Paola Lenzi, PhD and Gianfranco Natale, MD
University of Pisa, Italy (Spring 2015)
The cloister of the Santa Chiara’s Hospital with the arcades.
In the background the leaning tower
The historical Ospedale di Santa Chiara (Santa Chiara’s Hospital), located beside the beautiful Square of Miracles, traces its roots to A.D 325, when the Emperor Constantine issued a set of rules that imposed Christian charity, relief of the poor, and the construction of a hospital in each city. The emperor wanted a place of shelter for the poor and needy where the values of the Christian doctrine could be put into practice; he appointed a bursar to administer these places. Many small places of care for the poor were built near or beside a church. In turn, the Latin terms hospitale and hospitalia replaced the Greek xenodochio, to indicate a health resort for pilgrims and sick persons. During the fourth century, pilgrims used such places for food and rest, and, if they died, a proper burial was provided; cemeteries were often built nearby. Later Charlemagne introduced the idea that the pilgrims themselves and ordinary people should make donations towards the upkeep of these structures, which until then had been funded only by rich and famous people, so that everybody now felt obliged to leave alms for the construction and maintenance of hospitals.
Around the year 1000 the Catholic Church’s armies initiated a cycle of military campaigns, the Crusades, lasting for nearly two centuries and carried out to free the Holy Land from Muslim control. During this period were born several Ordini Ospitalieri (Orders of the Hospital), such as the military order Cavalieri Ospitalieri di San Giovanni di Gerusalemme (later Cavalieri di Malta, also present in Pisa). Caring for needy and indigent pilgrims meant that people regarded a hospital as a religious body to be identified with the tasks of the crusade. During this period, military orders founded several other hospitals, such as the Hospital of St. Mary of the Teutons in Jerusalem that became known as the Teutonic order.
Like many other cities, Pisa had many small hospitals built next to their respective churches, with a few beds – often less than ten – made with straw mattresses and covered by bags, to accommodate sick people. Such hospitals allowed people to care for the infirm and prevent spreading disease to others. In the modern sense, the first Italian hospital was Ospedale di Santo Spirito in Rome, where the poor sick people were taken and treated with a Christian spirit and with an almost medical approach. In Pisa there were political considerations besides Christian charity. The city had been excommunicated by Pope Gregorio IX in 1241 for allying itself with Emperor Frederick II; the Pisan fleet had also arrested three Apostolic Legates and some bishops, thus preventing them attending reaching the papal council in Rome. In 1257 Pope Alexander IV withdraw the excommunication on condition that the city recognized an emperor approved by the Church and founded a hospital for sick people: “uno spedale per gl’infermi, nella fabbricazione e dotazione del quale si dovesse impiegare la somma di dieci mila lire, spendibili in anni cinque a ragione di lire due mila per ciascun anno” (a hospital for the infirm costing 10,000 lire, with an annual expenditure of 2,000 lire over a five-year period, to cover building and equippment).
The Pisa hospital was founded thanks to the work of Franciscan monk and Apostolic Penitentiary Mansueto Tanganelli, and it incorporated various churches and monasteries. The construction lasted more than eighty years and the hospital went through several names: Nuovo (New), Papa Alessandro IV (Pope Alexander IV), Santo Spirito (Holy Spirit) or Misericordia (Pity). At last it took the name of the nearby church of Santa Chiara, and its administration, granted independence, was entrusted to Augustinian monks. By the papal bull of June 24, 1258, Archbishop Visconti was authorized to unite in Spedale Nuovo all the hospitals and health garrisons of the city.
The hospital was built in a large area near the cathedral. The basic structure of the complex was a square space – similar to a castle – surrounded by walls and reinforced by four towers in each corner. The cemetery, the cloister, and the sacristy adjoining the church of Santa Chiara were all within the walled area. Pope Alexander favored and greatly encouraged the hospital and wanted his monogram – consisting of the capital letters Æ, (Alexander Episcopus) – to be reproduced in many coats of arms placed in the hospital and as stitched monograms on robe the Augustinian monks had to wear. The hospital had blacksmiths, tailors, bakers, greengrocers, and an apothecary who prepared ancient medicines with the herbs cultivated in the its vegetable garden.
Already by 1300 the hospital was quite active. In 1330 an infermaria mulierum and a peregrinario infirmorum were built, and in 1334 sixty-three men and eighty-two women were hospitalized. But in 1406 Pisa was occupied by Florentines and a dark period started for the city. The hospital underwent a slow and inexorable decline. It passed during the reign of Cosimo I under the jurisdiction of the Ospedale di Santa Maria Nuova in Florence and did not become independent again until 1771. Cosimo I restructured the administration by appointing the first Spedalingo, a prefect manager responsible for running the hospital. These Spedalinghi, who were ecclesiastic persons, administered the hospital for 225 years (until 1771) and under their direction returned it to its ancient splendor. They left a visible reminder in their coats of arms placed in the loggia degli Spedalinghi inside the hospital. Today this loggia still partially exists, shaped like a cloister, with characteristic arcades reminiscing the Franciscan architecture (see figure). The loggia degli Spedalinghi was the hospital entrance allowing both men and women access to the hospital.
In 1737, when the last member of Medici Giangastone died, the Grand Duchy of Tuscany came under the rule of the House of Habsburg-Lorraine. In 1771 Santa Chiara’s Hospital became independent from the Hospital of Santa Maria Nuova of Florence by virtue of the Grand Duke Francis Stephen’s will, transforming the hospital’s ecclesiastical management into a lay administration.
The hospital was greatly enlarged and improved during the administration of Grand Duke Peter Leopold, an open-minded ruler. A new lane was built for the sick, named San Leopold, and the hospital included the hospital of Trovatelli (orphans) under the comprehensive name of Spedali Riuniti di Santa Chiara.
From 1808 to 1814 Tuscany was under French rule, and Santa Chiara’s Hospital underwent financial distress so that it was forced turn away patients with chronic disease. After the Napoleonic rule, Tuscany passed again under the administration of the Grand Duchy and Santa Chiara’s Hospital was defined a regional hospital. After the unification of Italy, Prime Minister Rattazzi established a greater participation of the city in the management of the hospital. Significant enlargement took place during the nineteenth century, alongside the evolving of medical and anatomical sciences at the University of Pisa. Currently the hospital has become the University Hospital of Pisa.
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GIANFRANCO NATALE, M.D. is director of the Museum of Human Anatomy “Filippo Civinini” and associate professor of human anatomy at the University of Pisa. He teaches human anatomy at the School of Medicine of the University of Pisa and is interested in the history of medicine. His scientific activity concerns the pathophysiology of the gastrointestinal tract with respect to experimental gastric ulcer disease and neurodegenerative disorders.
PAOLA LENZI, PhD. cooperates in the management of the Museum of Human Anatomy “Filippo Civinini” and is assistant professor of human anatomy at the University of Pisa. She teaches human anatomy at the School of Medicine of the University of Pisa. Her scientific activity concerns the molecular mechanisms involved in neurodegeneration.