With the rise in permanent armies in Europe in the 1600s, governments and monarchs faced the problem of discipline, control and care of soldiers. The Hotel des Invalides was established in Paris in 1670 as a kind of general hospital for veterans. Similar motives led to the establishment of the Greenwich Hospital in London in 1705. Many of these hospitals were more medicalised than existing civilian hospitals. Facilities were well designed and soldier patients were carefully divided in terms of their afflictions. They were also highly regarded as teaching establishments. By the first decade of the 1700s, France supported a network of military hospitals with fixed ratios of medical staffing. Also noticeable was the high proportion of surgeons in these hospitals.
The military hospitals inspectorate was a force for standardisation across France. The country’s first royal inspector of (civilian) hospitals and prisons, Jean Colombier, was appointed in 1781. Throughout the 1780s he toured provincial hospitals, ensuring that military-style standards were maintained in civilian hospitals. His recommendations were enforced by provincial authorities and military notions of hospital organisation were introduced. Inmates were hospitalised because they were sick, not just poor. Equally, the institution existed in order to heal patients through medical intervention. Civilian hospitals were soon after described as machines à guérir, healing mechanisms, or healing factories. Although historians date the ‘birth of the clinic’ from the outbreak of the French Revolution, many of the modern medical approaches associated with hospital medicine, including bedside teaching, autopsies and statistics, were already appearing in military hospitals in the early 1700s.
M Foucault, The Birth of the Clinic: an Archaeology of Medical Perception, A M Sheridan trans (London: Tavistock, 1976)
C Jones, ‘The Welfare of the French Foot-Soldier from Richelieu to Napoleon’, in The Charitable Imperative (London: Routledge, 1989)