Engraving of a row of buildings along a waterfront embankment.

Healing on Credit: Medical Bills and the Politics of Medicine in Eighteenth-Century Pondichéry

Jacques Albert, the surgeon-major of Pondichéry, India, probably thought that Marie Cuperly was “good for it” when it came to paying her outstanding medical bill. He put that belief to the test in 1711 when Cuperly, his patient of more than five years, died. Just hours after she passed away, Albert submitted a petition to the city’s governing body, the Superior Council, asking for total repayment of the remedies, procedures, and curatives he had prescribed to Cuperly over the previous five years.[1] Albert included an itemized bill for Cuperly along with his petition.[2] The ten-page bill listed more than 130 different remedies and procedures he had administered to her since her husband’s death in 1706 until her own death. The bill emphasized that Albert had assumed a risk letting Cuperly get by on credit to such an extent, but now the question remained: would the Superior Council cover him?

Community members in Pondichéry, France’s principal holding in India, relied heavily on credit. In an often cash-poor society, credit networks were important for people in early modern France and its empire.[3] Even though Cuperly was extremely wealthy, she too was cash poor. People whose wealth was tied up in property and goods, a common characteristic for many of Pondichéry’s residents, often used credit to maintain the stability of their domestic circumstances. To produce the money to pay for her treatments, Cuperly would have needed to sell goods from her home, either at public auctions (which cost further money to host) or at a local bazaar (where she might not have received as much value in return). Neither of these options were efficient or realistic – given the regularity with which she required medical attention – and, further, few other residents in the city would have had a similar amount of nonessential goods they could sell off piecemeal to produce the continually needed money to pay for regular procedures. Credit, not just in everyday exchanges but also medical expenditures, shifted the financial burden from one resident to another potentially more financially stable party. In an extreme way, the bill between Cuperly and Albert demonstrated the transfer of financial burden.

In the last two years of her life, Cuperly was not a physically healthy woman. With only a small hospital to care for the military officials in the city, her options for requisite medical needs were few.[4] As the widow of the city’s previous governor, Cuperly had known Albert for many years and their personal relationship allowed her to easily acquire her oft-needed aids. Albert’s submission indicates that he attended to Cuperly with great frequency by the end of her life and ordered her doses of “purgative enemas” and “cordial” or “cardiac” potions nearly every other day.[5] The remedies themselves were generally commonplace and reflected medical teachings of the time, when treatments sought to restore balance to the body’s four natural humors. Each cost about fourteen fanons per dose, which would have been the expected amount for Albert’s patients to pay. We know from the probate inventory of Cuperly’s home that her personal effects excluded leftover medicines and the materials to produce the prescribed medicines.[6] Each item Albert recorded was one he had prepared on his own. Though we don’t know if the medicines were premade or if he produced them anew for each prescription, it’s clear he was taking some kind of a financial hit every time she sought him out.

While the charges Albert listed appear to be run-of-the-mill, if not occurring at a staggering frequency, the bill’s sum clues us into the level of risk associated with the continued consultations. In total, Cuperly’s debt amounted to 1056 livres tournois – a substantial debt given that Albert’s annual salary from the French East India Company was only six hundred livres tournois.[7] Without being paid, Albert would have to rely on his own money, income, and even credit to replace what was prescribed, lest he have nothing for other patients. Only because of his salary could Albert (and his own household in the city) continue to make ends meet and assume further debt. Every encounter with Cuperly meant a risk assessment on Albert’s part to continue accruing the costs with an expectation that she, or her estate, would eventually pay him. Ultimately, the Superior Council ruled in his favor. Subsequent probate records for Cuperly’s estate show that after the payment of the specific bequests she had dictated in her will, Albert was the first creditor whose debts were settled.[8]

Crumpled banknote with French writing and embossed stamp.
A ten-livres-tournois banknote issued by La Banque Royale, France, 1720. (Courtesy Wikimedia)

Certainly, Albert and Cuperly’s example is unique given the status of both in the community and thus the size of the debt, but their case speaks to a more general practice of delaying the payment of medical bills with credit. Though most other examples of unpaid medical bills in the archives of eighteenth-century French India are less extensive, their presence speaks to the regularity of the practice. When a particular Madame Welch died, both Albert and another of the city’s surgeons, Du Jarry, submitted bills to the Superior Council against her estate for the costs accrued during her illness.[9] And French-born medical practitioners weren’t the only ones who might expect to get repaid for compounding medical debt. A number of South Asian medical practitioners directly engaged with the Superior Council to get their own repayments for deceased patients. Perie Tambi, a local practitioner, had treated Marie Feriera, a woman of Luso-South Asian descent, until she died without settling her debt. Just like Albert, Perie Tambi brought his treatment records to the Superior Council seeking a settlement.[10] In 1722, Baba Adam and Moutourama, designated as medecins malabars, attested that they received their outstanding debts from the estate of Madame Bongré for remedies provided before her death.[11] The Superior Council ordered all of these petitions to be paid, indicating a support for the practice of medicine on credit that extended across the city’s class and ethnocultural divisions.

Of course, medical bills weren’t the only form of credit in the city that someone might look to settle after one party’s death, but they were special. There are numerous examples in the archives of other residents who brought obligations – a marker or note of credit – to the Superior Council during probate proceedings. The Council tried to honor all debts made on estates; but in some cases they couldn’t. If the estate did not have enough money to cover debts, the Council would intervene to make sure that, at the very least, everyone got some part of their debt repaid. However, when it came to medical bills, the Council never adjusted the value of the payout. When residents with outstanding bills died, the Council ensured that medical debts were settled in full, allowing medical practitioners to recoup their entire risks. In addressing medical bills fully, the Superior Council continually reaffirmed its support for the practice of medicine on credit, regardless of other debts and claims on the estate.

Medical bills, as an institutionally supported form of credit, gesture to the broader way that the French governance related to the medical landscape in the city as a potential site of colonial intervention. By supporting these kinds of credit practices, the Council mitigated concern by allowing people the flexibility to seek out treatment without the pressure of immediate payment. By supporting a payment system which might have allowed for greater access to medical care in Pondichéry, the Superior Council used medical debt as a means to reduce some financial strains on households. By healing now and paying later, practitioners and patients could keep a fledgling colony and its financially precarious colonists healthy.

Notes

  1. France, Archives Nationales d’Outre Mer [Hereafter FR, ANOM], INDE, P 006, ff.107–108.
  2. FR, ANOM, INDE, P 006, ff.109–118.
  3. There is an extensive literature on credit in early modern France and Europe more broadly. For a recent work, which emphasizes the flexibility of the early eighteenth-century credit networks, see Elise M. Dermineur, “Rethinking Debt: The Evolution of Private Credit Markets in Preindustrial France,” Social Science History 42, no. 2 (2018): 317–42.
  4. Alfred Bigot, “La médecine française à Pondichéry aux XVIIIe et XIXe siècles,” in Comptes rendus du 91e Congrès nationales des sociétés savantes [Rennes, 1966] (Gauthier-Villars, Bibliothèque Nationale, 1967), 31.
  5. For example, between November 1710 and January 1711, there were only a total of eighteen days when Albert did not prescribe a new remedy for Cuperly.
  6. Cuperly’s probate records are extensive, and can be found at FR ANOM, INDE, P 006, ff.31–146.
  7. France, Archives Nationales, Paris, Microfilm, COL, C2, 69, ff.51v. Currency conversions were very irregular during the early eighteenth century given regular fluctuations in both French and South Asian currencies. For this essay, the conversion rate used was one pagode = eight livres two sous, as noted in Catherine Manning, Fortunes a Faire: The French in Asian Trade, 1719–48 (Aldershot: Variorum, 1996).
  8. FR, ANOM, INDE, P 006, ff.77.
  9. FR, ANOM, INDE, P 010, ff.201 and ff.205.
  10. FR, ANOM, INDE, P 014, ff.89.
  11. FR, ANOM, INDE, P 022, ff.437. “Malabar” was a general term that the French often applied to South Asians living in Pondichéry. The eighteenth century saw a development in the professionalization of medicine, which in part contributed to a stronger distinction between the designation of “chirurgiens” and “medecins.” See Toby Gelfand, Professionalizing Modern Medicine: Paris Surgeons and Medical Science and Institutions in the 18th Century (Greenwood Press, 1980); and Christelle Rabier, “Les chirurgiens de Paris et de Londres: économie, identités, savoirs,” (PhD diss., University of Paris, 2008), 1.

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