In chapter one of The Guermantes Way, the third volume of Marcel Proust’s In Search of Lost Time, the narrator stops to consider the corporeal nature of his grandmother’s sickness. “It is illness that makes us recognize that we do not live isolation but are chained to a being from a different realm, worlds apart from us, with no knowledge of us and by whom it is impossible to make ourselves understood: our body.”[1] While it is foreshortening to read this passage as evidence that his multi-volume opus magnum fictionalizes Proust’s own illness – an almost life-long affliction with asthmatic and pulmonary conditions – this passage does indeed encourage us consider the embodied nature of illness and the relationship between the sense of selfhood, the sick body, and the medical objects we engage with in medical treatments. In terms of the sense of selfhood in illness, asthma is of particular interest at the fin de siècle, given that it was held to be a nervous, psychosomatic illness. A consideration of asthma and its treatment in the 19th century can help us to understand the materiality of the medical experience in useful ways.
Asthma and entanglement. Living with medical technologies around 1900
Proust had his first asthmatic attack at the age of nine and his letters and private writings are highly reflective of the corporeal nature of illness and of the material mediation of medical technologies. He writes to his mother in 1900 about: “An attack of asthma of unbelievable violence and tenacity – such is the depressing balance sheet of my night, which it obliged me to spend on my feet in spite of the early hour at which I got up yesterday.”[2] These asthmatic episodes also impacted on his writing in very real ways. Although subsequent literary critics have been keen to draw out a heroic reading of Proust’s suffering by declaring his asthma to have been the precondition of his artistic genius (Walter Benjamin claimed to have felt the breathlessness and laboured breathing of the asthmatic episode in his prose),[3] Proust’s own comments are less optimistic.[4] In a letter to Marcel Boulenger from 1920 he notes a more taxing correlation between his art and his suffering: “I have been gasping for breath so continuously (incessant attacks of asthma for several days) that it is not very easy for me to write.”[5]
Notably, this uncertainty and suffering also extends to the experience of medical treatment. Proust’s father, himself a physician, believed the aetiology of his son’s asthma was psychological and psychosomatic, leading him and the rest of the family to dismiss his symptoms as the neurasthenic imaginations of a hypochondriac. The diagnosis of asthma as a ‘nervous’ illness was not unusual. The publicity-loving English physician Morell Mackenzie, for example, wrote: “Sufferers from hay fever [a contemporary name for asthma] may, however, gather some crumbs of comfort from the fact that the disease is almost exclusively confined to persons of cultivation. As, therefore, summer sneezing goes hand-in-hand with culture, we may, perhaps, infer that the higher we rise in the intellectual scale, the more is the tendency developed.” Proust accepted treatment for his asthma at a sanatorium for mental illness outside Berne at the turn of the century, acknowledging the medical authority of his father. Other forms of treatment were more brutal. Proust repeatedly underwent a process of nasal cauterization in an attempt to reduce the activity of the mucous membranes in his nose. Presumably playing down the actual pain of this experience he would recall “I had such faith that I underwent 110 cauterizations, hardly pleasant.”[6]
Many forms of therapy involved oral and inhaled consumption of substances – from the mundane like coffee and beer to more invasive medical cocktails of barbiturates, opiates, and aspirin. Proust’s stramonium cigarettes and inhalations with asthma powders also suggest a growing awareness towards the end of the 19th century that more focused, localized drug delivery to the lungs was a reliable method of treating asthma. Specialist devices like Potter’s Patent Inhaler Cone would have been used for burning powders while cigarettes, pipes, and similar devices were used for inhaling belladonna/stramonium.
Successful experiments by James Young Simpson in Edinburgh (1830s and 1840s) confirmed the ability to generate pharmacological affects by inhalation; Charles Scudamore performed clinical trials of inhalation in respiratory patients “to show that they are capable of exerting a very important and beneficial influence in certain states of pulmonary and bronchial disease”.[7] Scudamore praises inhalation for not affecting the stomach of respiratory patients in addition to their pulmonary distress, while James Murray had already argued in 1829 that “bathing the lungs” ensured a more focused delivery, “local affections […] which can be directed to and confined upon any point or part affected” is the preferred form of pharmaceutical therapy.[8]
In the same period more specialized and reliable inhalation technologies began to be developed across Europe. The first pressurised inhaler was invented in France by Sales-Girons and was presented at the Medical Academy in Paris in 1858.
Developed from Victor Auphon’s vapour inhalation rooms (which vaporized spa waters by projecting liquid at walls at high velocity) at the spa resort of Euzet-les-Bain, Sales-Giron’s device was hand-pump driven and provided more focused delivery to the throat and nose. Dr Siegle’s inhaler (based on Sales-Giron’s model and developed in Stuttgart, Germany in 1864) offered a transportable, steam-driven vaporizer for convenient use at home.
It was marketed under registered patents in Germany, France and Britain and there was also a handy version for use while travelling
.
The Siegle Inhaler is perhaps most notable as the prototype for Lister’s carbolic spray, the first widespread and effective form antiseptic preparation for surgical treatments.
The success of Lister’s antiseptic sprays were probably a motivating factor behind the prescription of carbolic acid for inhalation by asthmatic patients, and indeed Proust’s foul fogs of medical powders and inhalations of balsam will have been based on these models, with the idea being that pulmonary mucus was a form of infection that could be treated antiseptically.
These devices were widely used in European spa resorts throughout the fin de siècle, and were indeed available for self-medication in cheaper versions that were advertised and marketed for wealthier patients like Proust. They were based around coal tar derivative, the core idea behind Lister’s carbolic antiseptic, which subsequently became popular as vapour inhalants for personal use around the home, with devices like the Vapo-Cresolene marketed in Britain and Europe for use with coal-tar extracts like cresol and balsams like eucalyptus. Other common inhalers around 1900 included versions of Verdin’s Inhalateur à Soufflerie (developed in the 1870s) and the Volatilizer Inhaler (designed ca 1890 for eucalyptus oil and creosote treatments and marketed as antibacteriological).
Inhaling the smoke from stramonium, lobelia and potash, alongside vapour inhalations of balsams and ethers, promised both the most immediate and the most effective relief against asthmatic spasms and bronchial congestion, even if many of the over-the-counter solutions available (such as carbolic acid) are useless by current standards.
In his self-medicating later years, Proust’s entire biorhythm changed as he subjected his body to combinations of barbital, opiates, stramonium, caffeine, beer and many other nostrums and prescription medications alike. Asthmatic episodes reached a duration of 48 hours and upwards and he started having to work through the night, with fits starting at 2.00 am forcing him to have breakfast at 3.00am; later his working day began even earlier in the night, beginning around 10.00pm and working through the night. The frequent abdominal pains that caused further distress were most likely the result of the concoctions of opiate-based asthma powders he consumed. Working his way through multiple remedies, from cigarettes to fumigations, from opium to inhalations, Proust underlines the lack of reliable medical relief for asthma in the period: “Yesterday after I wrote to you I had an asthma attack and incessant running at the nose, which obliged me to walk all doubled up and light anti-asthma cigarettes at every tobacconist’s as I passed, etc. And what’s worse, I haven’t been able to go to bed until midnight, after endless fumigations”.[9] He also mentions various powders, caffeine, epinephrine/adrenaline cures, opium, morphine, spa resorts, and inhalation therapies. And indeed, the ritualised inhalations and treatments on a daily basis reveal a writer fully reliant on his medical therapies, no different, however, to the average asthma patient reliant on basic inhalation technologies such as the Aerhalor, nasal inhalers, cigarettes and other such portable forms of therapy.
What Proust’s illness shows us, then, is that there is a fundamentally material and embodied experience of illness that is also technologically – in the widest sense – mediated. In the experience of illness and its therapy it becomes clear that Proust the patient is entangled in real ways with the pharmaceutical and medical technologies, from drugs to fumigations and inhalations. I use the term entanglement in the sense of Ian Hoddard, for whom “human existence and social life depend on material things that are entangled with them”.[10] While Hoddard is interested in broader ecological and historical matters, tracing “the long term increase in entanglement” (34) on a global and historical scale (which, incidentally, is by no means unproblematic in terms of its reading of global political structures), in terms of medical objects the term seems particularly useful. In the case of medical things and technologies, “depend” is an apt descriptor of human-object interrelations, given that wellness, quality of life, and often even life itself can quite literally depend on material culture. Entanglement impacts on our sense of self, our social identities in meaningful ways, just as it produces them. This shows us that, in Elaine Graham’s words, human nature is already fundamentally “modified (encultured) by technologies, which in turn have become assimilated into ‘nature’ as a functioning component of organic bodies”.[11] “What we name as technology, technical artefact, or animal (and so disavow as non-human) are all essentially ‘part of an interactive stabilisation of the human’”.[12]
Of course this is an experience of medical technologies that is linked with abject suffering, with managing scenarios of corporeal suffering. It expresses a less than comfortable nature of the human-technology interface with and through medical objects and technologies. Indeed, Proust describes the emotional and physical suffering induced by his asthma in rather more harrowing terms: “As soon as I reached Versailles I was seized with a horrifying attack of asthma, so that I didn’t know what to do or where to hide myself.”[13] We need an approach which can account for the material processes constituting our relationship with medical objects in a balanced and more critical manner. An approach which accounts for negative experiences without demonising medical technologies as the tortuous other to a misplaced sense of ‘whole’, monadological selfhood, which critically considers these technologies in relation to our embodied and technologically mediated sense of selfhood without fetishizing a concept of our intellectual selves.
The Pharmacology of (Medical) Objects
The work of Bernard Stiegler offers us such a model which is “pharmacological” in its traditional sense.[14] The pharmakon, as that substance or object which is both poison and cure, simultaneously, is at the heart of object relations theory that conceptualizes the relations between humans and technologies. The meaning of pharmacology here is “not limited to chemico-therapies but actually concerns all techniques”[15] such as, for example, “psychotechnologies constituting the media infrastructure”.[16] Following Ian Hodder’s understanding of “entanglement” there is a “dependence and dependency” between man and (medical) technology that is “positive and negative”, forming and constraining (Hodder 20, 28-30). The usefulness of Stiegler’s object relations theory is that his “pharmacological” model enables us to draw out both the positive and negative potentials and relations of medical objects with human patients.
The pharmacological explanation of our relations to objects and the technological environment is based on a paradox which is developed in the writings of Donald Winnicot, and in particular his concept of the “transitional object”.[18] At an early stage of development, children become attached to certain objects – blankets, soft toys, soothers etc. – which allow the child to move from the space of parental care and unconditional love to the sphere of social relations, where we must negotiate our relations ourselves without feeling abandoned. Emerging from the unconditional and constant care and attention of the mother, the transitional object occupies an attachment that offers security and safety at precisely the moment in childhood development at which the biological distance from the mother is noted. Drawing on Winnicot, Stiegler argues that the transitional object is not the absolute other to the subject, somewhere beyond or outside a pre-existing personality, it is in fact a central component in the process of subject formation: human consciousness is a co-product of its technological environment and indeed depends upon it. By extension, this would suggest for our contexts that we need to account for the relationship between the human and medical objects not as one of categorical difference, but as co-constitutive and co-relational.
Alongside Gilbert Simondon and N. Katherine Hayles, Stiegler argues that our interrelatedness with objects predates our own technological and media age. Hayles describes this formative moment in her book How We Think as “technogenesis” arguing that human cognition, personality, subjectivity, and social identity are always already integrated into our material environments and have indeed co-evolved with them.[19] In Technics and Time Stiegler argues how the development of tools by pre-Homo sapiens hominids was not the sign of increased cognitive powers (as their brains were still underdeveloped), but rather an enabler of increased intellectual ability.[20] Steven Pinker likewise argued that there is a link between the human nervous system and the growing capacity to use language and to fabricate more complex tools.[21] But Stiegler develops the pharmacological model of object relations because of an inherent danger of pharmacological toxicity in this framework whereby this co-relationship with technology potentially becomes one of complete reliance on the technological object. The introduction of a ‘gap’ between us and technology opens up the potential for bondage and complete dependency – the monstrous machine, the uncanny object over there threatening and debasing humans in a techno-dystopia, the technological or the pharmaceutical management of the sovereign individual.
According to Stiegler’s analysis then, medical objects would not be other to our bodies and our selves. They, like other technologies, can “shape, regulate and define our bodies, they are constitutive of our very humanness and the capacity for knowing that humanness”.[22] Selfhood, identity, and consciousness of the human do not precede medical objects, rather the “human invents himself in the technical by inventing the tool”, “the interior and the exterior are the same thing […] since man (the interior) is essentially defined by the tool (the exterior).”[23] Or perhaps we should also say that in the medical encounter the human re-invents herself/himself. The interaction with medical therapies and technologies changes the sense of selfhood itself, just as Winnicot’s and Stiegler’s “transitional object” shows that personality and consciousness are co-evolutionary with technological systems.
Asthma and writing: Proust and inhalation
For Walter Benjamin, and many literary critics since, Proust’s authorship is fundamentally entangled within his experiences of illness and therapeutics: “This asthma entered his art”. Benjamin meant this stylistically too: “Proust’s syntax rhythmically and step by step reproduces the fear of suffocating.” (323) Thrown back into the limits of his unwell body, Benjamin suggests, Proust’s writing becomes co-dependent on this experience of illness and therapy. Although Benjamin remains broadly metaphorical here, Proust’s private correspondences and writings do indeed reveal an interesting co-dependency on inhalation and pharmaceutical cures and his sense of selfhood as a patient. While he smoked medicated cigarettes for his asthma on those occasions where he did leave home, he preferred to use powders commercially marketed powders and fumigations marketed by Espic, Legras or Escouflaire: “This is the only thing that has ever given me any relief”, he explained to Céleste: “I once tried the cigarettes made with this same Legras powder, but I am sure the paper they use, though thin and carefully prepared, disagrees with me. I prefer just the fumes.”[24]
Although these therapies and technologies seemed to have helped little in the long run, with the cocktails of relaxants and sleeping remedies being counteracted by adrenaline and caffeine, for example, there is a sense in which Proust grounded his authorial identity and productivity through the management of his illness and his therapeutic measures. He retreated into a room lined with cork in the hope that it would regulate bronchial spasms which he thought to be allergenic reactions to dust, pollen, and other air-borne stimulants. He developed a fully-fledged inhalation ‘ritual’ which began as soon as he woke up, lasting for hours at a time and involving high dosages of stramonium and opiates. This began as soon as he woke up and they took place in the corridor linking his bedroom with his bathroom; his housekeeper Céleste records that the sessions could last anywhere up to seven hours and she was occasionally asked to buy new boxes. For each inhalation a new box was opened because Proust feared that the powders could become dusty if opened and hence aggravate his perceived dust allergy.[25]
Proust’s self-dosing will frequently have produced intoxicating effects, and he favoured the most concentrated solution of stramonium, Legras powders. It is little wonder that the first flights of involuntary memory in In Search of Lost Time, the physiological, almost chemical memories of Aunt Léonie, the madeleine, and the decoction of lime-blossom in Swann’s Way, are marked in pharmaceutical, embodied terms:
one day in winter, on my return home, my mother, seeing that I was cold, offered me some tea, a thing I did not ordinarily take. And as soon as I had recognised the taste of the piece of madeleine soaked in her decoction of lime-blossom which my aunt [Léonie] used to give me (although I did not yet know and must long postpone the discovery of why this memory made me so happy) immediately the old grey house upon the street, where her room was, rose up,…and with the house, the town. (Swann’s Way, 54)
But this experience is linked with Léonie’s medical past, this being the concoction she consumed when holding court in bed while ill. As Bragg and Sayers put it, “The key to childhood memories, the medicine for the ailing memory, has been the taste of a sick-room treat, that is, somatic experience under the aegis of ill health.”[26] Aunt Léonie’s sick-bed decoction is associated with a sense of expansion, with a blossoming of memory, and hence with an imaginative project that ultimately drives the narrator’s memorializing writing project. This unlocking of a sense of selfhood is tellingly described in pharmaceutical terms: “a charming prodigality on the part of the chemist [pharmacien]”.[27] It is almost as though the mind becomes a laboratory of imaginative flights at this stage, retracing the origins of the dried blossoms from the tea-bag to the pharmacy, from the pharmacy to the trees and their smells on the roads (ibid). As Nicola Luckhurst has discussed the real-life curative analogy for the lime-blossom is most likely to have been Proust’s experiences with stramonium.[28] In Guermantes Way, Proust’s narrator discusses the effects of stramonium in some detail in a digression on sleep, dream, and memory (91-95) that recall the physiological memory of the madeleine. It is a sleep-inducing drug, like “Indian hemp […] multiple extracts of ether […] of opium of valerian” and it induces dreams which “grow like unknown flowers whose petals remain closed until the day when the predestined stranger comes to open them with a touch and to liberate for long hours the aroma of their peculiar dreams for the delectation of an amazed and spellbound being” (92). The senses of selfhood, imagination, and remembrance merge here in a fictionalized treatise on the workings of the mind that are pharmacological in nature.
It is a chemical, or rather pharmaceutical, model of the mind that Marcel the narrator develops here: both are based in the first instance on the kind of botanical cures and drugs that may have been found in collections of Household Medicine and Herbals, but with the step to ether and opium we are clearly in the realm of pharmaceutical preparations. These are, of course, the kind of preparations which Marcel the writer was reliant upon in his cork-encased room in the Boulevard Hausmann. According to Céleste’s accounts, Proust is likely to have consumed up to twenty-five-times the regular dose through inhalations. The effects of this concentration of stramonium will have included sensory hallucination, disorientation, euphoria, abnormal heart-rates, dizziness, lack of co-ordination, and ultimately sleepiness.[29] Reading Proust’s novel in this manner thus enables us to develop an actual pharmaceutical understanding of Stiegler’s pharmacology of medical things, then.
Proust’s asthma and his experience of medical therapies for the illness show us how “subject and object, mind and matter, human and thing co-constitute each other” (Hodder 19). We can see in his letters that this produces a sense of self that is fundamentally linked into the medical treatments he underwent. In short, the example of Proust’s asthma treatments show us how patients are tied up in a network of technologies that co-create a sense of embodied selfhood. In the fictional works, Proust goes further, suggesting the production of an experience of memory, imagination, and selfhood which is mediated through medical devices and cures. This is less a question of the reader being able to feel the author’s own struggle for breath in his syntax, however, and more a result of Proust developing a self-reflexive poetics of memory which is anchored firmly in the embodied experience of asthma therapies around 1900. This is a fictional pharmacology of medical objects and therapies that reveals how “humans and things are relationally produced” (Hoddard 19) in the medical techniques and structures experienced by their author.
[1] Marcel Proust, In Search of Lost Time: The Guermantes Way. New York, London: Random House, 2003 404,
[2] Marcel Proust. Letters to his Mother ed. and transl. By G. Painter. New York: Greenwood Press, 1973, 121.
[3] Walter Benjamin, “Zum Bilde Prousts”, in Walter Benjamin Gesammelte Schriften ed. R. Tiedemann and H. Schweppenhäuser. Frankfurt am Main: Suhrkamp, 1991, here Vol. II, 310-323.
[4] See most recently J. Bogoussiavsky, “Marcel Proust’s diseases and Doctors: the neurological story of a life.” In: Neurological diseases in famous artists ed. J. Bougousslavsky J, M Hemmerici. Basel, Karger 2007.
[5] Letters of Marcel Proust, ed. Mina Curtis. London: Vintage, 1966, 342.
[6] Cited in William C. Carter, Marcel Proust: A Life. New Haven, Yale: Yale UP, 2003, 34.
[7] Charles Scudamore, Cases illustrative of the efficacy of various medicines administered by inhalation, in pulmonary consumption; London: Longman, 1830, 2.
[8] James S. Murray, A Dissertation on the Influence of Heat and Humidity: With Practical Observations on the Inhalation of Iodine, and Various Vapours, in Consumption, Catarrh, Croup, Asthma, and Other Diseases. London: Longman, 1829, 157.
[9] Marcel Proust. Letters to his Mother ed. and transl. By G. Painter. New York: Greenwood Press, 1973, 124.
[10] Ian Hoddard, “The Entanglements of Humans and Things: A Long-Term View”. In: New Literary History 45 (2014), 19-36, here 19.
[11] Elaine L. Graham, Representations of the Post/human: Monsters, Aliens, and Others in Popular Culture (Manchester: MUP, 2002), 10.
[12] John Seltin, “Production of the Posthuman: Political Economies of Bodies and Technology”. In: Parrhesia 8 (2009), 43-59, here 48. Quote in quote: Adrian McKenzie, Transductions: Bodies and Machines at Speed. London, New York: Continuum, 2002, 43.
[13] Marcel Proust. Letters to his Mother ed. and transl. By G. Painter. New York: Greenwood Press, 1973, 123.
[14] Bernard Stiegler, What Makes Life Worth Living. On Pharmacology. London: Polity, 2013.
[15] Bernard Stiegler, Taking care of youth and the generations. Palo Alto: Standford UP, 98-99.
[16] Bernard Stiegler, For a new critique of political economy. London: Polity, 2010, 101.
[17] Hodder, “The Entanglements”, 20 and 28-30.
[18] D. W. Winnicot, Playing and Reality. London: Routledge, 1990, 2-4.
[19] N. Katherine Hayles, How we think. Digital media and contemporary technogenesis. Chicago: UP, 2012.
[20] Bernard Stiegler, Technics and Time 1. The Fault of Epimethius. Stanford: UP, 1998, 56-8.
[21] Steven Pinker, The Language Instinct. New York: W. Morrow and Co., 1994.
[22] John Seltin, “Production of the Posthuman”, 49.
[23] Bernard Stiegler, Technics and Time 1. The Fault of Epimethius. Stanford: UP, 1998, 142.
[24] Céleste Albaret, Monsieur Proust, ed. Georges Belmont, London, Collins and Harvill Press, 1976, 62-63.
[25] F. B. Michel, Proust et les écrivains devant la mort. Paris: Grasset & Fasquelle, 1995, 54-60.
[26] Lois Bragg, William Sayers, “Proust’s Prescription. Illness as the Pre-Condition for Writing”. In: Medicine and Literature 19:2 (2000), 165-181, here 170.
[27] Marcel Proust, In Search of Lost Time: Swann‘s Way. New York, London: Random House, 2005, 60
[28] Nicola Luckhurst, Science and Structure ,in Proust’s A la recherche du temps perdu. Oxford: Clarendon, 2000, 219-220.
[29] F. B. Michel, Proust et les écrivains devant la mort. Paris: Grasset & Fasquelle, 1995, 54-60.
Digital Dispensary 