Designed according to the most advanced knowledge available at the beginning of the 19th century, it underwent regular refurbishment to keep pace with the evolution of medical and sanitary techniques and the number of patients admitted.

On October 15, 1793, the departmental council decided that the buildings should be used as a hospital and that the borders of the Maison des Pénitentes, from which the nuns had been expelled in February, could be transferred there, but the operation never took place.

[9] This last mission was for a time entrusted to the Hospice des orphelins, founded in 1774 by the shipowner and slave trader Guillaume Grou, but due to a lack of funds, the establishment closed in 1815.

The premises were dilapidated, their upkeep having been made difficult by the change of regime in France, with hospice revenues linked to taxes and privileges abolished by the Revolution.

In 1826, the Hospitaller Order of the Brothers of Saint John of God proposed opening a facility for the mentally ill at the Saint-Jacques begging depot, similar to those already run by the congregation.

He proposed to transform the former begging depot into a hospice for the elderly, the infirm, and orphans, and to erect new buildings to accommodate the insane under the conditions then recommended by psychiatric medicine.

[14] The operation was suspended due to the 1830 July Revolution,[18] but then the social situation led the government of Louis-Philippe I to favor plans to open charity workshops to keep the unemployed busy.

[19] In April 1832, a cholera epidemic struck Nantes, and to remedy the Hôtel-Dieu's insufficient capacity, the Sanitat, the Refuge des orphelins, and the hospice Saint-Jacques became temporary hospitals.

[25] The Douillard brothers called on a civil engineer (apparently named M. Pervac[26]) to install a steam-driven pumping station to bring water up from the Loire, and a rainwater collection basin.

In addition to a small outpatient department (annex of the Hôtel-Dieu), Saint-Jacques comprised three hospices: one for the insane, one for the destitute elderly and infirm, and one for orphans and deaf-mutes.

[29] Its location away from the center of Nantes, on a site open to the wind, responded to the theory that the air, filled with supposed "miasmas", was a cause of mental illness.

Doctors Ange Guépin and Eugène Charles Bonamy in particular emphasized the project's success in this respect, although they had reservations about the buildings to the north and the first floors, which were subject to damp seepage.

[30] From 1835 onwards, even before the building work was completed, the Hôpital Saint-Jacques took in lunatics from the Loire-Inférieure and neighboring départements, which had no psychiatric asylum of their own, even though the law required them to do so.

[31] Not all "lunatics" were on the same footing: an 1875 study showed that the cure rate at Saint-Jacques was slightly higher than the national average, but also indicated that internees whose families paid for their stay were much better off than indigent patients.

Following the publication of the law of July 3, 1906, a weekly rest period was introduced, and in 1955 this type of activity was banned, as it was considered to be forced labor, unreported employment, and unfair competition with hospital staff.

Things changed at Hôpital Saint-Jacques: the youngsters were supposed to apprentice with a foster family, but it seemed, in the early days, that this practice was less beneficial to the children than what the Sanitat had offered.

[39] Branch hospital In 1848, the arrival in Nantes of the railway line from Tours to Saint-Nazaire led to an influx of wounded and sick, which the Hôtel-Dieu, already overcrowded and in poor condition, could not cope with.

[42] Respect for residents' freedom of conscience was enshrined in the hospital's rules, but proselytizing was unavoidable: one patient complained of having suffered reprisals for refusing to comply with a religious rite.

Their conduct was far from irreproachable in the eyes of the administrators, as in the case of Georges Clemenceau, who avoided dismissal only because those in charge "suggested" to the father of the future minister that his son be withdrawn from the establishment.

The idea was to create a "colonie hospice", a branch of the hospital far from the city, to house "non-dangerous lunatics, as well as foundlings raised in the countryside and destitute or infirm old people".

When France went to war against Germany in September 1939, memories of the previous conflict prompted the hospital management to dig shelter trenches in the main courtyard, request authorization to purchase 4,500 masks to protect against asphyxiating gases and create a washing center for mustard gas victims.

The destruction of the Pirmil bridge, cutting off communication between the south and north of the Nantes conurbation, would deprive the southern Loire region of rapid access to a hospital.

After five weeks of sabotage and intelligence gathering, notably concerning the Salorges warehouses on Quai de la Fosse, Péneau's deputy is arrested by the Gestapo on denunciation.

[69] Psychiatry Division In 2009, the reorganization of the psychiatric center provided the opportunity for an architectural creation designed to link the heterogeneous parts of the complex, the fruit of a historical evolution carried out without concern for unity.

[71] As part of a university hospital center, Saint-Jacques is under the responsibility of a supervisory board which, in 2012, was chaired by Jean-Marc Ayrault, President of the Nantes urban community.

[76] The Centre nantais de la parentalité is a child psychiatry service whose aim is to support the parent-child relationship and treat early developmental disorders.

[88] The department's training mission is aimed at students of medicine, physiotherapy, podiatry, and osteopathy, as well as those applying for the “brevet d'état d'éducation physique et culturisme”, nurses and general practitioners within the framework of the “capacité de médecine du sport”.

[96] The center can provide rehabilitation care for hemophiliacs (in an infrastructure whose range of specialties has led to national recognition),[97] athletes who have suffered trauma (notably players from FC Nantes and Hermine de Nantes, FDJ-BigMat cycling team or the Crédit Agricole cycling team),[98] musculoskeletal disorders (within the regional “Lombaction” network),[99] osteoarticular infections,[100] management of the consequences of falls among the elderly,[101] management of multiple and polytraumatic injuries.

The central pharmacy is also home to OMEDIT Pays de la Loire, the regional health agency's support structure for drugs and medical devices.

On hearing of her departure, Brigaut, the Major's son, her childhood friend, now a carpenter's boy in Nantes, came to offer her the sum needed to make the journey by car, sixty francs, the entire treasure trove of her painstakingly amassed apprentice's tips, accepted by Pierrette with the sublime indifference of true friendships, and which reveals that, in a similar case, she would have taken offense at a thank you.