Human Traces (21 page)

Eight

There was a timid knock on the door, and Thomas, who had been looking out over the chestnut trees and daydreaming, leapt to his feet. "My receptionist," he said, 'is absent. Please excuse me." A note on the desk from Jacques told him to expect Madame Lafond. A Parisian woman of about thirty stepped into the room. She was wearing a burgundy silk dress with black gloves that she twisted in her hands; she had golden hair swept up and pinned beneath a black velvet hat. "Please do sit down, Madame." The woman spoke rapidly and nervously. "I have previously consulted your colleague, Dr. Rebière." "So I understand." He picked up some notes from the desk. "And how are you feeling, Madame?" Madame Lafond passed a hand across her forehead. "Not well, Doctor." "You seem a little short of breath." "Well, naturally. The stairs..." "Forgive me. I am so used to them that I sometimes forget. And what difficulties are you having?" "I have headaches. I do not sleep well. And I have a pain here." She held her hand to an area above the waist. "Is this the same pain for which you originally consulted Dr. Rebière?" "Not exactly the same. It is a little more severe. I first consulted Dr. Charcot. Then Dr. Babinski. Then Dr. Rebière for a second opinion. I am beginning to feel a little like a parcel no one wishes to unpack. But my husband..." "Yes, Madame?" "He insists that I must be cured. I took the waters at Aix last spring. And then we went to Vittel. I was bored." "And I see that Dr. Rebière diagnosed exhaustion. Have you been able to rest?" "It is difficult to find the time. My husband is a financier and he is obliged to entertain a great deal. Naturally he wishes me to act as hostess when his guests come to dine." "Naturally. And how often would you have to preside at such a dinner?" "Perhaps twice a week. Then we are also obliged to dine out frequently." "I see," said Thomas. "And these dinners. Do they consist of many courses? Are they rich?" "I eat so little I could not really tell you. I suppose they are sometimes lavish." "What was the dinner the last time you entertained?" "Some foie gras. Oysters. My husband is very fond of oysters. Some sole perhaps. A side of beef. Champagne. I forget." "And wines?" "Of course. You are English, I believe, Doctor." "I am indeed. I am familiar with French wine, however. One of the glories of the world." "I suppose so." Madame Lafond looked distracted. "I drink only water. Sometimes a little brandy. Tell me, what do you think the matter is?" "I shall need to examine you before I can be sure. If you would care to step behind that screen and take off your clothes." Madame Lafond obeyed with the docility of the chronic patient. Thomas went over to the window and looked down on to the traffic of the rue des Saint Peres. He had found the attic room in his first week in Paris and hastily arranged a brass plate; it was an unfashionable street and its three flights of stairs made it impossible for elderly patients. Most of his clientele, however, seemed to be young women, impressed by its proximity to the Boulevard St. Germain and strong enough to make the climb. Madame Lafond was sitting on the edge of the couch in her underclothes, staring stoically ahead; her narrow blue eyes had a look of weary patience as Thomas rubbed his hands together. He touched her arm. "Please tell me if my hands are too cold." "All right." "Please lie down. I am going to examine your abdomen." As he lifted the silk chemise and laid his fingers on the skin of her belly, Thomas had a picture in his mind of the first female corpse he had seen in "Meaters', as the Cambridge undergraduates had called the dissecting room or meat-shop, a shanty with a tin roof and an overpowering atmosphere of formalin and pipe-smoke. He often brought to mind the billowing stoves, the tallow soap and clammy towels by the sink when he was examining a female patient; it helped him concentrate. Madame Lafond's skin was soft, and the flesh beneath it felt normal to his touch. He pushed down the ivory drawers a little, and pressed over the appendix. "Do you have children, Madame?" "I have one son." "And is everything regular? Your monthly period? May I touch here? I am looking for any sign of ovarian disorder. Has there been any swelling? Any pain? Good." With some relief, he moved up to the area beneath the ribs, where he did elicit a small cry when he pushed firmly against the stomach. "Nothing to worry about," he said. "A little air, I think. Now the liver. Is that tender? No? Very well. If you sit on the edge of the couch again and lift up your slip. I am going to test your knee reflexes. No need to roll down your stockings. Just sit on the edge. Very good. You may get dressed now." He asked her some more questions about her diet, her habits and whether she took exercise. He checked her pulse and examined her eyes. He looked at his watch: patients usually wanted a consultation to last for at least half an hour. "And your relations with your husband, Madame. Are they quite normal?" Madame Lafond looked a little uneasy. "Yes. He is a... demanding man. He likes to... I don't know what is normal, but I imagine so, yes. Listen, Doctor, there is a Swedish doctor I have heard of who diagnosed a friend of mine. He said she had colitis. It seems to be a very common ailment in Paris at the moment." "Yes," said Thomas. "So I believe. Very fashionable." Madame Lafond flushed. "And do I have colitis?" "I think not. I could detect no problem with the colon." She looked disappointed. "So what is the matter with me?" Thomas licked his lips. This was the moment he found most difficult. "I naturally agree with my colleague, Dr. Rebière, that you are tired. However," he said quickly as her face clouded further, "I think there is a secondary problem." "And what is that, Doctor?" "I diagnose a mild gastritis." A look of wonder came into Madame Lafond's face. "Is it serious?" "In its chronic form it can be very serious. In its acute form, less so. It may cause vomiting. In the form that you have... It is unlikely to be too debilitating." "And how did I catch this disease?" "I should say it was probably... Idiopathic' "Idiopathic gastritis." She repeated the phrase slowly. She seemed to enjoy it. "They told me you were a good doctor. You have a reputation already, you know." Madame Lafond's cheeks, flushed with excitement, made her look the embodiment of youthful wellbeing. "And what should I take for it?" "Quite a strict regime, I am afraid." "So much the better." "Take these pills, twice a day. You must walk briskly for an hour each morning. Avoid alcohol, and rest for half an hour on your bed after lunch. No longer, mind, or it will spoil your sleep at night." Madame Lafond stood up, holding the bottle of pills in her gloved hand. "And shall I come and see you again?" "Undoubtedly' said Thomas. "A week today at the same time." "Goodbye, Doctor. Thank you so much." Thomas heard her staccato steps dancing down the wooden stairs. I have cured her, he thought. Sonia arranged a small jar of flowers in Jacques's room and tidied the papers on his table. "Traumatic Hysteria," she read in Jacques's increasingly untidy writing. "Case study Four. Henri R: coachman involved in traffic accident, Pont Neuf, July 5, 1887. Note particularly: memory of trauma retained in part of brain outside normal consciousness." In the margin of the page, he had scribbled, "This mechanism potentially universal?" She smiled as she organised the papers, being careful not to alter the order in which they had been left; she had no wish to see again the look of amazed sadness in Jacques's eyes that had followed her first attempt at tidying his work. It had been the only uneasy moment in their infant marriage. Her parents' displeasure at her marrying again so soon, to a poor foreigner, had expedited the journey to Paris and made her blind to the less attractive aspects of Madame Maurel's boarding house. While Jacques put the last touches to his thesis, she bought flowers, mended his clothes and repainted the room. The days were long without him. She visited the Louvre and stood before the paintings of Poussin and Ingres; her favourite was The Raft of the Medusa, by Gericault, where the figures seemed to ascend the scale of human happiness, from the mournful foot of the canvas to the top, where the bent-backed African sailor flourished his scarlet banner of hope. She had time to explore the Latin Quarter and the whole stretch of the Left Bank as far as the Gare d'Austerlitz and the Salpetriere itself, where she sometimes took a sandwich to Jacques for his lunch and ate with him on one of the benches of the Promenade de la Hauteur, with a few patients for company. Sometimes she could meet Thomas as well, and would return to his attic in the rue des Saints Peres because the bathroom arrangements were preferable to those of Madame Maurel and she could act as an unpaid receptionist when Thomas had a patient. Sonia could not recall a time when she had felt happier. The boarding house did not repel her, it charmed her. Madame Tavernier and her daughter did not irritate her, they made her laugh, though not as much as Pivot, the psoriatic salesman, or the perpetually reluctant Carine. To supplement the cooking, Sonia baked small flans or tarts when Carine was out of the kitchen and sent them off to work with Jacques the next day. The narrow bed in his room was barely large enough for both of them, but Sonia slept in his arms each night, motionless with joy. Jacques admitted that he had at first surreptitiously checked her pulse, amazed at the depth of her unconsciousness, but then thanked providence for a tranquil wife, and wrapped himself tight around her. With some of the small amount of money she had been able to bring, Sonia bought a wardrobe for her clothes and had it installed in a corner of the room; she found a laundry that was reasonably priced, at least by the standards of Paris if not by those of Lincoln, and took it on herself to turn the cuffs of Jacques's shirts. She felt it was important that she provide some comfort and stability for him, because he and Thomas were in a state of perpetual agitation. The final stage of Jacques's qualification was the defence of his thesis in front of the examiners at the Salpetriere, and although he had been given to understand, by no less a figure than Dr. Babinski, that this would be straightforward, the writing of the thesis was still not complete. Sonia occasionally reminded him, but did not wish to nag when he seemed preoccupied. The trouble, she thought, was that he and Thomas were so enthralled by Charcot's lectures that Jacques had no time left; day after day, he would come pounding up the stairs of Madame Maurel's house with news of the professor's latest revelation. Sonia had to try to understand; it was part of her love for Jacques that she simply must understand. He marvelled at how well she could follow, with no medical education; he told her she was a doctor manquee and thanked his good fortune in having married such a paragon; yet she saw how he had to struggle to be patient when she had missed an important link in the chain of his reasoning, and she knew how hard she was fighting to hold her mind to the point. He assured her that there were no more than a dozen words two dozen at most that she needed to know in order to be able to follow, in broad terms, what he was doing. On the back of an old Comedie Francaise playbill, he even wrote some of them down, and she studied and learned them in his absence. "Neurology: the study of diseases of the nervous system, typically caused by "lesion" (think of a tiny cut or blister) in the brain or spinal cord which causes problems in the nerves that stem from that point, typically disorders of the muscles, thus odd movements. Morbid: diseased, unwell. Somatic: of the body, physical. Psychic: of the mind, opposite of somatic (but I generally say mental because psychic looks too like physic or physical on the page). Innervation: the fact of having, or the process of acquiring, nerves (for instance, the arm is innervated, but the colon or the brain itself, oddly enough, are not; if someone stabbed a knife into your brain, you would not feel it). Neurasthenic: suffering from a mild nervous exhaustion of undefined cause and varied symptoms, including insomnia, mild phobias and so on. Usually responsive to rest and dietary change. Nosology: the process of denning a disease by grouping symptoms together as a named entity. Organic: having an observable physical existence. Dynamic: moving, therefore not observable in the same way. Physiology: the study of how bodily systems work and what they do. Neurophysiology: the study of what the nervous system does and how it works. Brain: organ in the skull responsible for control of the body (via the nerves), emotion, sensation, reason and thought (all via its own cells in different areas). Mind: cognitive function of brain (cognitive: to do with reason, memory and the connections they make). Consciousness: human self-awareness, probably a function of mind but possibly of brain; we do not know. Psychology: the study of how the mind works. Psychiatry: the diagnosis and treatment of illnesses of the brain and mind. Neuron: basic unit of nervous system with ability to transmit electrical impulses in chains. Hemiplegia: paralysis affecting one side of the body. Epilepsy: a malfunction of the brain (probably caused by a lesion, see above, possibly resulting from birth trauma (wound or injury) or from infection) that causes an electrical discharge in the brain, like a small thunderstorm, that spreads down various pathways. Its final destination, often in some centre controlling movement, determines its effect on the body, for instance in convulsions or spasms of the relevantly controlled part." They invented a game in which Jacques played the part of a grand examiner and Sonia the role of a nervous student just up from the Auvergne. Jacques clearly enjoyed swaggering about the low-ceilinged room while she sat demurely on the rush-seated chair. "All right, young man," he said in his professorial voice. "That's enough about Parkinson's. Now hysteria, please." "Also a standard neurological illness. Lesion in brain or spinal cord, precise location yet to be confirmed, causing damage to nerves at the site and consequently shaking or paralysis at the end of the pathway where the nerve meets the muscle." "And?" "Inherited, though we do not yet know quite how that works. Also influenced by the patient's womb or ovaries." "Yes, though that aspect is no longer considered fundamental. What particularly distinguishes hysteria from other standard neurological illnesses?" "It has a mental element." "Explain, please." "Patients undergoing hysterical attacks appear to be reliving horrible things ' '"Horrible things"? Hardly a scientific term." "Traumatic events, sir. Things which happened a
long time ago." "And, most important?" "It seems that such horrid traumatic events may actually set off the illness. They unlock the door on to it." "Very good." "We do not yet know how." "But we will find out?" "We are close to finding out." "One last detail on the mental side?" "All hysterics can be hypnotised. Under hypnosis they can be made to live out the classic hysterical attack which ' "Which has how many phases?" "Four." "Correct. And what most crucially does this tell us?" "That the mental element in the disease may also work through the process of "auto-suggestion"." "Young man, you are a scholar. May I embrace you?" "You may, sir." "Thank you. You are now ready to move on to the question of traumatic hysteria." "Am I? Am I really?" "I believe so. I promise you that it is the very last thing I shall ask of you, but understanding it is the key to the work on which we are about to embark. It may well be the key to understanding how the human mind works." "My dear Jacques," Sonia laughed. "How right Thomas was. He told me that if I married you I should never be bored. Penniless, he said, exasperated, exhausted, uplifted, but never bored." Jacques smiled. "All right. I think you should come with us one morning soon to hear Professor Charcot." "But I am not ' "Half the audience are not medical people. We shall need to be there in good time, to be sure of our seats." They arrived shortly after nine, an hour early, and made their way to the amphitheatre where they were able to find places in the front row. As Sonia settled herself between her husband and her brother, she found herself reminded of the last time she had been taken to Drury Lane by Richard Prendergast. She looked up at the stage, which was set with a double row of chairs for the assistants and, at the front, an armchair and table for Charcot. On the other side of the stage was a platform with a blackboard on which were written the words: "Traumatic Hysteria. Three cases." Behind the platform was a large oil painting of Pinel striking the chains from the lunatics of the Salpetriere. Sonia's eye was drawn to the central figure, a young woman with waving auburn tresses, on the point of liberation by the father of French psychiatry. Pinel was just in time, Sonia thought; a moment later and her extreme decolletage would have led to indecency: it was certainly too late for the young lady writhing on the ground, the upstanding firmness of whose naked breasts defied the gravity of her situation. Neither patient looked one bit like the gibbering crones with whom she ate lunch beneath the plane trees. In the hour before the lecture was due, the auditorium began to fill with medical students, many of them wearing top hats, which looked peculiar, Sonia thought, with their unshaven faces, tired linen and greasy neckties. There was an unmistakable smell of stale alcohol, an odour she associated with Fisher, the occasional butler at Torrington; some students were humming tunes they might have picked up the night before in a cafe, some rustled newspapers and scratched their heads. There were a few older men with notebooks whom Sonia took to be reporters and others, better dressed, who, Jacques explained, were simply interested members of the public. The lights above the raked seats went down, and the spotlights rose on the stage. All was quiet for a moment; then the audience rose and applauded as Pierre Marie, in faultless morning dress, with a scarlet buttonhole, led the assistants to their place, followed, after a momentary pause, by Charcot himself. Sonia looked about, smiling, amazed by the fervour that greeted the little man. He wore a short coat and peculiar black skull cap over his long, grey hair. A builder's labourer was ushered onto the stage by one of the interns. He had been at a site near the Tuileries Gardens when a passing wagon, driven at some speed, had knocked him from the scaffold where he was working, down onto the pavement. He lost consciousness, having taken a blow to the head, but suffered no physical injury. After some time (Charcot did not say how long) at the Hotel-Dieu, he regained consciousness and returned to his wife and family. He appeared to recover fully, but following another interval, whose exact length was again not specified, he began to experience headaches, trembling, episodes of amnesia, and part-paralysis in the lower half of his body. He could not feel it when a flame was held to his left leg. "Before we discuss this most interesting case," said Charcot,"I wish to establish the patient's heredity." An intern read out details of the life of the man, whom he referred to as "Paul B'. He lived near the Barbes-Rochechouart intersection in a slum house beside the railway bridge. His family, as far as could be determined, was a Sodom of idiocy, drink and syphilis; he himself liked nothing more than to reduce himself to insensibility on absinthe or cheap wine. He was sexually incontinent and had fathered children by several women. "Degeneration," said Charcot, 'has him in its grip, but that is not the intriguing feature of Monsieur Paul B. This patient is suffering from traumatic hysteria. Some of you will be surprised that a man can suffer from what used to be a woman's ailment, especially a man who is not in himself effeminate. In this instance, the hystero-genic action of the womb itself is absent, though we may surmise that there has been some testicular influence in its place. Dr. Gilles de la Tourette will now show the map of the male body with its hysterogenic areas marked. The shaded parts, here, here and here. Thank you, Doctor. "None of this need detain us. What is of interest both in this case and in the treatment of traumatic hysteria in general, is the part played by the patient's mind, and in particular his memory of the accident that threw him from his scaffold. He was taken, uninjured, to the Hotel-Dieu. There he lay, until such time as he was apparently well enough to go home. During that period, however, the trauma he had sustained was held outside the normal activity of his mind, outside the physiology of the cortex. It existed in a state of latency from which it eventually emerged, a considerable time later, to activate the hysterical disposition that is his sad neurological inheritance." Charcot paused for a moment in the rapt silence of the auditorium and drank from a glass of water on the table. "The trembling, the hemiplegia and the headaches, even the sense of choking the patient has described, we recognise as classic symptoms of hysteria. What is most interesting about the nature of traumatic hysteria is the way in which somatic paralysis has been activated by trauma, or the memory of trauma. This is an example of what an English colleague, Mr. Reynolds, referred to as 'paralysis by idea' not imagined paralysis, for this man is as physically afflicted as any of my multiple sclerosis patients no, paralysis by idea. An experience has been held out of conscious thought in such a way that it has been able to exert its influence directly upon the nervous system and thus upon the muscles of the patient. And that, ladies and gentlemen, is the peculiar interest of this condition." Sonia felt Jacques rise beside her and break into spontaneous applause. She blushed for his rapture, but not for long, as the rows behind them followed suit, with many students stamping their feet on the wooden floor and hammering the desks. Charcot was obliged to hold up his hand for silence, so that he could conclude. "When Paul B undergoes an hysterical attack or when his lower left side is paralysed, it is because the trauma of his accident has exacted its delayed toll on a system predisposed by his inheritance to hysteria. The physiopathological pathways by which it does so can be shown in operation if the patient is hypnotised. Exactly the same mechanism will produce exactly the same result. Please watch." As Paul B was hypnotised, Sonia whispered into Thomas's ear, "Could it not be that the poor man suffered some damage to his brain when he fell off his scaffold? Would that not be a simpler explanation?" "Well, yes, but when they examined the brain of a traumatic hysteric who had died they could see no changes." "Perhaps he just needs a better microscope." "Please, Sonia. Hush." Afterwards, they went to have lunch in a jostling brasserie on the Boulevard de l'Hopital where the waiters carried plates at shoulder height and shouted back their orders to the bar. They found a stall near the misty window and Thomas produced the banknote with which Madame Lafond had paid for his services. They ordered champagne to celebrate the formation of the new partnership. An impatient waiter in a white apron stood drumming his fingers on the edge of the table while they deliberated; when he brought the champagne he poured it clumsily, so their fingers were wet when they raised the glasses. "To what are we drinking?" said Sonia. "Marriage," said Thomas. "Thank you," said Sonia. "And to a month of medical partnership. No creditors, no debtors, and a small profit even after the rent is paid. Jacques?" "To new horizons. To the view we shall have from the shoulders of Charcot." "Yes," said Thomas. "That view. Queenie, did you understand the significance of what he said?" "It was hard enough to understand the words." "Omelette," said the waiter. "The most important part was when he made it clear that emotions and memories can lodge in a part of the mind outside the usual mental processes as it were in a vacuum, a sort of psychic Deauville. Here, they can actually be transformed into bodily symptoms which ' "Herring and potatoes in oil?" "When they are ready, can be expressed as tics, or pains or partial paralysis or ' "And this," interrupted Jacques, 'is the kind of authority we have long been looking for." "Exactly. Charcot's early discoveries more or less invented neurology. He is an authority, yet now also an adventurer." "But how exactly ' "You must understand the principle of the dynamic lesion, which..." Sonia sat back and smiled as Thomas and Jacques waved their knives and forks at one another. What was apparent to her was that Thomas and Jacques were so in love with their master's mind that they had no time for less elevated thoughts. It did not really matter that she herself had not quite followed all Charcot had said; when he had a spare moment, Jacques would take her through the morning's lecture in his role of examining professor. What was important was that he and Thomas fully understood, and felt confident that they could build on what Charcot was suggesting. "You have not forgotten your thesis, have you?" she said, caught by a mundane thought. "No. Thursday week is the last day. My oral test is a month later. I have shown the first half to my director already. He has recommended a new patient to me for a second opinion." "I too have a new patient," said Thomas. "After Madame Lafond's visit, a gentleman called and left his card. The concierge described him as looking like a Middle Eastern prince." While the waiter cleared their plates and laid a cheese board on the table, Thomas found the card in a waistcoat pocket and placed it in front of them. Above an address in the Faubourg St. Honore was the name: Monsieur Nairn Munzar Kalaji. "I have been to visit him," said Thomas. "He is a wealthy merchant and philanthropist from I forget which country. Arabia somewhere. He has a fine collection of art, a Poussin, an Ingres, a landscape by le Lorrain. There is a family with a sick boy and a neurasthenic sister. They are to go on a tour of Europe in the spring. He wants a doctor to accompany them. He will pay for the entire tour and the medical services himself. The father of the family is a painter, and Monsieur Kalaji wants him to be inspired by his travels. I think I let slip to Madame Lafond in our second appointment that I had been on such a tour as a student and she told this Kalaji." "And will you go?" said Sonia. "When I tell you how much money he is offering, I think you will no longer need to ask that question. "Thomas looked about the brasserie full of scruffy students, their textbooks and their stethoscopes bagging out the pockets of their worn coats; he felt suddenly diffident, and scribbled the figure on the back of Kalaji's card. Jacques rolled his eyes. "But it means you will have to leave Paris," said Sonia, 'and we are so happy here." "It is not until the end of March, when the weather begins to be warmer. We have plenty of time together. With this much money, taken with what I have saved from England, with what you have brought, and with whatever we can persuade other investors in Paris to give us, we will have enough to buy a lease on our clinic' Thomas's face shone with confidence, and Sonia shook her head, a little sadly, but with resignation. He had already decided. Paris did not mean as much to him as it did to her, and perhaps that was not unreasonable: he did not lie down each night in a dream of earthly love; he did not pass his days in the reverie of hope regained. "Perhaps you two could move into my room in the rue des Saints Peres," Thomas said. "And leave Madame Maurel?" said Sonia. "Certainly not! I love it there. And Jacques and I must make our contribution while you are amusing yourself in the Mediterranean. We shall sublet your room for a little profit, and Jacques, once his thesis is done, will take on all the fashionable ladies of Paris. Don't look so despondent, my dearest! You can still spend the morning with the old biddies at the Salpetriere and your evenings in the laboratory. Four appointments a day will suffice. Two will cover our costs and the other two will be pure profit, which shall be our contribution." Jacques's face finally gashed open in a reluctant smile. "What one must do for science." Being married was not how Jacques had imagined it would be. He had pictured a house in a village with a pet dog and himself feeling unaccountably dignified as he presided at a dinner table of children and servants. What happened, in fact, was that there was a woman in his room. He was the same man, with the same early start and late bedtime he had had since boyhood, but his dissecting knives were sometimes hidden under pages of a half-written letter to England; there were silk stockings draped over the back of the desk chair at night; there were small ceramic pots and mysterious floral pillboxes on the mantel; on a side table there was a framed photograph of someone's mother, not his: in the bed linen and the chairs and the fabric of the room, Sonia had left a trail of minute prints, like spoors of femininity. It was intoxicating, such physical closeness, it was suffocating, yet he found himself hungry for more of it at night-time in the narrow bed, when he melted into her. He was disappointed that Thomas was to leave Paris after such a short stay, but did not try to dissuade him. They urgently needed money,