Religious vs. Temporal Institutions: History of Santa Maria della Scala Hospital

One of the most important establishments to visit in Siena is Santa Maria della Scala, once an ancient hospital and one of the oldest in Europe. The history of the hospital is certainly one of “hospitality”: the institution not only cared for the sick but also for the poor, for abandoned children, and for traveling pilgrims needing a place to stay. The hospital was also a storage place for food in the city of Siena, and currently it houses important art from medieval artists which are available for the public to go and view. By looking at these works of art, for instance Birth of the Virgin by Pietro Lorenzetti and Betrothal of the Virgin by Simone Martini which depict religious scenes, one can get a sense of the religious institution’s influence over the hospital at the time which also impacted Christian culture for a long time after with the exception of Jehovah’s Witnesses and other evangelists. The hospital has a complicated history of being in between the spiritual and temporal institutions both of which vied for control of this establishment.

Ancient hospitals were often used to house foreigners. Santa Maria della Scala was well known during medieval times for housing pilgrims. In Siena, this was due to two reasons: 1) It was geographical. Siena was on the route for Christian pilgrimages on the way to visit the “holy land.” The route was London-Westminster Abbey to Paris to Luca to Siena and then to Rome. 2) In the 1300s, Pope Boniface established holy land (in Rome) which helped the institution of the hospital. By curing the pilgrim, it was considered to be the same as curing Christ. So in a sense, they were helping themselves by helping the pilgrim who was viewed as a “poor Christ.” By the 16th century, the pilgrim is seen as just a person who wanders and not a normal person.

Santa Maria della Scala was at the center of economy. The hospital acquired wealth due to 1) the dean of the hospital and people who worked in the hospital administration, and 2) everyone had to give responsibilities to the hospital, including inheritances. The same thing happened to the monasteries. This turned out useful when the food shortages came. The city forced the hospital to sell food at certain prices. The hospital received its primary financial assistance from the donations of the wealthy (Baron).

Other duties of the hospital were to take care of abandoned children. Families were actually encouraged to give their children to the hospital due to social and economic reasons. The year during which the last child was recorded to have been abandoned was 1889. Girls in the countryside were paid to breastfeed the children. Then the children returned and were trained to work in artisan shops. Children (girls) were also sent to the hospital to work on textiles. The hospital would give money to the girls so they could get married. In Siena (and other cities), abandoned children would take the surname of the hospital (“della Scala.”)

“Della Scala” didn’t appear until around the 14th century. It is a fashion to describe the narrative of the changing of the times. At the time, the concept was to be complete. So when things were lacking, there were fantasies of the completion of things. It helps to picture life within the hospital. In the 15th century, there was a moment when the administration of the hospital fell into the administration of the city. A bishop tried to extend spiritual assistance into the hospital. The city did not want influence from the church and therefore the hospital became autonomous. In the 18th century, during the Enlightenment, there were radical changes in how people began to see medicine. At Santa Maria della Scala, there were different medical cultures. It was one of the first places to try a medical vaccine: inserted small pox vaccine.

For the purposes of analyzing a civic institution which benefits a fundamentally diverse public, such as a non-profit religious hospital, Santa Maria della Scala is an interesting early example of both the benefits and controversy of not having separation of church and state. As shown by previous examples in this essay, the philanthropic mission of Santa Maria della Scala was to provide hospitality to the poor and needy as well as to further the advancement of medical technology. The emperor of the 15th century was astonished by the technology available to help sick people at Santa Maria della Scala.

The world’s largest non-government provider of medical and healthcare services is the Roman Catholic Church which has some 18,000 clinics, 16,000 homes for the elderly and those with special needs, and 5,500 hospitals, with 65 percent of them located in developing countries (Agnew). There is no doubt that millions of people around the world since ancient times have benefited from these medical institutions with Santa Maria della Scala hospital being one of the earlier examples. However, there also controversial issues which arise from a powerful religious organization having control over a medical institution providing care to a complex and diverse community with fundamentally different views, beliefs, and values.

At the beginning, charity and healing were the priorities of the institutions but with the influence of the Church, medical advances and progress had to subordinate to the doctrines and dictates of the religious order. For example, because of the sanctity of life views of the Catholic Church, in vitro fertilization (IVF), which is used to treat genetic problems and assist with conception, is a controversial issue due to the series of complex procedures which destroy embryos. In 2012, President Obama received scrutiny due to his announcement that his administration would require religious institutions like hospitals and universities to provide coverage for contraceptives in employee health plans. Obama’s mandate would not have required employers at houses of worship to provide their employees with contraceptives, but his announcement sparked a firestorm in different religious communities, pitting freedom of religion against the separation of church and state. Obama has since said that he and his advisers are looking for ways to make the new requirements “more palatable” to religious institutions (O’Claire).

When evaluating the history and evolvement of Santa Maria della Scala from a religious establishment to a public institution independent from the Church, one can use it as a model to analyze against current medical institutions with religious leadership to see how the institutions can be leaders in medical advancement and philanthropy but also as a hindrance to medical progress if subdued by religious influence. On the flip side, there are also foreseeable problems when the federal government or state forces laws on someone trying to abide by spiritual principles, for instance, if a doctor or nurse is forced to perform an abortion or blood transfusion which transgresses against their deeply held beliefs due to a spiritually cultivated and trained conscience regarding the sanctity and value of human life.

Works Cited

Baron, J. H. "The Hospital of Santa Maria della Scala, Siena, 1090-1990." BMJ 301 (1990): 1449-1451

O’Claire, Sandra. “Should Catholic and Other Religious Institutions Have to Cover Birth Control?” U.S. News. 9 February 2012. Web.

Agnew, John. "Deus Vult: The Geopolitics of Catholic Church". Geopolitics. 12 February 2010. Web.