Among the scores of essays Montaigne wrote, while occasionally serving in various government roles, are accounts and commentaries concerning many of his infirmities. Kidney stone attacks in particular plagued Montaigne, and so they became subject matter for several essays. His focus on “the stone,” as he called this condition, generally concerned the physical and mental suffering acute attacks caused him, his work at reconciling a life with intermittent attacks, and from these two features, the profit his attacks afforded him. (N.B. I have drawn Montaigne’s words from the Everyman’s Library collection of Montaigne’s essays.)

Attack of The Stone

Pain from acute kidney stone attacks always ranks amongst the worst humans suffer from diseases, injuries, or various conditions. Montaigne’s vivid and horrifying descriptions of his kidney stone attacks lend credibility to these rankings: “I am at grips with the worst of all maladies, the most sudden, the most painful, the most mortal, and the most irremediable.” (p. 698)

To others looking on during one of his attacks, Montaigne says: “They see you sweat in agony, turn pale, turn red, tremble, vomit your very blood, suffer strange contractions and convulsions, sometimes shed great tears from your eyes, discharge thick, black, and frightful urine…” (p. 1019) No observer could doubt the intensity of pain kidney stone attacks produce after reading Montaigne’s accounts; no current sufferer would contradict them. 

A Life Accommodated

The pain and agony kidney stones inflict are never forgotten. And, the fear of knowing they will strike again is ever present, with good reason; they often return time after time. Indeed, this threat is a form of suffering of its own. Montaigne was cognizant of this reality, and writes about how he learned to live with the inevitability of a next attack. 

In the eighteen months or thereabouts that I have been in this unpleasant state, I have already learned to adapt myself to it. I am already growing reconciled to this colicky life; I find in it food for consolation and hope. So bewitched are men by their wretched existence, that there is no condition so harsh that they will not accept it to keep alive. (p. 697).

His primary approach was adopting a mentality allowing him to maintain as much function as possible while under frequent sieges of the stone: “I have kept my mind, up to now, in such a state that, provided I can hold fast, I find myself in a considerably better condition of life than a thousand others, who have no fever illness but what they give themselves by the fault of their reasoning.” (p. 701) Montaigne advises these thousand others they would do well to adjust their reasoning because the problem “occupies in us only that much room as we give it.” (p. 47) As for how much room to give the stone, he says, “we have no cause for complaint about illnesses that divide the time fairly with health.” (p. 1020)

With his reconciliation of a life with the stone, Montaigne carries on as close to a normal life as possible and not being obsessed with his condition: “Do not expect me to go and amuse myself testing my pulse and my urine so as to take some bothersome precaution; I shall be in plenty of time when I feel the pain, without prolonging it by the pain of fear.” (p. 1023) 

Profitable Kidney Stones

“I have in [my] time become acquainted with the kidney stone through the liberality of the years. Familiarity and long acquaintance with them do not readily pass without some such fruit.” (p. 697) The fruit is the profits he gains with kidney stones. The profits derived mainly from lessening his fear of death, better appreciating the health he had, and getting on with his life more easily. As such he has profited from receiving benefits exceeding the costs he incurred through suffering. 

“I’m not dead yet.” Montaigne wrote that when the stone visited him, he felt he was “so far forward into death that it would have been madness to hope, or even to wish, to avoid it, in view of the cruel attacks that this condition brings.” (p. 771) He had come face to face with death on those occasions only to survive. What he gained from these encounters he eventually appreciated as a form of profit. 

I have at least this profit from the stone, that it will complete what I have still not been able to accomplish in myself and reconcile and familiarize me completely with death: for the more my illness oppresses and bothers me, the less will death be something for me to fear. (p. 698) 

“What a feeling.” The perception of good health is created mostly either by various metrics like physical fitness standards (e.g., weight, strength, endurance), medical diagnoses, and other empiric findings, or by contrasts to states of bad health. Montaigne claimed great profit because his kidney stones reminded him how good his health is generally when he’s not in the midst of an attack. 

But is there anything so sweet as that sudden change, when from extreme pain, by the voiding of my stone, I come to recover as if by lightning the beautiful light of health, so free and so full, as happens in our sudden and sharpest attacks of colic? Is there anything in this pain we suffer that can be said to counterbalance the pleasure of such sudden improvement? How much more beautiful health seems to me after the illness, when they are so near and contiguous that I can recognize them in each other’s presence in their proudest array, when they vie with each other, as if to oppose each other squarely! (p. 1021)

Montaigne also perceived profit from the finite nature of kidney stone attacks. He points to the abrupt resolution of an attack followed by a quick return to good health in contrast to other diseases causing their victims continuous suffering: “My sickness has this privilege, that it carries itself clean off, whereas the other always leave some imprint and change for the worse that makes the body susceptible to a new disease.” (p. 1022)

“Brush off the clouds and cheer up.” To Montaigne, kidney stone attacks are gruesome and can make the sufferer wish to die. But, by their nature, and as a form of profit, they can make life better between attacks than it would be otherwise. Montaigne sees this profit in the certainty that any attack will end and lives can go on as planned, because the stone is “a disease in which we have little to guess about. We are freed from the worry into which other diseases cast us by the uncertainty of their causes and conditions and progress—an infinitely painful worry.” (p. 1023) This means for Montaigne, that the stone “almost plays its game by itself and lets me play mine. (p. 1022)

The idea that there can be profit or any form of benefit from having kidney stones is likely preposterous to modern day sufferers, especially when effective analgesics and surgical techniques for acute attacks and methods for preventing them are available. Many people, however, still struggle with chronic kidney stones making Montaigne’s observations and advice relevant yet. Drawing from a cultural analog, he might tell them to look for the profit kidney stones generate, and when found, they will see that gray skies are going to clear up, so put on a happy face. Alas, his admonition would likely be met with stony silence. 

Kidney stone image from the gallery at KidneyStoners.
Title image credit: Three Kidney Stones Highlighted in Red. Sanderlewis, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

Although his story opens with the establishment of the Johns Hopkins Hospital in 1876, Barry immediately takes a detour into the history of medicine dating back to Hippocrates, and traces the history of medical/scientific thought from Ancient Greece to the end of the 19^th century. He then introduces a series of physicians, scientists, and medical researchers who will play their parts in the story of the pandemic (this first section is called “The Warriors”) and outlines their training, research, and interactions.  

It isn’t until page 91 that he takes us to the rural Kansas county in which the story of the pandemic begins. For although it was called the “Spanish Flu,” that was actually an eponym of convenience; in fact, the first cases of pandemic flu seem to have arisen on the American prairie. However, newspaper reporting on the new pandemic was felt by the Allies and Central Powers alike to be contrary to the public interest (the war was still raging), so it was left to neutral Spain, whose king had come down with the disease, to publish the early reports. In this section, “The Swarm”, Barry also briefly reviews the basic (not to worry, very basic) microbiology of viruses and the history of some prior pandemics. He follows this with the section called “The Tinderbox,” in which he traces the events leading up to the entry of the United States into World War I, and the importance of that war and the political and social conditions surrounding it in the history of the pandemic. From here on in the influenza itself takes center stage; in sections called “It Begins,” “Explosion,” “Pestilence,” “The Race,” and “The Tolling of the Bell,” the rapid and lethal course of the pandemic is described in gripping (no pun intended) detail. The last two sections discuss the scientific advances (and some false starts) brought about by the cadre of researchers working day and night to tame the outbreak, and then Barry finally turns to the retreat of the virus and ultimate end of the pandemic. The book ends as it began, returning to the stories of the individual men and women of science who engaged in the battle to beat the disease of which it had initially been said by many that “[t]his was, after all, only influenza.”  

For anyone seeking to understand the 1918 influenza pandemic not only from a scientific and medical historical standpoint, but also with an appreciation of the political and sociocultural milieu in which it took place, you can’t do much better than Barry’s work. It is not short—it clocks in at 461 pages, with another nearly 40 pages of endnotes and a 20 page bibliography—but it is well-paced and reads smoothly; the narrative carries you along, a testament to the author’s writing style. Barry succeeds in putting a human face on the pandemic and creates a mental image of the horror of pandemic disease which can stand up alongside those we have of the Black Death of the mid-fourteenth century, with which it is often compared. For those of us who know the flu as a seasonal visitor, (for most of us a major annoyance, but nonetheless a disease that kills tens of thousands each year), the images of massive and rapid death—villages abandoned except for piles of corpses, trains that “left one station with the living…[and]…arrived with the dead and dying”—seem surreal. Barry paces the book in such a way that one can almost hear the stopwatch ticking in the background; The Great Influenza is scientific and historical reporting done with great attention to detail and to getting the medical facts right, but it is reporting done with a novelist’s flair.  

Even as the pandemic begins to recede, leaving in its wake not only the dead but those living with its sequelae, such as post-encephalitic syndromes (the Woodrow Wilson/Treaty of Versailles anecdote is particularly striking), the helplessness of medical science is reaffirmed; the pandemic recedes of its own accord, because the virus mutates to less virulent forms, and the very large number of those who have survived helps to create herd immunity.   

In the book’s Afterword, added in 2018, the author discusses and compares influenza pandemics which followed the 1918 experience, talks about some of the antiviral drugs introduced over the years and how they work, and speculates about what the next great influenza pandemic might look like and how it might be prepared for. His concern was prescient, although it would be a coronavirus, rather than influenza, that would cause widespread death and societal disruption. In fact, one of the most jarring aspects of this story is the fact that, if one changes the dates and the names, the tale bears an uncanny resemblance to the COVID-19 story, right down to the attempts at minimization by the government and even the isolation and victimization of an ethnic group (in 1918 the Germans, who were the enemy in the world war, rather than Asian-Americans, as it would be during COVID).  

The Great Influenza is a detailed, highly readable, and sobering account of an episode which demonstrated once again that despite what we may think, we are not the masters of the world in which we live, and that a microbe could rapidly kill on a devastating scale and upend society—again—and there was initially little that could be done to stop it.  

THE GREAT INFLUENZA: A Story of the Deadliest Pandemic in History
John Barry 
Penguin Books, New York, 2004 (reissued with new afterword, 2018)
461 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org

He was wrong.  

In Nazi Germany, sleep was a poor protection from the horrors of the external world, as Charlotte Beradt, a Berlin journalist, found out. Beradt, a Jew and a Communist—and thus an ultimate outsider in Hitler’s state—began having unsettling dreams shortly after the Nazi takeover of the government in 1933, dreams of being “chased, tortured, shot at, [and] scalped,” from which she awakened drenched in sweat. Wondering if others might be having similar experiences, she began collecting dream reports from neighbors, friends, and acquaintances, aided in some cases by a friendly physician who would ask his patients about their dreams in the context of their office visits. She recorded them in her notebook or on scraps of paper, often in coded language so they would be unrecognizable to prying eyes, especially of the police. This project engaged her from 1933 until she left Germany in 1939, ultimately winding up in New York City and settling among a community of German expatriates and refugees, including Hannah Arendt. She originally published her dream reports in 1966; this new English translation by Damion Searls appeared in 2025. 

The book is divided into eleven chapters, each reporting several dreams that are linked by a common thread. Patterns emerge and are echoed: initially, the loss of privacy and the intrusion of state policies into everyday life. There are dreams in which the dreamer is under surveillance or feel they must conform to state policies; Goebbels and Hitler appear in several of these, or exist in the background. There are Kafkaesque nightmares where household items like stoves and pillows become monitors of activity or nagging and accusatory voices (Beradt refers to the “Orwellian” sense of being watched, noting that the dream content prefigures Orwell’s 1984 by many years).  

Interestingly, after 1935 (and the passage of the notorious Nuremberg Race Laws) dreams show up in the text characterized by a preoccupation with the wish for the ideal Aryan body type (blonde, blue-eyed, tall), or, more commonly, the preoccupation with the dreamer’s falling short of this ideal and being singled out for it. Non-Jewish Germans have dreams in which their noses are too prominent and “the authorities” accuse them, directly or indirectly, of having Jewish ancestry. And in her final chapter, “Jewish Dreamers, or, ‘I’ll Make Way for the Trash, if Needed,’ ” Beradt catalogues the dreams of Jewish Germans, dreams of exile, loss, hounding and pursuit, and self-abnegation. 

The book is a relatively brief (122 pages) compendium of nightmares, some of which have the feel of surrealistic short film clips, which catalogues the increasing encroachment of a totalitarian state on the lives—and into the unconscious worlds—of its subjects. The author’s analyses of dreams bespeak her familiarity with dreamwork concepts (she is referred to in several biographical sketches—not part of the book—as a “member of the Berlin psychoanalytic community,” although she was not a trained psychoanalyst), and many of her interpretations are sophisticated and suggest significant familiarity with Freudian concepts.  

It is worth noting that Beradt has probably surveyed a skewed population; her subjects are mostly people she knows, or referred by people she knows and presumably trusts, and there is a selection bias, in that she has probably not approached, say, Nazi Party members or sympathizers for their dreams. A large number of the dreams seem to date from the early years of the Third Reich, 1933-1935/6; it is possible that in the later years it was just too terrifying to talk about one’s nighttime visions…or that the dreamers had started to leave the country. 

The Third Reich of Dreams makes absorbing and chilling reading. It is fascinating to see how dreams, the realm of the personal unconscious, become infiltrated by and reflective of societal change in real time. Sometimes “the royal road to the unconscious” leads straight to the dreamer’s front door.  

The Third Reich of Dreams  
by Charlotte Beradt, translated by Damion Searls 
c. 1966, 2025 
Princeton University Press 
122 pp. 

Web photo by Ed Wingate 

For nearly two decades after the fatwa was issued, his literary career flourished, and he became a visible spokesperson for freedom of artistic expression. As president of PEN, Rushdie promoted initiatives to protect and promote the careers of writers living in fear under repressive political regimes. In August 2022, he was invited to speak on this topic at the Chatauqua Institution, an adult education and social movement. On a sunny summer morning, as he sat on the stage of the amphitheater to begin a public conversation with his interlocutor at Chatauqua, he noticed a man dressed in black suddenly rise up from the middle of the audience and charge the platform. There was no security at Chatauqua that day or any other day because the violent world had never intruded into the bucolic space of the institution during its entire 148 year history. Rushdie found himself rooted to the spot, frozen and unprepared to defend himself as the attacker stabbed him seventeen times – in his eye, his face, his neck, his chest, his abdomen, his hand. Heroic people charged the stage and subdued the assailant. Miraculously, Rushdie survived and he was helicoptered to the nearest trauma center for emergency treatment. Knife is a meditation on the event, the ordeal of rehabilitation that Rushdie had to endure, and his reaction now that he is healed, and his life is restored.

Knife is a visceral book that is grounded in the harsh reality of crazed, religious zealots and painful, tedious rehabilitation. It is different from the magical prose that characterizes much of Rushdie’s writing. The events are described in excruciating detail. One can feel the hurt and sense the worry etched into the pages. It is testament to the many doctors and nurses and therapists who took part in his bodily reconstruction and long convalescence. Most of all it is an inspiring testament to his wife who had the fortitude to be at his bedside throughout the entire ordeal . Rushdie gives her most of the credit for his stamina, the tenacity and resilience that he displayed during the long months after the attack. He substitutes an imaginary dialogue with his attacker in lieu of a face-to-face encounter in prison to express his contempt for his religious intolerance. Rushdie and his wife summon the courage to revisit the Chautauqua stage one year after the attack and achieve some degree of closure on the event.

There is much humanity and wisdom in these pages, lessons on how to confront and overcome adversity. One might question what we, mere mortals, can learn from a singular person like Rushdie who was blessed with such an abundance of human and professional resources to draw on as he recuperated from his injuries. However, differences in fame and access to expertise do not ultimately carry the day. Instead, it is how we as individuals, regardless of our wealth or social status, are able to tap our inner strength and utilize the help and support of our loved ones. The task for us all is to draw on our cognitive and psychological reserves and convert life-threatening tragedies into surmountable setbacks. If, like Rushdie, we succeed, then we will have reached a more mature and meaningful embrace of life in all its beauty and complexity. Rushdie’s story played out in the international limelight. The narrative also unfolds every day on countless hospital floors and rehabilitation units the world over as people strive to overcome injury and illness in their own private world. Rushdie’s template is universal.

But for readers of the Medhum website, I suggest that there is an unspoken but instructive message lurking in Rushdie’s story, specifically for health care providers, doctors and nurses both. There were unexpected turns of events during Rushdie’s recovery. It was not an uninterrupted march from near death to healing. He experienced disabling complications from medications that were prescribed for rational clinical reasons, iatrogenic problems. In one case, severe urinary retention requiring repeated painful bladder catheterization, it was only through the astute observation of one of the clinicians that the causative medication was stopped and the problem spontaneously resolved. In another, he experienced symptomatic hypotension, a disabling side effect of one of the drugs prescribed for him. There was a cancer scare when an imaging study performed to assess his urological problems. suggested he might have a lesion in his prostate. He experienced excruciating pain when his eyelids needed to be sutured together to protect his injured eye. In each case, Rushdie was reassured that things were proceedings according to plan and that things should improve with time. Follow up tests were done to monitor the prostate anomaly and confirm improvement in his symptoms but the discomfort and unease lingered in his body and his mind. The anxiety that the problems might not resolve was ever present in Rushdie’s consciousness. 

Doctors know that recovery from injury or illness is a time consuming process that rarely occurs overnight. They are right to encourage their patients to take the long view of their health problems, to reassure them the treatment is usually a continuing proposition. But even for a highly intelligent patient like Rushdie, the doctor’s confidence in how things were going could never completely allay the fear that his broken body would not heal, and his health would not be restored to what it had been pre-knife attack. Daniel Kahneman and Amos Tversky won the Nobel Prize in Economics in 2002 for groundbreaking studies that explored how people assess loss and gain and make financial decisions. Kahneman expanded on their studies in behavioral economics and proposed that rational thought utilizes two operational modes. System 1 is rapid and instinctive in contrast to system 2 which is slower, more deliberative, and more reasonable. Channeling this work by Kahneman, there may be two systems operating during recovery from bodily injury. Doctors may be employing an analog System 2 method of thought as the disease is steadily halted, reversed, and repaired. Patients, however, live through illness in a binary System 1 approach of thought: sick or back to normal. We physicians would do well to remember that the only words our patients really want to hear from us when they come to us for care are, “You are now fine. We can stop the medications and stop the follow up. You are back to normal.”

Knife
Salman Rushdie
Knopf 2024, 209 pages

Human behaviors in many segments of society during the Covid-19 pandemic could have been predicted based on literary texts from the past and right up to the moment the pandemic began. In this episode, we compare excerpts from selected literary texts imagining or depicting human reactions to plagues ranging from as far back as 700 years to just one month after the pandemic began with statements made or actions taken during the pandemic. The similarities are uncanny. Russell is inclined to think this means we’re doomed; Dan is not so inclined.

Links:
Links to Russell Teagarden’s blog pieces in According to the Arts on the sources discussed in episode:
— The Decameron, Giovanni Boccaccio, New York, Penguin Classics, 1972 (written in 1351-1353) 
— The Pandemic’s Impact on NYC Migration Patterns, New York City Comptroller Scott M. Stringer, Bureau of Budget, November 2021.
— Arrowsmith, Sinclair Lewis, In: Sinclair Lewis: Arrowsmith, Elmer Gantry, Dodsworth, Library Classics of the United States, New York, 2002 (first published in 1925)
— The Betrothed, Alessandro Manzoni, Penguin Books, New York, 1972 (first published in 1827)
—The End of October, Lawrence Wright, Alfred A. Knopf, New York, 2020

Links to sound clips:
Contagion (2011) – Steven Soderbergh, director; Scot Z. Burns, writer

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by CDC

We feature James Dickey’s poem, Diabetes, with our guest, the renowned physician-poet Dr. Jack Coulehan. We discuss insights the poem offers about the trajectory of type 2 diabetes from the time of symptom onset until the time a balance is achieved between maximum compliance with disease management requirements and the compromises an acceptable lifestyle can necessitate for many individuals. In addition to providing his perspectives on how the poem expands on the biomedical components of diabetes in recognizing effects such as fear, anxiety, frustration, and oppression, Dr. Coulehan recounts how he has used this poem and others in teaching medical students and residents. He also tells stories of particular instances in which he used poetry as part of the care he provided certain patients, and as a way to connect with them. 

Links:
Dr. Jack Coulehan’s bio and posts on Medhum.org

The poem, Diabetes, and the comparative biomedical text discussed can be seen here in Russell Teagarden’s blog, According to the Arts. 

Dr. Coulehan’s poem, I’m Gonna Slap Those Doctors, which was central to one of the stories he told, can be accessed here. And, his poem, The Man with Stars Inside Him, which was central to another story he told, can be accessed here.

In this episode, we make a distinction between illness as the subjective perceptions of a health problem and disease as the pathological basis of a health problem. This distinction is explained in much greater depth here in According to the Arts. 

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by Álvaro Serrano