It was not until 1908 that age was recognized as sufficient grounds for receiving relief. However, throughout the XIXe century, we perceive a hospital impulse towards the elderly, isolated and vulnerable, but also active, even politicized. The end of life has a history.
This book is based on a doctoral thesis prepared under the supervision of Dominique Kalifa, defended in 2015 at the University of Paris 1 Panthéon-Sorbonne. This is an important work, which qualifies an entire historiography that had made the hospice a death house. Following the work of Jean-Pierre Bois and Jean-Pierre Gutton, who focused on the “invention of old age” in the modern era, Mathilde Rossigneux-Méheust is interested in the institutional response to the social question of old age.
The people of the retirement homes
THE XIXe century is indeed a key period in assistance for the elderly; it extends the work of the Mendicity Committee resulting from the Constituent Assembly, which had given an important place to the elderly in the framework of charity and the social contract. Throughout the XIXe century, we see a proliferation of public initiatives in favor of the construction of hospices and retirement homes; they lead to the implementation of the law of April 5, 1910, which established an insurance system guaranteed by the State.
Starting from a central question (who are these thousands of old people who populate the hospices and retirement homes of XIXe century?), Mathilde Rossigneux-Méheust offers a renewed social history of old age, shifting the gaze from administrators to those receiving assistance. She explores the relationship between men and women who grow old in the hospice, assistance institutions and society as a whole. To do this, she focuses on a whole range of institutions: the General Council of Hospices, created in 1801 and which became the General Administration of Public Assistance in 1849; the congregation of the Little Sisters of the Poor, also created in 1849, responsible for various retirement homes in Paris; the Police Prefecture, which is in charge of the Villers-Cotterêts establishment, transformed into a retirement home in 1889; as well as a whole set of small denominational houses that depend on parishes, the Consistory, the Reformed Church of France and the Israelite Charity Committee.
These various institutions are analyzed as legal-political realities, as organizations responding to a demand, but also as systems seeking to produce standards. It is a question of understanding the forms of domination that are inscribed in bodies and spaces and what are, in return, the margins of maneuver of those receiving assistance.
Assistance, a public thing
The sources used are abundant and diverse, but also very variable from one establishment to another. Indeed, unlike the hospices and retirement homes managed by the Public Assistance and the Police Prefecture, the sources relating to private establishments are either incomplete or unclassified and therefore inaccessible. Only the admission registers are found everywhere.
A set of normative documents consisting of admission regulations, internal regulations, circulars and decrees were also used, as well as documents providing information on daily life in hospices: account books, administrative notes and correspondence registers. Letters from assisted persons and accounts of visits allow us to compare the experiences of the elderly in the hospice and the representations that are made of them. Thanks to these sources, Mathilde Rossigneux-Méheust manages to identify in a well-constructed plan the institutional process of the birth of a new category of assistance, that of the elderly who cannot remain at home (“Becoming assisted”), the personal experience of life in an institution (“Ageing in assistance”) and finally that of decline and death (“Declines”).
It was first in Paris that the hospice became the pivot of a new form of social assistance. In the aftermath of the Revolution, the proclaimed interest in the fate of needy old people found a concrete application. More than thirty establishments were built, founded or rebuilt under the supervision of the General Council of Hospices and at least twenty-six were born from initiatives outside this institution: assistance was now a public matter.
In the early days, work was the gateway to assistance, and it was only gradually that age was taken into account. It was not until the circular of 15 January 1908 that age was recognised as a sufficient reason to receive assistance. While home help remained a recognised form of assistance throughout the century, there was a real surge in hospitals aimed at the elderly. The offer was diverse, with both free and paying establishments, public and private, mixed and single-sex; but from the 1840s onwards, a hospital ideal specific to old age was formed, in which tranquillity and comfort were emphasised.
All administrative reports stressing the mismatch between supply and demand for beds, those who are unable to live independently are given priority. Economic vulnerability, advanced age and isolation are the primary characteristics of the assisted populations. However, due to the multiple administrative procedures to obtain a bed, in particular the issuing of numerous certificates, the hospice is ultimately only offered to a small part of the elderly destitute. If admission to the hospice appears to be a real opportunity, it also implies living in a community, wearing a uniform and respecting the rules.
The implications of the right to assistance
The sources provide a concrete understanding of the living conditions at the hospice. The size of the establishments requires a whole management of circulation and food, clothing and pharmaceutical supplies. As in past centuries, work remains a reality of daily life at the hospice. Whether paid or not, community service such as peeling vegetables or sewing is the norm.
Men and women were confined to the same tasks, and it was not until the turn of the century that a divide between women’s and men’s work emerged. At the same time, working hours in hospices were set at three hours per day, with the exception of Sundays and public holidays, and while work was still desirable, it was now seen as a distraction to counteract boredom.
The archives contain many traces of the difficulties of cohabitation and the conflicts that animate the daily lives of those on welfare, quarrels over the occupation of space, the temperature that should reign in the rooms, verbal or physical violence. There are also examples of old people who break the rules (rudeness, drunkenness, theft). Deviations are generally punished, even if we observe a gap between the disciplinary arsenal and the attitude of the directors of the establishment.
From this point of view, life in the hospice underwent major changes throughout the century. The practices of confinement and surveillance borrowed from prison spaces declined to gradually give way to greater freedom and increasing attention given to the words of those receiving care. The elderly in institutions were not marginalized people reduced to silence and their requests were, if not always satisfied, at least listened to.
During the Second Empire, hospices became lands of mutualism; free-thinking societies developed there and one could detect, either through participation in political meetings or through reading a committed press, signs of politicization. These latter illustrate the mutation of the individual as a political being and the fact that the right to assistance confers a new legitimacy on those who benefit from it.
If death is an integral part of life in hospices, they cannot be considered as death houses. It is certain that the few accounts left by residents reveal a strong feeling of vulnerability, the shame of being assisted, of feeling downgraded. For their part, the directors also describe the distress of some, a distress that can take the form of depression, fear, or even violence. Fear of staff, mistreatment, poor care, and theft are recurrent. It is in fact the fragility and dependency linked to old age and the experience of death that emerge from the writings.
Mathilde Rossigneux-Méheust offers a beautiful work, rich, well-written and full of sensitivity, which gives food for thought on the links woven between society and people at the end of their lives.