Dear listeners,
As I mentioned during this month’s two part feature on Marcel Proust and Céleste Albaret, the ultra-socially-distanced Marcel wasn’t even the most COVID-friendly member of the family! That title has to go to his father, the innovative public health leader, Adrien Proust. (I originally tried to squeeze his story into the podcast episodes, but y’all saw how long the episode was already 💀) Whether you’re getting ready for another lockdown or desperately trying to sign up for a vaccine appointment, Adrien Proust’s work feels….eerily prescient these days.
When Marcel Proust stepped out for a last midnight stroll before fleeing Paris ahead of the German army in World War One, he was taking part in a hyperspecific tradition. Almost exactly forty-four years earlier, another man had faced almost identical circumstances: an invading army on the doorstep, Paris preparing herself for a siege, a city unsure whether to stay and fight or flee for safety. Like Marcel, this young man was at a turning point: after rising steadily through the ranks of his profession, he was on the cusp of a great breakthrough. Like Marcel, he would use the war to come as fodder for his career, and by the war’s conclusion, he would enjoy international fame. But as the Prussians advanced towards Paris on that sunny afternoon, the young man had only one thing on his mind: it was September 3rd, 1870, and Doctor Adrien Proust was getting married.
At the age of 32, Adrien Proust embarked on the adventure of his life. For the past ten years, he’d been a rising star: graduating with honors from the Academie de médecin, before defending his doctoral thesis in 1866. After passing one final exam, Adrien was certified for a teaching post at the Academie de médecin - but a medical catastrophe that summer changed the course of his career.
For the third time that century, a dreaded monster reared its head: cholera. Cholera was a disease of cities, found where too many people cluster together and contaminate the water supply. Originating out of India, the disease made its way to Europe by boat, and as trade between Asia and Europe grew, so did the threat of an outbreak. In 1832, cholera arrived in France and killed 100,000 people. In 1849, it returned and killed three times that many. In 1866, as Dr. Proust began weighing the option of a teaching position or a practice, cholera returned to Paris, deadlier than ever. That year’s outbreak had a fatality rate of 50%. All summer, Dr. Proust worked long hours, caring for patients while maintaining strict personal hygiene standards to keep himself from getting infected. As hard as he tried to save his patients, there was only so much Adrien could do - once infected, patients often died within 72 hours, by which point their family members would usually arrive with symptoms of their own. The only way to beat cholera, he knew, was to prevent it from happening in the first place.
Adrien Proust belonged to a burgeoning discipline we would eventually come to know as epidemiology. Studying under his mentor, Adrien learned about the concept of a cordon sanitaire - a means of keeping infected persons isolated to prevent the spread of disease. While John Snow had famously shut off the Broad Street Pump in London during its 1854 cholera outbreak, the jury was still out about what exactly caused cholera, and it would be another 20 years before a German scientist discovered the guilty bacteria. In the meantime, Doctor Proust experimented in his own clinic, by isolating his cholera patients away from everyone else, to great success. After seeing the results on such a small scale, Proust wondered whether big results could only come from big measures: what if you could apply a cordon sanitaire to a whole country? What if a country with an outbreak could be hemmed in, to prevent outsiders from getting in to contract an infection, and to prevent infected people from getting out? In 1869, Doctor Proust represented France at the International Health Conference in Vienna to propose this audacious idea. “The question of international hygiene,” he proclaimed, “passes and surpasses political frontiers.” But before you could even begin to stop the transmission route of a disease, you’d have to know where, exactly, that transmission route was located. With the blessings of the conference, Doctor Proust set out on a grand international quest: starting in Russia, making his way to Persia, and then from Persia to Mecca, Turkey, Egypt and then finally back to Paris, he would map the voyage of the invisible enemy across the Western world.
Aleksander Orlowski, “Traveler in a kibitka”
The voyage spanned thousands of miles, crossed on ever-changing modes of transport. Leaving Paris in a gleaming luxury train, after crossing into Russia he downgraded to the rudimentary wooden kibitka carriage. From there, he crossed the Caucausus Mountains on horseback, before descending into Persia on the back of a camel. In Tehran, Adrien found himself meeting the shah of Persia, desperate for relief from the cholera epidemics raging through his own empire. In Mecca, Proust watched millions of pilgrims sharing squalid conditions on the road to Hajj. Finally, in Egypt, Doctor Proust walked through the ports, inspecting ships bound for Europe. Retracing the path of every cholera outbreak of the 19th century so far, Doctor Proust had asked himself, “Where was cholera breaking out just before it reached Europe?” Every time, the answer was the same: “Egypt”. As the chokepoint between India and Europe, Egypt, Proust would one day write, “must be considered Europe’s barrier against cholera.” After completing his epic voyage, Doctor Proust returned home on November 28, 1869, accompanied by steamer trunks full of notes. He was the talk of Paris, and everyone wanted to meet this brave, pioneering young doctor to hear of his adventures - including a beautiful young woman from a good family, Jeanne Weil. (Jzhan Vey-uh) In the summer of 1870, Adrien made one last trip to inspect ports of entry around the French coast, but it was no time to be far from home. The Prussians were rattling their sabers, and Adrien had a girl waiting for his return. On September 2nd, 1870, the French army surrended to the Prussians. On September 3rd, Adrien Proust and Jeanne Weil were married. On September 19th, Paris was under siege.
In a single terrible blow, after a year spent traveling thousands of miles across the world, Adrien’s world suddenly shrank to a single city. He found himself subject to an older, crueler form of isolation: the cordon militaire. Cut off from the outside world, Paris was a world apart. With all lines of communication cut except a few brave carrier pigeons and a daring hot air balloonist, Parisians knew they were on their own. Nothing could cross the barrier, not even food. Rationing kicked in at once. The cows disappeared, then the horses, then eventually dogs, cats, rats, and worse. Almost immediately, disease ravaged the capital. Two months into the siege, smallpox deaths tripled, and dysentery deaths quintupled. By the beginning of December 1870, Parisians were dying at triple the normal rate. Almost as terrible as the hunger and disease was the isolation: like Susan Sontag’s “kingdom of the ill” Parisians existed in a different time and space from the rest of the nation. They felt abandoned and forgotten. Paris was a world apart. At that moment, Jeanne came to Adrien with an announcement: she was pregnant.
In the weeks ahead, Paris descended into a hellish winter: in subzero temperatures, Prussians cut the gas lines, firewood ran out, and food was a distant memory. By the end of the month, as discussed in the second episode of this podcast, desperate Parisians broke into the city zoo to eat the animals. Victor Hugo’s Christmas dinner was a slice of roasted elephant. Finally, on January 26th, just before the last of the food was set to run out, the French government in Versailles declared a truce. While starving Parisians fought over rations distributed by the Prussian army, the French government reassembled at Versailles to determine the outcome of the Prussian war. By that point, Parisians were estranged from their countrymen in every way: for four months, they’d held out against the Prussians, refusing to betray their country by giving in to the enemy, paying a terrible cost for their loyalty. But for what? Now, they’d been sold out by the same bungling government which had gotten them into this war, and if the peace treaty wasn’t insulting enough, it couldn’t have been more insensitive to the needs of starving, impoverished Parisians. In one outcry which feels particularly resonant today, the government announced that all landlords were entitled to full back payment on rent, which had been suspended during the siege, at the same time they suspended wages to the National Guard. Little surprise that in March, a violent uprising commenced in the poor districts of Paris, which we now know as the Commune.
Fearing for the safety of his wife and unborn child, Adrien weighed his options. He’d just spent four months enduring the unthinkable in the city he loved. But he couldn’t bring himself to abandon his patients. When Jeanne begged him to stay home rather than travel through the barricades to treat wounded fighters, Adrien refused. In a prescient argument his son would one day echo, Adrien explained that he had a duty to fulfill, and a fear of death was not a good enough reason to abandon his duty. When Jeanne was six months pregnant, an insurgent took fire at Adrien, and the bullet just barely grazed his coat. Jeanne dissolved into fear, and became so overwhelmed with anxiety for Adrien’s safety that the doctor began fearing for her health, and that of their baby. More for their protection than his own, Adrien finally crossed the barrier, passing his family through the city gates to the estate of Jeanne’s uncle, Uncle Louis, in the suburb of Auteuil. In May, Paris burned. In June, the government broke through from the other side. After months of Parisians trying to get out of the capital, the French army was now getting in, killing 17,000 Communards and dumping their bodies in mass graves. A few weeks later, on July 10th, 1871, Jeanne went into labor. Once again, the transition from within to without was not easy. In the first of many such occasions, Marcel Proust was unwilling to enter the wider world. After a long and difficult labor, Marcel nearly died. It took two weeks before Adrien and Jeanne believed he was out of danger. They realized at once that Marcel was a frail child. Between Jeanne’s malnutrition, anxiety, and suffering, Marcel was the victim of a turbulent world before he was even born.
In 1873, the Proust family experienced two major triumphs: the arrival of Marcel’s younger brother, Robert, and the publication of Doctor Proust’s groundbreaking paper: “An Essay on International Hygiene: Its Applications against Plague, Yellow Fever, and Asiatic Cholera”. The so-called essay was really over 400 pages explaining how cholera originated in Asia and traveled its way to Europe, complete with a map. Cholera, Doctor Proust explained, was like an invading army. Constant vigilance at the borders could keep infection out - better yet if you could draw a line around the sick to separate them from the well. Once again he argued for a cordon sanitaire, in which European nations would cooperate to enforce a quarantine for all international ships trying to enter their waters. It’s not hard to see how the siege of Paris could seep into Doctor Proust’s thinking about illness, even if he wasn’t conscious of the fact: by standing united against a common enemy, by barring the gates to the outside world, by inspecting anything that crossed the threshold to the inner sanctum, Europe could stay healthy. To anyone who’s lived through 2020, however, the response will hardly come as a shock. The rest of the world rejected Doctor Proust’s arguments. Not because of any ethical concerns about what it means to seal up an entire community, but because they were worried about the impact it would have on the global economy. Sure enough, cholera reared its head again a decade later. After that epidemic, France finally adopted Adrien’s idea, and the next time cholera showed up in the Middle East, ships began quarantining at French ports before unloading. Years later, based on his recommendations, France would lead the formation of the International Office of Public Hygiene, which you may know better as the World Health Organization. The 1873 essay, and his eventual success at keeping cholera outbreaks out of France, secured Adrien Proust fame and fortune and the Legion of Honor. But for all his international expertise, there was one health puzzle he couldn’t seem to solve: why was his eldest son, Marcel, so very, very ill?
Adrien Proust feeding the pigeons in Venice, ahead of the 1896 International Sanitary Conference.
Well, THAT was more than you were expecting to learn about a 19th century epidemiologist. Maybe next month we’ll just stick with a bunch of YouTube videos….
Bisous,
Diana