Sally Metzler
Chicago, Illinois, United States

Renowned for his restoration of the legendary Sistine Chapel at the Vatican, Pope Sixtus IV (Francesco della Rovere; 1414–1484) embellished Rome with such rapidity and magnitude that he earned the title Urbis Restaurator. Some lauded him as the new Augustus of the Eternal City and praised him for surpassing his predecessors. The poet Aurelio Brandolini crafted the following panegyric:

But Sixtus dared this and he alone ordered old Rome to rise up again; no, actually he himself founded a new Rome! This man returned beauty to the city and he removed the old ruins and he laid out in all directions a road of baked brick. He built a famous work of a bridge and he restored churches…but he built still more new ones…He himself brought back the Aqua Vergine to the Campus Martius. And what those and others did in 1500 years, this man himself accomplished in ten years. Father Romulus, yield! All ancients, yield!¹

Without doubt, Sixtus deserved Brandolini’s praise, considering his bountiful patronage of both newly anointed projects and restorations, among them the Ponte Sisto Bridge, Aqua Vergine (the only surviving Roman aqueduct of the ancient eleven),² Capitoline Museums, and Vatican Library. But he also focused on the infrastructure and practical needs of the city, establishing a department of urban planning, the Maestri di Strada, to overhaul the roads and make Rome clean and safe. In 1473, he wrote:

Amongst countless other cares we must also attend to the purifying and beautification of our City, for if any other city should be clean and fair, certainly this one, which is the head of the world…by reason of the chair of St. Peter, it ranks first among all others. Considering…through the tolerance or negligence of those whose duty it is to keep the streets and squares of the said city in good order, they are in many places foul and unsightly…by the tenor of the present letters, command you for the future to pay special attention to this matter.³

The magnificence of the Sistine Chapel and his other civic works overshadow the impressive medical contribution of Sixtus IV, that of the resurrection and restoration of Europe’s oldest hospital and Rome’s first public hospital, the Ospedale Santo Spirito (Hospital of the Holy Spirit) in Sassia (Fig. 1). Conceived in 797 as a hostel for pilgrims, in 1198, Pope Innocent III established at the site a hospital for foundlings and the infirm. He financed it in part from charity, and additional purchases of farmland nearby provided a steady income. The investment proved so lucrative that the Ospedale established the Bank of the Holy Spirit, using the lands as collateral.⁴ Later, the bank separated from the hospital and became one of the great banks of Rome.

Near St. Peter’s Basilica in the medieval Borgo district, and nearly destroyed by a fire in 1471, the Ospedale stood in such disrepair that Sixtus called the crumbling hospital “a place intended for the captivity rather than health recovery.”⁵ He embarked on an ambitious project featuring myriad components, among them an ancient spicery that notably conducted early experiments with quina bark to treat malaria, a persistent affliction considering the district’s proximity to the swampy Tiber River. An anatomical theatre enticed prominent medical practitioners and even artists Michelangelo and Leonardo DaVinci decades later to visit. Sixtus also joined the Church of Santo Spirito to the Ospedale. Dedicated to Santa Maria and a victim over the centuries of raids and destruction, notwithstanding the Sack of Rome, the Church façade owes its present appearance to the restoration of Sixtus V between 1585–1590.

In 1714, papal physician Giovanni Maria Lancisi inaugurated an immense library of medicine and science, the Lancisiana, at the Ospedale. Among the more than 20,000 holdings is a precious thirteenth-century illuminated manuscript of Avicenna. Restored in 2021, the Lancisiana today welcomes scholars and the public.

In contrast to today’s clinical, minimalist hospital buildings, the Ospedale of Sixtus IV merged beauty and functionality. A large pipe organ provided comfort to the ill—an early incidence of the belief in the use of music as a healing agent. Music interwove with the daily rhythm of the Ospedale. In 1620, the Ospedale appointed renown organist Girolamo Frescobaldi, who also held an appointment at nearby St. Peter’s. His duties required him, aside from playing at Mass and Vespers for the attached Santa Maria Church, to play in the sick ward during mealtimes. Accounts from witnesses relate this practice and comment on the quality of the organ: English courtier and diarist John Evelyn visited the hospital in 1645, and noted that “The organs are very fine, & frequently play’d on to recreate the people in paine’.”⁶ In addition to Frescobaldi, organist Sigismondo Arsile received payments for relieving the suffering of the sick.

The main sick ward established by Sixtus stretched four hundred feet long, forty feet wide, and forty feet high. Art played a leading role in the massive coffered ceiling space. Sixtus embellished the ward with forty-six frescoes illustrating the founding of the hospital and pivotal moments in his own biography. The participating artists represent the so-called “Umbro-Roman School,” and although firm attributions to specific artists cannot be determined, names such as Melozzo da Forlì, Domenico Ghirlandaio, Pinturicchio, and the workshop of Antoniazzo Romano have surfaced.

The frescoes served to beautify the space and to educate patients and the staff; today the fresco scenes provide an archive of the history of the Ospedale. One fresco narrates the myth of the founding of the hospital, the Dream of Innocent III, during which fishermen display the nets they cast into the Tiber, and, rather than gathering fish, the nets caught unwanted babies cast into the river (Fig. 2). Legend recounts that Innocent, horrified at the plight of these infants, had visions of an angel who instructed him to build the Ospedale and save the orphans from their tragic fate.⁷ A vividly realistic and disturbing fresco explicitly addresses infanticide; divided into two parts, the left illustrates a peaceful bedchamber where a woman rests after giving birth. The scene transitions to an act of violence in which a woman swings a naked newborn upside down, the baby bleeding from a blow to the head. A woman in the background emphatically gestures despair (Fig. 3). A troubling Latin inscription originally found beneath the fresco narrates the complicated situation between the foundlings and the mothers: “[h]ow in different ways the cruel mothers butcher their offspring, which have come into the light following illicit coitus. Their infants shall be dashed to pieces before their eyes and no pity shall be taken upon the sucklings of the womb.”⁸

To mitigate infanticide and to preserve the anonymity of those who abandoned these unfortunate infants, Innocent erected a ruota degli esposti (foundling wheel), whereby one placed an infant in a hatch, and remained outside and undetected by those inside the Ospedale. This tradition has continued in part in modern society, witnessed in safe-haven laws, which provide a no-questions-asked opportunity for one to surrender an unharmed infant to a hospital, fire station, or police station.

Oft cited as the oldest hospital in Europe and the first public hospital in Rome—and still in operation—today the original ward of the Ospedale hosts conventions, art exhibits, and other public events, thus preserving the artistic heritage of this seminal complex of health.

In the early days of the Ospedale, a variety of individuals cared for the patients, among them the female foundlings: “The early (1204) rule of the hospital states that on Tuesdays the nuns wash the patients’ heads and on Thursdays they wash their feet. An order of 1649 directs that the hands of the patients are to be washed before meals are distributed to them.”[ix] In 1894, the Ospedale offered 3,000 beds, caring for foundlings, psychiatric patients, and the general population. One fresco illustrates the appearance of the beds, which at one time were canopied. A view from the ward in 1950 illuminates the arrangement of beds (Fig. 4). Additional activities at that time included autopsy, surgery, and research.¹⁰

Sandro Botticelli, in a fresco for the Sistine Chapel celebrating the Cleansing of the Leper in the foreground and the Temptation of Christ above, designed the east façade of the Ospedale Church to symbolize the Temple of Jerusalem.¹¹ In light of the magnitude of care the Ospedale Santo Spirito has graced upon so many in the Eternal City throughout the centuries, and the extensive artistic program gracing its walls, it likewise represents a temple of humanity and benevolence.

End notes

1. See Blondin, Jill E., “Power Made Visible: Pope Sixtus IV as “Urbis Restaurator” in Quattrocento Rome,” in The Catholic Historical Review, (Jan 2005), Vol. 91, No. 1, pp. 1-25, p. 4 for Brandolini poem in Latin and references. For a more general survey of Sixtus and the art he commissioned for the Ospedale, see Eunice D. Howe, Art and Culture at the Sistine Court: Platina’s “Life of Sixtus IV” and the Frescoes of the Hospital of Santo Spirito. Studi e Testi 422. Vatican City: Biblioteca Apostolica Vaticana, 2005.
2. Blondin, 8.
3. Blondin, 10.
4. Ospedale Santo Spirito in Sassia, The Hospital of the Holy Spirit in Rome, adapted from a colloquium given on February 28, 1995 to doctoral students in the School of Nursing, University of Wisconsin-Milwaukee, https://www.santacruzspirituality.net/hospital.htm. Concerning the Bank, it was founded by Pope Paul V in 1605 and operated as Rome’s longest running bank until it merged in 1992, first with Banco di Roma, and later again with several others.
5. De Angelis, Pietro, Ospedale di Santo Spirito in Saxia, Vol. I: Dalle origini al 1300. Rome: Biblioteca della Lancisiana, 1960.
6. Barker, Naomi, “Frescobaldi at the Ospedale di Santo Spirito: a portfolio career in 17th-century Rome,” Early Music, Volume 49, Issue 3, August 2021, 395–412. See 400.
7. Keyvanian, Carla, “The Papal Hospital: Santo Spirito in Sassia,” in Hospitals and urbanism in Rome, 1200-1500. Walter S. Melion, Editor, Leiden: Brill, 2015. See 357.
8. Diana Bullen Presciutti, “Dead Infants, Cruel Mothers, and Heroic Popes: The Visual Rhetoric of Foundling Care at the Hospital of Santo Spirito, Rome”, Renaissance Quarterly, Vol. 64, No. 3 (Fall 2011), 752-799. See 766.
9. Ospedale Santo Spirito in Sassia, The Hospital of the Holy Spirit in Rome, adapted from a colloquium given on February 28, 1995 to doctoral students in the School of Nursing, University of Wisconsin-Milwaukee.  https://www.santacruzspirituality.net/hospital.htm
10. See 708 in: “The Hospitals and Clinics of Rome,” The British Medical Journal, Mar. 31, 1894, Vol. 1, No. 1735, 707-711.
11. This façade depicted in Botticelli’s fresco was obliterated in 1742 to make way for an extension eastward, designed by Ferdinando Fuga, but in 1927, restorers referred to Botticelli’s fresco and were able to rebuild the east façade as faithfully possible. See Keyvanian, C., 347.