Human Traces (18 page)

full and pure form of the hysterical attack, as my staff will now demonstrate." Charcot nodded to one of the aproned interns, who approached the hysterical woman and laid his hands on her eyes. A gong was sounded a few inches from her ear, and she quickly began to show signs of distress, clutching her throat, as though something was choking her. Dr. Gilles de la Tourette stood to one side of her and Mile Cottard to the other. "After the aura," said Charcot,"the premonition of the rising attack, comes the globus hysteric us the patient's sensation that her uterus has risen in her abdomen and threatens to choke her. Next will come a sub-epileptic seizure. This is the first phase proper." The woman fell to the stage, tearing her blouse as she did so and beating her head on the boards. The doctors watched over her intently as she writhed and thrashed. Jacques noticed Richer, an artist as well as a neurologist, making rapid sketches. The woman stopped her writhing and raised herself on her back, supporting her weight on her feet and hands only. "The second phase," said Charcot. The woman held the position, her body in an arc with her belly thrust up at the peak of the semicircle, her breasts moving backwards and sideways over her thorax. "This acrobatic clownism," said Charcot, 'requires considerable strength of the wrists and feet, far more than she would normally have. It will be followed by the striking of impassioned poses, as though the patient has seen someone she fears or hates. I should warn you that this is sometimes accompanied by profane language." At once the woman stood up, and held her arm over her eyes, as though scanning the horizon in terror. Then she rushed from one side of the stage to the other, pausing to hold a position of horror and dismay. Jacques was aware of a burbling vocalisation as she moved, which eventually became audible in a sort of masochism of the gutter, using language familiar to Jacques from his ward rounds but causing gasps from the audience. This finally gave way to a protracted delirium in which meaning was lost and the woman reverted to thrashing back and forth on the floor. "The final stage," said Charcot. He nodded to two of the interns who awoke the woman from hypnosis by rubbing her eyes and banging the gong loudly again in her ear. They then guided her to a chair, where she sat looking quietly bewildered. "And what do we deduce from this?" said Charcot. "That this illness not only has a mental element, as I described before, but also an auto-suggestive element, as we have seen. Yet this woman is not mentally unwell; on the contrary, hysteria remains a classic neurological illness with a somatic base. Our main task is to locate its cerebro-spinal lesion, but I may say to you that the auxiliary task may turn out to be more challenging. And it is this: to determine the neural mechanisms by which trauma, thought and memory take over the motor functions of a patient to produce such symptoms of ataxia, contractu res and so on. Hypnosis allows us to examine the course of an hystero-epileptic attack with the clarity normally reserved to the other end of our work beneath the lights of the post-mortem laboratory. However, let us not forget that hysteria remains also an affliction of the ovaries." Charcot nodded to Richer and Bournville. "An attack may be triggered without hypnosis by a neurologist who knows the hystero-genic points." Bournville placed his hand on the woman's naked ribs below her left breast and squeezed. At once, she began the first part of the cycle again, going into sub-epileptic seizure. "Equally," said Charcot, 'it can thus be halted by pressure to the ovaries." He nodded again. A bearded intern stepped forward and, while Mile Cottard and Dr. Gilles de la Tourette pinioned the woman's flailing arms, pushed his hand down the waistband of her skirt. After a few moments of the intern's manual pressure, she relaxed, her seizure left her and she was once more escorted to her chair where she sat, panting, with her sweat-drenched hair hanging down over her face and breasts. There was no smile or look of triumph on Charcot's face as he checked his watch and turned in conclusion to the audience. "So there, ladies and gentlemen, we have been able to watch an hysterical attack not in a partial or bastard form, but in a pure and classic form, fulfilling each of the four defining phases of its nosology. You may have found the pathology confusing, particularly my description of the effects of mental activity, auto-suggestion and remembered experience in such a somatic complaint as this. I propose, however, that the explanation is available to us if we are to consider the as-yet unfound lesion of hysteria to be not a static but a dynamic lesion, caused by an alteration in the tissue of the brain brought on by metabolic or chemical change. Such process is quite consonant with our understanding of hereditary disease. I propose to you that although the lesion is imperceptible to present-day science, this will not be the case for long. I am a practical man and I do not like, as my students know, to theorise. However, I am prepared to offer an hypothesis that the lesion will be found in the grey matter on the side opposite to the hemiplegia, which you saw begin during that attack, probably in the motor zone of the arm." Charcot began to gather the notes from the table behind him. "As to the connection with what I have called the mental side, I do not see an insurmountable problem there; I do not see anything in that complication that need remove hysteria from the domain of neurology and hand it to the alienists. One need only view the problem this way. As one may describe the physiology of the lungs as breathing or the physiology of the colon as the evacuation of waste matter, then one need merely envisage what we call "psychology", or thought, as the physiology of the cortex. In that way," he said, levelling off the edges of his gathered notes, 'the entire process falls within the map of human neurology as we have it." He thrust his notes at the chest of his chief assistant, Pierre Marie, said, "Arrange all this for publication," and strode from the stage. That afternoon, as Jacques was walking in a delirium of excitement across the Promenade de la Hauteur towards the chapel, Mile Cottard came hurrying towards him. "I have a note for you, young man," she said. "From Dr. Babinski." "For me?" Jacques felt honoured that Babinski, one of Charcot's favoured sons, should even know who he was, and Mile Cottard's raised eyebrows suggested that she agreed. "Monsieur," said Babinski's note,"I have heard good reports of the freelance teaching work you have done with the first-year students. I know that you are close to the end of your time with us and I believe that your defence of your thesis before the examining board will be a formality. I wonder therefore if, in the name of our common search for knowledge, you would care to offer a second opinion on a private patient, a young woman with a mild nervous affliction. Since you are not yet formally qualified, this must of course be viewed as an intellectual exercise only. "However, the young woman's family is extremely wealthy and will continue to require medical services. Doubtless you are aware that our great professor himself enjoyed such patronage at the start of his career, travelling abroad as physician to an entire family, and that that aspect of his work continues to nourish. Please call in after my clinic tomorrow at five if the idea interests you. Yours truly, Joseph Babinski." Jacques began to run back to Madame Maurel's boarding house. He was not late, but there was no other way in which he could express his happiness. In the morning he had witnessed human beings at the edge of greatness, men standing on top of the mountain that only they, by virtue of their genius and determination, had known how to scale, and looking for the first time into a promised land the other side. These great explorers peering narrow-eyed into the mist... He had seen them, been with them in the room, and he knew, as they knew, that when their gaze became accustomed to the view and the mist began to clear, the vista that emerged was little less than a complete landscape of what it meant to be a human body, mind and soul the geography of being, revealed in all its beautiful simplicity by the pure light of science. As if that exhilaration were not enough, one of the expedition leaders had now singled him out by name to join them to be an associate in that enterprise. The classes were coming out as he ran down the Ecole de Medecine. From the Ecole Pratique, the weary students issued onto the cobbles, cigars clenched between their teeth, and, just like the fastidious ladies who had once so irritated him, he held his breath as he went past them. He stopped to buy a bag of roast chestnuts on the corner of the Boulevard St. Germain, then, in a moment of exhilarated self-indulgence, went into a cafe and drank a glass of hot rum at the counter. He smacked the empty tumbler down on the zinc, wiped his moustache on his sleeve, and went on his way, down into the dingiest streets of the Latin Quarter, where the students and the prostitutes lived, where the artists' models and the provincial boys from Angouleme and Aurillac who had to find their fortune coexisted with widows of dwindling income, powdery dotards and sharp-featured men with bad clothes looking for investors in their fail-safe business schemes. Representatives of all such people dined at Madame Maurel's at seven in the evening. The panelled parlour was filled with the vapour of their failing aspirations; it hung like fog above the pewter candlesticks, with the smell of tallow, boiled vegetable and Madame Maurel's tomcat. Jacques took his napkin from its place in a wooden box on the sideboard, reserved to the dozen full-time residents of the boarding house. This inner core was joined at dinner by half a dozen others, drawn to Madame Maurel's table by the modest rate the old widow charged them for their mutton and potatoes with mealy white bread. When the 'externs', as Jacques thought of them, had gone home, the residents felt free to comment on their pretensions, hygiene and appearance. Between themselves the 'interns' kept a semblance of civility, though Madame Tavernier and her round-faced daughter, who had the second largest suite of rooms on the first floor, found it hard to conceal their distaste for Pivot, the lank-haired travelling salesman in the single above them, who disturbed their sleep by walking up and down on the bare boards to ease the torment of his psoriasis. He in turn referred to them as Marie Antoinette and her little pug bitch and relished the way they wiped the rims of the greasy wineglasses before deigning to touch them with their lips. "Mend those lace cuffs one more time," he said, 'and there'll be no lace left." "Do not answer the gentleman," said Madame Tavernier with a sniff. After dinner, the guests who could afford it took a cup of coffee in the drawing room, a place furnished with the pieces of furniture that other houses had rejected; Jacques thought they were like the women of the Salpetriere, given asylum by Madame Maurel because no one else would have them. There were indestructible sideboards, tastelessly carved, a table with an oilcloth and a wooden clock with copper inlay, greened with verdigris. The room was cold because its fire was never lit; even when Pivot took a glass of cheap cognac, it seemed to bring no warmth to him, because the air had the same saturated quality as that of the parlour, as though it had been too often exhaled from damp lungs. Jacques's was one of four attic rooms, next to that of a law student from Tours who played the violin. These were the cheapest lodgings, uncleaned, unvisited by the handyman; they were the rooms whose occupants Carine was last to call in the mornings, and then only if her legs were not too swollen to permit her to climb the final flight. He lit a candle, pulled his chair up to the table and began to write: My dearest Sonia, May I call you that? To me you are most dear the most dear person in the world, dearer even than your brother dearer even than my own brother, whom I love without reservation! I think of you in your lovely room, looking over at the church. No it is nine in the evening, so you are still downstairs. You have dined in one of your fine dresses and entertained whatever dull merchant your parents wish you to impress. You have been loving and dutiful; but is there that look what is the English word? playful, perhaps, a little humorous, in your eye, as though you wished that there was somebody else there, whose eye you could catch? And could that somebody be me? You seem so far away that sometimes I wonder if I can still exist in your heart, or in your memory. Now you are reading your book, wondering when it might be time for you to leave and go upstairs. My heart hurts with your absence. Yes, I feel it there against my ribs. I do not care what modern science says; that is the organ of my emotions! But today, dear Sonia, has been a great day. We are on the edge of making such discoveries here as will change the treatment of the sick, but more than this it will change what we understand it means to be a human being (I have not expressed that well). And today one of the most distinguished doctors offered me one of his private patients! I shall see this young lady Jacques dropped his pen with a cry. Where would he see this young lady? Charcot had a palace on the Boulevard St. Germain, Babinski had a respectable consulting room at the hospital, no doubt; but he, he could not invite a society lady into the tubercular stew of Madame Maurel's parlour, invite her to disrobe and leave her silk dress -where, next to Pivot's soiled napkin on the sideboard, out behind the kitchen door on top of the suspended meat safe God. He picked up his pen again. Tell Thomas that when you both come to join me in the summer he must take decent rooms from which we can both consult. I know he has saved some money from his pay at the asylum. If I can find somewhere to do my first consultations, I too should be able to save something to contribute. Once we have a little practice running it will pay for itself, but these landlords are cruel about wanting a deposit, so we must have something to offer. Sonia, I cannot wait for you to come. I can arrange for Thomas to walk the wards at the Salpetriere for a time; most important is that he comes to Charcots lectures, which are changing the course of medicine. Thank you for your last letter. I love reading about Torrington. It feels almost like a home to me more like a home than my own in Sainte Agnes, where I shall never return. I do not believe that Violet still talks of me. I think you are flattering. I can write no more. I am too happy and too full of plans. Until the morning! When the