“I can find out.”
“Do you think I’m ridiculous?”
“Of course not. Of course I don’t think you’re ridiculous. I think”—he bent forward, speaking gently—“we have faith that life means something, and the attempt to resolve it, to seek it out, this is what keeps us going. And that’s the same for things in the past, if they are important to us.”
“Well, that is very rational. Here, this is the list. Nausea, migraine, headaches. Intercostal neuralgia, cramp, tinglings, prickings … rheumatism, pains in the forehead, the gums, the back of the neck, the throat … occasionally in arms, chest, loins, stomach, knees, feet, ankles … upon examination genital parts all tender.” Jeannette made a little shocked motion of her eyebrows—she had been reading without processing, he saw, and perhaps had not intended to read that part aloud.
“This is a long list,” he said. He had learned from his grandmother to skip over shameful things. At the same time he was playing a doctor, with a doctor’s dispassionate attitude to matters of the body. He could not help admiring himself.
“And this,” Jeannette continued, “this one is a list of symptoms she seems to have written herself, in her own handwriting. I’ll read it to you—she says: ‘The walls of my father’s house were totally transformed. I was woken up by the sensation of weight on my leg, my bed being beside the window, the man had stepped onto it. I screamed and quickly he climbed back out again. It took a while to settle as my sleeping mind woke fully, and when it did, I saw the walls had vanished. Or rather, they had become simply walls, plaster and wood and brick, just a structure with no inside or outside. Inside and outside were an illusion.’ That’s that one, and here, another, she says: ‘There is little keeping me alive. When I am well I cannot be from too high a height or I will make myself fall on purpose.’ Let me know if there’s any word you don’t understand, by the way.”
“What does that mean, do you think? I understood it, I mean, but generally, what is she saying.”
“What she means … I don’t know if it’s something we can necessarily …” She left off.
Midhat loved that we. “It sounds,” he said, “as though she was in pain all the time, most of the time. Physical pain. Even when she was healthy. Don’t you think?”
She turned over the page and read from the bottom. “Listen: ‘I feel sometimes as though my head were being stirred with a stick, and at other times as though my head were being alternately opened and closed. Nausea, almost daily. Sometimes it feels like motion sickness, as if I were going somewhere. Often it is in the nose again, and I have the old dreams.’”
“She is mad.”
Jeannette gave him an irked expression.
“I’m sorry, I didn’t mean that. It seems, I think, that being alive is to stay inside the body.” He could hear, returning into his voice, that note of glib certainty. He tried a more tentative intonation. “This is one way to look at it. And if the body is a place of pain, then that makes it difficult to stay there. So, I suppose, your mother wanted to leave.”
Jeannette nodded. She reached across the gap to touch his arm, and inhaled as though to speak. Then she pulled back, and rubbed her hands.
“I will let you alone, of course. You are studying.”
“You don’t need to,” said Midhat. “I want to help, I told you so.”
“I know you did,” she said, rising. “I don’t know why I’m fixed on this, I shouldn’t be. You must think I’m … I don’t know. I’ll see you later then, I suppose.”
On one of his visits to the university hospital, Midhat had taken part in the observation of a patient suffering from a stomach ailment. The patient was a teenage boy whose abdomen was distended and painful, resulting in some vomiting and loss of appetite.
The boy’s ears were pointed and pale. The four students stood against the wall by the door while Docteur Brion spoke to him. Seated on the bed, shoes off, dressed in a hospital gown, he looked past the doctor at them lined up with their notepads, wearing black robes; his eyes were wide, chin loose, thin legs bent open from the hip and trousers hanging, while Docteur Brion spoke to him in a bright voice. Brion examined the boy’s tongue and the four students hovered behind. The tongue looked angry and raw. His bloated stomach was sensitive to pressure. Brion instructed the boy to push his head forward for the soft-rubber stomach tube, and to open his mouth while he, Brion, directed the tube down the throat. He asked the boy to swallow.
“This attempt at swallowing will first cause the pharyngeal muscles to grasp the tube … and then as they relax it may be pushed downwards until the stomach is reached—in the average individual a distance of about sixteen inches from the line of the teeth.”
The boy’s eyes widened further. He gagged, and his bent knees convulsed.
“Good, well done. Now, the attempts at retching will usually cause the contents of the stomach to come up through the tube. And … here they come.”
A trickle as the liquid came up through the tube and poured out the other end into a glass receptacle. It was thin and yellowish, with mealy grey lumps and a few strands of bile.
“If the contents do not come up at once,” said Brion, pulling the tube up out of the boy’s gullet while the boy rasped, “the patient should be told to strain as if making an effort to pass stool. Or, alternatively”—he reached for a rubber bulb the same red as the tube—“one may aspirate the stomach contents by attaching this to the extremity of the tube, compressing it and gradually, very important that it be gradual, allowing it to expand.”
He slowly compressed and expanded the rubber bulb. The boy’s mouth hung open. A globe of spittle dangled from his lower lip.
What they discovered when they strained and examined the liquid was a low level of hydrochloric acid and a great deal of mucus. Brion’s diagnosis was chronic gastritis. Such a diagnosis always required further tests for lactic acid and the Boas-Oppler bacillus, which were symptoms of cancer. Accordingly, Brion reached for a bottle of Gram’s solution from a shelf, and using a pipette added some of the filtered contents to a small container of the solution. The solution turned bright blue: the Boas-Oppler bacillus was present.
The boy stared over at Midhat and his colleagues while all this was going on, until the solution turned its shocking colour. Docteur Brion trembled uncharacteristically—perhaps he had not expected the test to come up positive, perhaps he would otherwise have chosen to conduct the test in private—and for a moment seemed not to know to whom he should pronounce the diagnosis. They could all see the evidence, however, and although the boy might not know precisely the rule that the Boas-Oppler bacillus stains blue with Gram’s solution, it seemed somehow so obviously a sign of alarm, the solution now the rich hue of a low sky gathering at the meridian.
“Carcinoma of the stomach,” said Brion. “You’ll have to see the surgeon this afternoon.”
For the first time, the boy spoke. “But I have to get back to work.” His voice was unexpectedly high-pitched.
The boy stayed in Midhat’s mind for days afterwards, and on his next visit to the hospital he sought out Docteur Brion to ask after the status of the carcinoma. Distracted then by a new flood of soldiers arriving wounded from the front, Brion looked confused and said he could not remember, waving Midhat out of the way as he pushed the swing doors of the next ward.
It was the look of fear on the boy’s face that weighed most heavily on him. That was the fear of discovery. The boy had glimpsed the malevolence within his own stomach, a thing living there inside him.
After Jeannette left, Midhat ran through his physics notes in a fever, and without time for lunch set off at a sprint for the afternoon class. There were only five other students in the classroom and they all sat in the first row of desks. Midhat raised his hand to ask the professor if they could go over Coulomb’s law of charged bodies, and was relieved to see that he was not the only one writing down the formula. In the corridor afterwards, he caught sight of his biology professor, and running up
behind him asked if they could briefly go over the chromosome theory of inheritance. “But there is not much to go over,” said the professor. “You understand the theory, do you? Simply, that chromosomes carry genetic material. That’s all there’ll be in the exam. What is it you don’t understand?” Midhat hesitated, and then expressed his gratitude, yes, at last he understood. He turned around and crossed the courtyard to the library. It was almost half past two. I feel sometimes as though my head were being stirred with a stick, he thought, as he heaved against the massive door.
Samuel Cogolati was the only other person in the library. He sat at a table on the far side and did not look up from his book. From this distance, Cogolati’s hairless, waxy complexion resembled a child’s. Midhat approached the medical dictionaries and pulled down the latest edition of Larousse. He sat in a chair and turned to “N.”
Page 746 showed an illustration of a wheeled machine captioned “Nettoyage par le vide.” On the opposite page was the definition he wanted:
Neurasthenia: – (Syn: Nervous exhaustion, nervousness, neuropathy, cerebro-cardiac neuropathy, hyperaesthesia general, general neuralgia.)
SYMPTOMS. Neurasthenia may be manifested in two very different ways. Sometimes the neurasthenic has a healthy appearance, a fresh complexion, and a confident air. And on the contrary he is sometimes a depressed individual; emaciated, pale, holding his head down, answering with difficulty even the simplest of questions. These two varieties of patients generally complain of the same ills: headaches occupying the top of the head, limited at the neck or various parts of the skull, increased by sounds, smells, and intellectual fatigue, and decreasing after meals.
This fitted with the stick-stirring, in any case.
Insomnia is frequent and painful. The patient feels the need to sleep after dinner but soon wakes up, failing to fall asleep again until morning; and so he rises already tired, since during the interval he has been persecuted—
A page of photographs intervened illustrating “Nettoyage par le vide.” A man stood in a street beside a vast black machine labelled: VACUUM CLEANER; the same man then knelt indoors, pressing the end of a tube into the floor; then two women in aprons raked the ground with various metal prongs.
—by a kind of jittering of thought and many distressing sensations, so that even when he seemed to rest he was assailed by nightmares.
Dizziness sometimes occurs: an empty feeling in the brain, flies before the eyes, staggering without falling.
A finger down the other symptoms: Digestive disorders … Respiratory and circulatory disorders … Disorders of the genito-urinary tract, one of the causes of the disease … Ringing, observed in the ear … Extreme sensitivity to hot or cold, causing pain …
The constant study of his health to which the neurasthenic applies himself causes him to perceive a thousand sensations, unnoticed by everyone else, which he interprets and exaggerates.
The treatments included a diet without crustaceans, with the addition of raw egg yolks and broth.
“Bonjour, Monsieur Midhat.”
Cogolati stood above him, holding a book with a finger between the pages.
“Ah, Samuel. How are you?”
“What are you reading, the dictionary?”
“I am, yes. I am researching neurasthenia.”
“Interesting. May I sit? What have you found.”
Midhat’s stomach rumbled. He coughed.
“Oh, not much,” he said. “The only unifying trait seems to be strange physical sensations. Apart from that, it seems you diagnose a patient as a neurasthenic if you can judge them to be a hypochondriac. Isn’t that strange? They are ill if they are not ill. There is no specific ailment, nothing physical or neurological, just this subjective, doctorly reading of the patient herself. Or himself.”
“Yes. That is vague. Perhaps this is what Rivaut means when he says we are part of a developing science!” Cogolati tipped his head back with silent laughter.
Midhat was already elsewhere. His mind was seeking out its well-worn channels and now streaming back by the gravity of habit to that shamed idea of his: the idea of invisible causes, that there might be other, hidden sources of Ariane Molineu’s pain. He thought of Jeannette’s resistance to the idea of madness. He thought of the babies in the jars, labelled and locked.
“We should look in the Psychiatry section.” Cogolati set down his own book and marked his place with a slip of paper.
Midhat was glad of the company. Together he and Cogolati examined the titles on spines, consulted contents pages, and set books in piles, mapping recurring terms. Midhat found no mention of “hystero-neurasthenia” anywhere but he seized on “hysteria” and other terms that appeared alongside it.
“What is the nature of the research?” asked Cogolati.
“I was just reading about neurasthenia in a … novel.”
“Aha! The best kind of research, led by the imagination. I admire that.”
Briquet’s “Treatise on Hysteria” contained 430 case studies. Almost all concerned young women, frequently lower class. A few mentions of aberrant sexual activity.
“Ho ho, listen,” said Cogolati. He elbowed aside a discarded volume on the table to rest open the one he was reading. “This writer says: ‘It certainly happens that neuroses above the belt are far more clearly understood than those below.’ How amusing. How awfully unhelpful.”
The rumble in Midhat’s stomach was sharpening into hunger. The clock said three; breakfast had been more than seven hours ago. In a recent issue of L’Encéphale he found an article entitled “Les Cénestopathies,” and he read through the six case histories at manic speed. The article argued that the cause of lesionless pain was disordered bodily sensation. Incorrect inhabitation of the body, Midhat wrote in his notebook, a little shakily.
The sun faded through the windows. Cogolati yawned.
“This has been instructive, but I am not quite sure what we have learned. That definitions are often in conflict? Or that the mind and the body should remain different spheres. You know, I have a friend you should talk to, majoring in psychiatry. At the moment he is working with traumatised soldiers. Would that be helpful?”
“Wait, listen. This is in,” Midhat shut the cover to see the jacket, “La Conscience Morbide, Blondel. ‘Morbid consciousness is a kind of cenesthetic instability,’ he says … ‘a rebel to logic’ … ‘a refractory in our conceptual regime, and different in kind from normal consciousness.’”
“Yes, it’s … I mean, I don’t know. I’ll have to go, Kamal. But this has been fun—we should—anyway I’ll see you in Botany tomorrow. Good luck. I look forward to hearing your conclusions.”
“Thank you,” said Midhat. “It has been wonderful having you here.”
“I am so glad the library is your home,” said Cogolati with a wink. “Until soon.”
The library door gonged shut, and echoed up the stacks. Midhat’s hunger was fading, as during a fast. He returned to the thread he had just dropped.
Perhaps Madame Molineu had not been normal. Perhaps she was “morbid.” But really, what did that prove in the end? It seemed worse to him than blaming an evil spirit. At least people would try to expel a spirit, and the victim was not isolated, they did not disbelieve her, nor diagnose her because they thought she did not have the symptoms she claimed. How could one tell if a symptom was not there, if it was not the kind of symptom that could be seen?
La France Intellectuelle, with her granite monuments engraved with birth dates and death dates and graduation dates, was a place of such unerring certainty that Midhat felt he was often gazing up her plinths in awe. Even in wartime the French argued from their lecterns, formulated between four walls; while in Nablus—in Nablus they reached for the supernatural when they were helpless, whether with prayers to God or the charms of a sheikh to protect them from the evil eye. Nabulsis spent their lives close to their graves, at nature’s mercy, and sought antidotes to the world’s pain in the vapours of ritual. Here in Europe the tra
ins always ran on time, the streets were paved perpendicular, one did not feel the earth—and yet it seemed now to Midhat that these structures were also illusory. They gave only the appearance of rightness. For at times and in certain lights you could see it was a baseless fabric, which could be lifted. And one could reach a hand beneath, and beyond it feel the thin air.
His hunger had disappeared. Four hours in the library and he had no new information for Jeannette, except that the doctors had failed to help her mother, but that much had already been clear. Here he was, exploring the same diagnoses the doctor had given. It was these that must be discarded in the first place. He returned the books to the reshelving trolley and stepped out into the courtyard. The streets were quiet but for the distant singing of the stretcher-bearers, and his feet clacked in the cool.
He turned a corner and the moon revealed itself suddenly, huge and white behind a flowered branch, an interloper before the sun had even gone. He stopped, and tried to consider outright what might have happened to Ariane Molineu in her lifetime. What interferences might have been made. What damning course of action. What—or who—in her life might have proved a cause.
9
Sylvain Leclair lived on his vineyard on the left bank of the Hérault, and spent his days between the trellises or in his vaults monitoring the barrels. At the same time, he was a figure about town, a feature at most major gatherings and many minor ones, in a way that had little to do with his profession. Possibly, it had more to do with his connection to Paris: his maiden aunts lived in the Fifteenth Arrondissement and he visited them several times a month, and was apparently popular at salons in the neighbourhood. But Sylvain never masqueraded as a cosmopolite, nor falsified his southern vowel sounds, or the nasal accent that rounded off most end-stopped words with that inconclusive syllable “uh.” On the contrary, Sylvain Leclair was unashamedly parochial, and always disgruntled, aggressive, self-righteous, and somehow this was his ticket to all classes and parties, in which he was famed and praised for his bad temper.
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