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Dr Robert Proust: a gynaecologist's contribution to world literature
European Journal of Obstetrics & Gynecology and Reproductive Biology 170 (2013) 47–49
Contents lists available at SciVerse ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb
Medical history
Dr Robert Proust: a gynaecologist’s contribution to world literature Caroline de Costa * James Cook University School of Medicine, Cairns Campus, PO Box 902, Cairns, QLD 4870, Australia
A R T I C L E I N F O
A B S T R A C T
Article history: Received 12 February 2013 Accepted 4 June 2013
Dr Robert Proust, though overshadowed in history by his more famous brother, the novelist Marcel Proust, was an eminent and innovative French surgeon who achieved recognition largely as a gynaecologist, but also was an accomplished urologist and general surgeon. He was the author of a textbook, The surgery of the female genital tract, that was very successful in his lifetime and ran to six editions. He was always very supportive of his brother’s writing, and after Marcel’s premature death Robert edited and arranged for publication of the final three volumes of his novel A` la recherche du temps perdu, which has been called the greatest novel of the twentieth century. ß 2013 Published by Elsevier Ireland Ltd.
Keywords: History of gynaecology Proust Robert Proust Marcel
Contents Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
Ethical approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
This year sees the centenary of the publication of the first volume of what has been called ‘‘the greatest novel of the twentieth century’’ – Marcel Proust’s seven part work A` la recherche du temps perdu [1,2]. Over the past hundred years, Proust’s masterpiece has produced immense discussion on such topics as whether the work is really a novel; the true identities of the many members of Parisian society on whom Proust based his fictional characters, including many medical practitioners; the impact of Proust’s illnesses (principally asthma and various neuroses) on his writing; the role of doctors in his fiction; and the implications of his own homosexuality on his depictions of homo- and heterosexual love [2–6]. Interestingly, considering the subsequent enormous success of the work (it won the Prix Goncourt in 1919, and has never been out of print since then in French, English and many other languages), that first volume had to be published at Marcel Proust’s own expense, by Grasset, after his manuscript had been turned down by several other publishers. In that same year, however, another Paris publishing house, Masson, was eagerly seeking the third edition of a book written by Marcel’s brother. This was The surgery of the
* Tel.: +61 7 4226 6830; fax: +61 7 4226 6831. E-mail address: [email protected] 0301-2115/$ – see front matter ß 2013 Published by Elsevier Ireland Ltd. http://dx.doi.org/10.1016/j.ejogrb.2013.06.008
female genital tract, by Dr Robert Proust, and it would later run to six editions, the final one appearing in 1927 [7]. Robert Proust was also to play a major role in editing and arranging the publication of the last three volumes of Marcel’s novel, following his death in 1922. Robert, overshadowed in history by his brother, was nevertheless an important figure in French medicine, his contribution recognised by the award of the Le´gion d’Honneur [2]. Born two years after Marcel, in 1873, the brothers always remained on affectionate terms. Their father, Dr Adrien Proust, was a physician with a strong interest in public health, who did much to eliminate cholera from Europe (by establishing a cordon sanitaire of countries like Egypt where the disease could be kept at bay); their mother, Jeanne Weil, was a ‘‘beautiful and intelligent’’ Jewish woman fifteen years younger than her husband [2,4,5]. When Robert was seven, he witnessed Marcel’s first attack of the asthma that was to plague his life [5]. Chronic illness, and what he referred to as ‘‘my kind of intelligence’’, led Marcel to be very attached to his mother, living in the family home until her death. He was not, he believed, understood by his father, who nevertheless ‘‘blindly indulged’’ him as a result. Robert, on the other hand, was clearly seen by his father as someone who resembled himself in character, and who carried on the medical tradition of the family [2].
48
C. de Costa / European Journal of Obstetrics & Gynecology and Reproductive Biology 170 (2013) 47–49
Both boys were educated at the Lyce´e Condorcet; Robert then entered the Faculty of Medicine in Paris and proved an outstanding student [2]. In 1894 he became an intern with the noted urologist Felix Guyon, who supervised the doctoral work that resulted in the production of Robert’s thesis in 1900, entitled ‘‘De la prostatectomie pe´rine´ale totale’’, an operation he would later do much to promote (and which his colleagues dubbed the ‘‘proustatectomie’’) [8]. Robert was a careful and caring medical practitioner, as well as showing particular aptitude for surgery. In the manner of his times, he was interested in all aspects of surgery, including the developing discipline of gynaecology. In 1903 he became assistant at the Broca Hospital to Professor Samuel Pozzi, the brilliant and cultivated surgeon known as the ‘‘father’’ of French gynaecology, who in 1901 was appointed to the first Chair of Gynaecology in Paris [9,10]. Gynaecology thus became the main area of Robert’s practice. Pozzi was a lifelong friend of Robert’s parents, and also of Marcel, who later described his first dinner ‘‘in town’’ as being at the Pozzi home. Pozzi, Marcel and Robert were all ardent Dreyfusards, supporters of the French Army captain unjustly accused of treason, whose case so polarised French society at the end of the 19th century. Pozzi moved in the upper echelons of Parisian society, where he ran a private medical practice. He also established the first gynaecological service in Paris for public patients, at the Broca, in wards decorated by his friend, the painter Georges Clairin, Pozzi declaring that ‘‘I treat my patients with Beauty.’’ Pozzi was the author of the magnificent Treatise in Gynaecology, first published in 1890, that gathered together everything then known in Europe and America about the diseases of women, and their treatment: he also published many articles on a variety of surgical topics [11]. Robert spent ten years at the Broca in Pozzi’s service, but he was also prominent as a urologist, published on surgery for pulmonary tuberculosis, and presented a paper in 1914 describing one of the first ‘‘open-heart’’ operations, in which he removed a bullet from the pericardial cavity of a child, who recovered completely [4,9,10]. He went on several occasions to the Mayo Clinic and Johns Hopkins at Pozzi’s behest to study American practice and incorporate its benefits into that of the Broca. From 1932 until his death in 1935 he was himself director at the Broca [9,10]. The first edition of The surgery of the female genital tract appeared in 1904 [7]. In the abundantly illustrated text, Robert, although he also refers to many other French and European gynaecological surgeons, often describes Pozzi’s practice, including his technique of vaginal hysterectomy, and his comments on abdominal hysterectomy as being the better route if the surgeon wishes to inspect the adnexae and make a decision about their removal: both Pozzi and Robert Proust advocated the conservation of the ovaries wherever possible. Much attention is given to the need for an absolutely aseptic surgical technique, and careful antiseptic preparation of the abdomen and vagina prior to surgery. The second edition appeared in 1908. By 1913, with the third, the book was enlarged with longer descriptions of the radical hysterectomy of Wertheim, modified by Parisian surgeons, for cervical or endometrial cancer, and frequent mention of the work of Howard Kelly and the surgeons of the Mayo clinic. Meanwhile, not far from the Broca, Marie Curie and her team were working on the physics and chemistry of radioactivity, and its potential applications in medicine. Robert was fascinated by this work, and Madame Curie was an enormous admirer of his ability to absorb both mathematico-physical and medical knowledge. He pioneered the use of radiotherapy for cancer of the cervix, and in the fifth edition of his book adds a section on ‘‘curiethe´rapie’’ [7]. He recommended the use of radium pre-operatively, and understood that radium alone could on occasion be curative. Radium application could be by the vaginal route, tubes of radium being
inserted through the cervix, or by the abdominal route, where via laparotomy, lymph nodes were identified and tubes of radium placed beside them. Rubber tubing securing these was sutured into the lower end of the abdominal incision, to enable removal of the radium after 3–4 days; external beam radiotherapy had yet to be developed [7]. In 1971 the centre for radiotherapy at Paris’s Hoˆpital Tenon was named the Pavillon Proust, on Marcel’s hundredth birthday, to honour the Proust medical family. Robert became a military surgeon at the start of World War I and served throughout the war, often close to the front. He developed the ‘‘auto-chir’’, a type of mobile operating theatre that could be carried to and used close to the site of battles. His proximity to the battlefields caused great anxiety to Marcel [2]. During Marcel’s lifetime Robert was always a strong supporter and admirer of his brother’s writing, as testified by the copy of the 1913 Grasset edition that Marcel gave him inscribed ‘‘Souvenir of lost time, refound for a moment each time that we are together.’’ Although Marcel, obsessed with his health, consulted many doctors other than his brother, Robert was always there for him, particularly during the events leading up to his premature death from a pulmonary abscess [2,5]. After Marcel’s death, Robert carefully oversaw the editing and publishing of the final three parts of the four thousand-page work that is A` la recherche. The seventh volume was particularly challenging, as only notes and fragments of text existed at the time of Marcel’s death. Robert’s efforts have not been without controversy: after the death of his only child, Suzy Mante-Proust, in 1986, her son-in-law discovered among her papers a manuscript of the sixth volume that had been corrected and annotated by Marcel himself but never published; it was duly published in France in 1987. Biographers and scholars of Marcel have searched in vain for any trace of Robert in Marcel’s characters [2,6]. One eminent biographer, however, describes the ‘‘mangled admiration and contempt with which Proust treats the medical profession’’, which probably arose partly from his divergent feelings towards his father and partly from his affection for his brother [2]. Another writer feels that ‘‘. . .in Proust the reader is inclined to see the medically reflected suffering of the knowledgeable, sick son and brother of a doctor shining through in each individual character’’ [4]. Certainly his experience of life in a medical household contributed vastly to Marcel’s views of his social environment and his depiction of his world. Undoubtedly much more remembrance will be refound over the next few years as various Proustian anniversaries are celebrated. While honouring Marcel, let us also spare a few moments for the achievements of his younger brother. Conflict of interest None. Funding None. Ethical approval Not required. References [1] Proust M. A` la recherche du temps perdu. Paris: Grasset and Gallimard; 1913– 1927. [2] Painter GD. Marcel Proust: a biography, vol i and ii. London: Chatto and Windus; 1965.
C. de Costa / European Journal of Obstetrics & Gynecology and Reproductive Biology 170 (2013) 47–49 [3] Ortoli S. Une machine a` explorer le temps. Editorial, Philosophie Magazine hors-se´rie; December 2012. 5. [4] Speck R. Robert Proust – an eminent doctor in the shadow of his famous brother Marcel. World J Urol 2001;19:285–91. [5] Straus B. The Maladies of Marcel Proust. New York: Holmes and Meier; 1980 . [6] Pearn J, Gardner-Thorpe C. A biographical note on Marcel Proust’s Professor Cottard. J Med Biogr 2003;11:103–6.
49
[7] Proust R. La chirurgie de l’appareil ge´nital de la femme. 1st ed. Paris: Masson; 1904, 1908 (2nd ed.), 1913 (3rd ed.), 1922 (5th ed.), 1927 (6th ed.). [8] La prostatectomie. Paris: C. Naud; 1904. [9] Vanderpooten C. Samuel Pozzi – chirurgien et ami des femmes. Paris: Fine Editions; 1992. [10] de Costa C, Miller F. Sarah Bernhardt’s ‘Doctor God: Jean-Samuel Pozzi (1846– 1918). Aust NZ J Obstet Gynaecol 2007;47:352–6. [11] Pozzi S. Traite´ de gyne´cologie. Paris: Masson; 1890.
Contents lists available at SciVerse ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb
Medical history
Dr Robert Proust: a gynaecologist’s contribution to world literature Caroline de Costa * James Cook University School of Medicine, Cairns Campus, PO Box 902, Cairns, QLD 4870, Australia
A R T I C L E I N F O
A B S T R A C T
Article history: Received 12 February 2013 Accepted 4 June 2013
Dr Robert Proust, though overshadowed in history by his more famous brother, the novelist Marcel Proust, was an eminent and innovative French surgeon who achieved recognition largely as a gynaecologist, but also was an accomplished urologist and general surgeon. He was the author of a textbook, The surgery of the female genital tract, that was very successful in his lifetime and ran to six editions. He was always very supportive of his brother’s writing, and after Marcel’s premature death Robert edited and arranged for publication of the final three volumes of his novel A` la recherche du temps perdu, which has been called the greatest novel of the twentieth century. ß 2013 Published by Elsevier Ireland Ltd.
Keywords: History of gynaecology Proust Robert Proust Marcel
Contents Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
Ethical approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
This year sees the centenary of the publication of the first volume of what has been called ‘‘the greatest novel of the twentieth century’’ – Marcel Proust’s seven part work A` la recherche du temps perdu [1,2]. Over the past hundred years, Proust’s masterpiece has produced immense discussion on such topics as whether the work is really a novel; the true identities of the many members of Parisian society on whom Proust based his fictional characters, including many medical practitioners; the impact of Proust’s illnesses (principally asthma and various neuroses) on his writing; the role of doctors in his fiction; and the implications of his own homosexuality on his depictions of homo- and heterosexual love [2–6]. Interestingly, considering the subsequent enormous success of the work (it won the Prix Goncourt in 1919, and has never been out of print since then in French, English and many other languages), that first volume had to be published at Marcel Proust’s own expense, by Grasset, after his manuscript had been turned down by several other publishers. In that same year, however, another Paris publishing house, Masson, was eagerly seeking the third edition of a book written by Marcel’s brother. This was The surgery of the
* Tel.: +61 7 4226 6830; fax: +61 7 4226 6831. E-mail address: [email protected] 0301-2115/$ – see front matter ß 2013 Published by Elsevier Ireland Ltd. http://dx.doi.org/10.1016/j.ejogrb.2013.06.008
female genital tract, by Dr Robert Proust, and it would later run to six editions, the final one appearing in 1927 [7]. Robert Proust was also to play a major role in editing and arranging the publication of the last three volumes of Marcel’s novel, following his death in 1922. Robert, overshadowed in history by his brother, was nevertheless an important figure in French medicine, his contribution recognised by the award of the Le´gion d’Honneur [2]. Born two years after Marcel, in 1873, the brothers always remained on affectionate terms. Their father, Dr Adrien Proust, was a physician with a strong interest in public health, who did much to eliminate cholera from Europe (by establishing a cordon sanitaire of countries like Egypt where the disease could be kept at bay); their mother, Jeanne Weil, was a ‘‘beautiful and intelligent’’ Jewish woman fifteen years younger than her husband [2,4,5]. When Robert was seven, he witnessed Marcel’s first attack of the asthma that was to plague his life [5]. Chronic illness, and what he referred to as ‘‘my kind of intelligence’’, led Marcel to be very attached to his mother, living in the family home until her death. He was not, he believed, understood by his father, who nevertheless ‘‘blindly indulged’’ him as a result. Robert, on the other hand, was clearly seen by his father as someone who resembled himself in character, and who carried on the medical tradition of the family [2].
48
C. de Costa / European Journal of Obstetrics & Gynecology and Reproductive Biology 170 (2013) 47–49
Both boys were educated at the Lyce´e Condorcet; Robert then entered the Faculty of Medicine in Paris and proved an outstanding student [2]. In 1894 he became an intern with the noted urologist Felix Guyon, who supervised the doctoral work that resulted in the production of Robert’s thesis in 1900, entitled ‘‘De la prostatectomie pe´rine´ale totale’’, an operation he would later do much to promote (and which his colleagues dubbed the ‘‘proustatectomie’’) [8]. Robert was a careful and caring medical practitioner, as well as showing particular aptitude for surgery. In the manner of his times, he was interested in all aspects of surgery, including the developing discipline of gynaecology. In 1903 he became assistant at the Broca Hospital to Professor Samuel Pozzi, the brilliant and cultivated surgeon known as the ‘‘father’’ of French gynaecology, who in 1901 was appointed to the first Chair of Gynaecology in Paris [9,10]. Gynaecology thus became the main area of Robert’s practice. Pozzi was a lifelong friend of Robert’s parents, and also of Marcel, who later described his first dinner ‘‘in town’’ as being at the Pozzi home. Pozzi, Marcel and Robert were all ardent Dreyfusards, supporters of the French Army captain unjustly accused of treason, whose case so polarised French society at the end of the 19th century. Pozzi moved in the upper echelons of Parisian society, where he ran a private medical practice. He also established the first gynaecological service in Paris for public patients, at the Broca, in wards decorated by his friend, the painter Georges Clairin, Pozzi declaring that ‘‘I treat my patients with Beauty.’’ Pozzi was the author of the magnificent Treatise in Gynaecology, first published in 1890, that gathered together everything then known in Europe and America about the diseases of women, and their treatment: he also published many articles on a variety of surgical topics [11]. Robert spent ten years at the Broca in Pozzi’s service, but he was also prominent as a urologist, published on surgery for pulmonary tuberculosis, and presented a paper in 1914 describing one of the first ‘‘open-heart’’ operations, in which he removed a bullet from the pericardial cavity of a child, who recovered completely [4,9,10]. He went on several occasions to the Mayo Clinic and Johns Hopkins at Pozzi’s behest to study American practice and incorporate its benefits into that of the Broca. From 1932 until his death in 1935 he was himself director at the Broca [9,10]. The first edition of The surgery of the female genital tract appeared in 1904 [7]. In the abundantly illustrated text, Robert, although he also refers to many other French and European gynaecological surgeons, often describes Pozzi’s practice, including his technique of vaginal hysterectomy, and his comments on abdominal hysterectomy as being the better route if the surgeon wishes to inspect the adnexae and make a decision about their removal: both Pozzi and Robert Proust advocated the conservation of the ovaries wherever possible. Much attention is given to the need for an absolutely aseptic surgical technique, and careful antiseptic preparation of the abdomen and vagina prior to surgery. The second edition appeared in 1908. By 1913, with the third, the book was enlarged with longer descriptions of the radical hysterectomy of Wertheim, modified by Parisian surgeons, for cervical or endometrial cancer, and frequent mention of the work of Howard Kelly and the surgeons of the Mayo clinic. Meanwhile, not far from the Broca, Marie Curie and her team were working on the physics and chemistry of radioactivity, and its potential applications in medicine. Robert was fascinated by this work, and Madame Curie was an enormous admirer of his ability to absorb both mathematico-physical and medical knowledge. He pioneered the use of radiotherapy for cancer of the cervix, and in the fifth edition of his book adds a section on ‘‘curiethe´rapie’’ [7]. He recommended the use of radium pre-operatively, and understood that radium alone could on occasion be curative. Radium application could be by the vaginal route, tubes of radium being
inserted through the cervix, or by the abdominal route, where via laparotomy, lymph nodes were identified and tubes of radium placed beside them. Rubber tubing securing these was sutured into the lower end of the abdominal incision, to enable removal of the radium after 3–4 days; external beam radiotherapy had yet to be developed [7]. In 1971 the centre for radiotherapy at Paris’s Hoˆpital Tenon was named the Pavillon Proust, on Marcel’s hundredth birthday, to honour the Proust medical family. Robert became a military surgeon at the start of World War I and served throughout the war, often close to the front. He developed the ‘‘auto-chir’’, a type of mobile operating theatre that could be carried to and used close to the site of battles. His proximity to the battlefields caused great anxiety to Marcel [2]. During Marcel’s lifetime Robert was always a strong supporter and admirer of his brother’s writing, as testified by the copy of the 1913 Grasset edition that Marcel gave him inscribed ‘‘Souvenir of lost time, refound for a moment each time that we are together.’’ Although Marcel, obsessed with his health, consulted many doctors other than his brother, Robert was always there for him, particularly during the events leading up to his premature death from a pulmonary abscess [2,5]. After Marcel’s death, Robert carefully oversaw the editing and publishing of the final three parts of the four thousand-page work that is A` la recherche. The seventh volume was particularly challenging, as only notes and fragments of text existed at the time of Marcel’s death. Robert’s efforts have not been without controversy: after the death of his only child, Suzy Mante-Proust, in 1986, her son-in-law discovered among her papers a manuscript of the sixth volume that had been corrected and annotated by Marcel himself but never published; it was duly published in France in 1987. Biographers and scholars of Marcel have searched in vain for any trace of Robert in Marcel’s characters [2,6]. One eminent biographer, however, describes the ‘‘mangled admiration and contempt with which Proust treats the medical profession’’, which probably arose partly from his divergent feelings towards his father and partly from his affection for his brother [2]. Another writer feels that ‘‘. . .in Proust the reader is inclined to see the medically reflected suffering of the knowledgeable, sick son and brother of a doctor shining through in each individual character’’ [4]. Certainly his experience of life in a medical household contributed vastly to Marcel’s views of his social environment and his depiction of his world. Undoubtedly much more remembrance will be refound over the next few years as various Proustian anniversaries are celebrated. While honouring Marcel, let us also spare a few moments for the achievements of his younger brother. Conflict of interest None. Funding None. Ethical approval Not required. References [1] Proust M. A` la recherche du temps perdu. Paris: Grasset and Gallimard; 1913– 1927. [2] Painter GD. Marcel Proust: a biography, vol i and ii. London: Chatto and Windus; 1965.
C. de Costa / European Journal of Obstetrics & Gynecology and Reproductive Biology 170 (2013) 47–49 [3] Ortoli S. Une machine a` explorer le temps. Editorial, Philosophie Magazine hors-se´rie; December 2012. 5. [4] Speck R. Robert Proust – an eminent doctor in the shadow of his famous brother Marcel. World J Urol 2001;19:285–91. [5] Straus B. The Maladies of Marcel Proust. New York: Holmes and Meier; 1980 . [6] Pearn J, Gardner-Thorpe C. A biographical note on Marcel Proust’s Professor Cottard. J Med Biogr 2003;11:103–6.
49
[7] Proust R. La chirurgie de l’appareil ge´nital de la femme. 1st ed. Paris: Masson; 1904, 1908 (2nd ed.), 1913 (3rd ed.), 1922 (5th ed.), 1927 (6th ed.). [8] La prostatectomie. Paris: C. Naud; 1904. [9] Vanderpooten C. Samuel Pozzi – chirurgien et ami des femmes. Paris: Fine Editions; 1992. [10] de Costa C, Miller F. Sarah Bernhardt’s ‘Doctor God: Jean-Samuel Pozzi (1846– 1918). Aust NZ J Obstet Gynaecol 2007;47:352–6. [11] Pozzi S. Traite´ de gyne´cologie. Paris: Masson; 1890.