Quelques éléments de l’histoire des premiers services ouverts en France

Abstract

AimsIn France, the creation in Paris of Henri-Rousselle Hospital and its “open” psychiatric ward, not subject to the Law of June 30th 1838, one hundred years ago, traditionally marks the end of the asylum period. In the first quarter of the last century, however, several other experiments had been conducted with the same perspective of opening up psychiatry, in general hospitals and in some specialized establishments before and after the First World War. This work aims to clarify the meaning of some specialized terms then in use in the medical field and to compare the objectives and the means implemented by the authors of these various experiments. MethodsThe reports, publications, and scientific communications of the period studied are consulted, compared, and analyzed. ResultsThe primary objective of the services established within general hospitals (variously called wards for delirious patients, wards for psychic patients, isolation rooms, etc.) was to ensure the treatment of people suffering from organic pathologies with psychiatric expression: delirious, overexcited, and noisy persons. Emmanuel Régis in Bordeaux in 1902, or Gilbert Ballet at the Hôtel-Dieu in Paris in 1904 paved the way for other achievements. Some of these wares also have a triage function, from which, after a period of observation, the insane person is directed to an asylum. Public hospital services for nervous diseases offered to the person suffering from disorders called psychoneuroses and then neuroses, free cures for the poorest, while the wealthy classes frequented private establishments. As for the open psychiatric wards created within or as annexes to the asylums, they were also for the most part initially intended to respond to these same unmet needs, rather than to improve upon care of the insanes. At the Clinique d’Esquermes with Georges Raviart and at Fleury-les-Aubrais with James Rayneau, two extraordinary experiments were carried out, a source of inspiration for the reformist alienist current, the first in which all patients were placed under the law of 1838, the second in which some were subject to the common hospital regime. During the First World War, the military neuropsychiatric centers offered to asylum doctors enlisted a new field of practice with psychoneurotics and confused patients who were not usually encountered in asylums. DiscussionThe term open psychiatric ward refers to a wide variety of achievements, responding to specific needs, mainly full education for medical students and better care of organic neuropsychiatric pathologies and neurotic pathologies. The achievements aimed at improving the care of “alienated” patients placed in asylum would be a rarity and an afterthought. ConclusionIn the interwar period, the shortcomings of the asylum system finally led to several initiatives, including that of André Mahon in Mont-de-Marsan, which is very close to what would be generalized in the 1950s in psychiatric hospitals; as had previously been enacted in Fleury-les-Aubrais, patients hospitalized at their own request and those hospitalized against their will share the same premises: with Mahon, the ward is open to everyone. As for the achievement of Edouard Toulouse, which would mark its time, it inspired the significant Rucart Circular of 1937 and the Model Regulations of 1938, even though their practical application wouldn’t taken effect for another twenty years.