From Housing the Poor to Healing the Sick: The Changing Institution of Paris Hospitals under the Old Regime and Revolution (review)

The title of this book, written, so the dust-jacket informs us, by an author enjoying long professional experience in hospitals, accurately conveys its content and thesis. The author treats his subjects in three main sections: Paris hospitals at the end of the Ancien Régime; hospitals during the Revolution; and the aftermath of revolutionary reforms, especially during the Napoleonic era. The thesis argued is straightforward: Ancien Régime hospitals were a disaster, Enlightenment reformers tried to change them, reactionary administrators and religious personnel blocked reform, the Revolution implemented Enlightenment ideals by changing the hospital from a charitable establishment to a site for the practice of modern, scientific medicine. In making this case, the author retells many oft-told tales about Paris hospitals. He cites accounts by contemporaries who decried the overcrowding, indiscriminate mixing of patients, and inadequate or nonexistent medical care in prerevolutionary hospitals. He applauds the efforts of reformers such as Jacques Tenon. He laments the attacks on medicine and physicians by wild-eyed Jacobins motivated by “anti-intellectualism and antiprofessionalism” (128). He recognizes the “short-term” effects that revolutionary legislation dispossessing hospitals had on the poor they had housed but argues that temporary dislocation opened the way to revolutionary, and self-evidently beneficial, change in the direction of modern medicine and hospital management.

This is all exceedingly familiar territory. Aside from some details of debates among administrators at the Hôtel-Dieu, whose records constitute the chief primary source used by the author, there is nothing in this book that is not already available in the work of two generations of scholars including Erwin Ackerknecht, Charles Coury, George Rosen, Louis Greenbaum, Jean-Pierre Goubert, Toby Gelfand, Jean Imbert, Dora Weiner, and Colin Jones, to mention only some of the most notable historians of the hospital in Ancien Régime and revolutionary France. It is unaccountable to me that the author should characterize the secondary literature on Paris hospitals as “sparse” when in fact, as the preceding (incomplete) list shows, this is one of the most thoroughly discussed subjects in French social history. If the author had a new interpretive perspective to offer, another book on Paris hospitals in this era might have been worthwhile. But what is in fact set forth here is a thesis utterly lacking in nuance: the Revolution made possible the medicalization of the hospital and this was good. The author has read Michel Foucault, whose books on medicine he summarizes in a bibliographical appendix, but he makes no effort to engage Foucault’s challenge to the humanitarian and scientistic interpretation of medical history that supplies his own interpretive framework. He simply states that Foucault “is hard to categorize” (187). Nor does the author recognize any of the complexities in the history of hospitals or in the judgments and actions of contemporaries that have emerged in the works of recent historians. A telling omission from the bibliography, and from the author’s thinking about the transition from the pre- to the postrevolutionary hospital, is an article published by Colin Jones and Michael Sonenscher over a decade ago devoted to the Hôtel-Dieu of Nîmes. Challenging the simplistic view of the Ancien Régime hospital as a cavern of death haunted by spectral nuns, Jones and Sonenscher probed the rhetorical and ideological uses made by late-century reformers of the macabre narratives that circulated about Paris hospitals and offered a subtle and historically sensitive account of hospital practice in the age of charity. ¹ In his headlong rush to celebrate the emergence of the “modern” hospital, the author ignores such historical niceties, asserting blandly that Paris “appeared to be a model for all French hospitals” (16). Nor does he put much stock in the work of those historians (Jones, Olwen Hufton, Cissie Fairchilds, Alan Forrest) who have sought to elucidate the concrete...