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École du Pharo

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École du Pharo
ActiveApril 12th, 1905–June 30, 2013
FounderAlbert Clarac Ministry of War, first director
DirectorMarc Morillon, last director
StudentsOver 9,000 in 108 years
Location
Marseille
,
France
LanguageFrench
Websitehttp://www.ceuxdupharo.fr/

The École du Pharo is a French military school based in Marseille on the grounds of the Palais du Pharo, specializing in teaching and researching tropical medicine.

It operated from 1905 to 2013, initially training mainly French doctors and pharmacists, both regular and contracted military personnel; then doctors called up for national service, foreign military doctors, and French and non-French civilian health professionals.

Almost all the doctors who worked in the French colonial empire passed through the École du Pharo, which played a key role in health policy in colonized territories. In 1936, its educational role was complemented by creating research laboratories dedicated to tropical diseases and nutrition.

After 1960, it continued to provide training for all doctors and pharmacists serving under the French Ministry of Health Cooperation. In 1981 an epidemiology and public health department dedicated to community health was created.

In 2008, the French government decided to close the school. The activities were then redistributed, with the research activities of the entire French Armed Forces Medical Corps (SSA) grouped within a new, single military biomedical research institute and the public health activities of the whole SSA grouped within the Armed Forces Epidemiology and Public Health Center created for this purpose, and responsibility for training activities transferred to the École du Val de Grâce (Paris). The establishment closed its doors for good on June 30, 2013.

Over the course of more than a century of existence, the École du Pharo was officially and consecutively known as:

  • École d'application du service de santé des troupes coloniales (1905);
  • École d'application et center d'instruction et de recherche du service de santé des troupes coloniales (1954);
  • École d'application et center d'instruction et de recherche du service de santé des troupes d'outre-mer (1958);
  • École d'application et center d'instruction et de recherche du service de santé des troupes de marine (1961);
  • École de spécialisation du service de santé pour l'armée de terre et institut de pathologie exotique (1970);
  • Institut de médecine tropicale du service de santé des armées (1975).

Background and origins

Colonial conquest

The formation of the French colonial empire posed the problem of its sanitary management by health professionals. Their ancestors could be the physicians, surgeons, and apothecaries of the Royal Navy, who worked in the colonies during the Ancien Régime. The Consulate organized a "Colonial Health Service" for the Navy, but this often duplicated the military health of the land troops involved in the conquests.[1]

At the end of the nineteenth century, the French Third Republic expanded its colonial empire through a policy of territorial expansion. The navy transported the troops needed for the conquests and later for the maintenance of order, and its doctors and nurses provided medical care for all these personnel, both on board and ashore.[2]

These doctors were confronted on land with appalling epidemics among soldiers (yellow fever in Gorée in 1878, dysentery in the Far East between 1859 and 1861, cholera in Tonkin between 1884 and 1887, malaria during the Madagascar campaign in 1895, etc.) and with endemic diseases unknown among the indigenous populations.[3] In addition, the administrative authorities wanted to improve the health of civilian populations as part of their "civilizing mission" to develop the colonies.

Colonial healthcare

Colonial Army Medical Corps badge.

As the Navy was unable to supply the ever-increasing demand for medical personnel, reform was needed.[4] In 1890, a simple decree[5] created the Colonial and Protectorate Medical Corps, detached from the Navy and placed under the authority of the Minister for the Colonies, responsible for running the hospitals in the colonies as well as supporting the military forces deployed in the colonies. The corps was therefore open to both civilians and military personnel.

This initial policy failed to solve recruitment problems. The career of a colonial physician was not very advantageous, dangerous, or rewarding. Very few civilians signed up, with the notable exception of Alexandre Yersin. In terms of honors, precedence, and advancement, colonials were at a disadvantage, and the staffing crisis worsened. In practice, recruitment remained almost exclusively military. What's more, ambiguities in the statutes made it difficult to manage careers and discipline, and consequently to keep the service running smoothly.[6][7]

To resolve these difficulties, the law of July 7, 1900, granted autonomy to the Troupes Coloniales (the new name for the Troupes de Marine). On November 4, 1903, a decree created the Colonial Troops Health Service (SSTC) to replace the Colonial and Protectorate Health Service.

This "decree of understanding" divided the roles of the Ministry of War and the Ministry of the Colonies: the Ministry of War was responsible for the general discipline of colonial physicians (in metropolitan France and overseas). They are placed outside the framework of their profession when they are placed at the disposal of the Minister of the Colonies for overseas civilian missions (sanitary police, epidemic control, etc.). In this way, the SSTC was officially entrusted with missions for the benefit of civilian populations, confirming the duality of its mission.[8][9]

Given the reluctance of civilian doctors to be civil servants in difficult conditions, health care in the French tropical colonies has always been a matter for military doctors.[7]

Creation of the school

The reforms did not solve the recruitment problem, which was added, with the explosion in knowledge (microbiology, parasitology...), a training problem.[10] Following the example of Albert Calmette as early as 1890, many colonial physicians asked to improve their skills at the Pasteur Institute, where a training course for colonial troop physicians was regularly opened from 1903.[7] But the scale of the practical problems encountered made it clear that a special school was needed for Colonial Troop Health Service officers.

The Palais du Pharo seen from the École in the foreground.

The project for a specific school was conceived in 1900. The Ministry of War, responsible for colonial troops, proposed the creation of a practical school of tropical medicine. The location of this school was hotly contested, as at the time every town in France was seeking the honor of hosting a garrison or military institution.

As early as August 1900, Marseille applied for the project. As a reminder, in December 1883, Marseille had already applied to host a military medical school[11] and had set aside a budget for this purpose, but the planned school was eventually set up in Lyon. The economic consequences of the Prado arena disaster on the one hand, and the cholera epidemics of 1884 and 1885 in the city on the other, were not unrelated to Lyon's choice of location.[11][12]

Choosing Marseille

The city of Marseille therefore decided to host the new establishment as close as possible to its medical school, which since 1893 has been housed in the enlarged and upgraded former imperial palace: the Palais du Pharo, partly used as a temporary hospital under the name "Hôpital du Pharo" since the cholera epidemic of 1884.[13]

Since 1875 The city of Marseille had only had a full-fledged school of medicine and pharmacy, and for decades had been seeking to turn it into a faculty of medicine and pharmacy (the only faculty authorized to award doctorates), hoped that this co-location would advance its academic cause.[14][11]

In 1902, the Director of the Colonial Health Service submitted a project for the creation of the school, in which he developed the necessary criteria for its establishment. Among other things, he emphasized the possibility of teaching tropical pathology in a hospital on site, which led him to conclude that "these elements can only be found in a seaside town" and to suggest Marseille, where colonial teaching at the medical school, a Colonial Institute and a Colonial Museum already existed.[14]

At first, the city proposed allocating a wing of the Palais du Pharo to the school, but finally, at its meeting on November 25, 1904, the City Council decided to set up the Colonial Health School in a purpose-built building in the Parc du Pharo, next to the Anatomy Institute. On April 12, 1905, an agreement was signed between the Mayor of Marseille, Amable Chanot, and the Minister of War, concerning the installation and organization in Marseille of the Colonial Army Medical School.

The Marseille City Council was delighted, and the mayor drew a positive conclusion from the event: "I don't think I'm going too far in expressing my conviction that the establishment of the Colonial Health School in Marseilles will enable us to finally obtain from the government the transformation of our fully-fledged medical and pharmacy school into a faculty". In fact, this transformation would not take place until 25 years later.[11]

Installation

On October 3, 1905, the decree creating the École d'application du service de santé des troupes coloniales, at Marseille.[14] was issued. Work began in 1906, under the supervision of the city's chief architect, Léonce-Aloïs Muller. On July 3, 1906, Albert Clarac, senior medical officer first class,[note 1] was appointed director of the school, while Paul-Louis Simond, senior medical officer second class,[note 2] was appointed deputy director, in charge of teaching bacteriology, hygiene and epidemiology. This first staff comprises 13 officers.[15] The first class joined the school on February 1, 1907. The school was inaugurated on September 29, 1907, by General Louis Archinard, Commander of the Colonial Army Corps.[12]

As France's colonial, decolonization, and cooperation policies evolved, and as the health function of the armed forces was reformed, the scope and name of the school changed.[16]

Schools before World War I (1905-1914)

The École du Pharo became the headquarters for doctors and pharmacists serving overseas (public health) or with colonial troops (in France and overseas). Its first official title was École d'application du service de santé des troupes coloniales.

Premises and location

The agreement signed in April 1905 between the city and the Ministry of War allocated to the new school the western part of the Jardin du Pharo, at the foot of the brand-new anatomy institute, opposite the field of maneuvers. A three-story building plus a half-basement was erected for teaching and administration purposes. In addition, the pavilion at the left entrance to the park was allocated as accommodation for the school's director. This was the counterpart of the pavilion allocated to the park's janitors and junior staff, which did not please the Director of the Colonial Army Corps Health Service.[11]

The town remains the owner of the land and buildings, which are subject to an emphyteutic lease. In addition, the Ministry of War, which had vast holdings in the district, allocated premises to the new school at Fort d'Entrecasteaux (a military site located on the other side of Boulevard du Pharo, which became Boulevard Charles Livon in 1922).[14]

Mission and teaching

From the outset, the school's vocation was to provide practical rather than theoretical training for doctors and pharmacists who had already graduated, as stated in the decree of October 3, 1905: "to provide second-class medical officers and pharmacists and trainee[note 3] medical officers and pharmacists in the Colonial Army with the special professional, theoretical and above all practical training required to fulfill the service obligations of the Colonial Army Medical Corps in France and the colonies... ".[17]

Albert Clarac, first director of the École du Pharo.

The first teachers were the school's directors, including Albert Clarac, who began work on his voluminous Traité de pathologie exotique, clinique et thérapeutique, the first volumes of which were published during his time as director of the school,[18] and Paul-Louis Simond, a renowned pastor who had just discovered the role of the flea in the transmission of the plague.

Theoretical teaching originally comprised 6 sections:

  1. Diseases of hot countries.
  2. Army surgery and special diseases.
  3. Bacteriology, parasitology, hygiene, and prophylaxis of tropical diseases.
  4. Sanitary police, forensic medicine, health service administration.
  5. Surgical anatomy, surgical medicine, and equipment.
  6. Chemistry, toxicology, pharmacy.

Practical training is provided in the school's laboratories and the departments of Marseille's civilian and military hospitals.

Students are admitted according to their graduation rank from the École de Bordeaux. Civilian doctors and pharmacists who have volunteered for service may be admitted based on a competitive examination. The training period lasts eight months, from February to October, and ends with a final grading. Work was therefore intensive, and trainees were subject to military discipline.

From 1907 to 1914, the school trained 258 students,[19][20] including 241 doctors and 17 pharmacists, at a time when, in 1911, the French colonial empire covered 11 million km2 and had a population of 45 million.[21] The structures were in place, but recruitment remained insufficient, as careers were deemed unattractive. Those who chose to become colonial physicians did so because of their difficulties in metropolitan France, and also out of a sense of vocation and adventure. Many colonial doctors came from modest backgrounds (often from Brittany), attracted by the free military schools.[22]

With the general mobilization of 1914, the school had to close and remained so until 1922.[23] Twenty-one Colonial Medical Corps doctors were killed in the First World War,[23] almost the equivalent of a graduating class.[24]

Colonial apogee (1922-1954)

This prolonged closure led to a long crisis linked to persistent recruitment problems. The colonial medical corps was affected by departures and resignations. Despite propaganda campaigns extolling the virtues of a career as a colonial physician, "Indochina was accepted, but a few candidates applied for Cameroon, Togo and the AOF, but none for the AEF".[24]

As early as 1924, Édouard Daladier, Minister for the Colonies, and his successor André Hesse, increased career benefits. The school was reorganized in 1928.

Location

Aerial view of 1905 and 1932 buildings.

By 1928, the number of pupils enrolled had made the premises too cramped, prompting the principal to ask the city for new premises.[12] In 1932, the construction of a new building to the west of the first was launched to increase capacity. Badly deteriorated at the time of the Liberation, it was raised by one floor in 1948 and became the Tropical Medicine Research and Documentation Centre in 1950. Over time, other smaller buildings were added to the school's footprint, both in the Parc du Pharo and in the military annexes of Fort d'Entrecasteaux, where a former powder magazine was converted into a building housing the historical archives of the Colonial Army Medical Corps.[24]

Education and research

The need to structure a teaching body while allowing career advancement in the tropics was obvious. At the instigation of Pierre L'Herminier, Director between 1926 and 1931, a competitive examination was held for the agrégation du Corps de santé colonial, based on the principle already developed at the École du Val-de-Grâce.[25] The first professors appointed took up their posts in 1930 for a normal five-year term. These associate professors (most of whom worked at the Marseille military hospital or in the school's laboratories) were grouped into chairs around a full professor, who himself held office for 5 to 8 years. This rotation of posts ensures that the teaching staff always have recent and renewed experience of the tropical health environment.[26] In this way, a teaching corps was formed, recognized under the generic term "Agrégés du Pharo", which even coordinated the production of textbooks under a collective name.[26] The Pharo's pedagogy is therefore based on knowledge, conviviality, and pragmatism.[27]

The research and documentation center building, built in 1934 and raised in 1948.

This reform transformed the school into a large, specialized higher education establishment, with new disciplines: neuropsychiatry (1928), ophthalmology (1934), stomatology (1935), and radio-electrology (1935)... In the 1930s, the school set up a documentation and research center, initially medical, which was also opened to colonial pharmacists in 1936. The center was dedicated to researching overseas health problems, but this new requirement was discontinued in 1939.[28]

Growing demand from the colonies led to an increase in the number of graduates, with the 1933 graduating class comprising 121 doctors and 11 pharmacists.[29] From 1922 to 1939, the École du Pharo trained 982 physicians and 98 pharmacists. The creation of a colonial section at the École du service de santé militaire in Lyon in 1925[30][31] improved recruitment8 by around 25%, although it was still insufficient for the 70 million inhabitants of the French Empire at the time.[24] In 1936, the Colonial Medical Corps numbered 1,006 officers (919 doctors and 87 pharmacists).[32]

World War II and Indochina (1939-1954)

With the declaration of war on September 3, 1939, the school closed again, only to be reopened by the Vichy regime. Graduates dropped to very low numbers: 21 in 1940, 24 in 1941. Exceptional recruitment of two classes, one per semester, was made in 1942 (65 doctors and 4 pharmacists).[32]

In November 1942, the Germans occupied the free zone. The second, newer building was requisitioned by the occupying forces, who also disrupted Marseille's military hospitals.[11] The École du Pharo continued to operate, retreating to its oldest premises. It welcomed students from the Lyon colonial section, with a graduating class of 30 in 1943, and 48 in 1944.[32]

During the war, the Colonial Medical Corps was divided like the rest of the army, with some accepting Vichy and others joining the Free French.[32] Among the 26 military physicians (22 active and 4 mobilized) who were made Companions of the Liberation,[33] there were no fewer than 19 former students of the Pharo.[34][note 4] During the conflict, the Colonial Army Medical Corps lost 21 doctors and one administrative officer to enemy action outside the Indochinese theater.

During the fighting for the liberation of Marseille (August 1944), the premises were severely damaged, in particular the research building, built in 1932 and inaugurated in 1934, which was partly burnt down.[11] In November 1944, the doctor Colonel Jean Vialard-Goudou, a hero of Bir-Hakeim, was appointed to reorganize the school, which moved back into renovated premises on March 1, 1945.

The Indochina War (1945-1954), which began with the Japanese coup of March 9, 1945, and continued with the opposition between France and the Viet Minh, was the deadliest conflict for the Colonial Medical Corps, which lost 34 officers, including 26 killed by the enemy, 5 duty casualties and 3 missing in action (mer[32]).

From 1945 to 1954, the school trained 453 doctors, 56 pharmacists, and 19 administrative officers. This marked the return of a staffing crisis, apparently linked to an uncertain future and a "moral crisis" as decolonization began.[32]

In 1954, the creation of the Centre d'études et de recherche en médecine tropicale within the school led to an initial change of name to École d'application et center d'instruction et de recherche du service de santé des troupes coloniales.

Decolonization (1955-1974)

On June 24, 1955, President René Coty awarded the school's flag the Chevalier de la Légion d'Honneur cross, and the Croix de Guerre 1939-1945.[35]

The 1960 promotion of doctors and pharmacists when choosing their exit positions.

In 1958, the gradual transformation of colonial troops led to their renaming as overseas troops. The school adapted accordingly, becoming the École d'application et center d'instruction et de recherche du service de santé des troupes d'outre-mer.[36] As both a school and a research center, and thanks to its close partnership with the Michel-Lévy military hospital (Marseille), where all the heads of department now belonged to the Overseas Troops Health Service, the Pharo School played a decisive role in the constant upgrading of staff skills. In 1959, for example, the Medical Corps could count on 20 military professors and 12 military physicians who were either associate professors or lecturers at civilian faculties.[36]

In 1961, the overseas troops reverted to their former nineteenth-century name, the troupes de marine. The school then became the École d'application et center d'instruction et de recherche du service de santé des troupes de marine.[36]

From 1966, at the request of the French Ministry of Cooperation, the school took in active national service volunteer doctors (VSNA), who later became national service cooperants (CSN). They are trained at the rate of one, then two, promotions per year before leaving for what is almost always their first job.[20]

In 1968, the Navy Medical Corps was integrated into the Army Medical Corps. A single medical application school was to be set up at the Val-de-Grâce in Paris, with specialization schools for the navy, air force and army, with the École du Pharo fulfilling the latter function for the army. Hence its new name in 1970: École de spécialisation du service de santé pour l'armée de terre et institut de pathologie exotique.

The school also welcomed foreign students, almost exclusively from Africa. Far from diminishing the school's role, decolonization has, on the contrary, amplified its importance, particularly with foreign governments and international organizations.[37]

Tropical medicine and cooperation (1975-1997)

Pennant of the Institut de médecine tropicale du Service de santé des armées, recto.

In 1975, the previous reform was amended. The specialization schools, all three of which included research centers specific to their field of employment, were transformed into institutes. The school became the Institut de médecine tropicale du service de santé des armées.[note 5]

The training of national service volunteers requires several annual sessions of the diploma in tropical medicine, co-delivered with the Marseille Faculty of Medicine.

In the mid-1990s, the French government decided to discontinue its policy of substitutive cooperation. The number of French health cooperants to be trained declined sharply,[38] all the more so as the national service obligation was abolished in 1997, ending the recruitment of volunteer doctors for cooperation abroad and in French tropical overseas territories. In all, over a period of more than 30 years, more than 2,000 national service doctors began their careers with an internship at the École du Pharo.[20]

The last turning point (1997-2013)

Since the early 2000s, the evolution of the French armed forces' external commitments has been strongly oriented towards operations in combat situations, in which troops have a high rotation rate and support for civilian populations becomes a secondary activity.

Foreign operations

As a result, the need for in-depth knowledge of tropical diseases, particularly infectious pathologies, loses its relative importance in terms of the emergency, disaster and war medicine capacity requirements of French military doctors. The École du Pharo needs to refocus its basic training not just on tropical diseases, but also on the needs of wartime and disaster situations. A new "brevet de médecine des missions extérieures" (diploma in medicine for overseas missions) was created, the latest incarnation of the Pharo diploma.[39]

In 2004, the French reform of the third cycle of medical studies affected the course of studies for young military doctors. Henceforth, future practitioners are required to choose a specialty at the end of the second cycle, and the third cycle is extended to three years for future specialists in general medicine, who complete their internship with a three-month placement at the Pharo.[40]

The Army Medical Corps adapts. In 2005, the École du Val-de-Grâce was established as the only specialization school of the Armed Forces Medical Corps, responsible for all medical, paramedical and sanitary training for the entire medical corps. The École du Pharo celebrated its centenary in style. Since the creation of the agrégation competitive examination in 1929, the school has "consumed" 117 full professors, seconded by 38 assistant professors, who have been succeeded by 169 agrégés, a high rate of renewal that guarantees the ever-present desire for teaching to be delivered by people working in the field, taking turns between the tropics and Marseille6. Since 1982, it has also trained 11 foreign African military associate professors.

See also

References

  1. ^ Michel (1985, pp. 186–187)
  2. ^ Deroo (2005, pp. 18–21)
  3. ^ Deroo (2005, pp. 12–15)
  4. ^ Fabre (1984, p. 354.)
  5. ^ Fabre (1984, pp. 353–354)
  6. ^ Fabre (1984, pp. 360–361)
  7. ^ a b c Michel (1985, pp. 188–189)
  8. ^ Fabre (1984, p. 363)
  9. ^ Deroo (2005, pp. 40–43)
  10. ^ Fabre (1984, p. 382)
  11. ^ a b c d e f g Voelkel (1980, pp. 631–634)
  12. ^ a b c "IMTSSA - Institut de médecine tropicale du service de santé des armées". archives-films-paca.net. Retrieved 2024-07-11.
  13. ^ Delaage, Michèle (2019). La santé à Marseille: histoire des lieux et des hommes. Comité du vieux Marseille, Association des amis du patrimoine médical de Marseille. Marseille: Éditions du Comité du vieux-Marseille. ISBN 978-2-9540246-5-3.
  14. ^ a b c d Serratrice, Georges; Vautravers, Constant (1996). Vingt-six siècles de médecine à Marseille. Marseille: J. Laffitte. ISBN 978-2-86276-308-8.
  15. ^ Deroo (2005, pp. 40–43)
  16. ^ Deroo (2005, pp. 178–179)
  17. ^ Deroo (2005, p. 46)
  18. ^ Grall, Charles; Clarac, Albert; London School of Hygiene and Tropical Medicine; London School of Hygiene and Tropical Medicine (1910). Traité de pathologie exotique, clinique et thérapeutique [electronic resource]. London School of Hygiene & Tropical Medicine Library & Archives Service. Paris : J.-B. Baillière et Fils.
  19. ^ "Milleliri, Jean-Marie - Persée". www.persee.fr. Retrieved 2024-07-12.
  20. ^ a b c Le Pharo à Marseille, une école novatrice en médecine tropicale (PDF). 2017.
  21. ^ Michel (1985, pp. 192–193)
  22. ^ Michel (1985, p. 212)
  23. ^ a b Deroo (2005, p. 53)
  24. ^ a b c d Michel (1985, pp. 194–195)
  25. ^ Cite error: The named reference :5 was invoked but never defined (see the help page).
  26. ^ a b Deroo (2005, pp. 60–61)
  27. ^ "Actu santé avril-juin 2013". calameo.com. Retrieved 2024-07-12.
  28. ^ Michel (1985, pp. 201–202)
  29. ^ Deroo (2005, p. 57)
  30. ^ Michel (1985, p. 195)
  31. ^ Lefebvre (1987, p. 247)
  32. ^ a b c d e f Michel (1985, pp. 206–207)
  33. ^ "SEVG - Amicale des Anciens Elèves du Val de Grace - L'affaire des poisons". sevg.org. Retrieved 2024-07-12.
  34. ^ Deroo (2005, p. 159)
  35. ^ Deroo (2005, p. 59)
  36. ^ a b c Deroo (2005, p. 58)
  37. ^ Michel (1985, p. 211)
  38. ^ Meimon, Julien (2007). "Que reste-t-il de la Coopération française ?". Politique africaine (in French). 105 (1): 27–50. ISSN 0244-7827.
  39. ^ Deroo (2005, pp. 190–192)
  40. ^ Deroo (2005, p. 202)

Notes

  1. ^ Rank corresponding to colonel in the general military hierarchy.
  2. ^ Rank corresponding to lieutenant-colonel in the general military hierarchy.
  3. ^ Rank corresponding to that of second lieutenant in the general military hierarchy.
  4. ^ They are Raoul Béon, Guy Charmot, Guy Chauliac, Guy Chavenon, Jean Coupigny, Adolphe Diagne, Xavier Gillot, Paul Guénon, Paul Guillon, Yves Hervé, Jean Laquintinie, Charles Mauric, Henri Montfort, Marcel Orsini, Adolphe Sicé, Pol Thibaux, Jean-Frédéric Vernier, Jean Vialard-Goudou, and Charles Vignes.
  5. ^ In the SSA, only schools are allocated a flag as part of their traditional heritage. Other units (institutes, hospitals, etc.) are given a traditional pennant10. The flag of the École du Pharo was returned and the new institute was given a pennant, but the mission remained unchanged.

Bibliography

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