The Author

Albert Camus (1913–1960) was a French writer-philosopher and a key figure in existentialism.

Born in Mondovi, Algeria, Camus began his philosophy studies in Algiers. He later moved to Paris where, during World War II, he actively participated in the resistance against Nazi occupation. His most renowned novel is “The Stranger.” In 1957, Camus was awarded the Nobel Prize in Literature.

“The Plague”

The novel is set in the Algerian city of Oran and chronicles a sudden plague epidemic that ravages the city.

Dr. Rieux serves as both narrator and protagonist, presenting the story as a firsthand account of the events.

Dr. Rieux, too, stood up. He was of medium height, broad-shouldered, and square-set. The brisk and energetic movements of his head, with its dark, steady eyes and firm mouth, suggested a man who was tenacious in purpose. His manner was direct, and he had a certain geniality of expression which never forsook him, even in his moments of irritability.

The narrative begins with the ominous discovery of dead rats—a warning sign overlooked by both authorities and citizens.

But what had happened in the last few days was quite out of the ordinary and, to his thinking, disquieting. For one thing, it was a fact that in this metropolis rodents were quite out of place, yet here they were, each day bringing in its train several hundred fresh rats, swept out of cellars and attics, to die in the open.”

Only when patients exhibiting high fever, swollen lymph nodes, and sudden deaths emerge does the diagnosis of bubonic plague send the population into panic.

Authorities place the city under strict quarantine, isolating it from the outside world. This isolation prevents communication even between family members, creating an extremely traumatic experience for the populace.

Rieux was astonished to find how easy it was to stop thinking clearly, how easy it was to lapse into a dream-like state where things happened of their own accord. In this state men could think of nothing but ‘the plague.’ All day they were caught up in an unbroken stream of rumors and alarms, one succeeding another.

As the infection spreads, the population’s reactions vary widely, ranging from apathy to moments of profound solidarity.

After several months, the epidemic begins to wane. Many have perished, and the survivors are deeply scarred by the experience. Dr. Rieux reflects that this event serves as a stark reminder of humanity’s enduring vulnerability.

The Novel from a Medical History Perspective

The novel transports us to the world in the middle of 20th-century medicine, depicting both its capacity to respond to disease outbreaks and the public’s perception of medical practices during that era.

Key aspects of the novel from a medical history perspective:

• Response to the epidemic: Initially underestimated, authorities soon impose strict isolation and quarantine measures. This mirrors historical responses to epidemics, as limited therapeutic and preventive capabilities made these the primary public health measures available.
• Therapeutic capacity: Dr. Rieux’s treatments are largely palliative and ineffective, reflecting medicine’s powerlessness against such infectious diseases before the advent of antibiotics and vaccines.
• Medical ethics: Dr. Rieux embodies a new portrayal of doctors, contrasting with previous centuries. Rather than a self-interested figure exploiting popular credulity and serving only the elite, he’s a people’s doctor who disregards social status and offers his limited abilities to all patients equally.

His profession required him to keep away from abstractions. ‘Only one idea was clear in his mind: that he was here to attend to the sick. And he had resolved to do that without a moment’s deflection. That, too, was a beginning. But it was no more than a beginning.

For who would dare to assert that eternal happiness can compensate for a single moment’s human suffering? Rieux had heard a mother crying for her dead child, and that cry remained with him… His job was to attend to them, to put his professionalism at the service of those who suffered, without questioning whether it was worth it or not.

Rieux said he knew the plague had cost him the power of emotion, and even the faculty of loving someone. Only love and duty made men endure their pain.

The work also reveals that disease, particularly the plague, was often perceived as divine retribution for collective sins. This view persisted for a long time, despite medical advancements.

Rieux knew now that the plague was here and that he must do his best to fight it. He remembered a phrase of his friend Tarrou: ‘Each of us has the plague within him; no one, no one on earth is free from it. And I know, too, that we must keep endless watch on ourselves lest in a careless moment we breathe in somebody’s face and fasten the infection on him.

Furthermore, it highlights a growing sense of solidarity among the afflicted populations and demonstrates how the epidemic catalyzed efforts to strengthen and better organize healthcare structures.

Dr. Rieux resolved to keep silent and stay in the fight… He knew that the tale he had to tell could not be one of final victory. It could only be the record of what had to be done, and what, no doubt, would have to be done again in the never-ending fight against terror and its relentless onslaught.

This work holds significant importance from a medical history perspective. It serves as a powerful reminder of society’s vulnerability to epidemics, even in the face of advancing medical knowledge. The novel emphasizes the critical necessity for unwavering medical ethics, particularly during times of crisis when ethical boundaries may be tested. It vividly highlights the paramount importance of strengthening control and prevention measures in public health systems, demonstrating how these can make a substantial difference in managing outbreaks. Furthermore, the narrative underscores the invaluable lessons that can be extracted from past events, emphasizing how this historical knowledge can be utilized to better prepare for and respond to inevitable future outbreaks.

There is, however, a second layer of interpretation that uses medicine as a metaphor for France’s political situation during the Nazi occupation.

This reading highlights how the “disease,” with its ever-present destructive force, can be seen as a metaphor for the Nazism oppressing France at that time.

Dr. Rieux, in this context, becomes a symbol of resistance against this metaphorical plague. He confronts it as he does the literal plague in the novel: organizing responses, aiding the suffering, and persevering in his actions—even while aware of his limited power to combat the “infection.”

The quarantine and isolation of Oran can be interpreted as a reference to the invasive and oppressive control the occupiers imposed on the population.

Lastly, the initial underestimation that allowed the contagion to spread, followed by the resolve to learn from these events, mirrors the determination to be better prepared when the metaphorical bacillus—which can never be fully defeated—inevitably returns.

Through its compelling storytelling, “The Plague” not only entertains but also educates, leaving readers with a deeper understanding of the complex interplay between medicine, society, and human nature during times of widespread illness.

Images from Wikimedia Commons

I alone remember. And if I don’t tell you, children, everything that was and everything we knew, all will be lost.

Jack London (1867–1916) was a prolific American writer. He’s best known for adventure novels like “The Call of the Wild” and “White Fang,” but his vast work also addressed social issues.

“The Scarlet Plague,” a short novel written in 1912, is notable for being one of the first post-apocalyptic novels in modern literature.

The historical references that likely inspired the author were the plague and cholera epidemics (as depicted in the stories of Boccaccio and Defoe). These occurred during periods when medicine was still in its infancy and lacked effective remedies against diseases. Interestingly, the Spanish flu pandemic itself emerged after London had written this story (1918–19).

The Story

Set in 2073, exactly 70 years after a catastrophic epidemic—the scarlet plague—decimated humanity, the story depicts a world where survivors have regressed to a primitive state.

Professor James Howard Smith narrates the events leading to this outcome, aiming to pass on the memory of the plague and its consequences to future generations.

The scarlet plague, whose clinical and epidemiological characteristics the author doesn’t elaborate on, was marked by an extremely high transmission rate and mortality. Its severe virulence and the inability to mount an effective response led to widespread panic and chaos.

It was a frightful epidemic. People were dying like flies. The disease killed within minutes and the infection spread like wildfire. People were seized by desperate panic, and everything descended into chaos.

Cities crumble, infrastructure collapses, and the few survivors gather in small, isolated communities. They revert to a state of barbarism where civil achievements and medical knowledge fade into obscurity. Centuries of scientific discoveries vanish, lost to time.

Everything has been lost. Not just civilization, but everything that was part of it. Science, medicine, all knowledge… nothing remains anymore

Healthcare systems were the first to collapse, unable to respond to the pandemic and lacking the resilience to survive it. Hospitals became viewed more as sources of contagion than places of treatment.

The cities emptied out. Hospitals were abandoned, no one had the courage to approach the sick. The government dissolved and people sought refuge in nature, far from the contagion

Doctors, in particular, were astounded by the speed and lethality of the unknown disease. Unable to identify its cause, they tragically became victims themselves.

“Doctors were brave, some of them died while trying to treat others, but nothing could stop the scarlet plague. There was no cure, there was no hope.

The post-pandemic state of barbarism, along with the loss of medical knowledge and basic health norms, demonstrates the fragility of scientific achievements and hygiene practices we often take for granted. This stark reality underscores the critical importance of careful public health management.

Without the knowledge of the past, men have returned to barbarism, no longer caring about hygiene or medicine. We live like beasts, devoid of the most basic standards of cleanliness

Ancient and Modern Pandemics

Jack London’s “The Scarlet Plague” demonstrates a remarkable foresight that echoes with our recent experience of the Covid-19 pandemic.

While the coronavirus certainly exhibited less virulence than London’s fictional “scarlet plague,” the parallels between the imagined events and our lived reality in 2020 are both striking and thought-provoking.

London’s prescient narrative serves as a reminder of how literature can sometimes anticipate future challenges, offering valuable insights into human behavior and societal responses during times of crisis.

The Covid-19 pandemic, although less severe, bears numerous similarities to London’s fictional “scarlet plague,” especially in its early stages.

The novel coronavirus vividly illustrated the rapidity with which pathogens can proliferate on a global scale in our interconnected world.

London’s work anticipated with accuracy the immense strain placed on healthcare systems worldwide. We witnessed overwhelmed hospitals, critical shortages of essential medical equipment such as ventilators, and healthcare professionals working under unprecedented pressure and personal risk.

In the period before the development and distribution of vaccines, society grappled with a pervasive uncertainty about how to effectively control the pandemic’s spread. This uncertainty led to the implementation of extreme measures, including widespread lockdowns, which echoed the drastic actions taken in London’s narrative.

Many individuals experienced a degree of isolation and fear reminiscent of London’s characters, albeit to a lesser extent.

I wasn’t scared. I had been exposed to the contagion and already considered myself dead. What struck me wasn’t this, but a feeling of tremendous depression. Everything had stopped. It seemed like the end of the world, of my world.

The pandemic brought to the forefront both the best and worst aspects of human nature, revealing a complex interplay of solidarity and self-interest.

Yet, even in despair, men were men. We fought, loved, cried, as we did before. The plague could not take away who we were.

While our society did not descend into the barbarism depicted in “The Scarlet Plague” – thanks in large part to successful epidemic control measures and scientific advancements – the crisis nonetheless exposed vulnerabilities in our social fabric and tested the resilience of our institutions.

Messages

The work imparts several messages that remain profoundly relevant in our current times:

• We cannot predict the emergence of new pathogens responsible for epidemic diseases, which can spread rapidly. Therefore, health organizations must be prepared to manage unforeseen situations with adequate reserves of personnel, equipment, and knowledge. Efficient healthcare systems are crucial not only for combating diseases but also for maintaining social cohesion by supporting populations during crises.
• It is vital to preserve, share, and document medical progress. Training, dissemination, and global access to medical knowledge must be guaranteed even in the face of catastrophic events. The loss of such knowledge would make any disaster even more devastating.
• Panic and disorganization during catastrophic and unforeseen events must be avoided. The healthcare sector, as well as other social organizations, must be prepared—both logistically and psychologically—to face these challenges.

Civilization is a thin veil. And without it, we have returned to what we once were, before we learned to govern ourselves, before we invented laws and moral principles.

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“A Young Doctor’s Notebook” by Mikhail Bulgakov is a goldmine of information for those interested in the history of medicine.

Mikhail Bulgakov, a Russian doctor and writer, lived from 1891 to 1940. Born into a family of intellectuals, he studied medicine in Kiev, graduating in 1916. He then worked in various rural villages, with his first experience in Smolensk, Russia, proving particularly formative. Many events narrated in “A Young Doctor’s Notebook” stem from this experience.

After contracting typhus during his medical work, Bulgakov gradually abandoned the profession to dedicate himself to writing. Among his notable works is “The Master and Margarita,” widely regarded as his masterpiece. He died in Moscow in 1940 and is now considered one of the greatest Russian writers.

In “A Young Doctor’s Notebook,” Bulgakov recounts the experiences of a young physician sent to a remote village in rural Russia shortly after the 1917 revolution. The work offers numerous accounts of the state of medicine in rural Russia during this period of profound social transformation.

The young, inexperienced doctor finds himself isolated. He has no nearby medical facilities for referrals, no seasoned colleagues to seek advice from and no possibility of specialist consultations.

This isolation, characteristic of rural doctors, subjected the young physician to constant pressure and challenges. He faced a lack of support and feared confronting difficult situations without the necessary experience.

“I found myself completely alone, a newly graduated doctor, with only four years of theory behind me, thrown into a hole, without the possibility of receiving advice from anyone.”

Lack of resources

The medical facilities lacked adequate diagnostic tools, even those limited ones available at the time. Medicines were scarce, a situation exacerbated by the post-revolutionary period’s disorganization. This situation led to a profound sense of frustration in the young doctor.

For instance, when faced with performing an emergency tracheotomy, he discovers he lacks the proper tools:

“I lacked the necessary instruments. I didn’t have a complete tracheotomy set. The knife I found was barely suitable and I felt like a butcher.”

Theoretical Knowledge vs. Practical Experience

The transition from theoretical knowledge gained in university to the demanding realities of clinical practice is a common challenge for doctors across different eras and locations. This gap between theory and practice often creates a sense of inadequacy. For the protagonist, this feeling is particularly acute due to his isolation and lack of resources—conditions that intensify the struggle faced by many young physicians.

A striking example occurs when the young doctor faces the daunting task of performing an amputation:

“There was a mountain of muscles, arteries, veins, and everything was moving. The textbook hadn’t prepared me for this. Muscles had never been part of my exam.”

Hygienic and Sanitary Conditions

The protagonist encounters deplorable hygienic and sanitary conditions among the rural population. Infectious diseases run rampant, and patients lack awareness of even the most basic hygiene practices.

“The woman presented herself with mud-caked feet, a filthy scarf on her head, and obvious signs of syphilis. She had no idea what hygiene was. She had never seen a doctor before.”

Medical Progress

Despite adverse conditions and limited resources, the young doctor recognizes significant advancements in his field. He consistently strives to maintain a scientific approach in his practice. When successfully employing a remarkable new technique during a challenging childbirth, he experiences joy and appreciation for the progress he witnesses firsthand.

“Thanks to chloroform, the operation was successful. It was the first time I had used an anesthetic, and it seemed incredible to be able to operate without causing pain.”

The pathologies encountered by the young doctor offer insight into the diseases prevalent in rural areas during the early 20th century.

Syphilis

Syphilis was one of the most common conditions treated by the young doctor. This sexually transmitted disease was rampant among the poorest social classes. It manifested through skin lesions (ulcers or eruptions) and systemic symptoms. Patients often sought medical attention only at an advanced stage. Since antibiotics hadn’t been invented yet, treatment relied on mercury or Salvarsan—a chemotherapeutic drug introduced in 1910.

“Every patient with signs of syphilis was terrified by the word ‘Salvarsan,’ refused to follow my prescriptions, and preferred to rely on folk medicine remedies.”

Diphtheria

Diphtheria was even more feared than syphilis, primarily because it affected children. High fever and breathing difficulties raised suspicions of the disease, with diagnosis confirmed by the presence of grayish membranes in the throat.

Though antitoxin serums had been introduced by this time, they were rarely available in rural areas. The only life-saving remedy, therefore, remained emergency tracheotomy.

“I’d never performed a tracheotomy before, but I had no choice. The child was suffocating.”

Typhus

Typhus was another prevalent infectious disease in rural populations, exacerbated by poor hygiene. It presented with fever, abdominal pain, and diarrhea, accompanied by a distinctive rash. Before the advent of antibiotics, no effective cure existed. Doctors could only offer supportive care, focusing on hydration and fever management.

“The hygienic conditions in the village were terrible, and each winter brought new waves of typhus.”

Complicated Childbirth

In that era, doctors could only identify a complicated childbirth through prolonged labor and the fetus’s abnormal position. Modern monitoring systems were nonexistent. Manual techniques proved largely ineffective, often necessitating the use of forceps to perform an assisted delivery. Inoltre non c’era l’anestesia e quindi questi interventi erano molto dolorosi. Additionally, the absence of anesthesia meant these procedures were excruciatingly painful.

“My hands were trembling as I tried to apply the forceps. It felt like I was holding not just a baby, but life itself in my hands, and I could only pray that everything would go well.”

Wounds and Injuries

Farm work frequently led to wounds or injuries, which occasionally resulted from violent incidents as well. The doctor’s treatment involved suturing, placing drains, and cleansing with antiseptics—primarily iodine and alcohol—to ward off infections.

“I had no means to prevent infection. I could only clean the wound as best as possible and hope it wouldn’t worsen.”

A central aspect of Bulgakov’s narrative is the contrast between theoretical training and practical reality, particularly in the rural and ill-equipped setting where he began his medical career.

The young doctor immediately perceives the stark contrast between his theoretical training and the practical realities of rural medicine, causing him considerable anxiety:

“I had studied the manuals, I had passed the exams, but nothing had prepared me for what I found here. The human body didn’t seem to be the same as described in my textbooks.”

This contrast between theory and practice breeds a sense of inadequacy, manifesting as intense anxiety and fear when confronting complex emergencies. Furthermore, the weight of responsibility is immense, as the doctor realizes that a patient’s life hangs in the balance of their every decision and action.

“My hands were trembling. I had never seen anything like it, let alone done it. But I couldn’t back down. The patient’s life was in my hands.”

Finally, there’s the realization that beyond the gap between theory and practice lies a reality surpassing what was taught. The young doctor encounters situations never addressed during his studies, forcing him to confront unforeseen challenges.

“The book said everything would go smoothly, but reality bore no resemblance to anything I had studied. The childbirth wasn’t proceeding as expected, and I felt lost.”

Despite this abyss of inadequacy, anxiety, and terror, the doctor summons the strength to resolve situations—inventing, adapting, and improvising.

“There was no time for doubt. I had to act. I took the scalpel and made the incision. I had never done it before, but I had no choice.”

Through facing novel and unforeseen situations, the doctor gradually builds confidence and skills. Learning on the job—with both successes and failures—he gains practical competence that his studies hadn’t provided. This hands-on experience, filled with trials and errors, proves invaluable in developing abilities beyond what textbooks could offer.

“After each procedure, I felt a new awareness growing within me. Every mistake, every success taught me something that no book had ever taught me.”

A final aspect worth exploring in Bulgakov’s text is the doctor’s relationship with patients and the broader community. The villagers’ shifting attitudes, their expectations, and their tendency to glorify successes while assigning blame for failures remain surprisingly relevant today. This dynamic between medical professionals and the public they serve continues to be a complex and often challenging aspect of healthcare.

Initially, when the young doctor arrives in the village, he is viewed with admiration. The villagers see him as an authoritative figure capable of curing diseases and solving problems. To them, he represents not only a bearer of scientific and modern knowledge but also a sort of possessor of esoteric powers.

“They looked at me and my bag with a sort of veneration. I was the first doctor they had ever seen in the flesh, and to them, I was a magical figure.”

However, as treatments fail to yield immediate results and his prescriptions stray from popular beliefs, the villagers’ initial admiration swiftly morphs into distrust and suspicion.

“Despite my best intentions, they continued to believe that their folk remedies were more effective than my medicines. They often looked at me with suspicion, as if they didn’t really trust what I was doing.”

Beyond the aspects we’ve already discussed, the doctor faces an additional source of anxiety: the knowledge that a single mistake or failure could irreparably damage his reputation. For instance, following a challenging delivery resulting in the infant’s death, the community’s regard for the doctor drop dramatically.

“After the baby’s death, I felt they looked at me differently. I was no longer the promising young doctor who would solve every problem. Now I was simply another fallible man.”

The villagers clung to their folk remedies and superstitions, often viewing the doctor’s modern treatments with suspicion and fear. This realization led the young physician to understand that his role extended beyond merely treating patients—he needed to educate them as well.

“When I prescribed a medication, they often refused it, preferring to rely on a spell or an ointment passed down from their ancestors.”

However, trust and confidence can be as quickly regained as they were lost, following a successful intervention and a patient’s recovery.

“After the operation, they looked at me as if I were a living miracle. I had brought someone back to life whom they had already given up for dead. For the first time, I felt the weight of my power.”

The relationship between doctors and patients in Russian rural villages continues to be characterized by a complex and ever-shifting dynamic in the modern era. This fluctuation in sentiment ranges from eager anticipation and hopeful expectations to skepticism and wariness, and from adulation and reverence to criticism and disdain. Such dramatic swings in public opinion don’t necessarily reflect the actual quality of medical care provided. Rather, they’re often influenced by the inherently unpredictable nature of medical outcomes, the varying experiences of individual patients, and broader societal perceptions of healthcare.

Mikhail Bulgakov, one of the most prominent and influential Russian writers of the 20th century, relied extensively from his medical background in composing his literary works. His experiences as a physician not only shaped his worldview but also provided a rich source of material for his writing. This is particularly evident in his collection of medical stories, most notably A Young Doctor’s Notebook, where Bulgakov probes deep into the complex nature of the medical profession.

In these narratives, Bulgakov explores the intricate human aspects of practicing medicine. He portrays the psychological struggles faced by medical professionals, from the overwhelming sense of responsibility to the constant battle against self-doubt. The moral dilemmas encountered in the field are exposed, offering readers a window into the complex decision-making processes that doctors must navigate daily. Furthermore, Bulgakov’s work sheds light on the nuanced and often challenging relationship between doctors and their patients, revealing the delicate balance of trust, authority, and vulnerability that characterizes these interactions.

Beyond the personal and interpersonal aspects, Bulgakov’s medical stories serve as a valuable historical document. They provide readers with a meticulously detailed and insightful portrayal of healthcare management in rural Russia at the turn of the 20th century. Through his vivid descriptions and astute observations, Bulgakov paints a picture of a medical landscape contending with limited resources, widespread superstitions, and the gradual introduction of modern medical practices. This unique perspective offers not only a window into the past but also a point of reflection on the evolution of medical care and its ongoing challenges.

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“On avait fait venir le docteur Cottard qui, après m’avoir ausculté, m’avait déclaré sujet à des crises nerveuses et m’avait prescrit un peu de lait chaud avant de me coucher.”

“They had called Dr. Cottard, who, after examining me, declared me subject to nervous attacks and prescribed a little warm milk before bed.”

In Proust’s monumental work, “À la recherche du temps perdu,” health issues feature prominently. This is partly because the protagonist—often seen as Proust himself—suffers from various chronic maladies, including respiratory problems, insomnia, and nervous hyperexcitability. Proust often explores these conditions through an emotional and psychological lens, reflecting their likely psychosomatic nature.

The protagonist contends with anxiety and insomnia, often tied to emotional states. In childhood, for instance, these conditions manifest in his anxious anticipation of his mother’s goodnight kiss:

“Souvent je m’endormais avant que ma mère eût pu monter. Mais d’autres soirs, j’attendais, dans la crainte du moment où elle allait partir, mon esprit tendu à l’effort d’entendre, d’éteindre ma conscience avant que fût survenu le moment redouté.”

“Often, I would fall asleep before my mother could come up. But on other nights, I waited, dreading the moment she would leave, my mind strained to the effort of hearing, of extinguishing my awareness before the dreaded moment occurred.”

Asthma also torments the protagonist, often associated with situations of psychological and emotional tension. For this condition, doctors fail to find effective remedies. Even trips and thermal cures, frequently proposed as treatments at the time, prove ineffective.

The narrative frequently alludes to a “nervous hypersensitivity” that triggers episodes of anxiety, agitation, and nervous attacks. These symptoms are often tied to social interactions or environmental factors; the author exhibits an acute sensitivity to changes in his surroundings. Ironically, trips and stays at holiday resorts and spa towns—intended to alleviate his condition—often become sources of distress themselves.

Health issues permeate the work, with medical science portrayed as largely ineffective in both diagnosis and treatment. This inefficacy originates not only from the era’s limited medical knowledge but also from Proust’s unique perspective on the human condition. In his view, physical ailments, psychological distress, and emotional suffering are intricately interwoven—a complex tapestry that defies simple medical solutions.

Dr. Cottard is a recurring character in several volumes of “À la recherche du temps perdu.” He first appears in “Du côté de chez Swann” and plays a significant role throughout the novel as a constant attendee of the Verdurin soirée, a gathering of artists and intellectuals hosted by a bourgeois family. As a representative figure of the era’s medical and social milieu, he often becomes the target of Proust’s sharp wit and biting satire.

Proust likely drew inspiration for the character of Cottard from multiple sources. One probable model was Dr. Gustave Roussy, whom the writer met in 1910 and described as an “example of medical vulgarity.” Others suggest Dr. Samuel Pozzi as a possible inspiration. However, it’s more likely that Cottard is a composite character, blending traits from various medical figures Proust encountered throughout his life.

Cottard’s character appears throughout various volumes of the work:

Volume 1 “Du côté de chez Swann”: at Madame Verdurin’s salon, Cottard presents himself as insecure and conformist. During discussions on artistic and intellectual topics, he often expresses appreciation for others’ statements with a coarse laugh—a behavior that underscores his need for approval and reveals his social anxiety.

Volume 2 “À l’ombre des jeunes filles en fleurs,”: Cottard reappears at the Verdurin gatherings, this time at the seaside resort of Balbec. Despite his professional success, he remains characterized as superficial and conformist—a man who has climbed the social ladder without shedding his bourgeois limitations.

Volume 3 “Le Côté de Guermantes”: Cottard has risen to prominence as a renowned physician and authority in his field. Despite his professional success, he continues to frequent the Verdurins’ gatherings, where his superficiality remains a constant, highlighted characteristic.

Volume 4 “Sodome et Gomorrhe”: Proust’s satire of Cottard, still a renowned luminary, intensifies in this volume. Despite his professional status, it highlights how often situations elude the doctor’s understanding.

In volumes 5 and 6, Dr. Cottard occasionally appears within the context of the Verdurin gatherings. However, his role in these volumes is limited and secondary.

Volume 7 “Les Temps retrouvé”: Cottard’s career is well-established but has aged and diminished in stature. Despite his brilliant professional achievements, he ultimately leaves an impression of emptiness and superficiality in matters of life and memory.

An analysis of the passages concerning Dr. Cottard reveals a rather uninspiring figure, despite his prestigious academic position.

From a human standpoint, Cottard’s insecurity and craving for others’ approval are evident. To gain acceptance, he readily conforms to trends, revealing himself as hypocritical, superficial, and overly concerned with status.

“Le docteur Cottard, un des piliers du petit groupe, mais qui, impressionné, intimidé par les grands mots de « maître », de « chef-d’œuvre », que Mme Verdurin lâchait dans la conversation pour s’amuser, était, quant à lui, enclin à être ironique vis-à-vis de cette œuvre nouvelle, mais comme on s’était extasié devant elle, il avait à son tour admiré le morceau de piano qui venait d’être joué.”

“Doctor Cottard, one of the pillars of the small group, but who, impressed, intimidated by the grand words like ‘master’ and ‘masterpiece’ that Madame Verdurin dropped into conversation for amusement, was himself inclined to be ironic towards this new work. However, as everyone had raved about it, he had in turn admired the piano piece that had just been played.”

Cottard’s raucous laughter, a ploy to curry favor with his hosts, ironically exposes his deep-seated need for acceptance.

“Le docteur Cottard, qui avait un rire sonore, bruyant, envahissant, et qui riait pour tout et pour rien, riait aussi quand il ne comprenait pas, mais pour lui ce rire était un mode de politesse.”

“Doctor Cottard, who had a loud, noisy, intrusive laugh, and who laughed at everything and nothing, also laughed when he didn’t understand, but for him, that laugh was a form of politeness.”

From a professional standpoint, the portrayal is even more unfavorable. While the era’s medicine had its limitations, Cottard’s character as a doctor represents something worse: an individual unable to comprehend the complexities of human nature. He fails to grasp the full extent of his patients’ suffering, both physical and psychological. This shortcoming underscores a fundamental lack of empathy and insight in his medical practice.

This inability is particularly evident in the poignant episode of the protagonist’s grandmother’s death. The grandmother, a pivotal figure in his life, falls gravely ill. Her passing becomes one of the most heart-wrenching events for the protagonist.

The eminent Dr. Cottard is summoned to treat and attend to the grandmother in her illness’s final stages. His actions, however, starkly reveal his superficiality and profound inability to comprehend human suffering.

He approaches the illness as a detached, clinical problem, misreads the prognosis, and fails to recognize the disease’s advanced stage. Even when confronted with its inevitable progression, Cottard maintains his superficial demeanor.

“Le docteur Cottard, après avoir examiné ma grand-mère, haussa légèrement les épaules, comme le font les médecins pour signifier qu’il n’y a rien de grave et que la famille exagère. Mais derrière ce geste, il y avait une certaine indifférence, presque fataliste.”

“Doctor Cottard, after examining my grandmother, shrugged his shoulders slightly, as doctors do to suggest that there is nothing serious and that the family is overreacting. But behind this gesture, there was a certain indifference, almost fatalistic.”

And, in the end:

“Pendant que ma grand-mère luttait contre la mort, Cottard continuait à parler de détails insignifiants, comme si l’agonie d’une personne aimée n’était qu’une question banale de santé.”

“While my grandmother struggled with death, Cottard continued to talk about trivial details, as if the agony of a loved one was nothing more than a routine health issue.”

The figure of Dr. Cottard, oscillating between comical and ironic, serves as a powerful personification of Proust’s critique of medicine in his era. Through this character, Proust underscores the shortcomings of a medical approach that prioritizes clinical detachment over empathy, and scientific knowledge over emotional intelligence.

Cottard’s depiction goes beyond mere caricature; it represents a systemic failure in healthcare to address the holistic nature of human suffering. His inability to comprehend the emotional and spiritual dimensions of illness reflects a broader disconnect between medical practice and the lived experience of patients.

Moreover, Cottard’s character arc throughout the novel—from an insecure practitioner to a renowned expert who remains fundamentally unchanged—underscores Proust’s skepticism about the ability of medical institutions to foster genuine growth and understanding. This narrative trajectory suggests that professional success does not necessarily correlate with an enhanced capacity for empathy or a deeper grasp of the human condition.

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