Disturbing Disorders: A Brief History of Harlequin Ichthyosis

H2Last Saturday, I was lounging around on the couch watching 5 straight episodes of Forensic Detectives (don’t judge) when I heard my computer ping. Being the internet junkie that I am, I immediately checked my inbox and saw a message from my old school friend, Andy, who is currently studying medicine at Case Western. He had an idea for a blog post, he wrote, but worried it might be too disturbing for my audience. Naturally, my curiosity was piqued.

Turns out, Andy had reason to worry. In the next message, he attached a photo of a 19th-century fetus (left), which is now housed at Museum Vrolik in Amsterdam. The baby had died from a very rare genetic disorder known as Harlequin Ichthyosis, which causes the overproduction of keratin protein in skin. As a result, those with the condition are born with huge, diamond-like scales all over their bodies, and usually die young due to infections from cracks in the skin.

I have to admit, I’ve seen and researched many terrible diseases, and yet I had a gut reaction to this particular specimen. For me, there is always a deep sadness attached to a child’s death—and even more so when one considers the pain and suffering that brought on such a premature demise. But it wasn’t necessarily the fact that I was gazing upon a life cut short that most disturbed me. It was the extremeness of the deformity that gave me pause. Was this a subject I should tackle on my blog?

As you are reading this post, you will know what decision I finally made in the end. Although Harlequin Ichthyosis is a horrible condition, it is still part of our medical past, present and future (since we have yet to find a cure). For that reason, alone, it deserves contextualization here. More so, our own emotional reactions to the specimen above may help us understand why people in the past feared disfiguring diseases, like smallpox or leprosy, and why many people today continue to struggle when interacting with those who suffer from serious deformities and disabilities.

Harlequin Ichthyosis’s history begins on 5 April 1750, when Reverend Oliver Hart—a cleric from Charleston, South Carolina—became the first to document (but not necessarily observe) the condition. He wrote:

I went to see a most deplorable object of a child, born the night before of one Mary Evans in ‘Chas’town. It was surprising to all who beheld it, and I scarcely know how to describe it. The skin was dry and hard and seemed to be cracked in many places, somewhat resembling the scales of a fish. The mouth was large and round and open. It had no external nose, but two holes where the nose should have been. The eyes appeared to be lumps of coagulated blood, turned out, about the bigness of a plum, ghastly to behold. It had no external ears, but holes where the ears should be. The hands and feet appeared to be swollen, were cramped up and felt quite hard. The back part of the head was much open. It made a strange kind of noise, very low, which I cannot describe. [1]

Mrs Evans’s baby died 48 hours later.

Hart’s description was very accurate. Babies born with Harlequin Ichthyosis have poorly developed ears and nose (which are sometimes absent altogether). Their eyelids are turned inside out, leaving the eyes and area around them susceptible to trauma and infection. They often bleed when they are born, and their lips—pulled upwards by the dry skin—resemble a clown’s smile.

H1Those suffering from Harlequin Ichthyosis are also extremely susceptible to hyperthermia; and they are frequently dehydrated as their skin is not well suited to keeping water or heat in. They often have difficulties breathing due to their armor-like scales, which impede the chest wall from expanding and drawing in enough air. Sadly, this can lead to respiratory failure in many infants.

The disorder’s name alludes to the character Harlequin in the Italian Commedia dell’arte, which made its debut in the 1580s. The Harlequin is characterized by his chequered costume. As you can see, the disease mimics a similar pattern on the skin of the afflicted.

In the past, babies born with Harlequin Ichthyosis had no hope of living more than a few days. As a result, there is very little mention of it in 18th- and 19th-century medical books; and I have only come across two preserved specimens in anatomical collections: one from Museum Vrolik in Amsterdam (mentioned above), and the other from Musée Dupuytren in Paris (pictured below).

H3Advances in medicine, however, have made it possible for people with this condition to live into young adulthood. Improvements in neonatal care, combined with the use of topical retinoids such as Isotrex which enable the skin to shed cells faster than they are produced, are helping to make Harlequin Ichthyosis a chronic condition rather than a fatal disease.

Just last year, 20-year-old Stephanie Turner—who herself was born with the disorder—gave birth to a perfectly healthy baby boy. Hope springs eternal.


1. Qtd from J. I. Waring, M.D., ‘Early Mention of a Harlequin Fetus in America’, American Journal of Diseases of Children, Vol. 43 No. 2, February 1932.

*This is the first article in a series called Disturbing Disorders. If you would like to learn more about Harlequin Ichthyosis, or donate to research, please click here.

Being a Medical History Blogger

1The year was 2010. I had just completed 9 years of university education which culminated in a PhD from the University of Oxford in the History of Science, Medicine & Technology; and I was about to start a 3-year postdoctoral research fellowship with the Wellcome Trust. I was on top of the world, academically-speaking.

Yet, for me, there was something missing.

It may not come as a surprise to you that I was a strange child, and the signs were there from the beginning that I would become an even stranger adult. I used to make my grandmother take me around to old cemeteries in Chicago when I was younger. I suppose you could say I have always been fascinated with death. But more so, I have always been fascinated with the past.

I’ve also always been a passionate storyteller. I suppose that’s what first attracted me to history as a subject. I’m so often moved by the stories I come across in my research—stories about the people who died, about the loved ones they left behind, and about the surgeons who opened up their dead bodies for the sake of medical science.

But back to 2010. I was feeling uninspired, and not a little burnt-out. I was tired of philosophizing and theorizing about the past. I wanted to fall in love with history again, and get back to the stories that once stirred my imagination. Thus, The Chirurgeon’s Apprentice was born.

I’m not going to lie. Not everyone agrees with what I’m doing. Some people think I am ‘bastardizing’ the discipline, and wasting my credentials. Others think I’m being purposefully sensational. And while there is no doubt that I hit upon sensitive subjects here, I hope that people come away with a real understanding of our medical past when they leave. I like to say: ‘Come for the skin book, stay for the history!’

Today, I am no longer part of academia. I have no institutional affiliation, and no funding. But I love what I do. Not a day goes by that I am not grateful to you, my readers, for your continued support and enthusiasm for the subject. Since its launch in 2010, The Chirugeon’s Apprentice has had nearly a million hits, and now has 45,000 fans from around the world. I am truly humbled.

Over the years, many of you have asked how you can support my work. I’ve always prided myself on providing free content for those who seek it. I believe the past doesn’t just belong to historians and scholars. It belongs to everyone. That said, I’ve recently launched a ‘Donate Page’ should you want to help defray the costs of running this website, or merely show your support for a freelance writer. You can also find a donate button below.

I absolutely do not expect it, but I do appreciate your generosity.

Thank you, Dr Lindsey (AKA The Chirurgeon’s Apprentice)

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The Horrors of Pre-Anaesthetic Surgery

L0034242 Five surgeons participating in the amputationI often joke that The Chirurgeon’s Apprentice is all about ‘the horrors of pre-anaesthetic surgery’ and yet, I’ve never written an article which focuses primarily on the patient’s experience before the widespread use of ether beginning in the 1840s. Suffice-to-say, it was not a pleasant affair.

In 1750, the anatomist, John Hunter, colourfully described surgery as ‘a humiliating spectacle of the futility of science’ and the surgeon as ‘a savage armed with a knife’.[1] He was not far from the truth. Surgery was brutal and only to be undertaken in extreme circumstances. In 1811, Fanny Burney had a mastectomy after being diagnosed with breast cancer. She later recorded the incident vividly for posterity:

When the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision—& I almost marvel that it rings not in my Ears still!

S2Fanny (pictured right) went on to depict her own terror as one that ‘surpasses all description’. The agony, she said, was ‘excruciating’. So terrible was the operation that her surgeons decided to limit her anxiety by choosing a day at random and giving her only two hours notice before they began.[2]

Fanny was one of the lucky ones. Not only did she survive surgery, but she also went on to live for another 28 years. Others were not so fortunate. When Stephen Pollard underwent an operation to remove a bladder stone in 1828, he did so under the gaze of 200 spectators. What should have lasted 5 minutes ended up taking almost an hour. The surgeon, Bransby Cooper, fumbled and panicked, cursing the patient loudly for having ‘a very deep perineum,’ while the patient, in turn, cried: ‘Oh! let it go; —pray, let it keep in!’[3]

Pollard died the next day.

Pain was not just an unavoidable side effect of surgery. Most surgeons operating in a pre-anaesthetic era believed it was a vital stimulant necessary for keeping the patient alive. This is why opiates and alcohol were used sparingly, and typically administered shortly before (not during) a procedure, as the loss of consciousness was considered to be extremely dangerous.

_100Today, patients are laid flat on an operating table. Before the latter half of the 19th century, however, patients were often sat upright in an elevated chair. This prevented them from bracing when the surgeon’s knife began to dig into their flesh. Unsurprisingly, they were also restrained, sometimes with leather straps. The operating chair depicted on the left is not dissimilar to ones which would have been used during these earlier periods.

The patients weren’t the only ones who felt anxious before an operation. Surgeons, too, were apprehensive about cutting into living bodies. The Scottish surgeon, Charles Bell (1774 – 1842), was described by one colleague as having ‘the reluctance of one who has to face an unavoidable evil’.[4] John Abernethy (1764 – 1831), a surgeon at St Bartholomew’s Hospital, confessed to shedding tears and being physically ill before or after a particularly terrible operation. He described the walk to the operating room like ‘going to a hanging’.[5] And William Cheselden (1688 – 1752) once remarked that ‘no one ever endured more anxiety and sickness before an operation…’[6]

Surgery was a last resort, and one which brought with it considerable risks. During an operation, patients could die from the sheer amount of blood lost during a procedure. In hospital operating theatres, a wooden box was placed under the patient to catch blood and pus during the surgery. Additionally, sawdust was placed under the floorboards to catch the overflow. Even if a patient survived the traumatic ordeal, he or she might die from post-surgical infection.

Surgeons, of course, were aware of these risks, and went to great lengths to avoid operating. The historian Stephanie Snow argues that because of these dangers, ‘an elaborate etiquette of medical consultations developed’ before a decision was made to operate.[7] Indeed, only a handful of surgeries took place each month at most of the major London hospitals in the first half of the 19th century. Robert Liston—known as ‘the fastest knife in the West End’—lost 1 in 10 patients in the operating theatre at University College Hospital during this period. His success rates were fairly good. Surgeons at nearby St Bartholomew’s lost approximately 1 in 4.[8]

This does not account for the number of patients who died later of complications.

Very few people who underwent surgery recorded their thoughts for posterity. They either did not have the resources to do so, or the inclination to write about their painful experiences. George Wilson—a Professor of Chemistry at Edinburgh University—underwent a foot amputation in 1842. He remembered ‘the fingering of the sawed bone; the sponge pressed on the flap; the tying of the blood-vessels; the stitching of the skin; and the bloody dismembered limb lying on the floor’. Later, he wrote that these memories were not ‘pleasant remembrances’ and were ‘never welcome’.[9]

When reading descriptions like these, it is easy to understand why so many patients’ voices are now lost to us. All too often, their memories, like the surgeries they suffered, were simply too painful to endure.


1. Quoted in P. H. Jacobson, ‘Dentistry’s answer to “the humiliating spectacle'”, Journal of the American Dental Association (1994), p. 1576.
2. The full description of this surgery can be found in Fanny Burney, Selected Letters and Journals, ed. Joyce Hemlow (1986), pp. 127-41.
3. Druin Burch, Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon (2007), p. 26. A fuller description of this incident can be found in an earlier article I wrote here.
4. J.M. Arnott, quoted in Gordon Gordon-Taylor & E.W. Walls, Sir Charles Bell: His Life and Times (1958), p. 82. Originally quoted in Peter Stanley, For Fear of Pain: British Surgery, 1790 – 1850 (2003), p. 205.
5. George Macilwain, Memoirs of John Abernethy, 2 vols (1854), Vol II, p. 203. Originally quoted in Stanley, For Fear of Pain, p. 204.
6. William Cheselden, The Anatomy of the Human Body (1741), p. 334. Originally quoted in Lynda Payne, With Words and Knives: Learning Medical Dispassion in Early Modern England (2007), p. 79.
7. Stephanie Snow, Blessed Days of Anaesthesia (2008), p. 4. I am hugely indebted to Snow for pointing me to some of the sources cited in this article.
8. Matt Soniak, ‘”Time Me, Gentlemen”: The Fastest Surgeon of the 19th Century’, The Atlantic (24 October 2012).
9. Jessie Aitken Wilson, Memoir of George Wilson (1860), pp. 296-7. Originally quoted in Stanley, For Fear of Pain, p. 276.

Public Health & Victorian Cemetery Reform

In 1843, the Scottish cemetery designer, John Claudius Loudon, explained that the purpose of a burial ground was to dispose of the dead ‘in such a manner as that their decomposition, and return to the earth from which they sprung, shall not prove injurious to the living.’ [1] A decade earlier, London cemeteries had reached critical mass. Death rates were rising within the city due to overcrowding and outbreaks of cholera, tuberculosis, diphtheria, smallpox and typhus. Burial grounds were bursting at the seams, causing one Reverend John Blackburn to remark:

I am sure the moral sensibilities of many delicate minds must sicken to witness the heaped soil, saturated and blackened with human remains and fragments of the dead… [2]

C1The rate at which burials were growing was mind-boggling. According to one report, many cemeteries around London were burying as many as 11,000 people per acre. To put this in perspective, most cemeteries today accommodate 750-1,000 burials per acre—a tiny fraction of what was acceptable in the past. [3]

Bodies were literally crammed on top of one another. Most graveyards contained open pits with rows and rows of coffins exposed to sight and smell. Pit burial was so common in London that two men asphyxiated on the methane and other gases emanating from decomposing bodies after falling twenty feet to the bottom of one such pit in the early 19th century. [4]

For those living nearby, the smell was unbearable, especially during the summer months. The houses on Clement’s Lane in the East End of London backed into the local churchyard, and ‘ran with stinking slime.’ The stench was so overpowering, that occupants kept their windows shut all year long. Even the children attending Sunday school could not escape these unpleasantries. They learned their lessons as insects buzzed around them, no doubt originating from inside the church’s crypt which was crammed with 12,000 decomposing bodies. Even after the chapel was closed in 1844, it continued to be used, this time for ‘Dances on the Dead’ (see illustration, below) until the bodies were eventually moved to West Norwood Cemetery a few years later. [5]

L0073464 Illustration of a dance hall above a cemetary area

With this in mind, it’s hardly shocking that people in the 19th century wanted to reform cemeteries. Londoners were up to their noses in blackened corpses and stinking slime. But for the Victorians, this wasn’t just about the aesthetics of living in a city bubbling over with rotting corpses. It was about public health.

During this period, people associated bad odours with disease. It’s easy to understand why. Poor areas where people were jammed together in cramped living quarters would have smelled horribly. It was the poor who would have been forced to live near graveyards and open burial pits. Not surprisingly, these areas were also hotbeds for disease. The English reformer, Edwin Chadwick, was particularly concerned with ‘putrid emanations’ from corpses, which he argued were ‘injurious to the health of the living’. [6] He believed that lead coffins were especially dangerous:

The retention of bodies in leaden coffins in vaults is objected to, as increasing the noxiousness of the gases, which sooner or later escape, and when in vaults beneath churches, create a miasma which is apt to escape through the floor, whenever the church is warmed. [7]

According to Chadwick, the Austrian Emperor had banned the use of coffins altogether for this very reason, insisting that ‘all people should be buried in sacks’ for sanitary purposes. The Turks also recognized the dangers of lead coffins, and made it mandatory that pine be used as an alternative as it ‘decays rapidly,’ thus allowing the corpse to return to the earth more naturally. [8]

Chadwick would not get his wish with respect to lead coffins. However, change did come about in the form of cemetery reform. In 1832, Parliament authorized the General Cemetery Company to build a large, park-like cemetery in Kensal Green, a suburb of London. Shortly afterwards, other ‘garden cemeteries’ sprung up outside the city centre: West Norwood (1837), Highgate (1839), Abney Park (1840), Brompton (1840), Nunhead (1840), and lastly, Tower Hamlets (1841). Collectively, these cemeteries are known today as the ‘Magnificent Seven’ (see slideshow below).

People continued to bury their dead within the city for two decades after the establishment of Kensal Green and the garden cemeteries. By 1852, burials within central London were finally outlawed, and the days of overcrowded graveyards died with their last occupants. In 1885, Britain’s first legal crematorium opened in Woking. It wasn’t until 1968, however, that cremations outnumbered burials. [9]

Today, nearly 73% of people who die in Britain are cremated.

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1. John Claudius Loudon, On the Laying Out, Planting, and Managing of Cemeteries, and on the Improvement of Churchyards (1843), p. 1.
2. Edwin Chadwick, Report on the Sanitary Condition of the Labouring Population of Great Britain. A Supplementary Report on the results of a Special Inquiry into The Practice of Internment in Towns. (1843), p. 134.
3. Ibid, p. 135.
4. Ruth Richardson, Death, Dissection and the Destitute (1987), p. 60.
5. Sarah Wise, The Italian Boy: Murder and Grave-Robbery in 1830s London (2005), p. 52.
6.Chadwick, Report on the Sanitary Condition, p. 31.
7. Ibid, p. 135.
8. Ibid, p. 136.
9.  I am greatly indebted to Ruth Levitt and her article, ‘A Grave Dilemma,’ in BBC History (May 2014) for inspiration & information for this article.

The Hung & Drawn Quarterly

HDQgibbet1I’m very excited to announce the launch of The Hung & Drawn Quarterly on Grave Matters! Illustrated by Adrian Teal, this comic follows Chris Skaife, Ravenmaster at the Tower of London, and myself on grisly adventures through history, documenting four terrible tales from each century. Beginning in the fifteenth with the execution of the Duke of Clarence, the series takes a humorous look at the dark history of crime and punishment.

Adrian, Chris and I don’t get paid for the content we offer on Grave Matters. If you would like to support our work, we now have an online shop where you can purchase artwork from The Hung & Drawn Quarterly (signed/unsigned), or make a donation to receive a laminated bookmark. We really appreciate any support you can give us on this new endeavor.

So without further ado, please click here to read the first in our grisly series! We hope you like it!

The Double Casket of Thomas & Mary Souder

PM15I remember rummaging through an old trunk in my grandmother’s house when I was a child and coming across what seemed to me at the time a very unusual photograph. It was a monochromatic image of a beautiful, young woman lying in a white casket (not dissimilar to the photo on the left).

Curious, I plucked the photo from the trunk and went to find my grandma, who was parked at the kitchen table sorting through the piles of mail that inevitably found its way into her house everyday. She told me that the woman in the casket was a distant relative of mine named Lena, who had died tragically at the age of 17. “You know, people used to take photos of the dead back then,” she said, taking the picture from me and studying it closely as if she had never seen it before. “Imagine that,” she remarked before placing the photo on the kitchen table and turning her attention back to the endless heaps of mail sitting on the table.

To a child, the image was haunting, and I never quite forgot it. It wasn’t till later in life, however, that I understood the historical significance behind the photo.

My grandmother was right (something she relishes hearing even to this day). Postmortem photos began to emerge shortly after commercial photography itself became available in 1839, and carried on being popular into the early 20th century. This was a time when people in Western Europe and North America had an intimate relationship with the dead, so it was inevitable that the recently deceased would feature prominently in Victorian family albums. The fact that my grandma only has one postmortem photo in her possession is now more unusual to me than the image itself.

Postmortem photos from the Victorian period varied considerably in presentation. The dead were not always photographed in their caskets, as you might expect. Often, they were propped up in chairs, occasionally alongside the living. This was especially common when the deceased was a child, as in this example above.

Sometimes, the dead’s cheeks were coloured to mask the telltale signs of decomposition, or the eyes drawn over to look as if they were open. R. B. Whittaker in New York described the latter services as “Fast Asleep and Wide Awake” in an advertisement card from 1860.

Other times, the corpse did not appear in the photo at all. Rather, it showed the gravesite with mourners standing around a tombstone. Yet no matter how different each photo was from another, death was always at the heart of these images.

By far one of the most unusual postmortem photos I’ve come across is that of Thomas & Mary Souder (below), taken at the time of their deaths in July, 1921. The couple died within 48 hours of each other from “the flux,” known today as dysentery—an intestinal inflammation that causes severe diarrhea that leads to rapid loss of fluids, dehydration and eventually death.

There are two forms of dysentery. One is caused by a bacterium, the other, an amoeba. The former is the most common in Western Europe and the United States; and is typically spread through contaminated food and water. Many people succumbed to the flux in the 19th and early 20th centuries, especially during wartime when access to clean water was severely restricted.

Thomas and Mary were in their late 70s and early 80s when they contracted the disease, and so their untimely demise is not shocking, especially when we consider this occurred before the discovery of penicillin (1928). What is surprising, though, is the double casket in which they were buried. For me, it raises many questions: was the casket commissioned while the two were dying or after both had passed away? And if the latter, how long had the Souders been dead before this photo was taken?

The Fort Worth Star Telegram in Hurst, Texas reported the deaths of the Souders on 16 July 1921:

Even death failed to separate Jefferson Souder…and Mrs. Mary E. Souder…his wife for more than half a century. Side by side, they will be laid to rest in the same casket in the little cemetery at Hurst Sunday afternoon after the span of more than an average lifetime, during with they were never separated. Only a few days intervened between their deaths. Mrs. Souder passed away at the old home near Hurst Wednesday. Her husband’s death followed Friday afternoon.

PM11The simple stone that marks their graves in Arwine Cemetery today gives no hint at the extraordinary casket that lies beneath the ground.

Sadly, this is not the only time two people have been buried together. In 2008, Ben and Arron Peak, two brothers who died tragically in a drunk driving accident, were buried in a double casket painted with the colours and logo of Manchester United, the boys’ favourite football team. Wilfred and Ann Fallows—husband and wife—were also buried this way after they died in a head-on collision in 2012. Most recently, Kelsey and Kendall Adams—two young children who were brutally murdered in New Orleans last year—were laid side-by-side and buried together.

So, as intrigued as I was by the Souders’ postmortem photo, I, for one, am glad that the double casket does not appear more frequently in my research. For when it does, it almost always involves a tragic tale filled with sorrow and unthinkable grief.


Beauty & the Macabre: The World of Dr Paul Koudounaris

lindsey%20%287%20of%2012%29“Where do you find your hats?” I ask Dr Paul Koudounaris, writer, art historian, photographer… or as he’d like me to describe him, bon vivant.

“Oh, you know. Wherever these things are found.” He replies, nonchalantly, his ringed fingers waving the question away as if the answer were blatantly obvious.

No, I don’t actually know, but it hardly matters. Speaking with Dr Paul (as his friends affectionately refer to him as) is like falling down the rabbit hole. Suddenly, you find yourself in a world turned upside down. Nothing makes sense, and yet everything makes sense. I find myself nodding as if I know exactly where he gets his hats now.

(Spoiler Alert: I don’t.)

I first met Dr Paul (pictured below) on a trip to Los Angeles when I attended the inaugural Death Salon. He was wearing a purple corduroy jacket and a grey silk shirt. Atop his head was an enormous feathered hat. He looked like an 18th-century highwayman might if he had been imagined by Tim Burton.

“To be honest, I look like a cross between Prince and Vlad the Impaler,” he says. He’s acutely self-aware for someone who is so lost in his own world. I can’t help but agree with his assessment.


While a chat with Dr Paul is a visual experience (the silk, feathers, and jewellery can be hypnotic at times), it is also a deeply cerebral affair. The author of Empire of Death and Heavenly Bodies has travelled the globe, and photographed some of the most macabre places that it has to offer. Naturally, his perspective on life differs from most.

“[My travels] have made me a more tolerant (and also patient) person,” he tells me. This I can believe. Dr Paul has travelled to over 70 different countries and encountered countless cultures and belief systems along the way. He’s sincere in his feelings about the places he’s visited, and the people he’s met along the way, many of whom are witch doctors, sorcerers, and monks.

lindsey%20%2812%20of%2012%29But what does it feel like to stand amongst the remains of thousands of souls? To gaze into the eye sockets of people who died long ago?

“There are a couple sensations I invariably have when I am standing alone in a large charnel house, just me and all these generations upon generations of bone: timelessness and connectivity,” he says. In this instance, I cannot help but imagine him—a flash of bright colour, so animated and alive—standing against the monochromatic background of death.

‘Timelessness,” he continues, “because I stand in the present, stare into the past, and at the same time come face-to-face with my own inevitable future. Time collapses in a charnel house, and I think that is why they made such effective liminal spaces.”

And the other?

“Connectivity because these places really enforced upon me the lesson that no matter who we are and how different we seem to be, we are all part of and subject to a greater cycle—a cycle which in the end ensures that we all end up unified and largely undifferentiated.”


Dr Paul reminds me that no one (not even a medical historian) can ever fully understand the past, having not lived there. In the end, these places teach us more about ourselves than they do about the thousands of souls who make up their walls.

It is not the catacombs, however, that have taught Dr Paul his greatest lesson about the preciousness of life. “Several years back, I was run over by a gasoline truck. It went right into my car on the freeway. Terrible collision. I should have died,” he tells me, much to my horror.

lindsey%20%283%20of%2012%29Dr Paul not only survived the crash, but he walked away from it nearly unscathed…physically, that is. “That [crash] affected me much more than the charnel houses or other macabre sites ever did. It changed my life instantly. I forever after stopped taking things for granted. You can learn a lot by studying the dead, but you learn much, much more by almost becoming one of them.”

For a man whose personal and professional life has been shaped significantly by death, Dr Paul is far more interested in life, and the people he meets along the way.

“There was a monk in Italy who handcuffed me and made me go to striptease club with him. And then there was some guy with a Hitler moustache in Guatemala who tried to kill me with magic. I have had some very odd encounters.”

The weirdest story by far, however, involved Dr Paul dressed like a mummy, some Orthodox monks, and Russian President, Vladmir Putin. But that’s a tale for another day.

Of all the characters who pepper his stories, none is as fantastical as Dr Paul himself. Yet, he seems perplexed by the attention he often attracts.

“I got a message from a friend of mine who was travelling in the Czech Republic. She took a trip on a bus tour…and in their brochure, there was a picture of me, with a caption explaining that I was a typical breed of itinerant Czech artists and Bohemian personalities that wander the country.”

DrPaul4This is a semi-regular occurrence in Dr Paul’s life. His picture ends up in travel brochures, magazines, and even on the back of other people’s business cards.

“My friend Lauryn has just informed me that my picture is on the back of some guy’s card. No idea where he even got that picture… it’s real weird. Why am I on this guy’s business card?!”

It seems everyone is fascinated with Dr Paul these days, not least of all, myself. And why shouldn’t they be?

His is a world made of witch doctors and curses; catacombs and jeweled skeletons; demonic cats and perverted ghosts. A world guided by a suspension of disbelief, and a willingness to engage with the esoteric.

“These skeletons and the belief systems that surround them are not like anything else I’ve ever come across… and I’ve come across some very interesting stuff. There is an elegant, macabre beauty to it all.”

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Dr Paul Koudounaris is doing a show at Wave Gotik Treffen in Leipzig, June 6th – 9th. You can also order Empire of Death and Heavenly Bodies  by clicking here