The Emergence of Tropical Medicine in France

By Michael A. Osborne

The Emergence of Tropical Medicine in France examines the turbulent history of the ideas, people, and institutions of French colonial and tropical medicine from their early modern origins through World War I. Until the 1890s colonial medicine was in essence naval medicine, taught almost exclusively in a system of provincial medical schools built by the navy in the port cities of Brest, Rochefort-sur-Mer, Toulon, and Bordeaux. Michael A. Osborne draws out this separate species of French medicine by examining the histories of these schools and other institutions in the regional and municipal contexts of port life. Each site was imbued with its own distinct sensibilities regarding diet, hygiene, ethnicity, and race, all of which shaped medical knowledge and practice in complex and heretofore unrecognized ways.
           
Osborne argues that physicians formulated localized concepts of diseases according to specific climatic and meteorological conditions, and assessed, diagnosed, and treated patients according to their ethnic and cultural origins. He also demonstrates that regions, more so than a coherent nation, built the empire and specific medical concepts and practices. Thus, by considering tropical medicine’s distinctive history, Osborne brings to light a more comprehensive and nuanced view of French medicine, medical geography, and race theory, all the while acknowledging the navy’s crucial role in combating illness and investigating the racial dimensions of health.

• Language: English
• Publisher: University of Chicago Press
• Release date: Mar 24, 2014
• ISBN: 9780226114668

Book preview

Michael A. Osborne is professor of history of science at Oregon State University and president-elect of the International Union of History and Philosophy of Science and Technology’s Division of the History of Science and Technology. He is the author of Nature, the Exotic, and the Science of French Colonialism.

The University of Chicago Press, Chicago 60637

The University of Chicago Press, Ltd., London

© 2014 by The University of Chicago

All rights reserved. Published 2014.

Printed in the United States of America

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ISBN-13: 978-0-226-11452-1 (cloth)

ISBN-13: 978-0-226-11466-8 (e-book)

DOI: 10.7208/chicago/9780226114668.001.0001

Library of Congress Cataloging-in-Publication Data

Osborne, Michael A., author.

The emergence of tropical medicine in France / Michael A. Osborne.

pages cm

Includes bibliographical references and index.

ISBN 978-0-226-11452-1 (cloth : alkaline paper) — ISBN 978-0-226-11466-8 (e-book)

1. Tropical medicine—France—History—19th century.   2. Medicine—France—Colonies—History—19th century.   I. Title.

RC962.F8083 2014

616.9'88300944—dc23

2013028983

This paper meets the requirements of ANSI/NISO Z39.48-1992 (Permanence of Paper).

The Emergence of Tropical Medicine in France

MICHAEL A. OSBORNE

The University of Chicago Press

Chicago and London

à une femme exceptionnelle

CONTENTS

List of Abbreviations

Introduction: Place, Medicine, and the Colonial Situation

ONE. Emplacements: Medicine, the Navy, and the Enlightenment Heritage

TWO. A Medicine and Hygiene of Place

THREE. Medical Constructions of Race: Biological Determinism and Anthropological Pluralism

FOUR. Belligerence, Bombs, and Bordeaux: A New Place for Naval and Colonial Medicine

FIVE. The Emergence of Colonial Medicine in Marseille

SIX. Colonial Medicine at the Paris Faculty of Medicine

Conclusion

Acknowledgments

Notes

Bibliography

Index

ABBREVIATIONS

INTRODUCTION

Place, Medicine, and the Colonial Situation

This history of the ideas, people, and institutions of French colonial medicine focuses on the period from the end of the Napoleonic Empire (1815) through World War I. France reconstituted an empire in these years and what counted then as colonial medicine, with the exception of the army colony of Algeria in the midcentury years, was largely naval medicine, a constellation of healing practices elaborated and refined in provincial medical schools in the cities of Brest, Rochefort-sur-Mer, and Toulon. In the late nineteenth century additional nodes of activity coalesced in Bordeaux, Marseille, and Paris. As the twentieth century opened, the vast majority of young healers bound for the colonies learned and refined their craft in coastal cities or while voyaging with the navy. For all but a few months of the period studied, the navy administered the colonies through a subdirectorate, though its grasp on colonial activities weakened in the 1890s. The book considers the social, technological, and disease environments of these Atlantic and Mediterranean port cities, and the ships that voyaged from them. It also, I hope, recovers an important dimension of French medicine and locates its place in the ideas, institutions, and practices of naval and colonial medicine over the long nineteenth century.

Why, it might be asked, is such a book needed? A primary reason, recognizable to all historians of medicine and of modern European imperialism, is the asymmetry of the field’s historiography and the attendant ways we conceptualize the problems we study. The vast majority of historical scholarship engaging the dynamics of health in Europe and its colonies focuses primarily on the British Empire and particularly British activities in India, Britain’s most important colony of the nineteenth century, and secondarily on Africa. There are sound reasons for these scholarly emphases beyond those of English-language sources and concentrated and well-ordered archives. The British Empire was larger and more populous than that of France. India, or at least its importance in matters of health, was also well-known to European physicians who identified India as the source of cholera, the major disease behind nineteenth-century European sanitary reform. Moreover, John Snow’s identification of Asiatic cholera’s water-borne nature in 1854, and the Indian Rebellion of 1857 followed by Britain’s Government of India Act of the next year, linked the destinies of the two countries for nearly a century. Studies by David Arnold and Mark Harrison on India, and those of Philip Curtin on Africa, have underlined the centrality of disease and sanitation measures for military activities, imperialism, colonial governance, and commerce.¹ Harrison, in particular, has examined British colonial medicine and noted that by the 1840s the experience of India’s physical environment, one aspect of place, occasioned a hardening of racial categories and a shift away from the notion that Europeans would eventually adapt to the Indian climate.² While I find this scholarship incisive, it is not an explanatory model for investigating French racial theory or French colonial medicine, or the dynamics of colonial medicine in the Portuguese, Spanish, or Dutch empires. Nineteenth-century colonial medicine resists incorporation into a pan-European model, although instances of international cooperation between empires exist. Colonial medicine was heterodox in the training of its practitioners, diverse in its missions and patients, and subject to divergent imperial and national policy regimes. The emplaced nature of the activity was itself enmeshed in the evolving contexts of colony and European nation-state relations, and those nations were frequently at war. Thus public-health procedures common in British India for the prevention of smallpox were more fluid in the neighboring Portuguese colony of Goa.³

A second reason for this book is rather more narrow and reflective of the historiography of French medicine itself. Most of what we know about nineteenth-century French medicine concerns civil medicine, particularly Parisian medicine and especially individuals associated with the Paris Faculty of Medicine. This is not very surprising, as the Paris Faculty trained more French physicians than all other medical faculties combined. Paris also hosted two additional fonts of medical imperialism: the army postgraduate medical school and hospital at Val-de-Grâce, and, after 1887, the Pasteur Institute. Both were important centers of colonial and tropical medicine, and the Pasteur Institutes and Pasteur’s science still generate much historical scholarship. Additionally, the archives of these Parisian institutions are concentrated, well-kept, and easily accessible. In short, a historian’s dream! Understandably, then, the historiography of French medicine and medical imperialism is often told in relation to Parisian institutions and actors.

Yet this current historiography of Parisian and civilian emphasis merits reevaluation. For colonial medicine and the study of exotic pathology and its pedagogy, the action until the very end of the nineteenth century was not in Paris but in those provincial port cities constructed by the navy, on the great school of the sea, at colonial stations, and later in Bordeaux and Marseille. The naval medical schools of the coastal cities and the Paris Faculty of Medicine had very different resources and patient populations. Moreover, unlike the civilian faculties of medicine which operated under the Ministry of Public Instruction, naval medical schools could not confer medical degrees. Additionally, naval medical training and career patterns were vastly different from those of civilian medicine and even from those of army medicine. It was, as its practitioners noted time and time again, a special and distinctive sort of medicine in virtue of its content, practitioners, patients, diseases, and places of practice. My hope is that this book will enable a more comprehensive and nuanced view of French medicine and will signal the navy’s crucial role in the fight against exotic diseases such as yellow fever and the construction and medical policing of the modern French Empire.

In this book I argue that maritime France was the cradle of the new French Empire, and I give voice to those physicians who had experience in the colonies, encountered colonized peoples, and battled colonial diseases. Colonial physicians, of course, pondered ideas of race and combined analyses of physical characteristics with observations on morbidity, mortality, habits, and physiology. Their perspectives complicate and in some ways recast the narrative of French racial ideas. Racial ideas and ideas of empire were fluid, and visions of the colonial project differed widely among those in Paris and agents in the colonies.⁴

When I began research on this book, the Service Historique de la Marine at the Château de Vincennes near Paris was a more independent agency than it has become since a 2005 décret forced greater integration with the army and the Ministry of Defense. The integration of naval institutions into those of the army has a long history in France, and in many ways the process has worked against the sorts of localism, discrete social worlds, and attachments to place that readers will encounter in this book. A chance encounter at Vincennes with the retired naval physician and historian Médecin Général Bernard Brisou provided a seed crystal to my ideas. Dr. Brisou is one of very few people to have written about the reformer of French naval medicine, Dr. Laurent Jean-Baptiste Bérenger-Féraud, who will appear in chapters 3 and 4. In 1982 and 1983 Brisou directed the successor institution to the navy’s central medical school in Bordeaux, the École du service de santé des armées. This was immediately after Prime Minister Raymond Barre’s government had attempted to close the school and incorporate it into the army medical school at Lyon. I asked Dr. Brisou if he thought that Bérenger-Féraud had really posted book bombs to government officials of the Third Republic. Brisou found the historical records ambiguous on this point, but his reply surprised me when he said, You would have to be from Toulon to know.⁵ What, I thought, could Toulon have to do with it? And further, since General Brisou was a member of the Académie du Var located in Toulon and had lived and worked in the city for many years, what sort of an answer was this?

The issue of Bérenger-Féraud’s culpability, and a fascination with the places of nineteenth-century colonial medicine, has taken me to archives in Toulon, Rochefort, Bordeaux, Brest, Marseille, and of course Paris. This book is my attempt to understand the logics of localism and the contexts of colonial medicine in France. It is about the power of place and how place functioned in one sector of French medicine.

Place, as defined in this book, is not only a point on a map. It is also a site of meaning and attachment, one to which value is assigned, often through the textured facts of experience and memory. There are, of course, studies of colonial places and health, and Dane Kennedy’s study of hill stations in British India and Julyan G. Peard’s examination of academic physicians in Brazil are good places to start.⁶ In contrast, I have focused on how attachments to places in France structured ideas and actions about diseases and peoples. Good history reconstructs this world of meaning, and as much as possible I have tried to elucidate emotional and intellectual attachments to place.⁷ The notion of places enabling and structuring actions has been around for some time. The microbiologist and environmentalist René Dubos endowed places with a special genius of physical, biological, social, and historical forces, and more recently Pierre Nora and others have tried to sort out how places and memory intertwine.⁸ Places are intensely human, and they change as human memory changes.⁹ For the philosopher Edward S. Casey, places are embodied in human action, for "we are not only in places but of them."¹⁰ For cultural and historical geographers, whose ranks have dwindled in the last few decades, the concept of place offers an alternative to newer cartographic perspectives such as spatial science which have tended to erase humans from geography. In medicine, the diagnosis of disease, therapeutic actions, and sanitation projects occur within socially emplaced worlds and are conducted within a nexus of intellectual and material constraints and opportunities.

As employed in this book, then, the concept of place incorporates regulatory, experiential, and locational elements of French maritime culture with chorology-like levels of local and regional analysis. The manuscript owes a minor debt of conceptualization to Jürgen Habermas’s distinction between the lifeworld of daily life and mutual interactions, and the system of more distant bureaucratic regulations.¹¹ But while Habermas interpreted these two spheres as being in more or less permanent conflict, I have treated them as resources to be marshaled and as productive of dynamic energies that at times might be channeled into states of quiescence, agreement, or conflict. In the case of the navy the system was not distant from the life of the port cities and their medical schools, for while regulations might be codified in Paris, they often addressed or incorporated recommendations from the ports.

This book, of long chronology and wide geographical breadth, examines how diverse places and peoples in France were situated in a highly problematic and enmeshed relationship with infranational realities and colonial regimes. Many scholars, including Eugen Weber and Mary Jo Nye, have examined the effects of telegraphy, the railroad, and the modern university system on regional identities and the French nation. They have shown how both local and national interests negotiated the passage to modernity.¹² As regards colonial medicine, I have tried to make a case for the centrality of cosmopolitan naval personages in this modernizing process, healers who circulated between the colonies and mainland French institutions in the provinces or Paris.

I have great respect for what Georges Balandier termed the colonial situation and his plea to reflect on the reality of colonialism as we write colonial and metropolitan histories.¹³ Balandier was not interested in medicine although he should have been. Modern colonization created an infrastructure for the transmission of diseases, not only from the colonies to Europe, but also in Africa where sleeping sickness became epidemic as a result of European incursion and plantation culture. Around 1900, the European empires nurtured international networks of specialists in a newer tropical medicine founded on medical parasitology.¹⁴ One recent scholar has even argued that the age of colonization was also the first age of universal contagion.¹⁵ Locating place at the center of the narrative recognizes the specificity of the colonial situation and brings to view how the vibrant and highly localized histories of French maritime culture conditioned the careers, ideas, and sensibilities of naval healers.

Naval and colonial medicine was conducted in discrete regulatory and physical environments. Their spheres of activity were similar but not identical, although until the early twentieth century training in naval medicine constituted the main gateway for colonial medical careers. The French navy trained their medical men in their own schools and prepared them for service to naval personnel, other state employees, prisoners, and workers shipped from one corner of the empire to another. Healers worked largely within a world structured by the navy’s ports, ships, and in the case of Southeast Asia prior to 1887, the navy’s own colonies and other colonial postings. French agents, and those who worked for them, constituted the majority of the patient base, and little attention was paid to the health of indigenous peoples before 1900. Hence, understanding French naval and colonial medicine mandates recognition of its discrete regulatory regime and educational institutions. Following Balandier’s lead, we might call this the special situation of naval and colonial medicine.

Perceptions constitute one way of associating people with places. The hygienic sciences, both before and after the bacteriological revolution, delighted in investigating and categorizing unclean and unhealthy places and peoples. Commentators, from the novelist Gustave Flaubert to the contemporary historian of medicine David S. Barnes, have noted how the places and peoples associated with the navy allowed Parisians and some Frenchmen and women to define themselves as clean or modern. The large naval port of Brest in Brittany and its naval medical school and hospital were iconic features of naval healing, and for Barnes, Brittany represented the absolute self-defining Other for secular, urbane, and scientific-minded Frenchmen. The prevailing way of life there became, in essence, the very antithesis of Frenchness.¹⁶ Defining Frenchness, of course, is problematic, as is determining the sort of medicine appropriate for most Frenchmen and women. Nineteenth-century France was a collage of people typified by differences in physiological constitution, language, ethnicity, diet, religious sensibility, and personal hygiene. These factors, while important for civilian healers, were often predisposing for naval physicians who cared for men under the stress of long campaigns and on foreign soil.

As the historian of medicine John Harley Warner has noted, there was wide appeal even in antebellum America to the notion that the medical art was not universal but had to be adjusted to such individuation characteristics of place as climate, topography, and settlement patterns, just as it had to be tailored to the gender, ethnicity, temperament, and race of individual patients.¹⁷ Accepted methods die hard in medicine and the navy could be counted on to support tradition. In the early twentieth century, several years after a viable germ theory of disease and the emergence of medical parasitology, French naval physicians continued to record and map the location and distribution of diseases. This tradition of spacial medicine, examined in chapter 2, continued even as naval healers embraced clinical and laboratory methods. Thus in 1929, when Alexandre Le Dantec—a naval physician and France’s first professor of exotic pathology in a civilian medical faculty—published the fifth edition of his textbook, the Précis de pathologie exotique, he reviewed basic geography and climatology as well as the geographical distribution of malaria and yellow fever. He also recorded how local circumstances and ethnicity altered the presentation and etiological course of these afflictions.¹⁸ As George Weisz and others have shown, even civil medicine in this era experienced a revival of climatological and hydrological healing under the banner of medical holism and neo-Hippocratic ideals.¹⁹ But naval healers, who often worked under extreme climates and in the cramped quarters of prisons, arsenals, and ships, were especially attentive to what Charles Rosenberg has termed the implacable situatedness of morbidity and mortality.²⁰

The Emergence of Tropical Medicine in France investigates two senses of place and attempts to balance analysis of the universal and particular, after the fashion of chorologists, or regional geographers.²¹ The first axis of investigation is translocational and administrative and follows the evolution of a naval regulatory regime which coalesced in the late seventeenth and early eighteenth centuries. A second sense of place derives from the physical and social conditions of maritime culture and the ecology of disease in ports, prisons, and on ship. Many of the physicians and surgeons in this book wrote of their attachments to the coastal cities of Rochefort, Brest, Toulon, and Marseille, and the regions of their birth. In this I hope the book goes some way toward recovering the personal attachments to real and imagined landscapes, people, and ships. These two elements of place, the translocational and attachment to region of origin and venue of training, counted for much in the advancement system of the French navy. Regulations, of course, could be circumvented or applied inconsistently. They might also be unenforceable, or nearly so, and fuel tensions and resentment.²² Disparities in salary and opportunities for advancement stimulated impassioned calls to overturn regulations and pitted navigans who voyaged against better-paid professors who taught in the port medical schools. Regulatory reform also provided pretexts for violence such as the book bomb incident recounted in chapter 4.

The regulatory apparatus of the French navy, codified in 1689, governed naval surgical and medical training for about two centuries. It structured and disciplined the place of naval and colonial medicine within the navy. This is why chapter 1 devotes many pages to the rarified, discrete, and cumbersome naval regulatory system and the ports, ships, and people governed by it. Cardinal Richelieu, who led the maritime offices after 1626 and served Louis XIII in several capacities, fashioned the core of the Royal Navy.²³ Inheriting a navy improvised from merchant ships and typified as extraordinarily fragmented and regional, he left as legacy a cohesive fleet of royal warships and a zealous mentality of accounting.²⁴ Richelieu focused less on colonial matters than on the subjugation of Protestant minorities (the Huguenots) and strengthening France for battle with the Hapsburg Empire.²⁵

Naval healing practices and institutions developed in tight relationship with the growth of the navy and the sovereign’s valuation or at least recognition of colonial activities. When Richelieu arrived on the scene, French maritime activities remained rooted in feudal privileges, obligations, and concessions. The maritime professions and trades of this era, more often the purview of adventurers rather than savants, were overseen by four separate jurisdictions or admiralties. These included the king’s fleet and three others: the admiralty of Guyenne, based northwest of Bordeaux in and around the Atlantic port of Brouage between the mouths of the Gironde and Charente rivers; the admiralty of Provence, which profited from trade with the Levant; and that of Brittany, whose destiny remained linked to French projects in the Americas.²⁶

Richelieu’s successors—Jean-Baptiste Colbert, who took over the department of the navy in 1669, and particularly Colbert’s eldest son, Jean-Baptiste Antoine Colbert de Seignelay—instituted reforms which crystallized as the navy’s Ordonnance (hereafter ordinance) of 1689, sometimes referred to as the fundamental ordinance.²⁷ Ordinances established basic legal codes promulgated by the king and thus constituted a higher order of comprehensive regulations. They were distinguished from less comprehensive legal actions such as édicts, which generally addressed a single specific issue, or déclarations, legislative acts modifying prior édicts or déclarations. The ordinance, signed by the king on April 15, 1689, constituted the French navy’s birth certificate. The contexts of its emergence, and the creation of naval hospitals, medical schools, prisons, and arsenals receive sustained attention in the following chapter.

Chapters 2 and 3, respectively, demonstrate how the administrative system and the daily activities of medical men intersected at significant sites of naval and colonial medicine. Chapter 2 focuses on the practice and status of hygiene within the naval medical schools and on the laboratory of the ship. Hygiene and medical geography constituted the quintessential sciences of place. The chapter also investigates the etiological riddle of dry colic, a disease perceived to be of tropical origin and one which emerged simultaneous to modernization of the French fleet and French colonial expansion into Africa and Latin America in the nineteenth century. Chapter 3 examines the medicalized body and concepts of ethnicity, or what I have termed internal and external concepts of race. The former refers to the perceived races of the French themselves, while the second or external concept focuses on studies of the peoples of Africa and the Caribbean. The evolution of these racial concepts is examined in relation to the staffing needs of the navy and colonies, and the ethnic selectivity of yellow fever, or, as John R. McNeill might say, the differential immunity to yellow fever.²⁸

The study of yellow fever, the memory of its place in French colonial history, and nineteenth-century encounters with the disease, filtered into the very fabric of French colonial medicine. Several of the physicians in this book considered yellow fever, a disease active in the Americas since at least the mid-seventeenth century. It seemed to follow the slave trade and was present as France developed the Caribbean cane colony of Saint Domingue (now Haiti). This engine of wealth for the French Crown was the iconic French colony of the eighteenth century and might have become a French colony to rival British India. But the French exited the island in 1803 after history’s deadliest outbreak of yellow fever. French colonial physicians encountered the disease at home and abroad and tried to control outbreaks of it on ships and in ports from French Guiana in South America to Mexico, Martinique, and Guadeloupe. The disease also frustrated French efforts in West Africa, and epidemics of 1878 and 1881 on the island of Gorée and the mainland city of Saint Louis decimated the European population.²⁹ The majority of the physicians who died in these West African epidemics were neither army nor civilian physicians. They were naval physicians in colonial service, and their presence exemplifies the special situation of French colonial medicine.

I argue that French naval and colonial physicians combined ethnological views of African and Caribbean peoples with perspectives from physical anthropology and physiology. Moreover, naval physicians were most interested in physiology and physical capabilities as these two attributes related to labor and staffing, and many naval physicians were more pluralist and less essentialist in their racial thinking than has been portrayed. Here, I think, inclusion of the medical dimensions of racial thinking complicates histories of the advance of physical anthropology over ethnography. I am of course fully aware that perceptions of difference are neither made nor supported solely on the basis of anthropology, ethnography, or medicine. A number of scholars including Tyler S. Stovall, Georges Van Den Abbeele, Laura L. Frader, and Herrick Chapman have shown how literary, linguistic, religious, and nationalistic terms inflect racial concepts.³⁰

Chapter 4 addresses naval and colonial medicine during the republican reforms of the Third Republic and charts the partial separation of these two activities. The expansion of the empire, its partial civilianization, and structural tensions within the system itself mandated changes. This time of crisis, reform, and centralization prefaced the eventual demise of the system of port medical schools founded under the Old Regime and forever altered the status and career patterns of navy medical school professors. It also signaled changes in the navy’s role in colonization and the teaching of colonial medicine.

Two concluding chapters examine aspects of the new civilian and army colonial medicine. Chapter 5 describes the key institutions of colonial science and medicine in Marseille. It compares and contrasts the scientific norms for physiological research found there with those of the very different world of Paris and shows how place and disease ecology influenced administrative choices and scientific research programs. Chapter 6 assesses the emergence of a civilianized colonial medicine in Paris and the founding of the Paris Faculty of Medicine’s Institute of Colonial Medicine. The institute’s founder, the parasitologist Raphaël Blanchard, was a medical humanist who elaborated a cultural program for colonial medicine and parasitology. An advocate of scientific internationalism, his career and creations mark the transition from the port-based local and regional medical traditions appropriate for naval and colonial medicine to a newer yet still emergent regime of universal tropical medicine. Blanchard, who was not a navy man, was a skilled manipulator of the system of regulations. His career at the largest civilian medical faculty in France exemplifies the convergence of the new lifeworld of practitioners with an altered system of colonial medicine.

ONE

Emplacements: Medicine, the Navy, and the Enlightenment Heritage

Naval and colonial medicine arose in the early modern era as part of France’s maritime activities and the emergence of a Royal Navy. This chapter examines the industrial, colonial, and military contexts of this emergence with special reference to the three naval ports of Brest, Rochefort-sur-Mer, and Toulon. The story includes lifeworlds of squalor and labor conducted within or on the margins of the navy’s discrete regulatory regime—a source of the navy’s alterity. After 1689 the naval ports housed a substantial population of patients with minimal but important rights to health care. Some six decades later the addition of bagnes, prisons structured around forced labor, transformed port environments. Prisoners fashioned the armaments of war, repaired ships, built hospitals and worked in them, and undertook a variety of public works projects. The bagnes also provided a steady supply of cadavers for anatomical and surgical instruction, and the institution itself was a kind of laboratory for the study of morbidity, forensic medicine, race, and epidemiology.

Historians of colonialism find it convenient to write of the French Empire as composed of old and new colonies. This distinction, though, is not especially useful for understanding the history of French colonial medicine. The so-called old colonies, for the main part acquired and lost prior to 1830, included holdings in South Asia (Chandernagor, Pondichéry), North America (New France, Louisiana), the Caribbean (Gaudeloupe, Martinique, Saint Domingue), South America (Guiana), the western nose of Africa (Ft. Saint-Louis, Île de Gorée), and the Indian Ocean (Île de France, Mauritius, Île de Bourbon). In the eighteenth and early nineteenth centuries wars, particularly the Seven Years’ War (1756–1763) and the French Revolution, reduced this colonial network to a shadow of its former self. The newer colonies, essentially those formed from 1830 onward when the French took the North African city of Algiers, became far more extensive than those of the Old Regime. By midcentury the French navy, diplomats, and commercial interests had established a presence in Southeast Asia. The French consolidated their holdings in the region and declared Vietnam a colony in 1887. With Algeria seemingly in control, the French expanded into Morocco, Tunisia, Sub-Saharan Africa, and Madagascar. Such a skeletal account of old and new colonies, however, presents an overly discontinuous view of empire. For example, France regained and strengthened its presence in West Africa in 1817 when it reacquired Senegal. It also developed Senegal in new directions once a primary reason for its existence ceased with the abolition of the slave trade. Other continuities existed as well, and the governance and institutions of colonial and naval medicine effectively straddles the pre- and postrevolutionary eras. Significant features of the old regulatory regime of the seventeenth century, and the domestic port bagnes of the eighteenth century, persisted into the early years of the Third Republic and continued to structure naval and colonial medical activities.

1. Map of France showing location of five major naval ports and other cities mentioned in this book. Target symbol indicates a major naval port.

Lived Environments: Lifeworlds and Early Modern Industry at Brest, Rochefort, and Toulon

Pedagogy for naval healing arose, as Balandier might have termed it, in a special or discrete situation, structured around the sea, colonies, and the highly specific social and technological environments of the Atlantic cities of Brest and Rochefort, and the Mediterranean port of Toulon. There ports arose from marsh, mud, and stone, and did so in accord with contingent and evolving naval mandates. Frustration and disaster marked this situation as the French navy was defeated and destroyed three times at the hands of foreign powers (1763, 1789, and 1870), and dry-docked and severely underfunded in 1690 while the Sun King conducted campaigns throughout Europe.¹

The navy designated the ports of Brest, Cherbourg, Lorient, Rochefort, and Toulon as strategically and administratively significant grands ports to distinguish them from secondary ports like La Rochelle and Nantes. Naval activities in these grands ports of the French state enabled an institutionalization of surgical and medical schools at Rochefort (1722), Toulon (1725), and Brest (1731). While Cherbourg and Lorient had hospitals and naval physicians in charge of port health, the system of naval healing and particularly its pedagogical dimensions were concentrated in Rochefort, Toulon, and Brest. These schools and their associated hospitals drew patients from those who worked for the navy. In the middle of the eighteenth century, the addition of bagnes and thousands of prisoners expanded the fund of patients overseen by the navy. The three schools were insular as the majority of students and professors hailed from regions near these ports. This circumstance ensured that ethnicity and regional ties remained features of naval medicine. French was the language of the French nation, yet in Brittany parish priests embraced Breton as a means of preserving the Catholic faith. Even as late as 1863, a public school inspector in the department of Finistère found that teachers used Breton to communicate with their students.² Substantial numbers of surgeons grew up speaking local languages such as Breton and counted French as a second language, a circumstance that reinforced their identity as Brestois, Rochefortais, or Toulonnais.

Brest, Rochefort, and Toulon shared similarities in that they were naval towns with arsenals and prisons. All of them experienced significant immigration from the surrounding countryside and wildly erratic cycles of economic expansion and decline. Yet they varied substantially in regional culture, language, and identity. In the 1660s the government of Louis XIV, after spending lavish sums to construct an arsenal at the Atlantic port of Le Havre, separated the ports of the Royal Navy from those of the commercial fleet. The rapid and intensive construction of harbors and arsenals and the later addition of large prisons structured these centers of early modern industry. Insularity mingled with the cosmopolitanism of empire in these naval worlds which lodged some seventy-two thousand naval officers and seamen on the eve of the revolution.³ The navy remained an abiding presence in the intellectual, commercial, and cultural lives of Brest and Toulon through much of the nineteenth century; however, the navy’s commitment to Rochefort receded within a few decades of its organization. Nonetheless, naval and colonial medicine gained and maintained a foothold in all three locations.

The formal institutional separation from the civil sphere marked inhabitants, naval careers, and naval medicine. Arsenal work anchored economic life in Toulon, Brest, and Rochefort, and lesser maritime workshops clustered around the northern Atlantic ports of Le Havre and Dunkerque.⁴ Toulon, Brest, and Rochefort sprang to life and persisted as places designed to marshal and engineer resources for the acquisition, maintenance, and governance of empire. With the possible exception of Bordeaux, site of commercial ventures with West Africa and the classic Old Regime sugar colony of Saint Domingue, the three new ports experienced infrastructural growth and demographic features not seen in France’s interior. In contrast to Bordeaux, which also had viticultural industries, the funding of sea power by the Crown and postrevolutionary governments was the lifeblood of Brest, Rochefort, and Toulon.⁵ Substantial Crown funding enhanced the separation of these cities from the life of their regions. For example, the economy of early eighteenth-century Brest bears more resemblance to the Mediterranean port of Sète, or the Atlantic port of Lorient which was home to the Compagnie des Indes, than to the agricultural economy of its region, and in all three cities laborers and artisans counted for about two-thirds of the population.

Location mattered as the three cities had different relationships to the seas they bordered. In the age of sail, only Toulon and Brest could be accessed consistently by large ships. But westerly winds at Brest, a town of about 3,500 in the 1630s, made passage difficult seven months of the year.⁶ In contrast, Toulon, poised on the Mediterranean between Marseille and Nice, possessed an ideal anchorage. The French state recognized Toulon’s strategic utility in the sixteenth century and in 1513 constructed an imposing tower to guard the harbor.⁷ The city and its fortifications grew as the French state reduced its reliance on Spanish and Genoan ships and built its own. Early modern Toulonnais engaged in fishing, commerce in slaves, and a bit of agriculture. But if the port was deep it was practically indefensible against invaders of all sorts. Romans, pirates, Normans, the English, and waves of cholera and plague invaded and took up residence in the city. Sited within the shadow of the more populous commercial port of Marseille, Toulon launched the fleets of empire including Bonaparte’s expedition to Egypt of 1798 and Charles X’s expedition to Algiers in 1830. The building of a massive arsenal and the construction of ships for the king’s navy, for which Toulon would be celebrated, began in earnest in 1665 with Louis Le Roux d’Infreville’s appointment as intendant.⁸

Shipbuilding and maintenance are complex and expensive processes. In times of rapid technological change, as when steam replaced sail power, the time required to build a ship could surpass its time in service. The three ports performed these tasks according to local contingencies and resource endowments of labor and materials. Provided a ship was not retired as the result of war or accident, the quality of materials and craftsmanship as well as its venues of service and anchorage determined its life span. One eighteenth-century commentator estimated that ships built in Rochefort might last up to fifteen years, while those of Brest and Toulon could be expected to last twice that time.⁹ Another estimate of the era calculated that Toulon’s ships lasted somewhat less than twenty years, while those of the Atlantic ports were likely to be retired after a decade.¹⁰ Toulon’s intendant noted in 1769, as had Colbert’s eldest son in the 1680s, that it was frequently cheaper and always faster to build new ships than to retrofit older ones.¹¹ Thus the differing material endowments of the three ports and most likely the quality of the timber which was at first gathered from the regions around the arsenals, and the manner in which that timber was cured, had a significant effect on perceptions of ship longevity and possibly the longevity itself.

In 1666 Toulon’s arsenal outfitted nineteen vessels, including France’s first 120-cannon ship. The entire flotilla then joined the Dutch in battle against England. Yet according to the intendant’s report of 1673 the arsenal was still too small. Weaponry and timber had to be stored outside the arsenal and at most the shipyard could work on only four ships at a time. The intendant hoped for a covered building for rope making as the present corderie, such as it was, was inside the arsenal in the open air where it disrupted other teams of workers.¹² The engineer and military architect Sébastien Le Prestre de Vauban addressed the corderie problem and others after his arrival in 1678 as Toulon’s new Commissaire général des fortifications. Vauban renovated the port and drew up plans for an expanded arsenal as well as a hospital and chapel. Colbert subsequently reduced the scale of Vauban’s plan but expanded the arsenal to include a covered corderie and buildings for constructing, arming, and disarming ships. From 1679 to 1691, the peak years of port construction at Toulon, the government spent at least 3.2 million livres. Between 1691 and 1705 funding collapsed and work slowed in Toulon and other ports. The budget for the navy, colonies included, fell from a peak of 33.43 million livres in 1691, gyrated widely, and settled at around 8 million livres in 1716 shortly after the Sun King’s passing in 1715.¹³ Nonetheless, by 1738 the Toulon arsenal had been accoutered with a massive door framed by Doric columns and topped by statues of the gods Mars and Minerva.¹⁴

The Toulon arsenal expanded substantially in the nineteenth century with the addition of three major annexes. Forced laborers had begun the first of these, the Arsenal du Mourillon designed to house naval timber, a century before the city launched the French fleet which took the city of Algiers. In 1853 Napoléon III commissioned a second expansion, the Arsenal de Castigneau, for the repair of steam engines. A third annex, the Arsenal de Missiessy, also begun under the reign of Napoléon III and expanded in 1875 and 1892, fabricated torpedoes and housed a school for mechanics. Around 1900 more than a thousand officers and administrators and some 9,600 employees and laborers worked at this industrial complex sprawling over 250 acres.¹⁵

Toulon’s population swelled precipitously during the reign of Louis XIV, growing from about 12,000 at his coronation in 1642 to around 27,000 at his death in 1715.¹⁶ The city expanded erratically and Vauban described it as being as full as an egg. By 1689 Toulon was the third largest city in Provence trailing only the 85,000