|Hôtel-Dieu de Paris|
Main entrance of the Hôtel-Dieu, in 2007
|Lists||Hospitals in France|
The Hôtel-Dieu de Paris (French pronunciation: [ot?l djø d? pa?i]) founded by Saint Landry in 651 AD is the oldest hospital in the city of Paris, France, and is the most central of the Assistance publique - hôpitaux de Paris (AP-HP) hospitals. The hospital is associated with the Faculté de Médecine Paris-Descartes. It still resides on the bank of the Île de la Cité, next to Notre-Dame, connected to the "Rive Gauche" by the pont au Double. Although the facility had been ravaged by disastrous fires on several occasions (the current architecture dates back to 1877), the two buildings of the facility were originally built in the 7th and 17th centuries. It was built as a symbol of charity and hospitality. It was the only hospital in Paris until the Renaissance.
The history of Parisian hospitals dates from the Middle Ages. Poverty was widespread during that period, and the Hôtel-Dieu became an opportunity for many of the bourgeois and nobility to come to its aid. Their efforts allowed the construction of the Hôpital de la Charité, which linked piety and medical care. Like many hospitals of that era, it started as a general institution catering for the poor and sick, offering food and shelter in addition to medical care. The creation of the Hôtel-Dieu continued this tradition of charity up until the 19th century, despite being called into question during the centuries which followed.
In the 16th century the Hôtel-Dieu faced a financial crisis, as it was only financed by help, subsidies or privileges. This brought about the creation in 1505 of a council of laymen governors: the Presidents of Parliament, the Chambre des Comptes, the Cour des Aides and the Prévôt des Marchands. The state progressively intervened, firstly by the intermediary of the Lieutenant Général de Police, member of the Bureau de l'Hôtel-Dieu de Paris (Bureau for the Hôtel-Dieu in Paris) in 1690, then by the intermediary of Jacques Necker, who created the roles 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).
During this period, the image of the poor changed. The 17th century elite created establishments to house the poor. Hospitals thus 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 in hospitals to prevent overcrowding and unsanitary conditions.
In parallel to her husband's work on the management of hospitals, Madame Necker progressively modified the symbolism of hospitals: from charity to benevolence. In addition, the ideas advocated by the Siècle des Lumières allowed reflection on hospitals. However it was not until the end of the 18th century that hospitals became a "curing machine", where the patient is treated and leaves cured. Previous Paris hospitals were characterized with poor sanitation and treatment followed by high mortality rate. The Hôtel-Dieu had a mortality rate close to 25%. Testimonies revealed that at least 3 patients shared one hospital bed, attempts at isolating contagious diseases were seldom, and women would even have to share beds while giving birth. The 1,200 beds in the hospital were completely inadequate for housing its over 3,500 patients. Conditions enhanced in 1787, when the Hôtel-Dieu implemented a code of medical services that shifted the hospital from a curing machine run by nuns to a medical and surgical establishment run by doctors. By the 19th century hospitals became places of teaching and medical research in addition to practicing medicine. The Hôtel-Dieu, however, had received a high status as a surgical training institution by the late 18th century with the appointment of Pierre J. Desault as chef de service in 1785. Desault established an elaborate educational program for surgical interns when previously they had only informal training.
In 1772 a fire destroyed a large part of the Hôtel-Dieu which was not rebuilt until the reign of Napoléon. This fire sparked discussions over the conditions and possible reforms that would be made to the Hospital system. Other designs were built and numerous modifications made.
King Louis XV ordered the demolition of Hôtel Dieu in 1773 after hearing of its poor patient conditions. The execution of the order was delayed due to the King's death and the ascension of Louis XVI, who was persuaded of an alternate plan to reconstruct the damaged parts of the hospital. This scheme was submitted to the Academy of Sciences for review, and debate regarding Hôtel Dieu extended until 1785 as it transformed into discussions about the reformation of Paris's hospital system. Before the revolution, Many problems had been identified and solutions had been proposed regarding France's medical services. Jacques Tenon's Mémoires sur les hôpitaux de Paris (Memoirs on the hospitals of Paris, 1788), discusses the horrendous sanitary conditions, overcrowding facilities and high mortality rates of the Paris hospitals. He mentions that Hôtel-Dieu had a mortality rate of almost 25 percent, making it "the most unhealthy and uncomfortable of all hospitals." Even though it was the largest of Paris' hospitals with 1,200 beds, many beds held three or more patients- women gave birth in shared beds and there was no separation amongst patients with contagious diseases.
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). This willingness to improve management brought about the creation of new services: the Bureau d'admission (Admissions office) and the Pharmacie centrale (Central Pharmacy).
Also during this period, the Hôtel-Dieu advocated the practice of vaccination. The Duc de La Rochefoucauld-Liancourt was a fervent supporter of this. Similarly, the discoveries of René-Théophile-Hyacinthe Laennec permitted the refinement of methods of diagnosis, auscultation, and aetiology of illnesses.
Faced with this development of medicine, the Hôtel-Dieu was unable to compete. It was for this reason that new Parisian hospitals appeared, each specialising in one or several clinical specialties. The Hôpital Saint-Louis became a large centre for the study and treatment of dermatology and the Hôpital Pitié-Salpêtrière became a centre for the study and treatment of the central nervous system and geriatrics. Progressively, each hospital developed its own centre of paediatrics.
It was not until 1908 that the Augustinian nuns left the Hôtel-Dieu for good.
For the last 50 years it has been home to the diabetes and endocrine illnesses clinical department. It deals almost exclusively with the screening, treatment and prevention of the complications associated with diabetes mellitus. It is also a referral service for hypoglycemia. Oriented towards informing the patient (therapeutic education) and technological innovation, it offers a large choice of care facilities for all levels of complications. It is also at the forefront of research in diabetes in areas such as new insulins and new drugs, effects of nutrition, external and implanted pumps, glucose sensors and artificial pancreas.
Notable physicians, researchers, and surgeons who practised at the hospital include Forlenze, Bichat, Dupuytren, Hartmann, Desault, Récamier, Cholmen, Dieulafoy, Trousseau, Ambroise Paré, Marc Tiffeneau.
However, the Committee also realized that there were other good poor persons without family support for whom the hospital remained a necessary destination during illness. For such individuals, hospital care was to be a right"; "By restricting assistance to the truly needy, deinstitutionalization would also save money and curtail waste in the hospitals themselves. Equally important, this plan would prevent overcrowding and thus improve institutional hygiene.