garden and goat’s field. Also in the same area of the hospital in 1722 and on either side of it, the “Fleur-de-lys” and “De la Mort vivante” arrangements. It was thus a very “hospitable” district, which was on the outskirts of the town of Bulle. In 1763, it was noted by the public prosecutors of the Geneva hospital “that the wooden beds were subject to bedbugs and ringworms”. They were then replaced by iron beds between 1765 and 1808 [LOU 00].
Located on the outskirts of the town or village, the hospital, since the Middle Ages, has been a community that requires a minimum of organization. It is close to a spring, a river or the ditches of the town8. From a cadastral and architectural point of view, the main “built volumes” (the largest buildings) of a small town in the Middle Ages, particularly in Freiburg (see Figure 2.1), Bulle and Romont, up to the end of the 18th Century, were the castle, the church, the hospital and the “fief bourgeois” (town house or town hall).
The lay hospitals under the Ancien Régime, particularly in French-speaking Switzerland, then bore a name whose very term, “l’hospital”, lospitaul or l’épetau or l’épetô in 17499, recalled a mission of welcoming, providing hospitality and protection to human beings. These terms were confused with the terms “maison” or “ménage” mentioned above. In other regions or countries, we found similar characteristics to this space and time that we have just presented. For example, a bourgeois hospital was founded in Porrentruy in 1406, and a bourgeois hospital also existed in Neuchâtel in 1539 [DON 00]. Also in 1377, the hôpital de Lausanne (the Lausanne hospital) bought a pair of shoes and a few lengths of cloth to make a garment for a hospital employee (Jaqueta Botlery) [MOS 05].
Figure 2.1. A lay hospital on Catholic soil in 1606.
(source: Musée d’art et d’histoire de Fribourg. Plan of Freiburg by Martin Martini – Copperplate engraving published in 1606. Photo B. Rochat 2006, retouched to highlight the hospital building)
This practice of providing shoes and work clothes was common for hospital servants, as very often their meager salary was paid in cash and in kind. There were also establishments in France similar to those in French-speaking Switzerland. In 1745, for example, the governess of the hôpital français d’Avranches (French hospital of Avranches) was paid an annual salary of 100 pounds and employed six servants to help her, who were given 30 pounds a year in addition to food and lodging [NAD 93]. Finally, in Montbéliard (France), for example, in the 15th Century, when the town had 1,500 inhabitants, the establishment with its outbuildings, kitchens, barns, stables and cowsheds had a capacity of 12 beds and a 13.77-meter-long façade on the street [CUS 86, BRO 98]. With its kitchen, cellar, equipment, barn, stables, garden, meadows and vineyard, this establishment was very similar to other establishments in Switzerland (Bulle, Romont, Yverdon, for example). With its 12 hectares of cultivable land, “the hospital at the end of the 15th century was a notable agricultural owner in the Montbéliard area” [CUS 86]. Near Montbéliard, the city of Belfort also (600 inhabitants in 1442) had its lay hospital with 10 beds [BRO 98]. Similarly in Canada, we know of Jeanne Mance who had a first hospital built in Ville-Marie (Montreal) in 1642 with a capacity of 8 beds (six for men and two for women). In this new work space thus created, “it seems that Jeanne Mance was, from 1642 to 1653, the only resource person in the colony in matters of health, assisted by servants, between one and four, and at least two other women of the colony: the wife of Louis d’Ailleboust and Madame de la Bardillière” [YOU 05].
These “maisons”, this “ménage”, this “hôpital” and ultimately this institution, needed to function. Only, “institutions don’t think, they don’t have goals or motivation. Only the flesh and blood participants in institutional life think, have goals and reasons to act” [DEM 99]. A hospital institution is therefore not just a set of rules or functions, but “a set of normative schemes that allow both situational and discourse settings of practical interactions between people and with the world. As schemas, norms are reflexive procedures, linking knowledge and capacities” [DEM 99]. So, which participants can we rely on to make a healthcare institution work?
Generally speaking, the activity of the staff and their know-how are close to the traditional occupations of women on large farms or in collective households. Women (governesses or servants) may serve the hospital (caring for residents) according to a maternalistic ideology. “When the rector was married, his wife was, as it were, a partner in the hospital management” [ROD 05]. The men (servants), if any, were more likely to have outside activities on the estate (maintenance, leaf removal, harvesting, livestock supervision, etc.). A sort of handyman, they were also in charge of the heavy work. The Romont hospital (Switzerland) in 1733, for example, had a “master of low works” to help the gardienne (caretaker). He was housed in the hospital [NAD 12b].
Once the care environment had been constructed, the first written statements served as prescriptions. They focused on how to carry out the activities of daily living in a community. If we want to find the first knowledge of the care discipline, we need to find the first walls framing the word and the first texts indicating what needed to be done to make everything work. In general, as Louis-Courvoisier points out, “the importance of those involved in healthcare is inversely proportional to the information disclosed by the sources” [LOU 00]. This is also what we have seen repeatedly. Within the hospital in the lay age of knowledge, “the nursing staff was the real hub and representative of the influences of the various healthcare protagonists” [LOU 00]. This still seems to be true today, even though the hospital has changed a great deal. That is why in our conceptual model of nursing published in 2013, we sometimes refer to “cultural intermediaries”10 and “health mediators” to describe the professional role of nurses as intermediaries between the various health stakeholders [NAD 13]. In fact, as we also specify in this conceptual model, “any intermediary is a mediator, even if often it is not recognized as such” [DES 19].
1 1 For example, in the city of Freiburg (Switzerland), four public hospitals followed in the wake of the first: the hôpital Notre-Dame (Notre-Dame hospital), the hôpital des Bourgeois (the Bourgeois hospital), the hôpital cantonal I (Cantonal I hospital) and the hôpital cantonal II (Cantonal II hospital). The latter, which is still in operation, is today called the “Hôpital Fribourgeois”, on the Bertigny site in Freiburg. With each transformation, the existing staff is transferred to the new building and their knowledge also evolves with the characteristics of the new place.
2 2 Nothing new, but we tend to forget this when we talk today about nursing knowledge or “advanced practices”. “From the outset, one fact is clear: the general hospital is not a medical institution. In its functioning or in its purpose, the general hospital is not similar to any medical idea” [FOU 72].
3 3 For Teysseire, who was inspired by the abbot of St. Peter, “in the 18th century, a person was called poor if he had only his work to survive” [TEY 93].
4 4 At the end of the 18th Century, the Geneva hospital owned 180 hectares of forest, which represented about “18% of the forest heritage of the territory of the Seigneury of Geneva” [ZUM 85].
