The hospital as a character

By : Fernando Neubarth
Médico e escritor. Especialista em Clínica Médica e Reumatologia. Chefe do Serviço de Reumatologia do Hospital Moinhos de Vento. Presidente da Sociedade Brasileira de Reumatologia/SBR 2006-2008. Presidente do Conselho Consultivo da SBR.

26 March, 2021

"Jean-Noël Fabiani is a physician, head of the department of cardiovascular surgery at the Georges Pompidou European Hospital in Paris, and professor of medical history at the University of Paris-Descartes. Author of numerous books, he was also one of the first surgeons in the Doctors Without Borders program."

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At a time when the health-disease binomial dominates all care, catalyzes energies and serves both as justifications and as ignominious omissions of responsibility, his book "The fabulous history of the hospital from the Middle Ages to the present day"(La fabuleuse histoire de l'hopital du Moyen Âge a nos jours. C'est l'hôpital qui se moque de la charité! Éditions les Arènes, Paris, 2016)  is, contrary to what one might imagine, a pleasant and even fun read.

In accessible language, Fabiani reminds us of the associations between the word hospital and its origin in medieval Latin. Host derive from hospes, hence also Hospitale, which generated the French hospital (now hôpital). Along the same lines, hospitable, hospitality and hospice. In short, from hospital to hostel, hotel: an inn that at first served to house the pilgrims, to later become a human repository for beggars, annoying, prisoners, the elderly, the sick and the crazy. Miserable, marginal.

Starting with the first Hôtel-Dieu in Paris, the "God's hostel", from the year 651, the author seems to want to pull all the ember for his escargot, privileging French passages in this long trajectory of evolution in health care. But it is an unequivocal fact that until almost the mid-20th century it was France that dictated much of what can be classified as modern Western medicine. The transformation brought about by the French Revolution, which takes away the power of the religious in the administration of hospitals and the responsibility of these "guests", culminates in Napoleon's initiative to select doctors by public tender to attend to the wounded soldiers, which that promotes an approach with the academy and a more programmatic teaching of medicine. The profile of patients also changed: until then, anyone with possessions would be cared for at home.

Personal experience, professional training and the challenges of the author's career enrich the work with episodes where good humor is not lacking, without neglecting the critical gaze. A good example is the reference to the excessive role of the pharmaceutical industry in the formation of medical knowledge, by institutional and social omission, which generates conflicts of interest and overloads the health system.

There are also issues related to hospital architecture, dissociations between needs and practicality, contrasting health reasons and aesthetic purposes. I understand that there may be, in this, perhaps, a new misunderstanding of the origin of the word, confusing the current conceptions of hotel and hospital. A bias that also serves, not infrequently and with regret, certain objectives of justice, in particular those involved in political fraud who seek a providential temporary refuge in hospitals.

There are many interesting and unique essays: opposing biblical purposes, Queen Victoria becomes an example of painless childbirth; Madame Lafarge, a bastard descendant of the House of Orleans, suspected of poisoning her husband with arsenic, serves as an inspiration for Flaubert's Bovary; the tragic passion that made Ernest Duchesne sick and delayed the use of penicillin for five decades; due respect for a lady with large breasts and the memory of a childhood toy led Laennec to the invention of the stethoscope, the most emblematic medical instrument; the intrepid Jamot is ready to wake up a continent slept by the tsetse fly ... You learn from the narration of successes and failures until this new age of strangeness.

Among so many stories, those of other pandemics, with an emphasis on the great plague. Jean-Noël says that, by order of Pope Innocent VII, in 1233, in the middle of the Inquisition, cats had to be eliminated for their "notorious" relations of servitude to the devil and witchcraft. It is estimated that the bubonic plague transmitted by Asian rats claimed 25 million victims in five years, 30 to 50% of the western population at that time. Lack of knowledge, ignorance of power, and unfounded beliefs - the shortage of cats was certainly not the only cause, but they were sorely missed in harbors back then.

At a time when it would be even more desirable not to need a hospital, a good book should be recommended as a therapeutic resource, preferably to be read at a safe social distance.

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