Social services in Paris during the eighteenth century were dominated by religious organizations and were divided up into the services provided by the hotel-dieu and the hospital general. The hotel-dieu was similar to what a present day hospital was intended for. Its purpose was to care for those in need of medical assistance. The hospital general was a multipurpose building. Within this building and in its close vicinity, there was an almshouse, a workhouse, an orphanage, and a prison for “incorrigible vagabonds.” Hospital generals also served as staging-points for poor travelers. While most large cities provided both a hotel-dieu and a hospital general, Paris had the most complex hospital general as well as the most hotel-dieus.
Within these structures, religion was an enforced institution. For example, doctors in Paris had to swear to defend the Catholic religion. A royal declaration in 1712 said that on the second day of a serious illness the doctor had to warn the patient of “the duty of confession.” As the quest for knowledge of the human body grew amongst the medical field, conflicts began to arise between them and a clergy that was more interested in helping the greatest number of people. For example, in 1788, Descant, a famous surgeon of the day, wanted to reduce the number of surgical patients in a bed to two. The sisters that helped run the hospital did not want this to happen because it would halve the number of people that could be treated.
What these nuns failed to realize, however, was what a report that came out in 1787 brought to the surface. This report indicated that the conditions at the hotel-dieus throughout the city were deplorable. The report stated, “nothing could exceed the wretchedness which prevailed in these abodes of human suffering.” Moreover, the report went on to state that the mortality rate at the hotel-dieus from 1734 to 1786 was dismal. Two out of every nine patients were lost (244,720 out of 1,108,741). For this reason, the report recommended that either the hotel-dieus radically reform themselves or that the patients should be transferred to other hospitals.
The hospital general in Paris was a complex of ten buildings. Of these buildings, the most important were the Salpetreire, the Bicetre, the Enfant Trouves and the Grand Bureau des Pauvres. Each of these structures served a distinct purpose within its walls. For example, the Saltpetreire was a converted saltpeter mine which now housed “erring or lunatic women.” Within this building, these women would be subjected to the most inhumane conditions. Many of them would be chained or confined in airless, low-ceilinged rooms, sometimes five to a bed. The Bicetre housed “madmen.” The lack of regard for the population in the Bicetre was evident by the fact that many would be served their meals while having bayonets pointed at them by soldiers.
Several other small foundations also dotted the landscape of eighteenth century Paris. The Hospice des Quinze-Vingts was a refuge for blind men who were regularly seen as beggars outside of churches. There were also various other charities like the home for the aged that was founded by Cure Cochrin out of his own fortune. The Hospital des Petites Maisons was created to help older married people who could live there for the rest of their lives with food upon paying 1,500 Livres. In 1780, the Societe Philanthropique was founded under the protection of Louis XVI. The main purpose of this organization was to distribute food by means of soup houses. Nonetheless, no matter how much these organizations attempted to alleviate the plight of the poor, they were unsuccessful due to the enormity of the task of providing for such a large amount of people.