University of Florence, Italy
University of Florence, Italy (Winter 2015)
The spedale of Santa Maria Nuova was founded in June 1288 by Folco di Ricovero dei Portinari, father of Dante’s Beatrice, who bought some houses in the centre of Florence to receive poor people who needed help. At first the hospital could only accept men from the large crowd of people who applied to the hospital, many poor or disabled, beggars and orphans, and not necessarily the sick.
This pledge to aid the needy characterized the origin of the charitable organisations typical of this period of the Middle Ages, when the Church offered indulgences to those performing charitable works. Accordingly, upon its foundation, Bishop Andrea de’ Mozzi entrusted the care of the hospital to the charity of the Florentine people. At first the needy in general were taken care of, but in the first half of the fourteenth century the architecture of the hospital was progressively improved to house the sick.
The patronage of the family Portinari continued throughout the sixteenth century, when the structure was even more enlarged, its fame spreading throughout Europe and the influence of the clergy and the Church growing. So important a health care institution was Santa Maria Nuova that it was taken as a model by numerous European dignitaries, including Pope Leo X (who appointed his personal physician to study its regulations), Henry VIII of England (for constructing the Savoy hospital in London), and Ferdinand of Austria, who requested a copy of Santa Maria Nuova’s regulations in 1546.
The chronicles of the time often reported eulogistic descriptions of the services provided, although we must make allowances for a certain excess of civic pride.
The famous architect Leon Battista Alberti in his De re aedificatoria (ca 1450) gave one of the most eminent descriptions of the Tuscan hospitals of his time, celebrating them for the large size of the buildings and the quality of services offered to citizens and also to foreigners. Positive comments were also made by Martin Luther, who was hospitalized in Santa Maria Nuova around 1510; being an ecclesiastic, he was accommodated in a small private room rather than in the large communal ward.
Luther was extremely impressed by the efficiency of the health care facilities, which had no equal in northern countries, mentioning silk sheets and fine pottery vessels, and devoting a particular tribute to the care he received and which was managed by the “Oblates.” These were members of the Congregation of the “Pie Donne” (Virtuous women), an organisation founded by Monna Tessa – the faithful servant of Folco Portinari who devoted her entire life to the care of the sick – which is still active today.
Originating from good families, these women helped the patients while carefully veiled so as not to embarrass them or create a sense of obligation. By remaining nameless and faceless philanthropists, they helped establish at the end of the thirteenth century the concept of organized charitable assistance in the very heart of Florence within the walls of Santa Maria Nuova.
In the second half of the sixteenth century, the architect Bernardo Buontalenti was appointed to enlarge the hospital and build a new ward for the male patients. Later Santa Maria Nuova developed a cross-shaped ground-plan, the long axis serving as the male and the short as the female ward. This structure saved a great deal of money because one person stationed at the centre of the cross could watch four wards at the same time.
The architecture of the hospital and its internal courtyards evolved progressively, and the monastery-like hospital interior included frescoes with biblical motives and altars adorned with Christian iconography. Such sumptuous decorations were the confirmation of the administrators’ power and of the institute’s wealth, but they also demonstrate how beauty was considered important in patient care many centuries before Ulrich’s article marked a turning point in modern sanitary architecture.1
Teaching and research also took place in the complex of the hospital. There was also a School of Surgery, its foundation traditionally attributed to the Grand Duke Ferdinando I de’ Medici (1549-1609). Around the middle of the seventeenth century, the lessons were entrusted to the Surgical Masters of the hospital, who gave them without receiving payment. The students were admitted to the School after passing an examination that entitled them to start on a seven years’ course of study devoted to practical exercises more so than to theoretical teaching. They were again evaluated after the first five years, and after two more years took an examination that would provide them with a certificate to be presented to the Collegio Medico, or medical board of the city. It was in front of this Board that the aspirant surgeons finally faced the licensing exam that would allow them to practice the profession. The rules of the School changed with the passing of time, but the School worked till the foundation of the Florence University in 1923.
In 1617 the Portinari family handed over the hospital to the Grand Duchy, and the ecclesiastical control definitively ended. New leadership made more changes to the buildings, constructing a new hospital for women on the other side of the square and, in 1688, a “pazzeria” or “madhouse.” This was a sort of psychiatric infirmary for poor demented men created within the general hospital, well before the birth of psychiatry as a science, housed in a small hospital placed at the northern extremity of Santa Maria Nuova. From that point, mad people were seen as patients in need of housing and treatment rather than being possessed by the devil.
In the same period, the construction of the front porticoes began: the porticoes were conceived as an all-embracing structure to protect the needy, emphasizing the original mission of the hospital. From that period are also the numerous frescoes by Pomarancio and the busts showing the Grand Dukes, which can be admired on the crowns of the arches.
Important reforms were instituted by Peter Leopold of Habsburg-Lorraine (1747-1792) and drawn up by the commissary Marco Covoni Girolami in 1783. The new regulations set the patient at the centre of the system, recognising the universal right to care, and reorganising all aspects of hospital activity: care, treatment, food, hygiene, and pharmaceutical prescriptions. Wards began to be reserved for different illnesses, and a system of written clinical records detailing all circumstances pertinent to treatment, care, and nourishment was introduced.
The regulations also required correct behaviour by the nursing staff, both in attitude and human relations. The reorganisation also extended to the wardrobe, the storerooms, the kitchen and the laundry, the use of brass cutlery instead of wood, and the provision of good quality bedsheets. All this was due to the Grand-Duke Peter Leopold, who reorganized the entire sanitary system of Tuscany, closed unproductive and uneconomic smaller hospitals, and centralized the administration of the city hospitals under the direction of Santa Maria Nuova.
Having assumed the honorary designation of “Regio Arcispedale”, the hospital consequently took over the services that had previously been provided by the suppressed structures. In the Lorraine period many eminent physicians worked at Santa Maria Nuova: among them, Vincenzo Chiarugi (1759-1820) introduced a completely new approach to mental illness, leading to the birth of psychiatry, and Giuseppe Vespa (1727-1804), who organized the maternity ward.
During the French dominion, the hospital went through a period of economic crisis, as the contributions granted by the previous governments were no longer available. Another important moment in the story of the Arcispedale was the Crispi Reform in 1890 after the unification of Italy. This reform established general rules for hospitals, leaving the internal and administrative organization to internal regulations. At the start of the twentieth century, the need to improve bed capacity and reorganize the university studies led to the creation in the estate of Careggi in the northern outskirts of Florence of a vast new hospital complex, the Careggi Polyclinic. Many of the hospital and teaching activities of Santa Maria Nuova were transferred there in the 1920s and 30s.
Today Santa Maria Nuova is the hospital for all emergencies arising in the old city centre. By caring for local residents and tourists, it continues its mission after being the stage for many great events in the history of medical care for more than seven centuries.2
1. Ulrich RS. View through a window may influence recovery from surgery. Science 27 April 1984;224 (4647):420 – 421.
2. Florence and its Hospitals. A History of Health Care and Assistance in the Florentine Area. (Tombaccini D. and Lippi D. Eds.), Florence, FUP 2008.
DONATELLA LIPPI, PhD, professor of medical history, is a scholar of classics, specialized in the history of medicine, archaeology, and bioethics. Visiting professor in many foreign universities, she is the vice-president of the Italian Society for the History of Medicine. Journalist, she is author of more than 300 scientific publications and is president of the Centre of Medical Humanities of the University of Florence.
, MD, full professor of cardiology, is the director of the Postgraduate School of Cardiology at the University of Florence (Italy) and is president of the Italian Heart Rhythm Society.