Disturbing Disorders: Cotard’s Delusion (Walking Corpse Syndrome)

C4In 1880, a middle-aged woman paid a visit to the French neurologist, Jules Cotard (pictured below), complaining of an unusual predicament. She believed she had ‘no brain, no nerves, no chest, no stomach, no intestines’. Mademoiselle X, as Cotard dubbed her in his notes, told the physician she was ‘nothing more than a decomposing body’. She believed neither God nor Satan existed, and that she had no soul. As she could not die a natural death, she had ‘no need to eat’.

Mademoiselle X later died of starvation. [1]

Although this peculiar condition eventually became known as ‘Cotard’s Delusion’ the French neurologist was not the first to describe it. In 1788—nearly 100 years earlier—Charles Bonnet reported the case of an elderly woman who was preparing a meal in her kitchen when a draught ‘struck her forcefully on the neck’ paralyzing her one side ‘as if hit by a stroke’. When she regained the ability to speak, she demanded that her daughters ‘dress her in a shroud and place her in her coffin’ since she was, in fact, dead.

[T]he ‘dead woman’ became agitated and began to scold her friends vigorously for their negligence in not offering her this last service; and as they hesitated even longer, she became extremely impatient, and began to press her maid with threats to dress her as a dead person. Eventually everybody thought it was necessary to dress her like a corpse and to lay her out in order to calm her down. The old lady tried to make herself look as neat as possible, rearranging tucks and pins, inspecting the seam of her shroud, and was expressing dissatisfaction with the whiteness of her linen. In the end she fell asleep, and was then undressed and put into bed.

_1Hoping to break her spell, a physician attended her bedside and administered a ‘powder of precious stones mixed with opium’. Eventually, the woman did awake from her delusional state; however, she continuously redeveloped her paroxysm every three months for the rest of her life. During the periods when she thought that she was dead ‘she talked to people who had long been dead, preparing dinners for them and hosting the occasion somberly and constantly’. [2]

Today, the condition is sometimes referred to as ‘Walking Corpse Syndrome’. Although rare, people are still diagnosed as suffering from nihilistic delusional beliefs that they are dead and no longer exist. Occasionally, the condition is characterized by a belief that one is missing essential body parts or organs, as in the a case of a 28-year-old pregnant woman who thought her liver was ‘putrefying’ and that her heart was ‘altogether missing.’

In 2013, New Scientist interviewed a man named Graham Harrison, who had attempted suicide 9 years earlier by taking an electrical appliance with him into the bath, and awoke in the hospital believing he was dead. He said:

When I was in hospital I kept on telling them that the tablets weren’t going to do me any good ’cause my brain was dead. I lost my sense of smell and taste. I didn’t need to eat, or speak, or do anything. I ended up spending time in the graveyard because that was the closest I could get to death.

It was his brain which had died. He had fried it, or so he thought. Doctors tried to rationalize with him, but to no avail. Eventually, Graham was referred to Dr Adam Zeman, a neurologist at the University of Exeter, and Dr Steven Laureys, a neurologist at University of Liège. They used positron emission tomography (PET) to monitor his metabolism. What they found was unsettling.

‘Graham’s brain function resembles that of someone during anaesthesia or sleep. Seeing this pattern in someone who is awake is quite unique to my knowledge’, Dr Laureys told New Scientist. ‘I’ve been analysing PET scans for 15 years and I’ve never seen anyone who was on his feet, who was interacting with people, with such an abnormal scan result’. The below image shows the areas of Graham’s brain which are underactive (coloured in blue) in comparison with a healthy person.

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Graham is the only patient with Cotard’s Delusion to have undergone a PET scan, and therefore scientists can draw few conclusions about the results since they have no basis for comparison. The condition has been tentatively linked to bipolar disorder in young people, as well as severe depression and schizophrenia in older patients. Treatment of the condition is varied. Typically, those suffering from it are put on a combination of anti-depressants and anti-psychotic drugs, although electroconvulsive therapy has also been known to be successful.

For Graham, psychotherapy and drug treatment has helped ebbed the symptoms of Cotard’s Delusion, though it’s been a long, hard journey. Over the past decade, he could often be found sitting in local graveyards in an attempt to get closer to death. ‘The police would come and get me, though, and take me home’, he said. [3]

Graham is one of the lucky ones. Many who have suffered from the condition in the past have died from starvation, and some have even resorted to pouring acid on themselves in an effort to stop being one of the ‘walking dead’. One thing is for certain: Cotard’s Delusion, or ‘Walking Corpse Syndrome,’ illustrates just how little we still know about the human brain in the 21st century.

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1. Berrios G.E & Luque R, ‘Cotard’s Delusion or Syndrome: A Conceptual History’, Comprehensive Psychiatry, 36:3 (May/June, 1995), p. 218.
2. Hans Forstl and Barbara Beats, ‘Charles Bonnet’s Description of Cotard’s Delusion and Reduplicative Paramnesia in an Elderly Patient (1788)’, British Journal of Psychiatry (1992), p. 417.
3. Helen Thomson, ‘Mindscapes: First Interview with a Dead Man’, New Scientist (23 May 2013).

Under The Knife – Episode 1: The Clockwork Saw

In the first episode of Under The Knife, I discuss the clockwork saw–a 19th-century medical instrument which failed on a massive scale. Make sure you watch to the very end as we have a few little surprises in store for you!

If you enjoy the video, please remember to subscribe to our YouTube Channel for updates. When we hit 1,000 subscribers, we’ll be raffling off the googly eyeball from the title sequence of the series! And really… who wouldn’t want to own this?!

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Ten Terrifying Knives from Medical History

I’m excited to announce that I’ve just finished filming the first episode of my new YouTube series, Under The Knife, and will be releasing it very soon (please subscribe to my channel for video updates). Unsurprisingly, that got me thinking about, well, knives. Here’s a list of some rather terrifying knives from our medical past.

  1. VALENTIN KNIFE, 1838. This knife was one of the few able to cut slices of organs and soft tissues for microscopic examination. The double-bladed knife worked best when the blades were wet – best of all when submerged in water. Named after its inventor, Professor Gabriel Valentin (1810-1883), a German-Swiss physiologist, the knife was invented in 1838. This example, however, dates from 1890.

  2. BISTOURY CACHÉ, c.1850. Invented in the mid-19th century, bistoury caché literally translates from the French as ‘hidden knife’. The device was used to cut internal organs or to open cavities, particularly during the surgical removal of a bladder or kidney stone – a practice known as lithotomy.
  3. CIRCUMCISION KNIFE, c.1775. Circumcision – the removal of the foreskin of the penis – is practised across the world often for cultural and religious reasons. In some countries it is also promoted for reasons of hygiene and health. This knife dates from the late 18th century.
  4. CATARACT KNIFE & NEEDLE, 1805. Georg Joseph Beer (1763-1821), an Austrian professor of ophthalmology, invented this cataract knife and needle around 1805. Cataracts cause blurred vision as the lens becomes cloudy and if left untreated can cause blindness. These instruments allowed for the surgical removal of some of the cloudy mass and, if necessary, part or all of the lens itself. Prior to effective anaesthetics, this was an excruciatingly painful process. This particular example dates from 1820.
  5. ORTHOPEDIC KNIFE, 1855. William Adams (1820-1900), an English surgeon, invented this type of knife for his new procedure called periosteotomy in 1855. This involved un-fusing the bones of the hip joint by cutting the neck of the femur (upper leg bone). He affectionately called it ‘my little thaw’, because the knife was used to cut through and ‘melt’ fused bones.
  6. LISTON KNIFE, c.1830. Robert Liston (1797-1847), a Scottish surgeon renowned for his speed and precision in surgery, invented this double-edged amputation knife in the 1830s. This particular example is made of steel with a nickel-plated handle. Nickel plating was introduced in the 1890s and meant that the knife could be boiled without it rusting and was therefore ideal for aseptic surgery. It was made by Down Bros, a leading surgical instrument maker, in the 1920s.
  7. SYRIAN SURGICAL KNIFE, c.900 AD. Most of the blade of this ancient surgical knife is rusty and part of it is broken. The steel blade is slotted into a brass handle. The loop at the end may have been used as a finger hole for gripping. This knife dates to a period when the Islamic world became a major centre for medical study and practice.
  8. PLAGUE LANCET, c.1600. Plague epidemics ravaged Marseilles in France throughout the 17th and 18th centuries. Lancets, such as the copy shown here, were used to open buboes in order to relieve pressure and also remove poisons from the body – an unsuccessful attempt to cure the patient. The lancet would have been stored in a brass case.
  9. DOUBLE BLADED LITHOTOME, 1812. This object was used to cut the bladder in order to remove stones – a practice known as lithotomy. Baron Guillaume Dupuytren (1777-1835), a French surgeon and pathologist, invented this double bladed lithotome for the bi-lateral lithotomy procedure he developed in 1812. This procedure became widely used from the 1850s onwards, and this example dates from 1825.
  10. FALCIFORM AMPUTATION KNIFE, c.1700. The curved shape of this amputation knife was common in the early 1700s. Amputation knives became straighter once the practice of leaving a flap of skin to cover the limb stump became the preferred amputation method. Ebony was a common material for handles as it is a hard-wearing wood. This knife was probably made by Eberle in Germany, as indicated by the inscription on the silver blade.

     

Disturbing Disorders: Sirenomelia (Mermaid Syndrome)

The sea king down there had been a widower for years, and his old mother kept house for him…she was an altogether praiseworthy person, particularly so because she was extremely fond of her granddaughters, the little sea princesses. They were six lovely girls, but the youngest was the most beautiful of them all. Her skin was as soft and tender as a rose petal, and her eyes were as blue as the deep sea, but like all the others she had no feet. Her body ended in a fish tail.

Hans Christen Anderson, The Little Mermaid, 1837.

Mermaids have teased our imagination for thousands of years. One of the earliest tales originated in ancient Assyria, where the goddess Atargatis transformed herself into a mermaid out of shame for accidentally killing her human lover. Homer called them sirens in the Odyssey, and described them as beautiful singing creatures who lure sailors to their deaths. Throughout history, these seductive beings have been associated with floods, storms, shipwrecks and drownings. They have been depicted in countless mediums: in Etrurian sculptures, in Greek jewelry, and in bas-relief on ancient Roman tombs. Christopher Columbus even reported seeing these mythical creatures on his voyage to the Caribbean in 1493.

But could our concept of what a mermaid looks like actually have originated from a real medical disorder?

M2Sirenomelia is a lethal condition characterised by rotation and fusion of the legs, resulting in what often looks like a fish tail (left). It occurs when the umbilical cord fails to form two arteries, thus preventing a sufficient blood supply from reaching the fetus. As a result, the single artery steals the blood and nutrition from the lower body and diverts it back up to the placenta. Due to malnutrition, the fetus fails to develop two separate limbs.

Sirenomelia, also known as ‘Mermaid Syndrome’, is extremely rare. It affects 1 in 100,000 babies and is 100 times more likely to occur in identical twins. Usually, those born with this condition die within days.

Over the course of my research, I’ve found very little about  the disorder’s history. There are snippets here and there which claim that fetuses born with sirenomelia were sometimes preserved in jars and put on display in ‘freak shows’ during the 19th century—but these sources are frustratingly vague. There is brief mention of the condition in a four-volume atlas published in 1891 titled Human Monstrosities, but nothing that hints at how medical practitioners understood sirenomelia in earlier periods.

Perhaps because the disorder is so rare, it’s also been hard for me to locate specimens in anatomical collections. My search in the Hunterian Museum at the Royal College of Surgeons in London came up cold. I did, however, find an early 20th-century example at the National Museum of Health & Medicine in Washington D.C. There are also three fetuses in the Anatomical Museum of the Second University of Naples, which have undergone 3D bone reconstructions (two pictured below).

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By far the largest number of fetuses comes from the Vrolik Museum in Amsterdam, which consists of more than 5,000 specimens of human and animal anatomy, embryology, pathology and congenital anomalies. The collection was founded by Gerardus Crolik (1755 – 185) and his son, Willem Vrolik (1801 – 1863), who both wrote extensively on anatomical deformities in the 18th and 19th centuries. The Vrolik Museum has both wet preparations and skeletal remains, all of which are on display to the public today.

Unlike the first disorder I examined in this series—Harlequin Ichthyosis—sirenomelia is extremely fatal. There are no accounts of anyone with this condition surviving in the past. Most died within days of being born due to kidney and bladder failure. Even today, the odds are against those with sirenomelia, though there are a handful of examples of children living past infancy.

In 1988, Tiffany Yorks underwent surgery to separate her legs before her first birthday. She continues to suffer from mobility issues due to her fragile leg bones, and compensates by using crutches of a wheelchair to move around. At the age of 26, she is the longest-surviving sirenomelia patient to date.

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Under the Knife – Sneak Peek!

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In my new YouTube series, Under the Knife, I will take you on journey into a curious past—one which is riddled with blood-sucking leeches, spring-loaded knives and rotting corpses. Together, we will visit a world where surgeons and executioners share a common goal; where colluding with murderers and thieves is a pre-requisite for gaining entrance into the dissection theater; and where ‘well-bred’ families are horrified at the thought of one of their own becoming a surgeon.

Thanks to the inexhaustible efforts of my talented friend, Alex Anstey, I’m thrilled to release the opener to Under the Knife. I know a lot of you have been waiting patiently for me to unveil this project. I hope you’ll agree it’s been worth the wait!

Please remember to subscribe to our YouTube Channel so you can receive updates when we post new videos. The first episode will be released once I hit my goal on Patreon – so kindly consider supporting my content.

Most importantly, please tweet, post and share this video so we can get people buzzing about Under the Knife! My friends and I can’t wait to show you more!

Click HERE to view video.

The Saddest Place in London: A Story of Self-Sacrifice

SS1Tucked away in a quiet area of East London is a peaceful place that goes by the unassuming name of Postman’s Park (left), so called because it once stood in the shadow of the city’s old General Post Office building. At first glance, you might mistake it for any green space in the city, with its manicured lawn, leafy trees and decorative water fountain. But if you took the time to venture through the gates, you would stumble upon something far from ordinary.

On a stone wall, underneath a makeshift overhang, are a series of ceramic plaques, each one painted beautifully with the names of people who died while trying to save the lives of others. One plaque reads:

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And another:

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And on and on they go. The first time I stumbled upon this memorial was on a walking tour given by Tina Hodgkinson. I was instantly overwhelmed with sadness. So many of the people listed on these plaques were children, like John Clinton, aged 10, who drowned ‘trying to save a companion younger than himself’. Or Henry James Bristow, aged 8, who ‘saved his little sister’s life by tearing off her flaming clothes’ only to catch fire himself and die later of burns and shock. And then there was Solomon Galaman, aged 11, who saved his little brother from being run over in Commercial Street on 6 September 1901. His plaque reads: ‘Mother I saved him but I could not save myself’.

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Unlike many valiant memorials dedicated to those in the armed forces, this was created entirely in honour of the everyday hero. It is a testament to the incredible sacrifices we, as humans, can and do make on a daily basis.

But how did this memorial come into existence in the first place? And why did we stop creating plaques for it?

On 5 September 1887, the painter and sculptor, Fredric Watts (pictured below), wrote to The Times, proposing a tribute of a different sort for Queen Victoria’s upcoming Golden Jubilee. Watts believed that art could act as a force for social change, and suggested a didactic monument celebrating ‘heroism in every-day life’. He wrote:

It must surely be a matter of regret when names worthy to be remembered and stories stimulating and instructive are allowed to be forgotten. The material prosperity of a nation is not an abiding possession; the deeds of its people are.

Watts referred to the case of Alice Ayres, a nursemaid who died on 12 September 1859 in a house fire after she saved the lives of her employer’s children by throwing a mattress out the window and dropping them to safety. She, herself, was overcome by the fumes and stumbled out of the window to her death.

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Watts proposed that a marble wall inscribed with the names of everyday heroes be built in Hyde Park. Sadly, his suggestion could not garner enough support, leading him to quip that if he had proposed a race course instead, he would have had plenty of sympathizers. In the years that followed, Watts continued to lobby for the memorial. Both he and his wife redrafted their wills to leave a bulk of their estate to its construction, and even considered selling their home to finance the project.

SS8Then, in 1898, Henry Gamble—Vicar of St Botolph’s Aldersgate and longtime friend of Watts—acquired the land which would later be called Postman’s Park, and Watts suggested that the memorial be built there. Although there was resistance to the idea of the park being used in this manner, construction began a year later after the necessary funds were secured (Watts himself donated the extraordinary sum of £700 to the cause).

On 30 July 1900, the 50 foot long wall with space for 120 ceramic plaques was unveiled to the public. Watts, who was then 83 years old, was too ill to attend the ceremony. He died 4 years later.

Over the course of several decades, plaques were added to the wall, many of the names chosen from Watts’s collection of newspaper clippings he had accumulated over the years about ‘everyday heroes’. In 1931, the 52nd plaque commemorating the life of Herbert Maconoghu—who died aged 13 while trying to rescue two drowning classmates—was placed. This would be the last name added to the wall in the 20th century.

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After Watts’s wife and lifetime advocate of the memorial died in 1938, the wall fell from fashion and it seemed that no names would ever be added to it again. Then in 2007, a man named Leigh Pitt died while rescuing a 9-year-old boy from drowning in a canal in Thamesmead. His colleagues and fiancée, Hema Shah, approached the Diocese of London to suggest Pitt be added to the wall. Despite opposition from the Watts Gallery to proposals that the memorial be completed, a new plaque commemorating Pitt’s heroic actions was added on 11 June 2009.

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Today, Postman’s Park remains an obscure destination, attracting only a handful of visitors who are drawn, perhaps, to the strangeness of the Victorian deaths chronicled on Watts’s wall. After all, not many people are trampled under the hooves of runaway horses, or die tragically in theatre fires these days. In this way, the plaques are as much a historical testament to an era long gone as they are to the lives of the people whose names adorn them.

To date, there are currently no plans to add further plaques to the memorial. I, for one, hope we don’t have to wait another 78 years before we see another ‘everyday hero’ commemorated in such a beautiful and thoughtful way.

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Become a ‘Patreon’ of The Chirurgeon’s Apprentice 

2Since I launched a donate button on my website several weeks ago, I’ve been overwhelmed by your generosity and support. Then, a few days ago, a friend of mine turned me onto a site called Patreon (no, that’s not a typo!) which would allow me to give a little something extra back to each and every one of you who donates to The Chirurgeon’s Apprentice.

Unlike Kickstarter or IndieGoGo which only allows you to fund one big project, Patreon allows people to support their favourite artists, writers, and musicians as they create free content online. The way it works: you donate a fixed amount of money (for example, 50 cents) each time I produce an article on The Chirurgeon’s Apprentice. In exchange, you get various perks. This can be anything from access to Morbid Minute—a video I’ll release each month revealing a weird/gruesome fact about our medical past—to the first chapter of a novel I’m currently writing called The Surgeon’s Tale.

So if you’d like to become a ‘patreon’ of The Chirurgeon’s Apprentice, please visit my page and watch my video by clicking HERE. I’m offering lots of fun perks which I hope you will like!

As always, I thank you greatly for your kindness.

*For those who’ve donated in the past several weeks, I’ll be in contact shortly to offer you a corresponding perk!