PART ONE: 

Surgeons and Surgery in the 18th Century

SURGEONS AND SURGERY IN FRANCE

At the time of the Renaissance, surgery was highly regarded as a healing art, as it had been in ancient times. Both surgery and medicine were practised by the same men and were considered equally worthy of scholarly study.[1] However, either because the physicians (médecins) lost interest in surgery because it was more distasteful and less profitable than medicine, [2] or because clerics (i.e. scholars) were forbidden to shed blood and had to hire laymen to perform operations, [3] by the 16th century surgery was definitely considered inferior to medicine. In fact. surgeons and barbers were classed together as artisens or manual labourers. [4]

In France, barbers and surgeons formed one corporation until the 13th century, although a distinction was made between barbers, who performed only "petite chirurgie" such as treating wounds or bleeding, and surgeons who performed "grandes opérations". [5] It is not known at what date the corporation split into two separate bodies - the surgeon barbers. and barber surgeons - but the reason for the division is clear. The surgeon barbers, desiring to dissociate themselves from their lowly colleagues, constituted a confrérie under the patronage of St-Côme. The barber surgeons remained under the wing of the Faculty of Medicine and accepted the controls imposed on them by the Faculty which the surgeon barbers were attempting to evade. [6] The surgeon barbers built an amphitheatre in 1605 which they termed a college and wore the robe longue (the mark of a member of the University).[7] This was very distressing to the Faculty of Medicine, which considered itself the only repository of medical knowledge. Thus commenced a long and bitterly contested struggle between the surgeons and the Faculty of Medicine. [8]

In 1655 the surgeon barbers and barber surgeons settled their differences, and united under the control of the premier barbier du roi, (King's barber).[9] The Faculty contested this merger before the Parliament and, in 1660, succeeded in stripping the surgeons of their "honneurs littéraires" that although the two groups remained united. [10] This meant surgeons were limited to the condition of "aspirans, mattres et communauté", and were forbidden to call themselves "bacheliers, liceneiés. docteurs, ou college". They could not hold lectures, or "actes publiques" and were forbidden to wear the bonnet and robe (all privileges of the University). [11]

In 1668 Louis XIV, who seemed to have "more confidence in surgery than in medicine", decided that the head of the corporation should be known as the premier chirurien du roi rather than the premier barbier. In 1686, Louis underwent a successful fistula operation and thereby considerably increased the prestige and popularity of surgery.[12]

The next improvement occurred in 1699 when surgery was declared a liberal art and surgeons were granted the privileges accorded to all the liberal arts. They remained a corporation, but were freed from some of the restrictions placed on them in 1660. [13]

During the 18th century, surgery rapidly advanced to a position of independence and respectability. In 1723 the king issued an edict re-establishing the lieutenants du premier chirurgien du roi. It is not known when this office was originally established, but it had been abolished by decrees in 1691 and 1692 and replaced by that of "chirurgien Jurez". The latter office was hereditary and had given rise to abuses such as receiving unsuitable candidates (for a price) and the holding of the position by unqualified persons through heredity. [14] Since the purpose of both of these positions was internal policing of the profession, a well-qualified lieutenant was essential in order to maintain high standards. The lieutenant du premier-chirurgien was to be chosen from among the master surgeons in each community. [15]

The Royal Academy of Surgery was established at St-Côme (the surgeons' amphitheatre mentioned above) in 1731, [16] and several schools of naval surgery were established in the major ports.[17]

In 1743 surgery was declared an "art savant", "une vraie science" and was forever raised above the level of barbering. The degree of Maître ès Arts was required before entering the Royal Academy, and the Academy was permitted to confer degrees under the authority of the Premier chirurgien du roi. This change in the status of surgery was also contested by the Faculty, and probably led to the arrêt du conseil d'état of 1750 which explained in great detail the course of study and the methods of examination. The Maître ès Arts degree was not required outside Paris until after 1756, and even then it was not required everywhere. [18]

Available evidence fails to indicate exactly what happened to the barbers at this point. According to Diderot, two corporations had the right to offer barbering services. They were the maitre chirurgiens and the perruquiers.[19] The latter corporation had separated from the barber surgeons in 1637 to join a corporation known as "Barbiers-Perruqiers-Baigneurs-Etuvistes". [20] According to Delauney, the edict of 1743 included a clause forbidding master surgeons to practice as barbers. This effectually split the united corporation of surgeons and barbers, and forced the barbers to join the corporation of barbiers-perruqiers-baigneurs-étuvistes. [21]

In 1756 surgeons were given the title and privileges of "notables bourgeois", meaning that they were free from financial and feudal burdens. On the other hand, an edict of 1765 included physicians with "avocats et bourgeois vivant noblement", while surgeons were considered with "négotiants en gros, marchands ayant boutiques ouvertes. et matîres exercant arts libéraux". ]22]

From this brief review of the history of surgery in France it is apparent that the legal status of surgeons had improved considerably by the mid-18th century, although they were still considered inferior to physicians. More significant perhaps, is the change in "professional" status indicated by the establishment of the Royal Academy of Surgery and the requirement of the Maître és Arts degree.

The study of the training of surgeons in the 17th and 18th centuries is rendered difficult by the constantly changing situation and by the fact that requirements were not uniform throughout France. Since the sources are contradictory and often confusing, only a brief sketch can be presented here.

It should be remembered that instruction for physicians at this time was given in the Faculties of Medicine of the Universities. Lectures and examinations were in Latin, and the Maître és Arts  was required before beginning the study of medicine. [23]

Before 1660 there was a difference in the training given to surgeon barbers and barber surgeons. The former were taken as paying pupils for two years while the latter were apprenticed for six years and then worked as compagnons (journeymen) for seven years. [24] This lengthy process could be shortened by working in a hospital instead of in a boutique. [25]

Apprenticeship was the general rule after 1660, but the length of both the apprenticeship and the journeymanship varied. In 1723, three years apprenticeship and three years journeymanship were required. In 1730 it was two years as an apprentice, and three as a journeyman (or two years in a military or civilian hospital, or one year at the Charité or Hiôtel-Dieu hospitals in Paris). Another alternative was service as a ship's surgeon on king's vessels. privateers. or commercial vessels.[26]

After 1699, although surgery was declared a liberal art, training of surgeons was still by apprenticeship. Each master had only one apprentice, but he could also train a garçon or frater. The apprentice could be examined after one year and the garçon only after six years. The student took a preliminary exam to determine if he was qualified to be an"aspirant à la matîrise". Then he took the examination called the "quatre semaines". In the first week he was examined in osteology, in the second week in anatomy, then in bleeding and finally in medication. [27]

According to the Arrêt of 1750, the course for surgeons at St-Côme was to extend over three years; the first year was devoted to physiology and hygiene, the second to pathology and the third to medication. After this course, which also included clinical work, the student had to work under a master surgeon for six years; next, he had to undergo extensive examinations, including the "quatre semaines" and give a public thesis in Latin (the acte publique). These regulations, however, applied only to Paris; in the province's both the training and the examination requirements were less rigorous. The practice in most provincial cities was for the student to serve a two year apprenticeship, then to work for three years with a master surgeon for two years in a hospital. He then took examinations similar to those prescribed in Paris, but without the thesis. In smaller towns and villages, the aspirant took only one examination lasting three hours, covering "principles of surgery, bleeding, tumors, wounds and medication". [28]

The diversity of training and examining must have affected the mobility of surgeons. This problem was recognized in the "Edict re-establishing the lieutenants of the King's Surgeon" which requested each community to draw up its own statutes concerning the length of the apprenticeship, the number and form of the exams and demonstrations required. These statutes were to be examined by the King's surgeon, then on his advice to be approved by the king.[29] It does not seem that this excellent scheme was put into practice, but it is very probable that the lieutenants verified the capacity of those surgeons wishing to establish themselves in the area of their jurisdiction as they did in the colonies.

Although physicians maintained their social superiority, and to some extent their professional and academic superiority, over surgeons throughout the 18th century, some writers have suggested that surgery was the more effective of the two healing arts. Even at the time it was generally recognized that the best physicians were to be found in England, the best apothecaries in Germany, and the best surgeons in France. [30] The surgeons who learned anatomy by dissecting cadavers and acquired practical experience during their apprenticeship were better prepared to deal with their patients than the physicians whose studies were mainly theoretical. [31]

It is necessary to look briefly at the differences between medicine and surgery, to discover the meaning of surgery in the 18th century. According to Diderot the difference between medicine and surgery lay only in the different types of diseases treated by each. Physicians and surgeons possessed the same knowledge of the science of healing, but applied it to different illnesses, or to the same illnesses located in different parts of the body. Thus, surgery was the art of recognizing and treating exterior illnesses of the human body, or any diseases that could be treated by operating or the application of external remedies. Some of these conditions were ulcers, wounds, tumors, fractures and dislocations. [32] Diderot gives further examples of "surgical diseases": superficial complaints" either "without prominence" (all sorts of skin conditions such as pimples), or "with prominence" (tumors, warts, abscesses); and also "maladies dialytiques", such as wounds ulcers, dental cavities, fractures, sprains, hernias. [33]

With this brief introduction to the history of surgery, the training and examining of surgeons, and the nature of surgery, we shall now turn to the question of surgery in the French colonies, and in particular, surgery in Ile Royale.

SURGEONS AND SURGERY IN ILE ROYALE

It is very difficult to find information about surgery in the French colonies because no thorough or systematic studies have been published on this subject. [34] There is no lack of information for Ile Royale itself, but it is often difficult to interpret the documents found because no framework exists in which to place the evidence. Thus, this section will deal primarily with surgery in Ile Royale, along with some comparative material from other French colonies wherever possible.

MEDICAL PERSONNEL

One of the most surprising facts to emerge from this study is the number and variety of medical personnel available in the colonies: physicians, ships' surgeons, surgeons major, master surgeons, apprentices, Brothers of Charity (Order of the Hospitallers of St. Jean de Dieu), various orders of nursing sisters, and midwives. For Ile Royale alone, 43 names of surgeons and apprentices were found. A brief sketch of their careers can be found in Appendix I.

The number of physicians in the colonies was inferior to the number of surgeons. The first physician in Canada seems to have been Sarrazin 35 in 1697, [35] and there was a physician in Le Cap in the French West Indies in 1714. [36] However, there were no physicians in Ile Royale, and the only mention of a physician in connection with the colony is in 1756, when Prevost suggested that a good physician would be of benefit. [37] Nothing came of this suggestion, however, and Ile Royale remained under the care of its numerous surgeons.

The legal status of surgeons in the colonies was presumably the same as that of surgeons in France, and the changes taking place in France must have had some effect on the colonial situation. Nevertheless, the absence or scarcity of physicians in the colonies meant that surgeons were often the only medical personnel available, a situation which must have enhanced their prestige. There does not appear to have been rivalry between physicians and surgeons in the colonies where the two professions existed, although the evidence concerning this problem is by no means complete.

The large number of surgeons in the colonies has been attributed to regulations of 1681 and 1717 requiring every ship making a long voyage with a crew of 21 or more to carry a surgeon. [38] These regulations caused difficulties both in France and in the colonies. The ship owners found it expensive to pay for a surgeon and frequently hired unqualified men, probably at a lower salary. One candidate was received at Honfleur in 1700 with the stipulation that he never practice on land. [39] Another solution to this problem was to hire a surgeon who also served as a fisherman. This seems to have been a fairly common practice; an engagement made in Canada in 1716 specified that the surgeon was to act in both capacities, [40] and a case heard before the Admiralty court in Louisbourg mentioned that the surgeon was to help with the fishing when required "as the ships' surgeons do on this island." [41]

Opinion in Ile Royale about these surgeons seems to have varied. Some St. Jean de Luz merchants, complaining about the hospital tax in Ile Royale, insisted that the inhabitants preferred the ships' surgeons to any aid they could get at the "imaginary" hospital. [42] It seems probable that the surgeons who established themselves in the ports of Ile Royale were ship's surgeons who remained to serve the sedentary fishermen, Bigot, in 1742, noted that these surgeons were "perfectly ignorant and hardly even know how to read". [43]

It is to be hoped that the surgeons on the king's ships were more highly qualified than those on the fishing vessels. Both Bertin and Descouts served in this capacity before taking up their posts as surgeons major at Louisbourg and Ile St-Jean. The creation of the school of naval medicine at Rochefort was said to have improved the quality of ships' surgeons, who had previously been "lamentables fraters". Canadian officials in particular asked for surgeons trained at this school to be sent to the Colony. [44]

Whatever the qualifications of the ships' surgeons, it seems to have been necessary to control their activities in all of the colonies. Raudot issued an ordonnance forbidding ship's surgeons and other surgeons not already established in Canada to attend to the sick. [45] Bigot's ordonnance of 1751 reiterated the prohibition, but allowed newcomers to practice if they passed a "serious examination" before the king's physician at Quebec or the king's surgeon at Montreal or Three Rivers. [46] De Costebelle issued an ordonnance at Plaisance that required all wounds resulting from accidents or other causes to be reported to the surgeon major. First aid only was to be given by other surgeons in such cases, but barbering and bleeding could be performed without reference to the surgeon major. [47] An ordonnance issued at Le Cap required the presentation of certificates to the king's physician before a newcomer was allowed to practice medicine or surgery in the colony. Those without certificates could be examined by the king's physician and two master surgeons and thus be provided with the required papers. [48]

No official control over surgeons existed in Ile Royale until the position of lieutenant du premier chirurgien du roy was established in 1735. This is made clear by the Conseil's reply in 1717 to Lagrange's request to be allowed to practice surgery in Ile Royale after he had lost his position as surgeon major. They noted that "il ny a point de maitrise al'Isle Royalle", [49] and therefore that Lagrange would have no difficulty in establishing himself there.

When Lagrange was received as lieutenant in April of 1735, the Conseil Supérieur ordered that "those who wish to establish themselves in future in this colony and its dependancies as barbers or surgeons must present themselves before Sr Lagrange to be examined by him and the other surgeons whom he wishes to assemble concerning the art of surgery, bandaging, knowledge and application of medication, and finally to be examined on their ability, before being allowed to practice barbering or surgery on this Island, under penalty of a fine and confiscation of their instruments". [50]

Although the lieutenant du premier chirurgien was not supposed to receive payment of any kind for the examination of candidates, an unsigned and undated document in the Greffes du Conseil Supérieur of Louisbourg lists the fees to be paid to the premier chirurgien, the lieutenant, etc. according to an Arrgêt du Conseil du Roi of 1671. [51] The lieutenant was to receive 66 livres 8 jettons dargent (valued at 1 livre a piece), and 2 pair of gloves (valued at 2 livres a pair).

The position of lieutenant du premier chirurgien du roi existed in Canada as early as 1658. [52] The lieutenants' function was "to ensure that surgeons followed the norms of their profession". [53] However, the ordonnances mentioned above indicate that this function was also given to the king's physician or surgeon major in Canada and other colonies. A king's ordonnance of 1723 regulating the position of surgeons major in the colonies does not mention the lieutenant du premier chirurgien and specifically delegates his authority to examine candidates to the surgeon major, in conjunction with the king's physician. [54] Thus Lagrange, as surgeon major, could have exercised the functions of leutenant du premier chirurgien du roi without going to the trouble of obtaining the title. It is not known why he did bother to secure the title, or what became of the lieutenant du premier chirurgien in Canada as a result of the ordonnance of 1723.

Although one of the lieutenant's functions was to examine apprentices, no documentary evidence of such examinations has come to light. Many Ile Royale surgeons had apprentices (see Appendix I), but unfortunately, the terms of these apprenticeships are not known. In Canada, apprenticeships varied from two to four years in length; the apprentice usually began by shaving the master surgeon's customers, then accompanied him on hospital visits, and eventually assisted with the more complicated treatments and operations.[55] One example of a contract between a master surgeon and his apprentice indicated that the apprentice was 17 years of age, and was to receive room and board as well as instruction from his master for three years. His parents promised to pay the master 200 livres and to provide their son with clothing. [56]

It is possible that the Brothers of Charity also trained apprentices. A declaration made in 1749 by Sollé (probably the son of Jean Sollé, an Ile Royale surgeon) indicates that he had worked in the hospital at Louisbourg. [57] Sollé was a student at the Rochefort hospital when he made this declaration, which may indicate that Ile Royale surgeons sent their sons to France for training. However, since all the inhabitants were forced to return to France in 1745 this theory is difficult to prove.

Many of the Ile Royale surgeons engaged in other activities, probably indicating that surgery was not particularly profitable. Pierre Meillon, surgeon at Havre Fourché, had a business partnership with Julien Fisel, a Louisbourg merchant.[58] Martin Descouts engaged in fishing before he became surgeon major at Ile St Jean, and Dcminique Collongue, although he was a surgeon major, had a wide variety of commercial interests.

Surgeons, particularly in the smaller communities, were probably better educated than their neighbours, and may have been asked to perform functions unrelated to their profession; for example, Pierre Meillon, along with the parish priest, made an inventory and witnessed a will in Havre Fourché. [59]

Besides caring for the sick and wounded, surgeons were required to examine wounds and perform autopsies when the cause of death was suspect. Their reports were often received as evidence in the trials of persons accused of murder or assault. [60]

Hospital care was provided in Louisbourg, Martinique, St. Domingue, and Guadeloupe by the Brothers of Charity, and in Canada by nuns of several different orders. [61] It is not the purpose of this report to discuss the hospital or the Brothers of Charity who operated it, except to note that the Brothers of Charity provided their own surgeon.

In addition to the various types of surgeons already discussed, the inhabitants of Louisbourg could also call on a mid-wife. The sage-femme or mid-wife was an important person in the 18th century when the number of women and children who died in childbirth was relatively high. [62]  Mid-wives have been described as "well-meaning murderesses" with a knowledge based only on observation. [63]

Sometime during the 17th or 18th centuries, rigid precautions were taken in France to prevent "clumsy and incapable" women from entering the profession. Apprenticeship with a maîtresse sage-femme or at the Hôtel-Dieu in Paris, followed by an examination by the king's surgeon or his lieutenant, were required in Paris. These standards were not followed in the provinces and certainly not in the rural areas. The mid-wife had to be a Roman Catholic "de bonne vie et moeurs", and had to swear to strive for the "spiritual and temporal-salvation" of both the mother and the child. [64]

Mid-wives existed in Canada, where they were "sworn in" by the parish priest. In 1750, the salary of a mid-wife was 600 livres. [65]

The first mention of a mid-wife in Louisbourg is in 1729: "la sagefemme Z'Emart". [66] Unfortunately, it has not been possible to identify this woman or to discover when or why she ceased to function as a sage-femme. However, by 1738 the colony was without a mid-wife and requested the minister to send one from France. He replied that it was not easy to find mid-wives for the colonies because there was a scarcity of them in France itself. He recommended that Bertin try to train someone in the colony for this position.[67] There did not appear to be anyone in the colony who could serve in this way, [68] and nothing further was done about the matter.

It appears that the women of Ile Royale solved the problem for themselves. The widow Droit, a mid-wife at Rochefort, delivered a number of babies between 1745 and 1748. The women of Ile Royale were so pleased with her that Prevost asked her to serve in the colony. She was apparently highly qualified (she described herself as a "sage-fame-mestresse de L'hostel dieu a paris"), and accompanied her request to the minister with a certificate from a naval physician attesting to her "ability, the success of her work, and her conduct".[69] The minister was impressed and requested the Intendant at Rochefort to discuss a suitable salary for her with Prevost.[70] Thus the widow Droit became mid-wife at Louisbourg in 1749, with an annual salary of 400 livres. [71]

Pichon suggests in one of the more scurrilous passages of his obviously biased indictment of the Brothers of Charity that the widow Droit suffered some competition from the Brothers: 

Since they are surgeons, physicians and apothecaries for the whole colony, they are continually wandering about the houses and God knows what they do there; I think that although some of the women at least do not complain about this, there are some husbands who should. In fact, the part of their surgical duties that they like best seems to be that of delivering babies. [72]

The widow Droit's salary was continued at Rochefort until at least 1759 with the intention that she return to serve in a colony as soon as possible.[73] Nothing further is known about the career of this woman who influenced the lives of many of the inhabitants of Louisbourg.

A number of individuals in Ile Royale provided medical services, although they apparently had no professional training. Esben Borda took in a sick sailor at the request of his captain "pour faire de remede" and was promised payment for his expenses. When the sailor died, the captain refused to pay and Borda took legal action .[74] In 1738, Nicholas Baron was paid 120 livres for treating two soldiers who had scurvy.[75] Once Sr. Solo, Maurice Hiop and Pierrot Saxe received payments for bandages provided for the soldiers. [76]

At least two surgeons were sent to Ile Royale as fils de famille; that is, their parents requested their removal because of extravagant or licentious behavior. One of these, a servant of St-Ovide, was allowed to return to France on condition that he cease his "libertine life".[77]

THE SURGEON MAJOR

The position of surgeon major is considered in a separate chapter because it poses a number of problems, and because a clear understanding of this position is especially important since the subjects of the following biographies were both surgeons major.

There are no documents detailing the functions of the surgeon major, and it appears that these functions varied from time to time and from place to place; the exact nature of the position depended to a large extent on the personalities involved (the administrators, the officers and the surgeon himself), and on the material conditions in each locale (presence or absence of a physicians barracks or a hospital, the type of hospital).

For the most part, the following account has been compiled from numerous references to troops, surgeons major and the hospital in the correspondence between Ile Royale and France. Though this outline attempts to present an accurate picture of the duties of the surgeons major in Ile Royale, It is not necessarily applicable to any other colony. In fact, it is hardly likely that the surgeons major in Canada, where the troops were usually billeted with the inhabitants, could function in the same way as those in Ile Royale, where most of the troops were lodged in barracks.

The problem of determining just what the surgeon major did in Ile Royale is complicated by the fact that this position was held for a time by the Brothers of Charity. The reasons for exchanging a lay surgeon (Lagrange) for a brother surgeon, and then reverting again to a lay surgeon were never made clear. The Conseil de Marine did not agree with the inability of a brother surgeon to the colonial administrators that the inability of a brother surgeon to follow the troops in time of war was a major drawback. [78] In 1725 St-Ovide, championing the re-appointment of Lagrange, emphasized the utility of having a surgeon's apprentice in the barracks "since the troops are now lodged there". [79] He did not explain why the Brothers could not provide this service.

Despite the confusion of these early years, it became the accepted rule that wherever troops were detached, a surgeon major was appointed. [80] Thus, for most of the period of French hegemony in Ile Royale, the king maintained surgeons major at Louisbourg, Port Toulouse and Isle St Jean, and in the 1750's, at Port Dauphin as well.

Perhaps the clearest statement of the surgeon major's duties is that given by a soldier during a quarrel with the surgeon major at Port Toulouse. [81] The two men had been drinking together, but when the surgeon major tried to make the soldier recognize him as his superior, the soldier replied that the surgeon major was paid by the king "to give help to the soldiers when they needed it". The "help" given by the surgeon major included such things as shaving, first aid, checking the soldiers in and out of the hospital, and giving certificats d'invalidité to those who could no longer serve or who required treatment in France.

Although the surgeon major's primary function was to care for the troops, he was not part of the military organization. This is clearly indicated by a quarrel between Raudot, the Intendant of New France, and some of the officers in Quebec concerning the appointment of a surgeon major, In 1708 the minister stated that this appointment was the duty of the Intendant. [82] The absence of any reference to the surgeon major in the ordonnance concerning the Companies Franches de la Marine, and the fact that the surgeon major's salary was listed with those of the "other employees" and not with those of the officers or the troops is also significant. In 1759, Bertin's son's name had to be removed from a list of cadets because this was an honour reserved for the children of officers. [83]

According to an ordonnance of 1691 concerning the Companies Franchas de la Marine, each company was to include a frater or apprentice surgeon who was also a soldier. The frater was to shave his fellow soldiers whenever they needed it. For his services he received 2 sols a month from each soldier. [84]

This practice was not always followed in Ile Royale or in Canada, the frater being replaced in both colonies by the surgeon major or his apprentice. In the early years of the colony Lagrange had a written agreement with the officers to shave their soldiers (approved by the commissaire ordonnateur).[85] It is not known what system was used when the Brothers of Charity functioned as surgeons major. However, as soon as Lagrange was re-appointed surgeon major, St-Ovide ordered him to maintain an apprentice in the barracks "to shave the companies and in case of accident to aid those who required it". With or without a written agreement, the captains (according to St-Ovide) willingly gave the surgeons three livres a year per soldier for this service and for treatment of minor illnesses.[86] The minister noted that this rum seemed high, since the surgeon major in Canada received only three livres per month per company and no salary.[87] St-Ovide replied that the officers had no complaints and that the soldiers were very pleased since prior to this arrangement they had paid six to seven livres a year for inferior service. In fact, the Swiss commander was very "mortified" when his colonel sent a sort of "barber-soldier" for his company, and requested that the Swiss soldiers receive the same treatment as the French, for the same price. [88]

The above exchanges took place in 1726; there was no further correspondence on Lagrange's duties until 1730. In that year de Mezy suggested that Lagrange's salary be raised to 720 livres a year, but that "the governor be forbidden to make each soldier pay him". He noted that this payment was an abuse, that it prevented the frater from working, and that the captains had complained to him, fearing a stab in the back ("cour de Jarnac") if they complained directly to the court. [89] Unfortunately, since de Mezy's letter was unanswered, it is impossible to discover which version of the affair was correct.

The only hint that some action was taken regarding de Mezy's complaint is a series of payments to all the surgeons major beginning in 1734, under the heading "diverses Depenses" or "Depenses Extraordinaire". The reason for this payment is given in detail in the 1735 "Etat de depenses": 

To Sr Jean Lagrange surgeon major of the troops, 120 livres for medicines and plasters that he furnished to the sick and wounded soldiers before they went to the hospital ... according to a verbal agreement made with him. [90] 

It seems reasonable to assume that this was some sort of compromise whereby the company frater shaved the soldiers, while the surgeon major was compensated for the loss of the three livres a year he had been, receiving from each soldier.

It is probable that the surgeon major continued to keep an apprentice in the barracks after this change. Bigot noted in 1741 that the surgeon major gave first aid to wounded soldiers and attended soldiers in their rooms when they were not seriously ill. [91] An account of a soldier wounded in a duel indicates that Bertin's apprentice was close at hand: the apprentice arrived very promptly in the wounded soldier's room apparently without being summoned. He did not treat the soldier however, because the man's sergeant took him to the hospital as soon as he saw the wound. [92]

The relationship between the surgeon major and the hospital was complicated by the fact that the Brothers of Charity operated the hospital, and supplied their own surgeon. In hospitals where there were no brothers, a physician, aided by a large staff including a surgeon major and an apothecary, was responsible for the troops consigned to his care. [93] According to a plan drawn up for the Louisbourg hospital by Soubras in 1714, the surgeon major would be responsible to a number of directors, and an "administrator" would be appointed to oversee the daily operations. [94] This plan was never put into operation because the Brothers were appointed to run the hospital in 1716. [95]

Presumably the surgeon major recommended when a soldier needed hospitalization, although in at least two cases a sergeant conducted soldiers to the hospital. [96] Apparently the surgeon major did not have to examine a soldier before he went to the hospital, because the minister recommended in 1735 that he do so. [97]

Once a soldier entered the hospital, he was under the sole care of the Brothers, who refused to allow the surgeon major to enter the hospital even when they had no surgeon of their own (presumably because he had died). This was reported in 1730 by de Bourville, major des troupes, who had ordered Lagrange to visit the soldiers in the hospital because the Brothers' care was inadequate. He complained that conditions were so bad in the hospital that the soldiers had to be forced to enter when they were ill. [98]

This apparent lack of concern for the patients, and the Brothers, refusal to receive the surgeon major, led to a long correspondence between the minister and the colonial officials resulting in a number of changes in the hospital administration. In 1732, de Mezy appointed a clerk to keep an account of the hospital furniture and supplies and to maintain a register of the number of soldiers received and the length of their stay. [99]

It was not until 1739 that the surgeon major made regular visits to the hosptal. As early as 1736 St-Ovide and LeNormant had agreed in principle that he should go there once a week to ensure that any soldier well enough to return to duty be released. [100] The Brothers refused to allow these visits, however, and the best that LeNormant could accomplish was to send the surgeon major to the hospital several times during 1738 "on different pretexts" to accustom the Brothers to the idea. [101] Bigot reported in 1739 that he had "engaged the Brothers to suffer the visits of the surgeon major" who now visited the hospital two or three times a week. [102] These visits, once established, apparently continued throughout the existence of the hospital, since Prevost mentions them in 1756.[103] 

Although the surgeon major did not visit the hospital until 1739, it appears that an officer visited the troops daily at least as early as 1726. [104] This officer reported to the major or the commander on the condition of the troops there, [105] and apparently incurred the Brothers' wrath in 1735 when he suggested that some of the soldiers were well enough to be released. [106] This practice seems to have been continued for it was mentioned again in 1752. [107]

It seems that the officers were treated free of charge by the surgeon major, although in Louisbourg this did not include shaving. Lagrange requested in 1717 that the officers be required to pay him for this service according to the account he had with each one. [108] Officers in Canada were treated free of charge when they went to the hospital until 1711 when a surgeon took legal action to force them to pay for his services. [109] In Louisbourg, officers were required to pay when they went to the hospital (although the rate of payment was under discussion for many years), but were treated free in their own quarters. [110]

Certificats d'invalidité attested to the physical conditions which made it impossible for a soldier or an officer to continue his duties. A certificat was required when a soldier was recommended for half pay or when treatment in France was considered necessary. It was part of the surgeon major's job to provide these documents for any soldier or officer dismissed or requesting leave for reasons of health. [111] Certificats d'invalidité were also provided by the Brothers of Charity and by the engineers.[112]

It would appear that the surgeon major was supn3.ied with medicines, and possibly with instruments. The first surgeon sent to Ile Royale was to be supplied with a coffre de chirurgie for 100 men and the "instruments of his profession", along with other supplies necessary for a small hospital. [113]

The surgeon major of the hospital at Plaisance and the Brothers' hospital at Louisbourg were similarly supplied. [114] The surgeon major at Ile St Jean received 100 livres above and beyond his salary to pay for medicines,[115] and the surgeon major of the Bourgogne battalion was given medicines for 100 men. Prevost complained that the latter refused to account for the use he made of these medicines. [116] If all the surgeons major received medicines in this way, the payments for "medicines and plaster supplied to the soldiers before they went to the hospital" were somewhat redundant.

On the other hand, some surgeons supplied their own instruments and medicines; Collongue, surgeon major at Port Toulouse, owned 285 livres 15 sols for a chest of medicines in 1738, and Bertin had 500 livres worth of instruments in his cabinet à remèdes. [117] These may, of course, have been for use with private patients.

In addition to caring for the troops, the surgeon major was frequently called in by the court officials to examine a wounded person or a corpse, and often performed autopsies to determine the cause of death. A selection of these documents has been compiled in Appendix II. It should be noted that any surgeon could make these reports, but in Louisbourg the surgeon major seems to have been preferred.

The surgeon major was permitted by the king's ordonnance of 1723 to examine candidates who wished to practice surgery, and to serve the civilian inhabitants as long as this did not interfere with his duties to the troops.

Little is known about the examination of candidates in Louisbourg, except that Lagrange had himself appointed lieutenant du premier chirurgien du roi in 1735. The Louisbourg surgeons major certainly treated the inhabitants, although they had to compete with the Brothers of Charity in this respect. [118]

A number of Canadian physicians and surgeons engaged in scientific research, such as the collection of plants for the Jardin du Roi or correspondence with the Academie des Sciences.[119] No evidence has been found to indicate that the surgeons major of Ile Royale took an interest in such research, although a memoire inviting his Majesty's subjects to collect objects of interest and to write about them was sent to Ile Royale in 1728. [120] As early as 1723 Boucher, the sub-engineer, wrote at length about what he had seen during his trips around the island, sent a stuffed puffin, some fossils, fruit, and a shell to the minister, and promised to send drawings of birds as soon as he had the time. Ballée, the king's surveyor, offered to make a trip for the purpose of surveying the island and collecting specimens if the minister would provide the  funds. [122] Nothing further was heard of this scheme. No less a person than the Comte de Raymond sent several pots of jam and a squirrel to the minister in 1751. [123] Thus, scientific research was not unknown in Ile Royale, but the surgeon's did not seem as interested in this field as their Canadian colleagues or their fellow inhabitants.

DISEASES, REMEDIES AND INSTRUMENTS

In order to understand the nature of surgery in Ile Royale in the 18th century, it is advisable to look at the diseases with which surgeons had to deal, as well as the remedies and instruments at their disposal. Since no detailed information has been found concerning the practice of either Lagrange or Bertin, these subjects will be considered from a more general point of view.

The most detailed information concerning diseases and remedies is found in the correspondence concerning the soldiers and officers. A surgeon's Certificat d'invalidité was required in such cases, and these documents provide numerous examples of medical conditions in 18th century Ile Royale.

Accidents were very common, especially among the soldiers working on the fortifications. One example was Bernard Gasquet dit Gasquet who 

"had the misfortune to find himself while working for His Majesty, underneath a mine, out of which he was pulled with his right leg shattered and broken, from which injury he suffers extraordinary pains, and is thus unable to render any service to His Majesty" [124]

Loss of sight, broken limbs and hernias were the most frequent injuries reported. Accidents with muskets were also fairly common. [125] Broken limbs were presumably set or amputated; a payment was made in 1750 for 12 pairs of crutches for the "sick soldiers". [126] Hernias were treated by bandaging them with special bandages. [127]

Gout (ulcères de Jambes) occurred fairly frequently, as did fistulas and rheumatic complaints. [128] The treatment for gout seemed to consist in bandaging and eau de vie, probably in the form of compresses soaked in the alcohol. [129] At least one soldier with a fistula returned to France and rheumatic complaints usually resulted in a trip to France "to take the waters". [131]

The recruits who arrived in 1756 were all suffering from the itch (gale),[132] and one of the naval officers managed to get sunburn or sun stroke (coup de soleil) in 1757.[133]

Venereal disease occurred regularly among the troops. The Brothers of Charity refused to treat soldiers suffering from this disease so most of them had to be sent back to France to be cured. [134]

Epilepsy was another disease which could not be treated in Ile Royale; the invalids were again sent to France. [135]

Insanity (folie or aliénation d'esprit) is mentioned twice in the documents. Such patients were usually returned to France, although Bigot suggested that they could be confined in the hospital at Louisbourg as long as they were alone in a room and the usual precaution was taken of tying their hands and feet when they were "feverish". [136]

The climate was blamed for numerous complaints. The Baron d'Espérance suffered from "Convulsive movements, caused by an obstruction of the circulation which is caused by the extremely corrosive nitre in the air, unsuitable to such delicate lungs as the patient's." It was said to be impossible for him to enjoy fifteen minutes of health in "such a hard and cold country". [137] An officer with a head. wound suffered frequent head-aches all winter long because of the cold, and two of the Brothers of Charity had to return to France because they could not bear the climate. [138]

Scurvy occurred regularly in Ile Royale. Normally only the sailors arriving in port suffered from. it, although the soldiers were also prone to the disease. [139] In 1750 the new inhabitants who were unaccustomed to the cold and the salted food, as well as many of the soldiers, were attacked by scurvy, but according to Prevost only a few good-for-nothings and the laziest of the inhabitants died because of it. [140] The treatment for scurvy consisted of rest and fresh food. [141]

Pneumonia (fluxions de poitrine) occurred in 1733 and in 1739, attacking the troops in particular, and causing Governor de Forant's death in 1740. [142] 

There is little information concerning surgical activity during the two sieges of 1745 and 1758, although they were busy times for the surgeons. During the first siege, one officer who was hit in the nose with a bullet was bandaged and returned immediately to his post. Another officer had to retire to the hospital in the casemates for five days to be bled twice when he was struck by stone chips from a shattered merlon. [143] A member of the militia was shot twice during a sortie, once in the arm and once in the index finger of the right hand. [144] During the second siege, a surgeon, at the cry "Beware the bomb" had to leave a wounded man while performing an amputation. [145]

There is only one description of a surgical operation performed in Louisbourg, with rather unfortunate results. A sailor whose leg was caught between barrels while unloading a ship was treated at the hospital for a "tumeur flegmoncule" on the inside of the thigh which resulted from this accident. After attempting to correct the injury with various remedies, the tumor was opened, with a "grande délabrement", but the victim recovered very slowly from the incision. In fact, his leg was weakened and slightly shortened due to the fact that the leg could not be kept straight because of the pain he had suffered. [146]

Epidemics of course, affected the whole population. Smallpox was the most feared of these diseases and caused at least two epidemics in Ile Royale. The first occurred in 1732-1733 when the death toll rose from 20 in 1731, to 72 in 1732, to 80 in 1733, and finally fell to 8 in 1734. [147] In 1755 Drucour and Prevost reported that smallpox "which has been greatly feared and usually makes great ravages in this climate" had broken out and was progressing rapidly. [148] Figures are not yet available for this period, so it is impossible to tell whether or not this outbreak was as disastrous as that of 1732-1733.

Typhus (known in the 18th century as fièvre maligne, or fièvre putride) [149] seems to have attacked the colony only once, in 1757. 

In 1753 one death in Louisbourg was attributed to yellow fever (Maladie de siam). [151] This was an epidemic disease more commonly found in tropical climates, but often carried from there by ships. [152] 

Some precautions were taken against the epidemic diseases. A letter was sent to St-Ovide and de Mezy in 1721 informing them of a "contagious disease" which had broken out in Marseilles and was spreading throughout the kingdom. It suggested that they issue an ordonnance ordering that ships arriving in port from the Mediterranean anchor in a designated place, and that no one be allowed to disembark or to go aboard until the physician or surgeon had inspected the vessel. [153] In 1729, a sailor was buried on the site where his ship had set up a hospital rather than in the cemetery, because of "the contagion of his illness", and during the small-pox epidemic of 1732-1733, numerous inhabitants were buried on the property of Jean Martin (probably in the fauxbourg) because "their illness did not permit transporting them to the cemetery". [154] All ships entering the port seem to have included in their declaration to the Admiralty the number of crew and passengers aboard and a report on the state of their health, usually in the words "tous en Santé". [155]

Little else is known about the health, or lack of it, of the inhabitants. An amazingly large number of them, both male and female, were treated for contusions and bruises caused by beatings. Death was frequently the result of a severe beating. Sword and knife wounds were also not uncommon among the inhabitants. [156] Bertin treated a woman who had been beaten by applying compresses made from "spirituous liquors" and then bleeding her. He advised her to rest for several days to avoid "accidents". In another case he put the victims of a beating on a diet and treated them with "remedes convenable". [157]

Another source of information on remedies used in Louisbourg are the surgeons' bills. A number of these bills have been found, although none of them concern Lagrange or Bertin. They have been collected in Appendix II, along with a long list of medicines and drugs ordered for the hospital. The latter has been included for comparative purposes only, and will not be considered in detail in this report. [158]

The surgeons' bills indicate that the most usual remedies were bleeding, infusions, potions of various kinds, purges and compound medicines (médecines composées).

Blood could be taken from the arm or from the foot and was collected in a pan (poellon). [159]

Infusions (tisanes) were made with licorice barley, or other ingredients which rendered them astringent or useful for chest conditions (tisane pectoral).

Potions were used for chest conditions (pectoral), as restoratives (cordial) or as astringents (astringent), to induce sleep (sonnifère), or sweating (sudorifique), or to relieve gas pains (carminatif).

Other remedies or medicines used were manna (manne), rhubarb. hartshorn, (esprit volatif de corne de cerf), cinnamon, blister plasters (emplâtres vesicatoires), confection alkerme (a stomach remedy or a restorative), and poudre cornachine (a purgative).

Jean Pierre Pessant, a surgeon who died in 1757 in Louisbourg, possessed two onces of mauve (a flower extract used in poultices and purges) and some sticks of ointment. [160]

In addition to the drugs and medicines at his disposal. the surgeon had, of course, various instruments which he could use in the treatment of diseases. There is little information concerning surgical instruments in Ile Royale, but it appears that all surgeons were not necessarily well supplied. Illustrations at the end of this report show some of the instruments mentioned in connection with Ile Royale, taken from Diderot's plates on surgery and barbering. [161]

Pierre Meillon, surgeon at Havre Fourche. mentioned only razors and lancets in his will. He may have possessed other instruments. but it seems unlikely. [162]

Pierre Pessant had five books about surgery (unfortunately no titles are given), dental forceps, a pelican (davier et pelican) and 13 raznrs. [163]

An early list of instrument's ordered for the hospital included a shaving basin, a syringe, a tin instrument box, a mortar and pestle, a sieve, a curved lancet (bistouri), a lancet for anal fistula operations, a sort of probe (algaly), and a small syringe for injections. [164] The instruments and medicines supplied to the ship's surgeon of a merchant vessel are listed in the vessel's bill of sale; [165] this is included in Appendix II and has been fully translated here because it is the only example of a complete list of one surgeon's supplies.