Imperial Heights

Escaping Death in the Tropics

Disease and Climate

At the turn of the twentieth century, a French soldier noted in awe and consternation that the cemetery adjoining Saigon's military hospital was "more populous than a large European city." This was all the more troubling, wrote the infantryman, since Saigon had only been French since 1859, and the city's garrison certainly never surpassed two thousand men at any given time.

The health of French soldiers, officials, and settlers had been of paramount concern to the colonial administration in Indochina since the earliest days of conquest. As this soldier's testimony suggests, there was reason to worry. During the first phase of invasion, French naval medics passed harsh judgment on the climate of Cochinchina-the southernmost part of modern-day Vietnam-a region France conquered between 1858 and 1862. After having spent a total of four years there, in 1876 Dr. Auguste-Pascal-Marie Danguy des Déserts declared Cochinchina's climate so vile that he doubted Europeans could ever acclimatize to it. The more modestly named Dr. A. Léon concurred. He had participated in the conquest of Cochinchina in 1858 and 1859. Léon described the climate around Saigon as nothing short of "murderous" and pronounced its soil "unhealthy." The region around Tourane (modern-day Da-Nang) elicited a similar, if not harsher, verdict. Léon recalled of his time there: "the climate is tough, the region unhealthy, the temperature excessive and the food lacking in variety."

Dr. François-Eugène Bernard, who served in the same campaign, eventually dedicated a dissertation to determining how Cochinchina's climate impacted European troops. His findings likewise gave cause for alarm. He observed that troops hailing from Northern France survived only a matter of days in these climes before needing to be repatriated. Algerian units fared no better, victims of a humid climate unlike that of their homeland, but also of fatal nostalgia, which purportedly hindered recovery from the inevitable fevers. It was fevers, Bernard acknowledged, that felled most servicemen. Europeans in the advanced "anemic" stages of malaria could count on a single, slim, hope: repatriation. "One cannot cure anemics here in Cochinchina," Bernard affirmed. "These wretches will all perish unless a prompt return to France can wrench them from certain death."

To be sure, Bernard, Danguy des Déserts, and Léon were unaware of the root cause of these fevers. The clouds of mosquitoes Bernard describes as tormenting French sailors were not even considered prime suspects. One of the great ironies behind Dalat is that this sanatorium founded on climatic determinism was established the very year-1897-in which the British scientist Ronald Ross, then working in India, debunked climatic determinism by establishing malaria's mosquito vector. Doctors like Bernard, Léon, and Danguy des Déserts were certainly mistaken to think of Cochinchina's climate, soil, or even latitude as the cause of death. Yet they grappled with the pathogen, whatever it might be, recognizing that it was both "very powerful" and "very rapid in its effects." Fundamentally, they were not far off the mark on one central point: Casualty rates were unspeakably high. Bernard tells of a unit of 319 artillerymen that arrived in Cochinchina in 1862; four years later, only fifty remained. Bernard and Léon's esteemed colleague, Dr. Mondot, argued that Europeans could in no case hope to survive more than four and a half years in Cochinchina. Bernard considered this optimistic. In his experience, Europeans died after on average two years in the region. He consequently recommended two years as the absolute maximum duration for a military posting to the area.

Disease-and not just malaria-actively shaped French priorities in Southeast Asia from the outset. The ravages of dysentery, in particular, prompted the French military to abandon Tourane in 1860, and to fall back on Cochinchina. Yet the South offered little respite from disease. In 1861, two years after Saigon had fallen to the French, 11.5 percent of military personnel perished from illness in Cochinchina. That same year, Saigon's main clinic alone registered 2,774 patients, out of whom 170 perished and 371 were urgently repatriated. In the words of Dr. Fontaine, Cochinchina's terrifyingly high figures established "[its] deserved reputation for unhealthiness." Cholera, too, was ravaging the South. In northern Cochinchina (at Baria) and southern Annam (Qui Nhon) in 1882, a cholera outbreak claimed several European lives and stirred fear as high as the governor general's office.

Doctors continued to battle high death rates well into the late nineteenth century. Between 1861 and 1888, the mortality rate among military personnel in Cochinchina only dipped below those of troops in British India for six out of twenty-seven years (in 1869, then again between 1873 and 1877). More anecdotally, Dr. Fontaine, a médecin principal des colonies, perished from tropical disease between the time he submitted his article on death rates in Cochinchina for consideration, and its publication-a bad omen even for those familiar with journal backlogs. His own untimely demise, coupled with the statistics he presents, belie his claim that the "progress of hygiene" was rendering Indochina hospitable to colonial troops. To be sure, mortality levels in the early 1880s had dropped to 2 percent of French naval troops stationed there. Yet they crept once again above the 2 percent bar in 1896. What is more, the 2 percent mortality rate from disease amongst colonial troops in Indochina between 1883 and 1888 compared unfavorably with 0.97 percent for Algiers, 1.1 percent for Tunis, and 1.5 percent for Oran in 1895. France's Southeast Asian territories remained twice as murderous as its nontropical North African ones.

If anything, colonial administrators chose some of the grimmest points of reference in tropical health to describe Indochina. Thus, an 1892 report by Prosper Odend'hal on the valleys of Khanh-Hoa and Kinh-Dinh, in the hinterland of Nha-Trang (Annam) reads: "The soil is excellent, the water abundant year round. Unfortunately, here one can apply the proverb we learned in Guyana: 'One could become rich in a year, were it not for the fact that one dies in six months.'"

Death was only part of the story. According to an 1888 account, no European left Cochinchina completely unscathed. After a few weeks, Frenchmen reportedly took on a "yellowish hue"-likely a symptom of hepatitis. As their health decayed, they reportedly grew increasingly irritable. Comportments and civilities too fell victim to the climate. Cochinchina "survivors" pondered the degenerative and debilitative cost of their time in the colony.

Repatriation

According to Dr. Fontaine, a significant number of fatalities occurred in the process of transporting patients. Within Indochina, many perished en route to the main hospitals. Fontaine attributed this to cost-cutting measures that had eliminated express river vessels, leaving patients with only slow, multipurpose steamers. These made frequent stops before reaching Saigon's hospital. Repatriation to France constituted the preferred option for the seriously ill. This preference stemmed almost entirely from the prevailing notion that a change of "air" could cure disease. Simply put, the method of choice for overcoming tropical afflictions was to escape the tropics as quickly as possible. An 1853 French guide to tropical hygiene and medicine already advocated two possible routes: latitudinal movement, also known as repatriation; or the simpler, cheaper alternative of altitudinal movement within the colony, in other words, seeking higher ground on location. In Indochina over the course of the 1890s, governors, military leaders, and doctors would debate the merits and drawbacks of these two types of escapes from the tropics.

Baron Albert d'Anthouard de Wasservas has left a vivid account of a return trip aboard a medical evacuation vessel. In 1885, the baron departed Saigon after the standard three-year posting of the era. He was not rushed home early, despite having lost twenty-seven kilos (sixty pounds) to the notorious "Cochinchina diarrhea," one of the banes of the colonizers. His fellow passengers aboard the medical transport ship Bien Hoa included 250 seriously sick, bed-bound patients-soldiers and administrators for the most part-as well as numerous convalescents, and 150 Vietnamese prisoners, resistors to colonialism, bound for a penal colony in distant Guyana. The long voyage to France via the Suez Canal was punctuated by the death of a naval infantryman, buried at sea. D'Anthouard, conversely, saw his health improve during the crossing. He invoked the reasoning of the time to explain this turn of events: "one says of colonial diseases that while they worsen in their land of origin, they improve when one changes airs or climes."

However, the repatriation policy fast proved problematic both practically and financially. Already in 1876, a medic noted that the ship-voyage home took a terrible toll on seriously ill patients. As a result, he asked, "After this arduous crossing, how many [Cochinchinese administrators and settlers] will see only Toulon's Saint-Mandrier hospital as their last piece of France?" Contrary to d'Anthouard's received wisdom, death often struck upon reaching French shores, although as Gilles de Gantès observes, these "deferred deaths" are hard to tabulate. The toll was also terrifying on board the evacuation ships themselves, even with teams of doctors on hand. Alexandre Kermorgant reports that casualties on repatriation vessels from Cochinchina soared at thirty to forty deaths per transport in the 1860s, before gradually tapering off to some six to eight deaths per voyage.

In 1886, the Breton naval doctor Lazare-Gabriel-Marie Palud defended his thesis on the Vinh-Long, a medical transport ship serving Indochina exclusively. Palud provided vivid details about conditions on board: two live milk-cows were along for every voyage, and bore responsibility for providing fresh milk to sick children; elsewhere on board, a chamber containing seven to eight barrels of ice kept perishables cool until Saigon, where an ice plant resupplied the ship. Palud observed that at least twelve fits of malarial fevers occurred on each westward crossing. Malarial patients were immediately wrapped in blankets and served thé punché, tea spiked with rum. In dire cases, they were injected with quinine sulfate. Palud witnessed radically different mortality rates on his three crossings. In the winter of 1884 he observed nine fatalities on board, which translated into 2 percent of all passengers; in the summer of 1885 the mortality rate had spiked to thirty-three people, or 6 percent of passengers, twenty-two of whom had succumbed to "chronic diarrhea"; on his third trip, 1885-86, it dropped to three dead or 0.5 percent of passengers.

The scale of repatriation operations was remarkable for the era, the costs involved daunting. In 1894, 19.6 percent of naval infantrymen, and 37.6 percent of naval artillerymen were repatriated for health reasons-a total of 290 men from those branches of the navy alone. Two years later, 19 percent of naval infantrymen, and 40 percent of naval artillerymen posted in Indochina were repatriated to France-340 men in all. Between 1890 and 1896, dysentery had been responsible for a third of all such repatriations, and malaria for a quarter. These figures account only for naval personnel rushed home outside of the regular rotation table. Administrators too were being repatriated in droves, though they are not reflected in Dr. Fontaine's statistics. Although admittedly risky, in the absence of an Indochinese sanatorium, repatriation was still considered one of the few alternatives to certain death.

Until the late 1890s, the state contracted out transport to and from Indochina to two companies, the Messageries maritimes and the Compagnie nationale de navigation. Hoping to both save on the tremendous costs of this operation and improve hygienic conditions on board, in 1895 the Ministry of the Colonies studied the possibility of creating a new Indochina line, under direct state control. In their discussions with steamship companies, the Ministry of the Colonies insisted that every ship include a hospital equipped with 150 beds. Here was another sign that horizontal repatriation continued to account for a large part of all returns.

Yet like Kermorgant, Palud was convinced that the trips had become on average less murderous than twenty-five years prior, when it had been common for fifty or sixty patients to perish per ship. Palud imputed these earlier rates to an unspoken policy of repatriating the seriously ill from their deathbeds, so as to lower Indochina's already horrifying morbidity rates and reassure the public (casualties at sea were registered in a separate column). Thereafter, doctors successfully lobbied to send home only those likely actually to survive the passage. Among those favoring such a reform was the hygienist Georges Treille, who insisted on counting all those who died on return voyages in the colony's own death column. Palud could see only one alternative to the repatriation system, which condemned the seriously ill to perish in Indochina or on the way home: a highland sanatorium in Indochina itself. In the words of historian Robert Aiken, who has studied the hill stations of British Malaya: "one rationale for the development of hill stations was that they obviated the necessity of a long and costly journey home by providing more accessible places with a benign, home-like climate that promised physical and emotional renewal." This option appeared increasingly appealing in light of the physical and financial costs of repatriation.

Dr. Mècre's Yokohama Sanatorium

Already in 1876, Dr. Danguy des Déserts bemoaned that Cochinchina possessed no sanatorium. Unlike Guadeloupe or Réunion islands, whose hill stations and spas allowed colonials to reinvigorate on location, Cochinchina offered no such site where "exhausted personnel ... can regain strength so as to confront new hardships." In most of France's overseas territories, wrote Danguy des Déserts, colonial life was marked by a cycle of sufferings and reprieves. At present, Cochinchina offered only suffering. The French naval, colonial, and medical establishments would soon set their sights on reprieves from "murderous" Cochinchina, which in Danguy des Déserts' words, "[presents] only swampy flatlands where we find the same insalubrity."

Dr. Kermorgant, an authority in tropical medicine with special expertise in the field of colonial sanatoria, claimed that "from the very beginning" French officials had sought an appropriate site for a convalescence center in Cochinchina-in other words a salubrious, cooler site bearing some resemblance to a European climate. Unfortunately, he wrote, the mountains of Cochinchina itself had proven too low-Ba-Dinh stood at a mere 884 meters (3,000 feet), and Chua-Chang a paltry 600 meters (2,000 feet). In the absence of readily accessible, local, cool microclimates, those whom Kermorgant termed "fatigued functionaries deemed insufficiently ill to be repatriated to France, and who seemed likely to return to their posts after a short while" were routinely steered to Yokohama, Japan. Kermorgant had been careful to identify a very specific category. The severely ill were still to be sent to France without question. However, the "fatigued" or anemic could be reinvigorated in short order through treatment in Japan-indeed, to some extent, simply through osmosis of Japan's temperate climate.

The French sanatorium in Yokohama had its origins in the Sino-French war of 1883-85. At the time, Admiral Amédée Courbet had ordered wounded and sick soldiers evacuated to Yokohama, where the doctor of the French legation, Louis Mècre, treated them at his small hospital on the French concession. In 1886, the Ministry of the Colonies took interest in Mècre's achievements, noting that the remarkable recovery of soldiers should be attributed to "his fine care, and to Japan's favorable climate." With most of Courbet's fleet reassigned to other operations in 1886, both the Ministry of the Colonies and the French authorities in Indochina saw an opportunity. In 1887, Louis Mècre founded a sanatorium in Yokohama, financed by the government of Cochinchina, which provided an annual subsidy. Soon, the contact with Cochinchina was folded into Mècre's previous deal with the French navy, with both agreeing to share the sanatorium's annual subsidy of 10,000 francs. In 1893, the governor general of Indochina, Jean-Marie de Lanessan, renewed the contract, increasing the annual subvention. De Lanessan's sympathies for Mècre's endeavor are hardly surprising, given that the governor had previously served as naval doctor himself. The new sum of 15,000 francs was absorbed by Indochina's various parts, with Cochinchina paying six-thirteenths, Annam and Tonkin three-thirteenths each, and Cambodia one-thirteenth (the Indochinese Union was founded in 1887, but Laos would only be incorporated into it in 1898). Presumably, this formula was intended to reflect the relative degree of actual use of the sanatorium.

How had French authorities in Indochina been persuaded to outsource healthcare to Japan? For one thing, local budgets actually stood to save by sending patients 4,338 kilometers (2,700 miles) from Saigon to Yokohama, rather than ten thousand kilometers (6,271 miles) to France. More significantly, Yokohama was considered a healthy, proto-European environment. In 1897, the Minister of Foreign Affairs drew the following portrait of the Yokohama site: "situated on a hill dominating the sea, exposed to sea breezes, under a temperate clime, this land is particularly salubrious." The French ambassador to Japan extolled the location's marine "saline emanations." Yokohama lent itself admirably, he explained "to a rest center where soldiers and functionaries of all ranks, weakened by Indochina's climate, could regain their strength and rebuild their fragile health." Yokohama would spare colonial troops and functionaries "the tribulations of the long and painful crossing of the Indian Ocean and the Red Sea." How many might have been saved, asked the ambassador, "had they benefited earlier from a temperate clime, rather than perish on the voyage home?" The ambassador betrayed an ulterior motive when he expressed hope that the sanatorium would also foster deeper ties between Japan and French Indochina. Still, the sanatorium's main asset was its potential as a panacea, one capable of saving numerous lives. How? Reimmersion in temperate climes and exposure to maritime breezes constituted the two chief remedies. Underpinning this scheme was the prevalent logic of the sanatorium and of "changing air"-immortalized by Thomas Mann and Marcel Proust, and practiced from Cabourg to Coney Island.

To be sure, the Ministry of the Colonies had emphasized both Japan's climate, and Mècre's "fine care." Mècre had indeed proven himself during the Sino-French conflict. Of the ninety-seven patients he received at that time, he boasted that only three had succumbed. He claimed to have cured all the gravest manifestations of "diseases from hot climes," including dysentery, anemia, and malarial fevers. His sanatorium offered hydrotherapy-then a French method of choice in the war against tropical disease-as well as leisure, thanks to its billiard room and comfortable living quarters.

Dr. Mècre's relations with the government of Indochina soured overnight in December 1897, when Indochina's new governor, Paul Doumer, refused to honor his end of the contract. The Mècre files reveal the doctor's understandable outrage. They also shed light on the reasons for this 1897 volte-face. The Minister of the Colonies presented the chief motive for this abrupt decision as follows. He explained to one of Mècre's powerful defenders, Senator Gauthier that "the new sanatorium which is to be constructed in Indochina proper will render unnecessary the sending of [sick] officials to Japan." The Yokohama scheme, a compromise between repatriation to France and a sanatorium in Indochina proper, had run its course.

A Sanatorium in Indochina

Unbeknownst to Mècre, plans for an Indochinese sanatorium had been brewing for at least a decade, though years of debate remained ahead to decide on specific locales. In 1887, Indochina's Conseil supérieur de santé had reported to the governor general on the need for local convalescence centers, dedicated to treating "our Indochina functionaries." The recommendation was solidly buttressed by several rationales, which the Conseil supérieur de santé de la Marine echoed in January 1888. For one thing, the "possibility for our officials to recover locally would bring notable savings, avoiding us costly repatriations." This must have been music to a governor's ears. Indochina's fiscal deficit had begun to soar in the 1880s. Then too, humanitarian principles dictated that the sick be treated locally, given how many perished on the return trip through the Gulf of Aden and the Red Sea. Yokohama could only provide an unsatisfactory semisolution, since patients still faced at best a twelve-day ocean crossing to reach it. As a result, those too sick could not be sent there, and those not sick enough avoided undertaking the voyage altogether. Finally, emulation of a colonial rival undoubtedly constituted the main driving force for this project. In the words of the Conseil supérieur de santé de la Marine: "France in Indochina owes its officers, soldiers, functionaries, and sailors what England has so successfully achieved in India for its army and its local administration." Throughout its existence, Dalat would be compared to hill stations the world over, but especially to those of the British Raj.

The pendulum had begun to swing towards an Indochinese hill station in 1887. However, the choice of its future site remained hotly contested, and would remain so well into the early years of the twentieth century. Indochina's Conseil supérieur de santé contented itself with recommending that a technical subcommittee determine multiple sites of convalescence based "upon the rules of hygiene."

Alexandre Kermorgant provides hints of a failed experiment on a hill near Baria, southeast of Saigon, which unraveled abruptly because of high casualty rates in 1887. The Baria failure showed that high altitude did not suffice, argued Kermorgant. According to him, "admittedly altitude is beneficial to some patients. But one must, first and foremost, remove trees and cultivate the lands. Otherwise, one runs the risk of placing a future convalescence site on a hotbed of malaria, one all the more intense because the virgin tropical ground will have to be stirred up [by construction]."

Kermorgant's article appeared in the Annales d'hygiène et de médecine coloniales in 1899, just over a year after the same journal had reported Ronald Ross's conclusive demonstration (1897) that the Anopheles mosquito constituted malaria's sole vector of transmission. What is more, mosquito transmission had been suspected for some time before Ross, with the French doctor Alphonse Laveran first advancing a mosquito hypothesis in 1884, after having uncovered malaria's parasitic nature in 1881. Yet Kermorgant remained frozen in the miasmic mold; malarial emanations, he feared, could be stirred from the fertile, virgin soil of the tropics after it had been disturbed. At Baria, but even more so at Dalat, French colonial doctors would negotiate and shift between miasmic and modern paradigms, between accumulated climatic knowledge and the new realities of bacteriology and microbiology. In these contests over Indochina's sanatoria, climatic determinist, telluric, and miasmatic models would prove remarkably resilient.

Yersin's Travels and the Search for Indochina's Switzerland

In July 1897 Governor Paul Doumer ordered his subordinates to compile information on possible locations for a "mountain sanatorium where functionaries and settlers alike will be able to rebuild their strength, whereas today they are obliged to return to France to the greatest detriment of our budget and their business." Doumer recognized the nefarious reputation of Indochina's highlands, but he attributed it to "the state of abandonment in which the natives have left them." Echoing Kermorgant, Doumer advocated a "preliminary deforestation" of the chosen location, "so that one will be able to find in the mountains of this land the vivifying air which one finds the world over at high altitudes." Most of the Résidents supérieurs and other high-ranking officials responded with lists of possible seaside resorts. Only in Annam did authorities read Doumer's memo closely enough-or perhaps only there did they dare brave the interior's terrible reputation-to investigate several highland options, across Annam.

The scientist cum explorer Alexandre Yersin responded promptly to Doumer's request for information on a mountain sanatorium. The Swiss-born doctor's legendary reputation stems largely from his discovery of the bacillus of the bubonic plague in 1894-immortalized as Pesta yersinia in his honor. He was a dedicated Pasteurian, having worked as assistant to Louis Pasteur and Emile Roux in 1886, and later founded a laboratory in Nha-Trang that would become a Pasteur Institute in its own right in 1905. Trained in Switzerland, Germany, and France by the likes of Pasteur and Robert Koch, Yersin's scientific credentials and achievements have made him a household name in France, Switzerland, and Vietnam: founder of Hanoi's medical school, introducer of the Brazilian rubber tree variety to Indochina, and of course breaker of the plague's secret. Yersin's curiosity led him not only to touch on all fields from botany to biology and medicine, but also to achieve breakthroughs in each of these areas. So tell us, quite convincingly, the various hagiographies of Yersin, one of the few colonials in whom French and Vietnamese seem to find common admiration, since his name and likeness survived the many street-name and statuary purges in Vietnam since 1945.

In addition to Yersin's logs and copious notes, the Pasteur Institute in Paris was recently entrusted with his voluminous correspondence with his Swiss mother. Through this source, a more nuanced portrait of the scientist emerges-perhaps simply a more human one. It reveals that in 1893, after having clashed with escaped Vietnamese political prisoners on his descent from the Lang-Bian to the coast, Yersin attended the execution of their rebel leader with morbid wonder. He insisted on photographing the condemned leader, named Thouk. He later noted that the rebel's head was only severed on the fifth saber blow. In 1895, in an altogether different setting, Yersin quipped of Réunion island's population: "the creoles are lazy ... the negroes and mulattos try to take on European airs-how unoriginal and un-picturesque." The scientist's filial devotion led him to collect "curious objects" for his mother on his trips amongst Indochina's highland minority peoples. In 1894, in the midst of his travels through the Indochinese highlands, he reported with disappointment that he would have to hand over this bounty to the Museum d'histoire naturelle in Paris. The museum's director, he explained, served on the dreaded mission commission, and would certainly not approve of artifacts collected on official business being handed out as family presents. Finally, Yersin was no colonial liberal, or advocate of reform. He complained privately, in correspondence with a fellow explorer, of Governor de Lanessan's purportedly naïve policy of "Annamitophilie." None of these snapshots detract from Yersin's achievements in the field of plague studies. They do, however, remind us that Yersin served not simply the Pasteur Institute, the Messageries maritimes, and science; he was also deeply implicated in French imperialism, even in its most extractive and oppressive dimensions.

This inquisitive, brilliant scientist took considerable interest in Doumer's project. He responded to the governor on July 19, 1897, presenting material on Annam's highlands that he had collected on his three treks through the region in 1892, 1893, and 1894. The diaries contained hints of an idyllic site for Doumer's sanatorium. Interestingly, Yersin's missions of 1892 through 1894 had not actually been aimed at finding a suitable locale for a health station. Rather, he subsequently recalled that his goals had involved "reporting on the [interior's] resources, on the possibility of raising animals, studying forest resources, and seeking exploitable metals in the mountains." Yet Doumer would subsequently mine the journals of these expeditions for a sanatorium site. Fortunately for the governor general, Yersin had recorded nearly everything that caught his eye.

"A vast, barren plateau featuring rounded hills." So reads Yersin's journal entry for June 21, 1893. Yersin had stumbled upon the expansive Lang-Bian plateau. Three days earlier, Yersin had caught his first close glimpse of the Lang-Bian summit, overlooking the plateau by the same name, where Dalat would later rise. He put pencil to paper, faithfully capturing its contours in the margins of his text.

On his return to the Lang-Bian in February 1894, Yersin recorded other useful details. Two days' walk from Lang-Bian, he already registered morning temperatures of 2 degrees Celsius. No doubt the imposing mountains, and these temperature readings, reminded Yersin more of his native Switzerland than of the Vietnamese coast where he had lived since 1891. On the Lang-Bian plateau he observed graceful deer or elk that roamed freely. He remarked that they were "the true kings of this strange land." The map Yersin drew of his itinerary shows that he crossed much of the Lang-Bian plateau, from south to north.

At Dankia, a village on the edge of the Lang-Bian plateau, Yersin noted that he stood at an effective border. Beyond here, he commented, indigenous minorities no longer paid a tax to Annam. In fact, the chief at Dankia purportedly refused to lead Yersin any further; villages beyond were considered "independent." Here Yersin touched on one of the unstated objectives of his three voyages. "Governor Lanessan," he writes, "had given me license to assure the Ma Moï that the Protectorate would care for them, that one day a Frenchman would come to protect them." He deemed his second trip a success because "the Moïs now know that we exist, that we must protect them, and they would not understand any indifference on our part."

Why this insistence on protecting the diverse, ethnolinguistically distinct minorities of Annam's mountainous interior, pejoratively termed "Moï"-meaning "savage" in Vietnamese? And from whom did they supposedly need to be protected? The answer, as it happens, was from the very auxiliaries Yersin had brought with him. In 1894 Yersin had traveled with fifteen linh, Vietnamese militiamen, and countless "coolies." On his 1892 mission, Yersin had recruited some forty porters and two Vietnamese servants. On his 1894 mission, no fewer than fifty-four porters accompanied him. It was ethnic Vietnamese like them, Yersin believed, who had long oppressed highland minorities, save for a few stubbornly independent peoples beyond Dankia. Yersin claims to have seen this dynamic of oppression at work within the columns of his own exploration missions. He relates: "I witnessed unbelievable events: simple coolies having ascended the [Lang-Bian] plateau, passed for [Annamese] district chiefs, sent by mandarins. They then proceeded to collect 'tax' by means of lashings." Time and again, Yersin asserted that the Lang-Bian lay beyond Vietnamese civilization. He later recalled: "there are no relations between the inhabitants of this region and the Annamese. A few Cambodians, elephant and rhinoceros hunters for the most part, sometimes pass through to trade. But even they are rare. Most Moïs have never even seen a gun." Several principles had been coined. The mountainous interior lay beyond Vietnamese control, and hence offered unique advantages to the colonizer. Highland minorities required protection, indeed liberation, and could easily be swayed to support the French cause. Here was an ethnopolitical opportunity, alongside the averred climatic one.

Had Doumer and his staff read Yersin's reports more critically, they might have spotted clouds on the horizon. For one thing, Yersin's diaries are replete with cases of indigenous minorities resisting the scientist and his schemes. Indeed, for his third mission (1894), Yersin requested and obtained the support of a small unit of militiamen, fifteen in all, so as to avert the confrontations he had encountered on his two previous trips. On the cusp of this third trip, Yersin confided to his mother, "I am starting to know these nasty savages, the Bihs and the Radés, who have already caused me so many miseries." As for the healthfulness of central Annam's mountains, careful investigation would have revealed it too to be dubious. In February 1893, at the tail end of his second expedition, a desperate Yersin had wired Hanoi. He reported suffering from "violent pernicious fevers, resulting from [his] last trip through the mountains." The description is entirely compatible with malaria. On his expedition the following year, Yersin did not place his faith blindly in the cool nights at higher altitude. He wrote his worried mother that he still weighed his regular 60 kilos (132 pounds) and was in perfect health, thanks to "a daily dose of quinine."

In 1897, after carefully reading the scientist's diaries, Doumer responded enthusiastically, even though the Lang-Bian remained only one of several possible locations at this point. He once again called upon Yersin, entrusting him with a mission to the Lang-Bian plateau. This time, he had a single, clear objective: "study the location of a sanatorium that the governor general would like to establish in the mountains." Two months later, Yersin boasted to his mother that he had persuaded the governor to "create a sanatorium in the Lang-Bian." This was certainly accurate, although Doumer reserved the right to establish other hill stations, and had yet to determine which would serve as Indochina's chief sanatorium.

In the Lang-Bian mountain range, Yersin explained to his mother, "there is a vast, barren plateau of some four hundred square kilometers in the middle of which rises a mountain. The plateau's average elevation is of 1,500 meters [5,000 feet] above sea level; the mountain surpasses 2,000 meters. I believe the region to be healthy because it is barren." Then Yersin betrayed his secret hope: "[The Governor has ordered] the construction of a road and railroad that will lead to the plateau directly from Nha-Trang. All of this will increase Nha-Trang's importance!" Revealed here are not only Yersin's miasmic theories (in the miasmic model, decaying organic material played an important role in transmitting malaria, and the more barren an area, the better), but also a hidden agenda: that the scientist's beloved town of Nha-Trang, home to his laboratory, would grow in importance thanks to the future Lang-Bian sanatorium.

Lang-Sa

If Yersin emerged as Doumer's most trusted local health advisor, Alexandre Kermorgant remained the sanatorium expert. In June 1898, Kermorgant was asked to assess Yersin and Doumer's plans for transforming the Lang-Bian plateau into a hill station. He began by bemoaning that no local Simla or Darjeeling-the famed hill stations of British India-had been found in the previous decades. This had led wealthy French settlers in Cochinchina to seek reinvigoration in the British colony of Singapore, and French officials and troops to find treatment at Yokohama, at great cost to the administration. At last, the Lang-Bian plateau promised to remedy this situation. Thanks to the Lang-Bian, wrote Kermorgant, "the sanatoria problem in the Orient has been resolved, which will ease the burden on state funds." All stood to gain according to the optimistic Kermorgant: the soldiers, settlers, and administrators who could sojourn there, and the administration whose coffers would benefit in equal measure.

Doumer, the future president of France, had strongly endorsed the sanatorium project-though he still remained vague about its precise location. In April 1898, he had stressed to the Minister of the Colonies the "high importance" that he ascribed to the project, given the "significance of this enterprise for French colonialism in Indochina." He reiterated his goals: finding a salubrious plateau on which Europeans could enjoy "vivifying air, a temperate climate, analogous to some extent to Southern Europe's, and capable consequently of restoring their health and vigor, altered by the humidity and heat of the lowlands."

A host of sites were considered, based on recent expeditions and consultations with explorers. Bavi, near Hanoi, was ruled out because "woodland fever" seemed to overcome all who stayed there. Doumer considered the Tonkin's natural sanatorium solution to lie in China, in the Yunnan, which would soon be connected to Indochina by rail, but which presented the disadvantage of lying outside French borders. Instead, Doumer focused on Annam, where several sites seemed propitious. Certainly, the Lang-Bian had much to offer. The Lang-Bian, he opined, combined all of the necessary conditions: sufficient altitude, water supply, fresh air, and breezes. Other regions within Annam still held promise, including the hinterland of Tourane (Da-Nang), where explorations for a hill station were about to begin.

To convince the Minister of the Colonies, Doumer cited outside opinions. Indochina's inspector of agriculture, Jacquet, who had been sent to examine the Lang-Bian's potential for sustaining European fruits and vegetables, declared: "I can barely contain my enthusiasm at the sight of this wonderful region." Proof of the land's healthfulness, insisted Jacquet, could be found in the highland minorities indigenous to the plateau. "They are robust and strong," he wrote, "next to the emaciated peoples of the valleys." Enter another witness. Jacques de Montfort, a world traveler and legendary marksman who had visited the Lang-Bian as a tourist, reported: "It is impossible to find a more pleasant temperature than on this plateau; the air is very dry, and a gentle breeze blows day and night." Doumer concluded with a flourish. Not only could the Lang-Bian become "a site of rest and comfort for tired settlers and administrators," it could one day become an administrative hub or even a de facto capital, and a military base where troops could be kept fresh and ready for combat.

Doumer dubbed the Lang-Bian's future sanatorium "Lang-Sa," which he understood to denote "French town" in Vietnamese (from Phu Lang Sa). Here, in other words, stood not only an ideal sanatorium site, but also a future French administrative hub. Its advantages were many: buffered from Vietnamese centers of power, nestled in healthy mountains, offering a vast expanse for future constructions, climatically akin to Southern France, and surrounded by minority peoples allegedly seeking French intervention.

Doumer's fascination with the Lang-Bian plateau was anything but incidental. He hoped to exploit Indochina's handful of "temperate and healthy regions." "May they be populated with settlers," implored Doumer, "and we will indestructibly establish both civilization and French sovereignty over this part of the Far-East." Thus, hills stations held the key to perpetuating the French presence in, and domination over, Indochina. Such was the grand vision of Paul Doumer.

The general principle of associating altitude, power, and health, had been firmly established. Details, however, had yet to be ironed out. Doumer kept his options open, realizing that Indochina's vast distances might call for several hill stations, spread out between Tonkin and Southern Annam. His 1897 memo to administrators had urged them to consider all healthy highland sites for a possible sanatorium. In this process, Doumer came to rely upon some of the intrepid travelers who had trekked the mountains in the 1890s.

Indochinese Context: 1897

Starting in July 1897, Doumer positioned teams of explorers in their starting blocks. Their finish line was Indochina's highland sanatorium. So far, we have followed only one of their itineraries, Alexandre Yersin's; in the following chapter, we will turn to his chief competitor, Victor Adrien Debay. Clearly, Doumer assigned a high priority to this race, since he initiated it within months of taking office.

The year 1897 proved fateful for the colony, or rather the Indochinese union, as it had been known for a decade. Paul Doumer's nomination to the post of governor general that year marked a sea change. One of his predecessors, de Lannessan, had advocated the respect of Indochina's many cultures, had championed a form of indirect rule, and even considered reversing the division of Annam and Tonkin-a partition that had torn Northern Vietnam away from the Nguyen dynasty in Hué. He had guaranteed the rights of the protectorates. In contrast, Doumer's mandate involved creating a strong central government-the Gouvernement général de l'Indochine. Accordingly, in 1897, Doumer founded Indochina's direction of finance, as well as its régies, or state monopolies. He stripped the Nguyen as well as the Cambodian monarchy of much of their power. Mostly, Doumer set into motion a massive increase in the size of the colonial administration. By 1900, Indochina's ratio of European officials to total population already dwarfed that of British India and the Dutch East Indies. Soon the number of European functionaries across Indochina would soar from 2,860 in the year Doumer took office, to 5,683 in 1911. According to one source, Doumer ushered in "a great era of bureaucracy."

Most of Doumer's objectives depended on the success of a sanatorium or hill station. With Europeans already perishing from disease at high rates, doubling the size of the European administration could only be justified by creating a site for periodic "cures."

As for carving out a French space in the Annamese interior, this decision was either tributary to Doumer's 1897 reforms, or vice versa. Under de Lanessan, only Cochinchina-a colony rather than a protectorate-could have even been considered for such a project. We have seen that Cochinchina's highest altitudes were deemed inadequate for a sanatorium. In fact, de Lanessan had favored the Yokohama option, a sanatorium that lay on a clearly defined French concession. The new plan to create a French convalescence site in the protectorate of Annam signaled a clear shift in the French relationship with the Nguyen dynasty. Such were the broader geostrategic stakes that Doumer pondered in 1897 as he dispatched columns of explorers into Annam's rugged interior.

Conceding a manifest fragility, French colonial doctors in nineteenth-century Indochina resorted to desperate and costly measures: repatriation and term limits on the length of stay in the colony. Colonial officials were acutely aware of the high morbidity rates Europeans suffered-rates so high that medics could barely write a paper on the topic and hope to see it published in their lifetime; so high that the administration tried to distort them by shipping the dying back to France so as to have them count as lost at sea. Desperation and a firm belief in the toxicity of Indochina's climate drove the costly and bizarre attempt to evacuate sick administrators to distant yet clement Japan. With the advent of Paul Doumer, and the French government's commitment to create an unusually strong administrative presence in Indochina, new, more practical and economic solutions needed to be found. Advocates of colonial sanatoria adroitly channeled a web of fears-of the climate, of mysterious fevers and emaciating digestive disorders, and even of indigenous peoples themselves-to justify a seemingly utopian project: the creation ex nihilo of a European health center, or even a French city, high atop the "uncharted" mountains of Annam.