The Salpêtrière Hospital: From Confining the Poor to Freeing the Insane

With this intention to nourish and educate, King Louis XIV founded the General Hospital on a site where 20 years earlier Louis XIII had built the “Petit Arsenal” to provide gunpowder (saltpeter) to the great arsenal on the other side of the Seine (1, 2). For this reason, the hospital would come to be known as La Salpêtrière.

The streets of Paris at the time were full of beggars, and the Sun King could not tolerate their presence diminishing his radiance. Some 5,000 of the city’s poor, primarily women, were soon forced to stay in the hospital. In time, the General Hospital became the hospital for women. At the end of the 17th century, according to the uses of the era (3), four categories of women were placed there (4). “Bad” adolescents were kept enclosed in the “Correction” section, with the idea that they could be rehabilitated. Women labeled as prostitutes filled the “Common” section. Women who had been imprisoned with or without sentences were quartered in the “Jail,” and inhabitants within the “Quarter of the Insane” were those who usually had been sent there by their families. In 1679, the institution housed 100 women who qualified as “mad” and 148 women with seizure disorders. By 1833, the numbers had increased to 117 insane women under treatment, 105 insane women labeled as sick, 923 women with mental illnesses characterized as incurable, and 266 women with seizure disorders (Charcot Library Archives, Hôpital Pitié-Salpêtrière, Paris).

The destiny of those enforced to the “Correction” or the “Common” sections was the deportation to Louisiana, which had to be peopled and needed women. This was the fate of Manon Lescaut—immortalized in the novel of Abbé Prévost and by the opera of Puccini. The insane remained, enclosed in their solitary confinement boxes into which the water of the nearby Seine river rose. Their only form of therapy was being kept in chains.

Philippe Pinel (1745–1826) is credited with freeing the insane of the Salpêtrière, as depicted above in the 1876 painting by Tony Robert-Fleury now hanging in the Charcot Library of the Salpêtrière Hospital Medical School. The painting is an idealistic view of Pinel and of his heroic act when he orders the chains to be removed from an insane woman. This initiative, the first step to humanizing psychiatry, probably came from Jean-Baptiste Pussin (1745–1811), who had himself been hospitalized in the Bicêtre Hospital and had chosen to be part of the nursing staff there. Pussin observed that the insane individuals improved when he took off their chains. He came with Pinel to the Salpêtrière as his assistant and head of the nursing staff and convinced him to order the freeing of the mentally ill (1, p. 132; 3).