PARIS HOSPITALS
FROM THE FRENCH OF M. L'ABBE O. DELARC.
Hospitals convey two very different impressions. If gone over on the day specified for public admittance, everything will be found in perfect order, every article used, every place, will shine with cleanliness; the patients will be seen lying under white coverlets behind the folds of neatly drawn curtains, and the men in attendance will be attired in their best uniforms. Every repulsive object has been put out of sight. But should the visitor command sufficient influence to obtain admission when he is not expected, when no preparations have been made for the public, he will acquire a more correct idea of human infirmity. The atmosphere is thick and heavy, the flickering night-lamp scarcely sheds its pale light around. Here lies one whose groans disturb his fellow-sufferers; there shrieks the victim of fever, endeavoring in his delirium to tear away from the infirmier who is holding him down; further on, half-closed curtains insufficiently conceal the mortal remains of such or such a "Number," who expired a few hours ago. Other details, too harrowing to retrace, shall be omitted, but their fearful reality may not be lost sight of in a faithful account of what scenes do occur in a hospital. A heavy coffin is from time to time viewed at the foot of one of the beds. It awaits the corpse of the sufferer, with whom his nearest survivor may have exchanged converse on the preceding day. These, in short, are some of the sights witnessed without the delusive cover of science or preparations for a public exhibition.
The aversion of the poor for benevolent institutions of this kind is hereby explained, although incessant efforts are being made in France to improve the condition of hospitals in a material point of view; and all the objections now made are to be attributed to mismanagement in the past rather than to shortcomings in the present. In spite of progress, nevertheless, the word "hospice" and the thing itself have retained a signification which is replete with mournful forebodings. On the other hand, repugnance for hospitals is perfectly legitimate when grounded on serious motives, and especially when inspired by a feeling of family love. That man would be worthless indeed who could abandon his relatives to public charity without experiencing some kind of sorrow at being unable to keep them, through a trying illness, in his own home. Examples of moral desertions are nevertheless too frequent in Paris. Physicians are well acquainted with those sham patients who prefer hospital bread to any other, because they have not to earn it. There are, however, certain adversities here below which defy all human foresight, which destroy old-established positions, and render the efforts of a whole laborious lifetime unprofitable. A large portion of some lives is spent in contending with unforeseen, unsuspected vicissitudes. Many may therefore die in a hospital who deserved better; but, as a general rule, this end is brought on by a long course of dissipation, and by oblivion of the most sacred duties. A hospital is not unfrequently the last stage on which retribution is played out.
When families are averse to trust their sick to public charity for reasons given above, it is wise not to argue with natural pride, founded, after all, on a praiseworthy motive; yet all who are anxious to relieve the suffering members of Jesus Christ are none the less bound to improve the present condition of hospitals, as far as they have it in their power so to do.
The following pages are published for the purpose of showing how much there is to be done. Not all the good-will nor all the experiments tried by physicians, managers, and almoners for the alleviation of bitter suffering, will ever be superfluous. Objections ever will be made to hospital treatment that cannot be remedied; and, do what we may, the most active Christian charity will never replace the tender care of a mother, daughter, or sister.
After a careful examination of the question, the first lesson acquired is that home relief is the best solution to the problem of misery and illness in needy families; it encourages the lower classes, besides, to perform their domestic duties.
In one case out of ten, it is highly prejudicial to remove a patient from his surroundings; moreover, it loosens the family tie, and in Paris especially, where these bonds are so slight and so incessantly undermined by false theories, it is a more damaging course than elsewhere.
Statistics are very justly resorted to for the solution of many of our problems, but their conclusions cannot be blindly adopted in medical cases; physicians themselves often warn us against glancing them over without investigation. Figures do, however, undeniably prove that mortality in hospitals is much larger than in private dwellings. A considerable number of patients, to whom fresh air is a boon, cannot breathe a vitiated atmosphere with impunity. Crowding is particularly prejudicial to the wounded and in lying-in hospitals. "In 1861," says Dr. Brochin, in his Encyclopædia of Medical Sciences, "the proportion of patients cured by home relief was 49 to 100, while the proportion of deaths in private dwellings was 9 to 100. During this same period, deaths in the hospitals were 13 to 100. The average space of time required for the treatment of each patient in his own home is from 14 to 39 days; in the hospitals, from 25 to 83. The average cost of a patient per day is 1 fr. 19 c.; the entire treatment of each, 16 frs. 90 c.; whereas, in the hospitals, a patient costs 2 frs. 25 c. per day, and 61 frs. 45 c. for an entire cure. These figures plead in favor of home relief."
A great deal has been said in these latter times of those immense edifices pompously called "Model Hospitals." There is Lariboisière, for instance, and the new Hôtel Dieu. It would have been wiser had the government spent less in one instance, and been more lavish in another; for, while these magnificent buildings were being erected, palaces were also in course of construction all over the capital, and the laboring classes, thus driven from their workshops, were compelled to seek lodgings up in attics or in out-of-the-way localities. If some trouble had been taken to cleanse and widen the poor man's tenement, or had something been done towards putting him in the way of getting food at little cost, we should boast fewer façades, fewer sumptuous edifices, but the work would be more meritorious.
Physicians have energetically opposed the idea of accumulating so large a number of patients in the Hôtel Dieu as it was originally intended it should contain. Let us trust the observations of experienced men will be taken into consideration, and that the number of beds will be diminished before final arrangements are completed.
HOSPITAL BEDS.
Our beds are too close; and another thing which strikes a foreigner on visiting our hospitals is that the divisions which are supposed to seclude one patient from his neighbor, are perfectly useless for that purpose. In many cases, they are done away with altogether. The proximity of beds varies, however, according to the different asylums. Some of the buildings were not intended for hospitals, and their managers have had to turn rooms into wards in the best way they could, in spite of defective architecture. It is difficult to specify the exact distance kept between the beds; but an idea can be conveyed when I state that any patient, by stretching his arm out, without any great exertion could easily touch his neighbor's hand.
In many hospitals, the beds have been coupled by two and two, so that, if two patients are thus closer to each other on one side, the distance is larger from other patients on the opposite side.
There is, however, always space enough left for a night-table between every two beds. In most hospitals, beds are hung round with white calico curtains; but in some asylums they are omitted, and in these there is literally nothing to hide patients from view. Such a system of total exposure is perfectly inhuman. I should say it originates in a spirit of medical socialism; for it compels sufferers to exhibit their wounds to each other during the doctor's visit. Some men and all women cannot endure this ordeal without a struggle. Why not sympathize with that which can be alleviated, if not entirely cured? What would be our feelings if, when brought low by fever and diet, we had to lie near a man who is breathing his last, and to remain in full view of his corpse for long hours after he had expired? But, as before said, the larger number of hospital beds are hung round with curtains, maintained in opposition to our Paris doctors, who have repeatedly protested against them, insisting that all hangings draw unwholesome miasms, and are therefore receptacles of contagion. This objection is not unfounded; eminent practitioners experience great uneasiness on the subject, and the curtain difficulty has often been debated by managers of sanitary institutions.
Endeavors have been made to obviate the evil by a renewal of hangings every six months; in spite of the great expense, the difficulty exists. It is next to impossible to ventilate a ward encumbered to excess with beds and hangings; and, if the principals of hospitals do still advocate curtains, it is because they are actuated by motives of a moral order. In M. Husson's Study of Hospitals we find: "These calico divisions are a great comfort to female patients; it is a great relief to them to be able to conceal their diseases from the public gaze, and thus to isolate themselves from surrounding wretchedness. This feeling of modesty, or shyness in other cases, will long resist the most eloquent exhortations of our doctors on general salubrity."
Our present hospital regulations do not carry out the purpose for which curtains are intended. It is usual to draw them all back at eight A.M., and they are left open until the doctor's visit is over and the wards have been swept. This lasts till about mid-day. The consequence of this arrangement is that, during the most delicate operations, such as the dressing of wounds, the doctor's examination, and the change of a patient's linen, there is no sort of privacy around the sufferer, no more consideration shown for women and young girls than for others. In the day-time, another regulation prevails. Inspectors forbid concealment behind the curtains on account of the difficulty they would experience on surveying proceedings in the wards. For these reasons, the curtains are elegantly looped aside, and contribute more to the decoration of the beds than to use.
Every ward contains two rows of beds, placed along the lateral walls in such wise that the patient's head is near the wall, and his feet turn towards the centre of the ward. Why could not a low partition, covered over with stucco, be raised between each bed? This separation need not exceed 1 metre 50 centimetres in height, nor 1 metre 50 centimetres in width. It would part the beds, and not obstruct ventilation in the upper regions or down the central passage. If the ward were lighted by a sufficient number of windows to allow of one being opened in each of these "cells," the circulation of so much fresh air would greatly benefit the sick.
The front of each cell being open, surveyors would find their task rendered easy, neither would their inspection be hindered by a small iron rod being affixed to the outer side of each partition, on which two light curtains might be drawn in case of a death, or when it were absolutely necessary that a patient should enjoy privacy. The slight screens would not entail the same inconvenience as those which are in use at present, as they are mounted on a very complicated plan all around the beds. Whenever a decease occurs, the stucco coating of the low divisions should be washed with a sponge. It is well known that stucco is not a receptacle for contagion in the same degree as drapery.
Such is the kind of cabinet each patient should have to himself, and it should be wide enough for a chair and night-table to find place by his bedside. These and a crucifix are the indispensable articles every patient has a right to. This system would greatly simplify our hospital beds, now consisting of so many and such cumbersome pieces.
A little space might possibly be lost; a ward now containing twenty-five patients would only hold eighteen; but, on the other hand, what an improvement, and how much healthier an arrangement in a medical point of view!
Patients have certain communications to make to their friends on the days set aside for public admission which are not intended for the hearing of strangers; and, when the hour of death is nigh, it is but natural they should be allowed to hold converse with their relatives without any witnesses. Even this semi-retirement is denied them under the present system; whereas the plan proposed would secure the preservation of family secrets. It will, perhaps, be alleged that the patient would thus be isolated from his fellow-sufferers. By no means. As above remarked, the cells would be open down the central passage, and each patient could see his opposite neighbor. This, added to the going to and fro of infirmiers, doctors, sisters, and regular visitors, affords quite enough excitement for an invalid.
Neither is this an innovation. It was once tried at Munich, and, if but imperfectly carried out, no hygienic objection was made to it. We find this organization existed in one of the oldest hospitals in France, the Tonnerre Hôtel Dieu—a monument described by M. Viollet Leduc in his work, Dictionnaire Raisonné de l'Architecture Française du XI. au XVI. Siècle. The learned writer says this institution can bear comparison with the most boasted foundations of the present day. In the archives of the Tonnerre Hospital we find the following document. I quote because it forcibly reminds us of S. Vincent de Paul: "The poor are provided for in this institution, and the convalescent are kept a whole week after their cure, when they are sent away with a coat, a shirt, and a pair of boots. A chapel will be added having four altars. The brothers and sisters in charge are twenty in number; they are bound to provide food and drink for the wayfarer; to board pilgrims and strangers, clothe the poor, visit the sick, comfort the prisoner, and bury the dead. The brothers and sisters will not take their meals before the sick have been attended to...."
On closing this paragraph, a question arises whether people in the dark, middle ages were not more solicitous for the poor than in the XVIIIth century. A glance down a report written for Louis XV. on the Hôtel Dieu will corroborate this.
We shall doubtless hear it objected that partitions between hospital beds will inconvenience the doctors and medical students; that it will be difficult to approach patients; and young physicians will declare they cannot follow the chef's instructions near enough. It will be said, further, that, when any operation is going on, the limited space allowed by a narrow cell must exclude the use of surgical instruments.
The following considerations clear the first of these objections; but, in a strict sense of the word, the only essential thing is that the physician should not be impeded in his movements round the sufferer. He, his assistants, and about seven or eight more are all the spectators necessary, and these form a sufficiently large audience. The central passage down all wards affords room for more. Even as the beds are now placed, it is not easy for a larger number to get nearer.
As to operations, they are carried on in a special hall, to which the patient is carried; patients never are operated on in the wards.
THE DOCTOR'S VISIT.
The great everyday occurrence in a hospital is the doctor's visit. It begins at about eight A.M., and lasts till eleven. The chef, a term designating the head-physician, examines each sufferer in turn, inquires into his or her state, and dictates prescriptions, which are taken down by an outdoor student. He is also attended by indoor students, other outdoor students, postulants, and auditors. The two latter must have gone through a course of two years' study before they are privileged to walk the hospitals. The postulant is not admitted before he has gone through a special examination, and then becomes an outdoor student. The highest degree under doctor is that of an indoor student; all are, therefore, familiar with medical science excepting the auditor, who, though he may have studied two years in the schools, is but a dilettante—a kind of amateur authorized by the chef to follow him on his rounds with the students. Many even call themselves auditors who slip in unperceived with the crowd. When the head-doctor is followed by all these young men, his cortége is very numerous. There are often as many as fifty in our principal hospitals, seldom less than thirty in the minor ones. Thus, without any amplification of a known fact, a patient has to see about forty strangers round his bed every day. He is operated on in public. Not a line of his features contracted by pain escapes the notice of indifferent spectators; not a motion of his muscles is unheeded. The professor meanwhile develops his medical theories on the living body, studying the "case" with care.
Let us for a moment imagine that your own daughter is lying at the hospital. She is twenty; you have brought her up with all the care and solicitude parents owe to their children; you have often said in her hearing that modesty is the loveliest adornment; that it replaces whatever else is wanting, and can be replaced by nothing. For twenty years, you have watched the growth of her budding virtues; her Christian advancement has been your daily care. Her state now requires she should see an eminent physician once every day. Look into your heart. What is the sensation you feel there at the idea of her being examined by forty or fifty medical students besides?
It is an indignant protest against their attendance.
It is the mission of a priest to be made the confidant of many sorrows; he has to suffer with the sufferer, to mourn with the mourner; and he can state that, of all trials which attend medical treatment in hospitals, there is not one more distasteful than the doctor's visit, especially to women. I appeal to any who have heard patients converse together; I appeal to any brother in the ministry. Is this not the great cause of repugnance for hospitals?
On the other hand, medical science has certain rights; doctors have to go through an apprenticeship, practitioners must follow a course of practice on living beings before they are qualified for operations; it is therefore indispensable that the head-doctor should be followed by disciples, and the height of absurdity to require he should go round the wards alone. It is necessary, likewise, that postulants and students should be present; for it frequently occurs that they are called on to dress wounds during the doctor's absence.
Their attendance is consequently unavoidable; but, this being the case, it is all the more desirable, in the name of female modesty, and in the name of common respect for a needy suffering female, that the presence of noisy auditors should be done away with. They crowd the wards, and learn very little. It should be with medical science as with every other: students ought to have become familiar with the rudiments and theories of their profession before they practice; and a few years in the private schools should be gone through before beginners walk the hospitals. The crowd is perfectly intolerable at the hour of the doctor's visit in our best hospitals, especially at the Cliniques and Charité. This might be remedied by each medical student being bound to keep to one asylum for an allotted space of time, let us say one year, after which he could be removed to another. One of the good effects instantly resulting from this would be that our central city hospitals, instead of being crowded to the neglect of others, would find the number of spectators greatly thinned for the benefit of minor hospitals now forsaken. The great thing in all questions relating to benevolent asylums is to examine whence the stand-point is taken for their consideration. Two principles present themselves: common sense and humanity say that physicians and surgeons are intended for hospitals, not hospitals for physicians and surgeons. Medical science—and here we allude to the materialistic and unsound branch of that science—replies: "By no means. Inconvenience must be tolerated, science and progress go foremost."
Let us manfully, though sadly, give up a share for scientific progress (which is not an imaginary thing); and, on looking into it, let us reflect on the bitterness of that irony which so often leaves us to utter the word equality, coupled with that other word, fraternity, which is just as little understood. Hospitals will not answer the end for which they were instituted until the smallest of those who flee hither to hide their misery and sufferings obtain the same respect, deference, and care lavished on the man who owns a yearly income.
Some time ago, a woman afflicted with an internal disease was carried to a hospital. The head-doctor examined her on the following morning, and immediately concluded that her case was too grave to be remedied.
He declared any attempt made to operate on her would prove fatal and hasten death; the only thing he could do was to prescribe lenients, in order to alleviate intense agony so long as life held out. The young students around him urgently insisted on the operation being performed; whereupon the physician, turning towards them, and finding expostulation unprofitable, said: "If this patient were my wife, gentlemen, I should not attempt what you suggest, I should leave her in peace; you must, therefore, not expect me to do otherwise by this woman...."
Such words as these should be engraved in letters of gold on the hearts of all practitioners.
THE POOR MAN'S DEATH.
A fact that has often been set forth by Christianity is that the secrets of man are revealed on his death-bed. Then it is that every syllable he utters, every motion of his spirit, are full of significance. The smallest sign is a ray of light by which a whole lifetime can be read; and, if the amount of faith in a man is thus disclosed, how easy it is to compute the amount of faith in a nation from what is supplied by observation in so many single cases!
O mors! bonum est judicium tuum!—O death! thy judgments are equitable!
No man is better qualified than the priest to look into this matter. A large portion of his time is spent by the dying, and my own personal experience has confirmed me in the following observations.
The most striking features as regards faith in the dying are moral dejection and an almost total absence of hope. These are the inevitable consequences of the efforts which have for some time been made to uproot religious principle from the hearts of the people. It is no wonder that hope fled with her divine sister, faith. Can any thinker form a notion of the state of a man who has been down-trodden all his life, who has been looked on as a bearer of burdens and a misérable, and who has nothing to hope for in a future state?
We read in Holy Writ that, when the waters of the deluge began to decrease, and Noe looked out of his ark after his arduous struggle with the elements, he saw a dove, bearing an olive-branch, fly towards him; the bird was the herald of good news, the harbinger of future deliverance.
Our poor, when exhausted by long adversity, look out in vain for the dove, and that hope which carries peace and help seldom brightens their last moments. Death to such as these is nothing but acquiescence in blind fate. What can a priest do in such cases? Teach and enlighten. Very true; but the patient's physical condition does not give him much time to do this thoroughly, nor can the sufferer always attend to the little the priest can do. The thing left to be tried is the awakening of the dying man's memory. The priest therefore recalls the scenes of boyhood, talks of a mother's teachings, of the village church, the long-forgotten first communion, etc., etc. If the poor man come from the South or from Alsace, the patois of his native place rouses wonderful reminiscences; but it is useless to attempt reasoning. A plain-spoken statement of fact that is neither commonplace nor trivial often creates a great impression. It is a mistake to use unrefined phraseology in the hope of redeeming the illiterate by descending to the level of their intelligence; the lower classes prefer plain but elevated language, and value the price of the liquid according to the cost of the vase in which it is contained. Returns to God in the last day are very scarce and always leave much room for the mercy of the Almighty; but it is something to have brought about a desire for the last sacraments, and to have been able to set forth, though imperfectly, one or two of the great truths of Christianity.
Three dissolving elements have greatly hastened the degenerate condition of Paris workmen, and, in general, of the lower classes in this capital. They are the wine-shop, the club, and the journal.
The enormous rate at which wine was taxed under the Empire forced the heads of small families to give up keeping a provision of ordinaire in their cellars; and, as wine could not be kept at home, it had to be fetched from the nearest wine-shop. There was also an additional reason why the usual barrel could not be kept. Houses no longer afford the luxury of a cellar to each flat, and those who could have afforded to pay the duties had no room for a cask of wine from the provinces. But there was the wine-shop; and alcoholic mixtures, colored with dyeing tinctures or logwood, were resorted to instead of the wholesome draught of thin but unadulterated wine which every Frenchman, a few years ago, was so accustomed to. When once the habit is acquired of turning in at a wine-shop, many are the baneful results which ensue; first drunkenness, then extravagance, bad associates, low talk and discussions round the counter, broils—all of which soon get the better of an originally upright conscience unsupported by firm principle.
The evil effects of drink were never known to breed in France such a cankerous wound as that which has spread among us since the siege and the Commune. Prior to these melancholy events, alcoholic patients were only now and then brought to our hospitals, but they have increased out of all proportion within the last few years. There can be no mistaking such cases with the following symptoms: delirium, inflammation of the lungs, extraordinary irritability, then languor and that sudden debility which is the forerunner of death. No sooner did a Communist suffer amputation than he expired; for it is almost impossible to operate on men who are in a continual state of intoxication.
Paris clubs were first heard of towards the end of the Empire. M. Emile Ollivier thought a good deal of these gatherings; but they have, in reality, proved to be a most disastrous institution. The only good they accomplished was to propagate a correct idea of the intellectual and moral degeneracy of our people. The lower classes met for no other purpose than that of uniting all their ignorance and hates. What errors, what curses, fell from those short-lived tribunes! What frantic applause welcomed false theories! No European nation could have resisted this trial, much less than any other the French, who are so credulous, so fickle, so sensitive to all outward impressions. The seeds which bore such noxious fruit under the Commune were first sown within Paris clubs.
As to the public press, it would be loss of time and space to demonstrate how that has contributed to general demoralization. The Siècle, the Opinion Nationale, etc., are read at all wine-shops. The smallest fault or misdemeanor committed by any one connected with the clergy is exposed by these journals to general scandal, aggravated by spiteful comment, exaggerated, then thrown as a rare morsel to open-mouthed multitudes. Such manœuvres are very hurtful with an unenlightened populace, who never discriminate between religion and those who profess it. To them the priest and the faith are synonymous. If the former is immoral, the latter can be good for nothing. A certain amount of logic is wanting by which the contrary could be demonstrated; but the larger proportion are incapacitated for so intellectual an effort. It would lead too far were I to analyze more closely the workings of the three causes which have destroyed our religious and moral convictions. Suffice it that the wine-shop, the club, and the journal have exercised a pernicious influence, and that our working-classes have not the means in their power wherewith to avert it so long as their education is considered complete at the age of twelve. From the day a mechanic commences an apprenticeship, he never hears the name of God, unless it is coupled with some curse on the lips of his elders. The church, Jesus Christ, the sacraments, soon become objects of derision.
In short, the end of such an educational system and of such a life is that the poor man who is carried to a Paris hospital, there to die, knows that he will no sooner have breathed his last than his body will belong to medical students; and as to his soul, that better part which, had it been cultured, would have been a glorious harvest for eternity, he cannot comprehend any discourse concerning it; if compelled to listen because he cannot help himself, he falls back on his pillow in morose indifference.
When a nation, once so devout, has come to this, some anxiety is felt for its future; and the words addressed to Ezechiel the prophet rise to our lips: "Lord, can a new life ever animate these scattered bones?"
THE POOR MAN'S BURIAL.
The deeper we dive into the subject of Paris hospitals, the more are we impressed by the melancholy spectacle of extreme misery presented. It is as if we stepped into Dante's circles, and saw nothing before us but horror; only here we look stern facts in the face, and have nothing to do with grand poetic conceptions. It is life, it is reality, it is anguish in a most poignant form; for I have now to speak of the mortal remains of Christians, of brothers, of men like ourselves. When a death occurs in the Paris hospitals, the corpse of the departed remains for one or two hours in the ward, after which space of time it is enveloped in a sheet and carried out on a litter by two infirmiers.
None who have ever seen this abandoned cortége will forget it. The corpse is instantly conveyed to an amphitheatre, where it is left, after being stripped of every thread of linen which covered it. Here it lies for forty-eight hours or more, according to the arrangements made by relatives, or to orders received from the authorities. When no objections are made by relatives, indoor and outdoor students proceed to the autopsy of the body.
Laws and regulations have been laid down, by which a certain number only of dead bodies are allowed for medical science; but these rules are frequently infringed, and too much precipitation has often been the cause of needless distress in poor families.
When the necessary formalities have been gone through, the corpses in the amphitheatre are divided into two series: those claimed by relatives, and those which are left to public charity.
We shall see what becomes of both, after a few preliminary considerations.
The mortal remains of all Christians are sacred in the eyes of Catholics. We never erect a temple, or build an altar, without consecrating a spot therein for the relics of a saint, which lie thus honored, like the corner-stone of an edifice.
Neither does the church authorize Mass to be said in any place not having a consecrated place for relics; and on such alone may the body and blood of Christ rest during the holy sacrifice.
Our belief in the resurrection of the body; our assurance that Christians will, on a future judgment day, either rise in glory or stand to hear their eternal condemnation, renders it impossible for us to look on the mortal remains of Christians as do materialists and the professors of unbelief. What to the latter is nothing but a dead body, a fit object for study, is to us a sacred deposit whence immortality will germinate. It is, therefore, no wonder if Catholics are so solicitous to obtain proper burial for such remains. In this instance, as in all others, Christianity is in perfect harmony with the tenderest aspirations of our kindred.
When it so happens that relatives of the deceased can afford to pay down the sum of fourteen francs (eight for a coffin, and six for the municipal tax), a bier is provided, and the body is buried; if the deceased leaves behind enough money to cover the above expenses, he is buried in like manner, and, if any sum remains over, it is employed according to the will expressed by the deceased. In some cases, survivors are willing to incur more expense than that which is included in an outlay of fourteen francs; for, although this insignificant sum is sufficient for a coffin, it does not suffice for a shroud nor for any body-linen.[47] Moreover, if the family cannot afford to pay fifty francs over and above the fourteen required, the body is interred in the common grave.
The common grave! What a train of sad thought this lugubrious idea gives rise to! It is no longer, thank God! what it was; the bodies are not now thrown, as before, pell-mell in a deep grave. A coffin is provided for each, according to the rule given above; but even in our days, the burial of a poor man is not what it should be.
Fancy a long ditch, in which the coffins are sunk as close as possible, and in juxtaposition; the spaces between are filled up with children's coffins, so as to leave no intervening space. When the soil is covered over this vast grave, it is not possible for each to have a cross above, and it is impossible, likewise, for relatives to know the exact spot occupied by the remains of a beloved parent. Grave-diggers have, of late, had orders to allow more room for the coffins; but until a radical rule is enforced, and until each corpse is authorized to have a separate grave, relatives of the departed are at the mercy of grave-diggers.
However narrow and confined the space thus left for each coffin in the common grave, that small share is only allowed for five years. After that short length of time, the bodies are exhumed, and the bones gathered to the catacombs. The big ditch, now vacated, again yawns for what the diggers call "a fresh set," and soon the work of decomposition again silently commences for another term of five years, and so on for all time.
Leaving every other consideration aside, does it not strike every reader that the period allowed for rest in the common grave is much too short? Many bodies are dug up in good preservation when thus brutally disturbed, and there are persons who can testify to the horror they have experienced when called on, by some untoward circumstance, to be present at these impious exhumations.
I shall not add to it by overdrawing this sufficiently painful picture; it does not become the pen of a priest to color with such ghastly elements. My object is simply to state plain facts—to be exact, and not leave room for the slightest contradiction.
Arguments have been advanced in favor of the good influence of this supreme misery of the common grave. It is hoped that such an end will be avoided, and that it will carry a lesson with it—a horror for relying on public charity; but it nevertheless deals a direct blow at every feeling of respect for kith and kin. Is not the grief caused by eternal partings deep enough, without being increased by our acquiescence in the total abandonment of the tomb?
Any one in authority who could suppress the common grave, and give every poor man separate burial—any one who, having done this, could render such a tomb inviolable for a reasonable term of years, would confer an immense blessing on Parisians.
When M. Haussmann gave out the project of a large burial-ground at Méry-sur-Oise, it met with opposition in all quarters. It was alleged that to send corpses out of Paris by special railway conveyances would be considered disrespectful to the dead. But, we would inquire, is the present system of interment in the common grave calculated to inspire respect? The distance of a few miles, of even a few leagues, would be nothing compared with the privilege of a separate tombstone over a separate grave; and it would be much wiser to have remote cemeteries, provided they were hospitable. This question of the common grave not only interests those who die within the hospitals; it is also of importance to the indigent wherever they die in misery—a state many have fallen into since the war and the Commune.
The above disclosures are certainly very melancholy, and yet I have only described the case of the more fortunate among the poor—of those who have, after all, a hallowed spot to rest in after death. There are some to whom even this boon is denied.
The interests of science and those of families being here antagonistic, it is necessary to quote a few figures:
On the 1st January, 1867, the number of sick in the Paris hospitals was 6,243. In the course of that year, the number was increased by 90,375; total, 96,618. Out of this total, 79,897 left the hospitals cured; 10,045 had died. There remained, therefore, on the 1st January of the following year, 6,676 sick persons. In 1869, the number of invalids in the hospitals was 93,355, out of which 82,283 left cured; 10,429 had died on the 31st December of the same year.
We have, in short, an average of 10,000 deaths every year; and the result shown by the above furthermore is that the proportion of deaths to invalids is about that of 1 to 8½. I will not dwell on this latter conclusion, which, however, proves the danger of accumulating a large number of cases under the same roof, and also the necessity of a reform in our establishments. I will pass on to the 10,000 deaths resulting from the report. In this average number, there are from 1,000 to 1,500 claimed by relatives, who purchase a right of separate burial for fifty francs; and there are from 3,500 to 4,000 who are conveyed to the common grave. The remaining 5,000, not claimed by any relative or friend, are dissected, either at the Ecole de Médecine or at the Rue Fer-à-Moulin. These corpses are used after dissection for the manufacture of skeletons, for anatomical institutions, for museums, etc., etc. The detritus collected when these purposes have been accomplished are carried promiscuously in biers to the Hospital Cemetery, which is situated near the Fort of Bicètre, not far from Turg.
No spectacle can be more distressing than that of this cemetery, to which access is gained by a side door in the wooden palings that fence it round. It is a dreary plain, and has no sign to show it is consecrated to the departed. The ridges look more like trenches than graves. No living being has been led here by love to mark the mounds with a cross, neither is this sign of redemption erected over the door, as it is in the smallest hamlet; no holy-water is sprinkled over these graves. Why should no difference be made here between a churchyard and a public field? I again repeat that these 5,000 corpses are those of the deceased not claimed by relatives; and this it is which constitutes a striking inequality between the indigent who die in their own homes, and those who die in the care of public charity. When a poor man dies on his own bed, and has not left any provision for his burial, the mairie of his arrondissement has to provide a coffin gratis, and the municipal tax is suppressed; whereas no such generosity as a coffin is granted in the hospitals. A man dying here without the fourteen francs mentioned is carried to one or other of the amphitheatres. There is no favor shown, even were the departed your own mother. Fourteen francs for a ransom, or the heart of the parent that beat for you is the prey of medical students. A priest is sent for when the corpses have been dissected. It is then his duty to stand up, facing the mutilated remains, and to read the prayers for the dead. When this ceremony is over, they are conveyed to the hospital cemetery. Need I insist that the religious rite performed as I have described is of little consolation to those who are left behind? It is not a separate service for each of the deceased; several bodies lie together, or rather, the members of their bodies—a galling sight, which surviving relatives avoid. Neither can it be defended; for, until the religious ceremony has been performed, the remains are not collected in a coffin; they lie unshrouded, a hideous exposure of human flesh.
I here repeat that I am not opposed to medical science, nor to the dissection of certain corpses; it is an unavoidable process for the benefit of progress in surgery, and for that of the living; what I have in view is the welfare of the state as acquired by respect for ties of kindred, and by veneration for the mortal remains of Christians.
There is a middle course to be adopted very evidently—a course by which surgery and science generally would be promoted and the religious convictions of Christians not trampled under foot. I propose that, when any person claims the body of a parent or relative in the first degree, that person should be privileged to obtain gratuitous burial, if he or she prove utter incapacity to meet the expenses. This proof is acquired by a certificate from the almshouses, by receipts from the Mont de Piété (Loan Bank), by a line from the mairie, and other sources. A relative in the first degree implies a father, mother, wife, husband, son or daughter, brother or sister. Even were grandfathers and grandmothers included, the 5,000 corpses left to hospital charity would not be greatly diminished; 4,000 bodies would remain at least for dissection—those of wandering strangers, of lawless, unknown persons mostly—and surely this is a high figure for the indigent population of one capital. There are no better surgeons in Europe than those of Göttingen, Wurzburg, Salerno, Montpellier, Vienna, and Berlin, and yet these cities have not near so many dead bodies in their amphitheatres.
I say that a Christian must feel deeply for those who are left without proper burial, a sign on their tombs, a stone to perpetuate their memory for a few years. All this is replaced by the jests of indifferent students; and, instead of the friendly parting kiss, there is the surgeon's instrument on a loved brow.
O old reminiscences of the early catacombs! how far off, how faint, are you now. Who is there in this large city that remembers what a work of mercy it is to bury the dead? O village churchyards! in the centre of which rises the humble church-spires; O graves! over which the fervent kneel every Sunday—graves that never open to give up their dead; O hallowed spots! around which thoughts of God are united with thoughts of our dear ones, and where the past is folded, as it were, hand in hand with the future, how do I prefer you to these grand cemeteries, in which there is so much show for one or two, and nothing for the poor man who will want no more!
FOOTNOTES:
[47] When an invalid enters a Paris hospital, the shirt he had on is taken from him. It would be but charitable to return it to the family in case of death.