CHAPTER VII.

ON THE POSITION OCCUPIED BY CHARITABLE SISTERHOODS IN FRANCE.

THE question whether it is desirable to establish a system of religious sisterhoods for charitable purposes is one in which any appeal which can be made to actual experience must obviously be of great importance. It is to France that we most naturally turn in order to study the results of such experience, for there the system has existed in full vigour from the earliest times in which we have any history of charitable institutions, and the necessary information is there most easily accessible. It has accordingly been the fashion with advocates of sisterhoods to bring forward the good management of French hospitals and other charities, with their regular staff of Sisters of Charity, as an argument for promoting the growth of sisterhoods among ourselves. The question of the comparative merits of French and English hospitals is one upon which I shall not venture to offer an opinion. Competent judges on both sides of the Channel are far from being unanimous in this matter. It is obvious, however, that in attempting to apply to our own case the results of French experience, we must bear in mind how different is the charitable organization of which religious orders form a part in that country, from anything which exists in England. The "Sisters," with whose appearance in French hospitals, schools, and streets we are so familiar, form part of a vast system, both official and ecclesiastical, the rest of which, whatever may be its merits or demerits, we are certainly very unlikely at present to borrow from our neighbours. In order to judge fairly how far it would be possible or desirable to copy this particular part of it, we should have to ascertain not only how it works, but how it is connected with the rest of the

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system, and how that system differs from our own. attempting fully to carry out so extensive an inquiry, I propose in this chapter to state some of the differences between France and England, or rather between Paris and London, especially as regards the provision for nursing the sick, which will indicate the qualified sense in which the experience of the one country can be considered as applicable to the other.1

In attempting to make any such comparison we are met at the outset by two great sources of confusion. One of these consists in the absence of any uniformity of system which characterizes all our own charitable institutions, and in particular the great diversity of character among our hospitals. No two probably are precisely alike in their internal arrangements, and the same offices are sometimes described by different names in different institutions. It is therefore difficult to compare one English hospital with another, and still more difficult to make any general statements respecting them with sufficient accuracy to serve as a ground of comparison with the system which is common to all the hospitals of Paris. This difficulty is increased by the scantiness of the reports published by most of our hospitals, which, as every one knows, consist chiefly of subscription lists, and, of course, do not enter into any comparisons between their own arrangements and those of other institutions. It is, however, in some degree met for my purposes by a report published in 1862 by MM. Blondel and Ser,2 the principal inspector and the engineer of the "Assistance publique." A discussion having arisen in the "Académie de Médecine" of Paris respecting the relative merits of French and English hospitals, the present Director of Public Assistance, M. Armand Husson, sent these two gentlemen to visit

1 The following account having been written before the present war, it is at present impossible to say how much of it may have been rendered obsolete as a statement of existing facts by the changes which have since taken place; but whatever interest may belong to it as a study of the working of religious sisterhoods in connection with public charities is, of course, untouched by those changes. (January 1871.)

2 Rapport sur les Hôpitaux Civils de la Ville de Londres: au point de vue de la Comparaison de ces Établissements avec les Hôpitaux de la Ville de Paris. Par M. Blondel, Inspecteur principal, et M. L. Ser, Ingénieur, de l'Administration de l'Assistance publique. Paris, 1862.

the hospitals and other charitable institutions of a corresponding kind in London, with a view to obtaining information upon the questions in dispute. Their report gives a great deal of information upon the points of comparison, which is condensed in a report upon their work1 presented to the Academy by M. Husson.

The second source of confusion to which I refer is the fact that the things to be compared do not, in fact, correspond with any exactness. Not only are the institutions and their inmates very different in character in the two countries, but there is also a difference between the French and English methods of distribution of inmates among the various institutions which are in other respects most analogous, and between which alone any comparison can be made. The population of a French hospital is not drawn from exactly the same social level as that from which our English hospitals are filled, nor are the hospitals supported by quite corresponding classes in the two countries. M. Husson has pointed out, in his report upon the work of MM. Blondel and Ser just mentioned, that the great difference between the practice of the two countries is, that in France the sick are considered as the charge of the State, which maintains all the principal hospitals, while the old and infirm are chiefly cared for by private charity; with us, on the other hand, legal provision is made for the support of the old and infirm, while hospitals and dispensaries for the sick poor are supported chiefly by private charity. The hospitals in Paris, being public institutions, are open to all classes, the admission of patients depending merely upon the opinion pronounced by the medical authorities upon the urgency of the case; and when once admitted, they are provided with everything they want-not only with food and medicine, but with linen and a hospital uniform, their own clothes being, if necessary, cleaned and repaired during their stay in the hospital and returned to them on leaving. In some cases, also, the children of patients are received into the asylum for "Enfants assistés" during the period required for the parents' treatment in the hospitals.

1 Rapport sur un Ouvrage de MM. Blondel et Ser. Extrait du Compte rendu de l'Académie des Sciences morales et politiques.

While the very poorest are thus supplied gratuitously with all they want, however, some payment is regularly required from those patients who can afford it. In most of the London hospitals, on the other hand, there is a rule requiring a recommendation from a subscriber as a condition of admission, although this may be dispensed with in urgent cases; in many hospitals all the patients are required to provide some part of their own diet (generally tea and sugar), to bring a change of linen, and to pay for their own washing. The effect of these regulations is, of course, more or less, to exclude the very lowest class; so that the population of a Londen hospital is of a somewhat higher grade than that of the public hospitals in Paris, which in fact correspond, as to the nature of their population, not exactly with hospitals in London, but with hospitals and workhouse infirmaries combined. The infirmaries in the "Hospices généraux" and other asylums for the destitute and infirm are intended only for the treatment of the inmates when ill, not for the reception of destitute patients like those who are admitted into our workhouse infirmaries.

These sources of confusion, though they destroy the exactness of any possible comparison, yet afford a strong instance of that which my comparison is intended to show; namely, the difficulty of judging what would be the effect of borrowing any single part of a system which differs from our own in a manner not only so essential but so complicated. For this and other reasons, I shall not attempt to set the two systems side by side; it will be sufficient for my purpose to describe some of the principal features of the French system, with occasional reference to our own institutions. The principal sources from which I shall take this description are M. Husson's work on hospitals, and that of his predecessor in the office of Director of Public Assistance, M. Davenne, upon the "Secours publics en France." I must take this opportunity of expressing my grateful sense of M. Husson's kindness, not only in giving me every facility for collecting information respecting the Paris 1 Études sur les Hôpitaux. Par M. Armand Husson, Directeur-Général de l'Assistance publique. Paris: Paul Dupont, 1862.

De l'Organisation et du Régime des Secours publics en France. Par H. J. B. Davenne. Paris: Paul Dupont, 1865.

hospitals on the spot, but in the still more valuable form of personal communications and encouragement in my undertaking.

It is well known that all the public hospitals of Paris, and the system of public relief which there corresponds to that administered by our own Poor-law, are under the control and direction of a central office, called the " Administration de l'Assistance Publique." But this arrangement is of recent date, and is peculiar to Paris. In the provinces, the hospitals and the "bureaux de bienfaisance" are managed by local boards, called "commissions administratives," the members of which, though nominated by the Prefects and subject to the authority of the Minister of the Interior, are not placed under the control of any central office. I have not attempted to make any inquiry into the management of the French provincial hospitals or other institutions. For every reason it seemed best to confine the comparison to Paris and London, and to occupy myself especially, though not quite exclusively, with the general hospitals of these two cities.

Before the Revolution of 1789, the Paris hospitals, of which the Hôtel-Dieu was by far the oldest and the most important, were quite independent of each other and of the "bureaux de charité." The hospitals were from the earliest times not only served by religious orders, but governed by ecclesiastical superiors. M. Husson1 gives full accounts of the great abuses which were discovered in the Hôtel-Dieu and other hospitals early in the 16th century, and quotes a decree of the Parliament of the year 1505 for its reformation, the means proposed for which are the separation of the spiritual from the temporal management of the hospital and the appointment of lay commissioners for the administration of its temporal affairs. Many similar measures followed, until, as M. Davenne tells us, "C'est à la suite de divers édits, renouvelés plusieurs fois sans succès dans le cours des XV et XVI° siècles, que, par celui du 24 Octobre, 1612, l'administration des établissements hospitaliers fut définitivement retirée au clergé et remise aux mains séculières." (Secours publics, p. 231.) The actual nursing, however, 1 Études sur les Hôpitaux.

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