Paris, March 9, 1802.

Among the national establishments in this metropolis, I know of none that have experienced so great an amelioration, since the revolution, as the

HOSPITALS AND OTHER CHARITABLE INSTITUTIONS;

The civil hospitals in Paris now form two distinct classes. The one comprehends the hospitals for the sick: the other, those for the indigent. The former are devoted to the relief of suffering human nature; the latter serve as an asylum to children, to the infirm, and to the aged indigent. All persons who are not ill enough to be admitted of necessity into the hospital the nearest to their residence, are obliged to present themselves to the Bureau Central d'Admissions. Here they are examined, and if there be occasion, they receive a ticket of admission for the hospital where their particular disorder is treated. At the head of the hospitals for the sick stands that so long known by the appellation of the

HÔTEL-DIEU.

Formerly, nothing more horrid could be conceived than the spectacle presented in this asylum for the afflicted. It was rather a charnel-house than an hospital; and the name of the Creator, over the gate, which recalled to mind the principle of all existence, served only to decorate the entrance of the tomb of the living.

The HÔtel-Dieu, which is situated in the Parvis Notre-Dame, Ile du Palais, was founded as far back as the year 660 by St. Landry, for the reception of the sick and maimed of both sexes, without any exception of persons. Jews, Turks, infidels, pagans, protestants, and catholics were alike admitted, without form or recommendation. Yet, though it contained but 1200 beds, and the number of patients very often exceeded 5000, and, on an average, was never less than 2500, till the year 1786, no steps were taken for enlarging the hospital, or providing elsewhere for those who could not be conveniently accommodated in it. The dead were removed from the wards only on visits made at a fixed time; so that it happened not unfrequently that a poor helpless patient was compelled to remain for hours wedged in between two corpses. The air or the neighbourhood was contaminated by the noisome exhalations continually arising from this abode of pestilence, and that which was breathed within the walls of the hospital was so contagious, as to turn a trifling complaint into a dangerous disorder, and a simple wound into a mortification.

In 1785, the attention of the government being called to this serious evil by various memoirs, the Academy of Sciences was directed to investigate the truth of the bold assertions made in these publications. A commission was appointed; but as the revenues of the HÔtel-Dieu were immense, for a long time it was impossible to obtain from the Governors any account of their application. However, the Commissioners, directing their attention to the principal object, reported as follows: "We first compared the HÔtel-Dieu and the HÔpital de la CharitÉ relative to their mortality. In 52 years, the HÔtel-Dieu, out of 1,108,741 patients lost 244,720, which is one out of four and a half. La CharitÉ, where but one dies out of seven and a half, would have lost only 168,700, whence results the frightful picture that the Hotel-Dieu, in 52 years, has snatched from France 99,044 persons, whose lives would have been saved, had the HÔtel-Dieu been as spacious, in proportion, as La CharitÉ. The loss in these 52 years answers to 1906 deaths per year, and that is nearly the tenth part of the total and annual loss of Paris. The preservation of this hospital in the site it now occupies, and on its present plan, therefore produces the same effect as a sort of plague which constantly desolates the capital."

In consequence of this report, the hospital was enlarged so as to contain about 2000 beds. Since the revolution, the improvements introduced into the interior government of the HÔtel-Dieu have been great and rapid. Each patient now has a bed to himself. Those attacked by contagious disorders are transferred to the Hospice St. Louis. Insane persons are no longer admitted; men, thus afflicted, are sent to a special hospital established at Charenton; and women, to the SalpÉtriÈre. Nor are any females longer received into the HÔtel-Dieu to lie-in; an hospital having been established for the reception of pregnant women. At the HÔtel-Dieu, every method has been put in practice to promote the circulation of air, and expel the insalubrious miasmata. One of these, I think, well deserves to be adopted in England.

In the French hospitals, one ward at least is now always kept empty. The moment it becomes so by the removal of the patients into another, the walls are whitewashed, and the air is purified by the fumigation with muriatic acid, according to the plan first proposed by GUYTON-MORVEAU. This operation is alternately performed in each ward in succession; that which has been the longest occupied being purified the first, and left empty till it is again wanted.

The number of hospitals in Paris has been considerably augmented. They are all supported by the government, and not, like those in England, by private benefactions. Sick children of both sexes, from the time of suckling to the age of sixteen, are no longer admitted into the different hospitals; but are received into a special hospital, extremely well arranged, and in a fine, airy situation, beyond the BarriÈre de SÈvres. Two institutions have been formed for the aged, infirm and indigent, who pay, on entrance, a moderate sum. One of these charities is without the BarriÈre d'Enfer; the other, in the Faubourg St. Martin. In the same faubourg, a Maison de SantÉ is established, where the sick are treated on paying thirty sous a day.

An hospital for gratuitous vaccination, founded by the Prefect of the department of La Seine, is now open for the continual treatment of the cow-pox, and the distribution of the matter to all parts of France.

In general, the charitable institutions in Paris have also undergone very considerable improvements since the revolution; for instance, the male orphans, admitted, to the number of two thousand, into the asylum formerly called La PitiÉ, in the Faubourg St. Victor, used to remain idle. They were employed only to follow funeral processions. At present, they are kept at work, and instructed in some useful trade.

A new institution for female orphans has been established in the Faubourg St. Antoine; for, here, the two sexes are not at present received into the same house, whether hospital or other charitable institution. In consequence of which, Paris now contains two receptacles for Incurables, in lieu of the one which formerly existed.

The place of the HÔpital des Enfans-TrouvÉs is also supplied by an establishment, on a large scale, called the

HOSPICE DE LA MATERNITÉ.

It is divided into two branches, each of which occupies a separate house. The one for foundlings, in the Rue de la Bourbe, is intended for the reception of children abandoned by their parents. Here they are reared, if not sent into the country to be suckled. The other, in the Rue d'Enfer, which may be considered as the General Lying-in Hospital of Paris, is destined for the reception of pregnant women. Upwards of 1500 are here delivered every year.

As formerly, no formality is now required for the admission of new-born infants. In the old Foundling-Hospital, the number annually received exceeded 8000. It is not near so great at present. To those who reflect on the ravages made among the human race by war, during which disease sweeps off many more than are killed in battle, it is a most interesting sight to behold fifty or sixty little foundlings assembled in one ward, where they are carefully fed till they are provided with wet nurses.

I must here correct a mistake into which I have been betrayed, in my letter of the 26th of December, respecting the present destination of

LA SALPÊTRIÈRE.

It is no longer used as a house of correction for dissolute women. Prostitutes, taken up by the police, are now carried to St. Lazare, in the Rue St. Denis. Those in want of medical aid, for disorders incident to their course of life, are not sent to BicÊtre, but to the ci-devant monastery of the Capucins, in the Rue Caumartin.

At present, the SalpÊtriÈre forms an hospice for the reception of indigent or infirm old women, and young girls, brought up in the Foundling-Hospital, are placed here to be instructed in needle-work and making lace. Female idiots and mad women are also taken care of in a particular part of this very extensive building.

The SalpÊtriÈre was erected by Lewis XIII, and founded as an hospital, by Lewis XIV, in 1656. The facade has a majestic appearance. Before the revolution, this edifice was said to lodge 6000 souls, and even now, it cannot contain less than 4000. By the Plan of Paris, you will see its situation, to the south-east of the Jardin des Plantes.

I shall also avail myself of the opportunity of correcting another mistake concerning

BICÊTRE.

This place has now the same destination for men that the SalpÉtriÈre has for women. There is a particular hospital, lately established, for male venereal patients, in the Rue du Faubourg St. Jacques.

March 9, in continuation.

Previously to the decree of the 19th of August 1792, which suppressed the universities and other scientific institutions, there existed in France Faculties and Colleges of Physicians, as well as Colleges and Commonalities of Surgeons. From one of those unaccountable contradictions of which the revolution affords so many instances, these were also suppressed at a time when they were becoming most necessary for supplying the French armies with medical men. But as soon as the fury of the revolutionary storm began to abate, the re-establishment of Schools of Medicine was one of the first objects that engaged attention.

Till these latter times, Medicine and Surgery, separated from each other, mutually contended for pre-eminence. Each had its forms and particular schools. They seemed to have divided between them suffering human nature, instead of uniting for its relief. On both sides, men of merit despised such useless distinctions; they felt that the curative art ought to comprehend all the knowledge and all the means that can conduce to its success; but these elevated ideas were combated by narrow minds, which, not being capable of embracing general considerations, always attach to details a great importance. The revolution terminated these disputes, by involving both parties in the same misfortunes.

At the time of the re-establishment of Public Instruction, the Schools of Health, founded at Paris, Montpelier, and Strasburg, on plans digested by men the most enlightened, presented a complete body of instruction relative to every branch of the curative art. Physics and chemistry, which form the basis of that art, were naturally included, and nothing that could contribute to its perfection, in the present state of the sciences, was forgotten. The plan of instruction is fundamentally the same in all these schools; but is more extensive in the principal one, that is, in the

SCHOOL OF MEDICINE OF PARIS.

This very striking monument of modern architecture, situated in the Faubourg St. Germain, owes its erection to the partiality which Lewis XV entertained for the art of surgery. That monarch preferred it to every science; he was fond of conversing on it, and took such an interest in it, that, in order to promote its improvement, he built this handsome edifice for the ci-devant AcadÉmie et Écoles de Chirurgie. The architect was GONDOUIN.

The faÇade, extending nearly two hundred feet, presents a peristyle of the Ionic order. The interior distribution of this building corresponds with the elegance of its exterior. It contains a valuable library, a cabinet of anatomical preparations (among which is a skeleton that presents a rare instance of a general anchilosis) and imitations in wax, a chemical laboratory, a vast collection of chirurgical and philosophical instruments, and a magnificent amphitheatre, the first stone of which was laid by Lewis XVI in December 1774. This lecture-room will conveniently hold twelve hundred persons, and its form and arrangement are such, that a pupil seated the farthest from the subject under dissection, can see all the demonstrations of the Professor as well as if placed near the marble table.

In one wing of the building is an Hospice de Perfectionnement, formerly instituted for the reception of rare chirurgical cases only; but into which other patients, labouring under internal disorders of an extraordinary nature, are now likewise admitted.

To this school are attached from twenty to thirty Professors, who lecture on anatomy and physiology; medical chemistry and pharmacy; medical physics; pathology, internal and external; natural history, as connected with medicine, and botany; operative medicine; external and internal clinical cases, and the modern improvements in treating them; midwifery, and all disorders incident to women; the physical education of children; the history of medicine, and its legitimate practice; the doctrine of Hippocrates, and history of rare cases; medical bibliography, and the demonstration of the use of drugs and chirurgical instruments. There are also a chief anatomist, a painter, and a modeller in wax. The lectures are open to the public as well as to the students, who are said to exceed a thousand. Besides this part of instruction, the pupils practise anatomical, chirurgical, and chemical operations. To the number of one hundred and twenty, they form a practical school, divided into three classes, and are successively distributed into three of the clinical hospitals in Paris. At an annual competition, prizes are awarded to the greatest proficients.

Although this school is so numerously attended, and has produced several skilful professors, celebrated anatomists, and a multitude of distinguished pupils, yet it appears that, since there has been no regular admission for physicians and surgeons, the most complete anarchy has prevailed in the medical line. The towns and villages in France are overrun by quacks, who deal out poison and death with an audacity which the existing laws are unable to check. Under the title of Officiers de SantÉ, they impose on the credulity of the public, in the most dangerous manner, by the distribution of nostrums for every disorder. To put a stop to this alarming evil, it is in contemplation to promulgate a law, enacting that no one shall in future practise in France as a physician or surgeon, without having been examined and received into one of the six Special Schools of Medicine, or as an officer of health, without having studied a certain number of years, walked the hospitals, and also passed a regular examination.[1]

At the medical school of Paris are held the meetings of the

SOCIETY OF MEDICINE.

It was instituted for the purpose of continuing the labours of the ci-devant Royal Society of Medicine and the old Academy of Surgery. With this view, it is charged to keep up a correspondence, not only with the medical men resident within the limits of the Republic, but also with those of foreign countries, respecting every object that can tend to the progress of the art of healing.

As far back as the year 1777, there existed in Paris a college of Pharmacy. The apothecaries, composing this college, had formed, at their own expense, an establishment for instruction relative to the curative art, in their laboratory and garden in the Rue de l'ArbalÊtre. Since the revolution, the acknowledged utility of this institution has caused it to be maintained under the title of the

GRATUITOUS SCHOOL OF PHARMACY.

Here are delivered gratis, by two professors in each department, public lectures on pharmaceutic chemistry, pharmaceutic natural history, and botany. When the courses are finished, prizes are annually distributed to the pupils who distinguish themselves most by their talents and knowledge.

In the year 1796, the apothecaries of Paris, animated by a desire to render this establishment still more useful, formed themselves into a society, by the name of the

FREE SOCIETY OF APOTHECARIES.

Its object is to contribute to the progress of the arts and sciences, particularly pharmacy, chemistry, botany, and natural history. This society admits, as free and corresponding associates, savans of all the other departments of France and of foreign countries, who cultivate those sciences and others analogous to them. Some of the most enlightened men in France are to be found among its members.

The advantageous changes made in the teaching of medicine, since the revolution, appear to consist chiefly in the establishment of clinical lectures. The teaching of the sciences, accessory to medicine, partakes more or less advantageously of the great progress made in that of chemistry. It seems that, in general, the students in medicine grant but a very limited confidence to accredited opinions, and that they recur to observation and experience much more than they did formerly. As for the changes which have occurred in the practice of medicine, I think it would be no easy matter to appreciate them with any degree of exactness. Besides, sufficient time has not yet elapsed since the establishment of the new mode of teaching, for them to assume a marked complexion. It is, however, to be observed that, by the death of the celebrated DÉSAULT, Surgery has sustained a loss which is not yet repaired, nor will be perhaps for ages.

Footnote 1: A law to this effect is now made.Return to text