Sex work, containment and the new discourse of public health in French colonial Levant

Abstract

This article addresses how French academics, doctors and state bureaucrats formulated sex work as a pathology, an area of inquiry that had to be studied in the interest of public safety. French colonisation in the Levant extended the reach of this ‘expertise’ from the metropole to Lebanon under the guise of public health. Knowledge produced by academics was used to buttress colonial state policy, which demanded that sex workers be contained to protect society against medical contagion. No longer drawing conclusions based on speculation, the medical establishment asserted its authority by harnessing modern advances in science and uniting them with extensive observation. ‘Empirical facts’ replaced ‘opinions’, as doctors forged new approaches to studying and containing venereal disease. They accomplished this through the use of statistics and new methods of diagnosing and treating maladies. Their novel approach was used to treat sex workers and to support commercial sex work policy both at home and abroad. Sex workers became the objects of scientific study and were consequently problematised by the state in medicalised terms.

Introduction

Sex workers in the Ottoman Empire prior to the 1800s were always prone to becoming part of public debate in the wake of a moral crisis or a moral scandal. ¹ While the discourse linking prostitutes to scandal and to morality persisted into the nineteenth century, a new discourse started to emerge alongside it, which framed sex work as an explicit public health threat. ² Venereal disease was no longer constructed as a personal hygiene concern, but came instead to be considered a public health concern warranting state intervention. Government officials in Europe argued that sporadic regulation of the sex trade could not contain the risks that prostitution posed to the greater public, and they relied on medical evidence to substantiate state intervention. Primarily driven by concerns over the threat that venereal disease posed to male military personnel, the Ottoman Empire adopted strategies developed in France to ensure the health of the male military population at the expense of others affected, most significant among which were women. ³ In terms of institutional reform, what ensued included the advent of medical management, bureaucratic oversight and regulatory enforcement.

This article addresses how academics, doctors and state bureaucrats construed sex work as ‘pathology’ and as an area of inquiry that had to be studied in the interest of public safety. Knowledge produced by academics was used to buttress state policy, which demanded the containment of sex workers as a matter of protecting society against medical contagion. Their innovative diagnoses and treatments centred on the commercial sex industry, and these were soon taken up by French politicians and inserted into public health policy and municipal administration – first in the metropole, and then in the Levant. ⁴

One way to understand the politicisation of medicine during the nineteenth and early-twentieth centuries was provided by Michel Foucault, who explained that the ‘doctor becomes the great advisor and expert, if not in the art of governing, at least in that of observing, correcting and improving the social ‘body’ and maintaining it in a permanent state of health’. ⁵ This shift constituted a significant departure for doctors, who went from being private practitioners to public consultants, a role that brought with it political prestige imbedded in social hierarchies. As Nelly Oudshoorn states, ‘perceptions and interpretations’ are mediated through espoused objective language produced by the biomedical sciences. ⁶ I intend to show in this article that the new medical discourses concerning sex work, which were first developed in France under physician Alexandre-Jean-Baptiste Parent-Duchâtelet and then carried to the Ottoman Empire’s Levantine territory under the professor and doctor Benoît Boyer, evolved into comprehensive medical practices requiring the continuous surveillance of sex workers by local authorities. Doctors leveraged their ‘expertise’ to insert themselves into the governance of hygiene, cordoning off sex workers for the sake of public welfare. My argument is that sex workers became the objects of scientific study and were consequently problematised by the state in medicalised terms. ⁷

To better understand how this transformation took place in the Levant, I examine closely some of the comprehensive scientific surveys produced during this period. Two public hygiene reports in the region, separated by approximately 30 years, are emblematic of the colonial state’s rising concerns about contagion spreading through commercial sex. In hindsight, these studies also marked one of the ways in which biopolitics came to be woven into the fabric of modern society. Benoît Boyer published the first such report in the Levant in 1897 at the request of Ottoman officials prior to direct French intervention in the region. His survey of the region’s social and medical hygiene in the late 1800s served as the basis for Les Conditions hygiéniques actuelles de Beyrouth [The Current Hygienic Conditions of Beirut]. The second work of note was two volumes in length and produced by the Lebanese Ministry of Hygiene and Public Assistance under French colonial rule: the Annuaire médical [Medical Directory] 1921–1924 and 1925–1928. These texts argue for the critical need for public health reform and the tight regulation of sex work in order to contain venereal disease in the interest of maintaining high public hygiene standards.

The insertion of scientific vocabulary into the state apparatus: the ‘truth’ about sex work

On 19 April 1920, General Henri Gouraud, acting as the French High Commissioner of Levant, signed Decree 188. This order became the first under the French Mandate to regulate public health in the region. It encompassed predictable measures, from minimising stagnant water to outlining the delivery of public hygiene services. Yet Title VI of the document addressed something less obvious: regulatory prostitution. This three-page section entitled ‘Réglementation de la prostitution’ [Regulation of Prostitution] outlined official French colonial policy on sex work and that such policy was a matter of public health, safety and security. France had already begun the process of legislating public health during the period of occupation, at the end of 1918, through establishing hospitals in the Western Zone of the Levant. ⁸ In addition, French-style regulations over sex work were in force by the time France claimed its official stake in the region. ⁹ This reality illustrated the transformation from the Ottoman regulation of sex work to the French regulation of sex work in the Levant.

The regulation of sex work existed in the Ottoman Empire throughout the eighteenth century. ¹⁰ Beginning in the 1800s, the authorities in the Ottoman Empire – and in Europe as well – asserted a new control over commercial sex through the transmission of medical information validating the profession’s public threat. Beyond the potential of prostitution to cause moral damage, as was the primary concern under the Ottomans, it introduced a new element that linked sex workers to disease. Medicine evolved as a new mode of social control, ascending into the realm of state administration, and exerting what Michel Foucault terms ‘medico-administrative’ knowledge. ¹¹ As Jane Scoular observes, sex work has been historically stigmatised, so this much was not new with the advent of the French system. But ‘[w]hat does change at this juncture, and what is novel, is not the problematisation of prostitution per se but the nature of its problematisation’. ¹² The French had long known about venereal disease, yet the acceleration of the spread of the disease thanks to modern transportation, military expansion and scientific and technological advances brought concerns about contamination and public safety to the forefront. New medical institutions were constructed as a result of these new fears, which operated in tandem with the moral condemnation of sex work. The introduction of modern tactics of identification and containment served as manifestations of power and control by the authorities over sex workers and, to a lesser extent, over the clientele that they served. ¹³ To situate the production of knowledge on sex work in the French colonial context, it is important to understand how certain discourses on sex work emerged in the metropole prior to being transported to the Levant.

The synthesis of medicine and state power in France coincided with the production of comprehensive medical texts on sex workers. The medical establishment asserted its authority by harnessing modern advances in science and extensive observation, distancing itself from prior methods that relied primarily on speculation. French hygienists forged new approaches to learning about venereal disease, using their newfound methods to recommend containing sex workers in the interest of public health and justify increasing state control over the sex trade. They translated old fears around corrupted morality into new fears around death and disease using the language of science. ¹⁴ Their innovative approach buttressed the metropole’s and, subsequently, Lebanon and Syria’s public health policy.

Although the French constructed regulationism in defence of (and because of) their military interests, they now recast it as seeking to protect the entire social body. In doing so, they managed bodies in a gendered fashion that explicitly prioritised dominant perceptions about men’s sexual behaviour. It is assumed that men were there to act on their sexual ‘needs’ and women were there to meet these needs through service to men. ¹⁵ Therefore, as France expanded its empire into Lebanon and Syria, the imperial project expanded what Philippa Levine calls its ‘fundamentally masculine enterprise’ in the form of regulationism. ¹⁶ As Levine argues in the context of the British Empire, ‘regulation and management of sex were key to maintaining and perpetuating the idea and the practice of [colonial] superiority’. ¹⁷ By inserting medicine into colonial administration, France legitimised itself as protector of the Lebanese and Syrian people, whose (supposed) lack of hygienic discipline allowed disease to flourish under the Ottoman Empire. ¹⁸

Research on sex work in the metropole: the ‘indispensable excremental phenomenon’

The work of Alexandre-Jean-Baptiste Parent-Duchâtelet (1790–1836) illustrates this new relationship between medicine and state power that originated in the metropole in the nineteenth century, and how state interventions in the name of public health developed in the colonies during the following century. The objective of these interventions extended beyond protection of armed service members to the protection of the entire civilian population. All this transpired at the cost of sex workers being construed as a threat to public safety and vilified as conduits of social contagion derived from their ‘pathological female sexuality’. ¹⁹ Only the state and its experts could protect the public from their pollution. The rise of male doctors in the academies, influencing the state apparatus, simultaneously reified and influenced the problematisation of sex work. ²⁰ This dominance of Western biomedicine enshrined the gendered body into public health policy and therefore, as Alison Bashford argues, can be said to have ‘managed gender itself’. ²¹

Parent-Duchâtelet began his research into the links between disease and sex work in 1828. His work examined commercial sex and its consequences through the combined use of police archives, field research and hospital and prison records. First disseminated in 1836, De la prostitution dans la ville de Paris, considérée sous le rapport de l’hygiène publique, de la morale et de l’administration [Prostitution in the City of Paris, Considered in Terms of Public Hygiene, Morals and Administration] is a 624-page medical-anthropological volume that served as a model for comprehensive public health studies. His strategic documentation of the regulations enacted by the government and the quantification of their effects through the use of statistics was a practice that would come to characterise reports on the Levant later on in the nineteenth century.

Parent-Duchâtelet’s work would become, according to Mary Spongberg, ‘the canonical text of the study of prostitution in nineteenth-century Europe. [His] methodical analysis of the bodies and lifestyles of prostitutes set the pattern for subsequent studies’ and soon became the authoritative text for discussing disease and sex work. ²² Premised on the common scientific understanding that numbers illustrated the truth, he derived his conclusions from rigorous, quantifiable tracking and observation, which presented him as an objective arbitrator of scientific information. The results of his studies distinguished sex workers as unique entities and their transmission of syphilis as being the greatest threat to humanity. ²³ To contain this threat, sex workers needed medical controls and state interventions.

Medical professionals like Parent-Duchâtelet produced the evidence that states needed to support the containment of sex workers that was already being implemented through municipal bylaws. As France regulated prostitution in 1802, it welcomed any ‘prestige and professional approval’ to justify the inscription of sex workers that was already in place. ²⁴ De la prostitution dans la ville de Paris provided legitimacy for their containment in the interest of society. Parent-Duchâtelet declared that the risk of illness among sex workers meant there was a large risk that they would infect the general population. Significantly, he did not show any concern for the health of the sex workers themselves while formulating a plan for disease control. ²⁵

Parent-Duchâtelet’s work is a clear example of the political power held by the scientists in directing and affirming state policy towards commercial sex. ²⁶ In the third edition of his book, which was released in 1857, government officials provided updates and additional documentation and granted the use of their names on the book’s cover, affirming the close and now official relationship between Parent-Duchâtelet and Parisian authorities. ²⁷ Parent-Duchâtelet’s reach extended beyond Paris. The book’s editors claimed that his ideas influenced the health and administration policies of other major cities in Europe. ²⁸ Translations of his work became promptly available in English (1837) and German (1837), and later in Dutch (1890) and Japanese (1922). Scholars and politicians in the United States and the United Kingdom often cited it. Though it was not translated into Arabic, French officials exported the book’s content to the region and medical practitioners from the Ottoman Empire who received training in France brought information back with them. This information would have been influenced by Parent-Duchâtelet, even if they did not directly encounter his text. ²⁹ The influence of Parent-Duchâtelet assured prostitutes’ marginalisation within society as the ‘indispensable excremental phenomenon that protects the social body from disease’ that permeated throughout Europe and, soon enough, throughout the Levant. ³⁰

The transmission of knowledge: the pathologising of sex work comes to the Levant

In his 1849 survey of the medical profession in the Levant, Cornelius Van Dyck declared: ‘Small as is the amount of medical knowledge among the Arabs, at the present day, the means of obtaining it are still more limited’. ³¹ This doctor with the American Protestant Mission also noted with dismay that advancements made in Egypt under Mehmet Ali through French-style medical instruction were an exception to the rule when it came to the rest of the region. ³² Decades later, the establishment of two medical colleges in Beirut rectified this ‘dearth’ of Western-style medical practitioners: the Syrian Protestant College in 1867 and St. Joseph University in 1883. ³³

Out of St. Joseph University arose a prominent figure in public health reform under the Ottoman administration, the doctor Benoît Boyer. In 1889, Boyer relocated to Beirut after graduating from the Hospice civil de Lyon in 1881, where he served as an intern. ³⁴ At St. Joseph, he served as a professor of therapeutics and hygiene in the Faculty of Medicine until his death in 1897. ³⁵ Jens Hanssen contends that the medical faculty’s foundation at the French university ‘marks the entry of French officials into the realm of governance’. ³⁶ As John Gagnon argues, colonial interventions went through stages in the nineteenth and twentieth centuries: first they operated through ‘agencies of religion and proto-medicine’ and then subsequently through the presence of permanent (military, government and commercial) personnel. ³⁷ During the Mandate period, the medical interventions traditionally administered through ‘medical missionaries’ (to use Hanssen’s term) morphed into more emboldened, direct ‘official’ interventions of colonial governance. Religious care was by no means eliminated from France’s foreign policy directives, but direct medical, military and bureaucratic directives became more common. All these three kinds of interventions – medical, military and bureaucratic – intersected with one another when it came to issues of sexuality and sex work. It accomplished this through positioning ‘experts’ trained in French medicine in colonial society, who provided information on public health. Boyer was one such expert. ³⁸

In 1896, the Ottoman Governor of Beirut, Vali Nassouhi Bey Effendi, commissioned Boyer to produce a comprehensive volume on the current health conditions of the city and provide recommendations for the remediation of any issues he might find. ³⁹ The resulting treatise discusses numerous topics and had sections on such disparate subjects as people’s culinary habits and their causes of death. In its section on morbidity, Conditions hygiéniques not only endorses regulating sex work, but also states that the government should take additional measures to the ones that were currently in place. It is likely that Boyer benefited from Parent-Duchâtelet’s research because of the latter’s notoriety, and Boyer also possessed knowledge of the French regulatory structure that had already been in effect during his tenure. He wholeheartedly endorsed the metropole’s position on medical surveillance, arguing that such surveillance should be en vigueur for the welfare of the Syrian region. Boyer premised his knowledge on the established rationale that sex workers’ inherent flaws set them apart from respectable citizens. That sex workers in Beirut operated without adequate surveillance appalled Boyer. As he observed, ‘about thirty women of the city come at night only, in these establishments, as auxiliaries’. ⁴⁰ Inconsequential to his inquiry were the reasons why sex work existed in the first place and sex workers’ countries or cities of origin, both of which became commonplace discussions in pathologising texts on prostitution.

Boyer’s account provides an illuminating picture of prostitution during the late-nineteenth century in Beirut: each brothel had, on average, five women. They were young and often from the local area. Others hailed from Damascus, Greece, Tripoli and Alexandria, while one was from France. ⁴¹ Boyer also noted an anomalous Greek matron within the group of mostly indigenous proprietors. The influence of increased travel throughout the Mediterranean provided for the diversity in origin that will continue into the following decades. ⁴² What is evident is that the French-style regulatory system found its way into the region at the invitation of Ottoman government officials, as his text was written in 1897 while the area was still under Ottoman control. ⁴³ This transformed the Levant from its prior, more flexible socio-political environment in the eighteenth century. Yet, for Boyer, the adaptation of the French system under the Ottomans did not quite go far enough.

Boyer noted with alarm the proximity of the commercial sex trade to the greater public. Inspired by his French training, he recommended cordoning off all sex workers from the rest of society on a full-time basis, thinking that such a measure would be conducive to good public hygiene. In his mind, the current part-time system that he witnessed, wherein some prostitutes would reside in their own homes and go to their places of employment after sunset, allowed for disease to prosper. ⁴⁴ Boyer only examined registered sex workers and did not survey clandestine activities since, as he claimed, Muslim tradition prohibited strangers coming into the home to conduct investigations. He stated: ‘I shall speak here only of regulated prostitution, for morals, forbidding all inquiries or visits to women, renders clandestine prostitution very easy and as a result it has flourished’. ⁴⁵ In effect, he blamed this moral sensibility for the fact that clandestine sex work was thriving in the city, for the domicile served as space free from outside intrusion, especially from intrusion from the government. ⁴⁶

Boyer recommended that officials consolidate the medical care that was being provided to the forty-odd maisons de tolérance [houses of tolerance, or brothels] in the city through specialised facilities in addition to centralising the locations of the city’s maisons. In short, the ‘houses of tolerance’ would all move into one area, a move that Boyer thought would surely help contain the spread of venereal disease. This solution would allow for constant government surveillance of sex workers and for greater hygienic compliance. He noted that regular medical check-ups were being given to sex workers three times per week in the 1890s. The workers, along with proprietors, bore the cost of these visits through paying a monthly tax. ⁴⁷ With the 200–225 registered prostitutes in Beirut in 1893, this appears to have been an ambitious medical inspection rate. Therefore, it may have been a measure that existed on paper was not fully carried out in practice. ⁴⁸

Like Parent-Duchâtelet, Boyer underscored the threat that the untreated and unregulated sex worker posed to the public and the need for state intervention in the interest of the safety and health of civil society. Syphilis occurred with ‘extreme frequency’ in Beirut; there were 632 cases in 1885–1896, according to his study. ⁴⁹ This is 632 cases out of an approximate population of 120 000 or a rate of 0.53%. ⁵⁰ In comparison, a contemporaneous survey of Turkey found a syphilis infection rate in the coastal region as high as 10%. ⁵¹ So his assertion that syphilis posed an enormous threat to the public in Beirut at the time could be interpreted as an overstatement. For Boyer, the rigorous surveillance of sex workers presented the only remedy to the ‘great dangers of infection’. Workers should be required to go to a specialised hospital, as medical visits to maisons de tolérance proved in his view to be insufficient. He criticised the use of scheduled, routine medical exams at the maisons de tolérance due to the female sex workers’ deceptive nature and ability to avoid inspection when they were infected. ⁵² Boyer also chastised the Ottoman government for its to properly regulate prostitution and allowing disease to spread. For example, referring to the closure of the Syrian Hôpital des vénériennes in April 1895, he stated: ‘I can only deplore the closure of this hospital, which, from the point of view of venereal disease prevention, was evidently an excellent institution. It would even be desirable to see this hospital reopened and expanded’. ⁵³ Yet Boyer also saw himself as an ally of the state, seeing the administrative authorities’ intervention as being critical to the modern public health transformation that he was advocating. ⁵⁴ While surveying the increased rate of gonorrhoea, syphilis and canker sores over the last 2 years of his study, he stated that he was ‘convinced that the Municipality of Beirut will reconsider its original decision’ of closing the hospital. ⁵⁵ Boyer was resolved to have more governmental control over women. Nowhere in his texts, however, did he mention patrons (who were men) as being a source of disease or recommend that they too need to be regulated.

Boyer linked his hygienic approach to prostitution as part of a civilising project bringing modern healthcare to the Levant. ⁵⁶ As such, he called for the expansion of sanitary inspectors’ powers. He reserved moral condemnation for those who refused to embrace the progress made in medicine and those who embraced the regressive customs that inhibit Beirut from entering the modern era. ⁵⁷ By implication, to be modern was to accept the presence of regulated commercial sex as part of the fabric of society. Therefore, in his argument to maintain municipal regulation, Boyer extolled the benefits that such a prophylaxis as containment would have for native Syrian society. As such, it was the responsibility of the state to mitigate the negative health consequences presented by sex work, as indigenous ignorance of proper hygiene would prevent disease from being adequately contained. ⁵⁸ Confinement demonstrated an acceptable measure, which for Boyer meant having women live in maisons de tolérance and submit to regular examinations in specialised hospitals. It delineated the sphere of commercial sex from the rest of the social order.

Conditions hygiéniques’ longest-lasting interventions included the reinstatement of specialised treatment facilities for venereal disease and the isolation of sex workers from the rest of the population. Even Boyer’s recommendation for unannounced visits to maisons de tolérance came to fruition. Decree 188 of 1920, referenced at the beginning of this article, required that ‘the doctor responsible for the visit of the prostitutes shall, at least once a month, ensure unexpected visits’ in addition to the regular visits, which occurred two times a week. As Boyer strongly recommended, the treatment of disease ceased to be in the home, at least for sex workers, and the centralisation of service through hospitalisation came into effect. This was done in the interest of public health, that is, the task that Boyer was charged with advocating on behalf of the Ottoman state and that was carried out by the French administration when the Mandate came into effect. Boyer himself said: ‘If I can contribute, for a modest part, to this magnificent result, my ambition will be satisfied’. ⁵⁹

The commission of medical reports with the same old message under the new regime

‘The employment, and above all the arbitrary abuse of police force against one sex, which masses together a crowd of women in a vague manner, and often without any proofs against them, under the too elastic name of ‘prostitute’, is discredited, and can no longer resist the public indignation’. ⁶⁰ Such are the words of Dr Charles Mauriac in 1896, who was protesting the regulationist system of his home country, France. Yet despite mounting criticism arising under the auspices of the International Federation for the Abolition of State Regulation of Vice, which was founded on 19 March 1875, France’s regulatory structures were not only maintained, but also expanded during the following century, as the coloniser extended its territorial hold under the League of Nation’s Mandatory system. ⁶¹ While France exported this practice to Lebanon and Syria initially through the invitation of the Ottoman government, as articulated by Boyer, it was the League’s mandate that allowed state repression of sex workers to become the official practice in the region under the colonial authorities. ⁶² Once France solidified its control of the Levant through the Mandate, a comprehensive medico-administrative and legal structure unfolded that detailed where sex workers could live and under what conditions under the measures Réglementation de la prostitution and Règlement sur la police des mœurs [Morality Police Regulation]. ⁶³

By the time the first Annuaire médical was published in 1921, Boyer’s recommendation for the stringent medical examination of a quartier réservé had become a reality. ⁶⁴ The swelling French military presence in the region in the 1920s coincided with an outbreak of syphilis. This provided legitimisation for state intervention regulating sex work in the name of public health, though Boyer was not alive to see his work bear fruit. Greater Lebanon, which was declared in 1920 and was the precursor to the modern nation-state of Lebanon, began to produce the Annuaire médical, which catalogued the Levantine country’s medical system and covered the periods 1921–4 and 1925–8. While not a lot is known regarding the production of the texts, the newly created Ministry of Hygiene and Public Assistance published the documents with the intended purpose of educating the Lebanese public and foreigners about the services that had been rendered by the Lebanese state since the inception of the ministry. ⁶⁵ It showcased the medical advances that were made in the region under the French. Whereas Boyer’s Conditions hygiéniques was a treatise on ‘what to do’, the Annuaire médical was a treatise on ‘what has been done’. It reflects the increasing institutionalisation of the Levantine medical community and conveyed the state’s ability to harness scientific knowledge at the expense of sex workers.

The Annuaire médical, each of its two volumes approximately one hundred pages, is similar to Conditions hygiéniques in many ways. It contained sections on the region’s climatology and general physical characteristics in addition to the region’s morbidity rates. The texts utilised statistics to highlight trends in mortality and in the spread of contagious diseases. Yet there are key differences in their composition and in their underlying messages. Boyer’s text provided an elaborate account of the hygiene and habits of the population in order to advance his recommendations on how the state can improve its citizenry’s health. The Annuaire médical was less interested in those details and instead stressed the infrastructural landscape of Lebanon. In effect, it demonstrated France’s successes in expanding and improving upon the structures that they had inherited from the Ottomans. The preface to the second volume, which covers the period 1925–8, underscored this point, inasmuch as the phrases ‘before 1918’ and ‘since 1918’ served to establish the historical timeline. ⁶⁶ The preface depicted the miserable state of public hygiene in the region when the French troops arrived. Furthermore, the preface to the first volume, written on 5 February 1925, by Dr Joseph Mandour, Director of Hygiene and Public Assistance for the State of Greater Lebanon, related that ‘[i]t is to France and its good deeds that this country owes its rapid recovery. It is also to it [France] that it [Greater Lebanon] owes the beginnings of our organisation of hygiene and public assistance’. ⁶⁷ By this characterisation, while Boyer used his French training to recommend improvements in the administration of public health, Lebanese officials in the Annuaire médical blamed Ottoman ineptitude as the barrier to implementing public health reform. ⁶⁸ The direct authority of the French allowed the centralisation that Boyer espoused to finally come into being.

Both the administrative apparatus and the ‘brick and mortar’ institutions constituted the subject material discussed in the Annuaire médical. With regards to the former, one aspect of the administrative structure highlighted at the outset of the issue published in 1925 was the instrumental role played in the French health establishment by Henri-Élysée-Daniel Escher, the médecin-major [chief medical officer] of the French forces: ‘He is owed much gratitude from the country [Greater Lebanon] for the distinguished services he has rendered and we hope that he will be able to continue for a long time’. ⁶⁹ The text extolled his specialties in dermatology and venereology, which were his areas of expertise until his death on 5 January 5 1958, in Beirut. ⁷⁰ Escher occupied a critical role in the evolution of medical surveillance of sex workers in the Levant under the French.

Escher was appointed by the Lebanese government as a technical advisor on 6 July 1923, called to the Levant to serve as the colonial military’s chief spokesperson on the issue of venereal disease. ⁷¹ As a co-director of the newly formed Ministry of Hygiene and Public Assistance, Escher was influential when it came to the regulation of sex work and the control of venereal disease. ⁷² Although listed in official documents as the technical advisor for the Ministry, in a 1923 letter Escher signed off, not coincidentally, as the head physician of the (unspecified) Centre for Dermatovenereology, the same position he held in Rhine while in the French army. ⁷³ In the same correspondence, another person lists Escher as the ‘Chief of Venerology Services of the Army of the Levant’. ⁷⁴ In whichever capacity he served (and sometimes he occupied more than one role at a time), he advocated regulating sex workers in the name of public health. ⁷⁵ Professor Henri Gougerot, as Secretary-General of the French Society of Sanitary and Moral Prophylaxis, stated that it was Escher’s suggestions and recommendations that prompted the passing of the 1924 decree in Lebanon regulating sex work. ⁷⁶ Noting Escher’s contribution to the fight against venereal disease, Gougerot’s review of the Annuaire médical 1921–1924 referred to him as a distinguished colleague who ‘continues the same calling [fighting against venereal disease] in Greater Lebanon’. ⁷⁷

Escher’s capacity as a military officer and academic ensured his prominent and lasting contribution to medical surveillance throughout the French Mandate period, including the government’s tracking of sex work and venereal disease through the Ministry of Health. He helped to organise the first training conference for members of the Beirut medical community at St. Joseph University. The conference courses ‘treated syphilis in general and from a statistical point of view’ to provide the medical establishment information on the dangers of venereal disease. ⁷⁸ As a government official training the medical community, his message served to buttress the Ministry’s claims on the threats that the disease posed. He illuminated the bureaucracy’s response through the strategic use of numbers and charts to articulate the position that the public health response must comprise containment policies that prevent the spread of disease to the general population. And part of the solution relied on the perceived conduit of contagion – that is, unregulated sex workers. ⁷⁹

Showcasing the medical system’s expansion is one method used in the Annuaire médical to solidify the state’s claims of effectively protecting the public against disease. In response to the increased number of venereal disease cases, through its Ministry of Hygiene and Public Assistance, the state showed precisely how it was addressing the crisis. ⁸⁰ For example, the Institute of Bacteriology’s screening for syphilis showed a marked increase in the use of testing. Through the government’s collaboration with the French Faculty of Medicine at St. Joseph, treatment and prevention of venereal disease increased. From 1919 to 1924, the annual total number of syphilis tests went from 138 to 643, a nearly fivefold increase. Not only was the demand for screening apparent, but also the results legitimised the existence of screenings: the rate of positive cases was 25.2%. ⁸¹ These tests were mandatory for all registered sex workers, maison de tolérance managers, and all maison personnel. The scope of mandatory medical inspections extended beyond the confines of those explicitly engaging in the business of prostitution to include those suspected of operating clandestinely as such, incorporating dancers, singers, musicians and anyone detained by the Beirut Police Department, the police des mœurs [literally, morality police or loosely translated as vice squad], on suspicion of engaging in illegal sex work. ⁸² Subsequently, during the period 1925–8, the rate of cases testing positive for syphilis increased to 28%. ⁸³ Yet, even considering the increased presence of venereal disease among its population under municipal regulation, the government defended its process of medical surveillance of sex workers. The authorities employed, in their opinion, an effective strategy of disease containment. As the report states, screenings of filles soumises [registered sex workers] occurred at a frequency that was rather efficient at detecting contagions. ⁸⁴ If their containment strategy, which was examined for over a period of almost a decade in the charts displayed in the two editions of the Annuaire médical, was successful, it left unanswered why the number of diagnosed infections increased, albeit slightly.

The treatment and physical containment of those diagnosed with venereal disease concerned both Boyer in the 1890s and the Lebanese government several decades later in the 1920s. According to the official statistics tracking the number of sex workers in the city of Beirut, their number doubled between these two decades. It is worth noting that the 1921–4 volume of the Annuaire médical cited Boyer’s text almost verbatim when describing the situation in the city in 1893. ⁸⁵ Lebanese officials contrasted the situation in Boyer’s time to the contemporary situation and concluded that the dramatic increase in sex workers necessitated a corresponding increase in the amount of surveillance by police and public health officials. Mockingly, the report stated that ‘public women … occupy a whole district, in the very centre of the city. Several streets access this area, so that it hardly deserves the name of “quartier réservé.”’ ⁸⁶ Even with tightening surveillance of the red-light district, venereal disease flourished. Clandestine activities, not the colonial policy or the patrons of the sex workers, became the focal point of blame for officials. The strategy of containment meant increasing control though the use of medical facilities and better enforcement mechanisms.

As noted above, Boyer lamented the closure of a treatment facility that was specifically dedicated to treating venereal disease and strongly recommended that remain open. The Annuaire médical made a point of situating the current French administration apart from the prior Ottoman administration. It is noted that the facility designated under the French for venereal disease treatment ‘belonged to the Turks and without any special assignment’ when it was constructed 20 years earlier. The French found a purpose for the space, wanting the Hôpital des Sablons to be ‘intended exclusively for the treatment of venereal disease [that] can hospitalise … public girls’. Moreover, the facility’s location evinces the realisation of Boyer’s strategy of isolation and containment. Government authorities situated the hospital in a ‘neighbourhood … constituted by houses isolated from each other by empty spaces; the density of the neighbourhood is low and the hygienic conditions of the neighbourhood perfect’. ⁸⁷

The nascent Lebanese Ministry of Hygiene and Public Assistance used official documents like the Annuaire médical to convey health policy priorities worthy of the public’s support. These official reports on the medical condition of Lebanon framed public policy as investing in the population’s welfare through medicine, which necessitated the republic’s increased and continuous financial support. ⁸⁸ As one example of such framing, the 1925–8 Annuaire médical highlighted the expansion of medical services to treat venereal disease, such as the opening of the Beirut polyclinic in July 1925. The Ministry framed this initiative as an answer to a demand for health services in impoverished areas. The clinic provided ninety-six health screenings in 1925, which rose to 947 in 1928. ⁸⁹ Within that 3-year period, the use of syphilis screenings increased eightfold. Using charts to illustrate the widespread use of screenings, the Annuaire médical underscored the necessity of the provision of this public health service. Any acknowledged failures in the colonial state’s policy were framed in such a way that the policies did not go far enough. Further strengthening of surveillance was always deemed to be in order. For example, the high occurrence of gonorrhoea (46 out of 100 tests submitted tested positive) and syphilis from 1925 to 1928 meant that Decree 2346, ‘Règlementation de la prostitution’ passed in 1924, proved ‘slightly insufficient to ensure the antivenereal struggle; [therefore] an additive draft bill was drawn up by a technical committee’ to address the gaps. ⁹⁰ For the colonial government, this meant generating more regulations that further constrained sex workers’ autonomy rather than recognising the failures of medical surveillance in reducing the number of cases of venereal disease.

In fact, visits of sex workers to the Beirut dispensaries and the subsequent diagnosis of venereal disease did not indicate a correlation between mandatory health checks and the effective containment of illness. The number of registered women required to undergo examinations did not vary dramatically from 1925 to 1928. In fact, these bookend years in the above report reveal the same number of registered prostitutes: 170. ⁹¹ Although the number of cases of syphilitic cankers increased from 56 to 98, the number peaked in 1926 with 122 cases and plummeted to 29 the following year. In addition, rates of gonorrhoea oscillated among the same population between 267 and 193 over the 3-year period. If anything can be concluded from these data, it is that screening registered sex workers did not consistently reduce the number of cases of venereal disease. But still the medical authorities insisted that the numbers would diminish only through additional reforms controlling the activities – and hence the bodies – of sex workers. ⁹² And the state did impose new regulations. We can see this from the fact that the initial healthcare regulation that pertained to sex work, Decree 188, stated that ‘public houses’ may be ‘found or not in a reserved quarter’. Yet, 11 years later, the amended regulation eventually became a law, which stated that ‘women who are subjected to medical examination by an ordinance of the special committee and who practice prostitution in an open way are obliged to live within the limits of the reserved quarter’. In addition, the Lebanese Governor Charles Debbas (under the watchful eye of the High Commissioner’s Office) gave doctors increasing control over sex workers. As Article 32 of the updated 1931 law stated, ‘it is the obligation of physicians commissioned to control venereal diseases and to take whatever measure they see fit and necessary to safeguard public health’. ⁹³

Conditions hygiéniques and the Annuaire médical contained similar approaches to controlling prostitution. They promoted the use of surveys and data collection to track the population. They produced recommendations based on perceived best medical practices of the time, use pedigreed medico-administrative professionals to administer the state’s programmes, and recommended an infrastructure to accommodate these programmes. The underlying message of these texts was that sex workers were the source of disease. And they promoted the view that the state can only protect its population through monitoring them.

Conclusion

All the documents reviewed in this article posit a direct connection between sex work and venereal disease. Through a close examination of these documents, we can also see how particular public health policies emerged as the way to identify and eventually solve this ‘problem’. Underscoring this supposed crisis was the implicit notion that women were solely responsible for the spread of disease; they therefore became ‘problematised’ in new ways. Any consideration of a conduit other than the female sex worker was markedly absent. The idea that the men who frequented sex workers also contracted the disease and therefore needed containment was never a part of the driving policy. A rare exception was when the French military intervened in 1919 as venereal disease cases spiked in the Levant, threatening the colonial authority’s supply of healthy soldiers. A memo issued by the French Ministry of War from that year called for an increase in the frequency of medical checks on soldiers, recommending there be one every 15 days. ⁹⁴ What state bureaucrats and academics alike did present was the soldier as physically threatened by the unregistered sex worker. In the medical reports covered in this article, demands for more surveillance of patrons did not receive any attention, only punitive measures to be taken against ‘threats’ to men’s well-being. To put it in Keely Stauter-Halstead’s terms, it was sex workers, particularly those belonging to the working classes, who became the ‘subjects of expert commentary and the objects of medical coercion’. ⁹⁵

The government and the medical establishment’s anxieties over the spread of venereal disease translated into extensive monitoring and reporting on citizens through the instrument of surveys. Using empirical knowledge, scholars and state officials substantiated their assertions with objective verification based on data. The regulatory system, which emphasised the public health benefits of the administration, relied on the control of commercial sex in the sanitised, neutral language of ‘good medicine’ to legitimise its existence. ⁹⁶ Thus, the French colonial state justified its regulations over sex work not on moral but on medical grounds. Administrators presented the issue not as an endorsement of legalised sex work, which held complicated moral implications, but as a practical public hygiene measure to protect the social body.

Parent-Duchâtelet stated: ‘Where the government of men is concerned, it is good to know their weaknesses and to use them in order to govern them’. ⁹⁷ The sexual prerogatives of men were determined to be their weakness, and so the state intervened to govern them not directly, but indirectly through the regulation of sex workers. Therefore, the ‘problem’ with sex work lay not within the men who solicited the services, but within the women who offered them. The state determined that, in order to protect its military interests by keeping a healthy army free of venereal disease, sex workers required medico-legal interventions that held material consequences. The discourse soon shifted from protecting the army to safeguarding the general public from contagion, an objective that provided the rationale for the wholesale adoption of regulationism in the interest of social hygiene. The French colonial state relied on doctors and academics to provide the expert knowledge to buttress its position. This new, exclusively male, professional class exercised a great deal of social power by shaping government policies, which called for the registration, medical examination, and incarceration of female sex workers. Conversely, in one of the few comprehensive texts investigating French colonial prostitution in the Mediterranean, Christelle Taraud demonstrates how the regulations imported into North Africa contributed to the professionalisation of the ‘prostitutes’, who were drawn from the ranks of women who had been previously working primarily as courtesans, artists, and singers in precolonial times. This professionalisation contributed to their marginalisation under the regulatory system, and it illustrated ‘the profound nature of male and colonial domination’ under the French. ⁹⁸

Experts drew on the developing field of statistics, which made ample use of surveys, as a rationale for why sex workers must be cordoned off and medically regulated unlike the rest of respectable society, including their male patrons. ⁹⁹ Statistics shifted the focus away from the moral discourse on sex work to a scientific one. ¹⁰⁰ According to James Scott, ‘statistical facts were elaborated into social laws … [as a] progressive nation-state … set[s] about engineering its society according to the most advanced technical standards of the new moral sciences’. ¹⁰¹ No more clearly was this illustrated than in the production of comprehensive reports that employed facts and figures to validate control over marginalised sex workers. Those conducting the surveys, such as Boyer and Escher, positioned themselves as expert academics within the government infrastructure, wielding authority over knowledge production on sex work. This, sometimes reciprocal, relationship between academics and the state contributed to the marginality of sex workers.

Surveys placed primacy on what diseases needed targeting and the infrastructural development required to meet the state’s goals. For example, as seen in Boyer’s Conditions hygiéniques, government officials solicited French doctors and academics for their knowledge of public health and hygiene. While not all of Boyer’s recommendations came into immediate effect, those pertaining to sex workers’ containment eventually came to fruition under the Mandate. Of more lasting impact was the influence of Escher, whose position within the French bureaucracy evolved from a technical advisor on public health to an academic advising the government on controlling the spread of venereal disease. ‘Prostitutes’ became a designated topic for health initiatives looking to manage and contain disease, inasmuch as they were believed to be the source of venereal disease. They were therefore a worthy topic of observation and intervention for the state and academics alike. ¹⁰² Sex became the site of imperial policy, or, as Levine puts it, ‘part of the politics of Empire’ and ‘central to the functioning of imperial governance’. ¹⁰³ In post-World War I Levant, containment was thought to be the ultimate answer, keeping commercial sex in concentrated areas in garrison towns and city centres where it could be surveilled and tracked. The state was ultimately the party in position to carry out this task, yet it relied on modern medicine and academics to support the development, application and enforcement of its policy.