Table Of ContentThe Administration of Sickness
Also by William Gallois
TIME, RELIGION AND HISTORY
ZOLA: The History of Capitalism
The Administration
of Sickness
Medicine and Ethics in
Nineteenth-Century Algeria
William Gallois
© William Gallois 2008
Softcover reprint of the hardcover 1st edition 2008 978-0-230-50043-3
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First published 2008 by
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A catalogue record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Gallois, William, 1971–
The administration of sickness : medicine and ethics in nineteenth-
century Algeria / William Gallois.
p. cm.
Includes bibliographical references and index.
1. Public health administration – Algeria – History – 19th century.
2. Medical policy – Algeria – History – 19th century. 3. Medical care – Algeria –
History – 19th century. 4. Imperialism – Health aspects – Algeria – History –
19th century. 5. Medical ethics – Algeria – History – 19th century. I. Title.
[DNLM: 1. Health Policy – history – Algeria. 2. Health Policy – history – France.
3. Colonialism – history – Algeria. 4. Colonialism – history – France. 5. Delivery
of Health Care – organization & administration – Algeria. 6. Delivery of Health
Care – organization & administration – France. 7. Ethics, Medical – history –
Algeria. 8. Ethics, Medical – history – France. 9. History, 19th Century –
Algeria. 10. History, 19th Century – France. 11. History, 20th Century – Algeria.
12. History, 20th Century – France. WA 11 HA4 G173a 2008]
RA552.A4G35 2008
362.10965—dc22 2008016413
10 9 8 7 6 5 4 3 2 1
17 16 15 14 13 12 11 10 09 08
Contents
Acknowledgements vi
1 Introduction 1
2 On the Idea of Medical Imperialism 29
3 On Humanitarian Desire 66
4 On Extermination 93
5 On Attendance to Suffering and Demographic Collapse 135
6 On the Just and Sovereign Testimony of Abdel Kader ben Zahra 185
7 On Injustice and the Disavowal of Autonomy 197
Notes 215
Bibliography 234
Index 257
v
Acknowledgements
The research for this book was generously supported by the American
University of Sharjah, the Mellon Foundation, the School of Oriental and
African Studies and Roehampton University. I also benefited from the
advice and expertise of a number of history of medicine seminars and con-
ferences at which I presented parts of my project, particularly those run by
Mark Jackson at Exeter, Hilary Marwick and Colin Jones at Warwick, the
Society for the Social History of Medicine, and Gino Raymond’s seminar at
Bristol. My colleagues at Roehampton – most especially Sara Pennell,
Cornelie Usborne, John Tosh and Meg Arnot – have been great supporters
of this project, as were Gez Hawting, David Arnold, Peter Robb, Michael
Brett and Tom Tomlinson at SOAS; Bob Cook, Larry Woods and Andy
Barnett at AUS; and Daniel Pick at Queen Mary. I should also like to thank
the staff at the following libraries and archives: CAOM in Aix-en-Provence,
the Bibliothèque Nationale in Algiers, the national archives in Algiers, the
Bibliothèque Nationale in Paris and the university libraries of SOAS, Exeter,
and the University of London, as well as the London Library, the Women’s
Library and the British Library. I owe a great debt to the anonymous reader
of this book, whose incisive criticisms of the text at different stages of its
life greatly improved its argument. I also received great help, encourage-
ment and friendship whilst writing the book from Oliver Craske, Jon
Cheetham, Niall O’Flaherty, Ruth Hall, Rebecca Fox, Jake Osborne, Rebecca
Niblock, Barbara Wallwork, Norman Wallwork, Ramues Gallois, Suzuka
Gallois, Richard Gallois, Sarah Gallois, Edward Gallois, Philip Taylor, Encarni
Corcoles, Martin Macmillan, Claire Macmillan, Nick Riley, Sole Riley and
Otis Kempinksi.
vi
1
Introduction
1.1 Beginning as it ended
On 5 April 1921, the mayor of Cherchell wrote to his Prefect to complain
that migrants from the interior posed a serious threat to the health of his
coastal town. ‘Long queues of people from Orléanville and Ténès’ had tried
to enter Cherchell, and when they had been expelled, they had simply
tried to come into the town through another gate’.1 They ‘brought with
them the threat of typhus ... to a settlement which had until then been
spared, and the only means we had of defending ourselves against this
invasion was to guard all the gates into the town’.2
That the Prefect took such problems seriously was made plain when, on
4 May 1921, he wrote to the mayor of Algiers of ‘the dangers posed to public
health by the large numbers of indigènes who arrived in the prefecture each
day, begging for our assistance’.3 As a means of arresting such population flows
and protecting the ‘hygiène publique’ of the coastal littoral, the Prefect sug-
gested that a form of ticketing system might be introduced so that only those
who were shown to be free from typhus could travel towards the capital.
The Prefect knew that such a suggestion would appeal to the mayor of
Algiers, for he had traditionally objected to paying for the cost of charitable
assistance from the city’s budget and had demanded that such expenses be
shared by the colonial government and the department of Algiers. Those
who were destined to received such gifts were, after all, ‘beggars who needed
to be purged from Algiers, for they had come to the city not to work or to
contribute to the “vie communale”, but to exploit the offerings of public
charity’.4
These local administrative responses to epidemics in the 1920s come
after the period 1830–1900 described in this book, but I open my argument
with them as examples of a culture of health in Algeria which I suggest
began in the nineteenth century and persisted right across the colonial
period. When we look, for instance, at the famines and epidemics of the late
1830s, or the period 1867–72, we find that French reactions to such events
1
2 The Administration of Sickness
were framed in more or less precisely the language we find here in the second
decade of the twentieth century.
This book, therefore, looks closely at cultures of medicine from nineteenth-
century Algeria to discover how permanent, structuring realities were
formed in the early decades of the colony and how such cultures of health
impacted on both local populations and settler communities. Yet we also
need to see that the end reached at Cherchell was arrived at in a particular
way, for cultures of health changed over time, so this book offers an account
of nineteenth-century Algeria which draws together analyses of both deep-
lying structural realities in its history of health and alterations in medical
policies, ideas and culture. From the inception of the colony in the 1830s to
its fall in 1962, French and Algerian writers consistently saw the French
imperial project in the Maghreb as an attempt to medicalise Algerian society.
This idea of medicalisation lay, I suggest, at the heart of the French attempt
to make an Algerian nation in the nineteenth century, its failure to do so
and in the encouragement of distinct modes of resistance to French rule.
One of the greatest shifts which took place between the arrival of the
French in 1830 and the brutal realities of the world of Cherchell and Algiers
in the 1920s was the slow death of the idea of medical imperialism, which
invigorated and formed a key part of the early French colonial enterprise,
but which can be seen to have collapsed in the examples set out above. That
idea of the civilising potential of medicine, and the manner in which
disillusionment set in with regard to the idea, amongst local, settler and
metropolitan constituencies, runs across the chapters of this book.
In continuing my initial theme of endings and beginnings, let us now
look at quotations from the inception and last days of the colony side by
side. The first comes from a book written by the politician Pellissier de
Raynaud in 1837, the second from Frantz Fanon’s resignation note from the
Blida-Joinville hospital, which he left in 1953 prior to joining the FLN:
There exists a dangerous illusion that Algeria presents us with a land ripe
for exploitation, a treasure trove into which we can dip our fingers, which
needs to be promptly destroyed. Instead we need to see that Africa
presents us with the possibility of unleashing the germ of a new people,
who might create a gloriously productive new society. It is to this end
which I wish to bring discussions, but before doing so we must under-
stand the theatre of operations in which we propose to operate.5
If psychiatry is the medical technique that aims to enable man no
longer to be a stranger to his environment, I owe it to myself to affirm
that the Arab, permanently an alien in his own country, lives in a state of
absolute depersonalization.6
What I think we see here are expressions of the importance of the idea of
medicine in the nineteenth century and, in the twentieth century, the
Introduction 3
manner in which critics of empire came to understand that the idea of
medicine and its implementation constituted one of the most pernicious
effects of French colonialism. From Fanon’s perspective it is of course quite
clear that Pellisier de Raynaud’s medical metaphors – ‘the germ of a new
people’ and so on – formed precisely the kind of ‘illusion’ which Pellisier
himself feared, yet a distinctive feature of the function of power relations in
colonial settings was that illusions really could become forms of reality, writ
large on the tabula rasa of the ‘theatre of operations on which we propose to
operate’. The description of quite how Algerians became ‘strangers’ in their
own ‘environment’, and not the ‘new people’ of ‘a gloriously productive new
society’ will be a key task in this book’s analysis of the ideas and realities of
colonial medicine.
1.2 Scope
This book explores the role which cultures of medicine played in the crea-
tion of Algeria in the nineteenth century. Its method is ethical in that it asks
whether French medicine was good and just, and whether the medical appa-
ratus of the colonial state can be shown to have improved or diminished the
lives of those who became Algerians: both the indigenous peoples of North
Africa and European settlers who migrated to the Maghreb.
It identifies three distinct phases in the medical-ethical history of
nineteenth-century Algeria. In the first of these stages, lasting from the con-
quest in 1830 until the 1850s, the idea of medicine and of its efficacy was
seen to be a crucial form of justification for France’s presence in North
Africa. A grand plan to medicalise the colony was viewed as being both
moral and pragmatic, in that it served the purposes of proving the benefi-
cence of France’s civilising occupation and it helped to pacify a hostile and
poorly understood environment.
At a second, overlapping, moment through the 1840s ’50s and ’60s, parts
of the grand medical plan were actualised, but it quickly became clear that
France could not afford to establish the comprehensive and universal health
service that had initially been imagined. The reality of medical provision
was that its organisation mirrored the fragmentary character of the colonial
state, which was divided between military and civil authorities which
tended towards competition rather than collaboration. Medical authorities
and conscientious doctors in the capital could look at much of their own
work and believe that the imagined medicalised state was coming into
being, but the reality for most of the country was that medical care was
sporadic, often costly and, in some cases, resisted by locals.
Finally, this situation worsened markedly in the past three decades of the
century: racial ideas definitively trumped those of the advocates of universal
care, medical provision became increasingly competitive and privatised, plans
to train Algerians as doctors and to integrate them into French medical culture
