John Henderson, 2006

Henderson’s stated aim is to ‘set the record right’ by showing that the view of mediaeval hospitals as hell-hole prisons for the containment of poverty and disease is just as inaccurate as the notion – promulgated by many Renaissance writers – that in these institutions all was sweetness and light. As he goes about achieving that aim he unfolds a wonderfully detailed picture of hospital life in all its fascinating aspects.

The book studies the transformation of the hospital from pilgrimage way-station into an institution for ‘healing the body and healing the soul’, managed by the Church, with much financial support from the citizenry and for the benefit of the entire city. Henderson focuses on Tuscan hospitals, and, because of copious archive material, on the Florentine hospitals in particular (the star among which is the still extant Spedale di Santa Maria Nuova, founded 1286). The title is therefore not quite accurate (as Henderson himself acknowledges), even if copies of the statutes of S. Maria Nuova were requested and used by Henry VII of England and others in setting up similar institutions (in England the Savoy Hospital). Hospitals in Spain, Germany and England are not discussed.

His time span is roughly the turn of the millennium to the mid-16thC, but the meat of the book concerns analysis of the period 1250 to 1450. This was when most of the important architectural and institutional issues were pinned down. Unsurprisingly, building forms derived from ecclesiastical models, at a time when the emphasis was on curative care rather than surgical intervention (though surgery was performed, and it might come as a surprise to learn that cataract removal was performed in the 14thC). There were therefore no calls for novel room types or architectural forms.

In the century after 1250, some 30 hospitals were founded in Florence, most of them small affairs with fewer than 50 beds – some fewer than 10 – and often sponsored by particular guilds. They served poor people with general ailments – the richer citizens would have had treatment at home. Only over the centuries did S. Maria Nuova grow from its three-bed beginnings to treating over six thousand patients in the early 1500s.

Architectural development was the same old story:  buildings expanded into limited urban space, using ingenuity and the few basic architectural forms available (well before the 19thC invented double-banked corridors), which were chiefly the hall and the cloister

The great achievement of Henderson’s book is the use he makes of Santa Maria Nuovo’s account books, its various statutes and a detailed inventory made in the 1370s. The result is a detailed, textured account of the life in these institutions, recalling Iris Origo’s Merchant of Prato, the telling of Francesco Datini’s 14thC life through his account books and letters to his wife.

The Quattrocento’s contribution was largely on the bellezza front, when ragged street fronts were tidied behind symmetrical loggias, such as Brunelleschi’s at the Ospedale degli Innocenti. Not that the loggia was a new thing, even for hospitals: it had been used on palazzi, spedali and chiese in the 14thC. But in their desire to create formal distinctions between urban building types, architects gradually reserved the loggia for hospital use – and this made practical sense apart from giving visual coherence and being a kind of ‘type-mark’. It would have provided a sheltered waiting or even treatment area, as well as a socializing space adjacent to the street but sheltered from its chaotic bustle.

This making of distinctions was as apparent with the hospital framework as it was in urban typologies. Early hospitals tended to all comers. With the Black Death and the plague’s  subsequent return at 10 to 15 year intervals, it was eventually regarded as prudent to have separate hospitals – lazzaretti – for plague sufferers, to avoid cross infection. The advent of the Mal Francese (syphilis)  in the 16thC gave rise to separate institutions for the incurabili.

The making of distinctions continued with the Counter Reformation and its restrictions on women’s contact with male society. Galleries were built to keep them out of the main body of churches, special passages built to allow them to  move about unobserved by men, and ‘when pressure was exerted on the commesse (female nursing staff) to lead a more sheltered life, the cooks carried the prepared food through the end of the female ward behind the chapel and placed it into a revolving hatch, in a manner’, adds Henderson with a delicious sense of humour, ‘akin to the way abandoned babies were left in the turning box at the Innocenti [foundling hospital]’.

Henderson insists repeatedly on the fact that these institutions cured ‘the body and the soul’. This is harder to judge. It is very difficult for a 21stC Protestant (whose religion has been distilled to aesthetics and ethics, God driven off in the process) to gain any kind of appreciation of the effect the religious nature of these institutions might have had on their patients. I would have liked to see a discussion of the concept of bellezza – which seems to have been the restorative device and meant, apparently, fine buildings and fine works of art. Did it have specific theological meanings in the Renaissance that have since been lost?

As Florence went through its economic boom following the Black Death (1348), not only did the hospitals become richer, they also became recipients of considerable artistic patronage. From frescoes (S. Maria Nuova, S. Maria della Scala, Siena) to sculpted figures above entrances and glazed terracotta friezes (Andrea della Robbia at the Ospedale del Ceppo, Pistoia) to painted altarpieces (Fra Angelico at S. Egidio), great artists were working to elaborate artistic programmes specific to the hospital. Nor did they shy away from the reality in favour of sentiment: Domenico di Bartolo’s fresco, the Care for the Sick, at S. Maria della Scala depicts the full cycle of hospital life, from admission of an injured man to the removal of a corpse.

Perhaps it was such frankness that led later generations to take such a grim view of what these places were like. But far from being the ‘chambers of death’ adumbrated by Foucault and others, places for the corralling and control of the poor, these hospitals had mortality rates in the range of 5% to 10%. Most people could expect to go into hospital either with a minor illness or else from temporary poverty, and expect to leave again in better health. They were well cared for, living in better versions of home: decent furniture (Filarete: ‘At the head of each bed was a cupboard, or a little window. When it was opened, the door made a little table where the sick could eat… At the foot of each bedstead there was a small chest where things could be kept in case of need’.), decent food (including chicken soup, ‘for which S. Maria Nuova was so famous’), and a degree of companionship.

The pressures on Florentine hospitals caused by the arrival of the Mal Francese and the siege by the French of 1529-30 pushed these once-wealthy institutions to liquidate most of their assets and still left them in debt at a time of economic stagnation. The city had forced the wealthiest to pay forced loans and heavy taxes to fund the Republic. Their economic and social importance – beyond health, also in terms of the employment they gave to hundreds of merchants and artisans – assured their survival within the appropriately-named Medici dukedom, but at the cost of independence.

Some very few books that are just exactly what you wish all books could be, and this is one of them. It is a gem. Aside from medicine and hospitals, it will without doubt be indispensable to anyone writing on Renaissance cities.