Denizens of the 21st century complain of how super-specialized the practice of medicine has become. Few modern medical students aim to be generalists – even the discipline now known as Family Practice is a specialty – as most aim for many additional years of training to become expert in scientific minutiae.
It would appear, however, that our world has nothing on 19th century Paris.
The City of Lights in the epoch between Napoleon and the Franco-Prussian War was an epicenter of medical study, one reason being that French citizens were entitled to free medical care by royal decree. Students and young doctors flocked there from all over the continent, and from across the Atlantic, because of the amazing proliferation of facilities dedicated to very specific conditions and illnesses. No where else could doctors-in-training see so much pathology at the sides of renowned clinicians all in the same place.
Obstetrical complications? That would be Hôpital de la Maternité, with no fewer than a dozen births per day. Gravely sick children? The largest such hospice in the country was Hôpital des Enfants-Malades, sadly filled to capacity. Venereal diseases? There were two: for the women, Hôpital Lourcine, and for the men, Hôpital du Midi – the former being a house of tertiary-staged horrors, and the latter, while equally ghastly, mandating in the earliest years the additional ‘treatment’ of public whippings to teach patients to stay away from strumpets and keep their trousers on.
Lunatic women of childbearing years, idiots and imbeciles and morons of both genders, the terminally ill, the deaf, the blind, the dumb… all had their own specific destinations in the capital. There was a hospital for elderly married couples who wanted to die together in the same room (they could bring their own furniture and effects, the price of admission in part being bequeathment to the facility on joint passing of all personal property).
Lepers, however, were not welcomed, and instead were shipped out of the city limits should any show up at the front doors.
There was even Hôpital des Enfants-Trouvés for homeless children (distinct from an orphanage, as Enfants-Trouvés had physicians on staff to tend to the lesser ailments of the abandoned whose sicknesses didn’t quite require admission to Enfants-Malades). Some of the arrivals were orphaned when their mothers died at la Maternité (1:50), while others were voluntarily surrendered by caretakers unable to provide for their special needs. When these youngsters were deemed medically stable, they were offered for public adoption, though without surprise, many stayed at Enfants-Trouvés until they reached majority and were turned back to the streets by the hundreds.
Enfants-Trouvés had an anonymous drop-zone called le tour d’abandon (‘the desertion tower’) where sliding doors and a small bell would herald to the nurses within the arrival of a new human deposit. The citizens of Paris were encouraged to mark their children so they could potentially be reclaimed, though very few were ever later sought.
The American doctors in town, however, were most astonished by École Pratique d’Anatomie. While not a hospital per se – it was more of a pathology foundation – it allowed any physician, for the equivalent of $6, to access his own personal cadaver for dissection (no doubt many of whom were unfortunate former patients of Paris’ other healing institutions). In the early 19th century, human dissection remained illegal in the U.S., and many practitioners there had to resort to grave robbing to obtain specimens. In Paris, for a modest fee, cadavers were plentiful for the taking.
There was one small catch. The stuffy and warm dissection room often contained two dozen physicians whittling away on unpreserved corpses. The smell was said to be overpowering, and at the end of the day, leftover chunks of the deceased were tossed to packs of snarling street dogs who waited out back.
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[Copyright 2013 @ The Alienist’s Compendium]