The practice of medicine in colonial settings is an inherently generative topic for historians. Medicine is viscerally material, directly affecting the physical body; at the same time, it is also highly culturally and ideologically significant, conveying the values, worldviews, symbols, and convictions of the individuals and groups who use it. Colonial encounters have historically brought dissimilar medical traditions into direct contact and hence, often, into conflict; in some instances, colonized places were also used by European researchers as laboratories for scientific and medical experimentation. The social, political, and economic tensions of colonial life can thus be read, writ small, in the dynamics of colonial medical practice, and a highly perceptive and vivid literature has explored this premise in diverse formerly colonized settings.
To this historiographical tradition, Laurence Monnais contributes an acute and fastidiously detailed entry with The Colonial Life of Pharmaceuticals: Medicines and Modernity in Vietnam. The ambition of this monograph is to examine the dynamics of colonial modernization and medicalization processes in Vietnam through the lens of medical substances themselves—their production, distribution, and consumption. In this animated account of the social life of drugs, Monnais draws on French and Vietnamese archival materials to explore the commercial, regulatory, and social dimensions of pharmaceuticals as they circulated through public, private, and black-market channels.
Intriguingly, this history project features a distinctly anthropological bent. Its nonpartisan, agnostic quality regarding what qualifies as a valid medical therapy ultimately makes the category of “medicine” seem unfamiliar and even up for grabs. Indeed, as Monnais argues, what counted as medicine changed radically from the 1870s to the 1940s, with the forms and capacities of materia medica undergoing significant transformations—both in colonial Indochina and in the French metropole. Not only did this period see important therapeutic innovations, such as the emergence of arsenical drugs and sulfa drugs, it also witnessed the standardization and industrialization of pharmaceuticals—a revolutionary development in a sector formerly dominated by the essentially artisanal labor of European pharmacists who prepared prescription drugs to order and by hand. In tandem, increasing commercialization shifted lay views about the nature of disease and the prospects for its treatment. Advertisements in the popular press, in both Vietnam and France, stoked demand for drugs of various sorts—which were often billed not only as therapeutics but as valuable adjuncts in managing the novel demands and stresses of modern life.
As Monnais notes, Vietnam is an important case study for understanding the imponderables of colonial-era medical modernities—in part, for synchronic reasons. Vietnam represented an important site for the development of vaccines and medical research via the early local establishment of a network of Instituts Pasteur; it was also the home to not one but two local medical traditions (Vietnamese and Sino-Vietnamese), making for complex instances of polypharmacy and therapeutic hybridization. Growing consumer interest in pharmaceuticals was also evidently an influential trend in Vietnam's vibrant public sphere, manifesting in the many outlets of a robustly prolific popular press.
Beyond the intrinsic interest of these colonial-era dynamics, The Colonial Life of Pharmaceuticals suggests the afterlife of decades-old debates. As Monnais shows, French medical professionals were actually quite reluctant about the use of medicines in the public health system in Indochina, preferring to prioritize the prevention of illness over the treatment of illness when possible; they endorsed a kind of “therapeutic skepticism” that also informed colonial (and postcolonial) policy elsewhere in the Global South. French colonial medical officers routinely expressed suspicion about the allegedly irrational practices of Vietnamese patients and consumers vis-à-vis pharmaceuticals, and in the present day, similarly uncritical and ethnocentric perspectives continue to influence international conversations about public health in contemporary Vietnam.
Monnais builds a thoroughgoing and deeply documented case to challenge these beliefs about the perceptions and behaviors of Vietnamese laypeople. Popular views regarding medicaments were, as she shows, highly malleable and responsive to evidence—not static or stagnant, as French colons were inclined to believe. Where the colonial medical establishment saw Vietnamese communities as either fearful of biomedicine or only selectively appreciative of its capacities, Monnais reveals that a complex and discerning public conversation about Western biomedicine took place off the radar of most French medical professionals. Documenting gaps between French colonial doxa and everyday material realities—of shortages, system failures, off-book practices, and therapeutic pluralism, for example—is an important leitmotif of this work.
Where critiques of colonial medicine tend to be grounded in cultural politics and political economy, The Colonial Life of Pharmaceuticals is distinguished by delivering a genuinely pharmacological history, attuned to the specificities of the drugs themselves. Some authors have also tended to paint all pharmaceuticals with the same brush, implying that they effect the same dynamics of medical hegemony. By contrast, Monnais carefully disambiguates classes of medicine and even individual branded formulations from one another. Compiling quantitative evidence from media and other archival sources, for example, allows the author to make inferences regarding the respective popularity of different types of therapeutics among colonial consumers. Her findings suggest that some European drugs were unpopular among Vietnamese communities for their toxicity or reputation for causing side effects, while others were seen as highly efficacious, desirable, and even prestigious. Evidently, biomedicalization was an uneven, contingent process in Vietnam—not one uniformly achieved by colonial fiat. Indeed, as Monnais suggests, “many medicalizations” took place under the French (p. 22).
In the first three chapters of the volume, Monnais establishes the concept of modern and colonial medicine and details the import and commercial pathways through which medicines circulated in colonial Indochina. Chapters 4 and 5 attend to the individual and institutional actors involved in the private pharmaceutical trade in Vietnam. The book's last three chapters discuss the consumption of medicines, emphasizing the agency and perspectives of Vietnamese individuals and communities. A uniquely satisfying read for area studies scholars and historians of medicine, The Colonial Life of Pharmaceuticals will also appeal to specialists in business history, postcolonial studies, and global health.
