Alberto Zanatta, PhD & Fabio Zampieri, PhD
University of Padua, Italy

 The first picture (XVI century) of San Francesco Hospital
with the characteristic colonnade of Padua architecture

The hospital San Francesco Grande in Padua was founded by the Piombino jurist Baldo Bonafari (†1418) and his wife Sibilla de Cetto (†1421), who also financed the construction of the San Francesco church behind the hospital. Work on the hospital began in 1414, and its first patients could be admitted by 1444.1 The main purpose of the hospital was charity; Baldo Bonafari embraced the Franciscans’ teachings, devoting himself to his dream of building a charitable hospital dedicated to Saint Francis of Assisi. Though founded on charity, its characteristics were similar to other Renaissance Italian institutions.

There were several “hospitals” in the Padua suburbs between twelfth and fourteenth centuries, but they normally did not reside within the town. Each door of Padua’s walls had two hospitals, one inside, the other outside, reserved mainly for infectious diseases. By contrast the San Francesco Grande was placed in the heart of the old town and specifically reserved for Padua citizens.2 Moreover, while most ancient hospitals were in churches or monasteries, used for wanderers, orphans, the poor, and the socially marginalized, San Francesco Grande was built from the beginning with the specific purpose to cure diseases, thus providing material as well as spiritual assistance.

When Baldo Bonafari died in 1418, he had specified in his will that his wife should continue the work of the hospital and it should be governed by Padua’s “Holy College of Jurists.”3 At its inception, the hospital owned about 400 plots of land in Padua’s countryside and some houses and stores in town, which funded the institution. These properties and the hospital itself were donated by Bonafari to the town of Padua,1 and increased over the centuries thanks to new donations by private citizens, religious institutions, and Venetian administrators. By the first half of the sixteenth century, the institution owned 1300 plots of land and many more houses and stores than before.1 This allowed the San Francesco Grande to finance itself from its foundation until 1798, when its patients moved to a new, bigger town hospital, called Giustinianeo, which was situated just before the walls inside the urban area.

The institution was headed by a “prior,” elected from the Holy College of Jurists and staffed by a physician (called “fisico,” a sort of internist), a surgeon, a barber (for bleeding), an apothecary, a chaplain, a farmer, a groom, and a cook. To these was added in the second half of the sixteenth century the position of “assistant physician,” normally for a young doctor having full time residence in the hospital and replacing the internist and surgeon when absent. In the second half of seventeenth century a second internist was appointed. In the beginning, there were about fifty beds for patients, divided into two infirmaries for men and women, while in 1798 patients moved to the new hospital were about 500 beds.

In San Francesco took place one of the first attempts at clinical teaching, it being a center not only for assistance and cure, but also for research and teaching. Its physicians were not necessarily affiliated with the Padua Medical School, but frequently taught at the university while practicing at the hospital. By the way, the patron saint of Padua Medical Faculty was Jesus Christ, confirming the religious root of European healthcare.

It has been suggested that Giovanni Battista da Monte (1489-1551), professor of practical and theoretical medicine at the University of Padua, taught clinical medicine to his students at the hospital as early as 1543,3,4 long before Franciscus Deleboe Sylvius (Franz de le Boë) (1614-1672) or Hermann Boerhaave (1668-1738); and in late sixteenth century5,6 some professors of Padua University would bring their students to San Francesco Hospital to show them in practice what they taught during their lectures.

Between 1553 and 1769 members of Natio germanica (the German Student Corporation of Padua University) wrote the Acta Nationis Germanicae Artistarum, a daily chronicle of university life and a unique source of information about the university itself and about the cultural, political, and economic life of the city of Padua in those years.

Here we can read that in 1578 Marco degli Oddi (1526-1591), top clinician of the San Francesco Hospital and professor of Theoretical Medicine at the University of Padua, and Albertino Bottoni (1596), professor of Practical Medicine in the same University, established the custom of completing their lectures by accompanying the students to the hospital to practice on patients and perform autopsies.5,6

In the Acta Nationis Germanicae Artistarum of that year there is the following description:

For us it is worth mentioning with gratitude the great benefit given to our Nation by the excellent Albertino Bottoni, Professor of Practical Medicine, who, through his singular benevolence, other than improving our instruction at the University, collaborated with the excellent Marco degli Oddi, top clinician at San Francesco Hospital and University Professor, to bring us to this Hospital after Lectures in order to visit the patients affected by different diseases. In this way they show us how to apply in practice the different doctrines taught during the Public Lectures, giving to students the opportunity to practice what a good physician should observe and exercise in favour of his patients.7

Even more interestingly, in the Acta of 1579 the practice of autopsy is mentioned in the following context:

Toward the end of October, being the right season for anatomical dissections, Bottoni and Oddi decided to open the cadavers of those women who died in the Hospital to see in the presence of students the seat and causes of diseases.7

From this quotation, it seems that in late sixteenth century, Giovanni Battista Morgagni's idea (1682-1771) that anatomy could be useful to study “seats and causes of diseases”8 was already present, in an early attempt to enrich clinical teaching with anatomo-clinical correlations. In 1619 the statute of Padua University provided for clinical teaching in the modern sense, jointing lectures at the University and practice at Padua Hospital.6 At  present the building of San Francesco Hospital still exists, recently completed and with plans to add a museum of medical history worthy of the tradition of the Padua Medical School.

References

1. Antonelli A. Cenni storici sull’origine e sulle vicende dello Spedale Civile di Padova e rendiconto morale-economico per gli anni 1872-1883. Padova: Penada; 1885.
2. Bandelloni E. Sulla fabbrica dell’antico ospedale di Padova. Padova: La Garangola; 1973.
3. Rasori G. Sul metodo degli studi medici. In: Rasori G. Opere complete. Firenze: Tipografia della speranza, 1837. pp. 287-296.
4. Cervetto G. Di Giambattista Da Monte e della medicina italiana nel secolo XVI. Verona: Tipografia di Giuseppe Antonelli; 1839.
5. Montesanto G. Dell’origine della Clinica Medica in Padova. Memorie storico-critiche. Padova: Tipografia della Minerva; 1827.
6. Ongaro G. L’insegnamento clinico di Giovan Battista Da Monte (1489-1551): una revisione critica. Physis, 1994, XXXI, pp.357-369.
7. Favaro G. Atti della nazione germanica artista nello Studio di Padova. Venezia: Deputazione veneta di storia patria. 1911.
8. Zampieri F, Zanatta A. and Thiene G. An etymological “autopsy” of Morgagni's title: De sedibus et causis morborum per anatomen indagatis (1761). Hum Path, 2014, 45, pp.12-16.

 


Alberto Zanatta, PhD, graduated in Natural Sciences and specialized in anthropology. He earned a PhD in cardiovascular sciences at the University of Padua Medical School. He is currently a researcher in medical humanities in the Department of Cardiac, Thoracic, and Vascular Sciences at Padua University and he is also the curator of the Museum of Pathological Anatomy. His interests are in anthropology and history of medicine.

Fabio Zampieri, PhD, graduated in Philosophy of Science at Padua University, and earned a PhD in the History of Medicine at the Institute of the History of Medicine and Health at Geneva University. After a post-PhD at the Wellcome Trust Centre for the History of Medicine in London, he was engaged as Researcher at the University of Padua Medical School, in the Group of Medical Humanities under the Department of Cardiac, Thoracic and Vascular Sciences. His fields of interest are the history and epistemology of life sciences. He is specialized in the history of Pathology, in the history of Cardiology, and in the history of Evolutionary Medicine.