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 .

A Medieval Doctor and His Career

Taddeo Alderotti was something of a rock star among 13th century physicians.  A brilliant teacher and a skilled medical practitioner, Taddeo was also well versed in philosophy.  He held that medicine derived its principles from (and was there a subdivision of) natural science, and thus natural science and logic were a necessary foundation for the study of medicine.

Much in demand for his medical skills, Taddeo demonstrated another formidable skill as well:  the art of making money.  It was this latter talent that earned him a mention by Dante, who in his Paradiso 12:82-85, put these words into the mouth of Saint Bonaventura, speaking of Saint Dominic: 

Non per lo mondo, per cui mo s'affanna di retro ad Ostiense ed a Taddeo,     ma per amor della verace manna

 in picciol tempo gran dottor si feo...

Not for the world, for whose sake they labor now, following the man from Ostia and Taddeo, but for love of the true manna,

in short time he became a great teacher...

(trans. Robert M. Durling)

 (The Ostian in the quote above is Enrico di Susa, a very successful scholar of canon law who became Cardinal-Bishop of Ostia and Velletri in 1262.)

Taddeo taught students who became the next generation of rock star doctors, and he treated patients ranging from a blacksmith to the pope, with stops in between at Florentine noblemen, a Venetian doge, a natural son of Emperor Frederick the Second, and a bishop who was himself an eminent physician, thus making Taddeo a physician's physician.  He treated men and women, old and young, all over Italy, both in person and as a consultant to their own physicians.  (Most of them did have in common a certain amount of wealth, for Taddeo did not come cheap.)  He wrote health regimens and consilia, detailing his recommendations for living a healthy life.

Two well-known anecdotes about Taddeo may give a little of the flavor of his time, and possibly also of the man.  One pertains to his teaching, the other to his medical practice.

First, there was the time that Taddeo cautioned his students against eating petronciani (eggplant, probably) on the grounds that it would cause madness.  One of his students disagreed, and, to prove his point, ingested eggplant and returned to class to announce that he was not at all mad.  And then he raised his garments and mooned Taddeo.  So - whose point did he prove, exactly?  (I think the usual conclusion here is that such behavior was not standard in a 13th century medical school classroom.)

And secondly, a chronicler reports that Taddeo had been called in on a difficult case, that of a nobleman who was seriously ill.  Taddeo believed that his patient was on the mend, so over the protests of his assistants, who were less sure of the outcome, he went home to get a good night's sleep.  When he returned the next morning, the patient was at death's door, and distraught family members were making wild threats, such as - horror of horrors - withholding the fee.  Taddeo looked around the sickroom, spotted an open window, and rounded on them:  had he not told everyone present that the windows had to be kept closed?  Therefore, the unfortunate change in the patient's condition was no fault of his.

Taddeo was largely responsible for taking medical education out of dusty translations of ancient texts and into the sickroom, teaching at the patient's bedside. He believed in taking a patient's medical history.  He advocated a scholastic and dialectical approach to medical teaching, and his methods to a large extent shaped medical education at Bologna, a curriculum which was in its infancy at the time he arrived there.

He got wildly excited about the medicinal benefits of distilled alcohol, including its use as an antiseptic, which to the modern mind seems like good sense indeed.  However, if you were his patient and you were suffering from epilepsy, his prescription might have been a concoction of burned human bones, wine, and peony juice, along with pills which included the gallbladder of a beaver and bear's testicles.  If that didn't appeal, you could try an alternative:  the liver of a wolf, burned and powdered asses' hooves, and the blood of a tortoise.  Bear in mind, he lived in a time when physicians believed in the evil eye (especially among elderly women, whose humors were considered to be cold and dry), and when people believed that the glance of a menstruating woman could cloud a mirror. 

Taddeo's Life

We have wildly divergent birthdates given for Taddeo.  I've seen dates as early as 1206 and as late as 1223, which means that when he died in 1295 (that one we do know), he was somewhere between 72 and 89.  He was a Florentine, probably from a family of modest means - it's said that as a child he sold church candles. 

He was teaching at the university in Bologna by the early 1260s.  Since in 1260 he would have been at least 37 and possibly as old as 54, this suggests that he may have begun his medical training later than most.

We'll take a closer look at both his teaching and his practice in a moment, but first I'll tell you what little we know about his life. 

He never lost his connection to his native Florence, although he spent his entire career based in Bologna and died there.  His wife, Adela, came from a Florentine family; they were wed in 1274 (when he was somewhere between 51 and 68).  They had a daughter, Mina, born around 1280, who married into the prominent Pulci family in Florence, bringing with her a sumptuous dowry of 1000 gold florins.  Taddeo also had a natural son, Taddeolo, who he legitimated in 1290.

It appears that he may have suffered some incapacitation in the last couple of years of his life, during which time he quarreled bitterly with one of his students (see Students, below).  He may have grown "manipulative and suspicious" in those years, as historian Nancy Siraisi surmises based on his numerous wills and the secrecy with which he surrounded his final will.

That will left large charitable bequests to the inform, sick, and aged poor, as well as a legacy to every hospital in Bologna.  His library of medical and philosophical books he left to the Franciscans and the Servites, and his body was laid to rest in the Franciscan church.


Taddeo's Students

We know the names of six of Taddeo's students, because each of them made a name for himself in his own right.  Here, as a sampling, I give you brief descriptions of the careers of two of these men, both of whom were noted for their contributions to anatomy.  A third student, Dino del Garbo, will merit a separate blog post for some of the odd and mysterious twists and turns his life took.

Bartolomeo da Varignana, the well-to-do son of a physician, did some forensic work for the city of Bologna, including (with four other physicians) conducting an autopsy to shed light on the suspicious death of a nobleman in 1302 - one of the first forensic dissections of the middle ages.  Caught up in the politics of his time, Bartolomeo, a White Guelf, was banned from Bologna in 1311 and joined Emperor Henry VII in his Italian travels.  Upon Henry's sudden death in 1313, Bartolomeo defended Henry's confessor against charges that the emperor had been slain by a poisoned host.

Mondino de'Luzzi, 1275-1326, was the son of an apothecary.  His family was Florentine but moved to Bologna while Mondino was a small child.  Mondino was a major figure in the history of anatomy, and may have performed dissections with his own hands, instead of looking on and directing his assistants, as had been the practice.  Known as "the restorer of anatomy," he played a major role in reintroducing the practice of public dissection.

Taddeo's Teaching Career

Taddeo's teaching at Bologna was so successful that he and his students were granted the same privileges afforded Bologna's elite, the students of law.  Although he was not a citizen of Bologna, the city granted him tax exemption and allowed him to purchase property.  One account states that he was even granted citizenship in 1289.  There is considerable evidence that his teaching colleagues respected him and valued him as a colleague, and chose him on various occasions to serve as arbitrator of their disagreements or guarantor of their agreements. 

Although the city of Bologna valued his teaching, it also liked having him practice medicine there; he may have been part of a team of forensic physicians called on when legal proceedings required a professional evaluation of a wound or the determination of cause of death.  Both Perugia and Venice vied with Bologna for his services, but unsuccessfully.  (He did agree to go to Perugia for a huge salary, but once there demanded even more.  Perugia's rulers refused, so he returned to Bologna.)  Bologna paid him well, his students paid him even better, and he had the freedom to travel to distant places at his pleasure, there to collect still more substantial fees.


Taddeo's Patients

In addition to the patients he saw in person, Taddeo offered his advice via letter to many other Italian physicians.  He traveled, when the price was right, to other cities to see patients in person.  As I mentioned above, he treated a wide range of people, but I'd like to take a closer look at two of his patients:  Pope Honorius IV, and Corso Donati.

Pope Honorius IV, born Giacomo Savelli, held the papacy for only two years.  Born in 1210 in Rome, he died in 1287.  Even at the point where he became pope, gout had incapacitated him, and he was unable to stand or to walk.  In fact, when he said mass he was unable to elevate the host without the help of a mechanical device to lift his hands.  Thus, when Taddeo was called to come to Rome and treat the ailing pope during what proved to be his final illness, no one would necessarily have expected a miraculous cure; the pope's health had been too poor for too long.  Taddeo went, and he commanded the princely sum of 100 ducats a day for his services.  My source says he eventually walked away with 10,000 ducats, a huge amount of money, so he must have been in attendance on the pope for 100 days.  Although Taddeo was probably not the only physician summoned, it was a signal honor to be called.

Honorius IV

Corso Donati, the turbulent Florentine nobleman who was distantly related to Dante by marriage, apparently was both friend and patron to Taddeo, who wrote a health regimen especially for him.  It incorporated much of the same sorts of advice Taddeo proffered to others in his many written consilia, but was specifically tailored to Corso's needs.  The regimen was probably prepared for Corso during one of his tenures as podestà (a city's chief magistrate, hired from outside the city for a short term, typically a half year).  Corso held that position more than once, and also served as Capitano (another high city office, similarly filled from outside the city in the interest of avoiding bias).  Corso served in one or the other of those offices in 1283, 1284, 1285, 1288, and 1293.  Historians suggest the latest of those dates as the likeliest for the creation of this remarkable book of health advice.  Corso in 1293 would have been in his low forties; he suffered from gout. 

And what did Taddeo advise Corso to do?  Well, among other things, he was advised to wear fine clothing, because the soul rejoices in it; to drink a "subtle and fragrant" white wine; to surround himself with pleasant aromas; to look at beautiful things; to remember pleasant experiences; and to strive for a cheerful disposition.  He also offered general hygiene advice:  stretch in the morning after waking, clean face and teeth, comb hair, walk 1000 steps after eating.

He offered dietary advice as well.  His usual included avoiding bread hot from the oven, and also avoiding cheese, some (if not all) fruit, and fish taken from still water.  Diet should consist of poultry and veal, with moderate amounts of herbs and vegetables.  He generally favored dry cooking methods (though in Corso's case he did advise soup), and he even prescribed specific mixtures of spices.

(Corso may have been less pleased at being told to avoid overeating and overindulgence in sexual intercourse during the summer, practices which Taddeo apparently thought Corso likely to engage in.)


Taddeo on Distillation

And last but not least, we should take a look at Taddeo's extraordinary devotion to the art of distillation.  He wrote a treatise on distillation of wine, a process that had been known since the 12th century but which Taddeo was the first to use medicinally.  And he used it a lot.

A 17th century distillation manual

Here's Taddeo on distillation:

Its glory is inestimable; it is the parent and lord of all medicines, and its effects are marvelous against all cold affections.

 Aqua vitae had endless uses, according to Taddeo.  It could prevent grey hairs and restore youth.  You could drink it, apply it topically, or sniff it.  It could be used to treat eye problems, toothache, facial tics, certain headaches, bronchitis, sciatica, dysentery, quartan fever, gout, and sterility of cold origin.  Not to mention cancer and fistula, plus it has the ability to expel poisons.  Here's his recipe against melancholy and sadness:

A half spoonful (of aqua vitae) every morning, taken on an empty stomach, together with a small dipper of fragrant wine, makes a man glad, merry, and happy, and strengthens all the animal virtues against all thick and turbid spirits.

 One might wonder just how big a spoon he was talking about, and how big a dipper, but hey - it could work.  And on that note, we'll leave Taddeo Alderotti, rock star doctor of the 13th century.

Images in this post are in the public domain, either by virtue of being sufficiently old or of having been placed there by the copyright holder.