L’organisation sanitaire en Tunisie sous le Protectorat français (1881–1956): Un bilan ambigu et contrasté (review)

Reviewed by: L’organisation sanitaire en Tunisie sous le Protectorat français (1881–1956): Un bilan ambigu et contrasté Richard C. Keller Benoît Gaumer. L’organisation sanitaire en Tunisie sous le Protectorat français (1881–1956): Un bilan ambigu et contrasté. Lévis, QC: Les Presses de l’Université Laval, 2006. xxiv + 276 pp. $40.00 (978-2-7637-8474-8). When the writer Guy de Maupassant visited Tunisia soon after the establishment of the French protectorate there in 1881, he was astounded by how healthy the population appeared. He noted in his diary that Tunis was one of the sites where “ordinary illnesses” were the “least rampant” in the French dominion.1 How strange that sentiment might have seemed to more interested observers and in particular to those responsible for managing public health in the new protectorate. Epidemic diseases such as cholera, typhus, and plague ravaged the population periodically, while endemic diseases such as smallpox and tuberculosis took advantage of the staggering poverty and malnutrition of many Tunisians. Ethnic and religious divisions—which entailed the near-total segregation of the country’s Muslim, Jewish, and European populations well into the twentieth century— greatly complicated the provision of medical care as well as epidemiological surveillance. Each population traditionally cared for its own members, only rarely trusting outsiders, meaning that French authorities were repeatedly stymied in the collection of even the most basic vital statistics, a problem that compounded the difficulties of organizing and implementing a health system to provide for all Tunisians. Benoît Gaumer, a French-trained Canadian physician and historian, provides in this book a narrative history of the effort of French administrators to modernize the Tunisian health system in the seventy-five-year history of the protectorate. The book is organized into three unequal parts. The author devotes the first to French attempts to know the Tunisian population and its health in an aggregate sense; the chapter covers censuses and their foibles, as well as French efforts to establish basic health indicators and assess the efficacy of health systems over the course of the protectorate. The second part covers epidemic and endemic diseases through the protectorate’s history, with chapters on specific diseases (such as malaria, trachoma, and tuberculosis) as well as on particular entities in the Tunisian public health armature (the Pasteur Institute in Tunis, for example) and the emergence of a concern with so-called “social diseases” (alcoholism and drug abuse, sex work, and mental illness, for example) in the interwar period. The final part covers the administrative history of public health in Tunisia, with attention to military medicine, the persistence of folk healing, the creation of a health ministry, and the establishment of a public welfare system, as well as a survey of public health in postcolonial Tunisia. The book is encyclopedic in several ways; this is both its greatest strength and its greatest weakness. Gaumer eschews a general argument in favor of a narrative of French colonial public health in Tunisia in which he documents several over-arching [End Page 413] tendencies: an administrative concern with the management of epidemics from the establishment of the protectorate to the outbreak of the First World War; an emphasis on social diseases in the interwar period; and the establishment of a social security system in the postwar era. The book thus serves as a catalog of efforts in each of these directions, aiming at an exhaustiveness that its slight bibliography has difficulty supporting in any great detail. The reader therefore finds subchapters and subsections on a broad range of public health phenomena but very little close engagement with any one category. As such, the book will make a useful first resource for scholars interested in documenting a given event or experience in the history of French colonial health efforts in Tunisia, but a potentially frustrating one for scholars hoping to find an engagement with an exploding literature on the politics of colonial medicine and public health. Richard C. Keller University of Wisconsin–Madison Footnotes 1. Guy de Maupassant, La vie errante (Paris: Librairie Paul Ollendorff, n.d. [1900]), p. 201. Copyright © 2009 The Johns Hopkins University Press

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