My research examines the transformation of the hospital system in Milan between the late Enlightenment (c. 1770) and the end of the French occupation (1815). In part, I focus on institutional change: the closure of old asylums and foundling hospitals in favor of their unification under the new Ospedale Maggiore, as well as the birth of new institutes such as a hospital for the “incurables.” Yet, I also analyze the people that interacted with these new institutions. I am specifically interested in two questions arising from this medical change. First, how the medicalization of the urban space, which made medicine more visible and accessible, changed the social fabric of Milan. Second, which new identities were constructed in relation to this process—who were the new incurables, what kind of children were born after the reform of foundling hospitals—and what role they played in the intricate relations between the people and their city.
Reseaercher: Ori Ben-Shalom
Project Documentation
In August 1783, the young physician Antonio Scarpa (1752-1832) set out to Vienna to examine its reformed medical institutions. Recently appointed to the cathedra of anatomy and surgery at the University of Pavia, Milan’s historical academic seat, Scarpa was well aware of the context of his voyage: he was there to study the medical world of Enlightenment Vienna and import its reformed ways to the Habsburgs’ Italian territories. More than anything else, he was stricken by the grandeur of the new hospitals, which incited in him “the greatest veneration of the enlightened and generous monarch.” Reporting on his visit to the governor of Milan, he praised the size of the Viennese hospitals, their structure, and, most importantly, their ventilation, which in his eyes must have annihilated the problem of hospital fevers.
Scarpa’s visit to Vienna encapsulates the forces working to reform Milan’s health system in the final decades of the 18th century. As the Italian capital of the Habsburg Empire, Milan became an important site for testing and implementing Joseph II’s (r. 1765-1780) enlightened policies. A group of leading physicians—among them Samuel-August Tissot (1728-1797) and Johann Peter Frank (1754-1821)—were gathered in the city and its university. Hospital reform became one of the most significant aspects of their work. During the 1780s, Milan’s hospital system underwent a careful reorganization process, which entirely changed the place of sickness and health in the urban fabric. As old institutions were closed and new ones established, the city began to forge a new relationship with its medicalized inhabitants.
The letter cited above is one of many documents I unearthed during a research trip funded by the Harvard Mellon Urban Initiative, which allowed me to spend a month working in archives and libraries in Milan and Pavia. During that period, I started to develop a research project that analyzes how Milan’s reformed hospital system triggered the development of new urban identities in the last decades of the Austrian reign and the first years of the French regime. On the one hand, I examine the birth of a new type of physicians who were unprecedentedly involved in the state apparatus. On the other hand, my work studies the ways in which the transformation of Milan’s charity institutions into state-managed hospitals reshaped the means to manage the city’s poor population as well as other marginal groups such as orphans, “incurables,” and mentally ill people.
My work throughout the summer focused on three historical questions. The first deals with the rising attention to clinical practice and the construction of new scientific personae. Focusing on reforms of clinical education and practice, I examine the importance of clinical observations and their relation to the Enlightenment’s political ethos of the “well-ordered police state.” Central to this line of thought are Tissot’s conceptual and architectural programs of the hospital clinic. Clean, well-organized, and highly efficient, his ideal clinic attests to a bourgeoning enlightened political regime. By providing the poor with advanced medical treatment in an extremely regulated environment, the clinic marks the beginning of the modern exchange between health and liberty. Yet, not only new patients emerged from this process, but also new doctors. From the 1780s, clinical observations assumed unprecedented importance in medical education at the University of Pavia. After graduation, physicians who practiced in Lombardy had to continue demonstrating their clinical virtues by submitting their observations to inspection by the State.
The second objective of my research is to examine the place of children’s medicine in Milan’s reformed medical sphere. During the 18th century, children became a distinct object of study. Their particular illnesses and medical conditions were meticulously studied by physicians, who believed that social progress passed through improving children’s well-being. The reorganization of Milan’s foundling hospitals as part of the reform of the 1780s provided fertile grounds to further medicalize children. Detached from their religious origins, foundling hospitals became a site where physicians could examine children’s bodies more extensively. Unprecedented experiments with smallpox prophylaxes—first variolation and, after 1800, vaccination—took place in the city. The archives of the city’s central hospital, the Ospedale Maggiore, preserve many other examples of medical policies that tackled various dietary regimes, sleeping arrangements, and the management of infectious diseases such as ringworm and scabies.
The last historical question I study revolves around the emergence of a new category of “incurable” patients. Unlike the syphilitic incurables of the 16th century, the new Milanese incurables were patients who suffered from mental illnesses and physical disabilities. Considered unfit for taking place in society, these people usually spent their entire life in the city’s charity institutes—often in the foundling hospitals where they grew up. In 1784, with the reorganization of Milan’s hospitals, such patients were extracted from their previous institutions and transferred to a new hospital for the incurables built in Abbiategrasso, a small town outside the city. In this process. they immediately lost their status as “children” (which they carried as long they lived in a foundling hospital) and became “incurables.” Unexpectedly, however, archival sources demonstrate that this violent change allowed for some patients to petition their doctors to be released from the hospital and take, perhaps for the first time, an active role in the urban fabric.
Keywords: Enlightenment, medicine, hospitals, citizenship