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A tour of old Parisian hospitals
By Trahern and Lindsay Jones
When it comes to cities, time is a disease. With each century comes the paving over of old streets and tenements that once were the haunts of artists, scientists and political figures, as well as millions whose names have evaded the notice of history. In most cases, all we have left are the words of writers who lived in a time before ours. But Paris is different; unlike most cities, it is resistant to the pathologies of time. The streets, the buildings, and the narrow alleys of Paris' arrondissements still ache with history.
This sort of thing is perfect for our tastes. Some travelers collect postcards, and others, souvenir spoons. For us, a student hospitalist and a budding scientist, medical history is the grail—specifically, the experience of standing in a rare spot, recollecting the medical memory of centuries.
All photos courtesy of Trahern and Lindsay Jones.
Our first stop was the Musée de l’Assistance Publique-Hôpitaux de Paris, which is devoted to the history of the city's hospitals. To find it, we followed the Quai de la Tournelle, a road that traverses the left bank of the Seine and is within view of Notre Dame. The museum's exhibits trace the development of medical Paris, from the medieval charities run by nuns and priests to the medical heyday of the nineteenth century. Highlights include the artwork of ancient hospital chapels, Jean-Martin Charcot's hypnotizer—an archaic, polished instrument swung like a pendulum to lull the subject into a trance—and Joseph Babinski's microtome.
Seeking more visceral historic fare, we soon turned our attention to the Musée Dupuytren, a historical pathology museum which occupies a small space at the old medical school on the Rue de l’Ècole de Médicine. Rummaging among the syphilitic skeletons and preserved organs, one soon encounters the brains that Pierre Paul Broca himself removed at autopsy, replete with resolved strokes in his eponymous region.
The front gate of Hôpital Necker.
Our deepest interest lay in the hospitals themselves, however, and one cannot trace the history of hospitals in France without beginning at the Hôtel-Dieu. To get there, we simply crossed one of the many bridges connecting the mainland to the Île de la Cité and, turning our attention away from the American tourists snapping photos of Notre Dame, found the old hospital just opposite the cathedral.
The current building maintains a low profile compared to Notre Dame, but the Hôtel-Dieu is far older than the cathedral. Dating back as far as the seventh century AD, it functioned largely as a religious charity to provide alms, shelter and rudimentary medical care to the medieval poor of Paris. A brief search of the literature provides some understanding of the hospital's prevailing conditions. Illustrations from the 1500s depict scenes of wards where priests bustled about administering last rites, nuns fed and bathed the ill in their beds, and others sewed dead bodies into linen, all within view of each other. The wards were little more than crowded halls where disease and death ranged over the bodies of the poor.
Plaque of René Laënnec in Hôpital Necker.
Some idea of the sheer overpopulation of these wards is provided by Jacques Tenon's Memoirs on Paris Hospitals, written in 1788. In his era, four to six adult patients shared each bed, and upwards of eight sickly children were piled upon one mattress. In times of severe crowding, patients were placed in the attic. Drinking water shortages were common, and the water itself was normally obtained from the Seine river, where the hospital's soiled linens were also rinsed—not to mention where all of the foul effluvia of eighteenth-century Paris was dumped. Smallpox patients frequently shared beds with those suffering other maladies. Tenon matter-of-factly noted the urine, blood and human refuse that dribbled down from the upper floors, particularly from the maternity ward. Perhaps most horrifically, surgery was performed in public view, with no effort made to shield patients from the screams of the pre-anesthesia surgical cases.
Seeking admission to the Hôtel-Dieu was a last resort of the poor; this was a place where one came to die. The staff was not immune, either. According to Tenon, it was impossible to spend much time in these halls without catching scabies, among other ailments, and surgeons and staff frequently spread such contagions among their patients, as well as themselves. History is still silent on how many died of such preventable iatrogenic causes in these halls. It was not until the nineteenth century and the rise of hospital hygiene that the nature of such wards changed. It is likely that the Hôtel-Dieu's repeated fires helped with this improvement. The deadly and routine threat posed by oil lamps and candles led to rebuilding that provided courtyards and ventilation in an environment seething with smallpox and tuberculosis.
The modern visitor to the Hôtel-Dieu is offered little chance to actually see the historic aspects of the hospital, however. Although a brief circuit around the building gave us a hint of the old courtyards that were a revolution in French hospital architecture, these are now used more often for the motor pool than for ventilation.
The front entrance of the Hôtel-Dieu.
To find an example of old hospital architecture in Paris, we turned to the Necker Hospital, joined with Enfants Malades, which is considered the first pediatric hospital in the world. Necker was originally founded in 1778 by Madame Necker, wife to a minister of Louis XVI, and one can still pass through historic entrances and courtyards that date to the middle of the nineteenth century. Thousands of physicians trod these passageways in centuries past. Among the most famous was René Laënnec, who invented and perfected the stethoscope while serving as an attending physician on these grounds in the early 1800s. Laënnec supposedly first employed a rolled-up notebook to listen to the heart of a patient whose gender and age precluded placing his ear directly on her chest. Laënnec's notes also confirm that many of the indigent poor who occupied his hospital beds were unwashed, lice-ridden and, in his words, “disgusting.” His stethoscope seems to have served to preserve the physician's health and sensibilities as much as the patient's.
Although the remaining open-air courtyards and gardens might bear a resemblance to the Necker Hospital of those days, much of the clinical environment has undergone a radical change. In Laënnec's age, the mortality rate in Parisian hospitals averaged about 20%. Laënnec believed that upwards of a third of Parisians suffered consumption, or pulmonary tuberculosis. Since then, hospital conditions have grown tamer but Necker's courtyards and facades are falling into disrepair. Modern, ongoing renovations at the Enfants Malades do not seem to include a fresh coat of paint for the more historic passageways of Necker.
Five minutes down Rue de Sèvres, the Hospital Laënnec, originally founded as the Hospice of the Incurables in 1634 and renamed in 1871 for the famous auscultator, is undergoing a total refurbishment. Many of its ancient courtyards and wards are slated for demolition. It would seem that while Paris is resistant to the ravages of time, it is hardly immune.
Farther to the east, just south of the Jardin des Plantes, we found the Pitié-Salpêtrière Hospital, first built on the grounds of a gunpowder factory in the seventeenth century. This was Paris's massive dumping ground for prostitutes, the mentally disabled, and the insane, held in incarceration upon its sprawling grounds. Jacques Tenon's mostly enlightened 1788 account of Parisian hospitals itemized hundreds of “raving madwomen,” “imbecile women,” and female epileptics within the Pitié-Salpêtrière's walls.
It is hard, from a modern standpoint, to understand the atmosphere of medicalized oppression that blended clinical diagnoses with criminal classifications. The Parisian public apparently also found this disagreeable—as revolutionary violence swept the city in 1792, mobs stormed the gates of the institution to release its imprisoned patients and prisoners. In later years, the Pitié-Salpêtrière's ongoing “relationship” with the mad and the marginalized led to its becoming an epicenter of clinical neurology, involving a group of medical men (Charcot, Georges Gilles de Tourette, Babinski, etc.) whose names still resound in today's medical literature.
Perhaps this serves to underline a final point about the old hospitals of a city like Paris. Ancient hospital courtyards and wards may eventually be wiped away in a spirit of urban renewal. When buildings that once housed so much suffering, forbearance and humanity disappear, all we will have left is the written word. Most of these words are written by and about the great physicians, leaving the patients upon whom they built their careers all but forgotten. By visiting these old hospitals and imagining the lives of the sick and infirm spilling out the front gates, we still have a chance to connect with those whom medical history often ignores. Such is our only remedy against the disease of time.
Trahern Jones is a third-year medical student at Mayo Medical School in Rochester, Minn. Lindsay Jones is an undergraduate at Rochester Community and Technical College in Rochester, Minn. studying laboratory sciences.
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ACP Hospitalist Weekly
From the May 22, 2013 edition
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Cartoon Caption Contest
This issue's winning cartoon caption was submitted by Jennifer L. Norris, MD, ACP Member. Thanks to all who voted!
"I had something else in mind when I asked for an outline of the patient's condition."
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