FURTHER DETAILS CONCERNING THE PARIS FACULTÉ DE MÉDECINE AND CONCERNING SOME OF THE LARGER HOSPITALS OF PARIS

The present chapter is intended to supply, in as condensed a form as possible, some of the facts relating to the growth of the Paris School of Medicine, and also information concerning one or two of the larger hospitals of Paris. As such details are not likely to possess interest for more than a comparatively small number of my readers I unhesitatingly advise all others to skip this chapter.

“The Medical Schools^[26] of the Rue de la BÛcherie,” says Chereau, “are still in existence to-day (1866), although somewhat altered in appearance. They stand at the angle formed by the Rue de la BÛcherie and the Rue de l’HÔtel Colbert. These buildings, however, masquerade under singular forms. Since the day when our fathers in medicine abandoned the Temple of Aesculapius (1775) it has been put to a great variety of uses, such as a public lavoir, a tap room, a cabaret where thieves meet, rooms equipped each with a number of beds, and a lupanar, where the fee charged was twenty sous a sitting; the room in which Riolan taught anatomy converted into a low-down billiard saloon; the ground over which Femel walked, soaked with all sorts of nasty fluids; the office in which sat the employÉs of the school—those vigilant guardians of the rights and dignity of the Faculty—plastered with police ordinances; the chapel, in which the doctors were wont piously to attend mass, now occupied as a miserable lodging-house; etc.”

In 1808 the FacultÉ de MÉdecine was given the splendid quarters of the CollÈge de l’AcadÉmie de Chirurgie, where it is still to-day located. Clinical instruction was carried on at HÔtel-Dieu, La CharitÉ and certain other hospitals. The school itself is no longer called “l’École de MÉdecine,” but “la FacultÉ de MÉdecine,” and the old building, suitably modified, has been preserved—not as a part of the present school, but as a sort of clubroom or social hall for the use of all the university students. (See accompanying illustrations facing page 260.)

Écoles de SantÉ.—When the statement was made before the Convention that the Army of the Republic had lost about 600 medical officers, and that the troops in the eastern Pyrenees were almost entirely without physicians and surgeons, a law was passed (December 4, 1794) authorizing the organization at Paris, Montpellier and Strassburg, of three medical institutes or secondary medical schools (designated as “Écoles de SantÉ”). They were originally intended to be simply temporary organizations where “officiers de santÉ” might be trained for service in the hospitals,—more particularly the military and naval hospitals. Each of the DÉpartements of France was entitled to send one pupil to be educated at one of these military medical schools, at the expense of the nation, for a period of three years. In accordance with this scheme Paris received 300 pupils, Montpellier 150, and Strassburg 100. Owing to the lack of places or schools where young men might, at their own expense, be trained as physicians, it soon became necessary to permit men of this class to attend these schools. And so in 1796 the Medical School at Paris was reorganized and provision made for the following twelve professorships:—

In 1798 a chair for pathological anatomy was added, and there were also organized several special clinics—one, for example, for sexual diseases; and among the names of the professors who taught at this period are to be found those of Sabatier, Chopart, Pinel, Corvisart, Baudelocque, Lassus, and P. A. O. Mahon. The last-named lectured on the history of medicine. No fees were charged for tuition. Under this new rÉgime the Paris Medical School rapidly rose in favor, until in 1799 the attendance had reached the extraordinary total of 1500. In addition to the regular students who expected to receive a medical diploma if they passed a satisfactory examination at the end of the course, there was a large attendance of quacks, at all three of these schools (Paris, Montpellier and Strassburg). Neither a diploma nor any special permit, however, was required of those who wished to engage in the practice of medicine. This state of affairs soon led to frightful abuses, and the Convention accordingly passed a new law (March 10, 1803), which stated that, for the future, only those who had passed a satisfactory examination in the fundamental branches (anatomy, physiology, pathology, materia medica, pharmacy, chemistry, hygiene, obstetrics, surgery and internal medicine) would be permitted to engage in practice. The duration of this course of training was four years, and the candidate was further required to furnish satisfactory evidence that he had completed the regular Lyceum course of studies (equivalent to the undergraduate course at one of our American Colleges) before he entered upon the medical course.

On the plea that the people who dwelt in the country districts live simpler lives, etc., and consequently are subject to illnesses of a less complicated nature, there was passed by the National Convention another law in accordance with which a lower grade of doctors was created—i.e., practitioners who were called Officiers de SantÉ. At first these men were given permission to practice after they had completed the third year of the regular course of studies, but later they were absolved from the necessity of taking any part of the regular course, provided they could show that they had spent five years in work connected with a hospital or had been in the service of a regular physician during a period of six years. Gradually, as the number of the regular physicians increased and as the country became more prosperous, the Officiers de SantÉ diminished in number. In 1847 there were 7456 such practitioners, but already in 1872 the number had fallen to 4653. On the other hand, the regular doctors of medicine had increased during the same period from 10,643 to 10,766.

In 1864 an attempt was made in the French Parliament to abolish the institution of Officiers de SantÉ, but one of the members, Bonjean, opposed the motion and it fell through. The argument which he brought forward and which is quoted by Puschmann, is essentially the following:—

When simple people belonging to the poorer class of the community are taken ill they want a physician who is himself simple and poor like themselves, a man who is able to comprehend the language and the needs of his modest patients, and who, because of his low birth, because of the fact that he has been habituated from early childhood to the plain and simple living of the peasant’s cottage, and also because he has been put to comparatively small expense to secure the grade which permits him to practice the profession of medicine, is quite contented to accept a modest fee for his services. The Officier de SantÉ is, for all these reasons, admirably fitted to fulfil his mission of modest devotion; for him, under these circumstances it will be comparatively easy to act as the confidant, the counsellor, and the sympathetic friend of the patient.

It is not possible for me to state (1919) how far the recent war has upset all the arrangements mentioned above.

Parisian Hospitals.—Of the three large hospitals which existed in Paris at the beginning of the nineteenth century—the HÔtel-Dieu, la CharitÉ and la SalpÉtriÈre—I am not able to furnish more than a few scanty details. According to an editorial which I find in the London Lancet for November 25, 1837, the management of the English hospitals destined for the relief of the sick poor during the period now under consideration was inferior to that of the similar institutions in France. There are good reasons for believing, however, that, after the lapse of a few years, the English hospitals became in every respect the equals of those in France. In Tenon’s elaborate report on the Parisian hospitals examined by him in 1816 I find it stated that la SalpÉtriÈre was used in part as a prison and in part as an asylum for the insane; but, in another part of this report, he states that at one time this hospital sheltered as many as 8000 persons, the great majority of whom were legitimate hospital patients.

Of HÔtel-Dieu John Cross, in his memoir concerning medical education in Paris, makes the following remarks:—

The patients at l’HÔtel-Dieu vary in number from 1500 to 2000, and generally approach near to the latter number. Beside the wards for medical and surgical patients, there is a ward for the reception of women actually in labor or suffering abortion. The medical patients are far the most numerous, and eight or nine physicians are attached to HÔtel-Dieu.... The number of dressers is not limited; when I was at l’HÔtel-Dieu, above one-hundred were attached to it.... Les ÉlÈves internes of the Parisian hospitals correspond to our house-surgeons; the number of them to each hospital is limited, and at l’HÔtel-Dieu there are nearly twenty. They have their separate apartments in the hospital, are boarded in it, and have, beside board and lodging, an annual salary of about twenty guineas each. They may retain their situation for two years.

Paris possesses a fourth large hospital, which as regards architectural beauty and the great consideration shown by the architect for a wise and convenient disposition of the different available spaces, certainly stands first among the hospitals of the French capital. I have introduced here a reduced copy of the plan of this hospital (HÔpital Saint-Louis), which dates back to the seventeenth century, but, much as I should like to do so, I am not able to furnish a description of the details relating to the precise purposes and the management of the institution at the present time. It is said to be largely devoted to the treatment of affections of the skin.

Tenon’s Criticisms on HÔtel-Dieu and HÔpital Saint-Louis.—Speaking of the wards in the HÔpital Saint-Louis Tenon, who wrote his treatise in 1786, says that it was a mistake to make the ceilings only eleven feet high; they should have been sixteen feet high. He commends strongly the complete separation of the hospital from the adjacent city by high surrounding walls. Only one kind of contagion, he says, should be admitted into any single ward. This precaution had not previously been observed. In the HÔpital Saint-Louis the water-closet arrangements were about as bad as they could possibly be. The same remark applies to HÔtel-Dieu, where overcrowding was at times scandalously bad. In the latter hospital there are, in the wards destined for men, 600 beds—of which number 378 are beds of the larger size, and 222 of the smaller. In the wards for women, he adds, the same predominance of large beds exists—viz., 355 larger beds, 264 of the smaller size.

Tenon says emphatically: “Beds for two or more persons should not be permitted in any hospital. These beds, on certain occasions, are occupied by four—yes, even by six persons—and as a result they are infested by vermin. Sleep is practically unattainable under such circumstances.”^[27]

Planned by the architect Claude Chastillon, of Paris, in 1608.

A. Wall surrounding hospital grounds.

B. Main entrance.

C, D. Court separating the first and second enclosed spaces.

C. Entrance to second enclosure, through the porter’s lodge.

D. One of the four buildings placed at the corners of the principal square; the members of the Religious Sisterhood occupy the building as their convent.

E. Gallery of communication between the convent and the wards of the hospital.

F. Another of the four corner buildings; it is destined for the use of the priests and the surgeons, and communicates with the hospital wards by means of a covered gallery like that shown at E.

G. Entrance to men’s promenade, to the reservoir, and to the cemetery.

H, I. Buildings in which may be lodged, during the prevalence of an epidemic, such citizens as may be affected with some contagious disease.

K, L, M, and N. Gardens belonging respectively to pavilions L, H, F, and D.

O. Lodge occupied by four gardeners.

P. Royal pavilion, not used after the Revolution.

Q. Open space planted with trees.

S. Church.

T. Kitchen, etc.

U. Bakery, wine cellars, etc.

V, X. Lodging rooms for cooks and bakers.