Louis-Ferdinand Destouches’ medical writing: an apologia for industrial and social modernization

This article proposes an analysis of the medical writings of Louis-Ferdinand Destouches. These writings reveal a critical reflection, in no way a whitewash, on hygiene and public health problems imposed by the war of 14–18. These medical writings, immediate post-war products, show thinking which is in line with the social and ideological ideas we find in Semmelweis, the first of the texts collected in Celine Book 3 (The Basedowine closes collection). Contemporary with the debates of the 20s, he questioned medical theses dedicated to the glorification of industrial and social modernization. Here is presented and clarified some data on their acceptance by the medical profession, the development of Destouches’ career, and his vision of his profession, concluding that these medical writings can be considered embryonic of the views of the man who would become Louis-Ferdinand Celine. Written, mostly, on behalf of the League of Nations during the period 1924–1932, these medical writings, like his medical history, provide the main leitmotifs that will illustrate the Celinian universe: miserable conditions, poverty, alcoholism and human degradation, all the things that made it difficult to exercise the profession of doctor in the urban-industrial society of the early twentieth century.

Being immediate post-war productions, these articles present not only a focus on medicine, but also on related social and ideological issues. Contemporaneous with the 1920s discussions, Destouches enquires into the condition of medicine as an apologia for industrial and social modernization.
In order to focus on his approach, it is necessary to choose the most representative writings in this apologia for modernization, found in the corpus presented in Cahiers Céline 3. We will not dwell on his medical and pharmaceutical writings of the late 1930s, which are not devoid of interest for an understanding of his medical work, but they have less of a bearing on his war experiences. Therefore, before focusing on the ideas of a public health specialist, influenced by Taylorism, a brief introduction to his medical career is necessary. This will lead us to the discovery of a number of medical writings about social order that illustrate the concerns of a French doctor in the urban-industrial society of the early 20 th century.

The discovery of the medical profession
Louis-Ferdinand Destouches was born on May 27 th 1894, in Courbevoie, in Paris, into a bourgeois family. His father worked in the insurance sector and his mother was a lace maker.
He enlisted as a cuirassier in 1912, but after the war broke out, shrapnel fractured not only his right arm but also his fighting spirit. He was subsequently taken to the emergency unit of Hazebrouck military hospital and so, on October 25 th 1914, Louis-Ferdinand Destouches made his first contacts with the medical world. He soon after retired from the military and was assigned to a post at the French consulate in London.
Having returned to Paris, young Destouches went to Africa in 1916, in order to work as a plantation supervisor for a logging company. In fact, it was in Africa that he first confronted the need to heal people, when he realized the extent of epidemics and discovered the reality of colonial life. He wrote to his friend Suzanne Saintu, saying: "I treat black patients as much as I possibly can, I'm not even sure if I'm useful to them" 1 (Destouches 1916, 207). From that moment on, his concerns about hygiene stirred and those concerns can be found in a letter written in 1917 and addressed to Simone Saintu: "Do not forget to burn this letter; it must contain trillions of microbes" 2 (Destouches 1917, 170). In order to help local people, he asked his parents to send him medicines and medical devices, so that he could heal based on real samples or on the reading of medical articles. It was within this context, and after feeling the need to relieve human suffering, that he had his first medical experience. He contracted malaria and had to return to France in April 1917. In Paris, as Michel Deveaux emphasized, he was: hired by La Sirène Editions and worked for a small magazine, Eurêka, that published scientific textbooks. (...) One day, Louis came upon a small ad from the Rockefeller Foundation. This Foundation was looking for agents to disseminate information on the fight against tuberculosis, a scourge in France 3 (Deveaux 2015, 50).
One year later, with the American Commission for Preservation against Tuberculosis, also known as Mission Rockefeller, renowned for advocating medical research and improving public health, he discovered the real meaning of social medicine. Recruited by one of the teams that worked for this mission, he took up a challenge which was of the utmost importance. While informing the population about basic hygiene, he also had to apprise them of the devastating ravages of disease that caused thousands of deaths in WW1, thus acknowledging the fact that existing structures did not work.
He also gave lectures to raise public awareness. His first lecture took place in Rennes on March 10 th 1918, at the request of Dr. Anastasius Follet, Dean of the Faculty of Medicine of Rennes, who sought urgent publicity for a Brittany dramatically affected by tuberculosis.
The testimony of a journalist that attended the lecture gives us an account of Destouches' speech, emphasizing his wisdom as a future physician: "He spoke about the issue with absolute mastery, and also with the experienced art of the finest experts" 4 (Huon de Kermadec 1976, 35).
After this experience, Destouches decided to study Medicine in 1919. He concluded his studies very quickly, because of the special conditions available to veterans. In March 1920, in Rennes, he obtained his completion of studies certificate in physical, chemical and natural sciences. Thereafter, he applied for Medical School and, after passing his exams, sought hospital internships and was acknowledged as a student with "a rare quality for establishing smooth communication with the patients" 5 (Guenot 1973, 37). 3 Author's translation of: "embaucher par les Éditions La Sirène et travaille à une petite revue Eurêka qui publie des manuels scientifiques. (…) Louis tomba un jour sur une petite annonce émanant de la Fondation américaine Rockefeller. Cette Fondation recherchait des agents afin de diffuser des informations concernant la lutte contre le fléau que constituait la tuberculose en France". 4 Author's translation of: "Il a parlé avec une grande science de la question et avec un art goûté des plus fins connaisseurs". 5 Author's translation of: "une qualité rare [ayant] la facilité d'entrer en contact avec les malades".
In 1922, Destouches continued his studies in Paris, and, in 1924, he  Days of Semmelweis)" 6 (Deveaux 2015, 58). Destouches's thesis deals with the biography of a Hungarian physician, Master of Surgery, PhD in Obstetrics, inventor of prophylaxis and asepsis, long before Lister and Pasteur. Semmelweis discovered that the maternal mortality rate (MMS) after childbirth was due to hygiene problems resulting from the fact that nurses and doctors lacked the habit of disinfecting before surgery, thus contaminating their patients.
MMS decreased when he imposed these hygiene rules. However, the importance of his discoveries in asepsis inspired jealousy, hostility and hatred among his peers. Dr.
Semmelweis was rejected, despised, dismissed and banned. The intransigence, independentmindedness and love for mankind which despite everything drove this scientist enables us to fathom how Céline would shape himself as a novelist.

The hygiene crusade of Dr. Destouches
Influenced by the death of the Hungarian physician who was not acknowledged by his peers and convinced that human beings are responsible for their own suffering and diseases, Destouches decided to get involved in a hygiene crusade. Following the example of Semmelweis whose "medical thinking [he said], so beautiful, so generous, perhaps the only truly human thinking in the world, is so clearly shown on each page of his existence" 7 (Destouches 1924, 123). That year, thanks to his acquaintances within the Rockefeller Foundation, he was reappointed and made himself available to work as a physicianepidemiologist at the Hygiene section of the League of Nations in Geneva. He began this quest under the direction of Dr. Ludwik Rajchman, a Polish Jewish physician, for whom he would hold deep respect as he demonstrated a few years later, stating that one "must be fair to him, he was much less stupid amongst great scholars, much less stingy, less of a scoundrel, less pretentious" 8 (Céline 1941, 64). Thereafter, he went back to Cameroon as a physicianepidemiologist of the League of Nations and from 1924 to 1927 his social and occupational medicine campaign expanded to another continent. In 1925, Rajchman invited him to attend the International Exchange of Physicians and Hygienists, who were working on public health and hygiene issues.
On February 14 th 1925, Destouches left for North America and Europe, or more precisely the Netherlands and Italy, with a group of Latin American physicians, to make them aware of several hygiene facilities already developed. He documented all these journeys and also had to prepare reports, which reflected the lectures and papers presented during his travels, to be sent to Rajchman, his director. Guided by Dr. Destouches, the group traveled through different regions and arrived in Pittsburgh to study the manner in which the Westinghouse Electric Company provided its health services, but not before going through Detroit, where they visited the health installations at the Ford factory.
As far as the Ford factories are concerned, the extreme mechanization there reminds us of the scene in Charlie Chaplin's Modern Times1 (936), which perfectly captured the image of workers acting mechanically, "a few gestures, always the same" 9 , according to Destouches (1941,173). In this regard, recalling his experience, Destouches maintained that "the machinery quickly takes on much more importance than a man in the manufacturing process" 10 The worker described by Céline is undignified, his thoughts are erased, and the author also displays the violence and brutality exerted on contemporary man alienated by new types of labor organization and by technological improvements, as shown in the excerpt from the text. Here we find the hero of Voyage au bout de la nuit during a medical checkup at Ford plants: 'For what you will do here, it's not important how bad you are!', the general practitioner reassured me, right away. 'So much the better.' I answered, 'but you know sir, I'm educated and even started doing medical studies. 'It does you no good here, your studies, boy! You didn't come here to think, but to perform the actions we will order you to do. We do not need creative individuals in our factory. It is chimpanzees that we need. Follow this word of advice: don't you ever tell us how smart you are! We'll think for you, my friend!' 11 (Céline 1932, 223).
It is worth mentioning that, through his texts on social medicine and hygiene, which are representative texts of the health concerns at the core of this new state of industrial spirit, Dr. Destouches was the only one, in the late 1920s, to endorse "the medicine of the proletariat" 12 (Destouches 1928a, 146), "medicine of expectancy and a special practice which is suited to a large population always at work" 13 (Destouches 1928b, 163), and not "the standard medicine" or even "the hospital medicine". It was in the post-war recovery period that he realized the existence of social injustices and discovered his own social awareness. Moreover, he acknowledges this revelation during an interview with Jean Guenot and Jacques Darribehaude: "(...) I was in the League of Nations, (...) There, then, relentlessly.
Journey to the End of the Night depicts a common character, Ferdinand Bardamu, faced with the greatest challenge of his time, the war of 1914-1918, in which he is enlisted and from which he discovers the horrors and the colonialism, but also its modernism and its progress.
At the beginning of the novel, Bardamu volunteers to fight in the war in 1914. Sent to the front, he mixes into the narrative of what he observes some acerbic remarks on his own incomprehension about the horror and absurdity of war and the behavior of his colonel.
That colonel, I could see, was a monster. Now I knew it for sure, he was worse than a dog, he couldn't conceive of his own death. At the same time I realized that there must be plenty of brave men like him in our army, and just as many no doubt in the army facing us. How many, I wondered. One or two million, say several millions in all? The thought turned my fear to panic. With such people this infernal lunacy could go on for ever…. Why would they stop? Never had the world seemed so implacably doomed.
Could I, I thought, be the last coward on earth? How terrifying!... All alone with two million stark raving heroic madmen, armed to the eyeballs? With and without helmets, without horses, on motorcycles, bellowing, in cars, screeching, shooting, plotting, flying, kneeling, digging, taking cover, bounding over trails, root-toot-tooting, shut up on earth as if it were a loony bin, ready to demolish everything on it, Germany, France, whole continents, everything that breathes, destroy destroy, madder than mad dogs, worshiping their madness (which dogs don't), a hundred, a thousand times madder than a thousand dogs, and a lot more vicious! A pretty mess we were in! No doubt about it, this crusade I'd let myself in for was the apocalypse! (Céline 2006, 9).
Celine gives an apocalyptic vision of an increasingly violent war, emphasizing its monstrous and wholly human-generated character, imposing a kind of collective punishment. The critical tone of this evocation of war comes from the choice of words with depreciative connotation. From the "monster" term that defines the colonel echoes back all the comparisons with dogs. The word comes up repeatedly: "worse than a dog", "more rabid than a thousand dogs", "more vicious". The presentation of men as inferior beings to dogs gives them a rabid character and a perverse and inhumane cruelty. In addition, terms such as "infernal imbecility", "heroic madmen" and "apocalyptic crusade", by their hyperbolic tone, accentuate the horrifying character of his images of war. The phenomenon of amplification of the long central sentence of the second paragraph, with his messy enumeration, leads to a sort of paroxysm of horror, underlined by the succession of the three terms "Germany", "France", and "Continents". The narrator evokes the gigantic scale of fighting across the world.
The narrator does relate an act or a series of acts of war. His comment is about the war in general. Therefore, it is on the phenomenon as a whole that he provides testimony: men turned into screaming hordes or moving, deadly masses, leaders wedded to false bravery capable of all kinds of killings, unleashing widespread violence. He stressed at the same time the extreme loneliness of the isolated man who thinks, and when not being carried away by the ambient madness, feels profoundly different.
By giving voice to his hero, by presenting the reflections of a man, witness and actor, Céline situates him so the reader can understand that in the middle of "heroic madmen", some, with lucidity, could analyze the situation and bring back accurate and humane testimony. Caught in the middle of the horror of the war, he retained a critical lucidity, to bear witness not only to the war but also to his own situation: Bardamu says what he thinks, loud and clear and with some violence of expression.
In WWI, Louis Destouches undoubtedly met with absolute horror, the nightmare of the fighting, the suffering, the numberless dead, the bloody insanity of men, the absurdity without appeal to the outside world and an ordeal from which he would never entirely recover. A world in which the madness manifests itself vividly in war: the drama of intelligence confronted with absolute nonsense and universal malice: "This war, in fact, made no sense at all." (Celine 2006: 4). Thus in Celine's world, there is no possible salvation for man thrown into a world dedicated to universal malice, there is no possibility for him to rise above it: "The truth is death. You have to choose: death or lies. I've never been able to kill myself" (Céline 2006, 97).
In front of this dark and pessimistic painting, Céline describes and denounces the absurdity of society, taking sides with the weak and the poor, without hiding his latent despair.
How therefore can we square this despairing writer/artist with the tireless pursuer of medical improvement, the man who gave his early career to causes of public health and the international organizations and initiatives which grew out of the war? Perhaps the experience of the war set up a real schizophrenia in Destouches. The public man keen to make his mark on the world, committed to improving the lot of suffering humanity. And his nom de plume,