Kate Elizabeth Shipman BMBCh, MRCP, MA (Hons Oxon) and Sudarshan Ramachandran PhD, FRCPath
Heart of England Foundation Trust, Birmingham, United Kingdom
Exterior shot of L’Hôtel-Dieu de Beaune, Burgundy, taken from within the central courtyard
Charitable hospitals are fairly ubiquitous worldwide and are often associated with religion. Indeed the earliest known institutes devoted to healing were Egyptian temples, followed by ancient Greek temples devoted to Asclepius. The modern idea of hospitals providing in-patient care stems from Christian charitable institutions founded following an ecumenical council, the First Council of Nicaea, in 325 AD. France has a fine tradition of generosity and philanthropy, promoted by the Catholic teaching that charity was required to receive a place in heaven. The Hospices de Beaune refers to a collection of charitable hospitals, alms houses, and orphanages - such as the Pommard and Nolay leper colonies, la Maison-Dieu at Meursault, and later the Beaune orphanage, acquired under a single administration. However L’Hôtel-Dieu stands out of the collection as being one of the finest examples of Northern Renaissance architecture, its original buildings still standing and still used as a hospital until 1971.
The quality of the art, furniture and design of the hospital have always been considered outstanding. L’Hôtel-Dieu rapidly acquired a reputation amongst the poor, merchants, and nobles alike, earning the moniker Palais pour les Pôvres (Palace of the Poor). Currently patients are seen in modern buildings, but the estates of the Hospices de Beaune are large enough to accommodate the hospital and other charities. L’Hôtel-Dieu opened to the public as a museum in the 1980’s and has about 400,000 visitors a year.
History of the Hôtel-Dieu de Beaune
Situated in the town of Beaune, Burgundy, the Hôtel-Dieu de Beaune was founded by Nicholas Rolin shortly after the signing of the Treaty of Arras in 1435 when the Hundred Years' War was brought to a close and the expulsion of the English left the populace of Burgundy destitute. Plague had also recently affected the area, and armed bands of pillaging and murdering écorcheurs ravaged the local area, causing the peasantry to forgo agriculture and flee to walled towns, thus worsening the famine and leaving three-quarters of the population indigent. Philip the Good was the Duke of Burgundy at the time, known for selling Joan of Arc to the English for 100 crowns to bring about the end of the war. The duke’s chancellor, Nicholas Rolin, was unusual in that he was not born into nobility but had been gifted with riches and lands for having facilitated the friendship between the King of France and the Duke of Burgundy (who had blamed the King for his father's assassination) and by brokering the peace treaty with the English. He became one of the first members of the Order of the Golden Fleece, one of the most prestigious orders of chivalry.
Rolin, through the wealth he accrued as chancellor and his third wife Guigone de Salins (a Piedmontese noble woman), founded the Hôtel-Dieu in 1443 as a hospital for the poor. This third marriage was a very happy one, and it is thought to be the influence of his wife that resulted in the building of the Hôtel-Dieu. Rolin declared his love for her by having the floor tiles inscribed with his motto "Seulle" meaning "only her." The institution was also blessed with the support of pope Eugene IV, granted in 1441, and Philip the Good.
The hospital charter is noteworthy. Rolin in his wisdom achieved tax relief and made the running of the hospital independent of church and state, a charter that still applies today. Rolin also founded the sisterhood of nuns, Les sœurs hospitalières de Beaune, to care for the patients. Having disapproved of the severity of the first sisters, Rolin subsequently changed the rules of the sisterhood, opening up the role to anyone of good reputation between the ages of 18-30, allowing them to leave to either marry or join a religious order at a later date. This allowed women to sign up for a limited time, yet be afforded the protection of the role of nun without any stigma or pangs of conscience on leaving the sisterhood later. On Rolin's death, his wife strove hard to protect the charter and to prevent the Church from seizing the organization’s wealth. Soon after, she joined the order to serve the sick until her death. There were some difficulties faced during the French Revolution, but the unusual charter allowed the hospital to regain its wealth and original purpose when Napoleon reinstated nuns; the sisterhood were still caring for the sick up until the twentieth century.
The design of the L’Hôtel-Dieu is attributed to Jacques Wiscrère, a Flemish architect. The structure is formed by two storey buildings around a central courtyard (Cour d’Honneur). Restoration work has been done by Viollet-le-Duc (the infamous medieval and gothic revivalist, who has restored many historic landmarks, including Notre Dame) as well as his son-in-law. Hospital wards, apothecary, kitchen and chapel were all located in these buildings, as well as living quarters for the nuns. The degree of detail in both interior and exterior design is remarkable, in particular the multi-coloured (red, brown, yellow, and green with interlaced designs) varnished roof tiles. These tiles were inspired by central European style, soon becoming symbols of Burgundy, the current tiles recreated between 1902 and 1907. The elaborate decoration and artwork stemmed from the belief that beauty could heal the souls of the poor. Of the 5,000 objects in the collection (half furniture, the remainder includes pots, tapestries and sculptures, mostly dating from the middle ages), the most famous is The Beaune Altarpiece “le polyptyque du Jugement Dernier” by Rogier van der Weyden. Nicolas Rolin himself bestowed an inventory numbering 1501 objects, both art and equipment required to fulfil the purpose of the establishment.
The first patients were admitted in 1452 to the main hospital ward called the “room of the poor.” The room was lined by four-poster curtained beds (still present), which at the time would have been shared by two patients. In an advanced view of the importance of cleanliness, Rolin banned the use of wooden bowls for patients. Instead each person was assigned his own napkin plus tin bowl and mug. The chapel is integrated into the room allowing the patients to take part in Mass. All medical treatment was finally transferred to a modern building in 1971 with the exception of the retirement home.
A new room was created in 1645 by Hugues Bétault, councillor to the King of France, who became a benefactor of the Hôtel-Dieu, saving it from ruin. The walls are decorated with murals representing the miracles of Christ, and the room is named for Saint Hugue. Hugue’s brother, Louis Bétault, also became a benefactor, and a room completing the central court was named for Saint Louis in 1661 serving as a winery. Louis XIV visited L’Hôtel-Dieu in 1658 and criticised the practice of having mixed-sex wards; he donated funds to make arrangements to separate them.
The original pharmacy, where the sisters made all necessary medications, at times with help from apothecaries, still retains a very impressive collection of equipment and a baffling array of ingredients, including powdered woodlice and crayfish eyes. A medicinal garden within the complex provided many of the necessary ingredients. In the charitable vein with which the hospital was founded, the bread ovens were also used to bake bread for the poor, and the hospital charter protected the use of the well for patients only.
Wine and health
It is perhaps no surprise, given the Burgundian saying “no asset being more precious than vines,” that gifts of vineyards were richly bestowed upon the hospital. Since 1457, when Jean Pamplays and his wife made the first gift of vines, vineyards have been donated by many to support the work of the Hospices de Beaune. Currently the estate has around 62 hectares of mostly Côte de Beaune and Côtes de Nuits, and a little Pouilly Fuissé. The gifts were doubly generous in that wine was considered to have both health-giving properties and be rich in nutrition. The sisters of the hospital used wine as a fairly ubiquitous treatment, preferably hot and with relevant plant additions.
Famous fans of the wine include Thomas Jefferson. The wine is sold by auction, originally by candlelight, on the third Sunday of November as part of a three-day wine and food festival, called Les Trois Glorieuses, which started in the early 20th century. Currently run by Christie's, in 2009 there were over 500 bidders from around the world with the sums tending to exceed commercial prices. The health benefits of wine are still being studied and the Hospices de Beaune continue with their illustrious history of cutting-edge healthcare by being actively engaged in research. With the INSERM research centre in Dijon, they are studying resveratrol, found in high concentration in red wine and proposed by some to be responsible for the "French paradox," the low rate of heart disease despite a high fat diet.
God and wine have both proven to be beneficial for the health of Burgundians, at the very least providing an exceptional hospital and other fine institutions. L’Hôtel-Dieu de Beaune is indeed a living testament to the health benefits of religious charity and vineyards.
- Hospices de Beaune”, Wikipedia, accessed October 14, 2014, http://en.wikipedia.org/wiki/Hospices_de_Beaune
- “L’Hôtel-Dieu”, Hospices Civils de Beaune, accessed October 15, 2015, http://hospices-de-beaune.com/index.php/hospicesdebeaune
- “Midnight Mass in Hospital of Beaune”, British Pathé, accessed October 14, 2014, http://www.britishpathe.com/video/midnight-mass-in-hospital-of-beaune
Kate Elizabeth Shipman, BMBCh, MRCP, MA (Hons Oxon) is a trainee chemical pathologist.
, PhD, FRCPath is a consultant chemical pathologist both located in the West Midlands, United Kingdom. He is also an honorary senior lecturer in the department of medicine at the University of Birmingham. Dr Ramachandran is currently interested in metabolic disease and particularly in techniques to establish cardiovascular disease risk. He is a keen amateur photographer and this article is inspired by the beauty he discovered in Beaune.