Overview Originally, the Hôtel-Dieu admitted a wide range of people: not only the sick and injured, but also needy travellers and pilgrims, and indigents. Run by the
Catholic Church for many centuries, the hospital's original mission was to provide "Christian charity dedicated to the shelter, spiritual comfort and treatment of the ailing poor." This broad, charitable mission was to dominate until the end of the
Ancien Régime. By 1789, the
Age of Enlightenment—with its focus on the pursuit of knowledge via reason and evidence and on ideals such as progress, fraternity, and government dedicated to the well-being of the people—had left its mark on the agenda for hospital reform. This ushered in a more scientific approach to hospital design that was to influence medical practice and management for more than a century. In its first several hundred years, the Hôtel-Dieu functioned as a general purpose charitable institution operated by religious orders This mixed social mission characterised its services for many centuries and was imitated by many other cities (for example, the Hôtel-Dieu de Beaune, founded in 1443). However, by the 16th century, admission to the hospital was available only to the sick and injured and to pregnant women. the Presidents of Parliament, the
Chambre des Comptes, the
Cour des Aides and the
Prévôt des Marchands.
17th century Poverty continued to be widespread during the 17th century, and the Hôtel-Dieu offered an opportunity for many of the
bourgeois and
nobility to come to the aid of the poor. Nevertheless, conditions in the hospital remained horrendous and overcrowding continued to be a problem, with daily patient numbers ranging from 2000 to 4000. Numerous episodes of the plague carried away thousands of patients and hospital workers, including 17 Sisters of Saint Augustine, the order of nuns charged with patient care at the Hôtel-Dieu. Later in the century, hospital-derived
scurvy, which was thought to be a communicable disease at the time, killed as many as 97% of the patients suffering from it. In 1670 alone, 250 patients suffered from scurvy. were a major source of pollution in the
Seine. Hospitals took the name of "
Hôpital Général" (General hospital) or "''Hôpital d'enfermement
" (Asylum), of which the Hôtel-Dieu was one. The centralized approach to extreme poverty in France was based on the premise that medical care was a right for those without family or income, and formalized the admission process to attempt to mitigate overcrowding and unsanitary conditions. The Lieutenant Général de Police became a member of the Bureau de l'Hôtel-Dieu de Paris'' (Bureau for the Hôtel-Dieu in Paris) in 1690.
18th century The problem of overcrowding continued into the 18th century. Although almost 50 hospitals and similar institutions were operating in Paris by the second half of the century, demand outpaced the supply of medical services, largely because of very rapid growth of both population and poverty. According to a census of 1791, Paris had a population of 118,884 indigents out of a total population of 650,000.
The Hôtel-Dieu's bad reputation As always, overcrowding was accompanied by poor outcomes — including hospital-derived infections and high mortality rates. The hospital statistics developed later suggest that the Hôtel-Dieu's record was worse than that of other Parisian institutions. As in earlier centuries, there was insufficient effective separation of patients with communicable diseases, though the hospital was divided into wards.
Official enquiry is launched Two serious fires occurred in 1737 and 1772. Public outrage at the loss of life amplified ongoing public debate about what was to be done with the hospital, a debate that naturally evolved into broader discussions of possible reforms to Paris' hospital system.
Louis XV ordered the demolition of the Hôtel-Dieu in 1773 after hearing of its poor patient conditions. However, the execution of the order was delayed due to the King's death. In 1785, the project of the architect
Bernard Poyet (1742-1824) was presented in a memoir entitled "On the need to transfer and rebuild the Hôtel-Dieu." Poyet proposed to build a circular hospital on an island on the Seine. Its exterior was to be a replica of the
Colosseum in Rome and it was to house over 5,000 beds and an efficient system of air circulation (constant renewal of the air). The
Baron de Breteuil (1730-1807), acting for Louis XVI, instructed the Royal Academy of Sciences to evaluate the Poyet project. For this purpose, a hospital commission of 9 members was established. Members included
Jacques Tenon (1724-1816) as well as other renowned scientists such as
Antoine-Laurent de Lavoisier (1743–1794),
Charles-Augustin de Coulomb (1736–1806), and
Pierre-Simon Laplace (1749–1827). The commission published three consecutive reports. The 1786 report concluded that the situation of the Hôtel-Dieu was irremediable and that the hospital should be moved outside of Paris. The 1787 report recommended that the Hôtel-Dieu be dismantled and that four smaller hospitals be established in various locations around Paris. The 1788 proposed that the pavilion-style of hospital be adopted, with each ward occupying a separate building to reduce disease transmission and to facilitate ventilation. The third report drew heavily on information collected by Tenon and Coulomb during their official study mission to England in the summer of 1787, during which they visited 52 hospitals, prisons and workhouses.
Publication of Tenon's Memoir At the request of the hospital commission Tenon published his 500-page
Mémoires sur les hôpitaux de Paris, which documented in detail the scandalous conditions in the Hôtel-Dieu. The Memoires criticized virtually everything about the hospital: the space, the circulation, the arrangement of the beds, the number and the mixture of the sick, the dirtiness, the rot and the bad smells, inhumanity and mortality. He notes that one in 15 mothers died in the Hôtel-Dieu's maternity ward, compared to one in 128 in Manchester.
Jacques Necker created the positions of
Inspecteur général des hôpitaux civils et des maisons de force (General Inspector for civil hospitals and jails) and
Commissaire du roi pour tout ce qui a trait aux hôpitaux (Royal Commissioner for all that relates to hospitals). The use of hospitals as teaching institutions was also reinforced as part of the reform movement, which studied medical practice and policy in other European countries. Generally, though, the progress anticipated by the reform movement initiated under the last of the French kings was hampered by the massive changes that were occurring in broader French society during the
French Revolution. Major reforms to the system of government itself needed to take place before the narrower reforms to the Parisian medical system could receive fuller attention. In 1801, the Parisian hospitals adopted a new administrative framework: the
Conseil général des hôpitaux et hospices civils de Paris (General Council for Parisian hospitals and civil
hospices). The objective of improving hospital management brought about the creation of new services: the ''Bureau d'admission
(Admissions office) and the Pharmacie centrale ''(Central Pharmacy).
Napoleon I finally rebuilt the portions of the Hôtel-Dieu that were destroyed in the fire of 1772. Also during this period, the Hôtel-Dieu advocated the practice of
vaccination, of which
Duc de La Rochefoucauld-Liancourt was a fervent supporter. Similarly, the discoveries of
René-Théophile-Hyacinthe Laennec permitted the refinement of methods of
diagnosis,
auscultation, and
aetiology of illnesses. The Pont au Double was demolished in 1847 and rebuilt without covering. The Hôtel-Dieu was rebuilt between 1867 and 1878 on the opposite side of the
parvise of Notre Dame, as part of
Haussmann's renovation of Paris commissioned by
Napoleon III. The reconstruction followed plans by architects
Émile Jacques Gilbert and
Arthur-Stanislas Diet. It was not until 1908 that the
Augustinian nuns left the Hôtel-Dieu for good. ==Role within the current hospital system of Paris==