Michael Mortellaro
Florida, USA

Replica of “The Anatomy Lesson of Dr. Nicolaes Tulp.” Originally by Rembrandt. Re-painted by Navid Eghbalieh, MD.

The concept of a hospital for sick people first emerged in the western world in late medieval Italy. A prime example of this was the Florentine hospital Santa Maria Nuova, which the humanist Cristoforo Landino dubbed “the first hospital among Christians” in 1430.¹ Italian hospitals of the Renaissance also left an impression on the likes of Martin Luther and King Henry VII of England.² What is the story and context of Santa Maria Nuova, and when did caring for the sick become its primary mission?

Many hospitals were founded in Florence beginning in 1200 and peaking between 1280-1350. The population peaked in 1300,³ leading to a drain of resources and more paupers in need of care.⁴ Hospitals were still clearly intended to serve the poor. There was also a corresponding shift in Catholic spirituality beginning around 1300, which changed the focus from contemplation towards active service.^5,i 

In 1348 Europe was ravaged by the Black Death. The plague certainly appears to be a major cause for shifting the focus of hospitals toward the sick, but it might not have been an instant change. Widows and orphans remained popular recipients of charity in Florence even after the Black Death, but in general, the trend remained an increased focus on the sick.⁶ This shift included the conversion of leper houses to plague housesⁱⁱ as well as the eventual establishment of medical boards to monitor the spread of plague and to push public health initiatives.⁷ In Florence, Ospedale San Paolo shifted away from housing the homeless and pilgrims and instead emphasized caring for the sick. A large expansion in Florence’s medical profession occurred simultaneously.⁸ Cities hired more doctors to serve the poor (for free), which was at least in part due to a spiritual change that favored material charity.⁹ This focus on charity from the 1200s-1300s and the medical crises of the mid-1300s paved the way for an institution meant to provide people with medical care.

Santa Maria Nuova was founded in June 1288 by Folco di Ricovero Portinari with the express mission of serving the “poor of Christ.”¹⁰ Given the context of the High Middle Ages where active charity was taking a more prominent role, it is unsurprising that such institutions were founded to care for the poor. Portinari, a patrician and merchant,¹¹ likely had quite a bit of money, so given the trends of the age it makes sense that he would set out to help the poor. What makes Santa Maria Nuova truly “the first hospital among Christians” is how quickly it became a hospital in the modern sense of the word. By 1320 the hospital had changed its mission to focus on the “sick poor” rather than the “sick and poor.”¹² This change occurred twenty-eight years before the plague. In 1348, the year of the plague, the chronicle of Matteo Villani notes that Santa Maria Nuova received 25,000 florins that year because of its almsgiving and that it was “always full of sick men and women who are … treated with great diligence and abundance of food and medicines…”¹³ By 1374 the non-sick poor were no longer admitted for more than three days,¹⁴ and by 1376 the hospital had over 100 beds for the sick and a pharmacy.¹⁵ Hospitals that predominantly served the sick did not emerge until the 1400s or 1500s in other locations,¹⁶ making the medicalization of Santa Maria Nuova ahead of its time.

Medicalization during the early modern period shifted the primary intent of hospitals away from the poor and towards the sick. Other forms of medicalization going on at the time included health boards and public health initiatives. Medicalization of society, however, seems to be more a product of the Enlightenment. Deteriorating health from urbanization combined with a new paradigm that viewed disease as entirely biological led to the view that sickness could be “controlled, removed, and even prevented.”¹⁷ Indeed, stories from Enlightenment Austria describe patients as opportunities for learning, but not so much as autonomous people.¹⁸ This perspective included a lack of informed consent for learning from corpses as well as experiments on patients.¹⁹ The internal operations of Santa Maria Nuova, however, showed that patients were not viewed simply as a bag of medical problems, but they were also viewed spiritually. As the medical profession today tries to broaden its scope and “de-medicalize” in a sense, there is much to be learned from the concept of “caring” for the sick as well as “curing.” The workers at Santa Maria Nuova tried their best to do both.

While Santa Maria Nuova is notable from a historical perspective because of their early focus on curing the sick, the hospital is notable from a modern perspective because of its focus on caring for the sick. The (presumably attending)ⁱⁱⁱ doctors took low salaries out of charity and made more money by working outside the hospital.²⁰ This implies that doctors viewed their work inside the hospital as not just a job but also as community service. Additionally, the rector (leader) appointed a servant to offer dried fruit or sweets to the patients three times daily, patients would have their hands warmed before eating, and the hospital statutes spent much time discussing the food and drink to be prepared for patients (especially the chicken soup). The hospital also tended to the spiritual needs of all its patients.^21,22

Santa Maria Nuova elucidates what it meant to be a provider and a patient during the Medieval to early modern era; a time where medicine was not all about symptoms, but about spirituality, charity, and patient comfort. Its founding and history may serve as a reference point as we work towards a kinder, gentler, more selfless and loving medical profession.

Notes

1. Catholic spirituality includes concepts of the active and the contemplative life. In the Bible this is represented by the story of Mary and Martha in Luke 10, where one sister is busy cleaning (active) and cooking while the other spends time with Christ (contemplative). Medieval monasticism, and piety in general, favored the contemplative life, so that religious activity predominantly consisted of spending time with God in prayer. A shift towards the active life, concurrent with the rise of the mendicant orders (Franciscans and Dominicans) would have entailed an emphasis on acting out one’s religion by actively doing good for others. For further information on this one could look at St. Thomas Aquinas’ discussion on the two lives in the Summa Theologiae. Researching the history of the Dominicans and Franciscans would likely elucidate the rise of the active life.
2. According to Risse, both diseases were explained via miasma theory, meaning that both could be spread through noxious fumes, hence the need for separation.
3. As will be described later, some younger doctors in training would live in the hospital, whereas the experienced “attending” doctors would come to the hospital in the morning to do “rounds” with the residents and others.

Endnotes

1. K Park and J Henderson, “‘The First Hospital among Christians’: The Ospedale Di Santa Maria Nuova in Early Sixteenth-Century Florence.,” Medical History 35, no. 2 (April 1991): 164–88.
2. Park and Henderson.
3. John Henderson, “The Hospitals of Late-Medieval and Renaissance Florence: A Preliminary Survey,” in The Hospital in History (New York: Routledge, 1989), 63–92.
4. Henderson.
5. Katharine Park, Doctors and Medicine in Early Renaissance Florence (Princeton, N.J: Princeton University Press, 1985); Henderson, “The Hospitals of Late-Medieval and Renaissance Florence: A Preliminary Survey.”;
6. Henderson, “The Hospitals of Late-Medieval and Renaissance Florence: A Preliminary Survey.”
7. Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York: Oxford University Press, 1999); Park and Henderson, “The First Hospital among Christians.”
8. Park, Doctors and Medicine in Early Renaissance Florence.
9. Park.
10. Park and Henderson, “The First Hospital among Christians.”
11. Park and Henderson.
12. Park and Henderson.
13. Park, Doctors and Medicine in Early Renaissance Florence.
14. Henderson, “The Hospitals of Late-Medieval and Renaissance Florence: A Preliminary Survey.”
15. Park and Henderson, “The First Hospital among Christians.”
16. Park, Doctors and Medicine in Early Renaissance Florence.
17. Risse, Mending Bodies, Saving Souls.
18. Risse.
19. Risse.
20. Henderson, “The Hospitals of Late-Medieval and Renaissance Florence: A Preliminary Survey”; Park, Doctors and Medicine in Early Renaissance Florence.
21. Park and Henderson, “The First Hospital among Christians.”
22. John Henderson, “Healing the Body and Saving the Soul: Hospitals in Renaissance Florence1,” Renaissance Studies 15, no. 2 (2001): 188–216, https://doi.org/10.1111/j.1477-4658.2001.tb00116.x.

Bibliography

• Henderson, John. “Healing the Body and Saving the Soul: Hospitals in Renaissance Florence1.” Renaissance Studies 15, no. 2 (2001): 188–216. https://doi.org/10.1111/j.1477-4658.2001.tb00116.x.
• ———. “The Hospitals of Late-Medieval and Renaissance Florence: A Preliminary Survey.” In The Hospital in History, 63–92. New York: Routledge, 1989.
• Park, K, and J Henderson. “‘The First Hospital among Christians’: The Ospedale Di Santa Maria Nuova in Early Sixteenth-Century Florence.” Medical History 35, no. 2 (April 1991): 164–88.
• Park, Katharine. Doctors and Medicine in Early Renaissance Florence. Princeton, N.J: Princeton University Press, 1985.
• Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals. New York: Oxford University Press, 1999.

The author wishes to acknowledge the work of Marrissa Cook, MA. She is a medieval historian who helped throughout the editing process.

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MICHAEL MORTELLARO received his B.S. in biomedical sciences at the University of South Florida and is currently a second-year medical student at the University of South Florida. His interests include the history of medicine (especially Galenic medicine) as well as the fields of neurology and pathology.

Highlighted in Frontispiece Volume 12, Issue 1 – Winter 2020

Summer 2019  |  Sections  |  Hospitals of Note