Medical Approaches to Cultural Differences: The Case of the Maghreb and France A thesis submitted to the Miami University Honors Program in partial fulfillment of the requirements for University Honors with Distinction by Janine Saliba May 2010 Oxford, OH 1 Abstract Medical Approaches to Cultural Differences: the Case of the Maghreb and France By Janine Saliba People experience cultural differences on many levels – a student leaving the United States for the first time, a government negotiating with another government that follows completely different standards and principles. Culture is an integral part of every day life and differences among cultures have been important contributing factors to how people perceive and react to others. In previous scholarship on this topic, culture has been explored through art, literature, foreign policy, etc. This paper takes a new approach to culture by examining cultural differences, as seen by doctors, between France and Algeria and Tunisia between the mid-nineteenth century and early twentieth. Three doctors were chosen for this purpose: Émile-Louis Bertherand, Lucien Bertholon, and Dorothée Chellier. The paper begins with a brief introduction to the definition of culture and the state of medicine during the period. It then examines other approaches to cultural difference, and then discusses the contributions of the doctors. Each of the doctors listed above contributes a different perspective on the Maghrebian region, and at the end of the exploration, we find that the doctors are an integral part of perpetuating French culture as well as bringing French culture to the indigenous populations. 2 Medical Approaches to Cultural Differences: the Case of the Maghreb and France By Janine Saliba Approved by: __________________________________, Advisor Dr. Jonathan Strauss ___________________________________, Reader Dr. James Creech ___________________________________, Reader Dr. Mark McKinney Accepted by: ___________________________________, Director, University Honors Program 3 Table of Contents Introduction 5 Part I. Constructing Cultural Difference……………………………………………….12 Part II. Medicine‟s Kinship with Culture……………………………..………………...19 Part III. The Impact of Language and Climate…………………………………………..27 Part IV. Medicine‟s Mission in Colonization……………………………………............31 Conclusion 33 Works Cited 36 4 Medical Approaches to Cultural Differences: The Case of the Maghreb and France “Nous en sommes intimement convaincu [sic], la Médecine française peut jouer un rôle des plus puissants et des plus complets dans ce grand œuvre de la civilisation d‟un peuple, dont le présent ouvrage a cherché à esquisser les tristes conditions physiques et morales.” -Dr. Émile-Louis Bertherand Medicine constitutes an extremely important component of contemporary societies. Not only do people exercise medicine in their own countries, but they also use it to access other countries‟ cultures. Much of the aid sent to various regions of the world struck by natural or man-made disasters such as Haiti, to use a current example, takes it shape in the form of medical relief. Groups, such as Médecins Sans Frontières, have become important ambassadors to people in need, not only providing aid and support but indirectly exchanging culture and knowledge. History and the quotation above illustrate that this exchange has been in practice since colonial expansion, particularly in regard to France and its colonial history in North Africa. Doctor Bertherand reveals his beliefs that French medicine plays an important part in the civilization of a people, in this case, Algerians, whom he believes live in a “sad physical and moral state” (Médecine et hygiène 547-548). Thus, he exploits medicine to observe and comment on aspects of another culture. This paper attempts to relate the importance of medicine in revealing and explaining cultural differences between France and Algeria and Tunisia by examining works by three doctors: Émile-Louis Bertherand, Lucien Bertholon, and Dorothée Chellier. The significant questions to explore are in essence: how does one transition 5 between medicine and culture? When does the study of medicine become a study of culture? How does a doctor look at culture, and what are the aspects of it that he notices? This paper does not include Morocco in its study for the very simple reason that the doctors chosen do not incorporate or focus on this country in their studies. Before delving into the primary texts, it is important to first define and explain the word “medicine” in the context of the nineteenth century. Émile Littré in his 1877 Dictionnaire de la langue française describes “médecine” as, “Art qui a pour but la conservation de la santé et la guérison des maladies, et qui repose sur la science des maladies ou pathologie” (“Médecine,” def. 1). This definition symbolizes the radical changes medicine and its everyday practice underwent throughout the century. People, for hundreds of years, considered medical practices to be rooted in art rather than science. The proliferation of charlatans and quacks peddling their medical concoctions and “proven” remedies contributed to the natural distrust patients felt towards physicians and anyone claiming to “cure all ills” (Ramsey).1 However, new discoveries and studies in areas such as pathology, continued epidemics of diseases such as cholera, and concern for sanitation and hygiene helped catapult medicine into the arena of scientific study and into the world of professionals (Bynum; Ramsey). This last classification implies that people did not previously consider medicine a profession with regulations, procedures, and consistent education; in nineteenth-century France, “. the state effectively imposed national standards for training, and it made considerably more sense than before to speak 1 It is difficult to make sweeping statements about the skill and knowledge of wandering medical practitioners; however, Ramsey finds that the assumptions and stereotypes about these people do have merit. Despite the charlatans and quacks, whom Ramsey defines as “mercenary and insincere,” many folk practitioners and local healers were often regarded with more trust by the local community than physicians because of their affiliation with the area (129). For more information see Ramsey 129-276. 6 of the „medical profession‟” (Ramsey 123). In contrast to the wandering quacks or village healers, medicine became a profession by establishing schools and publishing research and knowledge. Furthermore, in regards to the development of medicine as a science, “[t]he doctor of 1900 had reason to be grateful for the scientific medicine of the previous century. His profession was more coherent, more stable, and probably more prestigious than it had been in 1850 or 1800” (Bynum 222). René Laennec‟s stethoscope in 1816, Louis Pasteur‟s vaccine for rabies in 1885, among numerous other inventions and discoveries reflect and support the medical field‟s importance during this period. In effect, medicine – the prevention of disease, scientific testing, hospitals, etc. – flourished throughout the century and became a fundamental part of everyday life. Medicine and its evolution do not represent the only key changes in French society and thought in the 1800s. Colonization, particularly the colonization of Algeria and Tunisia, played a major role in shaping people‟s perceptions of non-western cultures, and medical doctors who practiced in regions such as the Maghreb contributed to these perceptions. A constant French presence in Algeria began in 1830 when France elected to invade Algeria with the original intent to curtail piracy and slavery in the region (Abun-Nasr 251). With its constant struggle to surpass England‟s and Italy‟s presences in Africa, France elected to remain in Algeria. Thus began the migration of French settlers to Algeria; their presence divided the inhabitants of the country into “. a privileged European and a suppressed Muslim community. Differences in political and civil rights, social outlook and organization, and economic opportunities separated them” (Abun-Nasr 263). In essence, Algerian society became polarized, with vast differences 7 between the standard of living of the local population and that of the European immigrants. Unlike Algeria, Tunisia kept its own form of government despite French and Italian economic pressure. France did not conquer the country in the traditional sense of the word, but it eventually made Tunisia a protectorate of France and heavily influenced the bey government system. In both cases, France‟s involvement in these countries, whether militarily or economically, paved the way for Frenchmen, Europeans in general, and their doctors to move into the region. Medicine is tied to this history of colonization because European medicine became an integral part of the French mission civilisatrice . facilitating political influence and economic expansion. The Revue tunisienne (1905) observed that „the doctor is the true conqueror, the peaceful conqueror....It follows that if we wish to penetrate their hearts, to win the confidence of the Muslims, it is in multiplying the services of medical assistance that we will arrive at it most surely.‟ (Gallagher 95) Similar to Doctor Bertherand‟s quotation at the start of this paper, this quotation demonstrates the significant connection between medicine and colonization. Both examples view doctors as ambassadors of civilization and consequently culture, and both illustrate the belief that medicine plays an important