Hospital Politics in Seventeenth-Century France: The Crown, Urban Elites and the Poor (review)

Since 1970, when Jean-Pierre Gutton published his groundbreaking study of poverty in the generality of Lyons, there has been a continual stream of publications about the poor and their confinement in early modern France. Much of the best work has been done by anglophone historians, such as Olwen Hufton and Colin Jones, and the work under review is a further contribution to a well-established Anglo-American historiography.

McHugh's focus of attention is the role of the crown and the central government in the incarceration of the able-bodied poor in hôpitaux généraux in the course of the seventeenth century. The orthodox view is that the initiative for the grand enfermement, as it is called, came from above and was part of the campaign to bring order and peace to the French state after seventy years of civil war. It is also assumed that the policy of confinement was operated uniformly. McHugh argues that the orthodoxy is wrong on both counts. By looking at the history behind the foundation of the hôpitaux généraux in Paris and in two very different provincial towns, Montpellier and Nîmes, he demonstrates that the initiative for the incarceration of the able-bodied but unemployed poor came from local lay elites and was a response to local circumstances. Thus the establishment of the hôpitaux général in 1656 in Paris was the work of the city parlementaire elite who shared the views of Counter-Reformation reformers that the poor were godless as well as idle. The catalyst, however, was not religion but the social dislocation brought about by the Frondes of 1649–53 that had brought large numbers of beggars into Paris from the countryside. Similarly, the foundation of hôpitaux généraux in Montpellier and Nîmes in 1680 and 1686 was closely connected with specific socioeconomic problems in Languedoc, which had brought increasing numbers of destitute into the town. In Montpellier and Nîmes, too, the poor were only partly confined in the new hospitals; many continued to receive outdoor relief. In Nîmes this reflected the strength of the underground Huguenot population even after the revocation of the Edict of Nantes. It was accepted that inmates would undergo relentless religious proselytization, and the elites running the hospital were unwilling to antagonize the Protestants, who still dominated the mercantile community. The role of the crown in the grand enfermement was in fact very limited. It facilitated the foundation of hôpitaux généraux by the edict of 1662, which called for other towns to copy what Paris had done. But it provided no funds and sometimes made it difficult for towns to levy local taxes to maintain them. Essentially, the Crown, as it always had, thought that poor relief was a local responsibility.

McHugh's study is based on detailed archival study and a close and intelligent reading of some key documents. It confirms the work of a number of recent historians of the reign of Louis XIV, notably William Beik, who have emphasized the extent to which the Crown worked with rather than against local elites. Its contribution to the history of medicine is more tangential. McHugh places the hôpitaux généraux in the broader context of French hospitals and compares their activities with those of the existing hôtels-dieu that took in the sick poor. This leads him to a discussion of the medical services that became attached to more and more French hospitals from the mid-sixteenth century, and the peculiar role played by the Paris Hôtel Dieu in training surgeons. In so doing, he seeks to rescue the Paris hospital from the obloquy that has been its lot since Jacques-René Tenon's famous diatribe in the 1780s. He makes a good point that the...