These early hospital-like institutions were deeply religions spaces, closely linked to the church, and their main focus was general care for the poor - food and shelter - along with spiritual treatment.
They promoted the link between spiritual healing and actual medicine, best exemplified by the ever-present Christus medicus in these medical institutions, an artistic representation of Jesus as a physician.
Paris established its general hospital in 1656, and it contained three divisions for men, women, and children - the Bicêtre, the Saltpêtrière, and Pitié respectively.
[3] Though hospitals were used to house specific groups of people (orphans, the poor, prostitutes, immigrants), they were also legitimately involved in their care, and were not just another form of penitentiary.
[5] Overcrowding created very poor health conditions, which in turn gave these hospitals high mortality rates - nearly 25% at the Hotel Dieu.
Many concepts of modern hospital medicine are considered products of social and political change of the French Revolution, arising in the late eighteenth and early nineteenth centuries.
Patients described Paris' hospitals as poorhouses, noting severe overcrowding, and that only those with the means to pay could secure a personal bed.
[7] In addition to the political factors of the revolution, several practical circumstances created a unique environment for change in Paris' system of hospitals.
Due to the lack of hospital regulation under the revolutionary government, the bodies of these patients were used for medical experimentation on an unprecedented scale.
A notable example was the Hôpital de la Charité, remodeled under the leadership of physician Jean-Nicolas Corvisart and several architects; changes involved removing the hospital's chapel, adding an amphitheater for clinical demonstrations, as well as dedicated rooms for surgical operation, hydrotherapy and electrotherapy.
By 1785, the Hôtel-Dieu de Paris had established a formal training procedure, including both demonstrations and hands-on experience, and was moving away from separate fields of medicine and surgery.
The lack of qualified surgeons coupled with the unprecedented scale of casualties in the revolution motivated medical education reform.
A range of new ideas arose from the need to provide large-scale systematized treatments: foster parenting, wet nursing, and the soup kitchen were all innovations originating from Parisian hospitals.
Doctors of the period, including François Victor Mérat de Vaumartoise (who studied under Jean-Nicolas Corvisart), noted the likelihood of patients exaggerating in their description of symptoms and pain, as well as an inability of the uneducated poor to accurately describe their experiences.
This Paris School came to be in part due to a high concentration of talented and innovative clinicians, led by figures such as Jean-Nicholas Corvisart, Philippe Pinel, and Xavier Bichat.
It was during this time period where traditional limits disappeared and innovation occurred, with numerous talented doctors in addition to the modernized facilities and abundance of patients.
Perhaps one of the biggest factors that turned Paris into the clinical capital of the world was the high quantity of cadavers produced[11] - a significant contributor being the Hotel Dieu - and used for dissection and medical education.
Hospitals prior to the Revolution were religious institutions where the ill would seek comfort - for example, the Sisters of Charity operated the Hôpital de la Charité.
However, the total separation of religion and medicine was not to last forever - as early as 1801 Jean-Antoine Chaptal called the Sisters of Charity to reopen their hospitals, as the Parisian infrastructure could not handle the massive influx of patients.
This marked a permanent gender reversal of roles as the female nurses were essentially demoted in comparison to the new physicians.
[11] The improper disposal of body parts from dissections became a public scandal as noted by Sebastien Mercier in Tableau de Paris in 1783.
Rene Laennec invented the stethoscope in 1813, which he then used in combination to the discovery of tubercles in the lungs to fashion a new diagnostic process for identifying tuberculosis.