchovny kinda liked it. "Everybody worked really hard and Kim Manners did a great job. It was really fun," he said in the guide. ... The show reportedly got a flood of angry letters and emails from supporters of Wicca and ritual magic after the show aired. I think Waite's depiction was favorable, but they were probably focusing on Franklyn's follies. Issue was also taken with Nurse Rebecca Waite's name since Rebecca Nurse was an innocent woman prosecuted at the Salem Witch Trials. ... The opening scene shows the clock at 3:40. That's during Satanic witching hour. ... Gilligan named the female doctor Shannon after one of his favorite actresses, Shannon Tweed, according to the guide.
Guest star of the week: Sorry, Richard Beymer, but O-Lan Jones snags the kudos here. Maybe if you had thrown up 100 straight pins instead of merely peeling off your face, you would have garnered the honors. By the way, Jones didn't get any extra points for being in Beethoven with David Duchovny, it's because she was creepier as the witchy heroine than the villainous face peeler.
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