The French hospital system during the 18th century was not well standardized and overall lacked good patient care. Hospital conditions were unsatisfactory, especially due to overcrowding, as exemplified by the
Hôtel-Dieu de Paris. After visiting this hospital, French
Encyclopedist Denis Diderot described it this way: :The biggest, roomiest, richest and most terrifying of all hospitals...Imagine every kind of patient, sometimes packed three, four, five, or six into a bed, the living alongside the dead and dying, the air polluted by this mass of sick bodies, passing the pestilential germs of their affections from one to the other, and the spectacle of suffering and agony on every hand. These kinds of harsh conditions prompted discussion of hospital reform among government officials. They called for improvements to the hospital environment and for strategic siting of hospitals to make it easier for families to visit hospital-bound relatives. As finance minister, Jacques Necker was particularly influential in steering the agreed reforms. One of the first of the proposed “neighborhood hospitals” was the Hospice de Charité, a small-scale hospital located in a vacated monastery. Responsibility for its development was placed on Madame Necker, and she turned it into a facility with a 120-patient capacity. She enlisted the services of around a dozen
Sisters of Charity, the women who traditionally managed the day-to-day tasks and tended to patients in French hospitals. The new hospital began accepting patients in 1778, serving the areas of St. Sulpice and du Gros Caillou in Paris and especially welcoming the poor. Madame Necker aimed to improve patient care while maintaining the institution’s financial efficiency, as detailed in the preface of the hospital’s first annual report from 1780. She summarized her goals for the Hospice de Charité project thus: :To show the possibility of nursing sick people, each one in a bed to himself, with all the care dictated by the kindliest humanity, without exceeding a fixed price. The dedication of Madame Necker and the staff to upholding a standard of good care with limited means was recognized by visitors to the hospital. John Howard, a British hospital reformer who visited in 1786, stated that the hospital was a “noble example of private charity”. The detailed reports released by the hospital each year further convey Madame Necker's commitment to the project. Not only were illness and patient statistics reported, but also less obvious expenses such as the cost and quantities of food and wine consumed within the hospital. Madame Necker emphasized
hygiene, assigning particular importance to good ventilation. The Hospice de Charité’s early mortality rates were somewhat better than at other hospitals, though still high. In 1780, the mortality rate was recorded at 17%, and the next year increased to 21%; by comparison, the overcrowded Hôtel-Dieu had a mortality rate of nearly 25%. Madame Necker's hospital model was employed in the development of other such hospitals, including a tiny 6-bed Montpellier hospital for Protestants that was named after her. In 1788, Madame Necker relinquished her authority over the Hospice de Charité. In 1792, the hospital was renamed Hospice de l’Ouest or Western Hospice. Today, it is known as the
Necker-Enfants Malades Hospital. ==Health problems==