Book Review: The Renaissance hospital: healing the body and healing the soul

Renaissance medicine usually conjures up visions of the new medical humanism, anatomical discovery and the rise of university learning. Hospitals, in contrast, have remained somewhat peripheral to the historical gaze, stereotyped as unhygienic houses of confinement populated by the old and dying. The author's goal is to present a much more nuanced picture of the Renaissance hospital by stressing continuities with the medieval past, thus softening the transition to a much more medicalized institution, although care persisted in healing the soul while mending the body. Henderson, who brings impressive scholarly credentials to the task, wishes to change this impression with an extensive and detailed analysis that aims to demonstrate the central role of these institutions in the development of Renaissance medicine. The title of the book, however, is somewhat misleading: the work is limited to Tuscany and primarily the city of Florence. Here the Hospital of Santa Maria Nuova is featured as emblematic for the story. In fact, it became a blueprint for other contemporary cities in Italy and Europe. The book is divided into three parts, each featuring three chapters. The first section successively attempts to place hospitals in a variety of contexts, including Florence's political, religious and cultural landscapes. Half of the foundations occurred between 1200 and 1300, driven primarily by a large influx of immigrants from the countryside. The author shies away from the cliche of secularization, arguing persuasively for church and state partnerships in the awarding of charity and the growing importance of hospitals as a vital cog in a support network designed to deal with the sick poor. The first chapter ‘Before the Black Death: the birth of the clinic’ argues that medicalization was already part of society's reaction to the threat of epidemic disease. Part II discusses the religious space of hospitals and their role in healing the soul. Much of the focus is on the institutions' church and ward chapels. Architectural features, commissioned frescos and paintings, devotional imagery were all part of what Henderson calls the institution's “bellezza”, playing an aesthetic role but above all creating spiritual inspiration and comfort. Attended by patrons and the public, special holidays and festivals signalled compassion and solidarity with the plight of inmates. Serving the hospital population was a devoted nursing community: “mature” mostly widowed women frequently drawn from former patients, in part because of their empathy and institutional experience. The final section focuses on the hospitals’ medical role. Instead of enforced admissions, patients came voluntarily to seek treatment from a cadre of competent medical professionals hired by the institution. The author discusses the establishment of a university-trained profession organized in guilds and colleges that increasingly viewed the hospital as beneficial for acquiring skills and prestige. Based on ample evidence, Henderson firmly rejects the Foucauldian notion that Renaissance hospitals were “antechambers of death”. In fact, the analysis of about 8,000 patients listed for the S. Maria Nuova between 1512 and 1530 yields a 10 per cent mortality rate. This statistic can be explained by selective admission policies that sought to exclude individuals with chronic conditions and those suffering from epidemic diseases such as plague and syphilis. Lacking hospital case records, the reconstruction of institutional life is based on admission and death records. Patients were usually servants, weavers, shopkeepers, craftsmen as well as members of the clergy. A third came from the city, a half from the rest of Tuscany. The length of stay averaged about twenty-one days. Temporary guests and impoverished aristocrats could use special chambers. As noted elsewhere, the hospital was being transformed into a house of recovery. A final chapter discusses the 1515 “ricettario” or pharmacopoeia from the Santa Maria Nuova Hospital containing a collection of 1,000 recipes. Many of these simple and compound remedies were drawn from past and present medical authorities, going back to the time of Galen and Dioscorides. Others represented established folk practices, plants from the “kitchen medicine” familiar to patients. Arranged in numerous tables, they furnish a glimpse of institutional drug practices based on Galenic humoralism. However, they do not reveal much about dietary practices and physical approaches to treatment such as the ubiquitous bloodletting. Indeed, the entire subject of patients' diseases, their symptoms, and medical decision-making remains cast in its original ambiguities. In sum, Henderson has written an exceptionally detailed account of Florentine hospitals mostly centred on data available from the famed Santa Maria Nuova, an institution that served as a model for others long into the modern era. His command of primary sources is impressive, the text fluid and generously illustrated. Numerous tables allow the reader to appreciate and understand the information. An appendix lists all hospitals founded in Florence from the year 1000 to 1550. Sixty-three dense pages of notes and a bibliography of primary and secondary sources complete this extensive work. Scholars will now be forced to include hospitals among the salient components of the medical marketplace during the Renaissance.