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  • Local Hospitals in Ancien Régime France: Rationalization, Resistance, Renewal, 1530–1789
  • Matthew Ramsey
Daniel Hickey. Local Hospitals in Ancien Régime France: Rationalization, Resistance, Renewal, 1530–1789. McGill-Queen’s/Hannah Institute Studies in the History of Medicine, Health, and Society, no. 5. Montreal: McGill-Queen’s University Press, 1997. xxvi + 275 pp. Ill. $44.95.

Most histories of hospital reform in Old Regime France have approached the question from the point of view of the Crown, which in the sixteenth and seventeenth centuries sought to rationalize the crazy-quilt network of institutions serving the sick and needy by closing inefficient, corrupt, and superfluous local foundations and appropriating their resources. This book reverses that perspective. Although most of the small provincial hospitals were closed down, more than a thousand were still in existence in 1789, and some managed to increase their revenues and introduce innovative approaches to health care and poor relief. Hickey’s thoroughly researched and densely argued study focuses on eight such hospitals, located in Normandy, Brittany, Provence, and Dauphiné, and shows how survival and renewal were possible.

For readers unfamiliar with the earlier literature, Hickey provides a useful overview of the overlapping efforts by royal officials, municipal authorities, and Christian reformers to renovate the old system of charitable institutions and almsgiving inherited from the Middle Ages. To simplify a complex story, these efforts were inspired in large part by the tide of beggars and vagabonds flooding into the urban centers from the countryside. This migration seemed to indicate a failure on the part of local institutions; the prevalence of mendicancy also suggested to urban humanists, and later to leaders of the Catholic Reformation, that traditional forms of indiscriminate charity encouraged malingering and shiftlessness. The reformers divided the old mixed population of beneficiaries into the poor and social marginals, on the one hand, who were to be shut up in urban hôpitaux-généraux, terminating their careers as beggars; and the sick and disabled, on the other, who were to be accommodated in hôtels-Dieu—though even these were still closer to the older model of the hospital as a custodial institution than to the modern model of the hospital as a provider of specialized medical and surgical services. Hickey takes a relatively benign view of what Michel Foucault called the “great confinement” 1 of deviants, which he sees as more paternalistic than repressive. He shows, however, the ways in which this program transferred power and resources from the hinterland to the center.

The survival of some smaller provincial hospitals owed much to the efforts of local elites, who saw these institutions as vital to maintaining the prestige of their towns, their personal status, and their control over the local population. In at least one case (at Grignan in Provence) they were in the habit of renting land from the hospital domains and taking out loans from its endowment; the hospital thus promoted prosperity and benefited in return from increased donations. Hickey also stresses the important role played by the Christian charity movement [End Page 764] in the seventeenth century, particularly by the women’s religious orders inspired by Saint Vincent de Paul. The local institutions increasingly depended on the services and support provided by nuns, lay sisters, and women volunteers and patrons. In the second half of the eighteenth century, the remaining local institutions benefited from the shift in the thinking of Enlightenment reformers, and then of royal officials, toward a policy of decentralization.

Since most of the hospitals concerned continued to function chiefly as shelters for the destitute and disabled, medicine has a rather small part, though an interesting one, in Hickey’s story. He provides fresh evidence of the low mortality rates documented by other recent accounts of provincial hospitals, contrary to the older view of the hospital as a place where the least advantaged members of society were sent to die. He confirms the active role that the sisters played in patient care, drawing on an armamentarium based on medicinal plants, and the importance of the surgical work of the Brothers of Charity, who trained apprentices and managed in the small provincial institutions to escape the relentless opposition...

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