Report on the Hospitals
Scientific tribunals, which should pronounce in the first instance while awaiting the definitive judgment of the public, were one of the requisites of our epoch; and thus, without any formal prescription of its successive regulations, the Academy of Sciences has been gradually led on to appoint committees to examine all the papers that have been presented to it, and to pronounce on their novelty, merit, and importance. This labour is generally an ungrateful one, and without glory, but talent has immense privileges; entrust Bailly with those simple Academical Reports, and their publication becomes an event.
M. Poyet, architect and comptroller of buildings in Paris, presented to Government in the course of the year 1785, a paper wherein he strove to establish the necessity of removing the Hôtel Dieu, and building a new hospital in another locality. This document, submitted by order of the king to the judgment of the Academy, gave rise, directly or indirectly, to three deliberations. The Academic Commissioners were, Lassone, Tenou, Tillet, Darcet, Daubenton, Bailly, Coulomb, Laplace, and Lavoisier. It was Bailly, however, who constantly held the pen. His reports have been honoured with a great and just celebrity. The progress of science would now perhaps allow of some modification being made in the ideas of the illustrious commissioners. Their views on warming-rooms, on their size, on ventilation, on general health, might, for example, receive some real ameliorations; but nothing could add to the sentiments of respect inspired by Bailly’s work. What clearness of exposition! What neatness, what simplicity of style! Never did a writer put himself more completely out of view; never did a man more sincerely seek to make the sacred cause of humanity triumph. The interest that Bailly takes in the poor is deep, but always exempt from parade; his words are moderate, full of gentleness, even where hasty feelings of anger and indignation would have been legitimate. Of anger and of indignation! Yes, Gentlemen; listen, and decide!
I have cited the names of the commissioners. At no time, and in no country, could more virtue and learning have been united. These select men, regulating themselves in this respect according to the most common logic, felt that the task of pronouncing on a reform of the Hôtel Dieu imposed on them the necessity of examining that establishment. “We have asked,” said their interpreter, “we have asked the Board of Administration to permit us to see the hospital in detail, and accompanied by some one who could guide and instruct us... we required to know several particulars; we asked for them, but we obtained nothing.”
We have obtained nothing! These are the sad, the incredible words, that men so worthy of respect are obliged to insert in the first line of their report!
What then was the authority that allowed itself to be so deficient in the most usual respect towards commissioners invested with the confidence of the King, the Academy, and the Public? This authority consisted of several administrators (the type of them, it is said, is not quite lost), who looked upon the poor as their patrimony, who devoted to them a disinterested but unproductive activity; who were impatient at any amelioration, the germ of which had not developed itself either in their own heads, or in those of certain men, philanthropic by nature, or by the privilege of their station. Ah! if by enlightened and constant care that vast asylum, opened to poverty and sickness, near Notre-Dame, had been then conducted, now sixty years ago, only in a tolerable way, we should have understood how, in taking human nature into consideration, the promoters of this great benefit would have repelled an examination that seemed to throw a doubt on their zeal and on their good sense. But alas! let us take from Bailly’s work a few traits of the moderate and faithful picture that he drew of the Hôtel Dieu, and you shall decide, Gentlemen, whether the susceptibility of the administrators was authorized; whether, on the contrary, they ought not themselves to have anticipated the unhoped-for help from the king’s power, united to science, which was now offered to them; whether by retarding certain ameliorations by a single day, they did not commit the crime of lèse-humanity.
In 1786, infirmities of all sorts were treated at the Hôtel Dieu: surgical maladies, chronic maladies, contagious maladies, female diseases, infantine diseases, &c. Every thing was admitted, but all presented an inevitable confusion.
A patient on arriving was often laid in the bed and in the sheets of a man who had had the itch, and had just died.
The department reserved for madmen being very confined, two were put to sleep together. Two madmen in the same sheets! Nature revolts at the very thought of it.
In the ward of St. Francis, reserved exclusively for men having the smallpox, there were sometimes, for want of other space, as many as six adults or eight children in a bed not a mètre and a half wide.
The women attacked with this frightful disease were mixed in the ward of St. Monique with others who had only a simple fever, and the latter fell an inevitable prey to the hideous contagion, in the very place where, full of confidence, they had hoped to recover their health.
Women with child, women in their confinement, were equally crowded, pell-mell, on narrow and infected truckle-beds.
Nor let it be supposed that I have borrowed from Bailly’s Report some purely exceptional cases, belonging to those cruel times, when whole populations, suffering under some epidemic, were tried beyond all human anticipation. In their usual state, the beds of the Hôtel Dieu, which were not a mètre and a half wide, contained four, and often six patients; they were placed alternately head and feet, the feet of one touching the shoulders of the next; each had only for his share of space 25 centimetres (9 inches); now, a man of medium size, lying with his arms close to his body, is 48 centimetres (16 inches) broad at the shoulders. The poor patients then could not keep within the bed but by lying on their side perfectly immovable; no one could turn without pushing, without waking his neighbour; they therefore used to agree, as far as their illness would allow, for some of them to remain up part of the night in the space between the beds, whilst the others slept; and when the approaches of death nailed these unfortunate people to their place, did they not energetically curse that help, which in such a situation could only prolong their painful agony.
But it was not only that beds thus placed were a source of discomfort, of disgust; that they prevented rest and sleep; that an insupportable heat occasioned and propagated diseases of the skin and frightful vermin; that the fever patient bedewed his neighbours with his profuse perspirations; and that in the critical moment he might be chilled by contact with those whose hot fit would occur later, &c. Still more serious effects resulted from the presence of many sick in the same bed; the food, the medicines, intended for one person, often found their way to another. In short, Gentlemen, in those beds of multiple population, the dead often lay for hours, and sometimes whole nights, intermingled with the living. The principal charitable establishment in Paris thus offered those dreadful coincidences, that the poets of Rome, that ancient historians have represented under King Mezentius, as the utmost extreme of barbarism.
Such was, Gentlemen, the normal state of the old Hôtel Dieu. One word, one word only, will suffice to tell what was the exceptional state: they placed some patients on the tops or testers of those same beds, where we have found so much suffering, so many authorized maledictions.
Now, Gentlemen, let us, together with our fellow academician, cast a glance on the ward of surgical operations.
This ward was full of patients. The operations were performed in their presence. Bailly says, “We see there the preparations for the torment; there are heard the cries of the tormented. He who has to suffer the next day has before him a picture of his own future sufferings; he who has passed through this terrible trial, must be deeply moved at those cries so similar to his own, and must feel his agonies repeated; and these terrors, these emotions, he experiences in the midst of the progress of inflammation or suppuration, retarding his recovery, and at the hazard of his life.”... “To what purpose,” Bailly justly exclaims, “would you make an unfortunate man suffer, if there is not a probability of saving him, and unless we increase that probability by all possible precautions?”
The heart aches, the mind becomes confused, at the sight of so much misery; and yet this hospital, so little in harmony with its intended purpose, still existed sixty years ago. It is in a capital, the centre of the arts, of knowledge, of polished manners; it is in an age renowned for the development of public wealth, for the progress of luxury, for the ruinous creation of a crowd of establishments devoted to amusements, to worldly and futile pleasures; it is by the side of the palace of an opulent archbishop; it is at the gate of a sumptuous cathedral, that the unfortunate, under the deceitful mask of charity, underwent such dreadful tortures. To whom should we impute the long duration of this vicious and inhuman organization?
To the professors of the art? No, no, Gentlemen! By an inconceivable anomaly the physicians, the surgeons, never obtained more than a secondary, a subordinate influence over the administration of the hospitals. No, no, the sentiments of the medical body for the poor could not be doubted, at an epoch and in a country where Dr. Anthony Petit thus answered the irritated queen, Marie Antoinette: “Madam, if I came not yesterday to Versailles, it was because I was attending the lying-in of a peasant, who was in the greatest danger. Your Majesty errs, however, in supposing that I neglect the Dauphin for the poor; I have hitherto treated the young child with as much attention and care as if he had been the son of one of your grooms.”
Preference was granted to the most suffering, to those in most danger, disregarding rank and fortune; such was, you see, Gentlemen, the sublime rule of the French Medical Corps; and such is still its gospel. I want no other proof of it than those admirable words addressed by our fellow labourer Larrey, to his friend Tanchou, when wounded at the Battle of Montmirail: “Your wound is slight, sir; we have only room and straw in this ambulance for serious wounds. They will take you into that stable.”
The medical corps could not, therefore, with any reason be accused or suspected in regard to the old Hôtel Dieu of Paris.
If economy be invoked, I find an answer quite à-propos in Bailly: the daily allowance for the patients at the Hôtel Dieu was notably higher than in other establishments in the capital more charitably organized.
Would any one go so far as to assert that the sick condemned to seek refuge in the hospitals, having their sensibilities blunted by labour, by misery, by their daily sufferings, would but faintly feel the effects of the horrible arrangements that the old Hôtel Dieu revealed to all clear-sighted people? I will quote from the report of our colleague; “The maladies continue nearly double the time at the Hôtel Dieu, compared with those at the Charité: the mortality there is also nearly double!... All the trepanned die in that hospital; whilst this operation is tolerably successful in Paris, and still more so at Versailles.”
The maladies continue double the time! The mortality there is double! All those who are trepanned die! The lying-in women die in a frightful proportion, &c. These are the sinister words that strike the eye periodically in the statements of the Hôtel Dieu; and yet, let us repeat it, years passed away, and nothing was altered in the organization of the great hospital! Why persist in remaining in a condition that so openly wounds humanity? Must we, together with Cabanis, who also abused the old Hôtel Dieu severely, “must we exclaim, that abuses known by all the world, against which every voice is raised, have secret supporters who know how to defend them, in a manner to tire out well-meaning people? Must we speak of false characters, perverse hearts, that seemed to regard errors and abuses as their patrimony?” Let us dare to acknowledge it, Gentlemen, evil is generally perpetrated in a less wicked manner: it is done without the intervention of any strong passion; by vulgar, yet all-powerful routine, and ignorance. I observe the same thought, though couched in the calm and cleverly circumspect language of Bailly: “The Hôtel Dieu has existed perhaps since the seventh century, and if this hospital is the most imperfect of all, it is because it is the oldest. From the earliest date of this establishment, good has been sought, the desire has been to adhere to it, and constancy has appeared a duty. From this cause, all useful novelties have with difficulty found admission; any reform is difficult; there is a numerous administration to convince; there is an immense mass to move.”
The immensity of the mass, however, did not discourage the old Commissioners of the Academy. Let this conduct serve as an example to learned men, to administrators, who might be called upon to cast an investigating eye on the whole of our beneficent and humane establishments. Undoubtedly, the abuses, if any yet exist, have not individually any thing to be compared to those to which Bailly’s report did justice; but would it be impossible for them to have sprung up afresh in the course of half a century, and that in proportion to their multiplicity, they should still make enormous and deplorable breaches in the patrimony of the poor?
I shall modify very slightly, Gentlemen, the concluding words of our illustrious colleague’s report, and I shall not in the least alter their innate meaning, if I say, in finishing this long analysis: “Each poor man is now laid alone in a bed, and he owes it principally to the gifted, persevering, and courageous efforts of the Academy of Sciences. The poor man ought to know it, and the poor man will not forget it.” Happy, Gentlemen, happy the academy that can adorn itself with such reminiscences!