Old and New Paris: Its History, Its People, and Its Places, v. 2

CHAPTER XXVIII.
SOME MORE PARIS HOSPITALS

The French Hospital System – The Laënnec Hospital – The Houses of Assistance – The Quinze-Vingts – Deaf and Dumb Institutions – The Abbé de l’Épée – La Charité

THE Hôtel des Invalides suggests the hospitals of Paris in general; and to the briefest possible glance at these – inasmuch as we have already given much space to the famous Hôtel Dieu – the present chapter may be devoted.

“England” says Dr. Le Fort, “opens to the poor wretch without an asylum and without bread the doors of a workhouse; France those of a prison. To be without shelter is a misfortune in England; in France it is a crime. Unable to suppress poverty, our law will tolerate no manifestation of it. ‘Mendicity,’ as many a printed notice proclaims, is forbidden in the department of the Seine.”

Dr. Le Fort maintains that the Paris poor are treated with too little sympathy by the Legislature, and seems to think that if their wants were more readily relieved, many an indigent invalid, whose health has gradually given way beneath hunger and destitution, would not have found his way into hospital.

The Paris hospitals differ from those of London on one important point. In our metropolis all such institutions are supported by private charity, enjoying nothing, or next to nothing, in the way of state subventions. They are open either to the subscribers themselves or to those whom they choose to recommend. The hospitals of Paris, on the other hand, are practically state property, entirely independent of the control of the public. They are beneath the domination of the Prefect of the Seine and the Minister of the Interior; both represented by a director fully invested with their power. Side by side with the director exists a council of superintendence, which investigates and approves, or disapproves, the acts of that director, without being legally able to prevent them; for the whole of the executive is in the hands of the chief official, who is alone responsible. The director, it should be added, is seldom or never a physician, but a member of the administrative body.

The council of superintendence consists, amongst its other members, of the Prefect of the Seine, the Prefect of Police, a Councillor of State, a member of the Court of Appeal, a Professor of the Faculty of Medicine, a member of the Chamber of Commerce, and two members of the Municipal Council, with a doctor and a surgeon attached to the hospital.

The medical service of the hospitals is effected by doctors and surgeons, aided by resident and non-resident assistants, sisters of charity, etc. The doctors and surgeons are appointed by competition, and they can practise, in the case of the former, till sixty-five, in that of the latter, till sixty years of age.

As regards the conditions under which patients are admitted to the hospitals, the first of these is not, as one might suppose, that the applicant be ill, but that he or she have been resident six months in the department of the Seine. This condition, which excluded poor patients coming to Paris from the provinces for special treatment, caused some years ago a good deal of lively criticism. Complaints, too, have frequently been made of the alleged extravagance of the administration and of the architectural embellishment of Paris hospitals, to the detriment of the patients upon whom in a direct manner the funds should, it was held, have been spent. Another defect which has been much commented upon is the inability of the surgeons to assign beds, on their own authority, to sick applicants whom they have pronounced to be in need of clinical treatment. Every morning, it should be explained, gratuitous advice is given at each hospital. Those applicants whose case is serious cannot, without further preliminaries, have beds assigned to them. The physician has first to represent their condition to the administrative director, and it is within the power of this latter functionary to grant or to refuse the admission. In practice, no doubt, the recommendation of the physician is acceded to; but the formality might well become, in some instances, a mischievous one.

During the day urgent cases can be received at the hospitals on the advice of the deputy medical officers. There exists, moreover, on the Parvis of Notre Dame, under the name of “central bureau of admission,” an establishment in which, from ten a.m. to four p.m., advice may be had from able physicians. Every morning the directors of the different hospitals send to this bureau a list of their vacant beds; and the consulting physician assigns them to applicants at his discretion.

Every invalid entering a hospital loses his or her individuality to take a number. Monsieur 6 and Madame 8 are the kind of appellations by which the patients are known. After having given in his or her name, age, address, and occupation at the registration office, the patient is taken up into the ward and undressed, receiving a grey cloak in exchange for the vestments put off. It used to be complained that these cloaks were passed from one patient to another without being in any way purified, whatever diseases they might be infected with. It may be hoped that this is no longer the case.

Soon after the new patient’s arrival he is visited by the house-physician, who prescribes for him a treatment which the physician-in-chief will confirm or rectify on his daily round next morning. At five a.m. the ward-servants come on duty, and then a clatter begins, the brush and the broom being freely plied. “So much the worse,” says Dr. Le Fort, a severe critic of the Paris hospital system, “for the patient who, having passed a sleepless night, is beginning to get a little repose.” In English hospitals, however, the same turmoil reigns at the same hour, and the sufferer from insomnia is as badly off as his Parisian fellow.

From eight to nine a.m. the physician goes his round of visits, accompanied by his assistants. He passes from bed to bed, feels pulses, looks at tongues, prescribes medicines, and so forth. At ten o’clock the breakfast-hour is sounded. Large cans, containing soup and vegetables, are brought into the ward. The ward-servants, or infirmiers present to the sister a succession of tin basins, into which she serves out the precise quantity of food ordered for the patients by the doctor. The quality of the food leaves nothing to be desired. The meat supplied is the best procurable, the fish is fresh, the vegetables irreproachable; but the cooking is the reverse of satisfactory. A mutton cutlet, cooked half an hour before dinner, and put in the oven to keep hot, comes sometimes to the patient’s bedside rather like a cinder; the joints are admirable, but as it is found convenient to carve them up some time before the meal, and keep them likewise in the oven, a cut off the joint occasionally means a slice of leather. Attempts have been made from time to time by the administration to reform this style of cooking, but the reformation has not yet, in practice, been effected.

After breakfast the patient reads or walks about. From one till three o’clock on Sundays and Thursdays he may receive visits from his family. At four o’clock the evening repast is served, and at eight the night commences, all conversation, as in English hospitals, abruptly ceasing. Thenceforth the repose of the vast wards is disturbed by nothing but the snoring of sleepers, and the sighs or groans of those to whose eyelids sleep will not come. The wards would now be in total darkness but for the faint glimmer of a little lamp suspended from the ceiling.

At No. 42 in the Rue de Sèvres stood the hospital or asylum (hospice) for incurable women, founded by the charity of Marguerite Roulié, assisted by Cardinal de la Rochefoucauld, Grand Almoner of France. But the institution has now been transferred to Ivry in a large building, where incurable men are also received. The house in which the original hospital for incurables was established is now occupied by the Laennec Asylum, containing upwards of 300 beds, of which nearly fifty are for surgical cases. Then there are charitable houses for sick and for convalescent children. In the Rue de Sèvres (Nos. 93 to 95) is the monastery of the priests of the mission of St. Lazare, which, since 1816, has occupied the mansion of the Duc de l’Orges.

The chapel dedicated to St. Vincent de Paul, founder of the Lazarists, contains the relics of the saint, which were transferred to their present abode on the 29th of April, 1830. Seventeen bishops, with all the clergy of Paris and of the diocese, took part in the ceremony. The brothers of the Christian schools, also the sisters of Charity and of the Foundlings, assisted; in all upwards of 10,000 persons. This was for the Parisians the great event of the spring of the year 1830, which, however, in the month of July was to witness a manifestation of a very different character: the Revolution that brought Louis Philippe to the throne.

At the right corner of the Avenue of the Invalides stood, up to the time of the Revolution of 1789, a country house belonging to the sculptor Pigalle. The congregation of Notre Dame des Chanoinesses Régulières de Ste. Augustine, founded there towards 1820 a house of education, which has remained celebrated under the name of the Convent of the Birds. Beyond the Boulevard Montparnasse, which branches off at this point towards the Boulevard des Invalides, is the House of the Infant Jesus, founded in 1751 by the zeal of the Abbé Languet, Curé of St. Sulpice, by the liberality of the Marquise de Lassay, and under the patronage of Queen Marie Lesczinska, in favour of thirty poor and noble young ladies; to become in 1802 a hospital for sick children. Here the mortality is at the rate of two out of eleven, which is almost twice the average mortality in the hospitals for adults. “The idea of creating a special hospital for children,” said Professor Bouchardat, “excellent at first sight, is fatal for the unhappy ones who are admitted.” Contagious diseases spread, as a matter of fact, with particular rapidity among children. To counteract this evil the Hospice des Enfants Malades has been provided with a garden, 31,000 square metres in extent, so as to permit as much as possible the isolation of the little patients.

Besides the inmates of the Paris hospitals a great number of out-patients receive treatment within their walls.

An important institution in Paris, to which we have practically no counterpart in England, is one for the nursing of the indigent poor at their homes. It is admirably organised, and has done a great deal of inestimable work; and Dr. Le Fort is as proud of it as he seems ashamed of the Paris hospitals.

On the 25th of May, 1791, the municipality of Paris was charged by the administration with the distribution amongst the different parishes of the funds raised for the poor. On the 5th of August a municipal “Commission of Benevolence” was formed to consider the best method of administering aid to the indigent; and it is to this commission that the creation of the “offices of benevolence” is due. At the present time these offices relieve some twenty Paris mayoralties, besides freeing the hands of the hospital administration. Each office consists of the mayor of the arrondissement, as president; two assistants, twelve administrators, an unlimited number of commissionaires and sisters of charity, and a secretarial treasurer. Attached to each office are physicians and surgeons, midwives, etc. The scheme comprises, in each arrondissement, two or three “houses of assistance” where the poor come to seek aid for their sick friends, and where patients inscribed on the list of the indigent may have gratuitous consultations, medicine, and so forth. Fifty-three such houses are distributed over the capital.

Any poor or necessitous person wishing to be nursed at home through this organisation applies in person or by deputy to the office in his particular arrondissement, and if his case proves to be one requiring medical aid, the doctor attached to his section is instructed to visit him.

Dr. Le Fort draws a very strong contrast indeed between the Paris hospitals and the “houses of assistance.” The former institutions he declares to be, as a whole, the “most defective and murderous in Europe”; the latter, a “title to glory” for the city of Paris. He attributes the difference to the fact that the medical element is eliminated from the direct administration of the hospitals, but allowed its proper sway in the “benevolence” system. Certainly, one advantage of this system is that it strengthens those family ties which a long residence in hospital relaxes and too often breaks.

In connection with the hospitals and relief institutions of Paris must be mentioned the National Institution for Blind Children, founded just after the Revolution by Louis XVI., before the Republican form of government had been definitely adopted. Its initiator was Valentine Hauy, the mineralogist, to whom a statue has been erected in the principal courtyard. The Institution for Blind Children is one of the ten general establishments of benevolence conducted under the immediate authority of the Minister of the Interior by a responsible director, assisted by a consultative commission. The instruction given is (according to a writer on the subject who evidently does not set too high a value on music) “technological, musical, and intellectual.” Employment is found for the children on the completion of their studies.

The house of the strangely named Quinze Vingts is designed for the reception of 300 blind persons of both sexes, each with his own private apartments for himself, or himself and family, together with many other advantages as well in money as in kind. Attached, moreover, to this institution are 1,300 outside pensioners in all parts of the country, receiving assistance in money according to the class to which they have been assigned: 200 francs, 150 francs, and 100 francs.

The origin of the Quinze-Vingts, or Fifteen-Twenties, is lost in obscurity. Hence all sorts of contradictory stories and conjectures without foundation, substituted for positive documents. According to some authors St. Louis, on his return from Palestine, founded the establishment of the Fifteen-Twenties for 300 knights – the sad remains of his army.

But the writers of the time make no mention of this alleged fact, and the ordinances of St. Louis contain no sort of reference to it. The legend of the 300 knights must therefore be regarded as a fable. It is certain meanwhile that the blind asylum dates from an epoch anterior to the reign of St. Louis, though it is quite true that this pious monarch, by his patronage and his liberality, became the real founder of the house.

The Fifteen-Twenties forming a mendicant corporation, subsisting by alms, and belonging body and soul to their own Order, were first established in the Rue St. Honoré, not far from the Tuileries. They remained there under the constant patronage of numerous and powerful protectors until 1779, in which year Louis XVI. transferred the asylum to the ancient residence of the Black Musketeers in the Rue de Charenton. Its revenues already amounted to more than 370,000 livres (i. e. francs). The constitution of the hospital was then modified, collections in the churches were forbidden, and mendicancy in the streets likewise. At the same time regular pensions were introduced.

Towards the gate of a modest edifice situated in the Rue St. Jacques, near the Luxemburg Garden, may daily be seen visitors attracted to this point from all quarters of France and even of the globe. The building they wish to enter was, until 1794, the seat of the minor seminary of St. Magloire, belonging to the Archbishop of Paris. In this year he ceded the house to the deaf and dumb institution, which, founded in 1760 by the Abbé de l’Épée in his own domicile, Rue des Moulins, was, just after the Revolution, raised to the dignity of a national establishment and transferred to the ancient monastery of the Célestins near the Arsenal. The national institution of the Rue St. Jacques, which still exists and which is under the direction of the Minister of the Interior, contains some 210 pupils of from seven to fourteen years. The school comprised, until lately, two divisions entirely separate and distinct, one for boys, the other for girls, when suddenly the girls of the Paris institution were sent to the institution of Bordeaux, and the boys of the Bordeaux school to that of Paris, so that at present, wherever they may have been born, the deaf and dumb boys are all at Paris, while the deaf and dumb girls are all at Bordeaux. Professor Ferdinand Berthier, of the Paris deaf and dumb school, himself deaf and dumb, maintained, in an article published some five-and-twenty years ago, that this pretended reform was no amelioration whatever; the deaf and dumb children studying perfectly well when the boys and girls were educated together under the same professors. At that time the Paris institution was administered by a director with the use of speech, assisted by an examiner of studies, similarly gifted, and a body of professors, some of whom spoke, while others were deaf and dumb.

One of the best private deaf and dumb institutions in France is at Lyons. It contains a good number of pupils of both sexes, and its director is, or was until recently, M. Claudius Forestier, a very distinguished deaf-mute; his wife, a highly educated person – the speech-endowed daughter of the deaf-mute founder of the school – acting as directress.

The number of deaf-mutes in France has been approximately estimated at 25,000; and here, as in nearly all countries where statistics are published, it is found that the male sufferers are decidedly more numerous than the female.

To each establishment, public or private, workrooms are attached, conducted by competent instructors, and in which all the pupils, poor or rich, serve an apprenticeship to some profession, art, or trade which will one day enable them to earn a subsistence. No longer, therefore, is the community encumbered by deaf and dumb idlers; the men and women thus afflicted leading active lives as shoemakers, dressmakers, tailors, sempstresses, locksmiths, compositors and even painters and sculptors.

It has been complained that the deaf and dumb institutions of France – about fifty in number – are insufficient for the instruction of 25,000 deaf-mutes, many of whom must consequently be deprived of instruction in those employments for which they are generally as apt as their neighbours who can speak and hear.

The question of the hereditary nature of muteness has been a good deal discussed by French experts. “Dumbness,” says Ferdinand Berthier, “far from being a necessary result of deafness, simply follows the latter by reason of a natural sequence. Whether deaf-muteness dates from birth or from some accident, it has been proved in the present day that the vocal apparatus of the deaf-mute and that of a speaking person are with rare exceptions equally well organised. A prejudice still too widely spread in the world, and worthy of every effort towards its destruction, is that deaf-muteness is infallibly transmitted from father or mother to child; when on all sides we see deaf-mutes, married between themselves or to speaking spouses, constantly producing children who both hear and speak, and in no way share the parental infirmity. Those arts which have enabled the sublimest efforts of genius to dazzle the world do not, in our opinion, merit greater attention from scholars and philosophers than the method which shall open to the deaf-mutes a road leading to intellectual labour and to the full enjoyment of civil and political rights.”

Looking back to antiquity, this excellent writer points out that the ancients regarded the education of deaf-mutes as an impossibility both physical and moral.

It was the custom at Sparta to allow children suffering from this double infirmity to die of hunger and thirst in the desert, where they were for that purpose exposed; and the laws of Solon were on this point no less severe. Aristotle, if he did not precisely justify the rigour of such laws, at least endorsed the moral prescription. In the fourth book of his History of Animals he unhesitatingly relegates deaf-mutes to the rank of idiots, declaring them hopelessly beyond all tuition. The Republic of Rome did not show itself more humane. It was in vain that intelligence beamed in the face of these unhappy victims: if their tongue could produce no sound they were condemned to be flung into the Tiber.

One of the earliest agents in the removal of this weight of infamy from the fraternity of deaf-mutes was, curiously enough, the stage. Lucian eulogises the pantomime of the dumb-show actors of his epoch, and the admirable influence they exercised in raising the deaf and speechless above general contempt. The Egyptians and Persians, more civilised and enlightened in this respect than Sparta, Athens, or Rome, showed for their deaf-mutes a solicitude which approached devotion.

In centuries less remote many efforts have from time to time been made by philosophers and philanthropists to invent an effectual method of instructing deaf-mutes. The sign method of the Abbé de l’Épée was one of the first great steps in this direction. The abbé held that the old-fashioned dactylology was insufficient, and that signs were essential to those who could neither hear nor speak. Starting from the incontestable principle that the bond existing between ideas and sounds which strike the ear is not more intimate, more natural, than the bond between ideas and traced characters which strike the eye, he found it by no means difficult to demonstrate the possibility of fully replacing speech, in the case of a deaf-mute, by mimicry.

As regards this mimicry, M. Berthier cautions people against the common mistake of confounding it with dactylology, or the language of the fingers. Dactylology is confined to the servile reproduction of the letters of the alphabet of any particular language, one by one, syllable by syllable, word by word, or in no matter what other conventional manner. Mimicry, a faithful picture of human thought, paints ideas and sentiments in a living language – the innate language of all nations – the language of humanity. By means of it thoughts are exchanged more quickly than by speech or writing – not to mention dactylology, which lags so far behind.

In the midst of his brilliant triumphs the Abbé de l’Épée had frequently to engage in conflict with two classes of powerful adversaries: the philosophers and the theologians; the former regarding words as the only vehicle for imparting metaphysical ideas, the latter regarding them as the sole means of inculcating supernatural religious truths.

Louis XVI. had granted the abbé out of his own privy purse an annual pension of 6,000 francs, in addition to his official appointment at the Célestins. Hitherto the school had, for twelve years, been maintained entirely at the cost of the founder, aided by such occasional alms as he received for the purpose. It was at the Célestins in 1789 that he expired, amid the weeping of his pupils and with the delightful thought that his work would not perish with him.

Amongst the disciples of the Abbé de l’Épée must be mentioned the Abbé Sicard, canon of Bordeaux, whom the archbishop of that town sent to Paris, where he had founded a deaf-mute institution, in order that he might study under de l’Épée that method of which there was so much talk. The high talents of this young priest soon enabled him to divine, comprehend, and complete the thought of his master in exciting the warm sympathies of the public towards those unfortunate persons whose tongue was tied and whose ear was stopped.

On the death of de l’Épée, Sicard competed for and was unanimously awarded the management of the abbé’s institution. Having already written not a little on the subject of deaf-muteness, he now published other works, “A Deaf-mute’s Course of Instruction,” among others, which only served to increase his renown; though in this treatise there was indeed one highly objectionable assertion concerning the condition of a deaf-mute which the author found it necessary to retract in his “Theory of Signs.”

During the Revolution of 1793 the Abbé Sicard did not escape persecution. Flung into prison after the eventful 10th of August, he was lucky enough to keep his head on his shoulders during the massacres of September. He had scarcely been set at liberty when, as editor of the Catholic Annals, he was condemned to transportation to Cayenne; and he passed the next two years of his life in flight far from his beloved institution, of which he did not resume the direction till after the Revolution of the 18th “Brumaire.” He died in 1822.

Among the professors whom he formed must be mentioned a speech-endowed one named Bébian, who in his turn trained several deaf-mute professors. His works are still consulted with advantage both in France and abroad by those who wish to devote themselves to this arduous method of instruction. The object he kept before him in writing was, as he himself expressed it at the commencement of one of his books, “to simplify the method and render it so easy that the mother of a family can teach her deaf-mute child to read just as she teaches the others to speak.”

Oblivion had already seemed too long to have overspread the remains of the Abbé de l’Épée when, in 1837, on the initiative of M. Berthier, a numerous and distinguished committee was formed for the purpose of raising to the clerical philanthropist a monument worthy of him in that chapel of the church of St. Roch which belonged to his family, and in which he was accustomed to celebrate mass, assisted by deaf-mutes. It was here indeed that his ashes lay. An admirable sculptor, M. August Préault, was unanimously chosen to interpret the homage which so many famous deaf-mutes and others wished to pay to the abbé’s memory, and he worthily carried out the intentions both of committee and subscribers. Eight years afterwards, in 1845, a crown of laurels in bronze was placed beside the monument with this simple inscription: “To the Abbé de l’Épée, from the Swedish deaf-mutes.” This crown, beautifully executed, was likewise the work of Préault. The year previously the same sculptor had testified his own admiration of the abbé by contributing to the Hôtel de Ville a fine statue of him. The town of Versailles, which was proud of being the birthplace of the great founder of the deaf-mute institution, could not do less than follow the example set by Paris in voting to his memory a statue, which was confided to the chisel of M. Michant. The same artist was subsequently commissioned by the Count de Montalivet, then intendant-general of the civil list, to execute a bust of the abbé for the historic gallery of Versailles.

The Paris hospitals are not, like ours, supported by voluntary contributions. Many of them have from the beginning been richly endowed. Others depend on grants from the State or from the Municipality; while a few are maintained from mixed sources. None of them, however, depend, as in England, on subscriptions and donations received periodically from charitable persons. Consequently, applicants for relief or advice need neither letters of recommendation nor introductions of any kind. Medical succour is given at certain hours to all who choose to ask for it. Patients seeking admission and regular attendance have sometimes to wait for their turn. But there are, in proportion to the population, quite as many beds at the service of the sick in Paris as in London.

Of the most ancient and most famous of all the French hospitals – the Hôtel Dieu – mention has already been made. Scarcely less celebrated, in view of the important services they have rendered and of the many physicians and surgeons of eminence who have lectured, operated, and prescribed within their walls, are the two hospitals named after those divine qualities Charity and Pity.

The Hospital of La Charité is the principal one on the left bank of the Seine; nor is its position likely to be forgotten by those who have heard of the famous professor of surgery – Lisfranc – and his attacks upon the illustrious Dupuytren, head of the Hôtel Dieu, whom Lisfranc, in his highly polemical lectures, used habitually to describe as “ce brigand de l’autre côté de l’eau.” Lisfranc had doubtless differed with his eminent rival on some slight theoretical point, for which reason he accused him, with a vehemence which Molière’s own doctors might have envied, of mental perturbations and moral offences in no way attributable to him.

No less than three benevolent institutions have been founded in Paris under the name of Charity – the Hôpital de la Charité Chrétienne, endowed and opened by Marguerite de Provence, widow of Louis IX., but destined in the course of ages to disappear; the Maison de la Charité, founded by the town of Paris at the beginning of the sixteenth century, with the aid of Francis I., against epidemics, afterwards to become known as the Maison de la Santé; and finally, the Hôpital de la Charité, already referred to, which remains one of the first medical and surgical institutions in Paris.

The origin of La Charité and its history up to the time of the Revolution are sufficiently curious. A hospital was founded at Grenada in 1540 by St. John of God, who became the chief of a religious order which occupied itself specially with the care of the sick. This congregation of hospitallers spread rapidly throughout Europe, and a certain number of its members being, in 1602, at Paris, Marguerite de Valois, the divorced wife of Henry the Fourth, who in her old age, when her passions had somewhat subsided, became religious, enabled them to establish a hospital, to which the name of La Charité was given. The brothers of the Order of St. John of God had already a place of their own, which they gave up in order to take possession of the larger premises placed at their disposal by Queen Marguerite. A capacious house, surrounded by vast gardens, was the first home of La Charité. Here patients were received and treated by the brethren, who, besides religion, had studied medicine, surgery, and pharmacy. Their vows did not allow them to admit women, and their utility seems to have been further limited by insufficient knowledge of the art of healing; and this notwithstanding the fact that several of the brethren made themselves a great name as surgeons and physicians. In the early part of the eighteenth century they joined to their staff medical men from the ranks of the laity; compelled to this step by an edict from the Parliament of Paris which ordered them to admit, without salary, a surgeon-apprentice to help them in dressing wounds, and a master-surgeon to share their labours generally. Throughout the eighteenth century they found themselves constantly exposed to attacks from the members of the various medical and surgical guilds, who claimed the sole right of attending the sick and wounded.