Treating A Young Colony: Doctors in The French Army of Africa, Fevers and Quinine, 1830-1870

Treating a Young Colony: Doctors in the French Army of Africa,
Fevers and Quinine, 1830-1870

Claire Fredj
In Le Mouvement Social Volume 257, Issue 4, 2016, pages 21 to 45
Translated and edited by Cadenza Academic Translations
Translator: Clare Horackova, Editor: Faye East, Senior Editor: Mark Mellor
ISSN 0027-2671
ISBN 9782707192240
This document is the English version of:

Claire Fredj, «Soigner une colonie naissante : les médecins de l’armée d’Afrique, les fièvres et la quinine, 1830-1870», Le
Mouvement Social 2016/4 (No 257) , p. 21-45
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Claire Fredj, «Soigner une colonie naissante : les médecins de l’armée d’Afrique, les fièvres et la quinine, 1830-1870», Le
Mouvement Social 2016/4 (No 257) , p. 21-45
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Treating a young colony: Doctors in the French
Army of Africa, fevers, and quinine, 1830-1870
by Claire Fredj*
In Algeria, at the beginning of the colonial conquest, French soldiers were faced with
a high rate of mortality due to malarial fevers. The treatment for malaria, sulfate of
quinine, was developed in 1820 and its consumption increased substantially with the
occupation of Algeria. Quinine became a commonly-used product by the military popu-
lation, and even beyond, as military doctors also treated European and Algerian civilians
in urban and rural areas. How, and in what form, did quinine enter the medical arsenal
of army doctors, who were the main distributors of this medicine, and how did it spread
across Algeria through the military and civilian populations? This paper explores how
the military administration supplied the Army of Africa, and considers related economic
issues—the military administration frequently expressed concern about the high costs
of using this expensive product on a massive scale. The paper then focuses on how the
populations in question adopted this medicine, and what this meant in terms of social
demand for treatment.
The motto of Marshal Bugeaud (Ense et aratro) is well known. But, I ask you,
what would have become of our Algerian colony without that of Doctor
Maillot: Sulfate of quinine!1

W hen, in Algeria in 1881, the village of M’Chedallah was renamed after
François-Clément Maillot, along with a street in Algiers and one in Bône,
Doctor Arthur Bordier took the opportunity to pay tribute to the contribution
made by this military doctor to the treatment of Algerian fevers: Maillot, who was
doctor at the military hospital of Bône from 1833 to 1835, recommended the
widespread use of sulfate of quinine in the treatment of the disease which, over the
decades, had been designated by various terms relating to pernicious fever, such
as “intermittent fever,” “marsh fever,” “malarial ague,” or “malarial fever,” before
the name of “malaria” became standard during the 1880s in medical literature and
common usage.2
Le Mouvement Social, October-December 2016 © La Découverte
These fevers, which have long been a factor in European and Mediterranean
morbidity rates, are inevitably debilitating and frequently fatal.3 French soldiers
* Associate Professor at Université Paris Nanterre, IDHES (UMR 8533).

1. Arthur Bordier, Le National, October 5, 1881.
2. Marcel Vaucel and Yvonne Feron, “L’introduction dans la langue française du mot paludisme,”
WHO/Mal/68.651, Geneva, 1968 <http://apps.who.int/iris/handle/10665/65460> [last accessed
February 21, 2018]. The concept of intermittent fever has been known since the Classical period,
but the link with a major classification of disease that reacts to cinchona was established by the Italian
doctor Francesco Torti, and until the middle of the nineteenth century the same terms were used to
describe not only malarial pathologies but others too.
3. James L. A. Webb Jr., Humanity’s burden. A global history of malaria (Cambridge: Cambridge
University Press, 2009), 13; Leonard Jan Bruce-Chwatt and Julian de Zulueta, The rise and fall of
malaria in Europe (Oxford: Oxford University Press, 1980).
II n Claire Fredj
arriving in the colony of Algeria were so stricken that the fever caused an unprec-
edented mortality rate, slowing down military operations and construction work
undertaken by the army, and contributed to transforming this region into a “white
man’s grave,” one of those areas of colonial Africa where acclimatization and survival
seemed almost impossible. A remedy for these fevers, however, did exist in the forms
of cinchona, which had been recommended by the physician Thomas Sydenham
from the last third of the seventeenth century, and, especially, of sulfate of quinine,
which was developed in 1820 by the Parisian chemists Pierre-Joseph Pelletier and
Joseph Bienaimé Caventou, whose work the following year confirmed that sulfate
of quinine has superior anti-febrile properties to cinchona.4 Sulfate of quinine has
the major advantage of allowing a far more precise administration of the treatment,
since doses are more easily measurable.5 Used in 1823 by some soldiers during the
French campaign in Spain, consumption of sulfate of quinine increased signifi-
cantly with the occupation of Algeria. Between 1830 and 1870, the French Army
of Africa, which numbered as many as 100,000 men in 1847, subjected the former
Regency of Algiers to a long and often devastating war that, nevertheless, did not
hinder the rapid growth of a foreign settlement of European origin.6
During the nineteenth century, when malaria spread considerably as a result of
migration, faster forms of transport, and war, sulfate of quinine was seen as a key
factor in Western expansion and especially in colonialism.7 This interpretation has
been criticized by several medical historians who, without denying the importance
of sulfate of quinine, contextualize its protective effect on colonial troops (quinine
was not always used in a preventative manner; there were insufficient supplies of
the drug; dosage was not always efficient; the treatment was not taken regularly).
These historians have highlighted other measures that might have lowered mortality

rates more significantly (drainage; the movement of troops to uplands; water quality
monitoring).8 The reduction in troop mortality in Algeria was significant during the
first three decades of its occupation. Success in the fight against malaria was partic-
ularly remarkable, since, according to Philip Curtin, mortality caused by fevers fell
by sixty-one percent between 1840 and 1860.9
4. Quinine is a white substance found in the bark of the cinchona tree, whose febricide properties
derive from the presence of organic alkalis (quinine, cinchonine, and quinidine). Sulfate of quinine, the
form in which quinine is administered medically, is a salt extracted from quinine. Quinine and sulfate
of quinine are used in a number of preparations: alcohols, wine, tablets, etc. See Eugène Soubeiran,
Nouveau traité de la pharmacie théorique et pratique (Paris: Crochard, 1840), 581. On cinchona reme-
dies, see Samir Boumediene, La colonisation du savoir: une histoire des plantes médicinales du ‘Nouveau
Monde’ (1492-1750) (Vaulx-en-Velin: Les éditions des mondes à faire, 2016).

5. Gabriel Gachelin, Paul Garner, Eliana Ferroni, Ulrich Tröhler and Iain Chalmers,
“Evaluating cinchona bark and quinine for treating and preventing malaria,” JLL bulletin:
Commentaries on the history of treatment evaluation (2016) (http://www.jameslindlibrary.org/articles/
evaluating-cinchona-bark-and-quinine-for-treating-and-preventing-malaria/).
6. Kamel Kateb, “Européens, ‘Indigènes’ et Juifs en Algérie (1830-1962), représentations et réalités
des populations,” Cahiers de l’Ined 145 (Éditions de l’INED, 2001).
7. Webb Jr., Humanity’s burden, 115-119; Daniel R. Headrick, The tools of Empire: Technology and
European imperialism in the nineteenth century (New York & Oxford: Oxford University Press, 1981).
8. David Arnold, “Introduction: Disease, medicine and empire,” in Imperial medicine and
indigenous societies, (Manchester: Manchester University Press, 1988), 10; Philip Curtin, Death by
migration: Europe’s encounter with the tropical world in the nineteenth century (Cambridge: Cambridge
University Press, 1989), 160.
9. Curtin, Death by migration, 62. According to Curtin, the mortality rate in the army dropped
from 78% in 1831-1835 to 15% by the end of the 1860s. For more information about morbidity
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n III
The limited availability of documentation and research makes it difficult to

estimate the actual extent of the role played by quinine in this decrease. It appears,
however, that sulfate of quinine quickly became a commonly consumed product
within the military population and even beyond. Indeed, military hospitals in the
towns were open to European civilians from the beginning of the conquest, and
soon became available to “native” civilians as well. In the countryside, the military
was able to provide care for both settlers and native populations through the Arab
Bureaus that were set up in 1844 and, for three decades, were one of the main cogs
in the military administration.10 How and in what forms did quinine become part
of the medical arsenal of the army doctors who were the principal distributors of
this medicine? How did it become widespread across Algeria within military and
civil populations of both natives and settlers? While there is still a lack of informa-
tion about the use of medications in all of the colonies,11 these questions constitute
an attempt to reveal more specifically how quinine became accessible in Algeria.
These concrete questions engage with the healthcare regimes of various groups and
facilitate a close examination of the medical practices that were accepted or opposed
by individuals.
This study will firstly review the centrality of Algerian fevers in medical discourse
from 1830 to 1850, as well as the rapid consensus concerning the curative use of
quinine. It will then examine the way in which the French military administration
supplied the Army of Africa and the ensuing economic issues. Finally, the article will
consider the relationships that the populations had with sulfate of quinine, as well
as the way that these relationships help us to understand social demands for care.
Quinine as the panacea to Algerian fevers


French army doctors, who were particularly numerous in Algeria between 1830
and 1870, contributed significantly to the understanding of local fevers and their
treatment. Their work, however, can only be fully understood as part of a series of
studies that includes those conducted by British and Italian practitioners as well.
Understanding Algerian fevers
In 1832, the Conseil de santé [hereafter Board of Health] reported that, in North
Africa, “a new soil, a climate that is different from ours, unusual diseases” awaited
military doctors, and called on them to increase understandings of “a land that is
so interesting and so little known.”12 Between 1830 and 1850, a significant part
of the writings of military doctors concerned one of the most common diseases
and mortality, see Matthew R. Smallman-Raynor and Andrew D. Cliff, War epidemics. An historical
geography of infectious diseases in military conflicts and civil strife, 1850-2000 (Oxford: Oxford University
Press, 2004), 177-184.
10. Claude Collot, Les institutions de l’Algérie durant la période coloniale (1830-1962) (Paris &
Algiers: CNRS-Office des publications universitaires, 1987), 38.
11. Laurence Monnais, “‘Rails, roads and mosquito foes’: The state quinine service in French
Indochina,” in Imperial contagions. Medicine, hygiene and cultures of planning in Asia, ed. Robert
Peckham and David M. Pomfret (Hong Kong: Hong Kong University Press, 2013), 195-214; and
Laurence Monnais, Médicaments coloniaux. L’expérience vietnamienne 1905-1940 (Paris: Les Indes
savantes, 2014).
12. Conseil de santé [French Board of Health], “Fragment pour servir à l’histoire médicale de
l’Armée d’Afrique,” Recueil de mémoires de médecine, de chirurgie et de pharmacie militaires RMMCPM 33
(1832): 201.
IV n Claire Fredj
recorded in the Army of Africa, namely intermittent fevers. A number of medical

officers suggest that they had witnessed “the disease in all its forms and affecting
hundreds of individuals,” and that they had often seen the disease appear “right
from the prodromal phase, at the moment when the soldier, returning from duty
at the outposts on the plains, felt the first symptoms, and [had] followed the course
of the illness after their admittance into hospital.”13 The rates of morbidity and
mortality caused by these fevers were shocking: in 1832, in the plains of Mitidja,
Ducroquet was particularly overwhelmed by “the enormous increase in the number
of patients in the army, whose ranks, within just a few weeks, fell from seven or
eight thousand men to four or five thousand.”14 In 1832, Maillot recorded 1 death
for every 7 soldiers discharged from the hospital at Bône; and in 1833, 1 death for
every 3.5 discharges.15 Ten years later, at Tlemcen, Charles Cambay noted that the
mortality rate increased from 1 in 47 patients in the case of simple remittent fevers,
to 1 in 3.76 patients for pernicious fevers.16 Even if the reliability of these statistics
is not to be entirely trusted, there is a clear trend and findings are clear for several
doctors: the intermittent fevers experienced in the marshes of Algeria differ from
those of temperate countries.17 This was the basis of Casimir Broussais’ conclusion
in 1846 that the pathology of this region “may have a number of points of similarity
with that of France, but also has a very distinct characteristic,” which, he claims,
is usually a feature only of extreme climates, although he notes that Algeria can be
categorized “somewhere between extreme and temperate climates.”18
Studies of these fevers, which describe their characteristics, their differences
from other fevers such as typhoid, and their seasonal occurrence, show that the
summer was an epidemic period, “during which the number of patients is rapidly
tripled or quadrupled by pathogenic causes, whether newly developed or becoming

more active.”19 Physical examinations and autopsies revealed distinctive charac-
teristics such as an inflammation of the spleen: “nowhere,” wrote Victor Ferrus,
who had previously observed fever patients in Holland, Russia, and Spain, had he
witnessed “systematic disorders of the digestive tract and peritoneum, such as those
[…] observed in Africa.”20 The fact that it was unclear whether this hypertrophy
13. L.-F.-Théodore Ducroquet, Quelques considérations sur les fièvres intermittentes pernicieuses

d’Afrique (Paris: Didot le jeune, 1836), 5; Pierre Joseph Eugène Martenet, Sur les fièvres miasmatiques
de marais, dans le nord de l’Afrique, et l’emploi du sulfate de quinine à hautes doses dans leur traitement
(Montpellier: J. Martel aîné, 1837), 5.
14. Ducroquet, Quelques considérations, 5.
15. François-Clément Maillot, “Recherches sur les fièvres intermittentes du Nord de l’Afrique,”

RMMCPM 38 (1835): 150.
16. Charles Cambay, “Topographie physique et médicale du territoire de Tlemcen et compte-rendu
des maladies qui ont été traitées à l’hôpital militaire de cette ville pendant l’année 1842 dans le service
des fiévreux,” RMMCPM 57 (1844): 56.
17. Martenet, Sur les fièvres miasmatiques, 6.
18. Casimir Broussais, “Notice sur le climat et les maladies de l’Algérie et compte-rendu des mal-
adies traitées à l’hôpital de la Salpêtrière à Alger pendant l’année 1845,” RMMCPM 60 (1846): 45.
See also Michael A. Osborne, “The geographical imperative in nineteenth century French medicine,”
Medical History 44, no. 20 (2000): 31-50.
19. J.-A. Antonini, C. and P. Monard, “Considérations générales sur les fièvres intermittentes
ou Rapport sur les maladies qui ont régné épidémiquement à Alger de 1832 à 1833,” RMMCPM 35
(1833): 5.
20. Victor Ferrus, “Nouveaux documents pour servir à l’histoire des maladies du nord de l’Afrique,”
RMMCPM 52 (1842): 243.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n V
of the spleen was the cause or symptom of the attacks provoked more in-depth
research aimed at understanding the disease, whose origin soon became a consen-
sus:21 this was a form of poisoning “contracted under the influence of emissions
from the swamps,”22 as was clear from regular medical topographies of Algeria from
the beginning of the 1830s.
These malarial fevers also came to be understood as a form of blood poisoning,
but there was debate about whether this was the cause or effect of the disease. From
the 1840s, some doctors hoped that chemical analysis of the blood would reveal
more, but in vain: at the end of their research, Léonard and Foleÿ could “neither
deny nor prove the existence of a specific body that had been either introduced or
created under the influence of malaria; and, for lack of appropriate instruments,
[…] we were not able to examine the blood gases.” If malarial fever was the result
of a poisoning of the blood, “the principle that causes it remains to be identified.”23
A few years later, Catteloup observed that “in malarial cachexia, […] there is
defibrination of the blood, an increase of blood serum, and a decrease of globules
and albumin,”24 but, in the middle of the nineteenth century, after twenty years of
observations, “we appear to have run out of hypotheses regarding the nature of the
disease, or the cause of the intermittence of malarial fever.”25 While the etiology of
Algerian malarial fevers remained a mystery, their treatment had been familiar for
a number of years.
Quinine: “The antiperiodic febricide par excellence”26
In a report dated 1833, Doctors Antonini and Monard list the various forms of
treatment for intermittent fevers used by the Army of Africa:

Wine in gradually increased doses, hot baths, friction applied all over the body
when the patient is shivering, astringents, bitters, aromatics, sudorifics, sinapisms,
vesicants, muscular exercise, theriac compounds, emetics, musk, binding of the
limbs, electrical impulses: all of these were, at various times, recommended and
employed against intermittent fevers; yet none of these was ever equal to cinchona,
which became increasingly widely used and eventually replaced all of the above
remedies.27
Even more than quinine, sulfate of quinine became the most effective means of
treating malarial fevers, even though, according to Adolphe Armand in 1854, “there
are still doctors who refuse to use this powerful substance, exaggerating the so-called
irritant properties of this salt, and preferring to administer, in tiny and repeated
21. J.-M. Labarre, Considérations sur les fièvres intermittentes d’Afrique (Paris: Rignoux, 1838), 17;
E. Collin, “Recherches sur les affections de la rate dans les fièvres paludéennes de l’Algérie,” RMMCPM
2/4 (1848): 83-148.
22. Alexandre Trudeau, Des fièvres intermittentes en Algérie (Paris: Rignoux, 1846).
23. N. Léonard and A. Foleÿ, “Recherches sur l’état du sang dans les maladies endémiques de
l’Algérie,” RMMCPM 60 (1846): 201.
24. B.-A. Catteloup, “De la cachexie paludéenne en Algérie,” RMMCPM 8 (1851): 65.
25. Pierre-Sylvain Brouillaux-Léger, De l’intoxication effluvienne. Essai sur l’étiologie et la nature des
fièvres intermittentes. Deux ans à Lella-Maghnia (Afrique) (Montpellier: J. Martel, 1850), 30.
26. J.-A. Gaudineau, “Nouveaux documents relatifs à l’histoire médicale de l’Algérie. Philippeville,”
RMMCPM 52 (1842): 220.
27. Antonini and Monard, “Considérations générales,” 44.
VI n Claire Fredj
doses, bowls of cinchona.”28 Armand, however, considered this form of treatment

incapable of preventing serious fevers from becoming pernicious.
Quinine quickly became part of the medical arsenal of the army. In 1825, after
military training hospitals had tested the qualities of sulfate of quinine, with “results
that were entirely in line with findings from civilian medical practice,” the French
Board of Health stated that this drug, “preferable to cinchona, is now categorized as
suitable to be supplied to military pharmacists.”29 It was, however, in Algeria that its
use became commonplace. It was also in Algeria that military doctors, with Maillot
at the forefront, gradually distanced themselves from the restrictive frameworks of
the French health service, which was at that time heavily influenced by François
Broussais, who believed that all fevers caused by the inflammation of an organ were
of identical nature and should be treated by controlling the diet, bloodletting, and
with compounds of mercury, opium, or arsenic: quinine was considered to be an
irritant and only to be used in small doses and as late as possible.30 There are several
accounts by Maillot telling us that he had opposed this teaching, and describing
how, at the military hospital of Bône, drawing on his past experience in Corsica,
he decided to give sulfate of quinine in high doses and immediately, “in all cases
of continuous affliction, without waiting for the onset of either a remittance or an
intermittence.”31 Thus treated, the course of the disease, which he also describes as
“the gastro-encephalitis of North Africa” halts “within a few hours.”32 Maillot was
keen to promote himself as a leader in his field, and denies having been preempted
by colleagues such as Gaspard Roux in Morée.
In fact, Maillot was not the first to recommend the use of quinine in high doses
to stop fevers. Several French doctors had been using it since the Spanish Expedition
of 1823.33 During the French Expedition to Morea in the Peloponnese, Prosper

Gassaud, like other doctors in the expeditionary force who were confronted with an
epidemic that resulted in 450 deaths, reported that “sulfate of quinine alone or in
compound was administered to all our patients and produced miraculous effects.”34
Similarly, Berjaud stated that this was the only worthwhile treatment: “the cure par
excellence is sulfate of quinine given at very high doses.”35 According to one of his
colleagues, Maillot
discovered nothing and invented nothing, but he made available a great body of
genuine evidence that familiarized French doctors with a whole range of illnesses
that were new to them but that he had encountered in Africa.36
28. Adolphe Armand, L’Algérie médicale (Paris: V. Masson, 1854), 242.

29. Société pour la propagation des connaissances scientifiques et industrielles, Bulletin universel des
sciences et de l’industrie, vol. IV (Paris: Mequignon-Marvis, 1825), 185-186.
30. Curtin, Death by Migration, 64.
31. Maillot, “Recherches sur les fièvres intermittentes,” 156.
32. Maillot, “Recherches sur les fièvres intermittentes,” 185.
33. Jean-Jacques Ferrandis, “États sanitaires des armées françaises en Espagne (Campagnes de
1818-1814 et 1823),” Histoire des sciences médicales 42, no. 2 (2008): 222.
34. Prosper Gassaud, “Mémoire et observations sur les fièvres intermittentes pernicieuses qui ont
régné à Nauplie (Grèce) pendant l’automne 1832, précédés d’un aperçu topographique de cette ville,”
RMMCPM 40 (1836): 29.
35. E. B. F. Berjaud, Histoire médicale du 35e régiment pendant la campagne de 1828 (Montpellier:
X. Jullien, 1829), 23.
36. Broussais, “Notice sur le climat,” 110.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n VII
The treatment that he recommended was new in that it constituted a rapid, high
dose intervention for all patients. Indeed, Gaspard Roux points out that in Greece,
his sulfate of quinine treatment worked well when used at general staff headquar-
ters to treat officers and their servants, and that “results would have been just as
successful and consistent among the ranks, if this precious remedy could have been
used as quickly and methodically.”37 This remark seems to indicate that the product,
which was not yet commonly used in the army, was not distributed in the same
way across the different corps and throughout the army hierarchy; this is confirmed
by a note written by his colleague, Vallette: men suffering from intermittent fevers
ended up in hospital “except for a few officers who had obtained supplies of sulfate
of quinine.”38 He regrets not having any for the ranks.
Sulfate as a curative or preventive?
In 1833, then, medical inspectors were in agreement “with regards to the superior-
ity of cinchona, and especially of sulfate of quinine.” Nevertheless, the way in which
these drugs function, “while entirely justified by the results, has not ceased to be the
topic of lively discussion and of contradictory or incomplete hypotheses … much
of which relies on practice rather than theory.”39
One of the topics of debate was that of the doses to be given to overcome the dis-
ease. Although an effective system of dosage was determined by François Magendie
in the early 1820s, there were as many opinions on dosage as there were doctors,
and it would be far too time-consuming to list the quantities (ranging from a few
decigrams to a few grams per day or per patient) that were considered optimal by
each one. In Africa, following Maillot’s model, “most doctors have a great tendency
to prescribe huge doses of sulfate of quinine to combat effluvial poisoning.”40 This

practice was contested throughout the 1830s and 1840s: based on his treatment
of thousands of men suffering from fevers in Spain, Corsica, Greece, and Africa,
Gassaud was convinced that “doses should not be exaggerated. One can just as
easily halt a pernicious attack with a gram or a gram and a half of sulfate of quinine
as with three, four, or five grams.”41 The other area of disagreement was the use
of bloodletting, which had long been used in conjunction with quinine—even by
Maillot—although it did not have unanimous approval. Labarre willingly resorted
to “general and local bloodletting, dry and wet cupping, and emollient poultices,”42
and Rietschel writes that he often “used bloodletting before administering sulfate
of quinine.”43 Others, however, considered it to be useful only rarely, or even likely
37. Gaspard Roux, Histoire médicale de l’armée française en Morée, pendant la campagne de 1828
(Paris: Méquignon l’aîné père, 1829), 27.
38. Roux, Histoire médicale de l’armée française en Morée note 1, 65-66.
39. Antonini and Monard, “Considérations générales,” 45.
40. Brouillaux-Léger, De l’intoxication effluvienne, 26. Maillot writes that he used between 24 and
180 grains (1 grain is the equivalent of 50mg).
41. Propser Gassaud, “Mémoire et observations sur les fièvres pernicieuses céphalalgiques subin-
trantes qui ont régné à l’hôpital militaire de Bordeaux, à la fin du printemps et pendant l’été de 1839,”
RMMCPM 48 (1840): 178.
42. Labarre, Considérations sur les fièvres, 17.
43. N. Rietschel, “Note sur la topographie médicale de la ville de Médéah, et sur les maladies
qui y ont régné pendant les mois d’avril, mai, juin, juillet, août et septembre 1841,” RMMCPM 55
(1843): 199.
VIII n Claire Fredj
to “produce the most unfortunate results;”44 this had been the position taken earlier
by Roux in Morea.45
Finally, it was debated whether quinine could be preventive. This question
had already been debated in relation to cinchona, and was once again discussed
when sulfate of quinine was confirmed as an effective drug. In August 1832, hav-
ing observed the “good effects” obtained in the treatment of fevers with sulfate of
quinine, high-ranking army officers expressed the hope that the use of a cinchona
wine, “suitably prepared in our laboratories, may be useful to soldiers occupying
posts that are rendered unwholesome by the proximity of marshes.”46 It was accord-
ingly planned that the wine be dispensed “every day (morning and evening)” in
order to protect the men “from endemic fevers.”47 Trudeau reported in 1846 that
“prophylactic sulfate of quinine did not fully live up to expectations.”48 It is not
clear, however, exactly which trial he was referring to since military administration
had refused to carry out the trial of quinine for preventive purposes that had been
proposed in 1842 by the French government: the idea had been to test its effects on
the garrison of Boufarik, with one third being given sulfate of quinine, one third
cinchona, and a control third being given no treatment.49 The Board of Health,
when consulted, noted that the British army had already rejected a similar proposal
that had been made in the 1770s (to treat soldiers preventatively with cinchona).
The Board therefore pronounced against the trial, highlighting the dangers of using
a drug on a healthy person, but also the risks of habituation to the drug, which could
jeopardize treatment in case of actual illness.50 The Board recommended, rather,
that the greatest attention should be paid to standards of hygiene (including the
organization of the camps and buildings, personal cleanliness and the use of clean
linens, diet, and morale of the troops) as well as to improving sanitation through

drainage construction and the draining of land and better planning: “Sources of
infection were thus dried up, as soon as an outlet was opened to drain off the foul
stagnant waters, and noxious marshes were transformed into fertile land!”51 For
these reasons, quinine was predominantly used for curative purposes, while it took
several decades for the preventive use of quinine to become common.52
If the French Expeditions of Spain and Morea proved the effectiveness of sul-
fate of quinine, then the conquest of Algeria transformed the scope of its use and
caused different sections of the army to consider how to efficiently supply a large
44. Brouillaux-Léger, De l’intoxication effluvienne, 27.

45. Roux, Histoire médicale, 26.

46. Archives du service de santé des armées [Army Health Services Archives], Paris (ASSA), 67/3-3
(Officiers de santé principaux à Intendant de l’armée [Chief Medical Officers to Army Supply Officer],
Algiers, August 2, 1832).
47. ASSA, 67/3 (Directeur de l’administration, Note pour le Conseil de santé [Director of
Administrative Services, Note to the Board of Health], August 30, 1832).
48. Trudeau, Des fièvres, 38.
49. Colette Bourély-Maucourt, Contribution à l’étude historique de la pharmacie en Algérie
(1830‑1870) (Algiers: Heintz, 1937) 112.
50. ASSA, 69, Réponse à une note de M. le Directeur du matériel de l’administration en date du
27 mai 1842 [Reply to a note from the Director of Supplies Administration dated May 27, 1842]
(Paris, June 6, 1842).
51. Brouillaux-Léger, De l’intoxication effluvienne, 23; Curtin, Death by Migration, 66-67.
52. On this issue, see William B. Cohen, “Malaria and French Imperialism,” Journal of African
History 24, no. 1 (1983): 23-36; and Gachelin et al., “Evaluating cinchona bark and quinine.”
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n IX
population who, without this precious commodity, might not be able to remain in
situ and carry out the necessary operations.
Supplying the French Army of Africa with quinine

In 1829, the three hospitals in Morea had supplies of four and a half kilograms of
sulfate of quinine, which allowed two grams per patient for a twenty-day period
of treatment.53 In August 1830, the health service of the Army of Africa requested
twelve kilograms of cinchona bark, and three kilograms of sulfate of quinine to
cope with a total requirement estimated to be six kilograms,54 a quantity that soon
proved to be insufficient. Maillot also recalled that in Algiers in 1832 to 1833, the
official supply of quinine was quickly used up, “at a time when communication
with France, which still relied almost exclusively on passage by sea, was rather rare
and irregular.”55 Without the tools needed to pulverize the cinchona bark, he was
reduced to “crushing it and making a decoction, which was administered to the
patients in small vials falsely labelled as a febricidal potion.”56 From that time on,
orders for sulfate of quinine increased. How did the army procure the quinine it used
in Algeria? What was the role of the military hospitals’ Central Pharmacy, which
manufactured some medical compounds and provided stocks of drugs to supply the
regular and mobile pharmacies of each army?57 It is also relevant to investigate in
what form it consumed in Algeria, given that the Army Supplies Office was trying
to limit the high costs associated with the widespread use of an expensive product,
made from cinchona imported from the Andes and particularly Peru, whose high
prices were subject to change—most often rising—due to growing demand but also
to political tensions in South America as well as the depletion of plantations.58

Quinine for Algeria
There is a lack of information about this aspect of military pharmacy, but it seems
that during the 1820s, the army manufactured the quinine it used. In 1829, the
army pharmacist Lesieure-Desbrière wrote that he had made, or seen being made,
“large quantities” of sulfate of quinine in the military training hospitals;59 and in
1834, although there is no certainty as to when this practice began, we know that
the Army Central Pharmacy was manufacturing the quinine used in the army from
the cinchona supplied by the firm of Garnier et Cie under the terms of a con-
tract awarded at the beginning of the year “for the supply of drugs and medicines
53. ASSA, 38/14, Conseil de santé, Note [Board of Health, Note] (Paris: August 30, 1829).
54. ASSA, 69/1, État de demande en médicaments et ustensiles [Record of requests for medications
and instruments] (August 12, 1830).
55. François-Clément Maillot, “Mon dernier mot sur les fièvres de l’Algérie,” Gazette des hôpi-
taux 113 (September 30, 1884): 897.
56. Maillot, “Mon dernier mot sur les fièvres de l’Algérie,” 897
57. A. Balland, La pharmacie centrale de l’armée (Paris: O. Doin, 1907).
58. The issue of the cost of sulfate of quinine was taken up on various occasions at the highest levels
of the medical institution: in 1854 for example, the French Medical Academy noted the rise in price of
the bark as a result of the political situation in Bolivia, Bulletin de l’Académie de médecine 19 (May 30,
1854): 730.
59. J.-J.-P. Lesieure-Desbrière, “Note sur un nouveau procédé pour obtenir le sulfate neutre de
quinine sans employer l’alcool,” in Mémoires de la Société des sciences, de l’agriculture et des arts de Lille,
année 1827-1828 (Lille: P. Danel, 1829), 145.
X n Claire Fredj
required by the military hospitals.”60 A few months later, military administration

requested Garnier et Cie to supply sulfate of quinine instead of cinchona. This
contract for essential drugs, including quinine, was considered to be “too finan-
cially burdensome”61 and was terminated in November 1838. After this, drugs
intended for Algeria, which until then had largely come from Paris, were generally
purchased from Marseille, “often from warehouses,”62 thus saving forty thousand
French francs. Indeed, we know that there was a drugs depot in both Marseille and
Toulon, although we do not know when these stores were established; in 1839,
these depots were requested to deliver the required products to Algeria as quickly
as possible. The Marseille depot, however, appears not to have been entirely satis-
factory since, in 1833, Larrey asked for all deliveries for Algeria to be sourced via
the Army Central Pharmacy, as most of the medicines bought in Marseilles were,
according to him, “poor quality or mixed with other substances;”63 this criticism
was also leveled in 1844.
This route does not seem to have applied to quinine, however, since, as of
1839, the army got its supplies directly from two firms, Pelletier, Delondre et
Levaillant and Thibouméry et Dubosc. As early as 1820, Pierre-Joseph Pelletier
was producing sulfate of quinine, initially in the laboratory of his Parisian dispen-
sary. As consumption increased, production became industrialized by the leading
French pharmaceutical firms. Accordingly, Pelletier joined forces with Jean-Baptiste
Bethemot in 1824 to found a factory in Neuilly-sur-Seine. Frederic Levaillant and
Auguste Delondre similarly began to manufacture sulfate of quinine, one in Clichy,
the other in Nogent-sur-Marne in 1828.64 In April 1836, the three manufacturers
joined forces: each retained ownership of his factory while producing quinine to be
sold under the joint brand of “Quinine des Trois Cachets.”65 French production of

sulfate of quinine, estimated at 90,000 ounces (2,552kg) in 1826, had increased to
120,000 ounces (3,402kg) twelve years later, two thirds of which were destined for
export.66 By the end of the 1840s, despite the development of a quinine industry
in other European countries and increased competition, the company of Pelletier,
60. Conseil d’État, “Fournitures médicaments pour les hôpitaux militaires; substitution de sulfate
de quinine au quinquina. Indemnité prétendue. Rejet,” Recueil des arrêts du Conseil ou ordonnances
royales, rendues en Conseil d’État sur toutes les matières, 2, no. 8 (1838): 559.
61. Ministère de la Guerre [French War Office], Tableau de la situation des établissements français
dans l’Algérie en 1839 (Paris: Imp. royale, 1840), 25.
62. The following year, the administration continued to purchase the most important medications
from Marseille, which provided “the greatest security” in terms of supplying the hospitals of North
Africa; see Ministère de la Guerre, Tableau de la situation des établissements français dans l’Algérie en 1840
(Paris: Imp. royale, 1841), 66.
63. ASSA, 67/3 (Larrey, May 7, 1833).
64. P.-J. Pelletier and J.-B. Caventou, “Lettre à MM. les membres de l’Académie royale des sci-
ences, sur la fabrication du sulfate de quinine,” Annales de chimie et de physique 33 (1826) : 333.
65. Maurice Bouvet, “Les Delondre: une grande famille pharmaceutique,” Revue d’histoire de la
pharmacie 129 (1951): 155-165. In 1837, Delondre joined forces with Joachim Armet de Lisle to run
the factory in Nogent, and from the middle of the century the factory was home to the three man-
ufacturers, Pelletier, Delondre, and Levaillant. In 1882, Armet de Lisle and Cie became the Société
anonyme du traitement des quinquinas [Anonymous Society for Cinchona Treatments]. See Armet,
Steinheil and Vivien, Sulfate de quinine (Paris: G. Gratiot, 1855); Anonymous, Sulfate de quinine des
Trois Cachets (Nancy: Berger-Levrault, 1889).
66. Pelletier and Caventou, “Lettre,” 334. Pelletier estimated that these dosages would provide
treatment for 1.4 million individuals. On Pelletier’s cinchona supply, see Auguste Delondre and
Apollinaire Bouchardat, Quinologie (Paris: Germer Baillière, 1854), 16 and 25.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XI
Delondre et Levaillant held “the monopoly, effectively, of the manufacture of the

sulfate,” and was supplying France, Russia, Germany, and America.
From 1839 on, it was therefore inevitable that the army bought its quinine,
which was mostly intended for Algeria, from this cartel.67 Thibouméry et Dubosc
do not seem to have been as productive, but the Army Supplies Office did some-
times purchase from them up to a quarter of its quinine, in “encouragement for a
newly established small company that might provide competition” and bring down
prices.68 Although the army benefited from a discounted price of 5% below the
market price, its administrative services always represented sulfate of quinine as a
great burden on the military budget, especially since its price tended to fluctuate,
as in August 1845, when the price per kilogram rose to more than four hundred
French francs because of a rise in the price of cinchona bark.69 These fluctuations led
the Army Supplies Office to reconsider having the drug manufactured by the Army
Central Pharmacy, in order to alleviate “[the army’s] position of dependence on
the producers of this salt.”70 The chemist Herpin calculated the costs of producing
sulfate of quinine at the Central Pharmacy compared to the costs involved in its
“customized” preparation for the army “by one of the manufacturers, with the army
paying for their labor and providing the cinchona, which would be bought by the
Administration;”71 in both cases, Herpin concluded that the current market model
remained the most economical.
Sulfate of quinine therefore continued to be bought from private firms. Delivered
in a bottle or in tin boxes,72 it was sold under the manufacturer’s seal, but this
did not prevent the occurrence of various forms of tampering, which increased in
scale and scope as pharmaceutical production became industrialized.73 According to
Auguste Chevalier, as well as the addition of a false seal, the bottles could be opened

“without damaging the seal and then closed again, after the sulfate of quinine had
been diluted” with substances such as “lime, sugar, mannitol, starch, or water.”74
The army, however, regularly monitored the quinine it received, checking both the
67. ASSA, 198/1, Envois de sulfate de quinine en Algérie 1839-1846 [Deliveries of sulfate to Algeria
1839-1846].
68. ASSA, 98-1/1, January 8, 1846. ASSA, 169/6, Lemaire, Note relative à la consommation et à
l’achat de sulfate de quinine [Note on the consumption and purchase of sulfate], Paris, July 26, 1848.
69. ASSA, 98-1/1. This was also the case in 1847 (ASSA, 69/3). These variations were in fact
constant: “the price of one ounce, with 32 ounces in a kilo, has long held at seven francs,” but in
September 1838, “following a rise in the price of cinchona supplies, it rose to eleven to twelve francs,”
A. Chevallier, “Quinine,” Encyclopédie du Commerçant, Dictionnaire du commerce et des marchandises

vol 2 (Paris: Guillaumin et Cie, 1841), 1894. The price was approximately 240 francs per kilo in 1856,
160 francs in 1870, and 500 francs in 1880. See Jean-Maxime Lebret, L’organisation du marché du
quinquina et de la quinine (Paris: A. Lepied, 1942), 42.
70. ASSA, 169/6, Herpin au sous-intendant [Herpin to the Asst. Supplies Officer], Paris, June 30,
1845.
71. ASSA, 169/6, Herpin au sous-intendant.
72. Chevallier, “Quinine.”
73. Sophie Chauveau, “Contrefaçons et fraudes sur les médicaments (XIXe-XXe siècles),” in Fraude,
contrefaçon et contrebande, de l’Antiquité à nos jours, ed. Gérard Béaur, Hubert Bonin, and Claire
Lemercier (Paris, Geneva: Droz, 2006), 711 and 713.
74. A. Chevallier, “Quinine,” Dictionnaire de l’industrie manufacturière, commerciale et agricole
vol. 9, (Paris: J.-B. Baillière, 1840), 452. As early as 1827, fraud such as the use of mannitol was being
noted (Le Moniteur universel de l’industrie française. Journal spécial d’annonces de tous les nouveaux pro-
duits des sciences, des arts et du commerce, October 1827, 117).
XII n Claire Fredj
purity of the salts and the water content. In 1847, for example, thirty-five kilograms
of sulfate of quinine destined for the depot in Algiers were inspected. While the
delivery from Pelletier, Delondre et Levaillant revealed a regulation water content
(12.5%), the goods from Thibouméry et Dubosc had a water content of 16%, and
the firm was warned that in future their product would be refused if it did not
comply with this quality standard.75
The quinine that was delivered to Paris was sent to Algeria or to the Marseille
depot, which could then respond rapidly to requests from Algeria. Thus, in 1845,
the establishment received an order of twenty-nine kilograms of sulfate of quinine
to go to Oran. As they did not have enough in stock, they purchased the missing
quantity from two firms, Cucurny and Roumieux, which allowed them to fulfill
the order quickly and to dispatch the goods by sea less than ten days after receiving
the order. If it had been necessary to send it via Paris, the time taken and the cost
of transport, which would have been by stage-coach, would have increased,76 so the
official in Marseille proposed that Cucurny should deliver directly to Marseille for
Algeria, and it appears that this was adopted without question. Containers for the
sulfate were also supplied by local companies. Thus, in March 1842, the master tin-
smith Coullomb of Marseille undertook to deliver to the city’s medical depot “the
amount of two thousand tinplate cases conforming to the regulatory ministerial
model […], deposited at the pharmacy of the depot,” at the price of fourteen francs
per hundred cases.77
The majority of the cases of quinine vials were therefore delivered to the Algiers
depot, which had been in operation since 1830. The depot therefore had to “store
and in part prepare the medicines required by the health services of the entire army
and, moreover, meet the demands of the civilian medical service.” In particular, the

depot sent the prepared drugs to the military hospitals of the three provinces, and
the regiments, the colonies, and other special services “obtained their medicines from
these hospitals.”78 There were clearly flaws in this channel of distribution since a
military decree of March 16, 1842 points out that troops employed in Algeria must
obtain their supplies “not only of sulfate of quinine, but indeed of all other medicines,
from the pharmacies of military hospitals, and that under no circumstances should
drugs be bought from civilian pharmacists or druggists,”79 since their quality was not
guaranteed and their prices were higher than those charged by military hospitals.
Monitoring the quantity and quality of quinine consumption
At the beginning of the occupation of the former Regency, quinine and cinchona
were often in short supply. The Army Supplies Office, however, endeavored to
ensure that the hospitals most affected by fevers were supplied as quickly as possible,
75. ASSA, 198/1, March 21, 1846; 169/6, Herpin au sous-intendant [Herpin to the Asst. Supplies
Officer], Paris, March 24, 1847.
76. ASSA, 169, Service des hôpitaux militaires, réserve de médicaments de Marseille [Military
Hospitals Service, medications store, Marseille], November 1845.
77. ASSA, 169, Soumission pour la fourniture de deux mille étuis en fer blanc pour le service de la
réserve de médicaments de Marseille [Request for the provision of two thousand tin cases for supplies
services], March 24, 1842.
78. ASSA, 69/11, Inspection médicale de 1851, dépôt de médicament [1851 Medical Inspection,
medications depot], September 23, 1851.
79. Ministerial Decree, March 16, 1842.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XIII
and between 1833 and 1837, the hospital in Bône received urgent deliveries of
sulfate of quinine.80 After the first years, the supply was regular and it is unusual to
read in a report, as in one written by Bazoche in 1860, that quinine “has sometimes
been lacking,” albeit only for mild cases of the disease.81 As early as 1833, the med-
ical authorities confirmed that there was no case for reducing the amount of sulfate
of quinine requested by doctors, “however considerable” that amount might be.82
Thirty years later, it was once more noted that:
the singular position of the troops in Algeria, and the necessity of providing treat-
ment, whether in wards or under canvas, to men who are suffering from afflictions
that absolutely demand the use of sulfate of quinine, means that physicians must
be allowed […] to ask for whatever quantities of this medicine that they judge to
be necessary.83
Requests were honored, but throughout the 1840s the consumption of sulfate
of quinine, although variable, remained at a level that was deemed to be high by the
military administration, who attempted to control it by various means.84
Suspicions soon arose about the high amounts being consumed: in 1834, the
assistant quartermaster of the military hospital in Bougie referred to “the enormous
quantity of sulfate of quinine that has been used” and called for regular monitoring
of receipts of drugs distributed to the army corps, “in order to exert some sort
of control over the prescription of medications.”85 He criticized the fact that the
drug was distributed too freely and without monitoring, and a similar point again
emerged in a communication of 1845 relating to the misappropriation of a consid-
erable amount of sulfate of quinine that had allegedly been committed against the
Treasury by a former pharmacist of Algiers named Defrance. On that occasion, the
military pharmacist Méquignon drew attention to the fact that, for a long time,

there had not been a thorough process of accounting for the drug: sulfate of quinine
(theoretically always prescribed by the doctor) was distributed in small packets to
the soldiers, who “sometimes exchanged this substance for wine or spirits or even
sold it for next to nothing.”86 It did not surprise him, therefore, that a large quantity
of sulfate of quinine had thus passed into private ownership.
80. Archives du Service historique de la Défense [Defences History Service Archives] (SHD), 1H18,
dossier 2, December 1832; 1H19, dossier 3, January-March 1833; 1H29, 14 December 1834; 1H42
dossier 3, 1836, expédition de Constantine; 1H44, dossier 3, January 20, 1837.
81. ASSA, 94-2/4, Bazoche, Aperçu topographique de Relizane, quelques considérations hygiéniques
concernant la population et les corps de troupe. Histoire des maladies régnantes depuis le mois d’octo-
bre 1859 jusqu’au mois d’avril 1860 [Bazoche, topographical notes on Relizane, some thoughts relating
to the health of the local population and the troops. Account of illnesses from October 1859 to April
1860] (1860).
82. ASSA, 67/3, Larrey, May 7, 1833.
83. Pierre-Augustin Didiot, Code sanitaire du soldat (Paris: Rozier, 1863), 197.
84. ASSA, 169/6, Lemaire, Note about the consumption and purchase of sulfate of quinine, Paris,
July 26, 1848.)
The consumption of sulfate of quinine in Algeria (in kilograms) is estimated as follows:
1840 1841 1842 1843 1844 1845 1846 1847
375 256 299 315 286 363 507 402
85. ASSA 69/8, Sous-intendant Prunière, Note pour le Conseil de santé [Asst Supplies Officer
Prunière, Note to the Board of Health], Paris, October 4, 1834.
86. ASSA, 198/12, cité par Urtis, chef de bureau, Note pour l’administration [quoted by Urtis,
manager of the bureau, Note to administration], Paris, November 26, 1845.
XIV n Claire Fredj
In the early 1840s, the military administration encouraged medical officers

to draw up monthly records of the consumption of sulfate of quinine to better
control the quantities dispensed.87 In 1846, these documents together prove that
orders were too frequent among the troops, which can be partly explained by the
inadequacy of the way that the drug was packaged: the bottles broke, particularly
when ambulances were used to transport goods other than medical equipment.88 In
a memo dated March 23, 1849, the Board of Health finally acknowledged that the
expansion of French territories in Algeria justified the sharp increase in consump-
tion, but not “the exaggeration in the doses at which this salt is administered,” and
required doctors to keep an “exact record of daily prescriptions,” which would allow
a monthly record to be drawn up.89 Two years later, military hospital medical officers
were generally complying with the 1849 instructions, to the point that the Board of
Health noted “with surprise” that sulfate of quinine was not prescribed uniquely for
fevers.90 Several doctors sent reports back from Africa of “an exaggerated propensity
to interpret a variety of conditions as intermittent or malarial in character.”91 This
was noted in 1842 by military medical officer Louis Laveran, who wrote that, when
he arrived in Algeria, he had been “so far forewarned by certain reading materials,
that [he] believed that he was witnessing just one illness in a variety of forms, and
that [he] thought only of using one single drug, sulfate of quinine,”92 despite the
fact that there were many other fevers that the sulfate could not treat. Consumption
therefore tended to be monitored, at least until 1862, when the French War Office
judged that the reasons for these checks no longer existed, and thus the requested
records “ceased to be provided.”93
In addition to these administrative measures to attempt to regulate demand, the
form in which sulfate of quinine was consumed can be seen not only as an economic

issue, but also a practical one: the way the drug was portioned out, distributed, and
transported were important logistical elements for mobile troops. The pharmacist
François Tripier was in charge of an active ambulance service between 1839 and
1841, and delivered sulfate of quinine to the field “as an ointment, as pills, as a
powder, and as a solution,”94 and praised the pill as the best form for precision
of dose and great ease of use for troops on the march. Until the 1840s, sulfate of
quinine had been used by troops in Algeria in its “natural form,” which was “a
form of consumption that, without benefiting the patient, was a burden to the
87. SHD, 1H78, d. 1, November 19, 1841; 1H79, d. 1, December 5, 1841: receipt for the quantity
of sulfate of quinine received; 1H81, d. 1, March 26, 1842: monthly records of consumption of sulfate
of quinine now had to be kept.

88. ASSA, 69/2, Officiers de santé en chef de l’armée [Chief medical officers of the army], Algiers,
May 15, 1846.
89. “Note ministérielle sur le traitement des fièvres intermittentes dans les hôpitaux militaires et les
infirmeries régimentaires et particulièrement sur l’emploi du sulfate de quinine, 23 mars 1849,” Journal
militaire officiel 5 (1849): 4-5.
90. Ministerial note on the monthly records of consumption of sulfate of quinine, January 4, 1851.
91. Didiot, Code sanitaire, 197.
92. Louis Laveran, “Documents pour servir à l’histoire des maladies du nord de l’Afrique,”
RMMCPM 52 (1842): 9.
93. “Note ministérielle concernant la suppression des relevés mensuels de la consommation de sul-
fate de quinine, 25 septembre 1862,” Bulletin de la médecine et de la pharmacie militaire (BMPM) 4
(1860-1862): 533.
94. ASSA, 69, Tripier aux officiers de santé en chef [Tripier to the Chief Medical Officers], April 22,
1844.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XV
Treasury.”95 Dosage of the powdered form “is long and complicated to determine;
its preparation as a solution is troublesome, and its administration inconvenient;
finally, division of supplies between groups of men when a unit has to split up, as
well as monitoring its use, also presents certain difficulties.”96 From 1840, however,
it was possible to “substitute […] the pill form for the powdered form,”97 and this
practice was formalized by a decision dated March 16, 1842: field surgeons putting
in an order would be able to request delivery of the sulfate in the form of decigram
pills, by the hundred, in a cylindrical tin case.98 This option rapidly gained popu-
larity and, within a short time, “twenty-two kilograms and eight hundred grams of
sulfate, transformed into 228,000 pills, were distributed.”99 According to the chief
medical officers, this helped to restrict the actual consumption of the drug,100 and
this mode of transporting and administering sulfate of quinine was mandatory in
1854 “for all corps of the armies of Algeria and the East.”101
We should also consider who prepared the pills. The circular dated March 16,
1842 specifies that they should be made “exclusively in the drug depots.”102 In
Algiers, preparation was entrusted to François Tripier, head pharmacist of the drug
depot. His pills contained a little less sulfate of quinine than those prepared in
the Val-de-Grâce military hospital in Paris, but, the inspectors acknowledged, the
same quality of manufacture could not be expected in Algiers, “where the large-scale
preparation of this medicine necessitates the employment of subordinates.” Other
establishments, and in particular Oran and Médéa, also prepared the pills, with
differences of size and possibly of recipe: the inspection of 1847—which judged the
sulfate of quinine used in Algeria to be of good quality—indicated that, in Oran,
the pills were “very uneven in their size,” and that in Médéa, “they were rolled in
licorice powder.”103 In 1853, the French War Office specified that all sulfate of

quinine pills prescribed in hospitals and mobile units must come from “cases from
the Algiers depot; the hospitals of Algeria should not be involved in preparation
processes.”104 In 1862, it seems that the pills were to be prepared “on demand, under
the direction of the chief pharmacist of each of the supply establishments.”105
95. Vaillant, “Note ministérielle relative au mode d’emploi du sulfate de quinine dans les corps de
troupe composant les armées d’Algérie et d’Orient, 22 juin 1854,” BMPM 1 (1852-1854): 279.
96. Vaillant, “note ministérielle […] 22 juin 1854,” 279.
97. Vaillant, “note ministérielle […] 22 juin 1854,” 280.
98. Ministerial decree, March 16, 1842.
99. French War Office, Tableau de la situation des établissements français dans l’Algérie en 1841 (Paris:
Imp. royale, 1842), 65.
100. ASSA, 69, Guyon, Monard, Horeau à Appert, intendant de la division d’Alger [Guyon,
Monard, and Horeau to Appert, Supplies Officer of the Algiers division], May 6, 1845.
101. Vaillant, “Note ministérielle […] 22 juin 1854,” 281.
102. Saint-Arnaud, “Circulaire ministérielle… accompagnant le nouveau tarif d’ordre pour l’éval-
uation des médicaments, 29 janvier 1853,” BMPM 1 (1852-1854): 61.
103. ASSA, 69/8, Rapport sur la nature et la valeur de plusieurs échantillons de sulfate de quinine et
de pilules préparées avec ce sel, le tout provenant de divers établissements hospitaliers ou de régiments
placés en Algérie [Report on the nature and value of a number of cases of sulfate of quinine and pills pre-
pared from the salt, all originating from various hospitals or regiments in Algeria], October 25, 1847.
104. Saint-Arnaud, “Circulaire ministérielle…,” 61. In 1874, sulfate of quinine pills would be
specially prepared and divided into doses at the Army Central Pharmacy for delivery to the regiments
and the hospitals, since the military pharmacists were “not supposed to prepare them […] unless their
supply had run out,” (“Note ministérielle relative à la livraison de quinine aux infirmeries régimentaires
de l’intérieur et de l’Algérie, 22 décembre 1874,” BMPM 6 (1870-1875): 695.
105. Pierre-Auguste Didiot, Code des officiers de santé de l’armée de terre (Paris: V. Rozier, 1863), 958.
XVI n Claire Fredj
The quality of the quinine pills was monitored, as was the solution of sulfate of
quinine which, according to a circular of December 6, 1848, “must be prepared in
advance in all the hospitals and mobile units of Algeria, so that dosages can then be
prepared on a daily basis and if necessary diluted;” similarly, all quantities should
be prepared to the same recipe.106 Hospital and depot pharmacists would then be
responsible for the substances delivered to them.
The attempt to replace quinine or naturalize the cinchona tree
Administrative executives repeatedly informed the Board of Health of the difficul-
ties they encountered in the supply of sulfate of quinine “both in terms of quantities
and of cost.”107 The excessive expenditure required for its use made it expedient to
“substitute other antiperiodic medications.”108 Since it was at that time harvested
only in the Andes, cinchona bark was a strategic product whose delivery was always
dependent on the political situation, and the “Peruvian bark” was seen to be placing
“an enormous burden on Europe,” which in France rose to 2,700,000 francs per
year in 1844.109
The cost of sending sulfate of quinine to hospitals in Algeria was estimated at
100,000 francs per year, a sum that had doubled two years later.110 As the colony
“consumes a prodigious amount of this exotic product,”111 in 1850 the Medical
Society of Algiers (la Société de médecine d’Alger) launched a competition to
“research and discover a quinine substitute sourced from indigenous substances,
for the treatment of intermittent fever.”112 The following year, the Pharmaceutical
Society of Paris (la Société de pharmacie de Paris) in turn launched a competition “to
find a chemical equivalent to natural quinine or a substitute for sulfate of quinine.”113
Various febricides had already been tried as replacements for cinchona, such as the

use of olive leaves to treat intermittent fevers in Spain between 1808 and 1813, and
further such experiments were carried out during the occupation of 1827, with the
aim of at least reducing the consumption of cinchona if not actually replacing it.114
106. Saint-Arnaud, “Circulaire ministérielle,” 62.

107. ASSA, 169, Conseil de santé, Note pour M. le directeur de l’administration [Board of Health,
Note for the Director of administrative services], November 24, 1848.
108. ASSA, 94-1/3, Hôpital militaire de Philippeville, rapport médico-chirurgical et pharmaceu-
tique du 1er trimestre 1851 [Military hospital of Philippeville, Surgical and pharmaceutical report from
the first half of 1851], April 22, 1851.
109. L’Abeille médicale 8 (August 1844): 192.
110. Jean-Christian Boudin, Traité des fièvres intermittentes, rémittentes et continues, des pays chauds
et des contrées marécageuses, suivi de recherches sur l’emploi thérapeutique des préparations arsénicales (Paris:
Germer Baillière, 1842), 17; L’Abeille médicale 8 (August 1844): 192.
111. ASSA, 69/5, Agnély, secrétaire de la Société de médecine d’Alger au gouverneur général de
l’Algérie, Alger [Agnély, Secretary of the Société de médecine d’Alger, to the Governor General of
Algeria, Algiers], February 26, 1850.
112. ASSA, 69/5, Note pour le service des subsistances et des hôpitaux militaires, Paris, 30 mars
1850 [Note to the supplies and military hospitals service]. In 1847, Dr. Mabille, a resident of Paris,
launched a prize of 200 francs for the best work selected by the Société de médecine d’Alger on the
treatment of intermittent fevers in Algeria: Archives nationales [National Archives], F173041/Algeria,
Note pour le ministre [de l’Instruction publique] [Note to the Minister of Public Education], Paris,
December 24, 1847. Émile Bertherand won the prize (Du Traitement des fièvres intermittentes en Algérie
et principalement du sulfate de quinine dans ces fièvres, Alger, Imp. du Gouvernement, 1850).
113. ASSA, 69, Bégin au ministre de la Guerre [From Bégin to the Minster of War], Paris, March 15,
1851.
114. Emmanuel Pallas, “Recherches chimiques et médicales sur l’olivier d’Europe,” RMMCPM 26
(1829): 159.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XVII
In 1848, in Algeria, Doctor France tried to use extract of oleander as a substitute

for sulfate of quinine, but without daring to abandon the latter for serious cases.115
Despite unsatisfactory results, a member of the Board of Health, undoubtedly
Jean-Christian Boudin, noted that “the study of the therapeutic qualities of medic-
inal substances that might be capable of replacing quinine is most worthy of the
attention of military medical officers.” A fierce supporter of arsenic, he drew par-
ticular attention to “the result of the use of preparations of arsenic in the treatment
of all types of malarial fevers;”116 indeed, he had hopes that, with the development
of an arsenic compound, “Europe will be relieved of the huge price that she cur-
rently pays to Peru,” and that the poor man “will finally have his own cinchona.”117
Elsewhere, we read that “in swampy areas, many unfortunate souls choose to suffer
on in their fevers rather than buy sulfate of quinine.”118
In Algeria, army doctors regularly referred to the different substitutes that they
or their colleagues were using. On the subject of preparations of arsenic, Contrejean
acknowledged the importance of “finding a universal and effective febrifuge without
paying a substantial tax to foreign powers,” although he considered that there were
other savings to be made rather than that of the soldiers’ health.119 The effectiveness
of arsenic treatments was, however, regularly debated: one young doctor noted that
results were “mostly unreliable,”120 while another “used Monsieur Boudin’s medica-
tion, but without being able to obtain satisfactory results.”121 One group of medical
officers seem to have formed their own course of action: “with numerous exper-
iments on the agenda in the attempt to ascertain the true value of arsenic in the
treatment of fevers, we find it fitting to await the results of the various conflicting
trials before making up our minds.”122 Arsenic preparations, however, continued
to be used in the army until at least the 1870s: one military doctor practicing in

Philippeville explained that, in earlier cases of malaria poisoning, he would “almost
always add to the extract of cinchona […] arsenic in the form of Boudin’s solution
or sodium arsenite in a solution of 1:1000.”123 However, the fact remains that it was
“difficult to dispense with the sulfate.”124
115. M. France, “De l’emploi de l’extrait de laurier-rose dans le traitement des fièvres intermit-
tentes,” RMMCPM 4 (1848): 193.
116. France, “De l’emploi de l’extrait de laurier-rose,” 193.
117. Boudin, Traité des fièvres, iv.
118. L’Abeille médicale 8 (August 1844): 192.

119. H. A. A. Contrejean, Des fièvres intermittentes de l’Algérie et de leur traitement (Paris: Rignoux,
1849), 41.
120. Brouillaux-Léger, De l’intoxication effluvienne, 26.
121. ASSA, 94-2/4, Bazoche, Aperçu topographique de Relizane, quelques considérations
hygiéniques concernant la population et les corps de troupe. Histoire des maladies régnantes depuis
le mois d’octobre 1859 jusqu’au mois d’avril 1860 [Bazoche, topographical notes on Relizane, some
thoughts relating to the health of the local population and the troops. Account of illnesses from October
1859 to April 1860] (1860).
122. Catteloup, “De la cachexie paludéenne,” 71.
123. ASSA, 94-2/8, Bincou, Inspection médicale 1877 [Bincou, Medical Inspection 1877], July 14,
1877.
124. ASSA, 94-1/3, Hôpital militaire de Philippeville, rapport médico-chirurgical et pharmaceu-
tique du 1er trimestre 1851 [Military hospital of Philippeville, surgical and pharmaceutical report from
the first half of 1851], April 22, 1851.
XVIII n Claire Fredj
Since there did not seem to be a substitute for quinine, which was seen as an
“almost always unequalled resource,” and particularly in Algeria, in 1848 the Board
of Health proposed to try to “appropriate the source of the drug, by transplanting
some of the trees that provide it to one or more locations within our territories,”125
either in the West Indies, in Senegal, or even in Algeria, which was an option that
was considered anew in 1849 and 1850. The increasing use of quinine convinced
the French, and indeed the British and the Dutch at the same time, to try to produce
cinchona in their own colonies. Thus, in June 1850, a few cinchona specimens from
Bolivia, which had been given to the French War Office by the Museum of Natural
History in Paris, were sent to Algeria, where Auguste Hardy, director of the central
nursery, attempted to naturalize them in the hills of Bouzaréah, near Algiers.126
These attempts at cultivation in Algeria failed, as would attempts in other French
colonies, whereas the more fortunate Dutch made their colony of Java into the main
producer of cinchona in the last third of the nineteenth century, thus marginalizing
imports from the Andes and transforming the market.127
The distribution of quinine to military and civilian populations

In 1857, the French War Office specified that sulfate of quinine could be used “in
all units of troops without distinction,” but with all “possible reserve” in troops
stationed at home, for budgetary reasons. This restriction was lifted for troops
stationed in Algeria and in the Mediterranean (Crimea and Italy).128 We will now
consider how this medicine was taken, and how it was distributed among the mili-
tary and civilian populations of Algeria.

Note to the Director of administrative services], November 24, 1848.
Note to the Director of administrative services], June 19, 1849; Conseil de santé, Note pour M. le
directeur de l’administration [Board of Health, Note to the Director of administrative services], April 2,
1850. In 1851, the pharmacist Millon proposed that 36 acres of market gardens at the military hospital
at Dey should be converted into botanical gardens, of which one hectare would be dedicated to experi-
mental cultivation, especially of quinine (ASSA, 69/3, Note sur la conversion des jardins maraîchers du
Dey en un jardin botanique [Note on the conversion of market gardens at the military hospital at Dey
into botanical gardens]); ASSA, 69/5, Lemaire, chef du bureau des hôpitaux des Invalides, Note pour le
Conseil de santé [Lemaire, manager of the Invalides hospital, Paris], Paris, June 14, 1850; ASSA, 69/5,
Tripier, Lille, February 18, 1851.
127. At the beginning of the 1860s, adjutant major Ribadieu was interested in the possibility
of planting cinchona trees in the oasis of Ghamra, in the south of Algeria, despite unsuccessful
earlier attempts (ASSA, 69/5, Rapport sur l’acclimatation du quinquina en Algérie dans le sud de la
province de Constantin, Sétif [Report on the naturalization of cinchona in Algeria in the south of
the province of Constantine, Sétif ], June 1, 1862). For an account of such attempts in the French
colonies, see E. Perrot, Quinquina et quinine (Paris: PUF, 1926); on the shift of production to India
and especially Java, see T. and W. Musgrave, “The quest for quinine,” in An Empire of plants. People
and plants that changed the world (London: Cassell & Co, 2000), 141-161; A. Goss, The floracrats.
State-sponsored science and the failure of the Enlightenment in Indonesia (Madison: Madison University
Press, 2011).
128. J.-B. Vaillant, “Note ministérielle récapitulative et complémentaire des dispositions qui
règlent l’approvisionnement des infirmeries régimentaires en médicaments, objets de chirurgie et usten-
siles de pharmacie, Paris, 31 janvier 1857,” BMPM 2 (1854-1857): 245 and 279.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XIX
The soldiers’ mistrust of sulfate of quinine

Maillot recounts that his treatment was criticized not only by doctors but also by
patients, and he describes a “crusade against high-dose use of sulfate of quinine”129 in
the Army of Africa, a crusade that was conducted at the highest level: during prepa-
rations for the Expedition of Constantine in 1836, the Duke of Orleans noted that
in Bône, 2,000 feverish soldiers were seeking, “by means of an excess of sulfate of
quinine, which is being more or less regularly distributed, to restore their strength
in the face of a lack of morale and zeal. Whole cases of this poison have been
swallowed in a few days in the regiments, which have been transformed into sick
wards.”130 Quinine was considered a toxic substance by much of the population,
who continued to harbor such prejudices for a long time: as late as 1852, a soldier
named Parisot, recently arrived in Algeria, wrote to his parents from hospital that,
“what with the herbal teas, the quinine, the méreuve, and all the different tablets,
[…] with all these poisons, a man cannot expect to live long.”131 A few months
later, his misgivings had abated: “Since the fifth of September, I have been in the
hospital, where I take a daily dose of eight decigrams of sulfate of quinine. I am well
recovered.”132 This mistrust was obviously not confined to the military population,
and in 1858, Paÿn, a civilian physician in Hussein Dey, expressed the hope that a
well-organized healthcare propaganda campaign would have positive effects “with
regard to medications. Then sulfate of quinine, so heroic in times of fever, might not
be rejected as it so often is, only to be replaced by those empirical remedies whose
consequences, alas always fatal, go unnoticed” except, he notes, by the doctor, who
was always called too late to warn of the deadly consequences.133
Sulfate of quinine was indeed subject to various criticisms: it was said to cause
hair to fall out and to have the side effect of “swelling of the abdominal viscus.”134

It did have side effects such as “insomnia, ringing in the ears, unusual cephalalgia,
vague limb pain, twinges in the epigastric region, and finally a gastric vulnerability
that is manifested by a tendency to vomit easily.”135 Moreover, its taste was revolting
to many patients. Doctors were interested in modes of administering this drug,
because its effectiveness depended on the way it was taken, since the active dose
was the amount that was retained in the stomach: “this observation, trivial as it may
seem, is nevertheless of a great practical utility for the military doctor who so often
has to fight against ill-will and the fatal blindness of his patients.”136
Several ways to take sulfate of quinine existed. In 1828, in Paris, “it is given
as a powder, either in jam or cordial, or wrapped in unleavened bread, or finally
129. Maillot, “Mon dernier mot,” 899.

130. Ferdinand-Philippe d’Orléans, Campagnes de l’armée d’Afrique (1835-1839) (Paris: Michel
Lévy frères, 1870), 195.
131. Flavien Parisot, “Lettre du 30 avril 1852. Orléansville,” in Marie-Françoise and Jean-
François Michel, Flavien de Fignévelle. Lettres d’Algérie et de Crimée d’un soldat vosgien (1850-1855)
(Grignoncourt: Éditions Saône-Lorraine, 1994), 61.
132. Parisot, “Lettre du 30 avril 1852. Orléansville,” 69.
133. A. Paÿn, “Cause et prophylaxie des affections automnales en Algérie,” Gazette médicale de
l’Algérie (GMA) (1858): 79.
134. Armand, L’Algérie médicale, 243.
135. C. and P. Monard, “Rapport sur les maladies observées à Alger en 1838 à l’hôpital militaire
du Dey,” RMMCPM 47 (1837): 225.
XX n Claire Fredj
dissolved in any liquid. In hospitals, it is given in pill form for ease.”137 The primary
mode of administration was by ingestion in potion form, but its taste caused diffi-
culties that were described on a number of occasions:
I had the patient take the potion of sulfate of quinine in front of me: we gave him
a full mouthful; he kept it in his mouth for some time; he made some attempts
to breathe, swallowed a few drops of the liquid that kept entering his airways, and
finally violently spat out most of the potion.138
Some doctors did not hesitate to aid the ingestion of the quinine by holding
their patient’s nose, but other means had to be used to deal with the reluctance
or even refusal of patients to take the medication: these included enemas and the
“endermic method” whereby quinine ointment was either rubbed in to the skin,139
or by using it as a vesicating agent to be absorbed through blistering of the skin;140
these two methods were judged ineffective by Jules Arnould who, in 1867, men-
tions the “unreliable rectal application” or the “even more illusory process of ender-
mic application.” Arnould preferred to concentrate on other means of introducing
quinine into the body, namely pills or hypodermic injections.141
Given the benefits already mentioned, the preparation of pills required the full
attention of the military administration. François Tripier initially used honey and
bread crumbs but, having noticed that the bread crumb made the pills “so hard,
in the heat, that when they were swallowed, they passed through the digestive
tract without dissolving,” he therefore decided to stop using this ingredient,142 and
manufactured his pills by mixing “one part of honey with two parts of sulfate of
quinine,” sometimes replacing the honey with sugar. Honey had the advantage
of “dissolving as soon as it comes into contact with a moist surface such as the

lining of the stomach.”143 Even when the pills were prepared “in accordance with
a special recipe that facilitated their absolute solubility in the digestive tract,”144
Doctor Trudeau wrote that he had no confidence in their effectiveness because
they had usually “been made too far in advance, had gone hard, and pass through
137. Félix Célestin Silvy, Dissertation sur l’emploi du sulfate de quinine dans le traitement des fièvres
intermittentes (Paris: Didot, 1828), 10.
138. Rietschel, “Note sur la topographie médicale de la ville de Médéah,” 200.
139. Labarre, Considérations sur les fièvres, 20.
140. Cambay, “Topographie physique et médicale du territoire de Tlemcen,” 58.
141. Jules Arnould, Du traitement des fièvres d’Algérie par les injections hypodermiques de sulfate de
quinine (Paris: Bulletin général de thérapeutique, 1867), 22. This issue should be considered in the
light of the new technologies available, which would have an impact on the manufacture of instru-
ments made of metal or glass (ventouses, syringes, cannula, ampoules, thermometers, droppers):
Jacques Léonard, “L’argent et le nombre,” in La médecine entre les savoirs et les pouvoirs (Paris: Aubier,
1981), 173. On forms of treatment, see especially Anne Rasmussen, “La résistible ascension du com-
primé. Pharmaciens, médecins et publics face aux nouvelles formes pharmaceutiques,” in La diffusion de
nouvelles pratiques de santé. Acteurs, enjeux, dynamique (XVIIIe-XXe siècles), ed. Patrice Bourdelais and
Olivier Faure (Paris: Belin, 2005), 103-123; Christian Bonah and Anne Rasmussen, eds., Histoire et
médicament aux XIXe et XXe siècles (Paris: Éditions Glyphe, 2005).
142. ASSA, 169/6, Les officiers en chef de l’armée à l’intendant en chef, Alger [Chief Army Officers
to Supply Officer, Algiers], May 6, 1844.
143. ASSA, 69, Tripier aux officiers de santé en chef [Tripier to Chief Medical Officers], April 22,
1844.
144. Vaillant, “Note ministérielle, 22 juin 1854,” 280.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XXI
the digestive tract without being absorbed. I have observed this many times.”145 In
1867, Jules Arnould therefore recommended administering quinine as a hypoder-
mic injection since this method avoided the problem of the stomach either rejecting
the substance “almost entirely, shortly after the dose has been administered in solu-
tion, or the pills [remaining] whole.”146 In injection form, “what is administered
is absorbed,” and this led to a saving per patient of about 66% of the quinine
otherwise required. Among other advantages, the injections spared the patient “the
horrible and persistent taste of sulfate of quinine” and reduced the intensity of side
effects such as ringing in the ears and headaches. Finally, the injections eliminated
“the foolish or self-serving tricks employed by some patients who would have done
anything to avoid taking the remedy, either because having the fever could get them
convalescent leave, or because they harbored the popular prejudice that quinine
causes the spleen to swell.”147 Soldiers as a group were particularly well supervised
in medical terms, and while many of them were clearly able to escape the doctor’s
attention (possibly with the intention of treating themselves, although the discipline
of military patients was a regular question for debate among the medical officers of
the armed forces), means of controlling these individuals remained a point of keen
interest within the military.148
It is also interesting to ask how quinine was distributed to foreign or native
civilian populations, whose health care was less formalized, but to whom the army
may have sought to provide care, for various reasons. The army’s pharmaceutical
depot in Algiers supplied not only military hospitals, but also delivered drugs to the
pharmacy of Algiers’ civilian hospital, which served as the central pharmacy for the
various urban and rural settlements of the civilian territory of Algiers.149 As for the
doctors and pharmacists of the health service, they supplied medicines to both the

settlers and the “native” population.
Civilian access to the army’s supply of quinine
In 1840, in relation to non-military beneficiary populations, the quantities intended
for civilians, whether European or native, were limited: for example, out of one
hundred kilograms of product available, the Algiers army drug depot supplied
the city’s civilian hospital with 1500 grams of sulfate of quinine, and the Arab
Bureau with 500 grams.150 Elsewhere, amounts were equally marginal relative to the
amount of sulfate available.

146. Arnould, Du traitement des fièvres, 22-23.
147. Arnould, Du traitement des fièvres, 23.
148. Claire Fredj, “Un aperçu de la relation médecin-patient dans l’armée française sous le Second
Empire: l’exemple des expéditions lointaines,” in La santé des populations civiles et militaires. Nouvelles
approches et nouvelles sources hospitalières, XVII e-XIX e siècles, ed. Elisabeth Belmas and Serenella Nonnis-
Vigilante (Lille: Presses du Septentrion, 2010), 87-98.
149. ASSA, 69/11, Inspection médicale de 1851, dépôt de médicament [1851 Medical Inspection,
medical supplies depot], September 23, 1851.
150. ASSA, 69/8, État indiquant les quantités de sulfate de quinine délivré aux corps étrangers et
ambulances de l’Algérie pendant l’exercice 1840 (extrait de la comptabilité de ces Établissements) et
dont la dépense n’est pas justifiée par les parties prenantes. [Record of quantities of sulfate of quinine
delivered to the overseas troops and mobile medical stations in Algeria during the 1840 expedition
(records taken from the accounts of these bodies), whose cost was not justified by the stakeholders.]
XXII n Claire Fredj
Quinine supplied to troops and mobile medical stations overseas in Algeria during
the expedition of 1840, where the cost was not agreed by stakeholders (extract)
Hospital Quantity available (in grams) For native populations For settlers
Blida 5721 5 166
Coléa 895 645
Constantine 15222 150 n. s.
Djidjelli 1369 357 n. s.
Guelma 4718 216 n. s.
Médéa 823 136 n. s.
Sétif 355 55 n. s.
These figures, however, appear to relate only to the distribution of the med-
ication outside hospitals, whereas military hospitals—of which there were about
thirty in the middle of the century—had long been treating civilians. In 1880, for
example, at the Philippeville military hospital, the number of civilian patients, who
were “mainly French, Italian, Maltese, Arab, and Kabyle,” was about “twice that of
military patients.”151
Sulfate of quinine was distributed in a similar manner in several places. The
army provided quinine to the European populations via the military hospitals, by
supplying firstly the depot at the Algiers civilian hospital, but also by having mil-
itary doctors provide a medical service to several agricultural colonies.152 In about
1860, the civilians of the nascent colony of Relizane were welcomed at military
establishments but also treated at home by army doctors.153
When the rural European populations were treated by the colony’s non-military

doctors, who formed an organized corps as of 1845, the general government decided
that they would be allowed to use the medicines that were supplied at cost price in
the military hospitals: a decree dated December 20, 1853 authorized medical prac-
titioners, in localities where there were no pharmacists—which had long been the
case—to sell medications to non-native settlers at cost price plus 10%.154 It was not
until the early 1890s that the drugs available to the colony’s non-military doctors
were mostly provided by civilian hospitals.155
As was the case within the military, monitoring of the quantities distributed is
an issue of interest. In a report dated November 1851, a Doctor Lévy estimates that
expenditure was sometimes too high: according to him, in the first half of the year
the sum spent on medications for the inhabitants of the suburbs of Philippeville
151. ASSA, 94-2/4, Sarazin, Rapport d’inspection médicale pour l’année 1880, Hôpital militaire de
Philippeville [Sarazin, Medical Inspection Report for 1881, Military hospital of Philippeville], May 1,
1880.
152. See for example P. Gandilhon, Quelques considérations pratiques d’hygiène et de thérapeutique
appliquées aux colons de l’Algérie (Montpellier, 1847); C. Fredj, “Les médecins de l’armée et les soins aux
colons en Algérie (1848-1851),” Annales de démographie historique 113 (2007): 127-154.
153. ASSA, 94-2/4, Bazoche, Aperçu topographique de Relizane, quelques considérations
hygiéniques concernant la population et les corps de troupe. Histoire des maladies régnantes depuis
le mois d’octobre 1859 jusqu’au mois d’avril 1860 [Bazoche, topographical notes on Relizane, some
thoughts relating to the health of the local population and the troops. Account of illnesses from October
1859 to April 1860] (1860).
154. Louis de Baudicour, La colonisation de l’Algérie, ses éléments (Paris: J. Lecoffre, 1856), 281.
155. Gaston Branthomme, De l’exercice de la médecine en Algérie (Lyon: A. Storck, 1892), 48.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XXIII
was disproportionate to their numbers: spending totaled 1,593 francs, of which

578 francs were spent on sulfate of quinine. He criticized a lack of seriousness
regarding the issue of receipts for distribution, as well as a general carelessness: in
the countryside, the agents responsible for distributing sulfate of quinine (colonists,
rural officers) supplied the drug on demand, without recording costs. Moreover,
patients who received this expensive remedy rarely took it in the presence of the
doctor, and nothing was to prevent them from selling it on.156
We have to ask whether this implies that the only quinine available in Algeria
came from the army, given that civilian pharmacies began to establish themselves in
the main urban centers of Algeria in the 1830s, with their numbers increasing at the
end of 1860s.157 Although military pharmacists were able to inspect private phar-
macies during the first decades of the occupation in order to monitor the quality
of products, such as the sulfate of quinine at the three pharmacies in Mostaganem
in November 1852,158 private pharmacies could get their own supplies, and this
quinine appears to have been sold at high prices; in 1856, according to Louis de
Baudicour, while hospitals bought sulfate of quinine at 360 francs per kilo, phar-
macists were selling it at 2,500 francs per kilo, which seems exorbitant. The cost
of quinine remained a potential obstacle to its use: outside the hospitals, where
quinine was free, pharmacists in Algeria, according to Jules Arnould, were charging
patients (and perhaps Arnould was referring specifically to Europeans) between one
and three francs per gram for sulfate that had been prescribed by doctors; this was a
price that would cause many fever patients to hesitate to pay for treatment.159
The competition between the free medication dispensed by army medical officers
and the medication sold for a fee by civilian doctors was a recurring source of com-
plaint. In El Arrouch, in 1847, for example, the pharmacist Rouneau complained

about pharmacists in military hospitals who were dispensing medicine to civilians
who presented “vouchers issued for this purpose by the local authority.” There
were other forms of competition too: in 1850, the pharmacists of Algiers protested
against the over-distribution of medicines by the civilian hospital and the Sisters of
Mercy.160 In 1855, the medical commission of the district of Algiers reported abuses
in the distribution of medicines by some charitable groups. From then on, local
authorities were required to ensure that medicine was dispensed for free only to the
poor, and only to those in possession of an individual prescription.161 In Saint‑Denis
156. “Dr Lévy au ministre de la Guerre, Rapport sur le département de Constantine, novembre
1851,” in Bourély-Maucourt, Contribution à l’étude historique, 161.

157. François Gomot, Annuaire de l’Algérie pour 1842 (Paris, Algiers: V. Magen-J.-B. Philippe,
1842); Annuaire de l’Algérie pour 1843 (Paris, Algiers, V. Magen-J.-B. Philippe, 1843); H. Barbera,
Annuaire de la province d’Alger, statistique, géographique, administratif et commercial, contenant les noms
des fonctionnaires et habitants de la province d’Alger (Alger, 1857); Annuaire administratif de la province
d’Alger, année 1863 (Algiers, Paris: Tissier-Challamel, 1865); P.-B. Nicot, Annuaire commercial des trois
provinces de l’Algérie (Algiers: Imp. centrale, 1870).
158. Bourély-Maucourt, Contribution à l’étude historique, 143.
159. de Baudicour, La colonisation, 281; Arnould, Du traitement des fièvres, 23.
160. Bourély-Maucourt, Contribution à l’étude historique, 158-159.
161. Archives of the Filles de la Charité, 28/22, le ministre de la Guerre Vaillant au supérieur des
Lazaristes [War Minister Vaillant to the Sister of the Order of Lazaristes], Paris, October 22, 1855. A
ministerial memo of April 16, 1828 states that Sisters of religious orders would be in contravention of
the laws concerning the practise of medicine if they dispensed or sold compound remedies or pharma-
ceutical preparations.
XXIV n Claire Fredj
du Sig, the Sisters distributed two and a half kilos of sulfate of quinine that had been
purchased privately. After this ran out, the civil commissioner obtained supplies
to be sold at fifty centimes per gram: the local population criticized a pharmacist
named German for charging too much (two francs per gram), although he himself
protested that elsewhere he could have sold it without a license.162 This was also
pertinent to the Sisters, who, in the absence of a doctor or a pharmacist, were left in
charge of supplies of basic medications for first aid.
Native consumption of sulfate of quinine
Native civilians could get supplies of sulfate of quinine in the hospitals, but also in
the Arab Bureaux, whose health services, established in 1847, included a certain
number of visits out into the local area.163 Medicine was, in fact, put forward as the
most likely means of rallying indigenous support for French domination, which
was part of a civilizing mission whose interests included the improvement of public
health.
Not all forms of care offered were successful, but these consultations appear
to have been well attended, especially of course by inhabitants who lived near to
the main town of each district.164 Malarial fevers, which had to some extent been
propagated by the displacements and destruction of the war, were frequent among
the Arabs, for whom quinine “was by far the most effective of the many treatments
they had experienced.” They would have “quickly understood and recognized the
wonderful properties of quinine (kina),”165 a drug that was in demand but which,
according to available sources, they could only obtain on French prescription at
that time. Doctor Lucien Leclerc, who was posted in 1857 to the Arab Bureau
of Souk-el-Arba in the region of Kabylie, and stationed for six years near to Fort

Napoleon, provided evidence about the relationship between his patients and this
drug. As early as 1857, he wrote that whenever he went out into the villages, he
would “always be able to dispose of my kina pills […]. If I was willing to give them
out to everyone who came asking for them on someone else’s behalf, I would easily
distribute a box a day.”166 As early as the expedition to conquer Kabylie, “a certain
quantity of pills had been distributed by the doctors of the field health unit,” which,
according to Leclerc, explained the fact that “on our arrival we found that sulfate
of quinine had a ready-made reputation, and, to cut a long story short, many fever
sufferers approached us with the words ‘quina, quina.’”167 He reports having treated
a large number of patients (2,026 in fifteen months, plus those he saw during his
visits), and he gives some detail in his account.
162. Bourély-Maucourt, Contribution à l’étude historique, 164.

163. Yvonne Turin, Affrontements culturels dans l’Algérie coloniale. Écoles, médecines, religion
(1830‑1880) (Paris: Maspéro, 1971), 81. There was a “medical service for Arabs” from 1832, and from
1843 Bugeaud made the case for the development of a regular medical service for native populations.
164. Jacques Frémeaux, Les bureaux arabes dans l’Algérie de la conquête (Paris: Denoël, 1993),
208-223.
165. Émile Louis Bertherand, Médecine et hygiène des Arabes: études sur l’exercice de la médecine et
de la chirurgie chez les musulmans de l’Algérie (Paris: G. Baillière, 1855), 469.
166. Lucien Leclerc, “Une mission médicale en Kabylie,” GMA (1857): 159.
167. Lucien Leclerc, “Une mission médicale en Kabylie,” GMA (1863): 82.
Treating a young colony: Doctors in the French Army of Africa, fevers, and quinine n XXV
Kabyle villages visited by Doctor Lucien Leclerc168

Estimated number Number of fever patients
Village
of inhabitants treated with sulfate of quinine
October 1, 1857 Taourirt Tamocrant 15
October 5, 1857 Taourirt Tamocrant 5
October 16, 1857 Iril Tazet 120 10
October 19, 1857 Tiriltel Hadj Ali 120 12
October 22, 1857 Iriguéfri 350 10
October 31, 1857 Iril Tigmounin 240 15
September 20, 1858 Taourirt Tamocrant 10
September 29, 1858 Taourirt Tamocrant 20
November 17, 1858 Yenni 15
These figures, however, do not give a clear picture of the spread of fevers since
the intensity of attacks and distance that had to be traveled kept many patients at
home. The demand for quinine seems to have regularly exceeded the doctor’s sup-
plies, which he reminds us were modest: during his visits into the villages, Leclerc
often had to send several feverish patients away “for lack of pills,” or persuade them
to go to Fort Napoleon.169 Many of these requests were made to him in the absence
of a patient by one of their family members.
In such cases, quinine was predominantly dispensed in pill form. When, in
1861, it was proposed that the use of pills should be discontinued, a number of
doctors pointed out the difficulty of distributing sulfate of quinine in a different
form to the Arab population.170 For example, adjutant major Lagarde, who was in

charge of the health service for the native residents of the district of Tizi Ouzou,
requested that the use of pills should be continued, and was supported by the chief
medical officer of the military hospital.171 A decree dated December 9, 1861 thus
permits the use of pills to be continued exceptionally for the Arab population, “for
whom the use of a different form of quinine has serious disadvantages.”172 However,
Leclerc noted that in the early days of his post at the Arab Bureau, he gave the
sulfate only in pill form, but that later on, “when we were better established, we gave
it in solution and found that this worked well.”173 He seems to have preferred giving
liquid sulfate rather than pills, perhaps because it was more difficult for the patient
to delay taking it. He recounts that patients who could not or would not make the
journey to see him would send someone on their behalf to get the medicine. He
168. Leclerc, “Une mission médicale en Kabylie,” GMA (1863), 81.

169. Leclerc, “Une mission médicale en Kabylie,” GMA (1863), 81.
170. ASSA, 69/6-11, Minute à M. l’Intendant de la division d’Oran [Memo to the Supply Officer
for the division of Oran], December 9, 1861.
171. ASSA, 69/6-11, Intendance militaire de la division d’Alger à MG [Military supplies office for
the division of Algiers to MG], November 27, 1861.
172. ASSA, 169/6, Lemaire, Analyse. Rétablissement de la forme pilulaire du sulfate de quinine
pour les corps et détachements qui voyagent en Algérie [Lemaire, Analysis. Reintroducing the pill form
of sulfate of quinine for troops in Algeria], Paris, November 22, 1862. It was confirmed that the pills
were reserved “for the services of native populations in Algeria,” in the “ministerial amendment to the
decree of December 9, 1860 which stipulated that the quinine pills used on regimental wards should
be replaced by solution of sulfate of quinine, Paris, November 25, 1862,” BMPM 4 (1860-1862): 538.
173. Leclerc, “Une mission médicale en Kabylie,” GMA (1863): 82.
XXVI n Claire Fredj
preferred to try to have the medication taken immediately, but even this did not
prevent numerous tricks: after having administered quinine in solution to a young
Kabyle, he saw the child turn his back to “spit the quinine straight out into a reed
he had hidden under his clothing.”174 Writings by French doctors present quinine
as a drug much sought after by the natives because they recognized its effectiveness,
although this did not mean that they welcomed other forms of care or were rapidly
converted to “French medicine.”175
The production of quinine, a highly strategic product, was, then, generally
delegated by the army to the private sector during the first years of its mass use,
particularly in Algeria. The Army Supplies Office therefore played a crucial role in
controlling orders of quinine and distributing it to pharmacists, who then prepared
various forms of the drug. This overview has shown that, in the Algeria of the first
decades of the conquest, any soldier suffering from fevers could expect to receive
curative quinine—whether in hospital or in the field—normally always under the
supervision of military doctors, who, however, tended to differ in their approach
to dosage. Outside the military framework, the quinine stocked by the army was
distributed in less generous quantities but was either free or very cheap compared to
supplies that were available to buy privately. Sulfate of quinine, which had already
become familiar in mainland France before 1830, but which had long been too
expensive for the majority of population groups, seems to have become accessi-
ble to a number of communities (including European, Algerian, urban, and rural
groups) who, despite different ways of using the drug, contributed to making its
use widespread, first in the army and then beyond, in ways that largely remain to be
explored. The army, which was central to the emerging colony’s structure, employed
its personnel in the health care of communities outside its own ranks. Alongside

vaccination against smallpox, the distribution of quinine, despite its limitations,
such as the low number of institutions and medical personnel relative to the total
population, was one of the most visible aspects of this service.
As the colony came under civil rule after 1870, the civil authorities in turn began
to distribute quinine as part of a public health policy that became more defined over
time: in 1893, the governor general ordered that sulfate of quinine supplies “are to
be delivered on a refundable basis by the hospital of the main district town” to all
town halls, and the drug was to be sold to settlers and natives at a price of five cen-
times per gram.176 Quinine continued to be used as a curative until the beginning of
the twentieth century, when the Institut Pasteur in Algiers launched its campaigns
against malaria, with one of the key elements being the systematic distribution of
preventive quinine.177
Translated from the French by Cadenza Academic Translations
174. Leclerc, “Une mission médicale en Kabylie,” GMA (1864): 8.

175. Laurence Monnais, “Ordonnance coloniale, prescriptions médicales et changement social,”
Genèses 69 (2007): 26-48; Claire Fredj, “Retrouver le patient colonisé. Les soins aux ‘indigènes’ dans
l’Algérie coloniale (fin XIXe siècle-années 1930),” Histoire, médecine et santé 7 (2015): 37-50.
176. Journal général de l’Algérie, May 28, 1893.
177. Clare Fredj, “Le laboratoire et le bled. L’Institut Pasteur d’Alger et les médecins de colo-
nisation dans la lutte contre le paludisme (1904-1939),” Dynamis 36, no. 2 (2016): 293-316. As of
1921, the Algerian antimalarial services got their supplies of sulfate of quinine from the Army Central
Pharmacy “at a far lower price than the commercial cost. It is then made into tablets or pastilles by
the [civilian] hospital at Mustapha;” General Government of Algeria, Assemblées financières algériennes
(Algier: Imprimeries nord-africaines, 1924), 254.

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Treating a Young Colony: Doctors in the French Army of Africa,

Fevers and Quinine, 1830-1870

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* Associate Professor at Université Paris Nanterre, IDHES (UMR 8533).

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Monde’ (1492-1750) (Vaulx-en-Velin: Les éditions des mondes à faire, 2016).

The limited availability of documentation and research makes it difficult to

Quinine as the panacea to Algerian fevers

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recorded in the Army of Africa, namely intermittent fevers. A number of medical

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13. L.-F.-Théodore Ducroquet, Quelques considérations sur les fièvres intermittentes pernicieuses

15. François-Clément Maillot, “Recherches sur les fièvres intermittentes du Nord de l’Afrique,”

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doses, bowls of cinchona.”28 Armand, however, considered this form of treatment

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28. Adolphe Armand, L’Algérie médicale (Paris: V. Masson, 1854), 242.

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44. Brouillaux-Léger, De l’intoxication effluvienne, 27.

45. Roux, Histoire médicale, 26.

Supplying the French Army of Africa with quinine

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required by the military hospitals.”60 A few months later, military administration

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Delondre et Levaillant held “the monopoly, effectively, of the manufacture of the

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A. Chevallier, “Quinine,” Encyclopédie du Commerçant, Dictionnaire du commerce et des marchandises

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In the early 1840s, the military administration encouraged medical officers

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of quinine now had to be kept.

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106. Saint-Arnaud, “Circulaire ministérielle,” 62.

In 1848, in Algeria, Doctor France tried to use extract of oleander as a substitute

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118. L’Abeille médicale 8 (August 1844): 192.

The distribution of quinine to military and civilian populations

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The soldiers’ mistrust of sulfate of quinine

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129. Maillot, “Mon dernier mot,” 899.

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145. Trudeau, Des fièvres, 39.

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was disproportionate to their numbers: spending totaled 1,593 francs, of which

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1851,” in Bourély-Maucourt, Contribution à l’étude historique, 161.

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162. Bourély-Maucourt, Contribution à l’étude historique, 164.

Kabyle villages visited by Doctor Lucien Leclerc168

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168. Leclerc, “Une mission médicale en Kabylie,” GMA (1863), 81.

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174. Leclerc, “Une mission médicale en Kabylie,” GMA (1864): 8.

28. Adolphe Armand, L’Algérie médicale (Paris: V. Masson, 1854), 242.

106. Saint-Arnaud, “Circulaire ministérielle,” 62.

118. L’Abeille médicale 8 (August 1844): 192.

129. Maillot, “Mon dernier mot,” 899.

1851,” in Bourély-Maucourt, Contribution à l’étude historique, 161.