Neutrality is something that we usually place unto scientific categories. Categories such as medicine are seen as cool, marble-like structures that have always been. However, we know this not to be true given numerous examples from the birth of gynecology to the Tuskegee experiments. The medical field always comes with an agenda. In the essay below, Edna Bonhomme discusses Napoleon’s occupation of Egypt and its impact on public health.
At its core the social and political afterlife of disease might work in the service of the empire or against it. French colonialism brought and intensified the bubonic plague epidemic in Egypt and Greater Syria between 1798 and 1801, and the colonizers attempted to manage the plague as a method of social control. The plague was not merely a biological ailment; it prevented the French from advancing in Egypt and Greater Syria. Before French colonization, the Egyptian state handled the plague quite minimally insofar as there were no public health institutions to implement quarantine. Yet a set of contradictions emerged during the occupation, and the French invasion engendered plague as well as new public health enforcement. Meanwhile, French concern for medical treatment did not forestall the epidemic among soldiers.
The French military campaign and the plague were part of an account of social and political control but also a consequence of life under occupation. Denying or minimizing the threat of the disease could function within the matrix of what I call “sanitary imperialism.” In each circumstance, French and Arab officials tailored their oral and written portrayals of the plague to give them an aesthetic appeal that made broader political claims about the French occupation. Moreover, Napoleon altered his position about the plague according to the viability of the French presence in Ottoman Egypt and Syria.
The French military occupation of Ottoman Egypt and Greater Syria is a story of how disease can be destabilized and how systems of control operate on multiple levels. The expedition can be evaluated in terms of the rise of institutions and of French military medicine, as well as along gendered lines.
Although information control and censorship occurred for other reasons, the plague served as a catalyst to the implementation of a colonial hospital and a colonial public-health regulation. In the French case, disease transmission was monitored and controlled by medical practitioners of the French military as they advanced within Ottoman Greater Syria, while playing a particular role in producing and reproducing medical hierarchies. It also had a political role because of French efforts to control it in order to achieve their broader aims of territorial expansion (Elgood 1936; Schur 1999; Howard 2006; Cole 2007). After the French occupation of Egypt, the Mamlūk political leadership was reshuffled; its military structure was discredited and a new layer of leadership stepped in (Fahmy 1997). By 1805, Ottoman Egypt was undergoing another political transformation as Muḥammad ʿAlī established semi-autonomous rule. At the heart of this moment in history was a colonial project in which medicine became modern.
Public Health
Colonial medical regulation was not merely applied to the living—even the dead were not immune from the French occupation. As part of plague and public-health regulations, the French forbade the population from burying the dead in cemeteries close to the communities of al-Azbakiyya and al-Ruway’ī—instead, they were expected to bury the corpses in graves far from the city center. In addition, they ordered Egyptians to hang their clothing and belongings on their roofs for several days after a death from plague to fumigate their homes and reduce the smell and contagion of the disease, arguing that the putrescence could penetrate people’s residences. On 18 Rabī al-Thānī 1213 AH/ September 28, 1798 CE, members of the qawwāsa (indigenous guards that served the French) demolished some graves in the al-Azbakiyya cemetery that resulted in the leveling of some monuments. This was a moment where military occupation prioritized public health over the sacred.
On May 26, 1799, Napoleon sent a letter to the French military Executive Directory, headquartered at Jaffa, and asserted:
The opportunity appeared to be favorable for carrying the place; but our spies, the deserters, and the prisoners, all agreed in stating, that the plague was then making most terrible ravages in the town of Acre [Greater Syria]; that more than sixty persons died of it every day; and that the symptoms of it were dreadful. (Berthier 1990, 11)
The French army perceived the plague as a terror perpetuated by its enemies—those who were no longer serving and those who had been captured. Yet layered in Napoleon’s critique is that these adversaries functioned to shift public perception about the plague. For him, there was consensus that the plague would affect people’s perceptions about the French presence in Ottoman Egypt and Syria. As rumors waxed and waned, the colonial army used medicine to stifle discontent.
As medical practitioners treated their patients, their ideas about the plague were challenged on many fronts. The battlefield was an opportunity for physicians and surgeons to experiment with medical treatment in periods when masses of people were flirting with death. The dynamics of military occupation and knowledge exchange set the stage for strained power relations. Disease emerged at the most volatile moments, and military doctors had to adjust accordingly. In their positions, René-Nicolas Dufriche Desgenettes (1762–1837)—the chief physician—and Dominique Jean Larrey (1766–1842)—the chief surgeon—documented that the wounded were more susceptible to disease and a quick death. Sanitary imperialism could only be possible with the complicity and cooperation of trained medical practitioners.
The precarity of life existed in a context where military occupation was the norm and illness prevailed. Of the 9,000 soldiers at Acre, approximately 150 were hospitalized at any given time because of the plague outbreak. Desgenettes commented on his treatment methods for the plague:
In order to sustain immediate hydration and strength, as a matter of urgency, a drink consisting of coffee and quinine, flavored with fresh lemon or lemon juice. The swelling of the glands requires, in principle, a soothing poultice, and when the patient is weak, his tumors must immediately be opened by the application of one or several cauterizing lances. Experience has already shown the effectiveness of this treatment; experience has also proved, through close observation of a great number of cases, that this sickness is not contagious. (La Jonquière 1899)
Each treatment and procedure might have been experienced at a radically different pace—what was done for a swelling limp was distinct from what could be done with an open sore. He believed that placing a soft, moist material on the open sores could relieve inflammation and pain. In another, he inserted his lancet into the pus of a bubo and made slight incisions with it. Desgenettes and his medical team were charged with diminishing the spread of infectious diseases. Their ability to treat patients was compromised when other political agendas interfered. Yet, another element of this excerpt is the extent to which he perceives that plague is not contagious which contradicted French perceptions of the disease at the time.
High officials took part in ongoing arguments about methods of treatment for the plague. Desgenettes and Napoleon occasionally disagreed about whether the plague was present and how to treat impaired soldiers. The chief physician insisted on setting an example in the wards by diagnosing the patients with plague and treating them accordingly. Napoleon claimed that plague was merely psychological, stating: “It is one of the peculiar traits of the plague that is most dangerous for those who are afraid of it; those who let themselves be overcome by fear almost always die of it.” Contrary to his initial warning that the bubonic plague was endemic to Jaffa and Cairo, Desgenettes tried to convey to the soldiers that they should not let their anxieties about the disease overcome their bodily strength. Napoleon also insisted that the plague could be attributed to poor hygiene for two reasons: he wanted to maintain control over diagnosis and assert his own medical diagnosis over the military. Nevertheless, physicians appeared to accommodate his wishes through standard treatment and sanitation measures.
Such health sanctions were part of daily practice as an attempt to minimize the spread of infectious diseases—not only the plague. Desgenettes advised his colleagues on how to maintain their hygiene:
The army is informed that it is very advantageous for the health to wash at frequent intervals feet, hands and face with fresh water and even better to wash them with warm water, into which has been poured a few drops of vinegar or alcoholic spirit. (Desgenettes 1835)
But when a soldier fell extremely ill, military doctors sometimes resorted to pharmacological treatment. For example, Napoleon wanted to give doses of opium to the sick in Jaffa. Desgenettes refused. The drug that was eventually used for the dying was laudanum, an opiate solution that could assuage pain (Wilson 1803, 92). The distribution of medication was one way physicians could challenge Napoleon or other top-level authorities. Yet not all top medical officials carried out Napoleon’s orders.
French military physicians constructed temporary hospitals in other structures. Provisional hospitals became part of the campaign. Larrey (1832, 71) documented the condition of one French officer in Egypt:
Peter Genet, a sergeant of the fourth half-brigade of light infantry, aged 30 years, of a dry and bilious temperament, entered the hospital (a farm of Ibrāhīm Bey, in Egypt) on the 4th of October 1800, with every appearance of opisthtonos; his jaws were locked, the muscles of the face convulsively and permanently contracted, the head thrown back upon the trunk, the lower extremities rigid and extended, the walls of the abdomen contracted and approximated to the vertebral column, the pulse small, respiration laborious, deglutition and speech difficult.
The soldier’s ailments become the main concern of the practitioner in a hospital located on a farm of Ibrāhīm Bey. But who was displaced from that farm? Where did they go? Could the fellahin still cultivate the land? The absence of indigenous voices could also be a product of the extent to which displacement was normalized under military occupation. This report shows how colonial spaces were absorbed to secure the army’s health; medical practitioners relied on military occupation to achieve their goals.
Medical reports were one way to produce and control information, and doctors described in detail the nature of the diseases and the condition of the people who contracted them. Although the hospital was a zone where knowledge was controlled and constantly monitored by other officials, a journal, if kept private, could divulge the intricacies of disease incidences and personal life while also pointing to the physical landscape of military occupation.
Desgenettes’s aristocratic background shaped his interactions with Napoleon, and in many respects he challenged Napoleon more than Larrey did. Their positionality as executors of colonial medicine gave them the power and privilege to create new institutions, monitor bodies, and implement policy. Some of the French scholars and Egyptian intermediaries were also part of the public-health machinery to rescind disease transmission. Given the extent to which ideas, goods, and people traveled, the issue of French control was part and parcel of their military campaign. The mandatory reporting they instituted is similar to late-nineteenth-century public-health reforms in Europe and North America (e.g., Rosenberg 1962). What was especially noteworthy about this proclamation was its threat of death as punishment for those who failed to report disease.
On April 17, 1799, the French military was defeated in the siege of Acre. The result was a reshuffling of militarization, public health, and imperialism in Ottoman Egypt and Syria (Tombs and Tombs 2008). Ottoman Egypt renegotiated its position under French occupation, and Mamlūk political leaders used the French defeat for their gain.
Thus, the French enacted public-health regulations as they monitored and negotiated their relationship with the Egyptian population. Most French medical practitioners focused on documenting and treating illness among soldiers. In contrast, al-Jabartī’s chronicle (1994) documented French and Egyptian discourses regarding plague regulations and represents a place where the subaltern voices could be recovered. It also points to the dynamic of French administrators regulating disease transmission by governing the behavior of the indigenous population.
Plague and Gender under Military Occupation
French policies often conflicted with those of Arab medicine and formal medicine was gendered insofar that Arab women medical practitioners were largely shut out of French colonial medical practice. In addition, women of “ill-repute” were blamed for the plague which was an ancillary element of the gender dynamic. Subsequently, the European colonial machinery produced racialized and gendered discourses around health that obscured the medical sphere in Ottoman Egypt and Syria. The French military occupation was a gendered endeavor that was skewed with respect to colonizer and colonized—the majority of the French occupying force was male, while the Arabs who were being colonized were of mixed gender. Gender featured in the colonial project in overt and covert ways, with the predominant literate perspectives those of men, leading to the historical erasure of many women (Solnit 2017). Yet, within this colonial matrix, plague and power unearth the gendered dynamics of contagion and therapeutics.
Following on the theme of social discourses on the plague, the French military perceived all Egyptians vectors as vectors of disease and Egyptian women were especially charged with being blamed. For example, the Assembly of the General Dīwān had the following proclamation:
After consideration, we have discerned that the shortest and most auspicious means for alleviating or preventing the danger, i.e., the ailment of the plague was derived by associating with women of ill-repute, for they are the primary vehicle for the above-mentioned ailment. (Boustany and Jabartī 1971, 65)
This assumption is riddled with misogyny because women, not men, were blamed for transmitting the disease. Up to this point, plague transmission was attributed to close contact with an infected person, irrespective of gender. This narrative positioned women of “ill-repute” as progenitors of disease and this could be interpreted in several ways. This could refer to women who were not regarded as practicing Muslims or sex workers; this is not entirely clear from al-Jabartī’s text. Nonetheless, discussions about the plague were gendered, and this document ascribes blame to certain women as vectors of disease.
There is a history where women are blamed, reproached, and chastised for transmitting disease. Yet this comes with a social force whereby disease can be an arbiter for broader political commitments. As the philosopher and writer Susan Sontag noted in Illness as Metaphor (1979, 38), “In its role as scourge, syphilis implied a moral judgment (about off-limits sex, about prostitution) but not a psychological one.” In much the same way, the plague functioned within the realm of moral judgment: the colonizer used moral discernment to set the tone and regulation for diseased bodies.
Medical pluralism was the norm in Ottoman Egypt and Greater Syria and in the broader Islamicate world, from al-Andalus to Persia. Consequently, Arab-Islamic scholars negotiated between classical Greek texts, Qurʾānic text, Sunnah, and the occult sciences to generate definitions and therapies for illness. Understanding premodern and early modern definitions, debates, and negotiations about contagion and disease helps to elucidate the theories and practices of Ottoman Egypt and Greater Syria. Moreover, eighteenth-century Arab medical practitioners were mostly divided along gendered lines; with midwives (dayas) mostly female and health barbers (halaq al-sihhas) mostly male (Gallagher 1990). Nevertheless, these medical practitioners used similar methods to ward off the plague (and anxieties) when an epidemic struck: rubbing oil on buboes, drinking a rose-infused elixir, hanging a magic square on one’s door. In addition to prayer, a person was expected to clean his/her body and house and give alms. The timing of prayer was also important for its effectiveness—dawn was the optimal period.
Traditional remedies were diverse, and domesticated plants played an important role in medieval Arab pharmacology and the remedies directly applied to boils (Amster 2013; Levey 1973). Herbs, ointments and spices were seen as both preventive and curative agents for the plague and were part of the political economy of therapeutics. The sixteenth century Muslim scholar Al-Suyūṭī (d. 911 AH/1505 CE) surmised that people used violet infused ointments to prevent the buboes from spreading to other portions of the body. As such, the eighteenth-century Egyptian ʿulamāʾ ‘Abd al-Mu’ṭā al-Sahalāwī (unpublished manuscript) reached similar conclusions to Arab medical philosophers and surmised that violet was a curative agent for the plague. Doctors, pharmacists, and blood-letters could profit from the plague insofar that they advocated for an herb and provided it to their willing and sometimes dying patient.
Moreover, traditional Egyptian medical practices were recorded in Kitab al-Khawāss (Book of Occult Properties) and Aḥmad al-Dairabī’s (d. 1151 AH/1738 CE) Kitab al-Mujarabāt (Book of Remedies) to find cures for a range of diseases, including impotence or the plague. The occult sciences complicated elite and religious notions of medicine and the natural world. What made occult practices “acceptable” for those who considered themselves pious was the incorporation of Qurʾānic prayers.
One strain of ḥadīth literature (a compilation of axioms by the Prophet Muḥammad; see Burton 1994) prohibited people from leaving areas infected by plague; other sayings warned travelers not to enter places where plague was known to be present. This argument was supplanted by another corpus of literature arguing that pious Muslims who died from the plague were martyrs (Conrad 1981). What this meant was that authorities could force people to remain in a plague-infected area—even if they wanted to escape its wrath. In practice, this meant that the Muslim segment of the population might avoid treatment or quarantine with the presumption that they might have salvation. Thus, some interpretations of prophetic law were discordant with the French response to the plague. For this reason, French soldiers who exhibited plague-like symptoms blamed local inhabitants, thereby justifying their control over the population.
Overall, the proximity of popular remedies and religious practices during the eighteenth century represented significant social reactions to the plague and operated within a broader medical community of medical philosophers, medical practitioners, and shifting political structures. In a colonial context where an invading army wanted to maintain a particular kind of health, traditional medicine was obscured, and Arab women health practitioners were mostly excluded.
Conclusion
At its core, the social and political afterlife of disease might work in the service of the empire or against it. Late eighteenth-century perceptions of the plague were fragmented and contested; those with authority and power were better positioned to put their ideas about the plague into practice. French colonialism brought and intensified the bubonic plague epidemic in Egypt and Greater Syria between 1798 and 1801, and the colonizers attempted to manage the plague as a method of social control. The plague was not merely a biological ailment; it prevented the French from advancing in Egypt and Greater Syria. Before French colonization, the Egyptian state handled the plague quite minimally insofar as there were no public health institutions to implement quarantine (Mikhail 2011). Yet a set of contradictions emerged during the occupation, and the French invasion engendered plague as well as new public health enforcement. Meanwhile, French concern for medical treatment did not forestall the epidemic among soldiers (Sonbol 1991; Kuhnke 1990; Gallagher 1990).
The French military campaign and the plague were part of an account of social and political control but also a consequence of life under occupation. Denying or minimizing the threat of the disease could function within the matrix of what I call “sanitary imperialism.” In each circumstance, French and Arab officials tailored their oral and written portrayals of the plague to give them an aesthetic appeal that made broader political claims about the French occupation. Moreover, Napoleon altered his position about the plague according to the viability of the French presence in Ottoman Egypt and Syria.
The French military occupation of Ottoman Egypt and Greater Syria is a story of how disease can be destabilized and how systems of control operate on multiple levels. The expedition can be evaluated in terms of the rise of institutions and of French military medicine, as well as along gendered lines.
Although information control and censorship occurred for other reasons, the plague served as a catalyst to the implementation of a colonial hospital and a colonial public-health regulation. In the French case, disease transmission was monitored and controlled by medical practitioners of the French military as they advanced within Ottoman Greater Syria, while playing a particular role in producing and reproducing medical hierarchies. It also had a political role because of French efforts to control it in order to achieve their broader aims of territorial expansion (Elgood 1936; Schur 1999; Howard 2006; Cole 2007). After the French occupation of Egypt, the Mamlūk political leadership was reshuffled; its military structure was discredited and a new layer of leadership stepped in (Fahmy 1997). By 1805, Ottoman Egypt was undergoing another political transformation as Muḥammad ʿAlī established semi-autonomous rule. At the heart of this moment in history was a colonial project in which medicine became modern.
Bonhomme’s bibliography is available here.
Edna Bonhomme is a historian of science, lecturer, art worker, and writer whose work interrogates the archaeology of (post)colonial science, embodiment, and surveillance in the Middle East and North Africa. A central question of her work asks: what makes people sick. As a researcher, she answers this question by exploring the spaces and modalities of care and toxicity that shape the possibility for repair. Using testimony and materiality, she creates sonic and counter-archives for the African diaspora in hopes that it can be used to construct diasporic futures. Her practices trouble how people perceive modern plagues and how they try to escape from them. Edna earned her PhD in History from Princeton University in 2017 and she is Postdoctoral Fellow at the Max Planck Institute for the History of Science and currently lives in Berlin, Germany. She has written for Aljazeera, The Baffler, The Nation, and other publications. You can follow her on Twitter at jacobinoire.
Notes