Antonio Dal Canton
Pavia, Italy

Chronicle of the foundation

On June 29, 1449, the morning in Pavia was unusually clear and the air dry and lukewarm. A light northern breeze moved the trembling silvery leaves of the willows on the banks of the river Ticino. It was Sunday and Holy Mass was celebrated in many churches, but all Pavia’s people seemed to have gathered in San Apollinare, the chapel of the Dominican monastery, where Mass was officiated by a friar, Domenico di Catalogna. Many attendants were standing outside the small church, in the neighborly narrow streets, but the voice of Domenico spread from the altar, rebounding on the brick walls of the tower-houses and could be heard from afar. Domenico was popular for his charity and for his dedication to an initiative of primary interest to the citizens of Pavia, i.e. to provide the town with a new hospital. For years he had spent his moral authority and diplomatic ability to attain that goal, and eventually, the date had come: the civil and religious authorities had given their consent. The news had rapidly spread in Pavia, and a feasting crowd had convened to Sant’ Apollinare to express its gratitude to Domenico; but Domenico was a humble man and he spent just a few words, at the conclusion of the Mass, to announce the realization of his dream and the achievement of an invaluable social benefit: “I am happy to inform you that the Duke* has signed the Authorization Act and the Confraternity° has been endowed with abundant financial resources. In the afternoon the Bishop will place the foundation stone of the Ospitale di San Matteo.” A long round of applause followed.

Modernity and excellence at the Ospitale

Domenico was the author of reputed assays on ethical issues and lectured in theology in the university. His writings reveal an open-minded personality, and he certainly inspired the modern concept of a “hospital” as figured in the Statute of the Ospitale, where it is stated that “the Hospital will admit only patients recumbent in bed, that can be cured with adequate therapy and heal, according to the faithful statement of the physicians of the Hospital.”¹ This view was far from the medieval concept of the hospital as an institution providing help to the sick people, food to the poor, and a roof to homeless and pilgrims. The novel mission committed to the Ospitale required adequate structures and personnel, continuity of funding, and dedicated administrative organs. The design of the hospital building was such as to create a hygienic environment, with large rooms exposed to sunlight, open to free air circulation, and easy to be cleaned. The original map shows two rectangular open arms forming a cross whose sides were lined by arcades covering corridors leading to the rooms. The wide central courtyard was covered by a high cupola. Exhaustive collections of documents archived from its foundation allow a detailed reconstruction of the organization of the hospital’s activity. The Ospitale employed full-time doctors who were asked to reside in the hospital and provide on call service. Until the late eighteenth century there were three to five doctors, either “Fisici” (Internists) or “Cerusici” (Surgeons). The hospital had its own pharmacy where galenic receipts were prepared. Nursing was provided by personnel paid by the hospital as well as by charitable people. The doctors’ duties, food and drug distribution, personal hygiene, and visitors’ behavior were the object of detailed regulations. The government of the Ospitale was under control of a Confraternity composed of a variable number of members—initially they were eight but they grew up to thirty-nine—that admitted new members by cooptation and elected a governor, a cashier, and some ministers who were the real responsible persons for decisions and administration. The membership was reserved to people having a distinguished moral conduct and implied the obligation of an entry tax and an annual fee. However, donations, mainly testamentary, were the principal source of funding of the Ospitale for more than four centuries, i.e. until it became part of the Public Healthcare System. Many donations consisted of land with farms and villas or castles, or town buildings, and actually the San Matteo Hospital remains today one of the principal owners of land in the province. Often the donors committed a portrait in which they were painted while exhibiting a paper representing their donations act. Today, part of these paintings are shown in the rooms or in corridors of the administration area. The fame of the hospital grew rapidly, mainly thanks to the prestige of the professors of the University of Pavia who practiced in the hospital. The Faculty of Medicine of the University, founded in 1361, had attained a sound reputation years before the foundation of the Ospitale, and several professors of the university were the doctors of the richest merchants and high-lineage nobles. Matteo Ferrari Da Grado (1432-1476), for example, was the personal doctor of the Duke of Milan, and of the Prince of Navarra.²

The doctors that made the Ospitale famous

Many outstanding doctors operated their “art” in the San Matteo, and some are part of the history of medicine for their contribution to the progress of science. I will mention here just the most reputed ones. Girolamo Cardano (1501-1576) is an example of the Renaissance man and genius. He is famous as the eponymous inventor of the cardanic shaft, but his scientific interests included mathematics, physics, astronomy, and medicine. He was the author of several treatises on medicine and is credited with the first description of the causal relation between asthma and powder or feathers. His method of preventing asthma by avoiding exposure to allergens was so famous as to induce John Hamilton, the Archbishop of Edinburgh to pay a huge sum to have a personal consultation in Scotland. Giovanni Pietro Frank (1745-1821) was a reputed clinician and author of textbooks, but his most important merit was his love for teaching and his interest in diffusing medical knowledge that induced him to reform the School of Medicine and to found a Museum of Anatomy and Pathology. This was the nucleus of the present Museum for the History of the University in Pavia, described as “treasure” by the journal Nature.³ Antonio Scarpa (1753-1823) was a great anatomist and surgeon. He published numerous treatises that contain several original findings, e.g. on the sensory organs and the muscular-skeletal apparatus. He is the eponymous source of ten anatomical parts, two of which are currently named after him (the triangle and the fascia). As for his personality, he had a very bad reputation of being a hard, aggressive man, and was a supporter of the Austrian domination over Lombardy, the region of Pavia, this in contrast with the patriotism of the students and most of the intellectuals who aimed to form an independent Italian nation. When Napoleon defeated the Austrian and formed the nominally independent Cisalpine Republic, Scarpa was dismissed and replaced by younger liberal doctors. After the Austrian restoration, his revenge was cruel. Perhaps this is why a young practitioner present at his autopsy cut off his head and fixed it in alcohol. The head, extraordinarily well preserved, can be seen in the Museum for History of University. Camillo Golgi (1843-1926): Entering the name Golgi on Medline one retrieves more than 43,000 references, reflecting the several structures and phenomena in anatomy and physiology named after him, among them the Golgi Apparatus, the Golgi tendon organ, and the Golgi brain cells. He received the Nobel prize in 1906 for his studies on the nervous system, but also made original contributions to the life cycle of the malaria agent and the structure of the nephron. He was elected Rector of the University of Pavia and used his charismatic authority to transfer the San Matteo from its historical location in the center of town to a new site outside the medieval town in new buildings that represented the most advanced hospital model at the time. Other relevant historical figures were Giulio Bizzozero (1846-1901), credited for the discovery of the platelets; Claudio Forlanini (1847-1918) who devised the artificial pneumothorax for treating pulmonary tuberculosis; and Scipione Riva Rocci (1863-1937), the inventor of the mercury sphygmomanometer. The original prototype of the instrument was home-made by assembling objects for every day different life, including a bicycle rubber tubing.

The policlinico San Matteo today

In recognition of its many clinical services and achievements the name Ospitale was changed into Policlinico when the hospital was moved from its medieval location. In December 2014 most of its activities were transferred from the twentieth century buildings to a new one designed according to the most advanced principles of sanitary architecture. The San Matteo has been qualified as IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), i.e. a hospital institutionally committed to research by the National Health Ministry. With 643 international publications and a 3182.22 cumulative Impact Factor (last data available for year 2013) it is the leading public institution in biomedical research in Italy.

Notes

• *The town of Pavia was part of the Dukedom of Milan
• °The Confraternities were free associations of lay people (brothers) that exerted some charitable mission, e.g. to help the poor, protect orphans etc.

References

1. Crotti R, Mazzarello P. Statuta Hospitalis Ospitalis  Sancti Mathei Papiensis.  In Ospitale di San Matteo in Pavia. 550 anni di buona assistenza sorro un cielo stellato di mille progetti di vita.  Edizioni Torchio dè Ricci, Certosa di Pavia, 2006.
2. Dal Canton I, Frosio-Roncalli M, Dal Canton A. The famous case of rheumatic hematuria described by Gianmarco Ferrari Da Grado, professor at the University of Pavia. Am J Nephrol 1997;17(3-4):282-5
3. Abbot A. Hidden treasures: The University History Museum of Pavia. Nature 2008;451:526.