The Hôtel Dieu of Paris: 1,375 Years and Counting

Paul Campbell
4 days ago
9 min read

It is no surprise that the longest running hospital in the world was founded in honor of the Great Physician. Though Christian history is not without conflict, Christianity has a longstanding history of care for the sick, the poor, and the oppressed. The Hôtel Dieu is no exception to either, and has its own long history of both conflict and care. In fact, the Hôtel Dieu in Paris is but one of many French hospitals founded by the Catholic Church, created to offer Christian charity to shelter, comfort, and treat the ailing poor.

While not technically a hotel at all, much of its history defines it neither as a hotel nor a hospital in the modern sense, but something in between. In modern times, we see hospitals and hotels as entirely different—and indeed they are today—but their roles stem from the same root. Indeed, hotels and restaurants are still recognized as belonging to the “hospital-ity” industry. In early centuries, “hospitals” and “hospitality” were quite synonymous. The name, “Hôtel Dieu,” meaning “Hotel of God,” indicated not only a place to heal the sick, but to offer food and shelter, minister to the poor, welcome the outcast, and comfort the dying.

The First Centuries

The Hôtel Dieu has been in operation since its founding in 651AD by Saint Landry of Paris. Although written records about the Hôtel Dieu do not begin until almost 200 years later, there is enough evidence to believe this date with relative confidence. Saint Landericus of Paris (Landry for short), then Bishop of Paris, dedicated the original hospital to Saint Christopher, the patron saint of travelers, which matches perfectly with its original purpose. As “Hôtel Dieu” became the common title for this type of institution, the "Saint Christopher" was dropped in lieu of the shorter “Hôtel Dieu de Paris.”

The hospital's primary function over the following centuries was more in line with its name, functioning much like a hostel for the poor and the pilgrim. Those with nowhere else to go were offered food and shelter, no questions asked. Citizens, foreigners, Christians, Jews, Turks, pagans: all were welcome. Of course, medical care was offered as well, but this role did not begin to encompass the entire function of the facility until much, much later.

As Paris grew, so too did the Hôtel Dieu, but Paris soon outmatched it. By the 1200's, the Hôtel Dieu consistently had more applicants than it was designed to hold. This difficulty continued for the next several centuries. As overcrowding became more of a problem, it soon became necessary for the Hôtel Dieu to narrow its focus. By the 1500's, it was no longer a hostel for pilgrims and strangers, but entirely focused on healing: offering beds only to the sick, injured, and pregnant. These changes, however, did little to diminish the problem.

The First Millennium

As the Hôtel Dieu neared and then rounded 1,000 years of service, things took a sad turn for the worse. During these centuries, the hospital expanded from 300 to 500 beds, but patients often reached as many as 1,500, especially during times of war or widespread disease. As often happens when demand far exceeds supply, conditions worsened. Typically, in such cases, institutions will raise prices to meet the demand, winnowing down demand to those only able to afford the inflated prices, but charitable organizations cannot do this, and are often reluctant to turn any away. Beds in the Hôtel Dieu often received three patients at a time. With no rooms specifically for surgery, surgeons performed necessary operations in these same beds, with the other occupants still there. Efforts were still made to isolate contagious patients, but in such crowded spaces, it became practically impossible. Mortality rates rose to nearly 25%, far more than other Parisian hospitals.

Like many other charitable hospitals of the time, it became a place of fear. Only the most destitute and desperate cases came there, and many of those who came did not leave alive. During the Renaissance, other hospitals sprang up in Paris, and those who could afford better care stayed far away from the Hôtel Dieu. During the height of the plague, in the early years of the fifteenth century, Marie de' Medici founded the Hôpital de la Cherité. Her husband, Henry IV, founded the Hôpital Saint-Louis, both in a effort to reduce the overcrowding at the Hôtel Dieu.

Despite the horrid conditions, poverty and desperation ensured the hospital stayed in high demand. Despite having 1,200 beds, daily patients rarely dipped below 2,000 and occasionally rose to 4,000. With such high numbers, not only were hygiene and contagion enemies, but meals as well. Malnutrition contributed significantly to not only the patients but the staff: monks and nuns who lived on site. Scurvy was a common condition and almost always fatal.

Further efforts during the 1600's sought to alleviate some of the Hôtel Dieu's financial burdens. At this time, all bridges leading onto the Ȋle de la cité were toll bridges, with revenues going to the government. Louis XIII, then King of France, offered the Hôtel Dieu opportunity to build a bridge of their own, not only close to the Hôtel Dieu itself but also Notre Dame Cathedral. This bridge was granted the right to collect tolls at twice the price of other bridges with all proceeds funding the hospital. Naturally, additional rooms were built upon the bridge—a common practice at the time—for more patients. This bridge lasted for over 150 years before it was replaced by a more modern one, this time without rooms. The name, however, remained: Pont au Double.

Attempts were made to separate contagious patients from other sufferers, but this helped only partly. Pregnant women often had to share beds with each other, leading to higher rates of infection and consequently longer stays to get over the infections that they caught due to the conditions.

**Auguste-Sébastien Bénard's 1810 painting of the Hôtel Dieu, the earliest depition I could find.**

Tragedy and Triumph

The 1700's saw little improvement. Paris continued to grow, and the disparity of wealth worsened. By the end of the eighteenth century, over 18% of the Parisian population was indigent. Every charitable hospital in Paris struggled, but the Hôtel Dieu consistently had the worst conditions. The final tipping point was a fatal fire in 1772. Even after the fire, which destroyed a significant part of the building, the hospital continued to operate—though, by this time, one might wonder how many people were truly helped by staying there. Still, the hospital endured.

**A Painting of the Fire at the Hôtel Dieu, artist unknown (at least to me)**

Unfortunately, "enduring" was about the best that could be said of the Hôtel Dieu during this time. As public horror of the conditions grew, Louis XV ordered the partially-burned hospital demolished. Ironically, while the Hôtel Dieu wallowed in disease, it was Louis XV who succumbed first, dying of smallpox in 1774. The demolition was put on hold, and the hospital still endured.

Something still had to be done, however, and much discussion arose as to what solution would best resolve the many problems which the Hôtel Dieu faced. For this purpose, the Royal Academy of Science commissioned Jaques Tenon and eight others to perform a thorough investigation into the Hôtel Dieu and surrounding hospitals.

Tenon's report, a 500 page monstrosity entitled Mémoires sur les hôpitaux de Paris, confirmed the Academy's worst fears. The Hôtel Dieu was in the worst state imaginable. Filth, stench, and disease were rampant. 1 in 15 mothers died in the Hôtel Dieu, compared to 1 in over 100 at comparative hospitals. Of the 52 hospitals, prisons, and poorhouses that Tenon and his team investigated, it seemed that the Hôtel Dieu was the worst. This examination transformed not only the Hôtel Dieu but medical care as we know it today, outlining a regimen of care and protocols that inspired other facilities to follow suit. Tenon's report is the line of demarcation when “hospital” formally split from “hospitality” in modern language. The Hôtel Dieu was transformed from a charitable organization run by monks and nuns into a scientific organization run by doctors (though nuns still worked actively as nurses and continued to up through 1908). One may rightfully argue over the evils of the French Revolution and the problems stemming from a removal of God from society, but this change in organization of the Hôtel Dieu was, without question, a good one.

From Pariah to Paragon

It was not only the Hôtel Dieu that changed greatly toward the end of the eighteenth century, but France as well. Even though Tenon's report, among others, recommended that the Hôtel Dieu be dismantled, the building managed to remain long enough for France to find itself amid even greater problems. We will never know what renovations might have ultimately been decided upon, but the French Revolution reared its ugly head before any major changes could proceed. As monarchies toppled, the Hôtel Dieu remained. During the height of the French Revolution and the overwhelming bloodshed that resulted from it, the Hôtel Dieu's doors remained open. Thankfully, with the implementation of scientific advancements, the Hôtel Dieu's reputation improved, though it is impossible to imagine any other possible direction, as horrid as the conditions were. It was not until 1801, after the French Revolution, that the damages done almost thirty years before were finally repaired by Emperor Napoleon.

**The Hôtel Dieu and the new Pont au Double sometime after Napoleon's repairs. Mid-to-late 19th century (You can see the towers of Notre Dame behind.)**

As the 19^th century marched onward, the Hôtel Dieu's transformation continued toward that of a modern hospital, including an educational clinic for surgical training that had previously been available only at medical universities. Their purpose was again two-fold: still keeping to the care and healing of the sick—but rather than a place to stay, it became a place to learn. Doctors presented new findings; training centers helped surgeons practice their trade in real situations rather than university classrooms; and new administration infrastructure focused on improving hospital management, so that conditions might never again grow so horrible as they once had been.

Of course, part of this remarkable turnaround is partly due to France's improvement as a whole. While the Hôtel Dieu was arguably the worst hospital in Paris during the 18^th century, Paris itself was hardly better. As widespread poverty diminished during the 19^th century, it allowed the Hôtel Dieu breathing room to expand. It is quite impossible to keep a hospital clean when it has three times the number of patients that it was designed to hold. As Paris prospered, so too did the Hôtel Dieu. In 1847, the Pont au Double was demolished and replaced by a new bridge of the same name, though without the extra rooms built atop it—and without the extra toll, which had stopped along with the old monarchy.

**Building the Foundation of the New Hôtel Dieu, 1867**

Two decades later, in 1867, work began on a new and larger building, still near to Notre Dame, but on the opposite side of the Île de la Cité and it is this new hospital that plays a role in the Student Riot of 1893 and therefore in the 3^rd Callahan Chronicles novel, Grayhound. The Hôtel Dieu, true to its original purpose of helping everyone regardless of their beliefs, tended the wounds of both rioters and police during the Student Riots. The police felt differently, however—at least some of them. One medical student supposedly hissed at an officer, ending in the arrest of the entire surgical staff. I have been able to find no mention of who made this arrest or for how long they were held, but we can hope that someone among the French Police saw the absurdity in this and hastily released them. It is, nonetheless, a fact of history, and you will find it mentioned in Grayhound.

**The Completed Building on the other bank of the Seine - Circa 1900**

Still Going Strong

After 1,375 years, the Hôtel Dieu is still in operation, and is actually the primary casualty center for most of Paris. Though parts of the building are no longer used, you can still visit the Hôtel Dieu, take a stroll through the central garden, and avoid the crowds that constantly swarm around its younger and far more famous neighbor, Notre Dame Cathedral. Despite its troubled past, the Hôtel Dieu endures. Founded some 500 years before the construction of Notre Dame, the Hôtel Dieu has witnessed the Dark Ages, the Black Plague, the Renaissance, the fall of French Monarchy, the rise and fall of Napoleon, and two world wars. It is truly an icon, reminding us that “God's Hotel” does not crumble easily.