Santa Maria della Scala in Siena: Going Medieval on Health Care

Directly across the square from the glorious cathedral of Siena, Italy, there’s one of the oldest existing hospitals in the world. It’s a vast complex, partly underground, built over centuries beginning in the 1100s.

The exterior looks modest, but just inside is the spectacular Pilgrim’s Hall, where over the centuries anyone could wander in and find free food, medical care, and compassionate social services.

The fresco above shows the Augustinian friar Agostino Novello, believed to be one of the most important leaders of the hospital, around 1305. He’s being robed in the modest dark cloak of his new job. Previously, he was a high enough churchman that he was entitled to rich and colorful silks. A pauper leaning on a stick stands to the right. The artist was Priamo Della Quercia, 1442.

The fresco above shows the (possibly legendary) time in 1195 that Pope Celestine III gave the hospital brothers the privilege of running their own affairs and choosing their own rector. The artist was Dominico di Bartolo, 1442-1444.

Above, a fresco shows one of the hospital brothers kneeling before an archpriest, describing a vision. The hospital cared for orphans and foundlings; possibly the vision was of the naked children climbing a ladder toward heaven and being scooped up by the Virgin. The artist was Lorenzo di Pietro, known as il Vecchietta, 1441.

I’m not sure why the guy in the foreground above is working in his tighty whiteys, but he’s working with a sextant: part of the continual hospital expansion. Somebody else is piling up bricks. A group of nobles are inspecting the building project on horseback. A bishop rides a mule as a mark of humility. A person in a long blue robe is handing out money.

The two frescoes above show the wet-nurses for the foundling babies being paid their wages in grain. The artists were Pietro d’Achille Crogi and Giovanni di Raffaele Navisi. They worked in the Florentine Mannerist style, 1575-1577. Grain was collected from outlying farms, measured into sacks, and payments carefully recorded.

This fresco, “Caring for the Sick,” shows a crowd of clergy, doctors and servants taking care of patients. The surgeon in the center is about to operate on the fellow with his foot in the basin. A brother wearing the order’s square headpiece tends to a patient on a bier. An Augustinian friar hears confessions on the right. The place looks a lot like a crowded emergency room in a contemporary hospital. The artist was Bartolo, 1440-1441.

Another Bartolo fresco, “Almsgiving,” shows a crowd receiving bread, which the brothers distributed to all comers for centuries. A near-naked man in the center receives a nice warm cloak.

Bartolo also did the fresco above, “Marrying the Hospital’s Girls,” 1441-1442. Foundlings were not only raised and educated, but were launched into adulthood. Boys learned a trade, and girls received dowries so they could marry respectably. 


Today, a tourist qualifies as a pilgrim. A ticket to Santa Maria della Scala buys a little loaf of bread like the ones handed out for centuries.

To this day in Italy, emergency rooms treat anyone–including tourists from the USA–either for free or for a nominal fee. This is true in most European countries.


Traveling in Europe, I am mortified to think of the dismal medical options available to Americans unlucky enough to have no private medical insurance. In July of 2017, thousands of people waited for hours to be treated at a once-a-year free medical event at a fairground in Virginia, while the United States Senate dithered and threatened to take away health insurance from millions of people who only recently acquired it. The photo above is from an article in the Daily Mail

I’d like the USA to “go medieval” and provide health care for all, as the city of Siena was somehow able to do centuries ago. 

Join me next time for more explorations in the art and history of Europe, Scandinavia and the British Isles!

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