Dying at the Salpêtrière:Autopsies and the Afterlife of the Hysteric
"LA MORGUE EST UN SPECTACLE à la portée de toutes les bourses, que se payent gratuitement les passants pauvres ou riches."1 This is how Émile Zola characterizes the Parisian morgue in his 1868 novel Thérèse Raquin. In it, Laurent finds himself a frequent visitor to this institution since, after having killed his lover's husband, Camille, by pushing him into the Seine, Laurent is haunted by the murder. He soon starts visiting the morgue in the hope that the cadaver has been fished out and that seeing his body might bring him some peace by confirming that Camille is definitely dead. If Laurent is able to enter the morgue repeatedly and look at each of its cadavers, it is because the nineteenth-century morgue bears little resemblance to what we now know morgues to be. Whereas today's morgues are closely controlled environments where dead bodies are kept hidden in refrigerated drawers, the Parisian morgue that Laurent anxiously visited in the days following his crime was a public place where one could roam freely. In fact, the presence of the public was necessary and encouraged since, as historian Vanessa Schwartz explains, throughout its history the morgue's main goal was to serve as a depository for the anonymous dead.2 If these spectacular bodies captured the imagination of passersby, other invisible cadavers also left a lasting imprint on the fin-de-siècle imaginaire. In Parisian hospitals, dead bodies were routinely subjected to clinical autopsies, and it is these other bodies' unstated contribution to scientific research as well as their wider nineteenth-century cultural prevalence that I propose to explore in this article.
Historian Bruno Bertherat points out the panoptic quality of the morgue where bodies were lined up behind a glass window, their identification mostly left to viewers.3 In fact, to fulfill this mission the morgue needed to be easily accessible to the public and its cadavers visible. Thus, in contrast to historian Philippe Ariès, who famously argued that death had become invisible in the nineteenth century,4 Schwartz sees in the morgue an example of what she calls a "spectacular 'real life' that chroniclers, visitors and inhabitants alike had come to associate with Parisian Culture" (Schwartz 47). Similarly, Bertherat notes that any forensic purpose was secondary since "On n'y vient pas seulement pour reconnaître un de ses proches; on y vient essentiellement par curiosité" (Bertherat 377). Thus, visiting the dead had become a popular fin-de-siècle attraction. [End Page 123] The visibility of these anonymous dead bodies, some of them in wretched shape, and their physical proximity to an inquisitive public, pose important questions concerning common conceptions of death in the nineteenth century, as well as the hypervisibility of death in the context of the rise of forensic medicine. A memento mori for the fin de siècle, the morgue was the place to satisfy a voyeuristic compulsion to see death and reflects what Schwartz terms the public's abundant "desire to look," which was an important cultural facet of the late nineteenth century (Schwartz 58). If dead bodies in the Morgue betrayed the "public taste for reality" in the fin de siècle, they nonetheless also fulfilled a practical role in that cadavers were used to solve crimes and identify the dead.5 Around the same time, in Parisian hospitals, dead bodies were dissected in the hope of uncovering the body's invisible inner workings, with a view to exposing the material existence of diseases and furthering medical research.
In the autopsy amphitheater
In the field of forensic medicine, the identification of bodies typically precedes the practice of an autopsy performed to establish a cause of death, a practice rooted in the question of visibility. As a surgical procedure, autopsy originated in Antiquity, and its Greek etymology points to its promise 'to see with one's own eyes.' Though commonly practiced since Antiquity, autopsies gained greater visibility in the second half of the nineteenth century as criminal investigations relied increasingly on forensic medicine. Autopsies had the potential to uncover a hidden truth and reveal, in the photographic sense of the word, the story of what happened. But autopsies were not just practiced for forensic purposes. As Rembrandt's 1632 Anatomy Lesson of Doctor Nicolaes Tulp famously shows, autopsies were also historically used for educational and research purposes. In the painting, a group of initiés leans in to observe the dissected arm of a cadaver. These autopsies, just like the forensic ones, promise to reveal the hidden truth of a body and its inner workings. In an era predating body-imagining technologies, the rise of clinical autopsies in the Parisian fin-de-siècle is evidence of the epistemology of the times. Indeed, historian of medicine Roy Porter traces back to Bichat and his Traité des membranes (1799) a shift in the understanding of the human body, where tissues are now seen as the site of lesions. He writes:
Bichat told doctors what to do: "you may take notes for twenty years from morning to night at the bedside of the sick," his Anatomie générale (1801) drily observed, "and all will be to you only a confusion of symptoms… a train of incoherent phenomena." But start cutting bodies open, and hey presto, "this obscurity will soon disappear". Here was the medicine of the all-powerful gaze.6 [End Page 124]
Autopsies offered the unique possibility of seeing the organic lesions believed to be the cause of diseases. Yet autopsies alone were not enough to read the body. Rather, they were a particularly powerful research tool when used in conjunction with detailed clinical notes derived from a careful observation of a patient during her lifetime. Only then could a set of confusing symptoms be matched with an organic cause.
This juxtaposition of clinical notes and autopsy reports is the foundation of the anatomo-clinical method, which connected clinical signs with anatomical lesions, championed in the second half of the nineteenth century by neurologist Jean-Martin Charcot at the Salpêtrière hospital in Paris. There, autopsies emerged as a crucial tool in the researcher's arsenal since they allowed for a diagnosis—albeit postmortem—and for a better understanding and theorization of specific medical conditions. But the anatomo-clinical method was difficult to implement on a large scale: it required a thorough documentation of cases, preferably over an extended period of time, and, eventually, the death of enough patients to corroborate clinical hypotheses. Consequently, the challenge was a practical one: where to find the necessary supply of incurable patients, whose conditions could be documented at length, and whose dead bodies could, in turn, be opened up?
Dying in a city of incurable women
Georges Didi-Huberman famously described the Salpêtrière hospital as "a cita dolorosa confining 4,000 incurable or mad women."7 The Hospice de la Vieillesse-Femmes, established in 1656 by Louis XIV on the site of a former gunpowder factory, was a city within the city, a cour des miracles of hopeless cases that would become the perfect laboratory for Jean-Martin Charcot when he joined the Salpêtrière in 1862. These incurable women became the focus of Charcot's investigations on hysteria, shaping the course of fin-de-siècle medicine. As one of the first diseases identified in Antiquity, hysteria had been known as the disease of the wandering womb, and its dramatic symptoms had been explained by the woman's sexual organs moving about her body. This definition of hysteria based on etymology framed the way the disease was apprehended and discussed for centuries to follow and was still very much in circulation when Charcot started his career at the Salpêtrière.
Hysteria had always been a medical mystery, its symptoms seemingly random and its causes unclear; at a time when diseases were believed to be rooted in organic lesions, the materiality of hysteria remained elusive. Roy Porter explains: [End Page 125]
What killed were underlying lesions—tumours, inflammation, gangrene—so attention had to focus on diseases understood as conditions with laws of their own, afflicting all alike; medicine's job was to establish the patterns of pathology. The new doctor was a detective, using the investigative tool of clinical-pathological correlation to be tirelessly on disease's trail.(Porter 306)
In this way, Charcot emerges as a detective on the hunt for evidence of hysteria's materiality and, because of the unusual size of its population, the Salpêtrière proves to be uniquely suited to allow him to investigate using the anatomo-clinical method. With a population of aging and terminally sick women whose symptoms had been carefully documented, the Salpêtrière could provide the seemingly endless supply of bodies necessary to conduct scientific research. Thus, the bodies of the anonymous sick women of the Salpêtrière were sent to the autopsy amphitheater in the name of scientific progress. Whereas hysteria had rendered the body illegible because of a profusion of apparently random symptoms, autopsies offered an opportunity to read a hysterical body rid of its distracting and spectacular symptoms. Once dead, unruly (mostly female) bodies were turned into docile ones, providing clinicians with an opportunity to explore a hitherto defiant anatomy. But these bodies were not only used to explore hysteria and other neurological conditions. They also helped settle the larger epistemological questions posed by diseases that lacked materiality, or at least whose materiality had remained hitherto undetected.
In contrast to the openness of the Parisian morgue, the Salpêtrière's dead existed behind closed doors, dissimulated in this city within the city. In this tension between the public morgue and the closed-off hospital, the dissimulated dead bodies of the Salpêtrière emerge as an uncanny presence. In fact, as made evident by Laurent's anxiety following his repeated visits to the morgue in Thérèse Raquin, one does not walk away unscathed from seeing death. After having faced the decomposing body of his victim, the image he sees starts haunting him: "Laurent comprit qu'il avait trop regardé Camille à la Morgue. L'image du cadavre s'était gravée profondément en lui, et, maintenant, sa main, sans qu'il en eût conscience, traçait toujours les lignes de ce visage atroce dont le souvenir le suivait partout" (Zola 224). Laurent's haunted state illustrates the powerful cultural imprint left by the proximity with death, which I argue reflects the similarly profound imprint left by clinical autopsies on the fin-de-siècle imagination. The question of the materiality of diseases—the organic existence of lesions—is, I suggest, the hinge on which the medical epistemology of the nineteenth century turns. In the remainder of this article, I propose to explore how autopsies, rooted in both the need to see a hidden reality [End Page 126] and the materiality of bodies, hold the key to this epistemological question. By first analyzing how autopsies were used by Charcot and his disciples, I will replace the practice within the anatomo-clinical method and the fin-de-siècle epistemological framework. Then, a reading of Léon Daudet's 1894 medical satire Les morticoles will illustrate how autopsies can be read as a metonym in the author's wider critique of scientific medicine. As Daudet's literary portrayal of autopsies both derives from and challenges medical science, I argue that this text also symbolically reveals the haunting presence of the Salpêtrière's dead bodies on the fin-de-siècle imagination.
Seeing is believing: autopsies and the anatomo-clinical method
Charcot understood the clinical possibilities offered by the Salpêtrière's patients early in his tenure. In 1875, he explicitly recognizes the hospital's unique potential:
Nous sommes, en d'autres termes, en possession d'une sorte de musée pathologique vivant, dont les ressources sont considérables. À la vérité, les premiers débuts du mal nous échappent souvent; mais, par compensation, il nous est permis de rechercher, par l'ouverture du corps, les lésions correspondant aux symptômes longuement et minutieusement étudiés pendant la vie. Or, qui ne reconnaît aujourd'hui l'influence décisive qu'ont eue sur les progrès de la neuro-pathologie les investigations microscopiques dirigées suivant la méthode anatomo-clinique?8
If the early stages of a condition may not be captured, the possibility of accessing such a large supply of bodies analyzing the autopsies' findings against clinical notes proved particularly promising for scientists. Material lesions served as the invaluable, ultimate evidence. Hysteria, whose cause and site had remained elusive, crystallized all the promises—and the shortcomings—of the anatomo-clinical method. Hysteria was characterized by a long list of spectacular and seemingly random symptoms and a similarly extensive list of potential causes. The causes of hysteria had become "a great etiological ragbag," where anything—including heredity, moral impressions, fears, the marvelous, exaggerated religious practices, earthquakes, pneumonia, the flu, syphilis, masturbation, and venereal excesses—appeared to be a potential trigger (Didi-Huberman 72). Hence, the problem was not the lack of causes for hysteria, but rather the overabundance of causes: everything and anything could potentially cause a hysterical attack. Similarly, virtually any physical symptom could also be attributed to hysteria.
This profusion of spectacular and seemingly random symptoms undoubtedly contributed to hysteria's posterity. Even after the advent of psychoanalysis, [End Page 127] it is Charcot's hysterics whom the Surrealists chose to commemorate in their fiftieth anniversary of hysteria as they saw in the condition a poetic expression that needed to be celebrated. Later, feminist scholarship found in hysteria the somatic language of socially muzzled women. By affirming that, in the late nineteenth century, "hysteria is already discursive," Janet Beizer shows that hysteria functioned as a language even before the advent of the Freudian "talking cure."9 Whereas much has been written about the stories these bodies tell, the traces these spectacular symptoms have left in the hysterics' bodies after their deaths, which is the focus of this article, constitute a missing piece of hysteria's contribution to the history of medical knowledge. Indeed, it was precisely by opening up the body of the hysteric that Charcot affirmed the anatomo-clinical method and attempted to assert the preeminence of material diseases.
The mysteries of hysteria, and the large number of hysterical patients at the Salpêtrière, made it a compelling topic of medical inquiry. In an attempt to identify tangible clues about the disease, Charcot spared no efforts and the anatomo-clinical method emerged as his voie royale. Charcot's method was grounded in the theory of "cerebral localizations," which attributed a particular function to each area of the brain. Charcot presented the method as follows:
Qu'entend-on, en somme, par ce terme: localiser? En anatomie pathologique, localiser c'est: déterminer dans les organes, dans les tissus, le siège, l'étendue, la configuration, les altérations matérielles et palpables; en physiologie pathologique, c'est, mettant à profit les données de l'observation clinique et s'éclairant des données expérimentales, établir le rapport entre les troubles fonctionnels constatés durant la vie et les lésions révélées par l'autopsie.10(Charcot 184)
By repeatedly affirming the necessity to locate "material and palpable changes" physically "in the organs," Charcot confirms his belief in the fundamental materiality of diseases.
Autopsies were conducted early in Charcot's tenure. In 1876, his fervent disciple Bourneville shared an emblematic example of the use of autopsies in his Recherches cliniques et thérapeutiques sur l'épilepsie et l'hystérie: Compte rendu des observations recueillies à la Salpêtrière de 1872 à 1875 (1876).11 The patient Lamb… Marie was admitted to the Salpêtrière in 1872, aged 17, suffering from epilepsy, and died from a coma-inducing convulsive attack in June 1874. Because she had been interned since 1872, her medical history and clinical notes are particularly detailed. Her medical history is typical: it includes an exhaustive account of her family history and abundant details on her childhood attacks (probably provided by a family member). The [End Page 128] autopsy report—especially the examination of her brain—is also very detailed. By contrast, the postmortem examination of her thorax and abdomen is unremarkable, betraying the physicians' pre-existing knowledge of her case and their expectation to find, and consequently look for, cerebral lesions. Thus, postmortem, it is her brain that is first and foremost of interest to doctors. As Bourneville notes:
Chez Lamb…, l'autopsie nous a fait découvrir: 1° des lésions anciennes (atrophie considérable de l'hémisphère cérébral droit, atrophie de l'hémisphère cérébelleux gauche) qui donnent la raison de l'hémiplégie ancienne du côté gauche; 2° des lésions récentes qui, seules peuvent être rattachées à l'état de mal […]. Nous devons dire que dans toutes les autopsies que nous avons pratiquées, nous n'avons pas rencontré de lésions autres que celles qui viennent d'être mentionnées.(Bourneville 13)
In this case, the autopsy reveals old lesions that explain her condition, and more recent ones that relate to the attack that killed her. The autopsy validates the physicians' suspicions by identifying lesions confirming the clinical symptoms documented before her death.
The most famous Salpêtrière publication is undoubtedly the Iconographie photographique de la Salpêtrière, published between 1875 and 1880. Because the first volume is solely composed of photographs, it does not include mention of autopsies.12 It is worth noting, however, that some of the photographs—often of women convulsing, eyes closed, and lying down—are evocative of cadavers. In addition, the volume's last image is a photograph of a dissected brain, illustrating the preeminence of this organ for Charcot's disciples. At the Salpêtrière, access to the brain was paramount. Later volumes present several cases of female neurological patients whose bodies were autopsied. In the 1877 volume of the Iconographie a case of hystero-epilepsy is presented as the textbook illustration of the anatomo-clinical method. Th. L… arrived at the Salpêtrière in 1872, aged 18, and was under observation there for the next five years, until her death by tuberculosis in 1877. As described in the case notes, Th. is "une hystérique ordinaire."13 In addition to a detailed family history and documentation of her symptoms dating back to before her admission, the notes include a comprehensive clinical assessment of her years at the Salpêtrière as well as a description of her hysterical attacks. Finally, the treatment provided for the attacks is also detailed (mechanical ovarian compression is the first line of treatment, but drug-based options are also used). Her death, as the result of a fast-evolving case of tuberculosis, is not connected to her underlying condition. In her case though, the autopsy reveals that the brain is normal and that the only abnormality was located in [End Page 129] her womb, where an additional ovary ("ovaire surnuméraire") was located. At a time when the nature of hysteria was still being debated, this mention serves as a reminder of the difficulty in separating the condition from its etymology. The presentation of this case is also accompanied by a series of photographs that document the different phases of the attack and, as was the case with some of the images in the first volume, they are reminiscent of death bed photographs. Because of the length of her internment, the detailed clinical observations, and her untimely death, this case stands out in the Iconographie corpus as a perfect illustration of the implementation of the anatomo-clinical method. While no conclusion is drawn from the normal condition of the brain, the womb hypothesis appears as an alternative explanation of the condition.
The 1879–1880 volume of the Iconographie showcases another example of hystero-epilepsy that ends in the unexpected death of a patient. The case of M… is not as thoroughly documented as previous cases. The notes do not comprise a patient or a family medical history, or even the patient's age, and only include a record of her attacks and vitals since her arrival in January 1879. Because the case is documented in a chapter dedicated to the sleep of hysterical patients, her sleep is closely monitored as is her dependence upon morphine. When the patient dies in her sleep, her death surprises the physicians in charge of her care:
M… a été gaie hier dans l'après-midi; elle s'est couchée sans offrir rien de particulier; on lui a fait deux injections de morphine et elle a bu son julep de chloral (4 grammes). Pendant la nuit, ni ses voisines, ni la veilleuse n'ont remarqué rien de particulier. Le matin on a trouvé Marcil… morte dans son lit.14
Because of her morphine addiction, it is suggested that she died from "un accident dû à la morphiomanie causé par l'insomnie pour laquelle la malade réclamait un soulagement" (Bourneville and Regnard 1879, 96). The autopsy, conducted by a disciple of Charcot, failed to identify either lesions or a cause of death: "L'examen des différents organes […] n'a fait découvrir aucune lésion. […] Il s'en suit que nous ignorons absolument la cause de la mort" (Bourneville and Regnard 1879, 97). Yet, in spite of the autopsy's shortcomings, the author remarks how interesting the end of the clinical observation—in other words, her death—is: "Nous n'insisterons pas sur les particularités intéressantes de cette fin de l'observation si instructive de Marc… que tant de médecins ont vue dans le service de notre maître" (Bourneville and Regnard 1879, 96). Hence, even when the autopsy is inconclusive, the unexpected death of a patient constitutes a benefit for clinically-minded physicians as it offers yet another exploratory opportunity. [End Page 130]
These three examples of autopsies illustrate not only the high death rate amongst patients, but the fact that autopsies are not a panacea, since they often lead to inconclusive results. This is, repeatedly, the story of hysteria, as autopsies fail to locate consistently the lesions responsible for the disease. Although the method of cerebral localization succeeded in matching regions of the brain with specific functions, it did not allow Charcot to identify the actual site of hysteria. Charcot himself was aware of this challenge and admitted the difficulty in proving the physical existence of some conditions:
En premier lieu, il importe de reconnaître, parce que l'illusion en pareille matière est la pire des choses, que, malgré tous les efforts, il existe encore à l'heure qu'il est un nombre considérable d'états pathologiques ayant évidemment pour siège le système nerveux, qui ne laissent sur le cadavre aucune trace matérielle appréciable, ou ne s'y révèlent tout au plus que par des lésions minimes, sans caractère déterminé, incapables en tous cas de rendre compte des principaux faits du drame morbide. Tels sont, par exemple, le tétanos et la rage. L'antique groupe des névroses, bien qu'il ait été sérieusement entamé sur plusieurs points, est là, toujours présent, à peu près inaccessible à l'anatomo-pathologiste. L'épilepsie vraie, la paralysie agitante, l'hystérie même la plus invétérée, la chorée enfin, s'offrent encore à nous comme autant de sphynx qui défient l'anatomie la plus pénétrante.(Charcot 173)
Hysteria, along with other neurological conditions, was a complex challenge for doctors. Yet Charcot does not doubt that such conditions are rooted in the nervous system and that the elusive material evidence would eventually be found. Hysteria's resistance, and bodies' reluctance to be read and interpreted, thus point to larger epistemological questions relating to the nature of disease at the fin de siècle. In Michel Foucault's investigation of the birth of the clinic in the nineteenth century, the question of materiality emerges as a crucial epistemological stake in the understanding of diseases, and he summarizes some of the contemporary debates with a series of question: "Toutes les maladies ontelles leur corrélatif lésionnel? la possibilité de leur assigner un siège est-elle un principe général de la pathologie, ou ne concerne-t-elle qu'un groupe bien particulier de phénomènes morbides?"15 In other words, is a physiological lesion a condition sine qua none for a disease to be real? What to make of apparent diseases whose lesions cannot be documented? Or can a lesion be invisible?
The elusive hysterical lesion challenged late-nineteenth-century epistemology by suggesting the possibility that there could be a disease without a physiological origin. Consequently, autopsies' ultimate failure to locate lesions shattered deeply held medical assumptions and paved the way for Freud's theory of an immaterial unconscious. As autopsies failed to deliver on their promise to reveal an invisible truth and were perceived as gratuitous morbid experiments, they came under increased scrutiny, including in literature. [End Page 131] Léon Daudet's medical satire Les morticoles represents the practice as the emblematic illustration of what is wrong with fin-de-siècle medicine.
Autopsies in the land of death
As a medical student who had failed the competition for a Paris internship, Léon Daudet was uniquely positioned to write what Toby Gelfand has called "an extraordinarily virulent antimedical novel."16 The son of Alphonse Daudet, he grew even more disillusioned with medicine when Charcot, a close family friend, failed to alleviate his father's pain from a chronic neurological condition. His medical knowledge and his proximity to Charcot himself give Daudet privileged insights to produce a satirical roman-à-clef that portrays the flaws of the Parisian medical system and more broadly of modern medicine. According to Gelfand, "as a working hypothesis, one might expect the intensity of antimedicine to be roughly proportional to that of medicalization" (Gelfand 155). The virulence of Daudet's criticism is therefore a testament to the place and pervasiveness of medicine and positivism in the fin-de-siècle culture.
Gelfand defines antimedical literature as "a genre in which the medical enterprise appears pedantic, mercenary, inept, potentially dangerous, and even lethal for patients as foolish as the doctors they trust" (Gelfand 156). This sense of danger is present in the very title of Daudet's 1894 medical satire. The title, Les morticoles, refers to a fictitious island ruled by physicians, and it can be read etymologically as a place devoted to the cultivation of death since the suffix "cole" derives from the latin colere, to cultivate, as used in terms such as "agricole" or "viticole." Les morticoles might then be understood as a place dedicated to the cultivation of death. There, the blind and senseless devotion to science reveals the absurdity of a science divorced from its humanistic purpose. On the island of Les Morticoles, medicine for medicine's sake is deadly. A satirical novel, Les morticoles is also a travel narrative, telling the story of a young Frenchman, Felix Canelon, who embarks on a ship that veers off course. As is often the case with travel narratives, this text gives Daudet an opportunity to assume the position of an outsider in a strange land, yet the reality he portrays is uncannily familiar for a fin-de-siècle reader. After fifty-six days lost at sea, the land of Les Morticoles is a welcomed sight. But the captain's description of the island, meant to reassure the passengers, foreshadows the problems ahead: "Les Morticoles sont des sortes de maniaques et d'hypocondriaques qui ont donné aux docteurs une absolue prééminence. D'après ce qu'on m'a dit d'eux, leur Faculté de médecine est à la fois un parlement, une diète, et une cour de justice. Les seuls monuments sont des hôpitaux et chacun y suit un régime."17 In spite of the island's ominous [End Page 132] name and the captain's intriguing description, the sailors see in this strange land an opportunity to recover since "nul havre plus sain ne pouvait s'offrir à nos corps délabrés" (Daudet 3). First quarantined, for hygiene is a serious matter on Les Morticoles, the sailors soon witness the social hierarchy at play in this positivist and eugenicist dystopia. When first faced with a group of workers tasked with the most menial tasks, they are told, "Ce sont des incurables. Nous leur donnons les besognes les plus pénibles, ce qui active leur fin et crée des lésions intéressantes" (Daudet 10). Thus, not only is the social hierarchy governed by bodily abilities, but bodies are also used in order to develop the most scientifically "interesting" types of lesions. In other words, medicine is interfering in patients' health, not to cure them, but to induce them to develop pathologies that would yield exciting autopsy findings. The anatomo-clinical method, and more specifically its reliance on usually scarce dead bodies, is at the heart of the criticism.
Les Morticoles is a medicocracy that places scientific research above everything and where individuals are seen as future cadavers on the altar of research. As a local explains to Felix, the individual patient does not matter since "qu'est-ce que ça peut faire qu'un particulier crève, si son observation éclaire un aperçu nouveau […] tu te figures, espèce de sauvage, que la médecine est faite pour guérir. Erreur grave! Sa seule fin est de constater" (Daudet 29). This remark directly echoes the reliance of the Salpêtrière on its anonymous incurables and exposes a practice of medicine that prioritizes the endless and often frivolous quest for knowledge at the expense of the patients themselves. Canelon's adventures through this medical labyrinth document the contemporary medical practices and the resulting abuses suffered by patients. Among all medical practices, autopsies best illustrate the dysfunctions of the hospital. They are first mentioned when Canelon is recovering and after he witnesses the gratuitous experiment conducted on the dead body of Alfred, his teenage neighbor in the ward. Canelon's description is chilling:
J'ai vu cette nuit-là, avant de m'endormir, quelque chose de pire qu'une violation de sépulture. La surveillante venait à peine de fermer les yeux d'Alfred et de faire de son lit un blanc sépulcre de toile, quand l'électricien Cudane entra dans la salle, suivi d'un aide qui portait une énorme machine […]. [I]l venait exécuter quelques expériences.(Daudet 46)
This medical experiment, presented as frivolous and even sadistic, evokes the brutality of practices, believed to be conducted without any respect for the body's dignity.
Still, repeated exposure to this kind of horrors eventually desensitizes Canelon, who no longer reacts to them. Soon after Alfred's death, his other [End Page 133] neighbor in the ward dies, his body autopsied. For Canelon, this event marks an emotional shift as he notices that he is now becoming indifferent to the suffering of his fellow patients:
Le lendemain, en effet, on le rapporta le ventre ouvert, et il mourut sans s'être réveillé du chloroforme. Jeté tout de suite à l'autopsie, il rassasia la curiosité des élèves et du maître. Quant à moi, à partir de ce moment, je ne pris plus garde à mes voisins, qui d'ailleurs se succédaient avec rapidité et passaient de vie à trépas avant que j'aie eu le temps de reconnaître leurs visages. C'étaient des paquets d'agonie entre lesquels je continuai à vivre.(Daudet 62)
After his recovery, his proximity to death reaches its morbid climax when he is appointed to work in the "service des autopsies" under doctor Trouillot, a brutal man who revels in his dealings with death. In his portrayal of this dreadful place, Daudet does not hold back and probably draws from his experience as a medical student. He depicts cadavers with grim realism, describing their "peau flasque et froide, la tête qui se balance au hasard des chocs et des secousses" (Daudet 75). Similarly, his description of the autopsy room itself is rooted in his observations: "au-dessous de quatre tables de marbre, le plancher se creusait de rigoles; sur elles étaient des billots graisseux et une caisse d'instruments rouillés" (Daudet 75). Finally, his portrayal of the medical profession reveals the nonchalant attitudes of doctors accustomed to death he had undoubtedly witnessed as a medical student: "un chef de service entra, suivi de ses élèves qui riaient, plaisantaient, s'envoyaient à cause du froid, d'énormes bourrades dans le dos" (Daudet 75).
Beyond the grim depiction of bodies, Canelon delivers a powerful reflection on the anonymity of the dead. In a medical system devoted to the anatomo-clinical method, the dead have no names. At the Salpêtrière, they sometimes are known by their initials, but they often exist as a nameless case defined only by a list of symptoms:
Aux poignets des bras étiques, où saillaient les cordes des muscles, étaient suspendues des étiquettes par une courte ficelle grasse. Là je lus des noms par lesquels on nommait ces êtres qui marchaient, qui parlaient, qui pensaient comme moi et comme tant d'autres avant et après eux. Cadavres maintenant, ils avaient, accrochés à leurs mains, ces signes qui semblent appartenir à l'individu, le mettre à part des autres, le différencier, ces signes où nous voyons la destinée, qu'on a répétés dans l'amour, dans la haine et dans la terreur, que nos parents nous ont appris, que nous avons tracés sur des feuilles volantes et dans les actes solennels de la vie, qu'on grave sur les tombeaux des riches, ces signes auxquels adhère la poussière de la gloire et qui sont si caducs, si loin de nous, si peu nôtres qu'il faut les attacher avec des ficelles, car on ne les reconnaît plus.(Daudet 73)
It is in this reflection on the bleak afterlives of patients that Daudet is at his most powerful in criticizing the fin de siècle's handling of its dead as anonymous [End Page 134] masses. This graphic depiction of dead bodies whose names no longer matter echoes the masses of unnamed women passing through, and sometimes dying at, the Salpêtrière. In this type of death, individuals are essentially divorced from their identity and the hospital morgue functions as a site of othering.
Autopsies' numbing effects can be shaken up only when Canelon is confronted with the dead body of one of his travel companions: "Quand ils dépeçaient un cadavre, je jetais sans souci pêle-mêle dans le seau ce qui fut jadis la vie, le gâteau blanc du cerveau, la moelle fine et courte comme une vipère. Mais quand, le lendemain, Trouillot m'ordonna de mettre Magaduque sur une table, je sortis pour éviter un malheur" (Daudet 78). This eminently visual evocation of the dissection, of the brain as cake-like, and of the snakelike marrow, highlights Canelon's detached familiarity with the autopsy process and contrasts with his unease with the autopsy of his companion. Thus, the morgue emerges as a place of dehumanization, where bodies have become objects. It is only when these death practices become personal that one is truly confronted with their actual violence. As a Salpêtrière insider, Daudet is one of the few to have witnessed the inner workings of the hospital. His travel narrative offers a criticism of fin-de-siècle medicine and its instrumentalization of death for disputable scientific gain. For Daudet, the fin de siècle is morticole, as it seeks out death under the guise of science.
Autopsies are a mysterious and distressing presence in the fin de siècle. While death itself had become particularly visible—as made evident by the public Parisian morgue—autopsies, though widespread, remained a confidential practice conducted behind closed doors and open to only a select few. The last step in the prized anatomo-clinical method, autopsies allowed for diagnoses to be confirmed and scientific research developed. Yet when they fail to find lesions and thereby prove the material existence of a disease, they weaken the whole theoretical edifice of fin-de-siècle medicine. It is their perception as frivolous and unnecessarily macabre and their place as a metonym for medicine as a whole that prompts Léon Daudet to write an acerbic criticism of a land where doctors are king and bodies cannon fodder. The recent scandal at the Paris-Descartes University Morgue, where bodies donated to science had been kept in undignified conditions, echoes Daudet's dystopian tale. As the families of the deceased plead to be able to honor the donors for their contribution to science and to have them taken out of anonymity,18 we are reminded that the specter of careless autopsies continues to haunt medical research [End Page 135] today, offering us a fresh warning about the practice of a proverbial science without conscience.
1. Emile Zola, Thérèse Raquin (Paris: Librairie Internationale, 1868), 107.
2. Vanessa R. Schwartz, Spectacular Realities: Early Mass Culture in Fin-de-siècle Paris (Oakland: U of California P, 1999), 49.
3. Bruno Bertherat, "Visiter les morts, La Morgue (Paris, XIXe siècle)," Hypothèses, 19 (2016): 377.
4. Philippe Ariès, The Hour of Our Death, Helen Weaver, trans. (London: Knopf, 1981), 611.
5. Vanessa R. Schwartz, "The Morgue and the Musée Grévin: Understanding the Public Taste for Reality in Fin-de-Siècle Paris," in Spectacles of Realism: Gender. Body. Genre, Margaret Cohen and Christopher Prendergast, eds. (Minneapolis: U of Minnesota P, 1995), 289.
6. Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York: Norton, 1997), 307.
7. Georges Didi-Huberman, Invention of Hysteria: Charcot and the Photographic Iconography of the Salpêtrière, Alisa Hartz, trans. (Cambridge: MIT Press, 2003), xi.
8. Jean-Martin Charcot, Œuvres complètes. Leçons sur les maladies du système nerveux. Recueillies et publiées par MM. Babinski, Bernard, Féré, Guinon, Marie et Gilles de la Tourette. tome 3 (Paris: Lecrosnier et Babé, 1890), 4.
9. Janet Beizer, Ventriloquized Bodies: Narratives of Hysteria in Nineteenth-Century France (Ithaca: Cornell U P, 1994), 10. Beizer does not limit her definition of discourse to the spoken or written words. In particular, her research questions dermographism, a spectacular practice documented in the Iconographie Photographique de la Salpêtrière consisting in doctors inscribing words on the bodies of the hysterics, thereby turning the hysterical body into a text to be read and interpreted. Yet, for Beizer these bodies do not speak, they are spoken (26).
10. Jean-Martin Charcot, Leçon sur les localisations dans les maladies du cerveau faites à la faculté de médecine de Paris (1875) (Paris: Delahaye, 1876), 184.
11. Désiré-Magloire Bourneville, Recherches cliniques et thérapeutiques sur l'épilepsie et l'hystérie: Compte rendu des observations recueillies à la Salpêtrière de 1872 à 1875 (Paris: Delahaye, 1876), 2.
12. Désiré-Magloire Bourneville and Paul-Marie-Léon Regnard, Iconographie photographique de la Salpêtrière (Paris: Delahaye, 1875).
13. Bourneville and Regnard, Iconographie photographique de la Salpêtrière (Paris: Delahaye, 1877), 3.
14. Bourneville and Regnard, Iconographie photographique de la Salpêtrière (Paris: Delahaye, 1879–1880), 96.
15. Michel Foucault, Naissance de la clinique (Paris: Presses Universitaires de France, 1963), 178.
16. Toby Gelfand, "Medical Nemesis, Paris, 1894: Léon Daudet's Les morticoles," Bulletin of the History of Medicine, 60 (1986): 157.
17. Léon Daudet, Les morticoles (Paris: Charpentier, 1894), 3.