Few fictional creations spark more of a visceral reaction than Dr. Hannibal Lecter, the sadistic psychiatrist who first jumped off the page in Thomas Harris' 1981 novel Red Dragon for his penetrating questions, impeccable manners and taste for making gourmet meals out of his victims.

The character is such a riveting one that he appears in multiple books, movies and a TV series, his depiction by a gleefully wicked Anthony Hopkins in 1991's The Silence of the Lambs deemed the No. 1 movie villain of all time by the American Film Institute in 2003.

But if it's frightening to follow Hannibal the Cannibal's grisly actions in print and on screen, it's even more disturbing to know that he was based on a person whose butchery spilled from the confines of the imagination to the flesh-and-blood contours of the world around us.

Harris met the doctor in a Mexican prison

As he revealed in the preface to the 25th anniversary edition of The Silence of the Lambs in 2013, Harris was a 23-year-old journalist in the early 1960s when he visited the Nuevo León state prison in Monterrey, Mexico, to report on an American convicted of murder named Dykes Askew Simmons.

Simmons, with his unnerving eyes and "bad Z-plasty repairing a cleft lip," certainly fit the profile of a killer, but Harris found himself more intrigued by the doctor who'd tended to the American following a botched prison escape.

Harris met "Dr. Salazar" in the prison medical office, describing him as a "small, lithe man with dark red hair" and "a certain elegance about him." After a few nondescript answers, the doctor sprung to life as he probed the reporter for his thoughts on Simmons' disfigured appearance.

"Were the murdered people attractive?" Salazar asked. "Yes," Harris answered. Was the doctor insinuating that the beautiful victims had pushed Simmons into a violent rage?

"Certainly not," was the Doctor's reply. "But early torment makes torment easily ... imagined.

"You are a journalist, Mr. Harris," he continued. "How would you put that in your journal? How do you treat the fear of torment in journalese? Might you say something snappy about torment, like 'It puts the hell in hello!'?"

Later that day, Harris was surprised to learn that Dr. Salazar was not a prison employee, as he assumed, but a convict facing a lengthy stay behind bars. "The doctor is a murderer," the warden told him. "As a surgeon, he could package his victim in a surprisingly small box. He will never leave this place. He is insane."

Hannibal Lecter Anthony Hopkins Silence of the Lambs
Anthony Hopkins as Hannibal Lecter in "Silence of the Lambs"; Photo: Orion Pictures Corp/Courtesy Everett Collection

The real doctor was known for his fashion sense and generosity with the poor

According to profiles in The Times of the U.K. and The Latin Times, the "Salazar" of Harris' story was known by the real name of Alfredo Ballí Treviño. He was born into a prominent family in Méndez, Tamaulipas, his strict father pushing the boy and his siblings to excel in their studies.

As a medical intern in 1959, Ballí Treviño got into an argument with his lover, Jesús Castillo Rangel, due to either money problems or the former's insistence on marrying a woman. The would-be doctor killed his boyfriend, carefully sliced him into pieces to fit into a box and attempted to bury the box on a ranch.

His handiwork was soon uncovered, however, and Ballí Treviño was sentenced to death in 1961 for his "crime of passion." He was also said to be a suspect in the killing and dismemberment of hitchhikers, though those accusations were seemingly never proven.

While in prison, the "Werewolf of Nuevo León" reportedly continued to display a deft sartorial touch with his light-colored suits, dark shades and gold Rolex watch. He also maintained an informal medical practice by tending to other prisoners and visiting townspeople.

His sentence commuted after 20 years behind bars, Ballí Treviño returned to his old neighborhood in Monterrey to treat the sick and the poor, often for free. He agreed to sit for a newspaper interview in 2008, months before his death from prostate cancer, but refused to talk about his violent past, saying, "I don't want to wake up my ghosts."

Lecter was also influenced by other serial killers

Prior to Harris' revelation about his fateful visit to a Mexican prison, theories abounded as to what inspired the writer to create such a potent character.

In a 1999 feature in Tulsa World, a group of homicide detectives acquainted with Harris suggested that Lecter was a composite of highly intelligent serial killers Ted Bundy and Edmund Kemper, with a dash of cannibal Issei Sagawa thrown into the mix. That same feature mentioned another cannibal-killer from an earlier generation named William Coyner, a bogeyman well known to Harris and his friends in Mississippi in the 1940s and '50s.

While Harris confirmed that Lecter wasn't entirely modeled on Salazar/Ballí Treviño in his Silence of the Lambs preface, he left no doubt about the Mexican doctor's lasting influence as the infamous villain of his novels took shape in his mind.

"My detective needed to talk to somebody with a peculiar understanding of the criminal mind," he wrote. "Lost in the tunnel of the work, I plodded along behind my detective when he went to the Baltimore State Hospital for the Criminally Insane to consult with an inmate."

"Who do you suppose was waiting in the cell? It was not Dr. Salazar. But because of Dr. Salazar, I could recognize his colleague and fellow practitioner, Hannibal Lecter."