Persistence of Memory and the Comma Bacillus

“T anyone should condescend to die of cholera at the bidding of so insignifi cant a creature as the comma bacillus,” wrote Marcel Proust, should not be astonishing to those in the know. Plagued by illness from childhood, the author was very much in tune with medicine, which he pondered often in Remembrance of Things Past (1913), his monumental novel on the nature of memory. He also knew about cholera. His father, eminent physician and public health pioneer Achille-Andrien Proust, dedicated much of his life to promoting cordon sanitaire for the control of the disease, convinced that “questions of international hygiene reach beyond the borders established by politics.” The elder Proust’s idea, ahead of his time, challenged free trade so it was not until the Bombay cholera epidemic of 1877 that the concept of quarantine prevailed over commercialism and self-interest. Marcel Proust was proud of his father. If visitors to the house were ever unwell, he was wont to ask them, “Would you like Papa to come to see you?” Once, when he made the offer to Anatole France, the man of letters replied, “My dear young friend, I should never dare to consult your father; I’m not important enough for him. The only patients he takes on nowadays are river basins!” Indeed, Dr. Proust had turned to public health. At great personal risk, he had cared for many a cholera patient during the 1866 epidemic in France and came to understand that individual treatment could not defeat this disease but prevention might control it. An early authority on epidemiology and a tireless advocate of an international sanitation system against disease spread, he is known in the history of medicine for his single-minded devotion to achieving the exclusion of cholera from the borders of Europe. This, some 20 years before Robert Koch identifi ed the causative agent of the disease. A severe infection spread by water contaminated with human waste, cholera was likely known in antiquity. Hippocrates and Galen described a compatible set of symptoms, and many sources point to similar illness, always present and frequently epidemic, in the plains of the Ganges River. In his landmark paper identifying the cause of the disease, Koch pinpointed the Ganges Delta as the Heimat (homeland) of cholera. Many studied the scourge. In 1854, Filippo Pacini in Florence described vibrios in the intestinal contents of cholera victims and was amazed at their large numbers in