Lifestyle Travel Hospitals, God, and paupers
Hospitals, God, and paupers
Written by Dr Rob McEvoy
Tuesday, 01 May 2007


The medical tourist who visits Tournus, France, will be struck by how history repeats itself when it comes to charitable religious hospitals and their relationships with government. Construction of the Tournus Hotel-Dieu (house of God) began in 1661, at the instigation of the Duc d'Albret, appointed Abbot of Tournus in 1660 and to become cardinal of Bouillon. He managed to persuade local dignitaries to endow their town with a hospital for the growing number of people impoverished by war, disease and famine.

Original pots containing liquid remedies were virtual fermentation chambers and were superseded by glass bottles. Other
Original pots containing liquid remedies were virtual fermentation chambers and were superseded by glass bottles. Other

These first hospitals or "hôtels-Dieu", were originally places where paupers could obtain the food, shelter and treatment they required. They sprang up across France in the sixteenth century. Even though a number of abuses by the clergy who ran them prompted the secular powers to step in and take over their financial affairs, they continued to be run by religious communities.

The Hotel-Dieu at Tournus, one of the first religious hospitals. Originally, a single ward for men and women was built, with dispensary, a sacristy and a surgeon’s room, as well as a kitchen, a refectory and bedrooms for the nuns. A men’s ward was added later, mainly financed by cardinal de Fleury, chief minister to King Louis XV.
The Hotel-Dieu at Tournus, one of the first religious hospitals. Originally, a single ward for men and women was built, with dispensary, a sacristy and a surgeon’s room, as well as a kitchen, a refectory and bedrooms for the nuns. A men’s ward was added later, mainly financed by cardinal de Fleury, chief minister to King Louis XV.

The nursing Sisters of Saint Martha ran Tournus Hotel-Dieu, as they did a number of similar hospitals in the region. The sisters were unpaid and supervised by the Superior who was elected from among them. They took vows of chastity and obedience in joining the order but were free to leave the hospital any time. The nuns were dedicated to the physical and moral well-being of the hospital inmates. (The last of them retired as recently as 1978 when the hospital at Tournus was finally closed down.)

Back then, the pauper was perceived as the incarnation of Christ and his sufferings, and therefore the object of charitable attention. Gifts and bequests kept the hospitals running. It was the duty of all relatively well-off Christians anxious to save their souls to assist the very poor. For example, Monsieur Blondel de Jouvencourt, donated a ‘bed foundation' to the Tournus facility, a covenant to pay the hospital costs of a number of patients for a given period. And there were estates and the proceeds from a number of specific rights, rents and tax exemptions granted by the monarchy, Saint Philibert's abbey or the Tournus municipality.

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But then the image of the pauper deteriorated. They became a danger to the established social order. The State began to tackle vagrancy and begging in 1662 when it decreed the creation of general hospitals to confine vagrants. Hospitals, which until then had been charitable institutions, now became places of incarceration.

Until the eve of the French Revolution in 1788, the type of medicine exercised there was rudimentary at best, and extreme poverty and contagion reigned supreme. In fact, over 80% of the hospital population in France was made up of cripples, the elderly, and foundlings, not the sick.

The Revolutionary period, instigated by a starving populace, continued on for 10 years and led to reforms. Initially, confiscated estates and abolished privileges plunged the Hôtel-Dieu's into severe financial difficulties. On the positive side, the management of hospitals became the responsibility of committees chaired by local mayors.

But the biggest changes came in the nineteenth century as hospitals became more focused on the practice of medicine. They became the terrain for study of the many pathologies within. They became centres of research and experimentation.

The layout of wards reflected ideas about ‘contagion’ at the time – diseases were believed to be transmitted by smells through the air. Consequently, wards were huge to allow air to circulate and large window bays were set up high to avoid drafts at patient level. With the limited heating available, patients suffered from the cold and damp. Doubling up patients in one bed aided warming but spread disease.The layout of wards reflected ideas about ‘contagion’ at the time – diseases were believed to be transmitted by smells through the air. Consequently, wards were huge to allow air to circulate and large window bays were set up high to avoid drafts at patient level. With the limited heating available, patients suffered from the cold and damp. Doubling up patients in one bed aided warming but spread disease.

 An example of the early art of medicine.An example of the early art of medicine.