Source: Katherine Park and John Henderson, “The First hospital among Christians”: The ospedale di Santa Maria Nuova in early sixteenth-century Florence in Medical History, 35:2 (1991:Apr.), 164-188.

Table of Contents

Contextual Introduction to the Statutes of the Sants Maria Nuova Hospital, Florence

Francesco Portinari‘s letter to Henry VII, incorporating statutes for Santa Maria Nuova (c. 1500)

Contextual Introduction to the Statutes of the Sant Maria Nuova Hospital, Florence

By Gary Devery OFM Cap

The statutes outlined in this letter written around 1500 to Henry VII, King of England and France and lord of Ireland, are very detailed. They are written by Francesco Portinari, the papal protonotary. King Henry VII is interested in constructing a similar hospital in England. The Savoy, influenced by these statues, was completed in 1517.

It is important to note that Francesco Portinari was part of the Florentine mercantile family that founded the hospital and so he would be presenting it in the most positive light. Contemporary sources support that it was considered an excellently run hospital.^[1] The statutes are well worth reading in their entirety. However, we will pick out only some key points. They serve to give insight into and contextualise what the early Capuchin friars were taking on when they took over hospitals such as that of St Giacomo for the Incurabiles in Rome in 1529, orphanages and other institutes.

The Capuchins will have a direct involvement with this hospital but at a later stage. In the early 1630’s a young friar, Illuminato da Bitonto, was sent from the province of Puglia to study in Florence. When a plague struck the city in 1633, he freely offered himself to serve the plague struck victims in the hospital. He died shortly after, struck down by the plague.^[2] In 1682 the Capuchins were called to give permanent service to the hospital and lived on site.^[3]

The hospital opened in 1288 and provided for hospitality and care of paupers, the “Poor of Christ.” Initially it had 17 beds, 5 of which were for the staff. Over the next few centuries it expanded dramatically. A separate male infirmary was built in 1313. By 1376 it had 62 double beds (that is how they did in those days!) for men and 58 for women. When this letter is written containing the statutes there were around 100 beds for both men and the same for women, plus around another 50 in other rooms. At this period, it was treating around 3,000 male patients per annum, with the records for the women incomplete. About 500 people were employed in some way by the hospital.^[4] The discharge rates for this period (1505-1514 from the available records) varied between 86 and 91 percent with the number of patients admitted during this period ranging from between around 2,350 to 4,700. ^[5] It was not a hospital for the Incurables that were initially handed to the Capuchins.

The statutes manifest a very healthy anthropology. There is detailed care for the body, mind, emotions and spirit. It is obvious how entwined was the Church and State.

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Francesco Portinari‘s letter to Henry VII, incorporating statutes for Santa Maria Nuova (c. 1500)^[6]

[Note: the coloured text sections below are to indicate sections that are to be read in class.

To Henry VII, most illustrious, glorious, and invincible king of England and France and lord of Ireland, Francesco Portinari, papal protonotary, wishes happiness and success.

There are three types of good things, most glorious king, and we shall call that man completely happy and fortunate and shall believe the heavens wholly propitious to him in whom all of these goods coincide: smiling fortune, a healthy body, and shining virtue. Among men of this sort, who are extremely rare, if they exist at all but then all admirable things are rare – you must be counted in the first rank by the greatness of your majesty and serenity, indeed as someone in whom all of these types of good fortune are present to perfection. But those higher goods of body and fortune are subject not so much to our will as to the accidents of fate, as Cicero so felicitously says. To cultivate the virtues of the mind, to embrace them, to engage in them – in truth, that must be considered wisdom and the treasury of prudence. For there is an infinite distance between man and God, which distance only virtue can truly span, through which alone mortals can attain immortality.

Truly you, most humane of all kings who have been, are and will be, have become a heavenly hero through the practice of all virtues, so that you can justly and deservedly be called Divine Henry, in the Roman style. Whence it happens. that drawn by the greatness of your power and the piety of your majesty – by which piety alone we approach God, the fulfilment of whose law is love – you are preparing to found a place of residence and succour for the sick. For that reason your most illustrious lordship has asked that we commit to paper the constitution, statute and organization of our great and splendid hospital. Which thing we have done all the more willingly, because our city has gained thereby a welcome lustre and because we felt bound to gratify you, most generous of kings, since we are devoted to your most excellent crown.

Therefore, most gentle king, accept with a smiling visage that which you have requested, which will be the more welcome to us, on account of our exertions, the more gladly your serenity accepts it. Farewell, perpetually happy one.

In the name of the supercelestial and glorious God, and of Mary, mother of God and perpetual virgin, here begins the account of the founding constitution, and practice of the great hospital of Santa Maria Nuova in the city of Florence.

Folco di Ricovero Portinari, a Florentine citizen, founded the hospital in June 1278 [actually 1288; Bodleian MS has 1284], to the honour and glory of God and of His mother Mary.

[1] How the Rector of the hospital is chosen.

The governors and patrons of the hospital are the descendants of Folco Portinari through the male line, and they elect the Rector of the hospital [hospitalarius], when the position falls vacant, by a two‐thirds majority of those present. The vote is taken using white and black beans, in the Florentine manner.^[7] The Rector is always a religious, at least forty years old, of good reputation and excellent character. A record of this election is drawn up by a public notary and confirmed in the usual way.

[2] How the Rector the hospital and its family should live.

First, we order the Rector of the hospital, its officers, its lay brothers [conversi], and all the other members of its household to live together in piety for the salvation of their souls and the good of the hospital, bearing each other’s troubles, grievances, and ignorance. They shelter and tend the sick poor who come to the hospital as they would Christ Himself. They must receive them with their own hands, care for them, console them, and warm, feed, and wash them with compassion. They must attend to their needs and treat them with all care and charity. We wish the Rector to appoint nurses and attendants for both the men’s and the women’s wards to look after the sick day and night, encourage them with charity, and see to all their needs.

Since the Rector is the leader and guide of his family, he must be of irreproachable life, holy and upright in his actions and manner, so that he can serve as a model of virtue and an example to the others. Thus we have decided that he, along with the other officers and members of the hospital’s household, should wear a simple habit of coarse and inexpensive grey cloth marked with the seal of the hospital, a crutch cut from red or green cloth; the Rector should bear this symbol on the left side, the others, on the right.

[3] The Rector may hold no other benefices. Furthermore, neither he nor any member of the hospital family may hold any property.

The Rector of the hospital may not hold, manage or occupy any other position or benefice except that of the hospital. If he does so at the time of his election he must renounce it within three months and so notify the archbishop of the city and the patrons and governors of the hospital; otherwise the election is null and void. The same goes for the lay brothers, perpetual servants [servi perpetuales], and other members of the hospital’s household.^[8] The Rector may possess no private property of any kind, either money or land. If he owns or has exclusive use of any such property at the time of his election, he must publicly renounce it within three months and transfer it to the hospital, where it will go to support the sick poor, and he must so notify the patrons and governors of the hospital, or the majority of them present in Florence at the time. If he does not, his election and appointment are void, the Rectorship is understood to be vacant, and the patrons can and should hold a new election. The same applies to the lay brothers, perpetual servants, and other members of the hospital household, both male and female.

[4] Rights and authority of the Rector of the hospital.

The Rector elected by the patrons administers and oversees both the men’s and the women’s hospitals. He has full authority to appoint and dismiss both male and female members of the staff and the perpetual servants in the hospital’s interest. He has the right to hire officials and healers to administer the care of the sick poor as described below. He also has the power to buy and sell property on behalf of the hospital and to do anything in its manifest interest. He has papal authority to alienate the hospital’s property.^[9]

[5] All owe obedience to the Rector.

Furthermore, we have decided that all lay brothers, perpetual servants, and all those under the hospital’s jurisdiction, both male and female, must do as they are asked by the Rector of the hospital or by the other officials under whom they work. They must obey them in all matters, diligently and piously, subject to the penalties contained in the chapters of this constitution.

[6] Election of the treasurer.

The Rector of the hospital, together with the lay brothers or with four of the oldest and most respected men among the perpetual servants and other members of the household, must choose a worthy and appropriate lay brother or perpetual servant to be the treasurer or bursar. Failing this, they must choose one of the temporary lay brothers. The treasurer’s term of office is one year. They may confirm him for another year within eight days of the expiry of his office; if they have not done so within those eight days, then his term is over.

Furthermore, within a month of his election the treasurer must take an inventory of all the property and possessions of the hospital, moveable and immoveable, pertaining not only to his own office, but also to the hospital church and to any other official or member of the hospital staff. All this property is committed to the treasurer’s care. He must make this inventory and present it within a month of his election, as noted above, to the Rector of the hospital and to its lay brothers, perpetual servants, officials, and other members of the household; he must also notify the patrons and governors, so that they may also attend if they wish. At the end of his term, he must render the property and account for it to the new treasurer, as the Rector of the hospital orders. The infirmarer and steward must do the same for the property that concerns them, together with the other officials in both the men’s and the women’s hospitals.

[7] The treasurer must record income and expenditures.

The treasurer must carefully and diligently record in his books everything‐money, payments in kind, immoveable property‐‐that he receives in the course of his term. He must record these things clearly and distinctly under the rubrics described below, noting both the names and surnames of the people from whom he receives them, the number of people, the nature of the goods, and the date received, so that it is always clear whence, when, and from whom they have come and in what they consist.

1) Under one heading he should record all income from testaments, bequests, codicils, and

any kind of will.

2) Under another heading he should record all alms given personally to the hospital and all offerings to the church and its altars and to the alms-boxes [ceppi] connected with the hospital.

3) Under a third heading let him record all rents received from tenants who hold houses and property from the hospital and the produce received from its farms.

4) Under a fourth heading he should record income from furniture and other possessions sold by the hospital.^[10]

[8] The treasurer must record expenditures in the public book of the hospital.

1) Under one heading let him note all payments for grain, bread, wine, wine casks, and everything else required by the steward, or cellarer, and the under‐steward, as well as for wax candles.

2) Under a second let him note payments for cheese, fish, oil, salt, meat, lard and fat, poultry, and whatever else pertains to food.

3) Under a third let him record payments for wood, charcoal, ashes, fruit, vegetables, and other things bought retail for the use of the kitchen or garden.

4) Under a fourth let him note all payments for sugar and dried fruit, herbs and spices, wax and medicines, and other things for the sick and for use in the infirmary.

5) Under a fifth heading let the treasurer record payments for building, repairing, and maintaining the hospital and the houses belonging to it, as well as the foundations and other things related to maintenance.

6) Under a sixth he will note payments for the salaries of our doctors, lawyers, patrons, notaries, and clerks, and for litigation expenses, as well as for documents, writing implements, paper, notebooks, books, and ink used for testaments, codicils, and records of any other kind.

7) The seventh heading contains payments for linen and wool clothing for the sick and the members of the hospital household; also payments for leather cloaks and hats and other things relating to clothing and shoes.

8) Under the eighth the treasurer will note payments for taxes, gabelles, and tolls levied on persons and on goods inherited by the hospital, as well as those to whom they are paid.

The treasurer may trade, buy, sell, receive, and claim all moveable property pertaining to the needs of the hospital, the house, the family, and the sick. He must do these things subject to the advice and will of its Rector, with one exception: when the treasurer is sick, absent, or unable for some other reason to receive and record payments the Rector can and must do so, and when the treasurer is again available the Rector must quickly consign to him everything he has received and recorded.

[9] The treasurer must account for the property he manages.

Every two months, by the eighth day of the following month, we require the hospital treasurer to present a full and accurate accounting of everything he has received and paid out during those two months. Once his term is over, he must present a general reckoning for his entire term‐moneys received and paid out, accounts payable and receivable, and all other things of this kind to the Rector of the hospital or to his deputy, as well as to one of the senior patrons.

[10] The property of the hospital may not be given away or alienated.

We have ordered that no one may sell, alienate, or give away money or any other thing, property or right belonging to the hospital to any lay brother, perpetual servant, or other member of the hospital household, male or female, either temporarily or permanently. There is one exception: the Rector of the hospital may donate to the poor and sick what money or moveable goods he wishes, in keeping with the hospital’s resources, according to God and his own conscience, which we consider the legitimate judge in these things.

[11] The hospital may not take married people into its household.

No married person, male or female, and no member of a religious order may be accepted into our household or wear its habit, in accordance with the practice of the hospital.

[12] No outsiders may live in the hospital.

In the interests of the hospital we have also decided that neither its Rector nor anyone else may invite outsiders, foreigners, or sick people to stay in the house^[11] for more than three days at a time, except for clerics serving in the hospital church. Nor may they invite any secular or lay persons, except one of the patrons, to attend the feasts of the hospital against the wishes of the governors and patrons; these feasts are the feasts of Sant’Egidio, Santa Lucia, and the Purification of the Virgin.

[13] Everyone living in the hospital must take the sacraments.

We require all members of the hospital’s household, male and female, lay brothers, officials and permanent servants, to go to confession at least three times a year and to take communion twice a year, at Christmas and Easter, from a priest either in the hospital or outside it, as directed by the Rector of the hospital. The women of the house receive these sacraments in a holy place from the priest appointed for the purpose.

[14] No one living in the hospital may leave it without permission from the Rector.

No member of the hospital family, male or female, may leave it to walk through the city or may go anywhere in the City of Florence or the surrounding countryside without explicit permission from the Rector of the hospital, and then he may not go alone. Even the Rector, when he has to go into the city, must be accompanied by one of the oldest and most senior members of the household, and he may not spend the night outside it without a legitimate reason, and then only with a companion.

[15] Choosing the sacristan.

The Rector of the hospital chooses a sacristan, someone getting on in years, to look after the church. This man oversees twelve other priests, called chaplains, and six clerics, who conduct services, as well as their acolytes. He keeps an inventory of everything used in the services and stored in the sacristy and sees that the masses and the seven canonical hours are performed according to Church practice. All of the above receive a salary and compensation for their work, in addition to food, lodging, and the services of a barber. The power to approve or disapprove these priests, that is to hire or discharge them, lies with the Rector of the hospital rather than with the sacristan.

The sacristan sees that on days appointed by the Rector, two masses are celebrated at Prime,^[12] one in the men’s church and one in the women’s; all members of the household must be there unless incapacitated or absent for legitimate cause. This includes the Rector of the hospital, who should encourage the negligent to attend services, warning and punishing them if they do not. The other priests should perform their rites day and night. The Rector of the hospital chooses two chaplains to hear the confessions of the sick and to give them the sacraments. One of these chaplains stays in the men’s infirmary, alternating day and night duties with the other; the other celebrates mass in the hospital chapel so that the sick can hear it, sometimes in the morning and sometimes in the evening and at vespers. The same priest leads confession in a loud voice, so that all the sick can hear, and commends them to God for the night.

[16] How the sick receive the sacraments.

We put up a board in a visible place divided by ruled lines into four sections. In one section we write the names of those patients making confession; in the second we record those about to receive the Eucharist; in the third, those commending their souls to God; and in the fourth, those receiving extreme unction. This board is looked after by the chaplains and priests responsible for the sick.

[17] Foreign priests may be called in.

We take in not only our own countrymen but also foreigners, and whenever sick people from England, Spain, France or Germany come or are brought to the hospital, we pay priests and other people fluent in these languages to come, so that each can receive the sacraments and make known his last wishes in his own tongue.

[18] The Rector of the hospital chooses the infirmarer, who has principal responsibility for the sick.

The Rector of the hospital appoints an infirmarer on his own authority to care for the sick; he is always chosen from among those who have offered themselves in perpetual service to the hospital. The infirmarer has four deputies, also chosen from the perpetual servants, called head nurses [here duces custodiarum et vigiliarum; elsewhere duces custodium et vigilum]. Each oversees seven assistants, men who are serving God and the poor because of a vow or out of piety; these receive their food and clothing from the hospital and may not leave it without the Rector’s consent. All wear the hospital’s grey habit and its symbol. The head nurses divide the day into six-hour shifts, so that one head nurse and his seven assistants are always on duty in the infirmary to serve the sick. They walk up and down among the patients, ready to run to them and assist them with piety and compassion, should the need arise.

[19] The hospital staff bring townspeople and travellers to the hospital on a litter if they cannot come by themselves.

Recently the Rector of the hospital has adopted the practice of having brought to the hospital [some] of the many pilgrims travelling to and from Rome, as well as sick and poor Florentine citizens and residents. He tells one of the perpetual servants to summon four or six others to carry the litter. The same man takes a small plate of sweets and goes with the others to the place where the sick traveller or townsperson has been reported, and they pick him up and carry him to the hospital. They do this almost every day, which is a great work of piety.

[20] How the sick are received.

The [men’s] hospital has 100 beds, each numbered, so that any patient can be located easily.^[13] These are made up with mattresses, pillows, linens, and covers. In the middle of the infirmary there is a little bed covered with a cloth on which the sick are laid when they first arrive. As soon as they are admitted the infirmarer comes to them to determine the nature of their illnesses. He assigns the feverish and those with skin lesions or wounds to empty beds, in either the upper or the lower place,^[14] and he sends one of the head nurses to wash the sick person’s feet and another to the sub-infirmarer to get slippers, a leather robe, a shift, a cap, and two pillows for him. In winter we heat the beds with bedwarmers, cover them with blankets and use caps made of wool; in summer the clothes and caps are made of linen, and we use tunics without sleeves.

[21] The Rector of the hospital chooses a sub-infirmarer.

Where there are many people and no order things become confused, for we cannot all do everything. Therefore the Rector of the hospital assigns different duties to different servants. He appoints a sub-infirmarer from among the perpetual servants to look after the linens, shifts, underpants, caps, cloaks, tunics, outer garments, pillows of all kinds, towels, sandals, slippers, bedwarmers, bedpans, and crutches‐all marked with the hospital‘s seal. The sub-infirmarer stores the patients’ clothing in the following way. Once the sick person has been assigned to a bed, he comes, collects all the clothes taken off by the patient, and wraps them up. He notes his name, father’s name, place of origin, family name, and the amount of money he is carrying, if any, and he writes all this on a label attached to the bundle, which he places in a storeroom called the Pergola. Before the bundle is taken away, one of the perpetual servants, who is appointed to this task by the Rector of the hospital, comes and records the patient’s name and patronymic in a book, together with his family or nationality, as well as his bed number and whether he is lying in the upper or the lower part. This book is kept in alphabetical order. If the patient should die, there is another book in which the particulars are recorded: when he died, when he left the hospital, and when he arrived. After all this has been recorded, the sub‐infirmarer takes the patient’s clothes and belongings and puts them in a storeroom or depository set up for this purpose and adjoining the place we call the Pergola. This depository is lined with chests or cupboards identified by the letters of the alphabet, and the bundle is placed in the cupboard corresponding to the patient’s initial. Thus when a guest recovers and wishes to leave, it is easy to find his effects once he tells his name. He is given his clothes and takes them to a place called the Apodyterium or dressing room, which we heat by a fire in winter. There he takes off the hospital’s clothes, puts on his own, and leaves in good order. Because many of the poor arrive teeming with lice, we separate out their clothes and store them in the same way but in a different place.

For the comfort and convenience of the sick, the Rector of the hospital delegates one of the perpetual servants to go around the infirmary three times a day; he approaches each bed and asks each patient in turn what dried fruit or sweets he would like ‐ pine-nuts, walnuts, or almonds coated with sugar. This man has responsibility for various things pertaining to the sick, including bread, napkins, sweets, and dried fruit. In the interests of hygiene^[15] we keep the hearth in the infirmary constantly lit, stoked not with smoking wood but with a great heap of charcoal; we burn 500 bushels [modia] of coals a year in that fireplace. Above the hearth hangs a copper cauldron, four casks [cadi] or more in volume, full of hot water for use in the infirmary. We use this fire to heat linens and blankets, surgical knives, bricks, compresses, poultices, syrups, medicines, and many other things needed by the sick.

Three doctors, called residents [adstantes], are always in the hospital looking after the sick. In return they receive board and a large and pleasant room worthy of their position. They are young men and, in the course of seeing a wide variety of illnesses and using many different remedies, they become increasingly skilled and expert, since, as they say, experience is the teacher of all things. Together with the infirmarer these junior doctors direct the treatment of the sick, dividing up the beds and the patients. All four report to six other doctors, the best in the city, who receive a salary from the hospital. These six senior doctors come to the hospital each morning at a set time. As he sees each one arrive, the head nurse on duty at the time orders a bell to be rung, and at its sound one of the pharmacist’s assistants runs to meet the doctor, bringing a white linen garment with which he covers his clothes; he then accompanies the doctor to the beds. The same bell summons the infirmarer and one of the resident doctors; following the senior doctor from bed to bed among those assigned to them, they explain to him the nature of each patient’s illness and its symptoms, his state of mind, and what has been done for him up to that point -syrups, medicines, ointments, massages, plasters, blood‐letting, and so forth. The senior- doctor then carefully prescribes treatment, which the pharmacist’s assistant writes down in a book. Later the medicines are made up for each patient, sparing no expense. When the doctors leave, water is poured for them so that they may wash their hands. Once they have left, the infirmarer goes to the pharmacy to see about the medicines, syrups, and other things ordered by the doctors. The name of the sick person for whom these remedies are prescribed is written on a scrap of paper; the bed number on the paper also serves to identify the flasks or trays used to bring the patient his medication. The pharmacist makes up all the prescriptions and gives them back in order to the infirmarer, who together with the head nurse on duty gives them to the patients for whom they were prepared. If the doctors order compresses, ointments, plasters, or enemas, they are administered by one of the permanent lay brothers entrusted with this work.

In the same hospital there is a separate place called the Medicinarium, where we treat those with sores and other minor illnesses; there are a great many such people in the city and surrounding countryside. We employ a surgeon to treat them, the best in Florence, and he is assisted by three of the lay brothers, who have learned surgery through long experience. Those who are able, come to the doctor; he goes to the others bed by bed, for example to the wounded and those with bad legs. The surgeon must spend two hours in the morning and two in the evening attending the sick. Of the three resident doctors, one or two are always in the hospital to attend immediately to people who are brought in wounded or otherwise ill.

People who cannot afford house calls by a private doctor come to us and receive everything they need. We give ointments to anyone who asks, so that in a single year we use 600 casks of oil to make them up. We also prepare linen cloths soaked with various medications for treating sores, of which we give away 2,500 ells [ulnae] each year. A lay brother collects the used bandages and cloths and brings them to the women‘s house, where they are washed so that they can be reused, which saves a great deal of money.

In addition, we have built a large and well-equipped office to store the herbs and spices used by our salaried pharmacist to make up medicines and ointments. He has four assistants who work for board alone, as an act of piety. The room has twenty-two vessels for distilling things needed for medicines. Two are used to prepare drop by drop the extract of chicken and capon that we give to the seriously ill both in the hospital and outside it. They are in continual use, and we use eight or ten capons every day in this way. The assistants prepare all the medicines using only the best ingredients. Each year we consume 4,000 pounds of cane sugar and as much again of honey, 2,000 pounds of native wax, 800 pounds of white wax, 2,000 pounds of cassia, 20 pounds of rhubarb, 12 pounds of manna, and other things of this sort. The total cost comes to between 1,500 and 2,000 gold florins.

The hospital also has eight rooms with hearths, washbasins, toilets, and other amenities reserved for the sick of higher social class, such as nobles, who have decided to come to us for treatment on account of poverty or a religious vow. We look after them with great care. There is also a place for those with bad wounds or skull fractures; this ward has no windows, because fresh air is very bad for patients of this sort. Two servants are always in attendance there to look after them and answer their calls. We call another place attached to the hospital the Sapientia, where we care for priests and clerics; a bell hangs there with which they can ring for help. We have set apart another place for those who have lost their minds through illness, where they are kept in chains.^[16]

When a patient is close to death, we place before him an image of Christ on the cross, and a nurse watches over him, never leaving him and reading him the Creed, the Lord‘s Passion, and other holy texts. When he is dead, the head nurse comes with his assistants; they take the dead man from the bed, clothe him in linen, and place him on a bier in the middle of the hospital, where the chapel is, with a consecrated candle at his head and a lamp at his feet. At the appointed time a bell rings, and the priests come with a cross. Two lay brothers light two torches, and the others take the body and bear it into the church, where the funeral service is sung. After these rites they go to the cemetery, and the corpse is buried by a servant appointed for the task.

Our servants are completely dedicated to the care of the sick; several are always on call away from the hospital visiting various houses in the city, and many gravely ill people, including nobles and patricians, are entrusted to their care. Let these few words suffice concerning their patience, dedication, and hard work. Everyone knows how dirty, smelly, and disagreeable the sick are; one must accept their importunities with patience. Our nurses take turns in the hospital as described above, running to and fro among the sick as they call. To some they bring hot water, to others an infusion of barley water, to others a julep or sweet drink. They must hold some up, carry others, dress others, restrain others, and to others bring bedpans. Some of the sick cry out, others shiver, others are delirious. But the nurses bear it all and serve with piety and patience.

[22] Distributing the chicken soup.

Before meals we offer to the seriously ill a soup made from pureed Chicken. At the sound of a bell, a servant brings a pot full of this liquid from the women’s quarters and places it on a bench in the middle of the hospital, where there is a sink set up containing vessels for drinking and washing hands. The infirmarer comes and ladles the soup into cups with a serving spoon as the servants stand by. The nurses have a brass basin that holds a napkin and two cups. One contains water flavoured with lemon, damson or another such fruit. The nurse uses the other cup to carry soup to the beds. The sick person drinks it, washes his mouth with the water, wipes it with the napkin, and the nurse leaves him.

[23] The organization of meals.

At dinner-time a servant takes the loaves of bread and cuts them into many pieces. Other attendants bring two napkins to each patients. The sick person spreads one napkin on a board rather like a table, which is kept at the head of his bed, and he uses the other to keep himself clean. The attendants bring water to each patient to wash his hands, cold in summer and hot in winter, and towels to dry them. Another nurse hands out pieces of bread and continues to distribute them throughout the meal to anyone who wants more.

Meanwhile the infirmarer orders a bell to be rung once, and then, after an interval, again. Between these two signals, trays are brought to a place called the Distributorium, where there are all sorts of wooden dishes and other utensils. There a table is spread, presided over by the infirmarer and two of the head nurses on duty at the time. They make up trays of food for each sick person, which are handed out by the servants and others in attendance. These carry the food to each patient as the infirmarer calls out his name and bed number. The people who do this include not only all the servants who are not otherwise occupied, but also all the guests of the hospital, both Florentine and foreign, who take off their outer robes for the purpose. In winter they bring each patient glowing coals in an earthen vessel so that he may warm his hands to eat. While the sick are eating, three servants go around the ward serving excellent wine. Each sick person receives an appropriate amount of the particular wine‐white, red, smooth, sweet, or dry‐suited to his illness and his appetite. All this is done in silence.

After the meal, everything is put away, and the dirty dishes and other wood and pottery utensils are brought to the Distributorium, where they are cleaned by a lay brother. The leftover pieces of bread are thrown in a cradle and distributed to beggars at the hospital gate by the same lay brother who cut them up. Note that during the meal one of the head nurses circulates among the patients with his seven assistants. If they see that some of the sick are too weak to eat they lift them up, prop them up with pillows, feed them, comfort them, and encourage them. At the end of the meal the infirmarer and the sub-infirmarer note which of the sick have not eaten and have a second meal prepared for them of lighter foods. We do the same thing in the evening, at supper, and follow all of the same procedures. Meanwhile the sub-infirmarer and the head nurse on duty smooth the beds and order dirty sheets to be changed. During this process those patients who are able get out of bed; if they cannot, we straighten their beds as well as we can.

We require that the Rector of the hospital and all the lay brothers, servants, officials, and other members of the hospital come to table together in their respective refectories, male or female, and eat the same food at the appointed times; no exceptions are made unless someone is obviously ill. Furthermore, they are required to observe all fasts and vigils and Advent, like other clerics.^[17] They eat in silence to the reading of some religious text, except on the feast-days of either the church or the hospital. And if there are guests from outside, let another person take charge of the readings at table.

The Rector of the hospital appoints a steward and under-steward, called Castaldi, from among the perpetual servants; they keep the keys to the wine and the bread and oversee the lunches and suppers of the healthy.

The refectory is large and contains five tables, one at the head and the others on the right and the left. The Rector of the hospital and the priest sit at the head table; the perpetual servants at the first, on the right; those responsible for the hospital’s food and clothing at the second, on the left. The rest sit at the other tables in no special order. One person looks after the refectory, washing the floor, laying the tables, handing out the cups, and bringing the dirty napkins to the women of the hospital each day. At mealtimes, the steward and under-steward go to the women’s residence for the various dishes for the healthy, which are carried in their own pots in special baskets to a small room behind the refectory. Wine is drawn from the containers where it is kept. Then the various dishes are passed out to each diner through a window, and he takes his place at table at the sound of a bell rung once and then again. Grace is sung, and everyone sits down, while a cleric mounts to a lectern and reads. The steward divides up the portions and the food and wine are passed out by two assistants. No food may be taken from the refectory except by special permission or request. Once the meal is over, the Rector of the hospital gives a signal, and those present rise and go into the church to give thanks. On Sunday the Rector urges everyone to perform his duties and rebukes those who need it.

Because not everyone can eat at the same time, we plan for two lunches and two suppers. At the end of the meal, one of the head nurses with his assistants – alternating by weeks ‐takes responsibility for washing the dirty dishes; they clean these in boiling water carried from the women’s residence. and bring them back to the steward. Next to the room in which the food is set out is a place called the guesthouse or Hospitalium, where the muleteers eat when they cannot observe the bell, as well as the overseers of the hospital’s estates and pilgrims who are guests of the hospital. This is the stewards responsibility. In winter we also use this room to feed the head nurse and other nurses on duty in the ward during the first part of the night, through the sixth hour. The steward also looks after the linens and linen clothing of the healthy; they hand in their dirty laundry, and he returns it to them on Sunday, after the women have washed it by boiling it. The steward or under‐steward also sees to the wine cellar. He stores wine of every kind separately: sweet, smooth, dry, white, and red – five or six thousand casks a year.

[24] Only those who die in the hospital may be buried in the hospital Church or cemetery.

Neither the Rector nor anyone else living in the hospital may give permission for the body of someone who has not died in the hospital to be buried in its cemetery, church, or elsewhere in its jurisdiction, without the express licence of the governors and patrons. The latter may, however, give permission for this, for the prohibition does not apply to them or the members of their households.

[25] Nowhere in the hospital may any shrine or chapel or other construction be marked with the insignia of any person.

We have decreed that neither the Rector nor anyone else living in the house may give permission, either directly or indirectly, for any person, organization, guild, or corporation to install any object in the church, chapel, cemetery, or any other place in the hospital – whether a building, painting, sculpture or other such work, or an altar, oratory, tomb, monument. standard, or inscription ‐ without the express permission of the governors and patrons of the hospital. Excepted from this are images of holy people and saints for decoration and devotion, but they must carry no arms or insignia of any individual or family.

[26] No one may divulge the affairs of the hospital.

We have further decreed that without permission of the patrons and governors, no member of our house may reveal or divulge to any outsider either directly, indirectly, tacitly or explicitly, any matter or affair relating to the hospital that could bring harm, prejudice, disgrace, or dishonour to it or any of its patrons or any of our household, under pain of severe punishment by the Rector of the hospital. The only persons excepted from hearing such things are the archbishop or his vicar. The Rector must recall this prohibition often and rebuke and punish offenders as he sees fit.

The Rector is responsible for warning, rebuking, or punishing any person subject to the hospital who has broken one of the provisions detailed above and below, or who has committed any other fault or misdeed, and he may determine the penalty for any such misdeed if it is not already specified in these statutes and regulations, with one exception: he may not expel any household member, servant, or lay brother from the hospital community without the consent and authorization of the household, the lay brothers, and the officers of the house, or of the majority of them, particularly the older ones.

[27] The oath and observation of these chapters.

We have decreed that within eight days after being named and confirmed and after being informed of the rules and regulations contained here, each Rector of the hospital must solemnly swear that he will observe them and ensure to the best of his ability that they are observed by everyone associated with the hospital, under pain of losing every right and privilege of the house – the penalty they will incur immediately after the infraction. Similarly, each member of the household swears and promises to do the same. If he does not he is punished in the following way. On the first offence, he must sit on the floor in the middle of the refectory and eat bread and water for three meals while the others look on and eat at table. On the second intentional offence, he must eat seven times in this way. On the third offence, he must be deprived of every office, benefice, service, function, and honour of the hospital, without respect to age or status, according to the judgement of the Rector of the hospital. No one punished in this way may be restored to his original position without the consent of the Rector, four of the lay brothers, the servants, and the governors and patrons of the hospital‐with one exception: absolution for perjury is reserved to the archbishop or his vicar.

For the profit of the house we have placed boxes for daily alms and personal donations in front of both the men’s and the women’s hospitals. They are locked with three keys, one kept by the Rector of the hospital, one by the treasurer, and one by the sacristan or the oldest and most trustworthy of the lay brothers. These men open the boxes four times a year; the treasurer counts the contents and records them in his daybook, that is the book in which he registers goods received.

[28] Hiring the notary.

We have found it useful to hire a notary with a good knowledge of the law to represent the hospital in legal matters. He receives a salary and is chosen by the Rector and the lay brothers for whatever term they wish. His duties are the following: to summarize and record testaments. draw up wills, and take care of all bequests, leases, contracts, and legal instruments and records relating to the hospital.

[29] An inventory is made when the office of the Rector falls vacant.

We have decided that when the Rectorship of the hospital falls vacant, the patrons and governors then present in the city, or a good part of them, should meet with the lay brothers‐or failing that, with four of the older members of the household‐and have an inventory drawn up of all the books, vessels, vestments, treasure, furnishings, goods, and other things belonging to the hospital, which must all be carefully looked after. Once a new Rector has been appointed, these things are reported to the treasurer and the sacristan.

We have set these things out concerning the administration of the men‘s house as neatly and briefly as possible. The same things apply to the women’s house, with some modifications. A hundred women live in the women’s part of the hospital, perpetual servants and assistants, humbly clothed like the men. They have been admitted by the Rector of the hospital, and they look after the sick and the well in the following ways.

First, they receive sick women in their hospital and care for them as described above. The Rector of the hospital appoints a female infirmarer and nurses, with exactly the same responsibilities as in the men‘s hospital. The women include several skilled in surgery, for experience is the mistress of all things.^[18] These have many remarkable cures to their credit and are even more trusted than the men. About ten women are responsible for making the bread for the sick and the well of both sexes. Employees of the baker located next to the hospital take the loaves and return them baked, bringing as many as are needed to each house. The women change duties each week, replacing each other in a fixed order. Ten take care of the cooking and prepare the food. Fifteen do the laundry, scalding, cleaning, washing, drying, and folding it each day. Eight look after the chickens, hens, geese and ducks, of which there are incidentally 1,000. For the hospital consumes 20,000 chickens each year and as many eggs. The Rector of the hospital appoints one woman to keep the linen clothes, another the woollens, and another the bed linens, the napkins, and the cloths. Another looks after the room containing the sacred objects.

The women’s quarters and hospital are closed each night at dusk, and the key taken by one of the lay brothers. If a female patient needs the sacraments, they call for a priest by ringing a bell. If a sick woman is brought to the hospital during the night for a legitimate reason, the hospital is opened to receive her. They ring the bell once if a patient wants the sacraments, twice if she wants communion, and three times if she needs extreme unction.

[30] How the Rector of the hospital looks after the women.

The sacristan of our church and an elderly priest of blameless life and irreproachable habits hear the women’s confessions and administer them the sacraments both day and night. Two of the older male servants attend them when they so, opening and closing the women’s hospital for them but remaining in the vestibule. They do not allow men to enter unless they are visiting patients [nisi infirmas intus habeant], and one of them accompanies male visitors at all times until they have left the hospital. Female visitors may come and go freely. These men have other responsibilities, and through them the women ask for bread, wine, oil, salt, and firewood when they need it. They report these requests to the Rector of the hospital or the treasurer. Another four male servants perform additional duties of this sort.

Two large jars stand at the entrance of the hospital, one containing boiled [water] and the other, oriza, or barley water. Anyone in the city may request them for the use of the sick, and we dispense ten casks of each daily.

[31] No one may enter the women’s quarters.

We have decided in addition that no Rector of the hospital, present or future, and no Rector, officer, lay brother, or member of the male household may enter or stay in the women‘s hospital and in the places where the women work and live. without a legitimate and honourable reason, and even then he must be accompanied by another member of the household.

[32] The Rector of the hospital visits the women once a month.

The Rector of the hospital must visit the women’s hospital once a month, especially on feast days, in order to encourage, warn, admonish and console them, and to maintain peace and harmony, root out scandals, and mediate quarrels‐keeping in mind the nature and weakness of the female sex – so that the women remain busy and diligent, cultivating and observing charity, piety, and patience.

[33] No meeting is to be called or compact made against the governors of the hospital.

Under no circumstances may the Rector presume to call any meeting or gather together the members of our household and its employees in order to impeach the honour and authority of the governors and patrons of the hospital or to prejudice any of their rights.

[34] How these statutes are to be kept.

We have decided in the general interest that these statutes concerning the Rector of the hospital and the rest be written down in two books, of which one will be public and kept in a suitable place, secured by a chain, and the other locked in an alms‐box. All provisions must be observed piously, carefully and diligently, under pain of the penalties contained in them – saving always and in all things the authority and power of the archbishop or his vicar, and their successors, to add to, delete from, change, and rewrite them as they wish.

At the end of this work we append a number of things relevant to the hospital’s expenses: The hospital has a garden kept by three gardeners; we take our vegetables from here, and if we need more we buy them in the public vegetable market, spending some 100 florins a year in this way.

The six muleteers keep twenty mules, which are used to carry things to the hospital from its farms and fields. The cost is 300 florins.

We hire an agent to visit the various estates of the hospital, to administer them, and to keep their records and manage their contracts.

We assign to various places lifetime agents, who are married but who have made over their property to the hospital, to various places in order to look after many of our farms. These are chosen for their trustworthiness, for they cannot always give an accounting of their revenues.

We have a butcher to manage the hospital’s slaughterhouse, for we raise sheep, lambs, pigs and calves. Each month we slaughter 1,200 rams, 700 lambs, 500 young goats, 400 calves, and 100 pigs. The expense comes to 1,800 florins or more.

Our shoemaker cuts out and sews shoes for everyone in the hospital, sick and well.

We hire a miller to grind our grain, for we use 360 bushels a year.

Each Thursday, four barbers come to the hospital to shave and cut the hair of its residents. The hospital pays for all of these things.

To the same most serene king of England:

These are the works of our city and our hospital, most glorious king, and the things, outstanding for their great piety and remarkable charity, that we have taken pains to convey to you, dividing them up and setting them forth according to our own wit and ability. But your crown by its eminence and its clemency will stand greater and more pious by far‐rather as the greatest and most pious, according you praise, glory and eternal life. As Pliny the Younger has said, both wisely and truly, “Seeing that we are not permitted to live long, let us leave something by which we bear witness that we have lived”. We pray for only one thing: that you will place us ‐ by our own merits the least of your majesty’s servants – not unwillingly but with a smiling visage under the protection of your crown. Live happy and forever, O King.

1. Cf. Katherine Park and John Henderson, The First Hospital among Christians”: the Ospedale di Santa Maria Nuova in Early Sixteenth-Century Florence, in Medical History, 1991, 35:2 p. 165. ↑
2. Cf., Alfredo di Napoli, I cappuccino in Salento. Testimoni e apostolate di misericordia (secoli XVI-XVII) in Idomeneo (2016), n. 22, p. 68. ↑
3. Cf. webpage of the Frati Minori Cappuccini Toscana. ↑
4. Cf. Katherine Park and John Henderson, The First Hospital among Christians”: the Ospedale di Santa Maria Nuova in Early Sixteenth-Century Florence, in Medical History, 1991, 35:2 pages 170-171. ↑
5. Cf. Ibid., p. 175. ↑
6. The following translation is based on a collation of Bodleian MS 488, which is probably the presentation copy produced for Henry VII, and BL Additional MS. 40077, which may be one of the hospital’s copies. Both are illuminated manuscripts of the early sixteenth century. apparently produced in Florence, and their texts are virtually identical. Professor de la Mare has attributed the illuminated border of the former to the Florentine illuminator Vante degli Attavanti, known as Attavante, and she has identified the scribe as possibly Alessandro da Verrazzano. See Professor de la Mare’s unpublished notes on the manuscript for the exhibition of ltalian manuscripts at the Bodleian. We are grateful to Professor de la Mare for permission to quote from her notes. Cf. also F. Saxl and R. Wittkower. British art and the Mediterranean, London, Oxford University Press. 1948. pl. 36. no. 4. On Attavante see A. Garzelli, Miniatura fiorentina del rinascimento, 1440‐1525: un primo censimento, Florence, 1985, vol. 1, pp. 219 37. The transcription of the Latin text in Passerini, op. cit., note 7 above, pp. 851 ‐67 is apparently based on a manuscript transcription made in the eighteenth century by Giovanni Targioni Tozzetti; besides being misdated (to 1524), it includes numerous minor errors and several major ones, including the substitution of Henry VIII for Henry VII in the prefatory letter. ↑
7. See Nicolai Rubinstein, The government of Florence under the Medici, 1434-94, Oxford, Clarendon Press, 1966. chapter 1. ↑
8. The main residents and staff of the hospital were the conversi, or lay brothers, and the servi and servae, or “servants”. The former exercised greater authority within the hospital and acted as advisors to the Rector, as specified by a number of provisions in this text. As early as 1324, the number of conversi was set at six, to be replaced as each retired or died: see SMN‐9, f. 23r; SMN-10, ff. 4r-v, 6r. The servants were of lesser status and performed the more menial tasks. There seem to have been two types of servants: “perpetual”, who had given all their property to the hospital and committed themselves to a lifetime of residence and service within its walls, and non-perpetual, who had made a temporary commitment to the hospital. A document from the early fourteenth century refers also to lay sisters (conversely “who will take care of the sick women” (SMN-1, ad annum 1313 ff.), but that office seems to have been replaced by the middle of the fourteenth century by the more humble designation of servant (serva), as the hospital expanded and the male conversi were given increasing responsibility for its governance. ↑
9. The Rector had this privilege from the pope at least as early as 1371, and it was confirmed by both Nicholas V and Sixtus IV: SMN-4, f. 34r, SMN-9, f. 46r; SMN-10, f. 27r. But there are earlier references to a communal privilege of this sort granted by the governing councils of Florence in 1330 and confirmed in 1348: SMN-10, ff. 26v‐27r. ↑
10. I.e., items of personal property received in bequests to the hospital. ↑
11. Note the clear distinction between the “house”, where the staff and residents of the hospital lived, and the infirmary and its annexes housing the sick, who could and frequently did stay more than three days. ↑
12. Prime is the first canonical hour of the Divine Office, beginning originally at 6 a.m., but often held at sunrise. ↑
13. For the women’s infirmary. see rubric 29 below. ↑
14. Aut in parte superiori aut inferiori. The meaning of this phrase is unclear; it could be interpreted as referring to bunk beds, except that such an arrangement seems inconvenient, and all the pictorial evidence from other early Italian hospitals shows double beds. The books of the dead from the early sixteenth century do indicate two places in each bed, abbreviated “k” and “p” (kapo and piedi?). This seems to suggest that the patients lay head to foot in the bed. This otherwise unlikely hypothesis may gain some support from a passage in the regulation of 1652, which describes the head nurses as attaching a note concerning the patient‘s treatment “at the sick person‘s head or at his feet” (a capo dell’Infermo a da piedi); Targioni, op. cit., note 7 above, p. 419. ↑
15. Hygiene (dieta) was the part of medieval and Renaissance medicine concerned with what were called the six non‐naturals: food and drink, air, exercise and rest, sleeping and waking, evacuation and repletion, and the emotions. See note 35 above. ↑
16. This provision excludes that small proportion of the mentally ill considered to have lost their minds through supernatural causes (divine judgement or daemonic possession) and who would therefore have required spiritual rather than physical treatment Cf. the description for King Ferdinand, which specifies that only the violent, who pose a threat to themselves or others, be sequestered in this way: Passerini, op. cit., note 7 above. p. 868. ↑
17. An agreement in 1425 submitted the residents of the hospital to the same religious discipline as the Augustinian canons: S M N 10. f. 28v. ↑
18. “… magistra rerum experientia”: In other words, these women were empirically trained surgeons who had learned their craft through apprenticeship and experience, presumably in the hospital, rather than through a formal course of study. ↑