Saturday, December 1, 2012

A Hospital with a Venerable History

Ospedale di Santa Maria Nuova, Florence

L'Ospedale di Santa Maria Nuova, the early years 

This large, sleek, modern-yet-ancient hospital in Florence, considered the city's most important medical facility, is also its oldest.  This hospital has been caring for Florentines and visitors to the city since the late 13th century.

It all started with one man, and one woman.  But before we get to them, let's take a brief look at exactly what a hospital was, and wasn't, in that distant time and place.

First, it was not necessarily a place where people went to receive medical care.  Rather, it served one or both of two functions (with perhaps some overlap):  hospitality for travelers, and succor for the poor and infirm.  In addition to providing for its resident clientele, hospitals often set up soup kitchens and gave alms to the needy of the neighborhood.

Of the hospitals and hospices that were already in operation in Florence at the time Santa Maria Nuova came into being, several were administered by religious orders by and for their own members (the same would soon be true of lay confraternities and artisan guilds).  Many were small, with just a few beds.  They tended to be located outside the city walls (the better to serve the needs of travelers, perhaps).

The people who worked in them were often lay religious:  penitents, in some but not all cases bound by vows of poverty and chastity, probably clothed in a simple habit, and acting out of religiously-inspired charity (and sometimes as a sort of insurance policy - widows and single women, for example, sought these positions in order to have a roof over their heads and food to eat as they grew older). 

Ancient facade of the Ospedale, by Fabio Borbottoni

By the time Santa Maria Nuova was founded in the late 1280s, hospitals were beginning to put more emphasis on nursing the sick.  Santa Maria Nuova was to become something of a pioneering institution in this effort, offering medical care at a time when some older hospitals still concentrated mainly on hospitality and poverty relief.

Santa Maria Nuova, which grew up around the ancient church of Sant'Egidio,  began with a  generous bequest by a man named Folco Portinari, in his last will and testament written in 1288.  Patronage of the rapidly-growing institution stayed in the hands of the (male) members of his family for many generations, including the right to elect the hospital administrator (spedalingo).  And the nucleus of the corps of nurses was the lay religious order established by Portinari's servingwoman, monna Tessa.

Consecration of Sant'Egidio by Pope Martin V, Bicci di Lorenzo

Sant'Egidio today

Folco Portinari

Folco di Ricovero Portinari is perhaps best known to history as the father of Dante's inspiration and beloved, Beatrice.  But he was more than that:  banker, elected city official on several occasions, philanthropist, usurer (by the standards of his day), and, in Dante's words, "a man of great goodness" as well as a man of great wealth.

Folco made his fortune in banking.  Thus, inevitably he practiced what the church then called usury, for he lent money at interest and collected the profits.  According to the strict definition of usury, money should not create wealth - only the work a person does should create wealth.  And yet, then as now, people went into business with the intent to better their situation, and they made investments, and they gave and took out loans.  This uneasy tension was often resolved by a deathbed charitable bequest meant to cancel out any sinfully usurious behavior in the decedent's professional life.

In addition to the hospital, Folco was wealthy enough to dower his four unmarried daughters generously, leave bequests to the families of his two married daughters (one of them was Beatrice), and to provide well for his wife, his natural sister, and his five sons, as well as to make donations to many charitable institutions, including other pre-existing hospitals.  Folco and his son Manetto, who was a friend of Dante's, and his grandson Accerito were all buried in the chapel of the male ward of Santa Maria Nuova.

Stemma of the Portinari
 Monna Tessa

Monna Tessa was Folco Portinari's servant, said to have been the nurse/educator of his children.  She was born to a humble family and married a saddlemaker named Ture.  Tradition says it was this pious woman who persuaded Folco to found a hospital to serve the poor and the elderly and infirm.

In 1288, coincident with Folco's bequest to the hospital, monna Tessa founded the Order of the Oblates, a lay order of Franciscan tertiaries, women who pledged themselves to a life of poverty and service to the poor.  Although the Order ran the hospital without a written rule for years, in 1301 a rule was established, formalizing the organization.  Among the women who followed Tessa's lead were several of noble families, including Margherita dei Caponsacchi, a relative of Folco Portinari's wife Celia Caponsacchi.  Monna Tessa died in 1327, and she was buried in the church of the hospital she had helped to found.

Monna Tessa

What was it like, this new hospital?  It seems likely that for a few years monna Tessa had already been caring for the sick on a small scale - perhaps half a dozen beds, with two patients to a bed, in some of the city houses owned by Folco Portinari, but the will took everything to a new level.

Folco supplied "seventeen beds furnished with straw mattresses, blankets, sheets, covers, feather pillows and bedsteads, which have already been put in place in the said hospital for the use of the poor."  Originally these beds must have been situated in houses privately owned by Folco, but it wasn't long before circumstances made it possible to begin work on a new hospital complex.

Land became available just outside the 12th century walls surrounding the city, when the construction of new walls, needed to encompass much more area for the growing city, meant that the old walls were torn down, in part to provide construction materials.  This cleared enough space to begin building the hospital, which is located on a street called via delle Pappe, after the bread soup the hospital once served to the poor and the sick, and it parallels a street that today is named after Folco Portinari.

The other factor making the hospital site available was that the monastery running the church of Sant'Egidio had been suppressed by Pope Gregory X in 1274, which had allowed Folco to purchase a lot of the adjacent land.

The first hospital ward housed male patients.  A few more years would have to pass before the women got their own new wing, which was begun in the first decade of the 14th century and completed some 70 years later.  (Presumably, in the interim female patients were cared for much as before, in privately owned houses.)

By 1334, the men's ward - an open ward design, with beds along two facing walls - attained an extension at right angles to the earlier construction, a step toward its later cruciform shape.  At the angle of the two wards, hospital personnel had all their charges in their line of sight.  Equally important, when daily mass was conducted in this spot, at the altar of St. Luke, all the patients could see the elevation of the host.

The hospital was to grow apace, adding many more beds, laundry facilities, expanded kitchen facilities, and much more of the services needed to care for a growing patient population.  At first, hospital personnel shopped for medicines and medical supplies at an apothecary shop in town, just as people caring for the sick at home did.

The local pharmacy

But eventually, the hospital even added its own pharmacy on site, the better to serve its patients. 

Maiolica jar used in the pharmacy of Santa Maria Nuova

The process of "medicalization" moved along rapidly for the first fifty years of Santa Maria Nuova's existence.  Its 1330 statutes stipulate that its function was "the good service of the poor sick" - no longer just the poor.  Significantly, the statues dictated that no person who was not sick could remain in the hospital for more than three consecutive days without the knowledge (and, presumably, the permission) of the patrons.  And those, of course, would have been the Portinari.

With medicalization comes a need for trained medical personnel.  From 1325 to 1331 the hospital employed seven medical specialists, including maestro Silvestro, who had a regular salary and was referred to as "nostro medico."  Others served as consultants:  ser Cione, who treated wounds and other lesions, and maestro Filippo, who treated eyes (probably by removing cataracts).  Other doctors were paid for various "medicines and syrups."

A hundred years into Santa Maria Nuova's history, it had three junior doctors in residence and several more senior doctors who visited daily, prescribing treatments and medicines which were administered by the nurses under the supervision of the junior doctors.  The visiting physicians received 24 florins a year, the barber-surgeons 14, and the resident doctors served in exchange for room and board and the chance to gain clinical experience.

Women patients were seen by women "well skilled in surgery."

As for the hospital's other employees, monna Tessa's oblates probably managed without much additional help in the early days, but as the institution grew, so did its need for workers.  Nurses and administrators alike were typically without medical training.  They often lived on the premises, in dormitory-style accommodations, and ate communally.

The ceremony for accepting a new employee - a penitent, committed to the care of patients - was not unlike the entry into a religious order.  There was an investiture ceremony held in the presence of the spedalingo (head administrator) in the hospital chapel, in which "girl novices" knelt, asked "God's mercy and that of His most holy mother Virgin Mary and your honest and good company."  Priests sang psalms, and the girls exchanged their clothing for the simple gray habits they would wear from that time on.  Each worker had the hospital's seal, a crutch cut from red or green cloth, attached to the shoulder of his or her habit.

In addition to nursing, the hospital needed people to cook, clean, garden (growing and harvesting medicinal herbs), and do laundry.  The hospital was known for its chicken soup, apparently thought to be restorative even then.  They served the most seriously ill patients a soup of pureed chicken - no thin broth, this - and an appropriate wine of good quality:  white, red, smooth, sweet, or dry, according to the patient's diagnosis.  In the early 16th century the hospital was purchasing 40,000 chickens and 80,000 eggs annually.

As for the laundry, freshly laundered linens were stretched out to dry on the upper terraces of the hospital buildings.  In 1454, the linen at another Florentine hospital (San Matteo) consisted of 150 pairs of sheets, 50 pillows and cushions, 200 napkins, 189 bedshirts (some new and some old), and 150 used aprons.  It must have been quite a chore.

By the time the plague struck Florence in 1348, Santa Maria Nuova could care for 220 patients.  It did take in plague victims, then and during later outbreaks; by 1464 Florence's government had realized the risk of spreading infection by this practice, but there wasn't much of an alternative in place, and so the hospital continued to manage as best it could. 

One outcome of the huge population loss caused by the plague, which wiped out entire branches of families, was that hospitals and other charitable institutions profited greatly from charitable bequests, as frightened people strove to save their souls, or simply had no living family left to receive an inheritance.

Chronicler Matteo Villani, speaking of this windfall of bequests, said, "The bequests to the hospital are well made, because the hospital gives much alms and is always full of sick men and women, who are cared for and treated with great diligence and abundance of food and medicines, and is administered by men and women of holy life."

Others thought well of Santa Maria Nuova, too, both elsewhere in Italy and in the rest of Europe.  When Henry VII of England wanted to set up the Savoy Hospital in London, he requested a copy of the "Ordinamenti" of Santa Maria Nuova, a document which was presented to him by Francesco Portinari, then a papal legate to the English court.

Henry VII

Martin Luther, who may have been resident in Santa Maria Nuova for a time, praised "the finest food and drink, attentive service, very learned physicians and clean beds."  Of course, it is true that nobles and churchmen in need of a hospital's services may have received Cadillac service compared to the paupers, but it does appear that Santa Maria Nuova maintained high standards for its time, throughout its long history.

Martin Luther

I'd like to mention one other prominent Tuscan, from Prato, a near neighbor to Florence.  This man, a wealthy merchant, had his own special connections to Santa Maria Nuova.

Francesco Datini

 "The Merchant of Prato," as he is known, lived from 1335-1410.  Although his main residence was in Prato, he did a lot of business in Florence and often stayed there for extended periods.  His personal relationship with Santa Maria Nuova began in 1392, when his slave Lucia gave birth to his daughter, Ginevra.  The child, apparently not welcomed by Datini's wife Margherita, was given into the care of Santa Maria Nuova, which, in addition to all its other functions, accepted and placed unwanted children. Santa Maria Nuova arranged for a wet-nurse and a foster family for little Ginevra.  In 1398, when the child was six, Francesco and Margherita, otherwise childless, welcomed her back to their home.  There is every evidence that both of them doted on the girl, and eventually they dowered her lavishly and married her to someone close to the family.

Francesco, mindful of what Santa Maria Nuova had done for his daughter, left the institution a large bequest to set up a foundling hospital.  The silk guild (Por Santa Maria, which had been Folco Portinari's guild) took over the project in 1419, and the eventual result was the Ospedale degli Innocenti.

The "baby hatch," where foundlings were left at the Ospedale degli Innocenti

Francesco Datini
Francesco Datini's close friend, the notary ser Lapo Mazzei, was employed as Santa Maria Nuova's notary for nearly 20 years.  For his salary of 10 florins a month, he administered at least 50 properties, visiting fields and vineyards and supervising farm workers.  He distributed alms to the poor, including "monies and gowns and dowries."  He ordered supplies, sometimes from his wealthy friend:  for example, 300 blankets for the hospital beds.

It was a job he loved.  He wrote, "I know no man who has greater freedom than I.  I am fettered neither by relations nor friends nor sects.  Yet I keep a yoke upon my neck, for it is this that I desire to be."  That yoke was his service to Santa Maria Nuova.

Images in this post include our own photo of the statue of Francesco Datini; twelve public domain images; and the following images by Sailko, licensed under the Creative Commons Attribution - Share Alike 3.0 license, via Wikimedia Commons:  Ospedale, Sant'Egidio, Portinari arms, monna Tessa,  and maiolica jar .

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