The social transformation of hospitals and the rise of medical insurance in France, 1914-1943

Historical Journal

Volumn 41, Issue 4, 1998, Pages 1055-1087

  Smith, Timothy B ^a  

^a QUEEN S UNIVERSITY   (Canada)

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[No Author keywords available]

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EID: 0011233064     PISSN: 0018246X     EISSN: 14695103     Source Type: Journal    
DOI: 10.1017/S0018246X98008164     Document Type: Article

References (218)

1. This subject receives only a passing remark in P. Guillaume's recent synthesis, Le rôle social du médecin depuis deux siècles, 1800-1945 (Paris, 1996)
2. and is not mentioned in C. Maillard, Histoire de l'hôpital de 1940 à nos jours: comment la sanlé est devenue une affaire d'état (Paris, 1986);
3. O. Faure, Histoire sociale de la médecine (Paris, 1994);
4. J. Imbert, Histoire des hôpitaux en France (Toulouse, 1982), and Les hôpitaux en France (7th edn, Paris, 1996). Abbreviations: AAP, Archives de l'Assistance Publique, Paris; AP-CMA, Assistance Publique de Paris, Comptes Morales et Administratifs; AP-CS, Assistance Publique de Paris, Procès-Verbaux des Séances du Conseil de Surveillance; BMO-CMP, Bulletin Municipal Officiel-Conscil Municipal de Paris, Délibé rations; CSAP, Conseil supérieur de l'assistance publique, fascicules; AML, Archives Municipales de Lyon; HCL-D, Hospices Civils de Lyon, Délibérations; HCL-CMA, Hospices Civils de Lyon, Comptes Morales et Administratifs; CML, Conseil Municipal de Lyon; CGR, Conseil Général du Rhône, Délibérations; RH, Revue des hôpitaux; RHF, Revue hospitalière de France; CM, Concours médical (Le); REB, Revue des établissements de bienfaisance; RP, Revue philanthropique; JE, Journal des économistes; RS, Réforme sociale (La); REP, Revue d'économic politique; RPP, Revue politique et parlementaire.
5. This theme is absent from the standard histories spanning the inter-war period. See, for example, J.-J. Becker and S. Berstein, Victoire et frustrations, 1914-1929 (Paris, 1990);
6. P. Bernard and H. Dubief, The decline of the Third Republic, 1914-1938, trans. A. Forster (Cambridge, 1985);
7. A. Sauvy, Histoire économique de la France entre les deux guerres, 1916-1931 (4 vols., Paris, 1965-75).
8. S. Reynolds's new book, France between the wars: gender and politics (London, 1996), contains a good chapter on the social services but nothing is said about the hospitals. Often, the landmark social insurance law of 1928 is mentioned in one sentence or paragraph by historians. Misunderstandings, too, abound: M.-J. Imbault-Huart, for example, wrote in the widely read French journal, Le débat, 79 (1994), reprinted in L'état providence: arguments pour une réforme (Paris, 1996), p. 294: 'l'état refusera jusqu'en 1941 de prendre acte de la transformation de l'hôpital en centre de soins', and 'seuls les indigents étaient admis à l'hôpital jusqu'en 1941'. This article will show that this is inaccurate.
9. R. Kuisel, Capitalism and the state in modern France (Cambridge, 1981). For the most recent expression of this view
10. see E. Weber, The hollow years: France in the 1930s (New York, 1994).
11. R. Tomlinson, 'The disappearance of France, 1896-1940: French politics and the birth rate', Historical Journal, 28 (1985), pp. 405-15;
12. F. Thébaud, 'Le ministère de l'hygiène, de l'assistance et de la prévoyance sociales', REB, 1920, pp. 1-3;
13. S. Pedersen, Family, dependence and the origins of the welfare state: Britain and France, 1914-1945 (Cambridge, 1993);
14. M. L. Roberts, Civilization without sexes: reconstructing gender in postwar France, 1917-1927 (Chicago, 1994);
15. M.-M. Huss, 'Pronatalism in the inter-war period in France', Journal of Contemporary History, 25 (1990), pp. 39-68.
16. Grinda, quoted in RH, 1920, p. 65.
17. V. Berridge, 'Health and medicine', in F. M. L. Thompson, ed., The Cambridge social history of Britain, 1750-1950, III (Cambridge, 1990), p. 222. The rough figure of 6% for France has been calculated as follows: 2.2 million people were covered, out of a population of roughly 37 million.
18. See M. Guaguery, 'Les assurances sociales et les établissements hospitaliers', RH, 1928, p. 381.
19. B. Abel-Smith, The hospitals, 1800-1948 (London, 1964), pp. 135-8;
20. CML, 30 Dec. 1913. Berridge has made this observation with regard to British hospitals, but it seems just as applicable to the French case, 'Health and medicine', p. 203.
21. E. Delore, Nos hôpitaux de demain (Lyon, 1917), p. 32.
22. F. B. Smith, The people's health, 1830-1910 (New York, 1979), p. 259. L. Lallemand, Etude sur la nomination des commissions administrathes et des établissements de bienfaisance (Paris, 1887). Other impediments to medicalization lay in the attitudes of French people themselves, many of whom were still peasants in 1914, wedded to traditional folk medicine. E. B. Ackerman, Health care in the Parisian countryside, 1800-1914 (New Brunswick, NJ, 1990), p. 164.
23. A. Fleury, De l'Assistance Publiqus à Paris (Paris, 1901), pp. 238-9;
24. A. Mitchell, The divided path: the German influence on social reform in France after 1870 (Chapel Hill, 1991);
25. D. S. Barnes, The making of a social disease: tuberculosis in nineteenth-century France (Berkeley, 1995);
26. T. B. Smith, 'The ideology of charity, the image of the English poor law, and debates over the right to assistance in France, 1830-1905', Historical Journal, 40 (1997), pp. 997-1032; Delore, Nos hôpitaux de demain, P.9.
27. From a 1913 report of the Inspection Générale des Services Administratifs, in RH, 1927, pp. 239-41;
28. RP, 1920, p. 273;
29. A. Picard, Le bilan d'un siècle, 1801-1900, VI (Paris, 1907), p. 59. For the British story, see J. M. Winter, The Great War and the British people (Cambridge, MA, 1986).
30. AAP D-346/2, Cent ans d'Assistance Publique à Paris (Paris, 1949), p. XXI.
31. A. Mignon, La service de santé pendant la guerre, 1914-1918 (4 vols., Paris, 1926-7), iv, pp. 679-702;
32. L. Bernard, La défense de la santé publique pendant la guerre (New Haven, 1929);
33. L. Murard and P. Zylberman, 'L'autre guerre (1914-1918) : la santé publique en France sous l'oeil de l'Amérique', Revue historique, 276 (1986), pp. 396-7.
34. AAP D-306, AP-CMA, 1914, pp. 75, 77.
35. AAPD-312, AP, Compte-moral, Hôpital de la Pitié, Historique de l'année 1920;
36. AAPD-308, Hôtel-Dieu, Historique de l'année 1916, p. 2;
37. AAP D-311, AP-CMA, 1919, pp. 7, 8, 9.
38. H. Joly, Contre les maux de la guerre: action publique et action privée (Paris, 1915), p. 8.
39. M. Lheritier, Tours et la guerre (New Haven, 1926), pp. 38-9.
40. REB, 1919, p. 1;
41. HCL-CMA, 1915, p. 15;
42. HCL-CMA, 1916, p. 15;
43. HCL-CMA, 1918, p. 14;
44. HCL-CMA, 1919, p. 18;
45. HCL-D, 2 Oct. 1918;
46. HCL-D, 1919, p. 457.
47. D. Dessertine and O. Faure, 'Assistance traditionelle, assistance nouvelle: cout et financemcnt: 1850-1940', in A. Gueslin and P. Guillaume, eds., De la charité médiévale à la sécurité sociale (Paris, 1992), p. 146.
48. Statistique de la France, Statistique annuelle des institutions d'assistance. Années 1934, 1935 et 1936 (Paris, 1941), p. xxiv.
49. AAP, AP-CMA, 1919, p. 10.
50. AAP D-314, AP-CMA, 1922, 'Note relative à l'Hospice Leprince en 1922', p. 345;
51. AAP D-313, AP-CMA, Hospice Debrousse, 'Historique de l'année 1921', p. 285;
52. Ministère du Travail, Statistique de la France, Statistique générate des institutions d'assistance, années 1920-21 (Paris, 1923), p. xxvi.
53. RP, 1920, pp. 270-1.
54. CML, 26 Dec. 1916, 16 Oct. 1916, 7 May 1917.
55. CM, 3 Jan. 1926, pp. 37-8. The process of opening up the hospitals to the middle classes had begun in Grenoble and Annecy in 1913, but accelerated during the war. CSAP 126, Annexe v, P. 139.
56. CML, 13 May 1918.
57. Delorc, Nos hópitaux de demain, p. 5.
58. CML, 7 Feb. 1916.
59. G. Lebas, 'La vie chère et les hospices et hôpitaux en province', RH, 1920, pp. 182-3, 203-4, 229-31.
60. Guillaume, Le róle social, p. 145;
61. M. Huber, La population française pendant la guerre (New Haven, 1931);
62. H. Jackson, 'L'impact de la guerre 1914-1918 sur la protection sociale', in Gueslin and Guillaume, eds., De la charité médiévale à la securité sociale, p. 118;
63. A. Prost, Les anciens combattants et la société française, 1914-1939 (3 vols., Paris, 1977).
64. P. Pessemesse, 'Les Unions hospitalières et la Fédération hospitalière de France: leur action de 1918 à nos jours', RHF, 1937, p. 92;
65. E. Brizon, 'L'origine de l'Union hospitalière du sud-est', RH, 31 May 1932, pp. 244-7.
66. A journal was founded, the Bulletin mensuel de l'Union hospitalière du sud-est (later in 1918 renamed the Revue des hôpitaux, and, as of the mid-1930s, the Revue hospitalière de France), in order to disseminate information across the nation. Bulletin mensuel, May-June 1918, pp. 14-15.
67. RH, May-June 1918, p. 15.
68. L. Murard and P. Zylberman, L'hygiène dans la République: la santé publique en France, ou l'utopie contrariée, 1870-1918 (Paris, 1996), p. 547.
69. C. S. Maier, Recasting bourgeois Europe: stabilization in France, Germany, and Italy in the decade after World War I (Princeton, 1975);
70. R. F. Kuisel, Ernest Mercier: French technocrat (Berkeley, 1967), and Capitalism and the state in modern France;
71. W. H. Schneider, Quality and quantity: the quest for biological regeneration in twentieth-century France (Cambridge, 1990).
72. Gimbert, 'Pour la réforme de l'administration hospitaliè re', RH, Nov. 1918, pp. 22, 15;
73. P. Alepée, 'Vers un ministère de l'hygiène', RP (1918), pp. 412-15.
74. RH, Dec. 1918, p. 4.
75. RP, 1918, p. 336.
76. G. Drouineau, 'Les œuvres philanthropiques de l'après- guerre', RP, 1919, p. 8;
77. G. Cahen, L'autre guerre (Paris, 1920), pp. viii, 3-11, 159.
78. A. H. Reggiani, 'Procreating France: the politics of demography, 1919-1945', French Historical Studies, 19 (1996), pp. 725-54;
79. M. S. Quine, Population politics in twentieth-century Europe (London, 1996), pp. 65-6;
80. J. H. Cole, '"There are only good mothers": the ideological work of women's fertility in France before World War I', French Historical Studies, 19 (1996), p. 671.
81. See L. Murard and P. Zylberman, 'La Mission Rockefeller en France et la creation du Comité national de défense contre la tuberculose (1917-1923) ', Revue d'histoire moderne el contemporaine, 34 (1987), pp. 257-81.
82. No sooner than June 1919, the conservative opponent of social insurance, La Réforme Sociale, and its ally the Société d'Economie Charitable, organized a conference to highlight the pitfalls of accepting the Alsatian model into the hexagon, RS, 1 July 1919, pp. 7-11.
83. Another conference took place in November, RS, 1-16 Nov. 1919, pp. 253-83.
84. Briand is quoted in JE, Oct. 1921, p. 146.
85. AAP G-864, Chambre des Députés, no. 5505, Annexe au procès-verbal de la séance du 31 janvier 1923. Rapport fail au nom de la Commission d'assurance et de prévoyance sociales...sur les assurances sociales, ed. M. Edouard Grinda (Paris, 1923), pp. 7, 104, 2. The same alarming rhetoric is evident in AAP C-865, Sénat, no. 435, Annexe du procès-verbal de la séance du 8 juillet 1925, Rapport fait au nom de la Commission de l'hygiène, de l'assistance... sur les assurances sociales, ed. M. Chauveau (Paris, 1925), passim.
86. Imbert, Histoire des hôpitaux en France, p. 302.
87. Both circulars quoted in RH, 1922, p. 345.
88. For example, the CSAP regulation of June 1929 which set out new guidelines for hospital secondary personnel (recruitment, advancement, discipline of), CSAP 133 (1929), 'Statut-modèle des fonctionnaires hospitaliers', Annexe 1, pp. 77-81
89. and the regulations which governed hospital administrators, ibid., pp. 107-9.
90. On opposition to this reform, see CSAP 134 (1930), 'Assurances sociales et hôpitaux', pp. 35-9
91. and CSAP 133, pp. 42-5.
92. G. Cros-Mayrevieille, 'L'état des établissements hospitaliers', RP, 1921, pp. 44-77.
93. M. L. Nicaud, the Inspecteur Départemental de l'Assistance Publique of the Marne, proposed the nationalization of hospitals in 1920, REB, 1920, p. 193;
94. minister of hygiene to prefects, 13 Oct. 1920, in REB, 1921, pp. 132-3.
95. RH, 1922, pp. 352-3.
96. Circular of 15 Oct. 1920, in RH, 1922, p. 197.
97. 'Lc Ministre de l'Hygiène...à MM. les préfets', REB, 1921, pp. 132-3.
98. Circular of 9 June 1922, RP, p. 289.
99. M. Sarraz-Bournet, 'Travaux hospitaliers', REB, 1931, pp. 53-66
100. and 'Esquisse d'une politique hospitaliere', REB, 1932, pp. 259-71.
101. Garnal was a tireless critic of French health policy (or, as he claimed, the lack thereof). For example, 'L'hydre aux cent têtes', RH, 28 Feb. 1934, pp. 51-7.
102. RH, 31 Oct. 1932, p. 544;
103. REB, 1939, p. 119.
104. On the evolution of the ministry, see M. Bargeton and A. Ziegler, 'Historique des ministères sociaux', Revue française des affaires sociales, special edn (1971).
105. Bulletin de la Ministère de la santé publique: textes officiels concernant la protection de la santé publique (2 vols., Paris, 1938).
106. On the Nancy reforms, see M. Gauguery, Les hospices civils de Nancy (Nancy, 1930), and RH, 1922, pp. 382-5.
107. Maier, Recasting bourgeois Europe. pp. 467-9;
108. AP-CS, 12 June 1924, p. 628.
109. BMO-CMP, 31 Dec. 1924, p. 5483.
110. RED, June 1934, p. 219;
111. BMO-CMP, 20 Dec. 1925.
112. On Parisian hospitals and child welfare in the inter-war years, see F. B. Burkhard, 'Henriette Valet's Madame 6obis: French social realities and literary politics in the 1930s', French Historical Studies, 18 (1993), pp. 503-23
113. and his paper given at the American Historical Association's 1997 meeting, New York City, 'Delivering babies: the Assistance Publique of Paris and the administration of maternity services, 1919-1939'. I. Gaussen, 'Principes de fonctionnement de l'assistance publique en France', RHF, Apr. 1938, p. 169.
114. AAP, Administration générate de l'Assistance Publique de Paris, 1920-1937 (Paris, 1937), p. 8.
115. Burkhard, 'Delivering babies', p. 6.
116. Paris had only 20, 000 beds, and not, as C. Rollet claims, 30, 000, in its hospital system at the outbreak of the First World War, 'The "other war" 1: protecting public health', in J. M. Winter and J.-L. Robert, eds., Capital cities at war: Paris, London, Berlin 1914-1919 (Cambridge, 1997), p. 423;
117. Burkhard, 'Delivering babies', p. 8;
118. Administration générale de l'Assistance Publique de Paris, 1920-1937, pp. 12-13.
119. Administration générale de l'Assistance Publique de Paris, 1920-1937, p. 185.
120. P.-F. Armand-Delille, Le Service Social dans les collectivités contemporaines (Paris, 1929);
121. Reynolds, France between the wars, ch. 6;
122. A. Del Re, Les femmes et l'état providence: les politiques sociales en France dans les années trente (Paris, 1994).
123. RH, 1926, p. 3;
124. P. Delore, Tendances de la médecine contemporaine (Paris, 1936).
125. M. Garden, Histoire économique d'une grande entreprise de santé: le budget des Hospices Civils de Lyon 1800-1976 (Lyon, 1980). By 1939, 4, 000 of France's 27, 700 doctors were specialists, and the dental profession increased from 3, 600 in 1921 to 9, 100 in 1937
126. P. Theil, Le corps médical devant la médecine sociale (Paris, 1943), pp. 207-8.
127. For example, RHF, 1936, pp. 602-29.
128. M. Fréjacques, 'L'evolution hospitalière', RH, 31 Apr. 1931, pp. 139, 142.
129. 'Aux Hospices de Montpellier: construction d'un Hôpital de Cliniques', RH, 30 Apr. 1930, pp. 158-68.
130. AAP C-1085, M. Schumann, Ministre d'Etat, Ministre des Affairs Sociales, Les hôpitaux en France (Paris, 1969), p. 44.
131. Guillaume, Le rôle social, pp. 224-5;
132. O. Faure and D. Dessertine, La médecine entre libéralisme et solidarités (1850-1914) (Paris, 1994).
133. P. Montel, Etude sur les prix de journée des établissements hospitallers (Avignon, 1936), p. 10;
134. Theil, Le corps médical, pp. 127-9, 207-8;
135. Statistique Générate de la France, Slatistique annuelle des institutions d'assistance. Année 1932 (Paris, 1935), p. xxvii.
136. M. Rochaix, Essai sur l'évolution des questions hospitalières de la fin de l'ancien régime à nos jours (Paris, 1959), p. 159.
137. Administration générale de l'Assistance Publique de Paris, 19920-1937, p. 9.
138. RH, 1921, pp. 362-3.
139. For example, 'Demande d'emploi', RH, 1922, p. 344.
140. K. Schultheiss, '"La véritable médecine des femmes": Anna Hamilton and the politics of nursing reform in Bordeaux, 1900-1914', French Historical Studies, 19 (1995), pp. 183-214;
141. M. F. Collière and E. Diebolt, Pour une histoire des soins et des professions soignantes (Paris, 1988);
142. P. Strauss, 'Bulletin', RP, 1921, pp. 99-100. During the war, volunteer nurses were, Margaret Darrow argues, 'targets of as much criticism as praise'.
143. M. H. Darrow, 'French volunteer nursing and the myth of war experience in world war 1', American Historical Review, 101 (1996), p. 83.
144. In 1908, there were 13, 956 lay nurses and 12, 362 religieuses in France; by 1939, there were 28, 818 nurses and 13, 719 religieuses. There were, by contrast, 110, 039 nurses in Britain in 1921. Berridge, 'Health and medicine', p. 184.
145. See also F. Thébaud, Quand nos grand-mères donnaient la vie: la malernité en France dans l'entre-deux-guerres (Lyon, 1986), pp. 39, 47-8;
146. Y. Knibiehler et al., Cornettes el blouses blanches: les infirmières dans la sociétéfrançaise, 1880-1980 (Paris, 1984). During the inter-war years, the Fédération National des Unions Hospitalières de France regularly saluted the thousands of religieuses who still worked in French hospitals. Of course, there remained tensions between those who believed that the hospital was no place for the religieuses, but the sisters stayed: their cheap labour was still too useful.
147. Ministère du Travail, Statistique Générate de la France, Statistique des institutions d'assistance. Années 1920-21 (Paris, 1923), p. xxvi;
148. Theil, Le corps médical, p. 129;
149. AML, 742/WP/41, prix des journées d'hospitalisation;
150. AML 742/wp/41, HCL to mayor, 13 Apr. 1921;
151. HCL-D, 6 Apr. 1921;
152. REB, 1934, p. 354.
153. Becker and Berstein, Victoire et frustrations, p. 150;
154. L. Chaptal, 'L'assistance aux personnes dites "de condition moyenne"', RP, 1928, p. 821.
155. See, for example, AAP C-865, Rapport...par M. Chauveau, p. 4;
156. RP, 1925, pp. 50-7;
157. RP, 1929, p. 259;
158. and CSAP 127, séance of 25 June 1925. This concern was raised by Isidore Monteunis in RH, 1923, pp. 380-1
159. and by Léonie Chaptal in RP, 1928, pp. 817-51.
160. CSAP 127, séance of 25 June 1925, p. 50.
161. Ibid., p. 52.
162. E. Morin, 'Essai d'assistance partielle aux Hospices du Havre', RP, 1924, pp. 57-9.
163. Administration générale de l'Assistance Publique, 1920-1937, pp. 172-3.
164. M. Laborie, 'Le rôle social des hôpitaux', RH, 1926, p. 6;
165. Dr Ch. Gosselin, 'Médecine sociale', CM, 22 Aug. 1926, pp. 2184-7;
166. CSAP 129 (1926), Annexe 1, Conseil Général des Bouchesdu-Rhône, voeu, p. 57.
167. RP, 1920, pp. 270-81;
168. Fréjacques, 'L'évolution hospitalière', p. 138.
169. CSAP 116 (1920), 'Règlement-modèle des hôpitaux et hospices';
170. RP, 1920, pp. 270-81;
171. REB, 1921, pp. 58-61;
172. RH, 1922, pp. 338-9, 58-61;
173. RH, 1924, pp. 46-50.
174. CSAP 126 (1925), Annexe v, 'Rapport sur l'assistance aux classes moyennes', p. 139.
175. Although opposition to the law came from all sides of the political spectrum, most of it came from the liberal political economy journals and newspapers (Le temps, Revue d'économie politique) and from Catholic conservatives (La réforme sociale, Revue catholique des institutions el du droit). The Journal des économistes was joined by La réforme sociale, the Revue politique el parlementaire, several other conservative and liberal political journals, and medical journals like Le concours médical, in opposing the medical insurance bill on a weekly and monthly basis. Le temps ran articles almost on a dailybasis opposing it; the Société d'économie charitable held conferences and meetings to oppose it.
176. On Le temps's opposition, see S. D. Carls, Louis Loucheur and the shaping of modern France, 1916-1931 (Baton Rouge, 1993), pp. 282-9.
177. R. Hubert, 'La loi des assurance sociales et ses diverses répercussions', JE, Oct. 1928, p. 133;
178. T. Rothe, 'Les assurances sociales', RS, Dec. 1923, p. 838.
179. See E. Villey's articles in the REP, 1921, pp. 496-503, 1923, pp. 375-83, 1924, pp. 556-74;
180. Dr J. Vanverts, 'Le projet de loi sur les assurance sociales et l'exercise de la médecine', RPP, 129 (1926), pp. 250-9;
181. Dr T. Gallet, L'assistance publique à l'hôpital: ce qu'elle est. Ce qu'elle devrait être (Paris, 1934).
182. G. Duhamel, Les excès de l'étatisme et les résponsabilités de la médecine (Paris, 1935), p. 6.
183. See R. Stevens, In sickness and in wealth: American hospitals in the twentieth century (New York, 1989);
184. P. Starr, The social transformation of American medicine (New York, 1982);
185. S. Cherry, Medical services and the hospitals in Britain, 1860-1939 (Cambridge, 1996), p. 57.
186. As late as 1943, no more than 100, 000 people had private medical insurance, Theil, Le corps médical, p. 102.
187. Gauguery, 'Les assurances sociales', p. 381.
188. The law is printed in the Journal officiel, 12 Apr. 1928, and was reproduced in several periodicals.
189. Susan Pedersen points to this law as well as the 1932 law which forced companies to affiliate with a family allowance Caisse as being the two most important pieces of inter-war social legislation, but stops short of concluding which of the two laws was the most significant, Family, dependence, p. 372. As of 1938, only 6.5 million workers and 3.9 children were covered by the 1932 law.
190. G. Rondel, 'L'assistance bourgeoise', RP, 1926, pp. 152-4.
191. P. Baldwin, The politics of social solidarity: class bases of the European welfare state, 1875-1975 (Cambridge, 1990), p. 293.
192. M. Sarraz-Bournet, 'L'établissement d'un plan d'organisation hospitalière', RHF, 1937, p. 45.
193. A. Rey, Confédération général du travail, Les assurances sociales (Paris, 1924);
194. Société Internationale pour l'Etude des Questions d'Assistance, Rapport présenté par M. le Dr. P. Boudin sur l'admission des malades payants dans les hôpitaux, 29 May 1920, in RP, 1920, p. 281.
195. AML 742/wp/43, Caisse d'Assurance Sociale (Rhône) to Hospices Civils de Lyon, 8 Feb. 1935.
196. AML 742/wp/43, 'Les assurances sociales et les hôpitaux publics', p. 1.
197. Fréjacques, 'L'évolution hospitalière', pp. 138-9. For a discussion of this practice
198. see CSAP 134 (1930), 'Application de la loi du 5 avril 1928, relative aux assurances sociales', Rapport, pp. 94-105.
199. For example, 'L'application des assurances sociales dans les hôpitaux', in AAP AP-CMA, Exercise 1936 (Montévrain, 1938), pp. 79-83.
200. Conflicts between hospitals and the regional Caisses were legion: P. Garnal, 'L'hospitalisation des assurés sociaux et le devoir social des hôpitaux', RH, Mar. 1931, pp. 146-51.
201. The hospices are another matter: until the 1970s, if not beyond, they remained dumping grounds for the country's social outcasts, the uninsured, and the marginalized.
202. E. Brizon, Les Hospices Civils de Lyon et leur aciivité actuelle, 1918-1930 (Lyon, 1932).
203. Smith, 'The ideology of charity'.
204. RHF, Oct. 1937, p. 562.
205. AML 742/wp/43, Assurances Sociales, Mairie de Lyon, 'Rapport, 30 Nov. 1935'.
206. Cited in AML 742/wp/43, 'Rapport, 30 Nov. 1935'.
207. CGR, 1930, v. 2, p. 445.
208. Ibid..
209. RHF, Oct. 1937, pp. 582-3.
210. P. Comet, L'hôpital public (Paris, 1965), 14;
211. Theil, Le corps médical, pp. 121-31;
212. RHF, Apr. 1943, pp. 132-5;
213. RHF, June 1943, pp. 246-51;
214. J. Deprun, 'Comment est née la nouvelle "charte hospitalière"', REB, Nov. 1943, pp. 245-8;
215. H. Thoillier, L'hôpital francais (Paris, 1943);
216. Imbert, Les hôpitaux en France, and 'La réforme hospitalière', Droit social (1958), pp. 496-505.
217. AAP C-1085, Les hôpitaux en France, pp. 23-4;
218. P. Durand, La politique contemporaine de sécurité sociale (Paris, 1953), p. 457.