Book Review

The Renaissance Hospital: Healing the Body and Healing the Soul

N Engl J Med 2007; 356:1077-1078March 8, 2007

Article

The Renaissance Hospital: Healing the Body and Healing the Soul
By John Henderson. 458 pp., illustrated. London, Yale University Press, 2006. $55. ISBN: 978-0-300-10995-5

This beautifully illustrated and thoroughly researched study surveys Florentine hospitals from their earliest appearances around the year 1000 to the reforms of Cosimo I in 1542. It concentrates, however, on the period after the Black Death from 1348 up to the 16th century, when sources such as hospital accounts, pharmacy books, and the tax registers of medical practitioners either became available for the first time or increased considerably in number. The book offers a holistic account of the hospital. Throughout, author John Henderson emphasizes the hospital's dual concerns: healing the body and healing the soul. Renaissance hospitals, with their cloisters and high ceilings, and their practices, with the staff washing the feet of patients in imitation of Christ, are exposed in their duality, fulfilling currently perceived dicta of medical theory and spiritual ends.

To be sure, the hospital was not a Renaissance invention. In fact, more hospitals were founded in Florence from the mid-13th to the mid-14th century than at any other time. Nor were hospitals before the plague exclusively of the kind that offered lodging and food to pilgrims and the poor, without regard for medical care. In fact, Henderson traces the origins of the medicalization of the medieval hospital to the 1330s and 1340s, when physicians, surgeons, and other health practitioners first became regular members of the staff. Nonetheless, the Black Death and the periodic appearances of the disease thereafter spurred the transformation of the hospital from an enterprise that focused predominantly on hospitality to one that provided medical care.

As doctors and nurses became more central to hospital operations, charity and medical services became more specialized, with different foundations caring for different categories of the poor, such as widows and children, orphans, guild members who had fallen on hard times, or women who had recently emigrated from a particular place. Similarly, medical services became more specialized, with separate hospitals or wards for different categories of illness. Hospitals were generally one of two broad types: those whose patients were stricken with chronic illnesses and stayed for long periods of time and those whose patients had acute illnesses and rarely stayed for more than a month. It was around this second category that the Renaissance hospital developed, especially Florence's central hospital, Santa Maria Nuova, which takes center stage in Henderson's account of the Renaissance hospital.

Pivotal to Henderson's story is an undermining of French historian and philosopher Michel Foucault's picture of Renaissance hospitals as antechambers of death, where the poor were confined against their will. Following the work of American historian David Herlihy on Florence's northwest neighbor, Pistoia, Henderson shows that hospitals were the most lavishly endowed institutions of the Renaissance, palaces of civic pride and beauty. In addition to being masterful achievements in Renaissance architecture — one example being Filippo Brunelleschi's Ospedale degli Innocenti (Hospital of the Innocents), built in phases during the years 1419 to 1427 — hospital chapels such as Santa Maria Nuova's Sant'Egidio became centers of Renaissance art patronage. These hospitals also attracted the services of the most prestigious doctors in Florence, who often donated their time free of charge or at reduced rates. By the end of the 15th century, hospitals such as Santa Maria Nuova had become centers of medical training.

Far from being places of confinement, the hospitals received patients who often had struggled to be admitted. Nor were new hospitals (such as San Matteo) or older hospitals that were greatly expanded during the Renaissance (such as Santa Maria Nuova) places for beggars or the utterly destitute. Instead, patients of the Renaissance hospital ranged from the respectable poor, represented by artisans and shopkeepers, to members of Florence's most renowned families. Finally, these institutions were hardly hellholes of death; only 5 to 12% of those admitted died during their stay.

In the last part of his survey, Henderson turns to medicine, in particular to a development that he sees as demonstrating a third phase in the medicalization of hospitals — the establishment of permanent pharmacies within wards and the appearance of new books and ordinances to advise and regulate the dispensation of drugs. At Santa Maria Nuova, these prescriptions were not derived solely from classical or Arabic theory but came from recipes “tried and tested” within the hospital itself. Henderson describes these concoctions in elaborate detail but ultimately shies away from evaluating their efficacy, even going so far as to suggest that such an endeavor would be misguided. Perhaps future scholars with stronger pharmaceutical backgrounds, who are less squeamish about using knowledge from the present to ask questions from the past, will be able to use Henderson's carefully gathered evidence to investigate medical progress, or the lack thereof, within these Renaissance temples of care for the body and the soul.

Samuel K. Cohn, Jr., Ph.D.
University of Glasgow, Glasgow G12 8QQ, United Kingdom