In 2010 Esther Diana and Marco Geddes da Filicaia published a superb edition of Regolamento dei regi spedali di Santa Maria Nuova e di Bonifazio (1789) by Marco Covoni (1742–1824), the first lay director of Santa Maria Nuova Hospital.1 Founded in 1288 in the area around the Church of Sant’Egidio, Santa Maria Nuova is one of Florence’s oldest and most significant hospitals. The reforms elaborated in Covoni’s Regolamento, like those implemented in other major European hospitals such as the General Hospital of Vienna, mark the birth of the modern hospital in Europe. Drawing on unedited material in the State Archives of Florence, Diana’s current volume offers the first comprehensive picture of the hospital’s architectural modernization, which spans from Covini’s time to 1968, and shows how the architectural modernization of Santa Maria Nuova was shaped by a complex interplay of developments in medical science and social hygiene, new approaches to hospital design, advances in technology, the dynamics of medical associations, and a range of social and political forces operating at the local and international levels. Prior to Diana’s work, this period had been the least studied stage of the history of the hospital’s built environment. Grounded in rich visual and documentary evidence, the book fills a major gap in studies of the architectural history of Santa Maria Nuova and modern public health reform in Florence. This book will be of interest to architectural historians as well as to historians of medicine, public health, science and technology, urbanization, and art.
The book is organized chronologically into five parts, each subdivided into chapters. Part 1 establishes the early stages of the hospital’s path toward modernization in the late eighteenth and early nineteenth centuries. In the first chapter, Diana reconstructs the hospital’s early eighteenth-century form using ground plans, which show it was aligned into two cruciform plans of open wards, one for men and one for women. She elaborates how the hospital, though retaining its basic cruciform layout, incorporated important structural and organizational reforms that point to its nascent modernization. Diana relates these changes to the development of eighteenth-century systems of taxonomy, showing how the classification of diseases by pathology, diagnosis, and treatment led to an institutional shift away from mass, regimented patient management to individual care and cure. Among the examples of this paradigm shift, she cites the development of the clinical specialization of surgery at Santa Maria Nuova and the establishment of the first surgical clinic for women not directly tied to obstetrics.
In the second chapter, Diana documents debates among the hospital’s administrators about removing the hospital from the old city center and rebuilding it elsewhere. She situates these debates in the context of the influence of the pavilion plan, a type of hospital design developed in France in the late eighteenth century and based on the principle that patients should be segregated and arranged by diagnosis and cared for in well-ventilated pavilions of limited size. The pavilion plan was realized in architectural form in 1846 when the Hôpital Lariboisière was built to replace the notoriously unhygienic and overcrowded Hôtel-Dieu in Paris.
The influence of the Hôpital Lariboisière is the backdrop of Diana’s account of city administrators’ efforts to remove Santa Maria Nuova from the old city center and rebuild it according to the pavilion-plan model in a less congested area on the outskirts of the city. Giuseppe Martelli’s pavilion-plan design, based on the French model, was proposed for the rebuilt hospital. Diana documents the development of Martelli’s plan, which came close to being implemented, and demonstrates that its ultimate rejection was related to nationalist concerns for cultural patrimony in the years leading up to the Italian unification.
Part 2 is composed of five chapters that focus on issues related to increasingly demanding standards of public hygiene. The first chapter documents the fierce critiques of Santa Maria Nuova for failing to meet new standards of hygiene, and the second addresses the debates surrounding the use of the cadaver within the hospital as a tool of research and study. The third chapter looks at the reform of hygiene standards for the city generally, noting that public health reform was well under way before the major urban improvements in Florence in the second half of the nineteenth century. The fourth chapter looks at the annexation of the historical Convent of the Angels to the hospital, and the fifth documents how criticism of the hospital’s unhygienic conditions led to the removal and addition of rooms and to the opening up of some areas for better light and ventilation. In this context the author elaborates a conservative impulse on the part of administrators to protect the hospital’s scientific and artistic heritage. Diana shows that while historical medical instruments and texts were integrated into the educational aspects of the hospital, the institution’s art had no place in its clinical space. Documenting the art’s removal and the troubled efforts by the hospital to establish a gallery to display its substantial artistic patrimony, Diana emphasizes that the separation of art from the therapeutic function of the hospital represents a major break from the medieval connection between art—especially sacred images—and healing.
Part 3 consists of five chapters focusing on the structural transformation of Santa Maria Nuova into a modern hospital. The first three chapters reconstruct the conditions and proposed plans to rebuild the hospital according to the principles of the pavilion plan. The years just preceding the unification of Italy in 1865 were marked by growing efforts among Santa Maria Nuova’s doctors, architects, and public health administrators to centralize standards of hospital care in accordance with the Risorgimento ideal of a unified Italian state. While concerns about loss of heritage and other similar issues relating to the hospital’s historic place in the city center had prevented major structural change in the earlier part of the century, proposals to rebuild the hospital into a modern institution gained traction in the context of Italian nationalism. They achieved further momentum when Casimir Tollet’s pavilion model circulated in Italy after it was presented at the Universal Exhibition in Paris in 1881. To demonstrate the influence of Tollet’s model, Diana documents its implementation elsewhere in Italy, citing the Ospedale Lugo di Romano (1881) and other hospitals in Genoa and Turin. The fourth chapter shows how the rebuilt hospital responded, despite significant spatial and financial limitations, to the structural and technological criteria of the modern pavilion plan. Reproducing numerous plans and photographs, Diana documents how the ancient double-cruciform ground plan was removed to make way for a pavilion model, the product of several architects’ designs and revisions. The last chapter focuses on the implementation of new technologies in the rebuilt space, ranging from heating and cleaning systems to a modern, steam-based cleaning method for the hospital’s laundry.
Part 4, composed of nine chapters, relates less to major structural changes to the hospital’s architecture than to factors shaping the institution’s internal organization and public image from the beginning of the twentieth century to the years just before World War II. The first seven chapters attend to the new dynamics of medical professional organizations, technological advancements in pharmaceutical care, infectious disease control, and Santa Maria Nuova’s direct administrative relationships with other medical institutions in Florence, such as the Meyer Children’s Hospital. The eighth chapter contains an extensive account of the creation of a vast new hospital complex at the estate of Careggi, to which many of the clinical and teaching activities of Santa Maria Nuova were transferred in the 1920s and 1930s. The ninth chapter relates the modernization of Santa Maria Nuova and other Florentine hospital complexes to advances in systemization of hospital architecture and urban planning in Italy until the outbreak of World War II. Diana documents tensions between the urban infrastructure of Florence and the city’s modernized health facilities, challenges that would have to wait until the postwar period to be addressed effectively. Part 5 focuses on documents of the period—letters, reports, and various orders are quoted at length—that demonstrate how the hospital, despite major impediments, was able to continue to provide health care to the city under fascism and German occupation during World War II and continue its service during the laborious and difficult process of reorganization after the war.
The book raises many issues that should be of wide interdisciplinary interest. Diana stresses the importance of the hospital’s secular character and how it enabled advances in scientific research, clinical debates, and implementation of new technology more rapidly than institutions bound to more paternal religious frameworks. She emphasizes how rapid advances in medical science and technology empowered doctors to become architects, engineers, and urban planners of the city’s health care facilities and policies. She also addresses advances in care for the specialized needs of women and children, the progress of patient advocacy and protection, the dynamics of labor relations, and the hospital’s relationship to major educational institutions. As the definitive work on Santa Maria Nuova Hospital’s modernization, this book is an essential resource for all scholars concerned with the subject.
Esther Diana and Marco Geddes da Filicaia, Regolamento dei regi spedali di Santa Maria Nuova e di Bonifazio (Florence: Edizioni Polistampa, 2010).