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.
Rome had important associations for Christians from the earliest Christian times because both Peter and Paul were put to death there. The Bishop of Rome was therefore one of the most important ones in Christendom, and when the other principal bishoprics fell to the advance of Islam in the seventh century, Rome was the only one of the originals to remain. It became a place of pilgrimage. As the centuries went on, more and more people came to Rome to see the tombs of the apostles and to see the Pope.
The map of the year 900 (map 900AD) shows the Tiber River, the Roman walls, the main streets within the walls, and the location of St. Peter's church. The shaded areas are the places where the diminished population of the city actually lived. The most travelled pilgrim route was from the north, entering the walls at their northernmost extremity and then crossing the Tiber on one of the two bridge crossings that had survived from antiquity. Between the bridge and St. Peter's there grew up a number of hospices for the pilgrims of this or that country. One, on the riverbank at the river’s more than 90 degree bend, founded in 726 for the English and endowed by the King of Wessex, was called the hospice of the Saxons. The church built next to it was dedicated to the Holy Spirit and was called the Church of the Holy Spirit in Saxia.
Unless otherwise noted, the information in this essay about the founding and development of Holy Spirit Hospital is from Enzo Bergami’s monographs and Angelo Palma’s L’Ospedale di Santo Spirito in Saxia. The published presentations, L’antico ospedale di santo spirito dall’istituzione papale alla sanitą del terzo millennio, of the May 2001 Congress of the same name, held on site, contain huge amounts of information about the hospital as well as numerous illustrations.
By the twelfth century, although the population of Rome fluctuated, it had grown. The inhabited areas, shaded on the map of Rome as it was in 1100, (map 1100AD) were more extensive. The old hospice of the Saxons had ceased to exist, but the Pope at the time (Innocent III) thought that a hospital where people could receive medical and nursing care should be built. There were few hospitals in Europe at the time; one in Paris and one in Lyons are famous. There were, however, people interested in establishing hospitals with organizations capable of running them.
Such a person was Guy of Montpellier, from the south of France, whom the Pope had met while studying in Paris. Guy had founded a hospital in Montpellier and set up an informal religious order of men to run it with, presumably, an informal women's religious order, under the men's direction, to care for women and children. The Pope had him come to Rome, and with his help founded a hospital where the former Saxon hospice had stood, the Hospital of the Holy Spirit in Saxia. 1198 is generally considered the date of founding.
A few years later the Pope approved Guy's group as full-fledged religious order of men dedicated to the care of the sick. This order grew to have a large number of hospitals spread from Hungary to England in the Middle Ages; some authors state that the order had as many as 500 or even 1000 Holy Spirit Hospitals (Heimbucher 1965, v. I, pp. 417-419, 612) ). There may, however, be confusion between hospitals operated by the Holy Spirit Order and others operated by Holy Spirit brotherhoods of men who did not take monastic vows. (Heimbucher, op. cit., p. 459)
THE SISTINE WARD
Things were going well in Rome towards the year 1500, and the Pope around 1470 promoted a great deal of construction. His name, Sixtus (IV) was especially immortalized in the Sistine Chapel in the Vatican. Sixtus had the small old Hospital of the Holy Spirit torn down and a large new one erected. The new hospital was for many centuries one of the splendors of Rome and still is, although not as conspicuously as it was at one time.
The third illustration (hospital 1) is a view from a city map of 1593, showing the hospital in relation to St. Peter's. The next illustration (hospital 2) is a closeup of the hospital by itself. The long building is the construction of 1474. Many other buildings have been added since then, and the whole triangular plot was been put to hospital use until recently. To visualize the hospital as it is today, imagine several large buildings between Pope Sixtus's structure and the river, noting that the church is not really as large as it is drawn here.
The fifth illustration (hospital 3) is a side view of the great Sistine ward, which is 400 feet long by 40 feet wide and 40 feet high (the cupola in the center is higher). Originally there was an open porch all along the side shown here, but it was bricked up. At the time this photo was taken the land across the street from the Sistine ward was vacant, and the photo was taken from some distance. Now, however, one can only stand across the street and view it from a short distance.
Illustration six (hospital 4) is a view of the east end, which can even now be seen from the street. The other end was attached to other buildings from the beginning, and there was an inconspicous inner window in it from which the hospital director could look down and make sure that things were all right in the immense ward below.
The final illustration (interior) is from a photo taken from inside the east end, showing the interior arrangement of the hospital in about 1950. The principle had been the same since 1474: long rows of beds along the sides. In the background of this photo is the partition which separates this end from the central area under the cupola, where there is an artistic gem of an altar. Originally, although there was an altar, there were no partitions. The ward was designed to hold 300 beds, but in time of plague, it is said, as many as 1,000 patients were crowded into it.
The ward's small, high windows do not admit much light or air by modern standards, but for most of the hospital's history medical lore had it that fresh air was bad for the sick. Even so, this was a light and airy building for its time. Locating the hospital next to the river, however, where infections, especially typhus, were apt to spread, was, as we now know, not suitable to hygiene. Between the windows you can barely observe that there are paintings. They are 45 large frescoes depicting the founding of the hospital by Innocent III and the life of Sixtus IV. The first set represents a legend that the Pope had fallen sick, and in answer to his prayer an angel appeared to him and told him to have fishermen cast their nets into the Tiber and bring him what they caught. He did this, and what they brought to him were the bodies of infants drowned by their mothers who could not, or would not, care for them. Horrified, he decided to build his hospital there and to make provision for abandoned babies.
In reality the hospital had from the beginning (and this can still be seen near one door of the 1474 structure) a "wheel," a rotating drum-shaped insert in an external wall where a woman could, without being seen, place a baby. Care for these children was one of the works of the hospital, which raised them, sending boys out to the country and girls to work in the hospital. The girls had very little chance to find husbands this way, but they were allowed to march three times a year in church processions, and so be viewed by young men, who, if sufficiently smitten by love at first sight, could ask for their hand and would receive a dowry for them from the hospital.
The frescoes have been repainted twice, and the ones visible in the 1990s, which were in need of restoration then, dated to 1650. One end, one half of the great ward was empty, but the other half was in use until 1998. It was divided by room height partitions which brought the working area down to proportions that seemed human.
ACTIVITIES ASSOCIATED WITH THE HOSPITAL IN MODERN TIMES
From its founding, the hospital of the Holy Spirit was considered the head and premier hospital of Rome. Many innovations were made there, such as its mode of support funding. Income was needed because hospital care in Rome, was, until modern times, always free for the common people. Pope Innocent, in the beginning, set aside a large tract of land near the hospital and along the river as a farm, the proceeds of which would sustain the hospital. This dependable source of income served well when sources of charity did not.
Because of the large numbers of pilgrims who passed by the hospital on the way to St. Peter’s, stores and businesses sprang up, and among the business institutions were banks. With its lands as collateral the hospital set up a bank, calling it the Bank of the Holy Spirit. Later this was separated from the hospital and became one of the great banks of Rome.
More along the line of health care, in the sixteenth century a new administration building was constructed, and in the eighteenth century another long ward, also 400 feet long, was added to the end of the orginal ward. This was torn down in the next century, but with other additions, the hospital increased in normal capacity to about 700 beds.
In the administration building, which had been built in the sixteenthth century, there was founded in 1714 a library, the Lancisiana, which is lined 20 feet high with books from many centuries, a primary resource for scholars. Lancisi, the hospital director who founded the library, began in 1715 to hold meetings about medical affairs in the antechamber of the library, and this was formalized as the Accademia Lancisiana, which is still a prestigious professional organization in Rome.
Situated in a more recently constructed hospital building is the National Museum of Health Care, a fascinating collection of surgical and other instruments and anatomical models. Holy Spirit was a teaching hospital for doctors long before modern times. Dissections of human cadavers took place there at least in the seventeenth century for the medical students of the University of Rome, which was about a half mile away. In 1856 there was a turning point in medical care in that barbers with their leeches were definitively excluded from the hospital.
Medical research also took place at the hospital. Malaria was a great problem along the Tiber and in swampy areas near the sea, so in 1645 a series of experiments was instituted using quinine compounds ground in the hospital pharmacy by a water wheel impelled by the water which came from the mountains to a fountain in front of St. Peter's
During most of the hospital's history nursing care in it consisted mainly of keeping patients fairly clean, well fed, and separated from outside contagion. Historically there is some confusion about who nursed whom. In the Middle Ages and Renaissance nuns, real cloistered nuns, ordinarily did not do nursing outside their cloistered environment; they were not allowed contact with laypeople. Pious Women who organized themselves in nun-like associations cared for the sick, male and female. There were both nuns of the Holy Spirit and pious women of the Holy Spirit who cared for the sick in the hospital, living in a cloister in a building next to the Sistine ward. The female foundlings at Holy Spirit also took care of the sick, although, as it seems, as servants rather than as nurses. 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.
During the Crusades orders of men, religious orders in the technical sense, whose work consisted of caring for the wounded, were established. These tended to lose sight of their purpose after a while, becoming bellicose like the Knights Templar or patrician, like the Knights of Malta, but in 1198 the founding of an order of monks to care for the sick in hospitals seemed to make good sense. A cloister was built next to the Sistine ward for the monks. Both cloister structures with their courtyards are still standing and are still in use for various purposes.
The monks were required to care for the sick, but men cared only for men. Actually, the zeal of these men waned, and when the Pope had the new building constructed in 1474 he also reformed the men's Order of the Holy Spirit. A hundred years after that these monks were scarce and they had servants caring for the sick. Also looking after the sick were condemned criminals because an alternative to punitive service in the galleys was service in the hospital of the Holy Spirit and other hospitals. At that time a new attempt was made to found an order of men to nurse the sick: the idea was to have them do it gratis in Holy Spirit (and, later, other hospitals) and support themselves by the charity of benefactors. This form of the order's activity did not last more than thirty years. (For a description of the inadequacies of care in the hospitals in the late sixteenth century and of the order of men founded at that time to remedy them, see histories of this order, the Order of St. Camillus.) The Order of the Holy Spirit itself dragged on in small numbers until it was finally disbanded by papal decree in the nineteenth century.
In 1743 people actually called “nurses” in the modern sense were introduced into the hospital, and two years later Santo Spirito started using charts at the head of the beds to show treatment and diets of the patients.
RECENT HISTORY: FROM HOSPITAL TO MONUMENT
In 1978 healthcare in Italy was reorganized, resulting in a diminished primacy of Santo Spirito. In 1998 the last patient bed areas of the Sistine ward were removed from service. The historical importance of the older buildings was fully recognized by the Italian government, but from then until 2009, at least, funds were not available for restoring them and the art they contain. The National Museum of Health Care remains there, as does the Lancisiana Library, although the library had to be moved from its historical site in 2004 because repairs were needed. (website of the Biblioteca Lancisiana, last updated in 2009) The school of professional nursing also remains there, its website in 2012 presenting a wealth of information about it and about the rest of the historical complex.
L’antico ospedale di santo spirito dall’istituzione papale alla sanitą del terzo millennio. 2 volumes. Roma: Il Veltro Editrice, 2001.
Aragozzini, Giovanna and Marco Nocca. Le Piante di Roma dal Cinquecento all'Ottocento. Roma: Dino Audino Editore, 1993.
Bergami, Enzo. Breve Storia dell' ospedale di Santo Spirito in Sassia di Roma. Roma: circulated by author, 1994
___________: I regolamenti ospedalieri: nel 1204 – nel 1751 – nel 1899 - ne1 1986. Roma: Estratto dagli "ATTI DELLA ACCADEMIA LANCISIANA DI ROMA," Vol XXX, n. 2, 1985-86.
___________: L'alimentazione nel Santo Spirito e negli altri ospedali romani dal 1200 ad oggi. Roma: Estratto dagli "ATTI DELLA ACCADEMIA LANCISIANA DI ROMA," Vol XXXVII, n. 1, 1992-93.
D'Onofrio, Cesare. Roma nel Seicento. Firenze: Vallechi Editore, 1969.
Heimbucher, Max. Die Orden und Congregationen der katholischen Kirche. Paderborn: Verlag Ferdinand Schoeningh, 1965. Volume 1.
Krautheimer, Richard. Roma: Profilo di una cittą 312-1308. Roma: Edizioni dell'Elefante, 1981.
Palma, Angelo. L'Ospedale di Santo Spirito in Saxia. Padova: Biblioteca di Galileo, 1994.
Sanfilippo, Mario. Roma medievale e moderna. Roma: Newton Compton editori, 1992.
SOURCES OF ILLUSTRATIONS
1 and 2 Adapted from Krautheimer, p. 309
3 and 4 Aragozzini and Nocca, pp. 74-75
5,6,7 Palma, pp. 21-23