A sardonic smile played around the third doctor’s lips, Doctor Maugredie, a distinguished intellect but a sceptical Pyrrhonian* who believed only in the surgeon’s knife, and agreed with Brisset that a man who was in excellent health could nevertheless die, and acknowledged, with Cameristus, that a man might well go on living after his death. He found some good in all theories, adopted none of them, claimed that the best way to treat medical theories was not to have any, but to trust in facts. This Panurge* of the School of Medicine, master of observation, great explorer, great sceptic, champion of desperate initiatives, examined the shagreen.
‘I should very much like to witness the correlation between your wishes and it shrinking,’ he said to the Marquis.
‘What good would that do?’ cried Brisset.
‘What good would that do?’ echoed Cameristus.
‘Ah, so you agree,’ said Maugredie.
‘This contraction is very simple,’ added Brisset.
‘It is supernatural,’ said Cameristus.
‘Indeed,’ said Maugredie, affecting a serious air and handing back to Raphael his shagreen. ‘The shrivelling of the skin is an unexplained and yet natural process, and since the creation of the world has been the despair of medicine and pretty women.’
As he observed the faces of the three doctors, Valentin could see they did not really care about his sufferings. All three, silent at each reply he gave, met his gaze with indifference and questioned him without any real concern. One could discern this lack of sympathy through their polite remarks. Either because they were certain of their opinion or because they were thinking hard, their words were few, and so sporadic that occasionally Raphael thought their minds must be on something else. Every so often Brisset alone would remark: ‘Good, fine!’ on hearing of all the worrying symptoms that Bianchon said he had. Cameristus remained deep in a profound reverie, Maugredie resembled a writer of comedy studying two originals with a view to representing them accurately on the stage. In Horace’s face there was deep anguish, a sympathy full of sadness. He had not been a doctor long enough to be insensitive to pain or to be impassive at the bedside of a dying man. He could not suppress the compassionate tears that blur a man’s vision and prevent him from seizing, like an army general, the moment propitious for victory, without listening to the cries of those about to die. After they had been there for about half an hour, taking, so to speak, the measure of the illness and the sick man, as a tailor takes the measure of a young man’s wedding suit, they uttered some platitudes, talked politics even; then they proposed they should go into Raphael’s study to exchange ideas and reach a verdict.
‘Gentlemen,’ said Valentin, ‘may I not then be present at the discussion?’
When he said that, Brisset and Maugredie objected strongly, and in spite of the patient’s entreaties, refused to discuss him in his presence. Raphael submitted to the usual practice, thinking that he could slip into a corridor from where he could easily hear the medical deliberations which the three professors were about to embark upon.
‘Gentlemen,’ said Brisset, as they went in, ‘allow me to give my opinion without delay. I do not wish to impose it upon you, nor to have it disputed: first, because it is clear, precise, and results from an exact similarity between one of my patients and the subject of our examination. And I am expected back at my clinic. The seriousness of the circumstances that require my presence there will justify my being the first to speak. The subject who occupies our attention is also exhausted by intellectual effort … What is it that he has written, Horace?’ he asked, addressing the young doctor.
‘A Theory of the Will.’
‘Heavens, that’s a vast subject. He is fatigued, I would say, by too much thinking, by departures from a regular diet, by the repeated use of over-powerful stimulants. The violent action on the body and the brain has impaired the functioning of the whole organism. It is easy, gentlemen, to recognize in the symptoms of face and body a prodigious irritation of the stomach, the neurosis of the sympathetic nerve, the hypersensitivity of the epigastrium, and the tightening of the hypochondriacal area. You will have remarked the size and the protuberance of the liver. Finally, Monsieur Bianchon has continually monitored the digestion of his patient and has said it is difficult and laboured. To tell the truth, there is no stomach left. The man has disappeared. The intellect has atrophied because the man can no longer digest anything. The progressive deterioration of the epigastrium, the centre of the life-force, has vitiated the whole system. Hence the continual, very evident irradiations; disorder has invaded the brain via the nervous plexus, hence the excessive irritation of that organ. There is monomania. The patient is oppressed by a fixed idea. For him this wild ass’s skin really does shrink, but perhaps it has always been exactly as we have seen it; but whether it contracts or not, this “shagreen” is for him like the fly that some important vizier or other could not brush off his nose. Apply leeches to the epigastrium without delay, calm the irritation of this organ in which the whole man resides, keep the patient on a diet, the monomania will cease. I need say no more to Dr Bianchon; that will be enough for him to understand the whole problem and the details of the treatment. Perhaps there are complications, perhaps the respiratory passages are also irritated. But I believe the treatment of the intestinal organs is much more important, more necessary, and more urgent than that of the lungs. The concentrated study of abstract ideas, and certain violent passions, have produced grave perturbations in this vital mechanism. However, there is still time to repair the springs, nothing is irreparably damaged. So you can easily save your friend,’ he said to Bianchon.
‘Our learned colleague is confusing the effect with the cause,’ replied Cameristus. ‘Yes, the damage he has so acutely observed in the patient has taken place, but I say that the stomach has not gradually sent the radiations into the organism and the brain, like cracks radiating out from a hole in a pane of glass. A blow was necessary to make a hole in the window. Who gave it that blow? Do we know? Have we observed the patient sufficiently? Are we familiar with all the accidents in his life? Gentlemen, the vital principle, Van Helmont’s archaea, is affected in him, the life-force has been attacked in its very being; the divine spark, the transitory intelligence which serves to coordinate the organism and which produces will, the science of life, has ceased to regulate the daily workings of the mechanism and the functions of each organ. Hence the disorders so acutely appreciated by my learned colleague. This movement did not travel from the epigastrium to the brain but from the brain to the epigastrium. No,’ he said, beating himself hard on the chest, ‘no, I am not a walking stomach! Not everything is lodged there. I cannot find it in me to state that if I have a good epigastrium the rest is in order. We cannot’, he went on calmly, ‘attribute to a single physical cause and subject to a uniform treatment the grave disorders that occur in different people to a more or less serious extent. No one man is like another. We all have organs that are particular to us, differently affected, differently nourished, for fulfilling our peculiar and different functions, and for developing the themes necessary to accomplish an order of things unknown to us. Our portion of the great whole which functions according to a higher Will maintains in us the phenomenon of animation, formulated in a distinct way in each human being, and makes of him an apparently finite person, but linked, at a certain point, to an infinite cause. So we have to study each person separately, examine him carefully, recognize what his life consists in and what is the driving force behind it.
‘From the softness of a damp sponge to the hardness of a pumice stone there are infinite gradations. That is man. Between the spongy organisms of lymphatics and the iron strength of the muscles of some who are destined for a long life, how many errors would not be committed by applying only one rigid theory, trying to cure someone by crushing and prostrating the human forces that you suppose must always be in a state of irritation! So in this case I would suggest a psychological treatment, an in-depth examination of the inner person. Let
us seek the cause of illness in the entrails of the soul and not in those of the body! A doctor is an inspired being, endowed with a particular genius, to whom God grants the power to understand the life of the body, just as He gives the prophet eyes to contemplate the future, the poet the faculty to evoke nature, the musician the ability to arrange sounds in a harmonious order whose model is perhaps in the heavens …!’
‘Always this absolutist, monarchic, and religious medicine,’ muttered Brisset.
‘Gentlemen,’ said Maugredie promptly, so covering up Brisset’s comment, ‘let us not lose sight of our patient …’
‘So that’s the state of science at the moment!’ exclaimed Raphael sadly. ‘My recovery lies somewhere in between a rosary and a string of leeches, between Dupuytren’s scalpel and the prayers of the Prince of Hohenlohe!* Maugredie hovers in doubt on the borderline between facts and words, between mind and matter. Those who say yes, those who say no, it’s always the same! It’s still Rabelais’s Carymary, Carymara.* I am mentally ill, carymary! Or physically ill, carymara! Shall I live? They don’t know. At least Planchette was more honest when he said, ‘I do not know’.
At that moment Valentin heard Dr Maugredie’s voice.
‘All right then, so the patient is monomaniacal,’ he cried, ‘but he has two hundred thousand francs a year. That kind of monomaniac is very scarce and we owe him at least an opinion. As for knowing whether his epigastrium has reacted on the brain or vice versa, we could perhaps verify the fact when he is dead. Let us sum up then: he is ill, there’s no denying that. He needs some kind of treatment. Let’s leave doctrines aside. Let’s put leeches on him to calm the intestinal irritation and the neuroses, which we all agree he has, and then let us send him to take the waters. We will act simultaneously according to the two systems. If it is the lungs we can scarcely save him anyway, so …’
Raphael speedily left the corridor and came back to sit in his armchair. Soon the four doctors emerged from his study. Horace was spokesman:
‘These gentlemen have unanimously recognized the need for an immediate application of leeches to the stomach, and an urgent treatment both physical and psychological. First a dietary regime, to calm the irritation in your body.’
Here Brisset nodded assent.
‘Secondly, a hygienic regime to regulate your mental state. So we unanimously recommend you go and take the waters of Aix in the Savoie, or those of the Mont-Dore in the Auvergne, if you prefer. The air and the locations in the Savoie are pleasanter than in the Cantal,* but you must follow your inclinations.’
At that point Dr Cameristus allowed himself a nod.
‘These gentlemen,’ Bianchon continued, ‘having found a slight deterioration in the respiratory tract, are in agreement about the correctness of my previous prescriptions. They think you will make a good recovery provided you follow these different regimes carefully … and …’
‘And that’s why your daughter is dumb,’* said Raphael, with a laugh, drawing Horace into his study to pay him for this useless consultation.
‘They have acted logically,’ answered the young doctor. ‘Cameristus feels, Brisset examines, Maugredie doubts. Does man not possess a soul, a body, and a mind? One of these three primary causes is more or less strongly active in all of us and there will always be a human element in the human sciences. Believe me, Raphael, we do not cure you, we help you to get better. Between the medicine of Brisset and that practised by Cameristus there is another: the medicine of hope; but to practise this with success you have to have known your patient for ten years. Deep down in medicine there is a negative force, as in all sciences. So attempt to live wisely. You might try a visit to the Savoie; the best thing is, and always will be, to put your trust in nature.’
* * *
A month later, returning from a walk one beautiful summer evening, a few people, who had come to take the waters in Aix, gathered in the club rooms. Sitting by a window with his back to the others, Raphael remained alone for some while, deep in one of these involuntary dreamy states during which our thoughts bubble to the surface, give rise to others, fade away without taking any precise shape, and pass through our minds like airy, faintly coloured clouds. Sadness then is sweet, joy is hazy, and the soul is near to sleep. Allowing himself to drift into this world of the senses, Valentin basked in the warmth of the evening, savouring the pure, sweet-scented mountain air, happy to not feel any pain and to have finally reduced his menacing ass’s skin to silence. Just as the red hues of the setting sun were fading on the mountain-tops it became chilly, and he left his seat and pushed the window shut.
‘Monsieur,’ said an elderly lady, ‘would you be so good as to leave the window open? We cannot breathe in here.’
This phrase jarred on Raphael’s eardrums with a singular sharpness; it was like the word imprudently uttered by a man whose friendship we had wanted to believe in, and which destroys some sweet illusion of sympathy by revealing untold depths of egotism. The Marquis threw the elderly lady the cold look of an impassive diplomat, summoned a footman, and told him curtly: ‘Open that window!’
At these words, an unwonted surprise broke out on everyone’s face. Those gathered there began to whisper, looking at the sick man with a variety of expressions, as though he had committed some unpardonable offence. Raphael, who had not entirely rid himself of his first youthful shyness, felt momentarily ashamed. But he shook himself out of his torpor, summoned all his energy, and tried to come to terms with this strange scene. Suddenly a flash of understanding went through his brain, the past appeared to him in a clear vision where the reasons for the feeling he had inspired stood out in relief, like the network of veins of a corpse whose tiniest ramifications can be coloured by a clever injection of chemicals. He recognized himself in this fleeting image, followed his own life day by day, thought by thought. He saw himself, not without surprise, as a gloomy, distraught figure among these cheerful people, always thinking about his fate, preoccupied with his illness, seeming to scorn the inconsequential chat, shunning the ephemeral intimacies which are established straight away between travellers, no doubt because they believe they will never meet again; not caring about others, and, like a rock, indifferent to the lapping of the waters or the fury of the breakers.
And then, in a rare privilege of intuition, he could read everybody’s mind. When he caught sight of the yellow cranium, the sardonic profile of an old man by the beam of a light on the wall, he remembered winning money from him without giving him a chance to take his revenge. Further off he caught sight of a pretty woman whose flirtatious overtures had left him cold. Each face was a living reproach to him for one of those wrongs which are apparently inexplicable, but the reason for which always lies in the invisible wound made to someone’s self-esteem. He had involuntarily wounded all the petty vanities that surrounded him. The guests at his parties or those to whom he had lent his horses had resented his obvious power and influence. Surprised by their ingratitude, he had spared them further humiliations of that sort: from then on they felt he despised them, and accused him of arrogance. Peering into their hearts in this manner he managed to decipher their most secret thoughts: he had a horror of society, its false politeness, its veneer. Wealthy, and of superior intelligence, he was both envied and hated. His silence thwarted the curious, his modesty seemed like snobbishness to these petty, superficial people. He guessed what unspoken, unforgivable crime he had committed in their eyes; he was beyond the judgement of their mediocrity. Indisposed to accept their inquisitorial despotism, he was able to do without them. They had all instinctively banded together to show their power and avenge this clandestine sovereignty on his part, ostracize him, and teach him that they, in their turn, could do without him.
At first moved to pity by this view of the world, after a moment he shivered at the thought of the subtle power he wielded, that could in this way lift the veil of flesh beneath which man’s real nature lies buried. He closed his eyes as though not to see any more … at once a dark curtain w
as drawn over this sinister fantasmagoria of truth, and he found himself in the terrible isolation which comes with power and dominion. At that moment he had a violent fit of coughing. Far from hearing a single one of those doubtless empty phrases, which at least pretend a kind of polite sympathy in people of a certain class who have been thrown together by chance, he picked up the hostile remarks and complaints they were muttering under their breath. Society no longer even deigned to put on a polite show for him, perhaps because they realized he understood it was only a show.
‘His illness is contagious.’
‘The Chairman ought to forbid him entry into the salon.’
‘Coughing like that ought not to be allowed.’
‘When a man is as poorly as that he should not come to take the waters.’
‘I’ll be forced to leave this place.’
Raphael got up to escape the general disapproval and wandered round the rooms. He wanted to find some friendly face, and came back towards a young woman who was by herself, and considered addressing some compliments to her. But at his approach she turned her back on him and pretended to be watching the dancers. Raphael was afraid he might already have made use of his talisman that evening; he did not feel the will or the courage to start a conversation, so left the salon and took refuge in the billiard-room. There no one spoke to him, greeted him, nor gave him the least kindly glance. His naturally meditative nature revealed to him in a sudden intuition the universal and rational cause of the aversion he had aroused.