Recently, I found myself doing a little seat dance in the British Library when I came across a fascinating series of letters (Sloane MS 4076) from 1715, written by apothecary William Lilly about the Countess of Suffolk, Henrietta Howard. Historians of medicine, of course, are generally loathe to engage in retrodiagnosis, but sometimes it’s just too tempting… What Lilly seemed to be describing was a case of Cotard Delusion!
Cotard Delusion, or Walking Corpse Syndrome, was first described as a cluster of symptoms by Jules Cotard in the 1880s. The symptoms include insensitivity to physical pain, a preoccupation with guilt and despair, and the belief that one is already dead, damned or possessed (or, conversely, immortal). Cotard was not the first to observe this sort of case, but he categorised it as a syndrome: hypochrondriac delusion and anxious melancholy, or lypemania—drawing on an earlier classification from Jean-Étienne Dominique Esquirol (1772-1840).
According to modern studies, Cotard Delusion starts off with a sense of general anxiety that could last weeks or years, but increases over time until the patient believes s/he is dead and is preoccupied with guilt and despair. Sometimes this is accompanied by muteness or paralysis. In some cases, the disorder might be accompanied by physical problems, such as a brain tumour or injury, multiple sclerosis, or Parkinson’s disease.
So what were Lady Suffolk’s symptoms? In a letter dated 20 July (ff. 7-8), Lilly noted that Lady Suffolk was taking little rest, but
“when she waked from her slumber call’d out in a frightfull manner for half an hour that she was deceased and a great deal of such Language”.
Once this “raveing fitt” ended, she became profoundly drowsy and “lay still without any motion”. She needed help with the bedpan, even “though she walk’d severall turns in her Bed Chamber yesterday”. Lilly bled her nine or ten ounces, which he hoped would prevent worse lethargy. Lady Suffolk’s blood was viscous and sizy. Lilly thought it suggested, along with her stopped urine, a “phrenites [acute inflammation of the mind and body] with the Mania”. Lilly also applied blisters on her legs to draw the bad humour down and out, laid pigeons to her feet (sometimes used to treat headaches and migraines) and shaved her head to relieve the excess heat in the head.
Four days later, Lilly had administered Sloane’s prescriptions “without the desired effect” (f. 9). Lady Suffolk no longer had a fever, but her other symptoms continued and she was drowsy, “which made me fear her turning lethargical or some other distemper on her Braine which I perceved to be already affected”. Lilly gave Lady Suffolk a glister, inducing her to flow in several ways. She produced a large stool and plenty of urine and spoke more than she had in two days.
On 26 July, Lilly reported that Lady Suffolk had vomited phlegm and choler, as well as had three stools. She could walk around her chamber, but “still continues very melancholy and silent and seldom speaks without being importuned to it”. Lilly was deeply worried. He hoped that Lord Suffolk would take his wife to London “where you may see her oftener”, as her “present indisposition will not quickly be removed”. Lilly again suggested that it might be an affectio hypochondrica [melancholy] or mania, and provided details about Lady Suffolk’s conversation:
“for what she sayes is that she is undone in soul and body that she is sure she will be damned at other times when I urge her to speaks she tells me she is dead and has been so for some time”.
In an undated letter that seems to come at this point in the series (ff. 12-13), Lilly listed Lady Suffolk’s symptoms as diarrhoea, fever and head pain and insisted again that the disorder was hysterical, not feverish. Given Lilly’s repeated attempts to persuade Sloane that the real problem was hysterical, it’s not clear that Sloane initially trusted Lilly’s diagnosis.
But by late July, Sloane had started prescribing anti-hysterical medications, including cordials and drops (29 July, ff. 10-11). Even so, Lady Suffolk “is more than usually melancholy” and complained of heart palpitations and swimming in the head: more symptoms of hysteria. Since Lady Suffolk’s fever had not returned, Lilly hoped that the danger had passed.
This sort of delusion was distressing to observers, including Lilly who was uncertain of his ability to help, but Lady Suffolk’s disorder was readily classified as hysteria or hypochondria—ailments that were as much physical as mental. The diagnosis and treatment for Lady Suffolk was humoral in nature, treating her emotions as fluids and using remedies to make her body and mind flow.
Although retrodiagnosis is tempting in Lady Suffolk’s case, eighteenth-century medicine already had a place for her religious delusions. Robert Burton, for example, included a lengthy section on religious melancholy in his famous Anatomy of Melancholy (1621). Eighteenth-century books on hypochondria also emphasised the often religious nature of sufferers’ fears, such as despair and damnation, especially in women (e.g. Nicholas Robinson, A New System of the Spleen, Vapours, and Hypochondriack Melancholy, 1729).
Retrodiagnosis is unhelpful in another way. Lady Suffolk was ill with problems besides the delusion, which had even lessened toward the end. In particular, Lady Suffolk’s ailments progressed rapidly in less than a month.
Lady Suffolk never made it to London to see Sloane in person. The danger had not passed: she died on the 10th of August.
G.E. Berrios & R. Luque, “Cotard’s Delusion or Syndrome?: A Conceptual History”, Comprehensive Psychiatry 36, 3 (1995): 218-223.
Hans Debuyne, Michale Portzky, Frédérique Van den Eynde, Kurt Audenaert, “Cotard’s Syndrome: A Review”, Current Psychiatry Reports 11, 3 (2009): 197-202.