Testing Drugs and Attesting Cures:Pharmaceutical Monopolies and Military Contracts in Eighteenth-Century France
This article explores the role of testing in the allocation of royal monopoly privileges for drugs in eighteenth-century France by following the multi-generational fortunes of a single "secret remedy" from 1713 to 1776: the poudre fébrifuge of the Chevalier de Guiller. On at least five occasions, this drug was tested on patients in order to decide whether it should be protected by a privilege and whether or not its vendors should be awarded lucrative contracts to supply it in bulk to the French military. Although efforts were made early in the century to test the drug through large-scale hospital trials and to relegate privilege granting to a bureaucratic commission, the case of the poudre fébrifuge instead suggests that military expediency and relatively small-scale trials administered personally by royal practitioners remained decisive in determining whether or not a drug received a monopoly privilege or a military contract.
pharmacy, military medicine, early modern France, testing, privilege
On November 17, 1733, after over a year of negotiations at the court of Versailles, a pair of tobacco controllers named Étienne Guérin and Pierre Brodin de La Jutais finally secured a monopoly privilege giving them the exclusive right to produce and sell a secret remedy against intermittent fevers—the poudre fébrifuge—throughout the kingdom of France. The privilege was granted in spite of a history of ambiguous patient trial results and against the objections of the newly formed commission of experts entrusted with the examination of new drugs. The two men owed their [End Page 362] success primarily to the personal patronage of Louis XV's first physician, François Chicoyneau, who believed the drug offered a low-cost solution to combating the perennial problem of intermittent fevers in the royal army, which was then mobilizing for the War of the Polish Succession.
This was neither the first nor the last time that the poudre fébrifuge would be granted a monopoly privilege despite ambiguous trial results. Nor was it the first time that the drug had been identified as a cheap, locally sourced substitute for the exotic febrifuge, cinchona bark, ideal for military applications. The first privilege for the poudre fébrifuge had been granted to Ferdinand de Guiller in 1713, and over the next sixty years, the drug passed through three generations of privilege holders and at least six sets of trials on patients overseen by a succession of royal physicians, evaluation commissions, and military practitioners. Because the poudre fébrifuge passed through a sequence of licensing and testing regimes, it provides an ideal case study for tracking changes—and continuities—in drug testing across the eighteenth century.
The eighteenth century witnessed a growing effort on the part of medical practitioners to use experimental tests to improve therapeutic knowledge. In his impressive synthesis of the history of drug trials in this period, Andreas-Holger Maehle has foregrounded the place of testing in the new scientific societies, the growing role of "in vitro" chymical analyses, the use of controls and other methodological developments, and the ethics of testing on animal and human subjects. Maehle has made a strong case that what he calls "experimental pharmacology" did not emerge in the nineteenth century, as has previously been maintained, but was "essentially an eighteenth century creation," with roots going back into the seventeenth.1
Although accounts of these debates have included many less well-known contributors—"rank and file practitioners" to use Maehle's terms—they have nonetheless tended to focus on "experimental pharmacology" primarily through learned scientific practices and learned debate in printed books and early medical periodicals. In other words, scholarly interest has centered upon the role played by testing in the improvement and dissemination of therapeutic knowledge, whereas my interest here is primarily in the more workaday role testing played in the evaluation of therapeutic goods by state officials. How did testing affect their decision making, particularly the allotment of commercial monopolies and military contracts? [End Page 363] Or, to put it another way, did the culture of "experimental pharmacology," which historians have documented among knowledge-seeking medical practitioners, also play out in the spheres of the state and commerce?
In this essay I argue that while trials on patients are a consistent feature throughout the sixty-year history of the poudre fébrifuge, these trials were deeply embedded in an older model of attestation, based on highly personal forms of experience, credit, and, ultimately, patronage. I show that royal practitioners assessed trials primarily through the prism of their personal authority and expertise, manifested in their own experience of the drug's effects on patients as well as their estimation of the inventor- vendor's character. I demonstrate that these elements persisted over the course of the eighteenth century, despite repeated attempts to rationalize drug testing and remove monopoly privileges from the influence of arbitrary authority and patronage. I also argue that an element of contingency affected the assessment of drugs: the fortunes of the poudre fébrifuge were repeatedly shaped by the timeliness of its presentation to the authorities. On two occasions, in 1713 and again in 1733, it was earmarked for specific military purposes, and so its passage through the evaluation regime was expedited by royal physicians keen to show their zeal to the king's war effort. Eventually, by 1775, the drug's long history of documented success and repeated privileges itself became an argument in favor of its continued approval, one which, in the final instance, was able to trump even the negative results of patient trials and chymical analysis.
At different points, all three of these factors came into play in the repeated renewals of the privilege for the poudre fébrifuge and conditioned the way that ambiguous trial results were interpreted for decision-making purposes. Indeed, the trials themselves played an important, even critical role in this broader constellation of factors, but they were highly personal, and did not generate systematic records, scientific publications, or learned debate. Because the goal of the trials was to determine whether or not a drug deserved to be protected by a monopoly privilege, the recipe and ingredients of the drug in question had to remain secret as a bulwark against counterfeiting. Their secrets were disclosed to the royal first physician alone in most cases; the improvement and dissemination of therapeutic knowledge was not the primary objective of the trials. Rather, their goal was to authorize the sale of novel beneficial therapeutic goods and determine whether or not their inventors should be rewarded with a monopoly.
The persistence of arbitrary authority in pharmaceutical privileges is especially remarkable against the backdrop of how technological inventions were treated in eighteenth-century France. From 1700 onward, these privileges were centralized in the Conseil and later Bureau de commerce, [End Page 364] which cultivated a close relationship with the Académie royale des sciences, whose members were often appointed to assess new inventions. In her study of invention privileges, Liliane Hilaire-Pérez has shown that the Bureau stands as a marriage of administrative monarchy and enlightened expertise, and that its stringent standards for utility and efficacy are manifested in the relatively low approval rates for new inventions.2
Matthew Ramsey has described similar reformist tendencies in the pharmaceutical privilege regime, beginning in 1728 with the reforms of Claude Jean-Baptiste Dodart, who recalled all existing privileges and sought to place the evaluation of remedies in the hands of an expert commission, and culminating with the creation of the Société royale de médecine in 1778, which was given the task of studying epidemics as well as regulating the trade in secret remedies, mineral waters, health foods, and surgical devices. Ramsey has shown that the Société royale had a relatively low approval rate for submitted drugs, with only 11.6 percent of drugs submitted receiving a favorable response, and has argued that this implies that the "enlightened physicians" took a cautious and critical approach to testing and approving drugs well in advance of nineteenthcentury therapeutic skepticism.3 Colin Jones, by contrast, has argued that beyond seeing the Société royale as a merger of "scientific curiosity and state power," it should also be acknowledged that its regulatory practices were guided in part by a "commercial mentality," and that it reflected "the values of the court milieu" in which it was embedded, including venality and patronage.4
Following Jones's lead, and taking the poudre fébrifuge as a case study, this essay tracks the persistence of these factors across the eighteenth century, showing that drug trials took place within a commercially oriented, court-centered regime of pharmaceutical privilege granting. It traces the complex and sometimes convoluted history of the poudre fébrifuge from its first trial circa 1710 all the way to the granting of its fifth monopoly privilege in 1775, divided into three discrete periods of the drug's history: [End Page 365] (1) the initial monopoly granted to Ferdinand de Guiller in 1713 and the subsequent state-sponsored trials of the drug in naval hospitals; (2) the renewal of the monopoly in the 1730s by Étienne Guérin and Pierre Brodin de La Jutais, who went on to furnish the drug in bulk to the French army; and (3) the final renewal of the monopoly privilege undertaken in the 1760s by the demoiselles de La Jutais, the daughters of the former privilege holder. Throughout these episodes, personal patronage, military expediency, and eventually the historical legacy of the drug's previous attestations all conditioned the ways in which patient trials were assessed.
A few final words on the poudre fébrifuge itself, before moving into the role of testing in the monopoly which surrounded it. Although the precise plant on which it was based was a carefully guarded secret throughout the narrative I will be untangling here, the poudre fébrifuge was believed by most historical actors to be based on a variety of tithymal (titimale, the euphorbia or spurge family): small herbs or shrubs native to France and other parts of Europe that possess a caustic milky latex. No detailed recipe or processing instructions from the Chevalier de Guiller or his successors has survived, but the powder was packaged in single-dose paper envelopes, to be mixed and ingested with a few spoonfuls of meat bouillon.
In many ways the poudre fébrifuge was touted as an indigenous European succedaneum or substitute for South American cinchona bark or quinquina (the source of quinine), accepted by many at the end of the seventeenth century as a "specific" against intermittent fevers. As Matthew Crawford has emphasized, however, cinchona bark was "powerful but fragile," and early modern healers and patients were well aware of the "fickleness" of its medical virtues. They recognized that the bark that reached them in Europe might have been taken from the wrong tree or from the wrong part of the tree; that its efficacy could degrade in transit from exposure to humidity; and that merchants might deliberately adulterate their supplies.5 Likewise, Samir Boumediene has suggested that the "instability" of the bark not only drove attempts to stabilize the supply, but also inspired a "quest for succedanea."6 Guiller's poudre fébrifuge was one of these succedanea, and the shadow of cinchona looms large in how it was received [End Page 366] throughout the eighteenth century. The drug's proponents touted it as an effective substitute to the bark that would save both money and lives, particularly among the king's sailors and soldiers; its critics argued that it had no special virtue against fevers and was merely a dangerous purgative that triggered violent evacuations.
Privilege and Medical Regulation in France
From the mid-seventeenth century to the French Revolution, the French Crown engaged in a policy of granting privileges to entrepreneurs for "secret remedies" (remèdes secrets). These privileges gave vendors exclusive rights to the sale of their remedies throughout the kingdom and provided them with a legal basis for pursuing counterfeiters and adulterators. Equally important, they circumvented the monopolies on medical practice held by the local medical corporations, that is, the guilds of surgeons and apothecaries and the faculties and colleges of physicians. So long as they stayed within the bounds of their privilege, vendors could sell their medications even if they lacked any other formal medical qualifications and were not members of the local medical corporations. In the form of parchment letters patent or brevets, these privileges were issued by the Secretary of State for the King's Household on the recommendation of the king's first physician (Premier médecin du roi). Although a handful of exclusive-sales privileges can be traced back to the early seventeenth century, they became increasingly common in the latter half of the reign of Louis XIV.
These pharmaceutical privileges were part of a broader patchwork of overlapping and sometimes contradictory forms of regulation. Most accounts of early modern medical regulation focus on practitioner-based licensing and inter-practitioner conflict, making only passing mention of substance-based examination and licensing.7 In Spanish and Italian jurisdictions, physician-dominated tribunals and licensing bureaucracies called protomedicati were entrusted with regulating medicine on behalf of civic or royal authorities. This model of medical regulation originated with the Tribunal del protomedicato overseen by the Spanish monarch's protomédico or first physician, but spread to the Spanish New World, the Kingdom of [End Page 367] Naples, and the Italian city-states in the sixteenth century.8 The licensing procedures of these tribunals tended to be pragmatic and permissive. Rather than attempting to wholly suppress the practices of medical "empirics" and "charlatans," the various protomedicati licensed them so long as they paid a fee and subjected themselves to regular inspection.9
France lacked a kingdom-wide institution analogous to the protomedicato. Instead, the regulatory landscape was characterized by the competing interests of the various medical corporations and privileged courtly practitioners. The medical corporations were embedded in the local structures of the university and the city, rather than the centralizing state. Medical appointments at the royal court, however, gave practitioners the privilege to practice anywhere in France, in contravention of local corporate privileges and despite the fact that many appointees did not personally serve the king or other members of the royal house. As such they were commonly used by outsiders—including foreigners or provincially trained practitioners—to gain access to the lucrative Parisian marketplace, despite the protests of the University of Paris Faculty of Medicine and the local medical guilds.10
Royal privileges provided drug vendors and courtly medical practitioners with exceptions to corporate regulation. They emanated directly from the monarch, going "over the heads" of the corporations, so to speak, sometimes even directly eroding their exclusive preserves. In fact, the use of privileges to provide exceptions to corporate regulation was a much more widespread phenomenon that extends well beyond medicine into other trades and professions. Privileges were also granted to merchants and artisans who served the royal household, from tailors to wig makers, called domestiques commensaux.11 Exemption from urban trade regulation was in fact one of the key incentives for taking on such positions. Pharmaceutical privileges bear an obvious affinity with such exemptions, but also resemble another variety of privilege that the Bourbon kings granted with increasing frequency in the last two centuries of the Ancien Régime: [End Page 368] monopoly privileges for inventions and industries. These economic privileges were granted to individuals, small groups, and even entire towns or cities for any number of things: the manufacture of everything from soap to steel, machines and labor-saving inventions, even mining rights and marshland drainage schemes. Somewhat closer to drugs, it should also be mentioned that privileges were granted during the Ancien Régime for other health-related products, such as the proprietary health foods and medical technologies such as hernia trusses. The assessment of drugs for monopoly privileges, however, remains understudied.12
At first glance drug monopoly privileges seem to resemble modern invention patents, but as Mario Biagioli has emphasized, early modern privileges were effectively gifts bestowed by a monarch and have important differences from the modern "patent bargain" and notions of intellectual property. Indeed, the main goals of such privileges were to reward invention with protection from competitors, to benefit a ruler's subjects, and to serve specific state interests.13 In their broader effects, they also served to weaken the existing local structures of urban corporatism, replacing them with more centralized ties to the monarchical state. A personal privilege constituted a direct personal bond between the individual and the monarch, rather than the mediated bonds manifest in membership in a privileged corporation like a trade guild.14
No official process for granting pharmaceutical privileges existed until 1728, when the first efforts were made by the royal first physician Claude Jean-Baptiste Dodart (1650–1730) to establish a standing commission that would reexamine existing privileges and review all new applications. The protocols of this body specified that the drug needed to be assessed first "par l'experience," presumably through the drug's use on patients as witnessed by the commissioners themselves, and only secondarily, "if it is judged necessary, by analysis (par l'analyse)" in the sense of chymical analysis.15 Even in its aims, this commission was still far less ambitious than the protomedicati of Spain and Italy: its jurisdiction extended only to secret remedies, not to a broader project of regulating medical practice [End Page 369] throughout the kingdom. As Alexandre Lunel has shown, the 1728 commission can be better contextualized within a long sequence of incremental and ad hoc reforms by which the practitioners of the king's "medical household"—particularly the first physician—increased their prestige and shaped royal policy.16 Before this time, pharmaceutical privileges were simply issued by the Secretary of State for the King's Household, usually following the personal recommendation of the first physician. Indeed, even after the 1728 reforms, the formal legal authority to issue brevets remained in the hands of the Secretary of the King's Household: all that had changed was the medical recommendations came from a commission of experts presided over by the first physician, rather than from the first physician alone. As we shall see, however, first physicians were not above using their personal influence to countermand the wishes of the expert commission over which they themselves presided.
Drug Trials, Attestations, and Privileges
In the case of pharmaceutical privileges, bedside trials appear to have played an important role in building confidence around a drug. Even before the 1728 reforms, the text of some letters patent and brevets explicitly mention that they were granted following successful trials (épreuves) or experiments (expériences). Few details are provided by the privileges themselves, however, and the language is often vague: out of the corpus of forty-six monopoly privileges I have assembled for the period before 1728, thirteen make specific mention of successful trials, supervised directly by the first physician or by other trusted royal practitioners appointed as commissioners. Out of these thirteen, only four explicitly underline that they were granted following hospital trials on multiple patients.17 As such, we are often left in the position of being able to say that some form of trial occurred and that its success was important to the issue of the privilege, but in most cases it is impossible to know even how many patients were involved, much less how the trial was conducted.
Little documentation has survived even in cases where hospital trials were undertaken. This is likely because they were typically not administered by the hospital itself, or even with the full cooperation of its staff. In [End Page 370] the case of the four-patient trial of Adrien Helvétius's ipecacuanha-based remède spécifique against dysentery at the Paris Hôtel-Dieu in 1687, the most salient point disclosed by the hospital's institutional archive is that the trials themselves were resisted by its staff, primarily on religious grounds. The nursing sisters and spiritual director objected to Helvétius moving and treating a man who had been served his last rights and should be allowed to die in peace.18
Hospital trials were of course not the only means by which the efficacy of a drug on large numbers of patients could be attested. Many appear to have taken place within the personal practice of the first physician and other practitioners. Some were even documented in notarized cure attestations collected by the applicant from patients themselves and reputable medical witnesses. For instance, the 1691 privilege of Louis Joüen, an oculist by trade who received exclusive rights to sell his secret remedy against cancer, scirrhus, and malignant ulcers, specified that he was granted his privilege not only based on the result of trials (épreuves) on several (plusieurs) patients at the Paris Hôpital général, but also "after having seen the attestations of other cures he made of said conditions in other towns of the kingdom."19
Cure attestations of this type, sometimes referred to as certificats, can be found throughout Europe and date back to the Middle Ages. The basic process was simple: a healer asked a patient to prepare a notarized statement that a given disease or condition was cured, to stand as a written testament of their success in practice. A medical witness (e.g., a local surgeon) was sometimes brought in to confirm the cure. Cure attestations thus constitute a form of "legitimation from below," collected and deployed by medical practitioners themselves as an alternative to licensing systems where practitioners submit themselves to an examination by university-trained physicians in order to legally practice.20 Attestations were often collected and printed as testimonials on secret remedy advertisements. These two sources of legitimation—licensing and cure attestations—could of course coexist and even be intertwined: the 1728 to 1731 reforms to the French medical privilege regime mandated that practitioners provide such attestations to the expert commission as a condition [End Page 371] of renewing their privileges.21 Even the hospital trials mentioned above fit into the "cure attestations" model: although the hospital furnished patients, the main product of the trials were personal attestations made by the credible royal practitioners assigned to assess the drug.
Like the privileges and hospital records, however, attestation letters do not usually provide detailed medical observations. This does not mean that observations or case histories were not taken by the practitioners involved, of course. It simply means that they did not need to be furnished as evidence: the validity of the trial is guaranteed through reference to the credibility of the attestor, who is confirming that the drug was successful in his experience, in effect vouching for the drug and its vendor.
These examples remind us to conceive of "testing" in broad terms: in the sense of épreuves, the "testing" of a drug could take a variety of forms, ranging from state-sponsored trials on hospital patients to other more personal forms of testing, such as the experience of a credible practitioner, or even the mediated testimony of cure attestations. Some brevets even point to the simplest (and perhaps the oldest) mode of attestation: word of mouth and favorable public opinion surrounding the drug.
Mixed Results: Three Trials of the Chevalier de Guiller's Drug (1710–15)
Thanks to a vicious legal battle over the division of profits between the two medical entrepreneurs that held the poudre fébrifuge monopoly in the 1730s, an exceptional collection of documents has survived surrounding the drug, including the original brevet, account ledgers, correspondence, and various attestations to the drug's efficacy.22 Dating back to 1713, these sources are unique in the scope and detail with which they allow us to reconstruct the activities of a proprietary remedy vendor in this period.23
An extensive case study of this kind is particularly important given the fragmentary nature of the available sources on early pharmaceutical monopolies in France before the 1760s.24 No institutional fonds have [End Page 372] survived for the 1728 or 1731 secret remedies commissions, nor have any papers survived from the royal first physicians for the earlier period, when they held exclusive sway over recommending drugs to the Secretary of State for the King's Household. Indeed, the only large institutional collection that has survived to document this phenomenon is that of the Société royale de médicine, which was given jurisdiction over secret remedies privileges in 1776, and the oldest dossiers that it inherited date only as far back as the 1772 Commission du Louvre.25 Lacking an institutional archive for the earlier period, we must draw recourse to the dispatch registers of the Secretary for the King's Household, which contain the texts of the privileges themselves, mixed pell-mell with a variety of other kinds of document, from naturalizations to pensions to prison transfers. While the privileges provide names and dates for further investigations, they tell us little else about their holders or the circumstances under which they were granted. The amply documented case of the poudre fébrifuge, by contrast, allows us to fill in some of the background of how drug privileges were allotted throughout the eighteenth century from the privilege holder's point of view, rather than being confined to the perspective of the regulator and the regulatory archive.
The first holder of the poudre fébrifuge privilege was Ferdinand de Guiller (d. 1729). Guiller was of French descent and his father had served as a royal garde des rôles, a Chancellery official charged with keeping the lists of officeholders. For reasons that are not clear, the elder Guiller was compelled to leave France for Antwerp at some point in the latter half of the seventeenth century, and his son went even farther afield, eventually commanding a company of cavalry in the service of the Republic of Venice.26 While serving in Dalmatia under the Venetian General Delfin, probably during the 1684–99 Morean War with the Ottoman Empire, Guiller was sent to inspect a prisoner camp, where he allegedly encountered an old Arab physician. The Arab had attempted to defect from the Ottomans to the Venetian army, but was imprisoned by the Venetians as a spy. He [End Page 373] begged Cuiller to speak to the General on his behalf. Cuiller did, and managed to secure the Arab's release. A few days later, the Arab visited him in his tent, and "as a mark of his gratitude, offered Cuiller the secret of a powder febrifuge, which he claimed to be infallible." Cuiller accepted the gift and recognized its efficacy for himself. Subsequently, "the love he had retained for his homeland inspired him to share it with France."27
The patriotic Guiller presented this poudre fébrifuge to Guillaume Le Blond (d. 1718), the French consul in Venice, who in turn informed the powerful Jérôme Phélypeaux de Pontchartrain (1674–1747), Louis XIV's Secretary of State for the Navy and the King's Household. The consul sent a sample of Guiller's drug, and it was given to Guy-Crescent Fagon (1638–1718), the royal first physician. After a trial (épreuve) of the drug—the details of which are not provided—Fagon reported that although it had cured several patients, it had failed in several others. The Crown already had a more "certain" febrifuge, namely cinchona, and therefore would not purchase Guiller's secret, although he was to be commended for his "zeal" in the service of the king.28
The story could have ended there, but three years later Guiller was traveling in France on other business and came in person to the office of M. Daubenton, a commis in the service of the Navy Secretary, Pontchartrain. Guiller requested that his febrifuge be tested again, fearing that the previous sample had spoiled en route or had not been properly administered. A second trial was organized. This time around, the drug was found to be "infallible," having cured hospital patients suffering from all species of fevers. The Crown offered to buy the remedy, but Guiller clarified to Fagon that he had no intention of profiting from its sale: he simply wanted the satisfaction of being useful to his homeland. When the king was informed of the quality of the drug and of Guiller's lack of interest in personal gain (désintéressement), Guiller ironically found himself quite amply rewarded: he was knighted in the royal hospitaller order of Saint Lazarus, granted a generous pension of twelve hundred livres, and, most importantly, given an exclusive privilege for the sale of his drug across the kingdom of France.29
What does Fagon's 1713 attestation tell us about the role of trials in arbitrating whether or not Guiller would be granted a privilege? As in the case studies discussed above, the attestation tells us very little about [End Page 374] the methodology or results of the patient trials, but tells us a great deal about the dynamics of credit and perceived utility that were at work in the drug's approval. A copy of Guiller's request for a privilege suggests the trials lasted four months, but even this detail is absent in the attestation. Fagon for his part simply and straightforwardly reports that Guiller's drug cured every patient he and Boudin administered it to, whether they had a tertian fever, double-tertian, or a quartan, "including some which even cinchona had not cured." Instead of detailing the trials, he focuses on Guiller's character and the expediency of the drug for military purposes. He distinguishes Guiller from the common crop of charlatans by emphasizing the sincérité and honnãeté with which he disclosed his secret.30 Assessments of character, confidence, and reputation—often called crédit in this period—played an important role at the royal court, and in French society more generally.31 As Clare Haru Crowston has recently shown, crédit shaped not only the world of commerce, but also governed the movement of patronage, influence, and power, in all spheres of Ancien Régime society. The case of the poudre fébrifuge strongly suggests that the drug privilege regime was no exception. Indeed, the language of crédit is here expressed by Fagon with a peculiarly medical accent by defining Guiller's character against the archetypal "other" of the charlatan. Well in keeping with this broader phenomenon, the poudre fébrifuge is thus validated not simply by the trials Fagon supervised, but also by his personal assessment of the character of its inventor.
On the question of military expediency, Fagon points out that the plant that serves as its key ingredient can be found plentifully throughout the French countryside—although he does not name it—and can be prepared quite easily:
Consequently [the poudre fébrifuge] can be employed at very little expense in all of the hospitals of the king's armies, and without a doubt, it will spare His Majesty from great expenses and save an infinite number of soldiers by healing them. They will suffer neither from the infection of hospital air nor from the swindling of the [hospital] entrepreneurs.32
The most important effects of the drug, it would seem, were the soldiers it would keep in the field and the money it will save the Crown from the [End Page 375] private contractors that managed army hospitals. Implicit and explicit comparisons to a proven febrifuge, cinchona bark, form the backdrop of Fagon's assessment of the poudre fébrifuge, particularly on the level of cost and easy availability.
As these comments suggest, Fagon had earmarked Guiller's drug for military purposes from the very beginning. Despite this fact, large-scale hospital trials of the poudre fébrifuge were not organized until after Guiller had already been granted his monopoly: the goal of these trials, organized by Pontchartrain, was not to test whether the drug merited a brevet, but presumably to decide whether a supply should be purchased in bulk by the navy. Alongside his many other responsibilities, Pontchartrain appears to have kept an eye peeled for new drugs that might be of use to the French navy. Pontchartrain's correspondence shows that he regularly received petitions from vendors hoping to furnish their remedies to the navy; that his subordinates, notably the intendants of France's Atlantic ports and arsenals, provided him with reports and samples of new remedies that they encountered; that he solicited samples of given drugs for testing; and finally that he sometimes sought the expert medical advice of Fagon on these questions.
Pontchartrain's interest provoked the third and by far most extensive trial of Guiller's drug. Fagon arranged with Guiller to provide a sample large enough for the hospitals of France's four Ponant (Atlantic) naval bases: Rochefort and Brest were each sent two hundred packaged doses (prises), and Port Louis and Le Havre were sent one hundred each. Pontchartrain requested that the port officials distribute the samples to the sick of the naval hospitals and then report back to him directly on their efficacy.33
The naval correspondence shows that at least three of the port officials acknowledged receipt and passed the samples along to their respective medical staffs.34 Unfortunately, a detailed report has survived from only one: Charles de Clairambault, ordonnateur at Port Louis, who forwarded the accounts of the trials undertaken by his surgeon-major, Pierre Labat, and the port physician, Guillaume Boizard (d. 1715).35 After a premature and inconclusive trial on a patient that was already recovering from his [End Page 376] fever, Labat advised that they wait until the habitual fall and winter fevers arrived in earnest.36 Sure enough, in the middle of the winter of 1714–15, the sailors at Port Louis came down with fevers, as apparently did several nonmilitary patients. The effects of the poudre fébrifuge, however, were disappointing. The surgeon-major Labat tried it on "twenty or thirty" patients in the hospital; and the port physician, Boizard, observes having administered multiple doses to five different patients, some male others female, all outside of the hospital. Labat reported that it produced good effects on one man, aged of thirty years and suffering from a quartan fever for eight months: after only two doses he was cured. In the other cases, however, the effect of the drug had been terrible, producing such violent purges that the patients strongly protested; all this in spite of the fact that he had followed the printed instructions to the letter. In some cases, the poudre seemed to have no effect at all, while in others, it provoked vomiting, but in neither case was the fever cured. Labat concluded quite succinctly, "This alleged febrifuge has two important disadvantages: namely, its violence, and the uncertainty of its effects."37
The terse assessment of the surgeon was echoed and elaborated by the Port Louis physician, Boizard. In his report, the defining features of the poudre are excessive and violent evacuations, patient protest, and only mixed effects against the fever. Boizard observes that after he gave one dose to a woman suffering from a quotidian fever, "The young woman vomited and purged abundantly almost forty times, and the fever left her, but she protested that if presented with the same circumstances she would have preferred to keep the fever than loose it at that price." The other patients he tried it on included a man suffering from a tertian fever who likewise only experienced evacuations from above and below; a poor man whom he lost track of; a man suffering from a tertian, to whom he gave three doses, the final of which provoked painful colic but did not cure the fever; and finally a woman who, after a single dose, adroitly refused to take any more. But the most interesting part of his report is the theoretical explanation he offers for the failure of the drug. The socalled poudre fébrifuge was not a febrifuge at all "by its nature or the virtue of its substance," as far as Boizard was concerned. If it acted against the fever, it did so accidentally, as a powerful purgative that might evacuate the "febrile leaven" from the digestive tract.38 [End Page 377]
The theoretical framework that Boizard appeals to in explaining the results of the trial is also very close to that which the first physician Fagon had used a decade earlier to explain the action of cinchona.39 In this short treatise, appended to the 1705 edition of Les admirables qualitez de la kinkina, Fagon declares that "there is no remedy more specific against fevers than cinchona" even though a few years later he would approve the poudre fébrifuge as more effective. Fagon rejects a humoral explanation of cinchona's effect and instead draws recourse to the then popular acidalkali theory of disease, describing the effect of cinchona on fevers as a neutralizing reaction.40 The key analogy he employs is that of the "crabs eyes," calcareous nodules that form on the stomachs of crawfish which, when placed in an acid, have the effect of neutralizing it. This curative fermentation occurs first in the stomach, and then elsewhere in the body, as particles of cinchona are absorbed by the stomach and distributed with the nourishing blood.41 Thus, the alkaline cinchona neutralizes the disordered acidic ferment of the fever.
When Boizard assessed the poudre fébrifuge, he observed that it was merely a powerful purgative, a type of drug long criticized by iatrochemists and which Fagon also dismissed as counterproductive in the case of a fever. When they work at all, purgatives work accidentally by ejecting everything in the stomach and intestines, which does not neutralize the febrile leaven and often leaves enough behind to reignite the fever. A true febrifuge that worked "by its nature and substance" would strike in a more targeted way at the root cause, or to use Boizard's terms, it would cure the fever "through the radical extirpation of its leaven" (par l'extirpation radicale de son levain).42 According to Boizard, using a violent purgative to get the job done was to cure in the same way as the empirics did when they used plants like hellebore: that is, through brute force and by damaging the patient's body.
Several points stand out from these three trials of Guiller's drug. The most general is that the exchanges surrounding Guiller's poudre fébrifuge circa 1713 to 1715 exemplify a convergence of entrepreneurial, medical, [End Page 378] and military interests, no doubt moved by the new needs of the growing armies and navies of the period and the persistent warfare of Louis XIV's reign. The highest levels of the state had taken an interest in prospecting and testing drugs. The French naval secretary himself was actively interested in new remedies and collaborated with the royal first physician to coordinate large-scale trials, with local practitioners reported back on their results. Harold Cook has shown that similar trends were at work in England circa 1700, with the army and navy showing an interest in entrepreneurs who could supply these kinds of therapeutic substances, "medical specifics" that could cure a circumscribed condition in any patient, regardless of their individual constitution. These drugs mark an important departure from the individualized therapies and regimens of traditional Galenic medicine. The interest of military officials in "specific" drugs that would be effective on entire populations also helps to explain why they would drive testing on large numbers of patients.43 In France, the search for cinchona-like "specifics" helped inspire the 1687 trials of Adrien Helvétius's proprietary remède spécifique against bloody flux and dysentery, which was likewise intended for military use.44 The poudre fébrifuge extends this narrative by showing that even after cinchona was well-established as a specific against intermittent fevers, military officials and practitioners were still interested in testing cheaper, easier to supply alternatives. Despite this stated goal, cinchona nonetheless persists as a kind of "model specific" against which poudre fébrifuge should be judged—favorably by its promoters, unfavorably by its detractors.
The number of patients involved in the three trials of Guiller's poudre fébrifuge is also worth noting. As with Helvétius's dysentery specific, the trials of the poudre appear to have been made on a relatively small groups of patients. We have no details at all surrounding the first "failed" trial circa 1710, and with Fagon's second trial in 1713 we read only of the drug's success on "several" patients, including some cases where even cinchona had not been effective. Finally, with the military hospital trials arranged by Pontchartrain in 1714, we know that in the case of the surgeon Labat, the drug was given to "twenty or thirty" patients. In the case of Boizard, more detailed observations survive for five patients (two of which, in [End Page 379] fact, were women, far from the population Pontchartrain and Fagon envisioned for the trial), but the majority of the report is devoted to his theoretical commentary. It should be acknowledged however that reports have not survived from the other three ports to where the drug was sent for testing, and evidence suggests that at least one naval physician, Jean Cochon-Dupuy (1674–1757) of Rochefort, endorsed the drug.45 In all of these cases, the exact number of patients on whom the drug was tested, ranging from "several" to "twenty or thirty," appears to have been incidental to the expert judgment of the practitioner charged with testing it.
Whatever the results from the other naval hospitals, it is worth emphasizing that the poudre fébrifuge was granted a privilege that explicitly underlined potential military applications before the larger military trials were undertaken. Large-scale military hospital trials and the reports of militarymedical practitioners may have affected whether or not naval officials requested the drug in bulk, but they did not affect the monopoly privilege itself. Nor do the negative 1714 naval hospital trial reports appear to have had any bearing on the later history of the drug: they go completely unmentioned in subsequent renewals of the monopoly and the later bulk purchase of the drug by the French army. Indeed, despite the ambiguous results of the first three trials, the poudre fébrifuge's relationship with the French court and military was far from over.
The Scheme to Renew Guiller's Privilege (1732–33)
The same critical factors—the patronage of the first physician and the potential military applications of the drug—were also at work two decades later when Guiller's successors worked to recover the secret of the drug and to renew its monopoly privilege. Sometime after 1713, Guiller retired to the town of Mondragon in Provence, comfortably pensioned, knighted, and holding a monopoly privilege for the sale of his drug throughout the kingdom. On July 1, 1729, he collected new attestations from the provincial intendant's subdelegate and the town consul of Mondragon, who both testified not just to the efficacy of the poudre fébrifuge but also to the importance of Guiller's charitable distribution of the drug to the local poor.46 These were intended to support the renewal of his privilege when the new 1728 commission requested all existing brevets be submitted for [End Page 380] reexamination. Before he was able to forward it on to the commission, Guiller died in Mondragon on August 18, 1729, followed six months later by his wife, Marie-Victoire.47
Almost two years after Guiller's death, two entrepreneurs, Pierre Brodin de La Jutais and Étienne Guérin, formed a partnership to renew his privilege for the poudre fébrifuge and market it themselves. The two men had worked together as administrators at the tobacco snuff manufactory in Mondragon. When it was closed in 1731, the older and more senior La Jutais was transferred to another manufactory in Arles, while Guérin was obliged to make his way up to Versailles to solicit a new posting from the Fermiers généraux, the royal tax farmers and holders of the state tobacco monopoly. La Jutais had evidently forged close personal ties to Guillerjust before he died: he had married Guiller's stepdaughter, claimed to have been taken under his wing, and even possessed his "livre bleue," probably a book of medical secrets. Although it is not clear whether he was Guiller's legal heir, La Jutais would later leverage his close relationship with Guiller as evidence of his legitimacy as inheritor of the poudre fébrifuge. This claim provided the initial impetus for his partnership with Guérin, who, for his part, served as La Jutais's agent on the ground at Versailles, making all the necessary inquiries to renew the privilege and, equally important, to recover the medical secret it protected, which Guiller had (rather inconveniently) taken with him to the grave.
From June 1732 to November 1733, Guérin regularly commuted to Versailles, pursuing his own interests with the fermiers, following leads on the poudre fébrifuge, and regularly corresponding with La Jutais in Arles. Guérin's half of this correspondence has survived, and describes his actions in great detail. He began by making inquiries at the Jardin royal, looking for leads on identifying the elusive "plante fébrifuge" that provided the active ingredient of Guiller's remedy. The plant, according to his informants (whom he does not name) was likely a species of titimale or tithymal, specifically tithimalus amigdaloïdes.48 With the identity of the plant apparently recovered, and with Guiller's original 1713 brevet and Fagon's attestation in hand, Guérin managed to secure an audience with Louis XV's new first physician, François Chicoyneau (1672–1752), confident that the whole matter could be settled then and there. [End Page 381]
Guérin was disappointed. Chicoyneau carefully examined the documents and found them satisfactory, but noted that he already knew that the key ingredient of the drug was tithymal: the key to Guiller's success with the poudre, he observed, was in its preparation. Furthermore, he explained that even the documents and the secret would not in themselves be sufficient to renew the privilege: the drug would need to be examined by the new secret remedies commission. Taken aback, Guérin even reports that he directly quoted the portion of Fagon's attestation that praised Guiller's moral character, namely the sincérité and honnêteté that distinguished him from "common charlatans." Guérin implied that he and his partner La Jutais shared these virtues, and objected that the approval of a commission had not been required before, but Chicoyneau stood firm.49
This new secret remedies commission was the end result of a series of reforms to the practice of privilege granting, initiated by the first physician Claude Jean-Baptiste Dodart in 1728 and continued by his successor, Pierre Chirac (1650–1732).50 These reforms began with the royal arrêt of July 3, 1728, which recalled all existing privileges for reexamination, followed by another arrêt on October 25, 1728, which extended the deadline for resubmitting the privileges and appointed the first physician to head a commission charged with evaluating subsequent privilege petitions. The arrêt implies either that Dodart perceived abuses in how privileges had been granted by his predecessors, or that he believed forged brevets were in circulation. The account of these reforms in Jean Verdier's Jurisprudence de la médecine (1762) in fact paints a picture of a first physician being imposed upon by various court interests to gratify their respective medical clients by licensing their medications. According to Verdier, Dodart wanted to share this embarrassing (gênante) prerogative with a commission, "to have grounds to refuse those who were asking him for weapons against humankind."51
The requirements of this new commission posed an important setback to Guérin and La Jutais's plans. Guérin's negotiations at Versailles were also hampered by La Jutais's leeriness in disclosing the secret of the poudre's preparation to his partner. Trade secrecy was a double-edged sword: Guiller's death before communicating the secret had already posed an important obstacle to identifying the elusive plant that served as its critical [End Page 382] ingredient, and now La Jutais's fears that the secret preparation could be stolen out from under him were, from Guérin's perspective, on the verge of ruining their whole enterprise. Instead, on the brink of failure, an unexpected turn of events gave their project new life: France began to mobilize its army for what would become the War of the Polish Succession (1733–38).52 Guérin and La Jutais had previously intended to distribute the poudre fébrifuge for private sale through a network of authorized vendors, provisions for which existed in Guiller's original privilege. Now, however, Guérin's activities in renewing this privilege became intimately tied to negotiating a lucrative military supply contract with the War Office.
The first physician, Chicoyneau, now took a keen interest in the potential military applications of the poudre fébrifuge. He assembled the commission (after repeated delays), and Guérin presented the poudre to it on September 18, 1733. By his own account, Guérin there faced "all these devils of physicians, surgeons, and apothecaries," who met his petition with a flurry of objections: some argued that the privilege had expired and there was no reason to grant a new one; others said the king himself had purchased the secret and so no new privilege could be granted; others yet claimed that they themselves knew how to make the poudre fébrifuge and that it was no secret at all. Chicoyneau stood by Guérin and La Jutais, however, and despite the opposition of the commission, Guérin reported that they had begun trials of the drug on October 11, 1733. The trials were performed on an undocumented number of patients, in this case at the Charité hospital in Avon, near the royal palace of Fontainebleau, and were personally supervised by the first physician. Chicoyneau personally attested to the efficacy of the drug in these trials and overcame the resistance of their "powerful adversaries" in the commission. The brevet itself—granted in La Jutais's name alone—was signed by Louis XV at a meeting of the Council of State on November 17, 1733, just a month after the trials began.53
Guérin and La Jutais had secured the renewal of privilege and apparently recovered the secret, but the 1733 medical supply contract for the French Army of Italy went to another bidder. They would have to wait until 1735 to reap their rewards from the royal coffers. In the meantime, they availed themselves of a clause in Guiller's original brevet, which permitted them to forage for the "plante fébrifuge" in royal forests, employing root foragers (chercheurs de raciness) to collect the plant from the forests [End Page 383] of Vincennes and Boulogne, royal hunting grounds just outside of Paris; they established a manufactory at their shared residence in Vincennes to process it; they had a public sign made for their Parisian retailer, the hatter Le Blanc; and they printed a pamphlet printed on the drug's legacy, virtues, and instruction for its use.54
The scale of Guérin and LaJutais's operation in 1735 is made clear by an extrait from the registers of the Extraordinaire des guerres. From February to November 1735, 10,025 livres were paid out to Guérin and La Jutais for 28,050 prises of their poudre.55 This sum seems to have been too large for Guérin and La Jutais to continue an honest collaboration, and their mutual distrust produced a sequence of legal actions that ultimately led to the formation of a special commission of the Conseil privé, the highest court in France, to settle their affairs. The Conseil privé commission was appointed to investigate whether Guérin had merely been an agent in the employ of La Jutais, in which case he need only be compensated for his expenses and fairly paid, or whether the two had formed a legal société or partnership, in which case the profits of their venture should be shared. Ultimately the judges ruled in favor or La Jutais.56 A few years later, however, Guérin responded in kind by manufacturing his own tablettes fébrifuges. Thanks to his continued relationship with Chicoyneau, he was able to sell fourteen thousand of his tablets to the French army in 1743—much to the ire of La Jutais, who claimed they were a shameless counterfeit of his own poudre in tablet form.57
Aside from the breakdown of relations between Guérin and La Jutais, the events of 1733 bear a striking resemblance to those of 1713. In both cases, the military expediency of the drug was instrumental to the first physicians' support. The drug encountered resistance from other practitioners (the Port Louis practitioners in 1714, the commissioners in 1733), but in each case, a hospital trial on an indefinite number of patients, personally supervised by the first physician, still carried the drug through. [End Page 384]
Most importantly, these cases demonstrate that both before and after the 1728 to 1731 attempts to reform the pharmaceutical privilege regime, the approval process relied heavily on the personal witnessing and medical judgment of the first physician.
New Trials versus Old Attestations: The La Jutais Sisters and the Louvre Commission (1772–75)
After the death of Pierre Brodin de La Jutais in 1765, the poudre fell into disuse. This prompted an inquiry by an anonymous Avignon physician in the 1768 Mercure de France, asking if any of La Jutais's descendants had preserved the secret or if it had been lost to history like so many other remedies. That same year, the Marquis de Chambray answered in the Mercure with an account of the drug's initial tenure by the Chevalier de Guiller, including some of the biographical details cited above, but gave nothing on the current status of the drug. It wasn't until 1772 that another reader of the Mercure, who signed as R.L.V., came across this exchange and followed up to see if the secret was still held by the family: he personally went to the original address of La Jutais, indicated on the old poudre fébrifuge advertisements, and found his widow and two daughters. He reported that they still possessed the secret.58
Alerted to the commercial potential of their inheritance, the La Jutais sisters, Marie-Victoire and Marie-Thérèse, appealed to the new Commission des remèdes secrets, sometimes called the Commission du Louvre, in order to request a renewed brevet for the poudre fébrifuge. This new commission was established by Louis XV in 1772 on the recommendation of his first surgeon, Germain Pichault de La Martinière (1697–1783), and superseded the previous 1731 commission. The prominent role of the royal first surgeon in this case is of course a sign of the vastly increased prestige of surgery, which La Martinière himself had played an important role in building. It can also be attributed to the low reputation of the previous first physician, Jean-Baptiste Sénac (1693–1770), who was widely believed to be corrupt. According to Frédéric-Melchior Grimm, Sénac's wife ran the "charlatans department" on his behalf, accepting bribes and securing privileges for vendors even when the commission had rejected their remedies.59 La Martinière himself denounced the first physician's [End Page 385] abuses and called for a reform of the commission. Under the new Commission du Louvre, the first physician continued to preside over meetings but could not approve remedies without a minimum of seven commissioners present, and approvals were supposed to have not only his signature but also that of the first surgeon and the dean of the Paris Faculty.60
The Commission du Louvre rejected the La Jutais sisters' 1772 petition. A summary of the decision has survived, probably based on a draft by Gérard Louis Deslon de Lassaigne, who was in charge of examining the drug. It concludes that "the poudre fébrifuge of the Demoiselles de la Jutais, has been viewed as suspect and dangerous, having been drawn from the root of a plant which abounds in a very bitter, burning latex sap (suc laiteux), good for inflaming the mouth, and which violently purges by vomit and stool."61 Indeed, the principal ingredient of the drug, tithymal, is described in seventeenth- and eighteenth-century herbals as a strong purgative. Most authors recommend it be used with restraint, but suggest that one could moderate the purgative attributes by maceration in vinegar, verjuice, quince, lemon, or barberry, making it more amenable for use as a febrifuge.62 Some form of maceration may in fact have constituted the "secret preparation" devised by Guiller. By the middle of the century, however, tithymal's reputation had further declined and it was being outright condemned by some authorities. Gabriel François Venel, chair of materia medica at Montpellier, characterized all tithymal-based remedies in the following terms in his 1765 article on them in the Encyclopédie. "The powder of tithymal root is nothing but a charlatan's remedy, and the seeds are the remedy of a peasant, and they succeed only among the most vigorous."63 According to Venel, all species of tithymal possessed the same basic properties, most importantly a caustic latex, and were nothing but violent purgatives (as implied by "spurge," the modern English name of the genus). Whatever treatment the La Jutais sisters had applied to the root, it had not sufficiently moderated its "resinous" purgative attributes, as far as the commission was concerned. Following a chymical examination and after hearing the complaints of a member who had personally witnessed the bad effects of the drug on patients, the commission voted unanimously to deny the request.64 [End Page 386]
Unfazed by this setback, the La Jutais sisters endeavored to have the commission's decision overturned by appealing to the same networks of courtly power as their father and Guiller had earlier in the century. Much of the correspondence on their behalf is written by one M. De Moulinot, the husband of Marie-Victoire, La Jutais's eldest daughter. De Moulinot was a former infantry captain and First Lieutenant of the King's Wolf-Catchery, an office of the royal household that afforded the La Jutais sisters a critical connection at court.65 With De Moulinot's help, they sought assistance from Louis Phélypeaux de Saint-Florentin, Duc de La Vrillière (1705–77). La Vrillière held the office the Secretary of State for the King's Household—which continued to be responsible for actually issuing brevets.
In their extensive mémoire, which was later forwarded to the commission, the La Jutais sisters pleaded with La Vrillière. They implied that the commission was exceeding its powers and defying the wishes of the king by "seeking to suppress a remedy precious to the State and to Humanity, and whose goodness, efficacy, and utility have been observed by sixty years of continued success" and repeatedly approved by royal physicians from Fagon to Sénac.66 They documented these claims with a series of pièces justificatives, preserved in their family papers or painstakingly recovered in official copies from government archives, literally chronicling the entire history of the poudre. By the 1770s, the legacy of the poudre from generation to generation had itself become the most effective argument in its favor: the La Jutais sisters included their father's privileges from 1733, 1743, and 1753, the recommendations of Fagon and Boudin from 1713, as well as other attestations documenting the more recent history of the poudre's use by the French army and the East India Company. These include an attestation by Chicoyneau to its utility in the campaigns of 1735 and 1736, which themselves point toward the numerous attestations by surgeons of its efficacy in the field, and even a 1737 letter from the Conseil supérieure de Sénégal underlining its utility combating fevers in West Africa.67
La Vrillière was persuaded by their arguments. He asked the commissioners for their motives in refusing such an evidently successful drug and had the royal first surgeon, La Martinière, perform an independent evaluation of the poudre fébrifuge. Ironically—considering his denunciation of Sénac's abuses and his role in establishing a new commission intended to be independent of arbitrary authority—La Martinière complied and [End Page 387] reported finding nothing dangerous in the poudre, despite the objections of the commission, and argued that the plant that formed its basis was well-suited to curing fevers. This convinced La Vrillière: in spite of the commissioners' objections, he informed them by letter that given the long history of the drug and the support of La Martinière, he would still grant the brevet to the La Jutais sisters—which he did, on July 4, 1775—and that they should register it. As a final reminder of his ultimate authority in these matters, La Vrillière also specified that his letter should be read aloud at the commission's next meeting.
The poudre fébrifuge was once again granted a privilege, for the fifth time. The commissioners rehearsed the same basic criticism that had followed the poudre since 1714—that it was merely a violent purgative, not a febrifuge. Their assessment was rejected by the Secretary of State on two grounds. The first was the drug's long and well-documented history of attestations, selectively assembled from royal archives by the La Jutais sisters. The second was the personal attestation of La Martinière that the drug was effective and not at all dangerous. Despite being rejected by the commission, the 1775 privilege was once again granted through the intervention of the Secretary of State and the medical authority of a senior royal practitioner (the first surgeon rather than the first physician in this case), just as it had been in 1733 and 1713.
The three-generation saga of the poudre fébrifuge illustrates an intriguing alignment of interests between the fiscal-military state, the royal first physician, and the vendors of secret remedies. Institutional players such as the medical corporations, the hospitals, the Paris Faculty of Medicine, even the Académie royale des sciences, played no official role in the granting of pharmaceutical privileges. Indeed, in spite of attempts at building a commission-based system during the 1728 to 1731 reforms, privilege granting remained highly personal and centered on senior state officials and courtly medical practitioners—particularly the first physician—as brokers or middlemen, mediating between the interests of the state and those of individual pharmaceutical entrepreneurs like Guiller and La Jutais.
In 1713 as in 1775, the key to securing a monopoly privilege was through bedside trials on small numbers of patients supervised by medical experts from the royal court. The durable result of a successful trial was a personal attestation, on both the efficacy of a drug and the moral character of the applicant, which required little in the way of documented observational evidence and relied instead on the personal credit and [End Page 388] judgment of the attestor, typically the king's first physician. No burden of proof or reasoned reports appear to have been necessary: these would imply a higher medical authority in need of convincing. Instead, it seems that the personal judgment of practitioners who had been entrusted with the health of the monarch was quite sufficient in deciding whether or not a drug "worked," whether it was useful to the interests of the state, and whether it should be rewarded with a privilege. Over the course of sixty years, Guiller, La Jutais, and his daughters assembled a veritable archive of positive attestations, not only from royal first physicians, but also from a variety of other medical, civil, ecclesiastic, and military authorities. They seemingly ignored documentation of negative or ambiguous results, like those of the 1714 navy trial, a fact that was never challenged by state officials, owing perhaps to the weak institutional memory of the Ancien Régime state, or to the lack of communication between different offices—notably the navy, which supervised the most extensive trials, and the army, which bought a significant volume of the drug in 1735. By the end of the eighteenth century, the accumulated weight of earlier attestations, coupled with powerful patronage and the "second opinion" of the first surgeon, could actually overrule new trials of the drug that found it to be ineffective and even dangerous.
The fortunes of the poudre fébrifuge demonstrate that the authority of the "expert" commissions appointed after 1728 could be overridden, by the first physician in 1733 and then by the Secretary of State himself in 1775. This system held the potential for corruption and venality and came under fire during Sénac's tenure as first physician. The 1772 Commission du Louvre was established in response to these abuses, but it too remained subject to the arbitrary authority of the Secretary of State for the Royal Household, who might disregard their recommendations. In the 1775 renewal of the poudre privilege, even the first surgeon, La Martinière, who had censured Sénac's abuses, was willing to independently override the authority of the impartial "expert" commission he had helped create.
Despite this persistence of arbitrary authority, French privilege-granting practices were founded on the possibility for pharmaceutical innovation and often employed bedside trials to assess the safety and effectiveness of new drugs. These trials did not generate learned publications, however, as the composition of the drugs typically remained secret. Rather, their goal was to authorize the sale of novel beneficial therapeutic products and determine whether or not their inventors should be rewarded with a monopoly. The success or failure of a trial was not validated by supplying carefully documented observations, arguing for the trial's degree of methodological sophistication, or tabulating the number and typology of [End Page 389] patients involved. These factors may well have been at play in the practices and judgment of the first physician and other royal practitioners, particularly as the "experimental pharmacology" of the eighteenth century developed. But on a social level, the judgment of whether a trial was a success or a failure was still guaranteed primarily by the personal credit of its beholder. Secret remedies remained embedded in the structures of patronage and power at the royal court, the fount from which privileges of all kinds flowed. [End Page 390]
Justin Rivest is a postdoctoral research associate in the Faculty of History at the University of Cambridge, collaborating on ''Selling exotic plant products in Paris, 1670–1730,'' a Leverhulme Trust project directed by Dr Emma Spary. His research focuses on early drug monopolies in France. He completed his Ph.D. in the History of Medicine at Johns Hopkins University in 2016.
I gratefully acknowledge the financial support of the Social Sciences and Humanities Research Council of Canada and the Charles Singleton Centre for the Study of Pre-Modern Europe. I would also like to thank Elaine Leong, Alisha Rankin, Mary Fissell, and Gianna Pomata for their constructive feedback on earlier drafts of this article, while accepting full responsibility for any remaining shortcomings.
1. Andreas-Holger Maehle, Drugs on Trial: Experimental Pharmacology and Therapeutic Innovation in the Eighteenth Century (Amsterdam: Rodopi, 1999), 1.
2. Liliane Hilaire-Pérez, L'invention technique au siècle des Lumières (Paris: Albin Michel, 2000), 52–65.
3. Matthew Ramsey, "Traditional Medicine and Medical Enlightenment: The Regulation of Secret Remedies in the Ancien Régime," in La médicalisation de la société française 1770–1830, ed. Jean-Pierre Goubert (Waterloo, Ontario: Historical Reflections Press, 1982), 215–32.
4. Colin Jones, "The Médecins du Roi at the End of the Ancien Régime and in the French Revolution," in Medicine at the Courts of Europe, 1500–1837, ed. Vivian Nutton (London: Routledge, 1990), 209–63, esp. 231–38, 258n109.
5. MatthewJames Crawford, The Andean Wonder Drug: Cinchona Bark and Imperial Science in the Spanish Atlantic, 1630–1800 (Pittsburgh: University of Pittsburgh Press, 2016), 14–15, 20.
6. Samir Boumediene, La colonisation du savoir. Une histoire des plantes médicinales du "Nouveau Monde" (1492–1750) (Vaulx-en-Velin: Les Éditions des mondes à faire, 2016), 246–50. On earlier reactions against exotic imports in favor of indigenous European plants see Alix Cooper, Inventing the Indigenous: Local Knowledge and Natural History in Early Modern Europe (Cambridge: Cambridge University Press, 2007).
7. See, for example, David Gentilcore, Medical Charlatanism in Early Modern Italy (Oxford: Oxford University Press, 2006), 137–49; Michele L. Clouse, Medicine, Government and Public Health in Philip II's Spain: Shared Interests, Competing Authorities (Farnham: Ashgate, 2011), 85–87.
8. Clouse, Medicine, Government and Public Health (n. 7), 17–41.
9. Gentilcore, Medical Charlatanism (n. 7), 118–51; Gianna Pomata, Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (Baltimore: Johns Hopkins University Press, 1998), 83–94; David Gentilcore, "All That Pertains to Medicine: Protomedici and Protomedicati in Early Modern Italy," Med. Hist. 38 (1994): 121–42.
10. See Alexandre Lunel, La maison médicale du roi, XVIe-XVIIIe siècles. Le pouvoir royal et les professions de santé (Seyssel: Champ Vallon, 2008), 87–92; Laurence Brockliss and Colin Jones, The Medical World ofEarly Modern France (Oxford: Clarendon, 1997), 238–45.
11. Sophie de Laverny, Les domestiques commensaux du roi de France au XVIIe siècle (Paris: Presses de l'Université Paris-Sorbonne, 2002).
12. On health foods, see Emma C. Spary, Feeding France: New Sciences of Food, 1760–1815 (Cambridge: Cambridge University Press, 2014), 125–66; on hernia trusses, see Liliane Hilaire-Pérez and Christelle Rabier, "Self-Machinery? Steel Trusses and the Management of Ruptures in Eighteenth-Century Europe," Technol. Cult. 54 (2013): 460–502.
13. Mario Biagioli, "Patent Republic: Representing Inventions, Constructing Rights and Authors," Soc. Res. 73 (2006): 1150–72.
14. Jeff Horn, Economic Development in Early Modern France: The Privilege of Liberty, 16501820 (Cambridge: Cambridge University Press, 2015).
15. Bibliothèque interuniversitaire de santé, Paris, Ms 2006, fol. 310r.
16. Lunel, La maison médicale du roi (n. 10).
17. For details, see Justin Rivest, "Secret Remedies and the Rise of Pharmaceutical Monopolies in France during the First Global Age" (Ph.D. diss., Johns Hopkins University, 2016), 19–67.
18. On this episode and the career of Helvétius more broadly, see Justin Rivest, "Secret Remedies and the Medical Needs of the French State: The Career of Adrien Helvétius, 1662–1727," Cam. J. Hist. 51 (2016): 473–99.
19. Archives nationales (AN) O1 35, fols. 258v°-259v°.
20. On fedi di guarigione and other forms of cure attestation, see Pomata, Contracting a Cure (n. 9), 50–51, 216–17n97; Gentilcore, Medical Charlatanism (n. 7), 119–20.
21. Arrest du Conseil d'Estat […] 17 Mars 1731 (Paris, 1751 [sic]), art. 2.
22. The sources are from the judicial records of the Commissions extraordinaires of the Conseil dÉtatprivé, AN V7
23. The nearest analogue is perhaps the ledger for Daffy's Elixir, published by David Boyd Haycock and Patrick Wallis, Quackery and Commerce in Seventeenth-Century London: The Proprietary Medicine Business of Anthony Daffy (London: Wellcome Trust, 2005).
24. On individual secret remedies and vendors, the best guide remains the work of Maurice Bouvet (1885–1964). For a full bibliography, see Pierre Julien, "Bibliographie des publications de Maurice Bouvet," Revue d'histoire de la pharmacie 73 (1985): 325–61.
25. Ramsey, "Traditional Medicine" (n. 3), 217–19; Caroline Hannaway, "Medicine, Public Welfare and the State in Eighteenth Century France: The Société Royale de Médecine of Paris 1776–1796" (Ph.D. diss., Johns Hopkins University, 1974), 228–317; and Maurice Bouvet, "Les commissions de contrôle des spécialités pharmaceutiques au XVIIIe siècle," Bulletin de la Société d'histoire de la pharmacie 10 (1922): 88–94, 119–24.
26. Louis Marquis de Chambray, "Lettre sur la poudre fébrifuge de M. de laJutais," Mercure de France, September 1768, 186–91. Chambray plausibly cites the commis, Daubenton, as his source, but it should also be noted that this account was published nearly sixty years after the events it describes.
27. Ibid., 187–88.
28. Ibid., 188.
29. For the original parchment brevet, dated September 20, 1713, see AN V7 246 (6), dossier 3, item 2.
30. "Le Sieur Ferdinand de Guillers nous a déclaré fort honnestement la préparation et avec une syncérité fort différente de la manière avec laquelle les charlatans s'expliquent sur leurs secrets," AN V7 246 (6), dossier 3, item 3 (January 30, 1713).
31. On crédit in court patronage relations, see Clare Haru Crowston, Credit, Fashion, Sex: Economies of Regard in Old Regime France (Durham, N.C.: Duke University Press, 2013), 21–55.
32. AN V7 246 (6), dossier 3, item 3, 1v°-2r°.
33. AN Marine B2 238, fols. 270–71.
34. AN Marine B3 222, fol. 214, Clairambault (Lorient), June 27, 1714; and Marine B3 220, fol. 286, Champigny (Le Havre), June 27, 1714.
35. AN Marine B3 230, fols. 53r°-54r°, "Mémoire des médecin et chirurgien major de l'hopital de la marine du Port Louis" (January 31 and February 1, 1715). On Labat and Boizard, see Henri François Buffet, Vie et société au Port-Louis: des origines à Napoléon III (Rennes: Bahon-Rault, 1972), 371, 375.
36. AN Marine B3 222, fol. 234v°, July 16,
37. AN Marine B3 230, fol. 53v°.
39. Guy-Crescent Fagon, "Nouvelles réflexions nécessaires pour se servir utilement du kinkina," in Les admirables qualitez du kinkina (Paris, 1705), 165–80.
40. On the acid-alkali theory, see Evan R. Ragland, "Experimenting with Chemical Bodies: Science, Medicine, and Philosophy in the Long History of Reinier de Graaf's Experiments on Digestion, from Harvey and Descartes to Claude Bernard" (Ph.D. diss., Indiana University, 2012), esp. 197–206, 361–82; Allen G. Debus, Chemistry and Medical Debate: Van Helmont to Boerhaave (Canton, Mass.: Science History, 2001), 103–37.
41. Fagon, "Nouvelles réflexions" (n. 39), 173–74.
42. AN Marine B3 230, fols. 53v°-54r°
43. Harold J. Cook, "Practical Medicine and the British Armed Forces after the 'Glorious Revolution,'" Med. Hist. 34 (1990): 1–26; Cook, "Sir John Colbatch and Augustan Medicine: Experimentalism, Character and Entrepreneurialism," Ann. Sci. 47 (1990): 475–505; and most recently Cook, "Markets and Cultures: Medical Specifics and the Reconfiguration of the Body in Early Modern Europe," Trans. Roy. Hist. Soc. 21 (2011): 123–45.
44. Rivest, "Secret Remedies" (n. 18), 474.
45. Académie nationale de la médecine (ANM) SRM 111 d. 29, "Mémoire des Demoiselles Lajutais," 7.
46. AN V7 246 (6), dossier 1, piece 30, Attestation from Durand and Augier (July 1, 1729).
48. AN V7 246 (6), dossier 1, piece 4, Guerin to Lajutais (August 3, 1732).
50. On the 1728–31 reforms, see Lunel, La maison médicale du roi (n. 10), 277–81, 287–93; Brockliss and Jones, Medical World (n. 10), 628–29; Ramsey, "Traditional Medicine" (n. 3), 217–18; Bouvet, "Les commissions de contrôle" (n. 25), 90–91.
51. Jean Verdier, La jurisprudence de la médicine en France (Alençon, 1762), 161–62.
52. AN V7 246 (6), dossier 1, piece 15, Guerin to Lajutais (July 25, 1733).
53. AN O1 77, fols. 287–
54. Usage et qualitez de la poudre febrifuge et entepleuritique (s.l., [c. 1736]), 8p., in AN V7 246 (6), cote 2ième. See also the later 1751 treatise, reprinted in multiple editions: Traité des vertus de la poudre royale fébrifuge du sieur de La Jutais (The Hague, 1751), 34p.
55. AN V7 246 (6), dossier 2, "Extrait du registre journal de recette et dépense tenu par M. de Launay, Trésorier général de l'Extraordinaire des guerres pour 1735."
56. AN AD XI 21, no. 14, "Jugement de messieurs les commissaires généraux du conseil […] du 4 juin 1737."
57. A Nosseigneurs les commissaires du conseil, députez pour juger les contestations que se sont ci-devant élevées entre les sieurs Guerin et la Jutais, […] signifié 20 mars 1744, M. Rousel avocat (Paris, 1744).
58. Mercure de France, May 1772, 201–2.
59. Maurice Tourneux, ed., Correspondance littéraire, philosophique et critique par Grimm, Diderot, Raynal, Meister, etc. (Paris, 1877–82), 9:229.
60. Lunel, La maison médicale du roi (n. 10), 326–27, 370–72.
61. ANM SRM 111B d. 29 (July 2, 1775).
62. Joseph Pitton de Tournefort, Histoire des plantes qui naissent aux environs de Paris (Paris, 1698), 153; Etienne-François Geoffroy, Traité de la matière médicale (Paris, 1756), 6:281–86.
63. Encyclopédie, ou dictionnaire raisonné des sciences, des arts et des métiers (Paris, 1751–72), 16:357–58.
64. ANM SRM 111B d. 29 (July 2, 1775).
65. ANM SRM 101 d. 40 no. 3.
66. "Mémoire des Demoiselles Lajutais" (n. 45).