- Journal d’observations sur les principaux hôpitaux et sur quelques prisons d’Angleterre (1787)
The eminent surgeon and anatomist Jacques Tenon (1724–1816) is remembered today by a major Paris hospital that bears his name, as well as by a capsule to which the muscles of the eye are attached. His Mémoires sur les hôpitaux de Paris (1788) remains the most widely cited and influential Enlightenment treatise on the architecture, goals, and operation of what was to become the modern hospital.
Tenon, member of the Royal Academies of Sciences, Surgery, and Agriculture, and well connected to the reforming ministers of pre-Revolutionary France, was a pivotal player in the work of a group of scientist celebrities from the Academy of Sciences, under Crown sponsorship, to rebuild the municipal hospital of Paris (1785–89). Since England held the undisputed lead in hospital technology and administration (the Plymouth hospital being the most frequently copied example), and since the reports of the Academy sought to embody these innovations, Tenon (with the physicist Charles Coulomb) was sent there in May 1787. Tenon recorded his visits to fifty-two English hospitals, prisons, and workhouses in a “journal d’observations,” studied in manuscript by scholars for years, and here published for the first time. His trip yielded a substantial fund of invaluable information, brought him into contact with some of Britain’s most celebrated scientists, physicians, inventors, and politicians, and definitively shaped the final reports of the Academy hospital committee, which recommended construction of four new Paris hospitals on English models. The choice of Tenon could not have been happier. Few could match his forty-two years of firsthand experience with the hospitals of France or equal his extensive clinical, scientific, and administrative knowledge. The historical operational notes, clinical data, statistics, and plans that he had collected over twenty years formed the basis of the first report of the Academy committee in 1786. His Mémoires, published two years later through recommendation of the committee, remains its most enduring monument.
Given the range and value of Tenon’s observations on each of the fifty-two institutions he visited, it is astonishing how much he managed to pack into so brief a stay. He assembled a vast body of data useful to hospital planning: vital [End Page 131] statistics; tables of patient morbidity and mortality by disease and sex; measurements of wards, beds, windows, staircases, privies, air volume, water supply, and sewage disposal; notes on heat, light, ventilation, furnishings, and hygienic and mechanical safeguards; lists of physicians, nurses, and other support personnel; information on administrative services, food, and length of stay; and patient-cost estimates. Tenon demonstrated a causal link between progressive practices and lower mortality. In his painstaking attention to detail, in critically comparing hospitals, in isolating and implementing emulable practices, and in appealing to an aroused public conscience, he consciously modeled himself after the British prison-hospital reformer John Howard.
Locating the hospital within the cosmopolitan, humanist culture of the eighteenth century, Tenon referred to it in his Mémoires as a “measure of the civilization of a people” (p. 1), an institution shaped by the climate, natural wealth, religion, laws, and customs of a country. These notions of physical and cultural environmentalism crystallized during Tenon’s stay in England, a country that influenced his thinking as dramatically as it had Voltaire’s and Montesquieu’s. The British hailed his trip to reform hospitals and to relieve human suffering as the “Commercial Treaty of Humanity” (France and England had signed the Vergennes-Eden Treaty just a year before, after centuries of armed conflict). From the experience of a happy and productive sojourn Tenon came to see the hospital as a cumulative, collaborative, supranational effort of scientists, physicians, learned societies, governments, even peoples, animated by common aspirations of humanity...