Salutogenic Urbanism : Architecture and Public Health in Early Modern European Cities [1 ed.] 9789811978500, 9789811978517

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Salutogenic Urbanism Architecture and Public Health in Early Modern European Cities Edited by Mohammad Gharipour · Anatole Tchikine

Salutogenic Urbanism

Mohammad Gharipour  •  Anatole Tchikine Editors

Salutogenic Urbanism Architecture and Public Health in Early Modern European Cities

Editors Mohammad Gharipour University of Maryland College Park, MD, USA

Anatole Tchikine Dumbarton Oaks Harvard University Washington, DC, USA

ISBN 978-981-19-7850-0    ISBN 978-981-19-7851-7 (eBook) https://doi.org/10.1007/978-981-19-7851-7 © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover image © Vidimages / Alamy Stock Photo This Palgrave Macmillan imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Acknowledgments

This publication stems from a panel that Mohammad Gharipour and Caitlin DeClercq organized for the European Architectural History Network in 2021. The postponement of this conference until 2022 because of the COVID-19 pandemic and the relevance of the topic gave birth to Epidemic Urbanism, an international initiative that now counts members from more than ninety countries. We would like to thank Caitlin DeClercq for her contributions to the conference panel and the authors for their dedicated work during the book’s preparation. We would also like to express our gratitude to Dan Coslett for copyediting an early version of this manuscript, Meredith Murray for making an excellent index, the two anonymous readers for their excellent feedback, and Sophie Li for overseeing this publication.

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Contents

1 Introduction:  Achieving a Healthy City in Early Modern Europe  1 Anatole Tchikine and Mohammad Gharipour Part I Dynamics of Isolation  47 2 Health,  Architecture, and Urban Identity: The Hospital Real de Todos-os-­Santos in Sixteenth-Century Lisbon 49 Joana Balsa de Pinho and Edite Martins Alberto 3 Architecture  and Plague Prevention: The Development of Lazzaretti in Eighteenth-Century Mediterranean Cities 83 Marina Inì Part II Salutogenic Infrastructure 125 4 Architecture  and Infrastructure: The Salutogenetic Plan for Karlsruhe127 Joaquín Medina Warmburg, Nina Rind, and Nikolaus Koch vii

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5 “Private  Vices, Public Benefits”: Self-­interest and Salutogenesis in Early Modern York155 Ann-Marie Akehurst Part III Spaces of Madness 201 6 Madness  in the Early Modern City: Florence and the Public Health Nexus, 1642–1788203 Elizabeth W. Mellyn 7 Rationalization  of Space, Rationalization of Madness: Louis-­Hippolyte Lebas and the Development of Psychiatric Hospitals in Nineteenth-­Century France245 Vassiliki Petridou Part IV Spa Cities 271 8 Cure,  Leisure, and Exercise: The Emerging Spa Landscapes in Eighteenth- and Early Nineteenth-­Century Hungary273 Kristof Fatsar 9 Promoting  Health Through Urban Planning: Spa Towns and Urban Development in Nineteenth-Century Greece305 Georgia Daskalaki I ndex329

Notes on Contributors

Ann-Marie Akehurst  received her PhD from the University of York. She is an art and architectural historian; a Fellow of the Society of Antiquaries of London; and a Trustee of the Society of Architectural Historians in Great Britain. She formerly taught art and architectural history at the University of York and is now an independent researcher with interests in architecture related to place. She speaks internationally and has written on sacred space, on urban identity, and on the art and architecture of health, broadly defined, in early modern Britain and Europe. She is currently editing a volume on the Art of Contagion from 1750 with Marsha Morton to be published by Routledge in 2023. Edite Martins Alberto  holds a PhD in early modern history (University of Minho, Braga, Portugal) and a master’s degree in Portuguese history (FCSH, Universidade NOVA de Lisboa). She is an integrated researcher at Centre for the Humanities (CHAM) research unit of the FCSH, Universidade NOVA de Lisboa and the University dos Azores. She works at the Center of Historical Studies in the Lisbon City Hall Cultural Department, where she is one of the coordinators of the “All Saints Royal Hospital: The City and the Public Health in Early Modern Times” research project. Georgia Daskalaki  is an architect and PhD candidate at the University of Cyprus, who also holds an MSc from National Technical University of Athens. Her research focuses on leisure and health politics associated ix

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with cultural identity, environmentalism, and nation-building in the Mediterranean context. She has taught history and theory of architecture and architectural design at the University of Cyprus and at NTUA. She has also worked as a research assistant at Mesarch Lab (University of Cyprus). As a practitioner, she has received awards in national and international architectural competitions and participated in various expositions and published design projects. Kristof Fatsar  is a Senior Lecturer at Kingston University London, where he is the Course Leader of postgraduate landscape programs. His topics include transnational cultural tourism at the turn of the nineteenth century, specifically the changing ideological and cultural connotations of popular travel destinations in different chronological, geographical, and social contexts. He has written on many aspects of early modern and modern Hungarian landscape history and its European context, including the first corpus of landscape designs of eighteenth-century Hungary. He is an advisory member of the ICOMOS-IFLA International Scientific Committee on Cultural Landscapes. Mohammad Gharipour  is Professor, Area Chair, and Director of the Architecture Program at the University of Maryland, USA. He obtained his PhD in architecture at Georgia Institute of Technology, USA. He has taught undergraduate and graduate courses and design studios at several universities and has received many prestigious awards from the Society of Architectural Historians (2008), National Endowment in Humanities (2015), Fulbright-Hays (2016), Foundation for Landscape Studies (2016), Council of Educators of Landscape Architecture (2016), American Institute of Architects (2018), and Fulbright (2019). In addition to organizing and chairing many panels and conferences and publishing more than 140 papers, encyclopedia entries, and reviews, he has authored, edited, and co-edited fourteen books including Persian Gardens and Pavilions (I.B. Tauris, 2013) and Health and Architecture (Bloomsbury, 2021). Dr. Gharipour is the director and founding editor of the award-winning International Journal of Islamic Architecture (IJIA), the director and co-­founder of the Epidemic Urbanism Initiative, and the second vice president of the Society of Architectural Historians.

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Marina Inì  is Assistant Professor of Early Modern European History at the University of Cambridge. Her PhD dissertation, titled The System of Lazzaretti in the Early Modern Mediterranean, explored the role of quarantine stations and plague prevention practices in the eighteenth-century Mediterranean. By focusing on quarantine regulations, architecture, and the material culture of quarantine, her research investigates the cultural history of the Mediterranean with an emphasis on how plague-prevention measures impacted the connected nature of the region. She has a forthcoming article in the Social History of Medicine. Nikolaus Koch  is an architect and architectural history research assistant at the Karlsruhe Institute for Technology. He studied architecture at University of Karlsruhe and Tampere University of Technology (Finland) and has participated in various projects in Russia and Turkey for the German Archaeological Institute (DAI Istanbul), especially in Oinoanda. He is writing a dissertation on the building history of the Freiburg minster tower. His research field is the archaeologic building research and has an interest in historic bath structures. As an architect he deals with building renovation, the preservation of historical monuments, and research on medieval buildings. Elizabeth W. Mellyn  is Associate Professor of History at the University of New Hampshire where she teaches a range of courses in early modern European history, the history of medicine, and the history of mental illness. Her publications include Mad Tuscans and Their Families: A History of Mental Disorder in Early Modern Italy (University of Pennsylvania Press, 2014). She is at work on a history of Santa Dorotea, Florence’s first hospital devoted to the care of the severely mentally ill. Vassiliki Petridou is Professor of History of Architecture in the Department of Architecture at the University of Patras, Greece. She studied Architecture at the Instituto Universitario di Architettura di Venezia, Italy, and holds a PhD in the History of Art and Architecture from the Sorbonne–Paris IV, Paris (1992). Her research focuses on the constitution of artistic and architectural knowledge in relation to the organization of modern western society. She has written studies and articles on

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modern and contemporary art and architecture in Greek, and in international journals and conference proceedings, and has authored chapters in edited volumes. Joana Balsa de Pinho  holds a PhD in the history of art from the University of Lisbon. Since 2017, she has been serving as the principal investigator of the project “Hospitalis–Hospital Architecture in Portugal at the dawn of Modernity: Identification, Characterization and Contextualization,” funded by the Foundation of Science and Technology in Portugal. Since 2020, she has served as an associated researcher appointed by Artis–History of Art Institute (University of Lisbon), in the context of an Individual Support Grant (Stimulus of Scientific Employment), with the project “Circulation, Appropriation and Reassignment of Architectonic Models: Portuguese Hospital Architecture in the 16th Century.” Nina Rind  is an architectural history research assistant at the Karlsruhe Institute for Technology and a freelance curator. She studied art history in Karlsruhe, Berlin, and Heidelberg. Her work focusses on history of urban infrastructure and architecture of modernity. She has also curated exhibitions in the field of architecture, art, film, and citizenship. She has authored the books Siedlung leben (exhibition catalogue, self-published, 2017), Stadtleuchten. Geschichte der Karlsruher Straßenbeleuchtung (Stadtwerke Karlsruhe, 2016), Trinkwasser. Lebensgrundlage einer jungen Stadt (Info Verlag, 2015), and Dammerstock (G. Braun Verlag, 2009). Anatole Tchikine  is curator of rare books at Dumbarton Oaks, an institute of Harvard University in Washington, DC, where he was previously assistant director of Garden and Landscape Studies. An architectural historian and specialist on early modern Italy, he holds a PhD from the University of Dublin, Trinity College. His work addresses the intersections of art and science, including the history of fountain design, botanical gardens, and collecting and representations of nature. He is the author, with Pierre de la Ruffinière du Prey, of Francesco Ignazio Lazzari’s “Discrizione della Villa Pliniana”: Reimagining Antiquity in the Landscape of Umbria (2021) and coeditor of The Botany of Empire in the Long Eighteenth Century (2016) and Military Landscapes (2021). His articles

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and reviews have appeared in Studies in the History of Gardens & Designed Landscapes, Renaissance Quarterly, Places Journal, JoLA, and Dumbarton Oaks symposia volumes, among other internationally recognized publications. Joaquín Medina Warmburg  is professor of architectural history at the Karlsruhe Institute for Technology (Germany). Trained as an architect at ETSA Sevilla (Spain) and RWTH Aachen (Germany), where he earned his PhD, he has taught in several European and American universities, including Universidad de Navarra, Universidad de Buenos Aires, and Princeton University. From 2011 to 2015 he was in charge of the Walter Gropius Chair of the German Academic Exchange Service (DAAD) at Universidad Torcuato Di Tella in Buenos Aires. He has conducted research in the field of the history of architecture and urbanism of modernity. His approach focusses on phenomena of cultural internationalization, including technical and environmental issues related to these exchange processes. He has written extensively on these topics, including Projizierte Moderne (Vervuert/Iberamericana, 2005), The Construction of Climate in Modern Architectural Culture, 1920–1980 (with Claudia Shmidt, Lampreave Editores, 2015), Walter Gropius: proclamas de modernidad (Editorial Reverté, 2018), and Paul Linder: de Weimar a Lima. Antología de arquitectura y crítica (Lampreave Editores, 2019).

List of Figures

Fig. 1.1 Fig. 1.2

Fig. 1.3 Fig. 1.4 Fig. 1.5 Fig. 1.6

Fig. 1.7

Francesco Maria Ciaraffoni, Ospedali Riuniti, Città di Castello, etching by Pietro Bombelli, 1785. Wellcome Collection, London. Public Domain Mark Pietro del Massaio, Map of Florence, ca. 1470s, from Claudius Ptolomaeus, Cosmographia, Jacobus Angelus interpres, Paris, Bibliothèque Nationale de France, MS Latin 4802, fol. 132v. Bibliothèque nationale de France, Paris. Creative Commons license Filippo Brunelleschi, Loggia of the Ospedale degli Innocenti, ca. 1419–1427, Florence, Italy. Photo: Anatole Tchikine Fonte Branda, ca. twelfth–fourteenth centuries, Siena, Italy. Photo: Anatole Tchikine Aqueduto da Amoreira, 1537–1628, Elvas, Portugal. Wikimedia Commons. Creative Commons license Gian Lorenzo Bernini, Fontana del Tritone, 1642–1643, from Giovanni Battista Falda, Le fontane di Roma (ca. 1691). Dumbarton Oaks, Washington, DC. Creative Commons license Domenico Cresti called Passignano, Bathers at San Niccolò, 1600, private collection. Wikimedia Commons. Creative Commons license

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9 11 15 17

19 20

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Fig. 1.8 Fig. 1.9

Fig. 1.10

Fig. 1.11 Fig. 1.12 Fig. 1.13

Fig. 1.14 Fig. 1.15 Fig. 2.1

Fig. 2.2

List of Figures

Lucas Cranach the Elder, The Fountain of Youth, 1546, Gemäldegalerie, Berlin. Staatliche Museen zu Berlin, Gemäldegalerie. Creative Commons license 21 Adriaen van de Venne, Game of pall-mall between Frederick V, Elector Palatine, and Stadtholder Frederik Hendrik, Prince of Orange, ca. 1620–1626, British Museum, London. Wikimedia Commons. Creative Commons license 23 Jan van Kessel III (attributed to), View of the Carrera de San Jerónimo and Paseo del Prado with a procession of carriages, 1686, Museo Nacional Thyssen-­Bornemisza, Madrid. © Museo Nacional Thyssen-Bornemisza, Madrid 24 Francisco Bayeu, The Paseo de las Delicias, 1784–1785. Prado, Madrid. Creative Commons license 25 Episodes in the plague in Rome in 1656–1657, between ca. 1656 and 1659, etching. Wellcome Collection, London. Public Domain Mark 28 Micco Spadaro (Domenico Gargiulo), The Largo del Mercatello during the plague of 1656, ca. 1656, Museo Nazionale di San Martino, Naples. Wikimedia Commons. Creative Commons license 29 Francesco Antonio Pichiatti and Domenico Antonio Vaccaro, Guglia di San Domenico, 1658–1737, Naples, Piazza San Domenico. Photo: Anatole Tchikine 31 Francesco Guardi, Procession to Santa Maria della Salute, ca. 1770–1780, Musée du Louvre, Paris. Wikimedia Commons. Creative Commons license 32 Panoramic view of Lisbon (Olisipo quae nunc Lisboa, civitas amplíssima Lusitaniae, ad Tagum, totis orientis et multarum insularum et Aphricaeque et Americae emporium), from Georg Braun’s Civitates Orbis Terrarum, V: Urbium Praecipuarum Mundi Theatrum Quintum, Fig. 2. (1598). Lisbon: Câmara Municipal de Lisboa, 1965. Câmara Municipal de Lisboa (available at https://rnod.bnportugal. gov.pt/rnod/winlibsrch.aspx?&pesq=3&doc=28795)52 Cross base, limestone, 1706, excavated by Lisbon Archeology Center (1999–2001) in Lisbon’s Praça da Figueira. Câmara Municipal de Lisboa—Centro de Arqueologia de Lisboa. Photo by José Vicente, CML|DMC|DPC 57

  List of Figures 

Fig. 2.3

Fig. 2.4

Fig. 2.5

Fig. 2.6

Fig. 3.1

Fig. 3.2 Fig. 3.3

Fig. 3.4

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Todos-os-Santos Hospital as seen in the panorama of Lisbon (Olisipo quae nunc Lisboa, civitas amplíssima Lusitaniae, ad Tagum, totis orientis et multarum insularum et Aphricaeque et Americae emporium), from Georg Braun’s Civitates Orbis Terrarum, V: Urbium Praecipuarum Mundi Theatrum Quintum, Fig. 2. (1598). Lisbon: Câmara Municipal de Lisboa, 1965. Câmara Municipal de Lisboa (available at https://rnod.bnportugal.gov.pt/rnod/winlibsrch. aspx?&pesq=3&doc=28795)58 View of the Rossio Square (facing Hospital Real de Todos-osSantos). Unknown author, oil on canvas, eighteenth century. Portugal, Álvaro Roquette/Pedro Aguiar Branco Collection (available at https://commons.wikimedia.org/wiki/ File:Rossio_e_Castelo_de_S._Jorge_antes_do_Terramoto_ de_1755.png)60 A late Gothic portico base of limestone. Late fifteenth or early sixteenth century, excavated by the Lisbon Archeology Center (1999–2001) in Lisbon’s Praça da Figueira. Câmara Municipal de Lisboa—Centro de Arqueologia de Lisboa. Photo by José Vicente, CML|DMC|DPC (2020) 67 Topographic map of Lisbon: Ilha em que estava edificado o Hospital Real de todos os Santos desta Cidade […]. Filipe Rodrigues de Oliveira, Guilherme Joaquim Paes de Menezes, 1750. Portugal, Biblioteca Nacional D.100R. (Available at http://purl.pt/22488)68 Plan of the Lazzaretto of Varignano, La Spezia, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789), Plate 6. Getty Research Institute, Los Angeles (85-B11700) 86 Plan of the ground floor of the lazzaretto in Ancona, eighteenth century. Biblioteca Comunale Benincasa, Ancona 87 Plan of the Lazzaretto of San Leopoldo, Livorno, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789), Plate 7. Getty Research Institute, Los Angeles (85-B11700) 88 Detail of the parlor in the Marseille lazzaretto, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789) Plate 1. Getty Research Institute, Los Angeles (85-B11700) 94

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List of Figures

Fig. 3.5

Plan of the project for the chapel, canteen and parlor of the lazzaretto of San Leopoldo, 1785. The stone basin is labeled with N and the canteen is labeled with G. Livorno, Archivio di Stato di Livorno, Magistrato poi Dipartimento di Sanità, 153 (657/34.34.46(8), 19.05.2020) Fig. 3.6 Plan of the Lazzaretto della Foce, Genoa, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789), Plate 2. Getty Research Institute, Los Angeles (85-B11700) Fig. 3.7 Plan of the Lazzaretto of San Rocco, Livorno, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […]: 1789), Plate 8. Getty Research Institute, Los Angeles (85-B11700) Fig. 3.8 Plan of the Lazzaretto of Messina, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […]: 1789), Plate 11. Getty Research Institute, Los Angeles (85-B11700) Fig. 3.9 View of the lazzaretto of San Pancrazio, Verona. Archivio di Stato di Verona, Mappe e Disegni, Ospedale dei Santi Jacopo e Lazzaro alla Tomba, 2024, 1 (1370-A, 19.05.2020, license n. 12/2020) Fig. 3.10 Plan of the Lazzaretto in Marseille, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789), Plate 1. Getty Research Institute, Los Angeles (85-B11700) Fig. 4.1 Christian Thran, View of the city of Karlsruhe from the north (1739). Stadtarchiv Karlsruhe 8/PBS XVI 47 Fig. 4.2 Johann Carl Hemeling, Greenhouse for the Lustgarten [Pleasure Garden] in Karlsruhe (1724). Generallandesarchiv G Karlsruhe 139 Fig. 4.3 John Claudius Loudon, Concentric expansion plan for London, alternating rings of urban development and greenery (1829). The Gardener’s Magazine, December 1829, 687 Fig. 4.4 Map of the riverbanks of the Kinzig-Murg-Rinne between the Black Forest and the Rhine. StadtAK 8/Bildstelle III 1236 Fig. 4.5 A comparison of the Rhine River’s course near Karlsruhe during the ancient Roman period and around 1900. Generallandesarchiv H-f/629 I

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Fig. 4.6

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General plan of Karlsruhe and its surroundings with the Landgraben canal (1788). Stadtarchiv Karlsruhe 8/PBS XVI 102 142 Fig. 4.7 Proposed naming for Karlsruhe’s radial streets by Margrave Karl Wilhelm (1718). Stadtarchiv Karlsruhe 8/PBS XVI 12 144 Fig. 4.8 Architectural drawings of a row of houses in the Amalienstraße 65, 67, 69 (1826). Generallandesarchiv G Karlsruhe 892 146 Fig. 4.9 House with a narrow ground plan (Carlsstraße 41), with a well set on the property’s border (1812). Generallandesarchiv 422/508147 Fig. 4.10 Ground floor with overlapping cellar floor plan (Waldstraße 77) showing vaulted manure pit, toilet, well, and laundry room. Generallandesarchiv G Karlsruhe 197 150 Fig. 5.1 Nathan Drake, The New Terrace Walk, York (1733–1756) 161 Fig. 5.2 John Haynes and John Cossins, New and Exact Plan of the City of York (1748) 162 Fig. 5.3 Henry Cave, On the River Ouse Looking Upstream (1795–1805)166 Fig. 5.4 Henry Cave, Scene of First Water Lane in York, with figures in street and cart (1813) 167 Fig. 5.5 John Haynes, The County Hospital in York (1743) 171 Fig. 5.6 William Heath, Microcosm, dedicated to the London Water Companies, Brought Forth All Monstrous, All Prodigious Thigs [sic.], Hydras, and Gorgons, and Chimeras Dire. Alternative title: Monster soup commonly called Thames water, being a correct representation of that precious stuff doled out to us!!! (ca. 1828) 175 Fig. 5.7 George Cruickshank, Salus Populi Supreme Lex Esto. Heading to a printed broadside: “Royal Address of Cadwallader-apTudor ap-Edwards ap-Vaughan, Water-­King of Southwark, Sovereign of the Scented streams, … Protector of the Confederation of the (U)Rhine, … [&c. &c, a parody of Napoleon’s titles], To His Subjects of the Borough.” An attack on the Southwark Water Works, owned by John Edwards, Esq. A… (1832) 176

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Fig. 5.8

Fig. 5.9 Fig. 6.1 Fig. 6.2 Fig. 6.3

Fig. 6.4

Fig. 6.5

Fig. 6.6

List of Figures

J. M. Williams, Engine-house, Crossness: Outfall of the southern metropolitan sewerage. Erected under the direction of Mr. Bazalgette, engineer of the metropolitan board of works (1865) 183 T. Sulman, Saint Thomas’s Hospital, Lambeth, seen from the south-east with the Palace of Westminster in the background, a plan and scale beneath (1871) 185 Santa Dorotea, site 2, 1754–88, in contemporary Florence. Photo: Elizabeth W. Mellyn 204 Santa Dorotea, site 1, 1642–1754, in contemporary Florence. Photo: Elizabeth W. Mellyn 205 Approximate location of Santa Dorotea’s first site. “DECIMA: The Digitally Encoded Census Information and Mapping Archive,” accessed May 16, 2017, www.decima-­ map.net214 Santa Dorotea, first site plan, bird’s eye view. Santa Dorotea Purchase Contract, 1723, Archivio di Stato of Florence, Santa Dorotea 23/40, no. 7. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/ Archivio di Stato di Firenze 216 Ground Floor Plan of Santa Maria Nuova, second half of the eighteenth century, Archivio di Stato of Florence, Santa Maria Nuova 592, IIr. The Pazzeria is located at number 23, which can be found directly above the plan’s key. The plan shows seven rooms, surrounding a small courtyard. here were likely more rooms directly above these on the second floor that are not represented. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/ Archivio di Stato di Firenze 220 Presentation plans for the ground floor of Santa Dorotea’s second site. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 599r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze222

  List of Figures 

Fig. 6.7

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Presentation plans for the first floor of Santa Dorotea’s second site. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 600r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze 223 Fig. 6.8 Presentation plans for the second floor of Santa Dorotea’s second site. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 601r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze224 Fig. 6.9 Presentation plans cross-section of Santa Dorotea’s second site. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 603r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze 225 Fig. 6.10 Axonometric model of Santa Dorotea’s second site based on Giuseppe Ruggieri’s plans. Benjamin Tulman, HMFH Architects, Cambridge, MA 226 Fig. 6.11 Detail of latrines in rooms along western wall of the ground floor. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto, 341, 599r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze227 Fig. 6.12 Detail of latrines on the second floor emptying directly into the river. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto, 341, 599r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze 228

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Fig. 7.1

Fig. 7.2

Fig. 7.3

Fig. 7.4

Fig. 7.5

Fig. 7.6 Fig. 7.7

List of Figures

H. Lebas and J. E. D. Esquirol’s plan and façade for an insane asylum (labeled “project by M. Esquirol”). (William Charles Ellis, Traité de l’aliénation mentale, ou De la nature, des causes, des symptômes et du traitement de la folie: Comprenant des observations sur les établissements d’aliénés [ouvrage traduit de l’anglais, avec des notes et une introduction historique par Th. Théophile Archambault, enrichi de notes par M. Esquirol], trans. Théophile Archambault (Paris: J. Rouvier, 1840)) Projet d’asile, 1822 (attributed to Léon Vaudoyer). (École des Beaux-Arts collection (inventory no. 70936)) (Petridou, Vassiliki. “La doctrine de l’imitation dans l’architecture française dans la première moitié du XIXe siècle. Du néo-­ classicisme au romantisme à travers l’œuvre de LouisHippolyte Lebas (1782–1867).” PhD diss., Université de Paris–Sorbonne, Paris IV, 1992) Leroux(?)’s project for the new Charenton Asylum on the Val Dosne site dating from 1823. (Pierre Pinon, L’Hospice de Charenton: The Charenton Hospital (Liège: Mardaga, 1989), 84) Hospital plans published by Durand in 1799. From left to right: Hospital of Genoa, of Milan, of Plymouth (1756), Saint-Louis in Paris (1607), the hospital by Poyet (1788), Hospital des Incurables, Paris. (J. N. L. Durand, “Hôpitaux,” in Recueil et parallèle des édifices de tout genre, anciens et modernes: Remarquables par leur beauté, par leur grandeur, ou par leur singularité, et dessinés sur une même échelle (Paris, 1799), plate 29. University of Heidelberg, Creative Commons license) Émile-Jacques Gilbert’s project for the new Charenton Asylum, variant A, adopted in 1834. (Pierre Pinon, L’Hospice de Charenton: The Charenton Hospital (Liège: Mardaga, 1989), 113) View of the Charenton Asylum chapel at the Charenton Asylum (as sein in 1989). (Vassiliki Petridou) The convalescents yard at the Charenton Asylum (as seen in 1989). (Vassiliki Petridou)

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Fig. 8.1

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Situation plan with proposed interventions to the layout of the spa at Bártfa (Bardejov, Slovakia), by Vince Beér, from the late eighteenth century. National Archives of Hungary, Budapest; OL, S 11, No. 1269 279 Fig. 8.2 Plan of a canal to regulate the local stream at the bath of Félixfürdő, c.1799. National Archives of Hungary, Budapest; OL, S 12, Div. VII, No. 8 280 Fig. 8.3 Development plan for the Püspökfürdő spa, c.1775. National Széchényi Library, Budapest, Map, Poster and Small Print Collection, Maps, TK 710 281 Fig. 8.4 The spas at Püspökfürdő (top right) and Félixfürdő (left) in 1860 on the second military survey of Hungary, Colonne XLIV Section 54. Österreichisches Staatsarchiv, Vienna 282 Fig. 8.5 Situation plan of the baths at Herlány by Carl Heinrich von Geispitzheim, 1787. National Archives of Hungary, Budapest; OL, S 11, No. 1737/1 284 Fig. 8.6 “Ideal Project Plan” for the embellishment of the spa at Herlány by Carl Heinrich von Geispitzheim, 1787. National Archives of Hungary, Budapest; OL, S 11, No. 1737/2 285 Fig. 8.7 Pavilion for the spa landscape at Herlány by Carl Heinrich von Geispitzheim, 1787. National Archives of Hungary, Budapest; OL, T 62, No. 1391/3 289 Fig. 8.8 The Herlány spa landscape (left) in 1819 on the second military survey of Hungary, Colonne XLII Section 38. Österreichisches Staatsarchiv, Vienna 290 Fig. 8.9 The Temple of Convalescence erected above the mineral spring at Tarcsafürdő by Rudolph Witsch in 1795. Zeitschrift von und für Ungern zur Beförderung der vaterländischen Geschichte, Erdkunde und Literatur vol. I no. 2 (1802): 193; National Széchényi Library, Budapest, General Collection, Periodicals, H 26.485 291 Fig. 8.10 The spa (top right) and the surrounding designed landscape at Tarcsafürdő (Bad Tatzmannsdorf ) on the stabile cadastral map of Tatzmannsdorf of 1857. Bundesamt für Eich- und Vermessungswesen, Vienna 293 Fig. 9.1 Modern spa therapeutic practices in early twentieth-century France. (Aix-les-Bains, France: a circular shower in a thermal establishment. Photographic postcard, ca. 1920. Wellcome Collection)313

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List of Figures

Fig. 9.2

Casino in the spa town of Vichy, France, at the end of eighteenth century. (Institut français d’architecture, Villes d’eaux en France (Paris: Hazan, 1984), 65) Plan of Kyllini, 1840. (Ministry of the Environment and Energy, Cartographic Documentation Department) Plan of Edipsos, 1896. (Ministry of the Environment and Energy, Cartographic Documentation Department) Plan of Hypati, 1890. (Ministry of the Environment and Energy, Cartographic Documentation Department) Loutraki’s urban plan of 1895. (Ministry of the Environment and Energy, Cartographic Documentation Department) Hotel at Hypati in the end of nineteenth century. (Hotel at Hypati in the end of nineteenth century. From Tryfon Evangelidis, Ta aftofii iamatika idata tis Ypatis (The natural thermal waters of Ypati), Athens: Raftani Papafeorgiou, 1907)

Fig. 9.3 Fig. 9.4 Fig. 9.5 Fig. 9.6 Fig. 9.7

314 318 319 320 321

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1 Introduction: Achieving a Healthy City in Early Modern Europe Anatole Tchikine and Mohammad Gharipour

The Old and the New A print engraved by Pietro Bombelli and published in Rome in 1785 with a dedication to Pope Pius VI (r. 1775–1799) celebrated the opening of the Ospedali Riuniti, a large hospital in the Umbrian city of Città di Castello built to the design of the Marchigian architect Francesco Maria Ciaraffoni (1720–1802) (Fig. 1.1). The dual scale in Roman palmi and local piedi that appears on either side of the papal coat-of-arms conveyed the impressive length of the three-story façade. Flanked by two open loggias, the building was rhythmically articulated by rusticated sections that continued into long pilaster strips—a vertical alignment anchored by the elegant belltower above the central bay. In the absence of the main portal, the even number of symmetrical entrances conveyed the hospital’s A. Tchikine (*) Dumbarton Oaks, Harvard University, Washington, DC, USA e-mail: [email protected] M. Gharipour University of Maryland, College Park, MD, USA © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_1

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Fig. 1.1  Francesco Maria Ciaraffoni, Ospedali Riuniti, Città di Castello, etching by Pietro Bombelli, 1785. Wellcome Collection, London. Public Domain Mark

rational organization, intended to separate women from men and provide access to both patients and visitors. For a modest-sized city such as Città di Castello with a long history going back to antiquity—the center of one of the patchwork territories that constituted the Papal States—the founding of the Ospedali Riuniti was a signal event that marked a path toward enlightened modernity. The hospital’s ambitious scale echoed other contemporary projects in Italy, such as the rebuilding of the Ospedale di Pammatone in Genoa in 1758–1766 and the founding of the Albergo dei Poveri in Naples by the Bourbon King Charles VII (r. 1734–1759). A mammoth edifice begun by Ferdinando Fuga in 1751, the latter was intended to house the “[sick] poor of the whole kingdom [of Naples],” according to a Latin inscription above the entrance. Originally, it was to have a façade consisting of 101 bays with five internal courtyards behind. The central of these quads was to be large enough to contain a domed church that was accessible through radial covered passages, where the hospital’s community segregated by

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gender and age would gather to receive communion and spiritual instruction.1 The enormous size of these buildings, designed in large part to deal with the problem of the urban poor, typified the new hospital architecture that was emerging across Enlightenment Europe. In the preceding centuries, such initiatives were generally led by the example of France. The country’s architectural landmarks ranged from the seventeenth-­ century La Salpêtrière and Les Invalides in Paris—intended, respectively, to accommodate destitute women and disabled soldiers—to the Hôtel-­ Dieu at Lyon, rebuilt beginning in 1741 by the leading French architect Jacques-Germain Soufflot. This monumental approach, however, was equally reminiscent of the earlier hospital architecture in Italy that claimed similar prominence within the city. Salient among such examples were the medieval complex of Santa Maria della Scala in Siena, occupying a prestigious location opposite the entrance to the cathedral, and the Ospedale Maggiore in Milan. The latter, based on a plan by the fifteenth-­ century architect and theorist Antonio Averlino known as Filarete, became an influential model for the functional organization of subsequent healthcare establishments. In keeping with the same trend, the Ospedale di Santo Spirito in Sassia in Rome was expanded several times since its original founding in the proximity of the old Saint Peter’s basilica as a hostel for Anglo-Saxon pilgrims, with its principal ward begun by Sixtus IV (r. 1471–1484) extending as far as the Tiber. The last major building project in Città di Castello under the papal government, the Ospedali Riuniti was the city’s culminating achievement prior to the disastrous earthquake of 1789 that put an end to its architectural ambitions. Nineteenth-century Castellane historians were united in recognizing the urban significance of this project. According to Giuseppe Andreocci, the Ospedali Riuniti was “worthy of a capital city,” a fitting monument to the governorship of its founder Luigi Gazzoli (1735–1809), later made cardinal.2 Another contemporary commentator, Giacomo Mancini, praised Ciaraffoni’s façade as a “magnificent structure,” adding, however, that “it was notable more for its length than architecture,” being a little too long with respect to height.3 He also remarked that “this hospital, so to speak, is but a composite of many hospitals joined together in both

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remote and recent times.”4 Indeed, rather than seen as a new point of departure, the Ospedali Riuniti stood at the end of a long process of institutional formation. For the nineteenth-century Castellanes, its Enlightenment veneer represented the city’s concerted efforts toward coping with disease and promoting health that had spanned several centuries. The prehistory of the Ospedali Riuniti was a complex narrative of financial and legal decisions—endowments, mergers, and closures— involving other smaller hospitals that resulted in their gradual consolidation. Founded in the thirteenth century by the powerful Vitelli family, it was originally dedicated to All Saints (Tutti i Santi). The hospital’s peripheral location in the south-western quarter of Città di Castello, across from the friary of San Domenico, was probably due to the neighborhood’s supposedly healthier air. Around a century later, the Ospedale di San Florido, which had stood on the opposite, northern, end of the city next to the church of Santo Spirito, was moved to the same site.5 The two institutions were merged in 1513, absorbing in the process a pair of minor hospitals, Santa Maria de’ Mercanti and Santi Giacomo e Filippo (known, respectively, as della Strada and de’ Lanajoli). The arrangement was ratified the following year by Pope Leo X (r. 1513–1521), with the new establishment assuming the name of the Ospedale di San Florido in honor of the city’s celestial patron. By 1773, during Gazzoli’s governorship, it was substantially enlarged and enriched by incorporating a host of other charitable institutions from around the city and its periphery— among them, de’ Projetti, dell’Orfane, della Misericordia, and de’ Malati di Pietralunga—accruing a substantial income.6 By 1785, the date of Bombelli’s print, it became known as Joined Hospitals (Ospedali Riuniti). This layered history reveals multiple ties that linked the Ospedali Riuniti to Città di Castello and its subject territory. The hospital’s creation marked the centralization of a network of more than five dozen institutions previously dispersed throughout the city and the settlements that it governed.7 The architectural rhetoric of Ciaraffoni’s façade gave a visible expression to the vast scale of this reorganization. More than a prominent building within the city, the hospital thus embodied the larger territorial geography of the Castellane sanitary infrastructure that, in the

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course of its long historical evolution, converged on a single monumental edifice commemorated in Bombelli’s print. This relationship between architecture and public health on the scale of a city rather than individual buildings is the subject of the present volume. Focused on Europe, it applies a wide chronological and geographical lens, covering a period from the fourteenth through the ninetieth centuries and examining different parts of the European continent, including less studied areas such as Hungary and Greece. Its chapters, rather than merely adding to the growing body of scholarship devoted to hospital architecture, address the larger urban infrastructure of healthcare and sanitation, analyzing the evolving response to the changing medical practices, scientific attitudes, and government policies and highlighting an increasingly monumental emphasis that such buildings received. Conceived during the onset of the COVID-19 pandemic, this approach reveals both contrasts and parallels with the previous measures toward preventing and regulating disease characteristic of the early modern period. This stress on historical continuities rather than ruptures, while enabling us to draw lessons from the past, aligns architectural history narratives with the efforts toward building and sustaining a safer and healthier urban environment. One aspect that makes this volume stand out among other, thematically related, publications while strengthening its interdisciplinary focus is the centrality of the concept of salutogenesis. Articulated in twentieth-­ century scientific discourse, this emphasis moves the discussion from the methods of combatting disease toward broader strategies of sustaining and promoting physical and mental health. Such considerations were particularly evident in the design and function of early modern gardens, as reflected in the medical and horticultural theories of the time. Countryside villas were not only safety havens in the event of plague, as famously suggests the opening scene of Giovanni Boccaccio’s Decameron. Since antiquity, they were purposely built in salubrious environments with healthy air, abundant greenery, and access to running water, away from the miasmic conditions of the city.8 Large privately owned estates as typified by the Villa Borghese in Rome had been recognized spots of public recreation long before networks of urban green spaces would be coordinated into nineteenth-century systems of public parks.9 The

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accessibility of these properties gained particular importance during outbreaks of airborne disease, notably smallpox, that plagued early modern cities. Quite apart from these private amenities, salutogenic solutions in the form of river embankments, pall-mall lanes, and carriage or pedestrian promenades increasingly defined the urban landscape, as Giuseppe Zocchi’s eighteenth-century view of Florence on the cover of this book palpably demonstrates. Following the medieval precedents, early modern government authorities also continued to invest into large-scale hydraulic initiatives to increase the availability of potable water while regulating laundry services, sewage disposal, and industrial waste. Many of these concerns had already been the subject of earlier legislation that kept noxious industries—for example, tanners’ and butchers’ workshops—away from the residential quarters and ensured the protection and regular maintenance of civic fountains and wells.10 These dialogues between the old and the new laid the foundation for the successive strategies of urban improvement, putting the questions of public welfare and health at the heart of the ongoing conversation between architectural planning and the medical discourse.

Urban and Territorial Infrastructures of Health While the origins of salutogenic design and theory in Europe can be traced to Greek and Roman antiquity, as testified by the grandiose architecture of the imperial baths, the early modern infrastructure of public health had its humbler beginnings in the urban revival of the late medieval period. Known as the “age of the cathedrals” in the words of the French historian Georges Duby, the thirteenth and fourteenth centuries were a time of exponential economic growth for major European cities due to flourishing trade and the rise of the artisanal class.11 In addition to investing in ambitious architectural projects, especially cathedral building, as a mark of urban identity, this newly achieved prosperity enabled the redistribution of wealth through networks of charitable organizations and institutions. The founding of new hospitals and orphanages was generally led by private initiative, motivated in large part by fears of divine

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punishment for the sin of usury associated with moneylending. Driven by pious attitudes, such philanthropic acts also fulfilled a broader social function by combining health, welfare, and charity under the Christian mission of community service to provide free care for the poor and needy as well as the sick. Run by religious orders and confraternities, hospitals continued to rely on private endowments and donations, often becoming substantial landowners themselves and deriving regular income from rents, sales of agricultural produce, and other investments. This growing wealth allowed hospital buildings to claim an increasingly prominent place within the city.12 Florence is a case in point for this discussion. A wealthy commune of merchants that owed its riches to the wool industry, banking, and trade, it underwent a rapid urban expansion between the eleventh and fourteenth centuries. This growth, evidenced by three medieval girdles of defensive walls, was cut short by the Black Death, the bubonic plague that ravaged Europe in 1347–1351, when Florence lost nearly half of its population. The disaster catalyzed the need for a larger sanitary infrastructure, necessitating the building of new hospitals in different locations around the city. Prominent among them was the Ospedale di Bonifacio in the Via Sangallo, begun in 1377 and opened in 1388. Dedicated to Saint John the Baptist, it was generally known by the name of its founder, the condottiere Bonifacio Lupi, in recognition of the individual who had endowed its creation. Contemporary with it were the Ospedale di Santa Maria dell’Umiltà (subsequently known as San Giovanni di Dio) in the Borgo Ognissanti, established by the affluent Vespucci family resident in the area, and the Ospedale di San Matteo, now part of the Accademia, both dating to the 1380s. More specialized was the Ospedale degli Innocenti, begun in 1419 under the patronage of the powerful Silk Guild and finished by 1444. An orphanage, it was home to the abandoned infants who typically stemmed from the poorest strata of the urban population. In contrast to these establishments that emerged after the Black Death, the Ospedale di Santa Maria Nuova—the largest and wealthiest among the Florentine hospitals—originated prior to the epidemic, owing its creation to the banker Folco Portinari, the father of Dante’s Beatrice. In 1285, three years before the official founding act, he had bought for this purpose a plot of land next to the friary of

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Saint’Egidio, later incorporated into the new hospital compound.13 On the eve of the fourteenth-century plague, according to a contemporary chronicler Giovanni Villani, Florence had around 30 hospitals with a total of more than 1000 beds.14 A late fifteenth-century map of Florence by Pietro del Massaio conveys the sense of civic pride associated with such institutions. It shows hospitals among the top urban attractions, asserting their importance next to the principal churches, convents, and palaces (Fig.  1.2). North of the domed profile of Florence cathedral stands Santa Maria Nuova, deceptively small the way it appears on the map. Having originated as a modest establishment with only 12 beds, by the time of the Black Death it was divided into separate areas for men and women, acquiring a characteristic system of cruciform wards later replicated in Filarete’s plan for the Ospedale Maggiore in Milan.15 A further distance away from the center are the Innocenti orphanage and the Ospedale di Bonifacio, taking full advantage of their suburban location. The ample land at their disposal enabled the addition of large gardens visible at the back, enclosed by walls with rows of trees planted along the perimeter.16 Although hardly a new type of building, the Renaissance hospital had no established antique models for architects to imitate. Functional requirements led to the adaptation of the traditional medieval forms filtered through the revived classical aesthetics. Hospital wards tended to be long, usually with two parallel rows of beds, although they greatly varied in size and shape. Internal courtyards for the recreational use by the convalescents derived their form from monastic cloisters, which, in turn, were based on ancient peristyles. One of the earliest examples was the Chiostro delle Medicherie in Santa Maria Nuova, dating from around 1420.17 Another architectural borrowing that defined the appearance of hospital buildings was the arcaded portico. Modeled on the design of private loggias—sites of family feasting and public display—these external additions served as temporary shelters for beggars, a sorrowful but familiar sight in early modern streets.18 The most celebrated example in Florence was the portico on the façade of the Ospedale degli Innocenti designed by Filippo Brunelleschi (1377–1446), which, despite its iconic use of the Corinthian order, had a close precedent in the late medieval arcade of the nearby Ospedale di San Matteo. From 1660, the portico’s

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Fig. 1.2  Pietro del Massaio, Map of Florence, ca. 1470s, from Claudius Ptolomaeus, Cosmographia, Jacobus Angelus interpres, Paris, Bibliothèque Nationale de France, MS Latin 4802, fol. 132v. Bibliothèque nationale de France, Paris. Creative Commons license

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northern extremity contained a mechanism with a pulley and a basket attached, in which the babies abandoned by their parents were received through a small window, preserving the poignant anonymity of such acts (Fig. 1.3). Whether severe or elegant, the monumentality of early modern hospital architecture, enhanced by classical proportions and detailing, turned these loci of Christian charity into sites of urban prestige. Kitchen and medicinal gardens (orti) attached to some of these institutions provided food for the patients as well as pharmaceutical ingredients and small additional income. Freshly grown vegetables and fruits were a source of nutrition for treating illnesses caused by dietary imbalance, such as scurvy and scrofula. This produce could also have broader therapeutic applications, as in the case of cucumbers, which were considered a “lowly” food best suited for the “coarse” stomachs of peasants and laborers. Peeled, cut into long slices, and soaked in cold water, they were given to patients suffering from acute fever to hold in the mouth to alleviate dryness and thirst, providing temporary relief from discomfort.19 Separate apothecary gardens (orti dei semplici) were managed by a number of hospitals and convents, including the Ospedale degli Innocenti and the Franciscan friary of Ognissanti.20 One of the oldest of them, recorded around 1518, was attached to Santa Maria Nuova, becoming a recognized center of botanical learning.21 The infirmary garden of Santa Maria Novella, the city’s main Dominican establishment, supplied the friary’s celebrated pharmacy. Among its produce were excellent capers, which, besides other therapeutic effects, were believed to improve the appetite, cleanse the spleen, and kill intestinal worms.22 Herbs cultivated in these gardens, in addition to their use in medicinal preparations, served to repel insects, such as moths and ticks. Strewn throughout the interior of buildings or carried in the street, they were also thought capable of blocking harmful miasma.23 Medieval cities were not isolated dots on a map, being connected through networks of trade and pilgrimage routes that generated a traffic of merchants, travelers, pilgrims, preachers, peddlers, vagabonds, and other itinerants. Catering to this migrant populace was a system of hostels or hospices that continued the tradition of medieval xenodochia found along the main roads.24 Known in Florence as spedaletti or spedaluzzi, they extended the urban sanitary infrastructure into the Florentine

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Fig. 1.3  Filippo Brunelleschi, Loggia of the Ospedale degli Innocenti, ca. 1419–1427, Florence, Italy. Photo: Anatole Tchikine

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territory. Originally intended for the care of sick and poor travelers, some of them later evolved into the city’s major hospitals, including the Ospedale di San Paolo in the Piazza di Santa Maria Novella and the Ospedale di San Gallo, demolished during the siege of 1529–1530, outside the eponymous gate (see Fig. 1.2). The size of the spedaletti can be judged from the number of beds that they provided, which ranged from two or four to twelve and even fourteen.25 One of the largest of them, which boasted the addition of a small oratory, was that of San Biagio a Monticelli. It was supposed to provide twenty beds: fourteen for men, four for women, and two for travelers and pilgrims. A contemporary pasquinade, however, suggests that these amenities were far from ideal: “Chi va a San Biagio / Perde l’agio / Chi va a Santa Maria Nuova / Lo ritrova” (He who goes to San Biagio / Will lose comforts / He who goes to Santa Maria Nuova / Will regain them).26 A sixteenth-century inspection revealed that the spedaletto of San Martino on the Via Chiantigiana between Florence and Siena had no beds at all, but only a small kitchen garden cultivated by its custodian.27 Brought into existence by the same charitable mechanisms and governed by similar regulations as larger hospitals, spedaletti could be managed by private individuals as well as religious orders.28 For example, the fourteenth-century Ospedale dei Castellani near the Badia a Ripoli on the old Via Aretina—a major pilgrimage route that connected Florence to Rome—bore the name to a wealthy family that enabled its operations. This hospital provided four beds, drawing its income from the rent of three houses—one with an added workshop—and employing a single attendant (garzone) who admitted the patients. Its annual budget was supposed to cover the cost of a mass said each month for the spiritual wellbeing of the occupants and twelve extra services celebrated on the feast of Pentecost every May or June.29 Further down the Via Aretina, in the locality of Apparita, stood the fourteenth-century Ospedale di Fonteviva (also known as del Bigallo). Founded on a hill from which travelers could for the first time glimpse the majestic dome of Florence cathedral, it was run from 1490 by the nuns who inhabited the adjoining convent. This hospital derived its name from a medieval fountain, the Fonteviva, on the opposite side of the road, built for the convenience of the pilgrims.30 Also outside the city but usually in more remote sites were

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hospices for lepers, whose illness required their isolation from urban communities.31 This territorial healthcare system underwent two waves of centralization in the sixteenth and eighteenth centuries. The result was the suppression of most of spedaletti, with larger hospitals emerging even stronger. In the end, Santa Maria Nuova asserted its absolute leadership in Florence, absorbing a number of small independent institutions and adding to its celebrated botanical garden a flourishing medical school.32 This process largely paralleled the situation in eighteenth-century Città di Castello, where the Ospedale dei Riuniti, according to the caption to Bombelli’s print, cared for “the sick, the invalid, the poor, and the orphaned” by bringing them all under the same roof (see Fig. 1.1).33 Such centralization was not a general rule. In the case of Dublin— hailed in the eighteenth century as the second city of the British Empire— the tendency was to spread out hospital services instead of concentrating them in one place. Following the founding of the Royal Hospital Kilmainham—a home for retired soldiers built in 1679–1687 on the model of Les Invalides—the city saw the emergence of other specialized institutions, notably the Rotunda, a maternity hospital for poor women established in 1745. Opened in 1757, Saint Patrick’s Hospital for the mentally ill drew on the funds bequeathed by the satirist Jonathan Swift (1667–1745), the author of Gulliver’s Travels, who wrote in his humorous epitaph: “He gave the little wealth he had, / To build a house for fools and mad.”34 The year 1779 saw the creation of the Simpson’s Hospital—a nursing home for poor men suffering from gout and blindness, a combination of ailments that had afflicted its benefactor, the merchant George Simpson.  Over a decade later, it was followed by the opening of the Westmoreland Lock Hospital for the treatment of venereal diseases. Unlike Italy, where such institutions were traditionally run by religious orders, these healthcare facilities were managed by philanthropic organizations led by the example of the Charitable Infirmary (later Jervis Street Hospital), founded in 1718 by a group of six Dublin surgeons. In the absence of a government system of poor relief, this decentralized model continued to rely on private charity with the aid of state and local taxes. Supported by parliamentary legislation, it persisted well into the nineteenth century.35

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The Politics of Water Supply An extensive and diversified hospital system could provide routine medical services but not by itself guarantee the health and wellbeing of the urban population. In addition to epidemics, sieges, fires, and floods, early modern European cities continued to suffer from squalid living conditions and inadequate waste disposal exacerbated by poor water supply and sewage systems, just as they did in the Middle Ages. Many streets, crooked and narrow, remained unpaved, while rivers and canals served for dumping domestic and industrial refuse. These unsanitary conditions, a cause of persistent infections that manifested themselves as dysentery, were often made worse by environmental factors. As sixteenth-century French writer and traveler Michel de Montaigne observed, “The affection that I have for those beautiful cities Venice and Paris is lessened by their offensive smells, which arise from the marshes of the former and the mud of the latter.”36 A key hygienic requirement was access to running water, which, besides being a safety factor during fire emergencies, enabled public bathing, laundry washing, and sewage disposal. Although many cities were built on rivers, elevated pollution made the quality of this water a call for medical scrutiny. In Rome, sixteenth-century physicians fiercely debated the potability of the Tiber, used for drinking by a large proportion of the city’s inhabitants including, allegedly, some of the popes.37 The Arno in Florence, in Dante’s time, had the reputation of a “cursed and unlucky ditch” (la maledetta e sventurata fossa), the cause of frequent inundations and putrid smells, its banks lined with cloth-dying mills and tanning workshops.38 It took several centuries and the construction of two quays (lungarni) between the Ponte Santa Trìnita and Ponte alla Carraia, as featured in Giuseppe Zocchi’s 1744 series of urban vedute, to correct this negative image. In the case of seventeenth-century London, the demand for street access to the Thames had less to do with urban aesthetics and recreational needs. The royal proclamation issued after the Great Fire of 1666 forbade lining the riverbanks with wooden houses, as had been the case previously, putting the river’s water beyond the reach of emergency squads.39

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This inadequate water supply plagued Europe since the collapse of the Roman rule. Few ancient aqueducts remained in operation, while the new ones, usually of smaller capacity and shorter in length, primarily benefitted church officials and monastic institutions. Exceptional in this regard was the eighth-century aqueduct in Salerno built by the city’s Langobard ruler. This monumental arcaded structure visibly conveyed the power associated with the control, provision, and distribution of water as an essential urban resource.40 During the later medieval period, when the center of authority shifted from local bishops to independent communes, the responsibility for such projects fell on municipal governments. A testimony to their efforts was the creation of the bottini of Siena, an extensive system of underground conduits that collected water and channeled it to several distribution points known as fonti within the city. These characteristic brick edifices, distinguished by their utilitarian forms, usually combined drinking outlets with washing facilities, sharing runoff with the nearby industries (Fig. 1.4).41

Fig. 1.4  Fonte Branda, ca. twelfth–fourteenth centuries, Siena, Italy. Photo: Anatole Tchikine

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The rise of early modern princely states opened new opportunities to spur this process of urban renewal. Putting ancient technology in the service of princely ambitions, their rulers had greater resources to enable large infrastructural projects including the restoration of antique aqueducts, such as the Acqua Vergine in the case of papal Rome.42 The Iberian monarchies were particularly successful in deploying urban beneficence to accrue royal prestige. One of the government acts following the dynastic union between the Castilian and Aragonese crowns, which marked the emergence of modern Spain, was the restoration in 1484–1489 of the majestic Roman aqueduct in Segovia in central Castile. This engineering feat paved way for entirely new projects conceived on a similar scale, such as the construction of the Acueducto Los Arcos (1537–1558) in Teruel in the Kingdom of Aragon and the Acueducto de los Pilares (1570–1599) in Oviedo, the capital of Asturias in the north. The broad geography of these initiatives presaged further dissemination of the aqueduct technology across the Spanish empire as far as its colonies in the Americas.43 Analogous projects were also pursued by the Portuguese kings. In 1488, João II (r. 1481–1495) ordered work on the Aqueduto dos Arcos in the port of Setúbal south of Lisbon. This humble beginning was soon overshadowed by such monumental structures as the Água de Prata (1534–1556) in Évora—for a brief period the seat of the royal court— and the Aqueduto da Amoreira in Elvas on the border with Spain, begun in 1537 and continued until 1628 (Fig. 1.5). The crowning achievement of Portuguese engineering was the Águas Livres in Lisbon, built by João V (r. 1706–1750) in 1731–1748. More than a hallmark of structural expediency, the aqueduct’s Gothic arcade spanning the valley of Alcântara was a tribute to the proud architectural tradition that had largely defined the artistic identity of Portugal.44 A manifestation of absolutist ambitions, many early modern aqueducts originated in connection with major garden projects. The Acqua Felice in Rome, according to a contemporary report, was initiated by Pope Sixtus V (r. 1585–1590) to “quench the thirst” of the Villa Montalto-­ Peretti he owned in the area of the current Termini Station. Other prominent examples included the Aqueduc Médicis (Aqueduc de Rungis), commissioned in 1612 by Queen-Regent of France Marie de’ Medici to bring water to the Luxembourg Gardens in Paris, and Luigi Vanvitelli’s

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Fig. 1.5  Aqueduto da Amoreira, 1537–1628, Elvas, Portugal. Wikimedia Commons. Creative Commons license

Acquedotto Carolino (1754–1762) in Caserta, the residence of the Bourbon kings of Naples.45 One of the earliest precedents for such projects was the system of conduits that Duke Cosimo I de’ Medici, Marie’s grandfather, had commissioned beginning in 1551 to irrigate the grounds of the Palazzo Pitti in Florence.46 Runoff from these properties was channeled for the use of the urban population. A classic model of this symbiotic relationship was the sixteenth-century Villa Lante at Bagnaia northwest of Rome, known for its elaborate waterworks that ultimately supplied the neighboring town. In this way, princely beneficence trickled down the urban infrastructure, driven largely by the same charitable impulses that enabled the operation of early modern hospital systems. Even several aqueducts, however, could rarely provision a whole city. Moreover, the growth of the urban population required periodic building campaigns to amplify and expand the existing distribution system, as evidenced by the extra story added to the Aqueduc Médicis in 1867–1874 by engineer Eugène Belgrand.47 Despite or perhaps because of this

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constant work in progress, water supply generally remained mixed, drawing on a variety of available sources that, in addition to rivers and wells, also included rainwater cisterns. Common problems concerned the commingling of aqueduct and sewage channels and other forms of contamination, leading to the spread of waterborne diseases that culminated in nineteenth-century cholera epidemics. Notwithstanding these setbacks, the early modern period saw higher availability and better quality of drinking water in many urban communities in Europe. These salutogenic efforts found a clear expression in the growing number of public fountains, elevated to the canon of sightseeing attractions even in cities with vast architectural and antiquarian heritage such as Rome. Publicized by contemporary prints, notably Giovanni Battista Falda’s platebook series Le fontane di Roma, these monumental structures signaled zones with improved water supply, celebrating the successive attempts to improve the conditions of urban living (Fig. 1.6). The reverse of this situation was the changing fortune of public baths. Having ranked among the essential hygienic and social facilities in both Roman and Islamic cities, they declined in number and popularity despite a brief revival in the aftermath of the Crusades following firsthand contact with the Muslim bathing culture.48 Derided by the Christian clergy as conducive to moral corruption and disparaged by Renaissance physicians as a cause of humoral imbalance, bathing persisted longer in areas that retained pockets of Arab influence, especially in Spain and Portugal. It is hardly surprising, therefore, that the only erotic encounter in a public bath described in Boccaccio’s Decameron occurs in Palermo, formerly the capital of the Emirate of Sicily, in a hammam-like atmosphere permeated by exotic aromas of musk- and cloves-scented soap, jasmine and orange blossoms, and rosewater.49 As religious restrictions and the medical theory continued to dictate the care of the human body, it was the perfume industry that took on the task of fighting unclean smells in place of regular bathing. As a consequence, while steam rooms continued to exist, bathing retreated to the realm of the private. This withdrawal from the public space, however, did not mean that by the late sixteenth century balneary practice disappeared as a communal activity; rather, segregated by sex, it was pushed beyond the urban periphery. A contemporary painting by

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Fig. 1.6  Gian Lorenzo Bernini, Fontana del Tritone, 1642–1643, from Giovanni Battista Falda, Le fontane di Roma (ca. 1691). Dumbarton Oaks, Washington, DC. Creative Commons license

Domenico Passignano shows an informal bathing spot on the Arno favored by the male Florentines. Upstream from Florence, it was next to the medieval arcaded mill, the Mulino di San Niccolò (Fig.  1.7). The scene’s palpably homoerotic undertones suggest that even a notional distance from the city demarcated by crenellated walls allowed certain laxity of behavioral norms. By contrast, women, especially those of noble standing, had the river’s water delivered to their homes. During a week in June 1565, Duke Cosimo’s daughter Isabella de’ Medici ordered twenty barrels of the acqua d’Arno for bathing (per far bagni). The ample size of these vats is testified by the fact that transporting eight of them at a time required the services of four to six porters.50 Unlike the decline of public baths, thermal bathing continued to gain popularity, consolidating the reputation of spa resorts as places of healing

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Fig. 1.7  Domenico Cresti called Passignano, Bathers at San Niccolò, 1600, private collection. Wikimedia Commons. Creative Commons license

that went back to antiquity. A large body of literature from the fifteenth and sixteenth centuries ascribed the restorative powers to mineral cures, including the ability to facilitate pregnancy.51 In 1414, humanist scholar and papal secretary Poggio Bracciolini left a detailed description of a contemporary spa—the word derived from the eponymous town near Liège known for its thermal springs—after a visit to Baden in Switzerland.52 Both tantalized and scandalized by the open display of female nudity, his experience resonates with the fantastic bathing scene painted over a century later by Lucas Cranach the Elder, which, in a tongue-in-cheek manner, captured the atmosphere of such balneary establishments (Fig. 1.8). Similar resorts, however, also existed in Italy, where they included Bagni della Porretta (now Porretta Terme) southwest of Bologna or Bagni di Pertiolo and Bagni di San Filippo south of Siena, actively in use from

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Fig. 1.8  Lucas Cranach the Elder, The Fountain of Youth, 1546, Gemäldegalerie, Berlin. Staatliche Museen zu Berlin, Gemäldegalerie. Creative Commons license

at least the fourteenth century. Widely celebrated were the thermal baths of Pozzuoli near Naples, located in the area of high volcanic activity that attracted the attention of natural historians as much as medical practitioners.53 One of the reasons for Montaigne’s voyage to Italy in 1580–1581 was the desire to avail of mineral cures to alleviate the pain caused by kidney stone disease.54 Spa tourism was the main source of revenue for small urban communities that grew around such resorts. In the case of Bagno Vignoni—a small Tuscan hamlet located on a major pilgrimage route, the Via Francigena—its layout centered on a large rectangular bathing pool. The enduring success of this business is attested to by the rise to international prominence of another spa town, Montecatini Terme, which would peak in the nineteenth and early twentieth centuries. It owed its beginnings to the initiative of the grand duke of Tuscany, Pietro Leopoldo of Lorraine (r. 1765–1790).

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Paradoxes of Urban Recreation A healthy city is now unthinkable without outdoor recreational facilities, such as bicycle paths, nature walks, picnic areas, swimming pools, tennis courts, and children’s playgrounds. Unlike the situation today, however, early modern physical exercise was gendered. Men ostensibly preferred active sports—horse riding, hunting, and swimming—while women were supposed to enjoy less strenuous activities such as dancing. For both sexes, physicians recommended moderate strolls as a means to stimulate appetite, improve digestion, and restore the humoral equilibrium.55 Yet, recreational walks were poorly suited to the densely built, chaotic, and often unsafe urban environment. Gardens with straight graveled paths, shady greenery, and cooling waterworks offered a welcome escape from these squalid conditions. Even if modest in size, they included such features as labyrinths, which, for all their ostensible symbolism, served the practical purpose of lengthening the distance of a walk that turned monotonous circling into a playful adventure.56 Sites of elite collecting and self-fashioning, early modern gardens, however, generally had access restrictions. While less exclusive than it is often perceived, they were not equivalent to nineteenth-century public parks or communal greens.57 Adapting garden solutions to the urban fabric was a groundbreaking innovation in seventeenth-century planning. A likely precedent for such initiatives was the Chaharbagh Street in Isfahan; admired by European visitors, it was begun by Shah Abbas I the Great after 1598.58 Among other contributing factors were persistent attempts by civic authorities to restrict hazardous sports. One special target was pall-mall (from the Italian maglio), the precursor of modern croquet. It was played with mallets by driving wooden balls down straight and narrow alleys occasionally lined with trees (Fig. 1.9). In addition to the physical risk of getting hit by such missiles,59 players generated commotion deemed inappropriate in residential areas, especially in proximity to religious institutions. In 1561, Cosimo I sought to eliminate “many disturbances and inconveniences” that the game caused in Florence by confining it, under severe penalties, to a remote lane near the ducal stables, subsequently called the Maglio.60 In Paris, King Henri IV (r. 1589–1610) went a step further by

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Fig. 1.9  Adriaen van de Venne, Game of pall-mall between Frederick V, Elector Palatine, and Stadtholder Frederik Hendrik, Prince of Orange, ca. 1620–1626, British Museum, London. Wikimedia Commons. Creative Commons license

banishing this sport beyond the city walls and opening for this purpose in 1597 a long alley between the Porte Saint-Honoré and Porte Montmartre lined by rows of trees. Another pall-mall course was built a few years later on the opposite, eastern, periphery of the French capital next to the Seine, near the royal arsenal located south of the Bastille. Many seventeenth-century cities followed suit by creating similar lanes either for playing sports, as was the case with the Maliebaan (1637) in Utrecht, or for the use as pedestrian promenades, as exemplified by the Unter den Linden (1647) in Berlin.61 A crucial factor that catalyzed this push to reconfigure suburban avenues in the manner of garden alleys was improved carriage design, which turned arduous commutes into an enjoyable pastime. The vast size of such seventeenth-century properties as the Villa Borghese in Rome, with wide straight paths lined with mature cypresses, holm oaks, and elms, was to accommodate such pleasure rides.62 A model site for these recreations was the Cours la Reine in Paris that ran west of the Tuileries

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Gardens parallel to the Seine. Ordered in 1616 by Marie de’ Medici, the widow of Henri IV, it was based, in turn, on the Cascine outside Florence, a lane with dense, double or triple, rows of trees leading to the eponymous farming estate later converted into a public park.63 Such alleys, intended for both carriage and pedestrian traffic, soon started to define the urban landscape of European capitals. In Paris, the Champs-Élysées, laid out beginning in 1667 by André Le Nôtre, continued the central axis of the Tuileries to facilitate the court’s access to the Château de Saint-­ Germain-­en-Laye and subsequently to Versailles. In the case of early modern Madrid, the Paseo del Prado and Paseo de Recoletos united the suburban areas adjacent to the Buen Retiro park, connecting the Puerta de Atocha in the south of the city to the Augustinian friary of Los Recoletos in the north. The southward extension of these avenues toward the Manzanares river, beyond the city walls built in 1625 by King Philip IV (r. 1621–1665), was the Paseo de las Delicias, a fashionable socializing venue for many Madrileños. Beginning at the Hospital General, the Spanish capital’s main healthcare establishment, it turned into a delightful country walk (Figs. 1.10 and 1.11). New defense priorities that marked the consolidation of early modern absolutist states broadened the typology of these urban improvements. A system of angle-bastion fortresses developed by the military engineer Sébastien Le Prestre de Vauban (1633–1707) secured the frontiers of France, rendering obsolete the massive walls that had defined the urban

Fig. 1.10  Jan van Kessel III (attributed to), View of the Carrera de San Jerónimo and Paseo del Prado with a procession of carriages, 1686, Museo Nacional Thyssen-­ Bornemisza, Madrid. © Museo Nacional Thyssen-Bornemisza, Madrid

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Fig. 1.11  Francisco Bayeu, The Paseo de las Delicias, 1784–1785. Prado, Madrid. Creative Commons license

identity of major French cities. Among such remnants of the past were the defenses of Paris. Having seen no military action since the days of the Fronde in 1648–1653, they continued to stand as a reminder of the advantage that potential insurgents could take of these earthworks. What the city needed were walks, not walls. The decision to turn the capital’s ramparts into boulevards—the French for “bulwarks”—was not as radical as one might think, since early modern fortifications were occasionally used for urban recreation, as was the case with the bastions of Lucca in Italy. Having begun in the 1670s, the conversion of the Parisian walls into carriageways marked one of the early demilitarization campaigns that were to sweep across eighteenth- and nineteenth-century Europe.64 The result was reduced density and additional space that could be used for recreational needs. These beautification efforts were analogous to urban greening, given the prominent role of trees that usually bordered such promenades. One must remember, however, that, rather than lacking greenery, early

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modern cities had it concealed behind street façades and back walls (see Fig. 1.2). The effect of newly laid avenues—from the Dutch maliebanen to the Spanish paseos and alamedas—was the reversed, public, status of these verdant amenities (see Fig. 1.11). In Britain, a leading horticultural theorist John Evelyn (1620–1706) advocated the planting of trees to counter air pollution that plagued seventeenth-century London. According to his vivid description, the city was suffused with “a cloud of sea-coal”—“this pestilent smoke, which corrodes the very yron, and spoils all the movables, leaving a soot on all things that it lights; and so fatally seizing on the lungs of the inhabitants, that the cough and the consumption spares no man.” His solution was to have the British capital surrounded by a green belt of arboreal plantations “for ornament, profit, and security” of the urban population, a distant precursor of the Garden City planning visions.65

When All Things Fail … The fourteenth-century Black Death was only one in a long series of epidemics that devastated early modern Europe. Hospitals with shared wards and limited bedspaces or physicians equipped with a range of traditional medicines, such as theriacs, were powerless in the face of rapidly spreading disease. Common solutions were lockdown measures, surprisingly uniform across the European continent. City gates were guarded and locked; military patrols were established on all the main roads; and quarantined households were subjected to forced isolation. Urban congestion and squalor heightened the exposure to risk. During the Moscow epidemic of 1570–1571, a foreigner in the service of Tzar Ivan IV the Terrible (r. 1533–1584) reported such brutal measures as walling off the infested homes together with their inhabitants, dead or alive, so that those spared by the disease would eventually succumb to hunger. Sentinel squads captured and burned random travelers along with their possessions, while mass burials opened around the Russian capital received between 100 and 500 bodies each. In 1654, during the reign of Alexis Mikhailovich (r. 1645–1676), the plague returned. This time, the situation was complicated by the need to protect the army that the tzar

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commanded on the western frontier of Russia. After evacuating the royal family from Moscow to a secluded monastery, the city was put under severe lockdown with workshop and storage buildings sealed in an attempt to block out the infectious miasma. Sinister bonfires burned around the guard posts patrolling the countryside.66 One of the most successful models of epidemic response was implemented in Rome during the plague of 1656–1657 by Girolamo Gastaldi (1616–1685), the papal sanitary commissioner under Alexander VII (r. 1655–1667).67 This comprehensive set of government measures regulated all aspects of urban life. The borders of the Papal States were closed and communications with other parts of Italy gradually severed as the news of the spread of the disease were received.68 The Ospedale di Santa Maria della Consolazione near the Roman Forum was designated as the plague hospital, while those in need of quarantine were confined to pesthouses (lazzaretti).69 Begging in public areas was forbidden, with the government assuming full responsibility for coordinating the poor relief. Market activities were restricted except commerce in food and fuel, including a full ban on the sale of secondhand clothes.70 Court hearings, trials, and litigations were suspended.71 Special provisions were made with regard to the functioning of the Jewish Ghetto.72 A burial site for plague victims was established in an isolated spot outside Rome close to the basilica of San Paolo fuori le Mura.73 Critical to the effectiveness of these measures was the control over eight city gates, with added palisades, guardrooms, and other protective barriers securing their periphery (Fig. 1.12). The authorities did not always act with such efficiency. In Naples, the same epidemic claimed around 150,000 victims as opposed to 4500 in Rome due to the botched response by the Spanish viceregal officials, who suppressed the initial reports of the plague and were slow to enforce quarantine. Despite early warnings, it took them several months to admit the arrival of the disease and recognize the gravity of the situation, by which stage it was already too late. A contemporary painting by Micco Spadaro of the Largo del Mercatello (now Piazza Dante)—one of the city’s major market squares dominated by the dome of the church of San Sebastiano and the campanile of the Gesù Nuovo—shows the horrors of the death toll (Fig. 1.13). Chaos and violence rule in a vast open space, between the

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Fig. 1.12  Episodes in the plague in Rome in 1656–1657, between ca. 1656 and 1659, etching. Wellcome Collection, London. Public Domain Mark

monumental Port’Alba on the left and the Porta dello Spirito Santo (Porta Reale) marked by the two-headed eagle at the end of the Via Toledo on the right. Doctors or officials in black struggle to enforce order amid the frenzied crowd, directing the removal of the dead bodies, which, together with their carts, are burned at the back. Such poignant details as the abandoned sedan chairs lined against the wall testify to the magnitude of the disaster. In the words of another eyewitness, writer Carlo Celano (1625–1693), “There was no longer any place to bury nor those who could perform burial; I saw with my own eyes the Via Toledo, where I lived, paved with corpses, so that no carriage heading to the [viceroy’s] palace could make its way if not over the Christian flesh. I cannot dwell more on recounting this tragedy as I cannot do that without tears.”74

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Fig. 1.13  Micco Spadaro (Domenico Gargiulo), The Largo del Mercatello during the plague of 1656, ca. 1656, Museo Nazionale di San Martino, Naples. Wikimedia Commons. Creative Commons license

Ironically, if the authorities were more efficient, social frustration was often the price they had to pay for their work. The 1630–1631 plague response in a small town of Montelupo west of Florence offers an eloquent testimony to these tensions, bearing an uncanny resemblance to the controversy surrounding the COVID-19 lockdowns.75 This illuminating microhistory is based on a judicial inquiry into the unauthorized dismantling of a stockade that used to bar one of the city gates, revealing deep divisions within the tiny urban community and its civic and ecclesiastical leadership. The closure of the local inn, the imposition of quarantine on select households, the ban on religious processions, and the prohibition of nighttime festivities met with vehement resistance, quiet sabotage, and open disobedience. Moreover, the effectiveness of these measures, a cause of much resentment at the time, remains questionable not only due to their social and economic costs, but also because of the

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erroneous belief in the airborne or miasmic mechanism of the plague transmission. Whether ultimately a success or a failure, any of these restrictions could mitigate the impact of the plague but not prevent its arrival. The proliferation of votive monuments across early modern Europe demonstrates that the belief in divine intervention prevailed over hopes of deliverance by human means. A reminder of the plague of 1656 in Naples was the prodigious Giglia di San Domenico, adorned with viceregal insignia and medallions featuring Dominican saints. Begun in 1658 and completed in 1737, this obelisk was conceived as a votive tribute to the city’s celestial patrons for its salvation though their intercession (Fig.  1.14). Another such monument was the Pestsäule (Plague Column) on the Graben in Vienna. Erected as a wooden structure by the Brotherhood of the Holy Trinity during the Great Plague of 1679, it was rebuilt in its current opulent form by Emperor Leopold I (r. 1658–1705) in 1687. One of the earliest among such urban landmarks was the Cappella della Piazza in front of the Palazzo Pubblico in Siena, added in 1352 to the architectural ensemble of the Campo—the setting of major public events, including the palio—as an ex voto offering to the Virgin after the Black Death of 1348.76 Even more common were votive churches. A notable example was the Karlskirche in Vienna, begun by Johann Bernhard Fischer von Erlach in 1715 to fulfill the plague vow made two years earlier by Emperor Charles VI (r. 1711–1740). In contrast with the celebratory mood of the Pestsäule, which captured the miracle of the city’s deliverance from the previous epidemic in answer to the emperor’s prayer, the pediment over the entrance to this church vividly portrayed the sufferings of the Viennese population. A city with a particularly rich tradition of plague commemoration was Venice, which had five votive churches built over more than two centuries of coping with disease. The earliest of them was San Giobbe (1462), located next to the eponymous medieval hospital. It was followed by San Rocco (1485) and San Sebastiano (1506), named after two most revered plague intercessors: Saint Roch, the fourteenth-century ascetic and healer whose relics were smuggled to Venice from Montpelier, and Saint Sebastian, the ancient Roman soldier tortured with arrow shots leaving wounds that were likened to bubonic sores. Two later votive

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Fig. 1.14  Francesco Antonio Pichiatti and Domenico Antonio Vaccaro, Guglia di San Domenico, 1658–1737, Naples, Piazza San Domenico. Photo: Anatole Tchikine

churches, Andrea Palladio’s Redentore (1577–1592) and Baldassare Longhena’s Santa Maria della Salute (1632–1687), became the loci of solemn civic rituals, when pontoon bridges laid across the Grand Canal and over to Giudecca allowed the staging of religious processions that started in the Piazza San Marco (Fig. 1.15). In this way, memories of the plague resonated through urban space, aided by annual public

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Fig. 1.15  Francesco Guardi, Procession to Santa Maria della Salute, ca. 1770–1780, Musée du Louvre, Paris. Wikimedia Commons. Creative Commons license

ceremonies with precise itineraries that focused on specific monuments and locations.

Salutogenic Perspectives The eight chapters that follow this introductory overview develop these divergent yet interrelated themes through illuminating case studies and original research. Moving the focus of discussion between individual buildings and the larger scale of the city, they push the boundaries of current scholarship by revealing dynamic intersections of urban and institutional histories, approached through the lens of salutogenic thinking, design, and practice. Grouped into four thematic sections dealing with a distinct cluster of issues—from plague prevention and hospital reforms to infrastructure and spa resorts—these contributions attempt to bridge the early modern medical, governance, and architectural discourses,

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highlighting their shared emphasis on the welfare politics of urban improvement. The first of these sections, Dynamics of Isolation, brings together the discussion of hospitals and lazzaretti, explaining their divergent roles in the context of early modern cities. In Chap. 2, Edite Alberto and Joana de Pinho examine the history of the Hospital Real de Todos-os-Santos in Lisbon as an early example of centralized state-endowed healthcare establishments. Conceived under the royal patronage, it marked a departure from the medieval type of small privately funded charitable institutions. This monumental building, founded in the Rossio on the outskirts of the Portuguese capital, was instrumental in increasing the area’s urban prestige as a center of social and market activities, which, paradoxically, would ultimately lead to the hospital’s transfer and demolition. Although not intended as places of healing, early modern lazzaretti, as Marina Inì shows in Chap. 3, were also spaces of seclusion, which enabled the operation of vital trade networks across the Mediterranean during outbreaks of the plague. These quarantine enclosures were purposely built in readily accessible but isolated locations, being surrounded by impassible walls to prevent the possibility of contact and contagion. Such distinct, open and closed, models of relationship with the city suggest a contrasting dynamic that health-related facilities generated within the urban environment in accordance with their specific functions, as also conveyed by signal differences in their architecture and decoration. The next section, Salutogenic Infrastructure, deals with the essential facilities and resources such as waterworks that enabled early modern cities to maintain adequate, at least by the standards of the time, sanitary and hygienic conditions. The focus of Chap. 4 by Joaquin Medina Warmburg, Nina Rind, and Nikolaus Koch is the German city of Karlsruhe. Originating in the beginning of the eighteenth century as the new capital of the small principality of Baden, it was founded in what was perceived as a salubrious location and based on a utopian radial plan. Despite the innovative layout that gave priority to green spaces, the city’s population, however, continued to suffer from the traditional urban ills, such as poor water supply and sewage disposal; while the solar orientation and uniform design of private houses did not prevent them from failing to meet the demands of salutary living. Unlike Karlsruhe, the city

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of York in northern England, the subject of Chap. 5 by Ann-Marie Akehurst, traced its origins to the Roman times. A fashionable social resort—a site of upper-class entertainment and a center of medical research—it proudly displayed its eighteenth-century urban achievements that included new hospital buildings, a riverfront promenade, and an expanded system of waterworks. This salutogenic veneer, however, concealed a darker reality, where public-oriented measures toward preventing disease were hampered by the reluctance of the medical establishment to damage the city’s reputation by disclosing the actual state of affairs, coupled with dysfunctional governance and shameless pursuit of business interests. The third section, Spaces of Madness, addresses the design of mental hospitals and their role within the urban setting, reflecting the changing attitudes toward psychiatric disorders in eighteenth- and nineteenth-­ century Europe. In Chap. 6, Elizabeth W. Mellyn reconstructs the history of the Ospedale di Santa Dorotea in Florence from its founding in 1642 to the eventual absorption into the medical complex of Santa Maria Nuova after nearly 150 years of independent existence. This humane healing environment, conceived in accordance with the ancient principles of humoral medicine, anticipated many improvements usually credited to the Enlightenment thinking, without, however, asserting the Foucauldian emphasis on surveillance and control.77 Paired with this narrative is the nineteenth-century rebuilding of the hospital of Charenton on the outskirts of Paris, discussed by Vassiliki Petridou in Chap. 7. This building—a nexus between psychiatric theory and Neoclassical aesthetics—was related to an earlier unrealized asylum project based on close collaboration between the leading French psychiatrist Jean-Étienne Dominique Esquirol (1772–1840) and the established Parisian architect Louis-Hippolyte Lebas (1782–1867). These contrasting examples of rationalizing spaces for the insane, while demonstrating the increasing specialization and diversification of hospital facilities, pitch the charitable ethos of social responsibility against the totalizing geometry of architectural vision. The final section of this book, Spa Cities, is built around the discussion of thermal bathing resorts in Hungary and Greece, seen as a means to increase the attractiveness of these localities and the respective regions as

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tourist destinations. What brought such projects together were their modernizing agendas, which, while understood in terms of westernization, took different guises reflecting the local identities and cultures. In Chap. 8, Kristof Fatsar explains how eighteenth-century Hungarian aristocracy cultivated its cosmopolitan image through the adoption of the British naturalistic style of landscape design that gradually replaced the traditional geometric approach. Spa resorts that developed around Hungary’s mineral springs were supposed to appeal to the upper-class international clientele, showcasing novel garden solutions adapted on a grander urban scale. In the case of nineteenth-century Greece, as Georgia Daskalaki argues in Chap. 9, the young country’s peripheral position in relation to the main economic and political centers of Europe generated a similar sense of inferiority, complicated by its self-awareness as a cradle of the European civilization. The creation of new spa towns based on the advanced model of French urban planning offered a legitimate answer to these conflicting concerns by reviving the antique tradition of public bathing at the expense of the disparaged and purposely eradicated Ottoman hammam culture. This spotlight selection cannot provide a comprehensive coverage of multiple factors that defined the early modern architecture and infrastructure of health. What this volume offers instead, without the risk of making its argument appear anachronistic, is a range of exciting new perspectives that the salutogenic lens opens for the students of historical urbanism. It is our hope that future scholarship would take this invitation to explore further meaningful and fruitful avenues of research to address the past, present, and future of cities, both in Europe and globally.

Notes 1. Terry Kirk, The Architecture of Modern Italy (New York: Princeton Architectural Press, 2005), 1:45. 2. Giuseppe Andreocci, Breve ragguaglio di ciò che in genere di belle arti si contiene di più prezioso in Città di Castello (Arezzo: s.n., 1829), 21.

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3. Giacomo Mancini, Istruzione storico-pittorica per visitare le chiese e palazzi di Città di Castello colle memorie di alcuni artefici del disegno che in detta città fiorirono (Perugia: Tipografia Baduel, 1832), 246–247. 4. Ibid., 245–246. 5. Ibid., 259 (based on the inscription of 1365). 6. One of these institutions, the Ospedale della Misericordia, was founded in 1348 after the Black Death; see Ibid., 275–276. 7. Eugenio Mannucci, Guida storico-artistica di Città di Castello (Città di Castello: Lapi, Raschi, 1878), 21–22. 8. See Matthew Hardy, “‘Study the Warm Winds and the Cold’: Hippocrates and the Renaissance Villa,” in Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited, ed. Barbara Kenda (London: Routledge, 2006), 48–69; Susan Russell, “The Villa Pamphilj on the Janiculum Hill: The Garden, the Senses and Good Health in Seventeenth-­ Century Rome,” in Sense and the Senses in Early Modern Art and Cultural Practice, ed. Alice E. Sanger and Siv Tove Kulbrandstad Walker (Farnham, Surrey, and Burlington, VT: Ashgate, 2012), 129–146; Anatole Tchikine, “The Expulsion of the Senses: The Idea of the ‘Italian Garden’ and the Politics of Sensory Experience,” in Sound and Scent in the Garden, ed. D.  Fairchild Ruggles (Washington, DC: Dumbarton Oaks, 2017), 236–238; Frances Gage, “Chasing ‘Good Air’ and Viewing Beautiful Perspectives: Painting and Health Preservation in Seventeenth-Century Rome,” in Conserving Health in Early Modern Culture. Bodies and Environments in Italy and England, ed. Sandra Cavallo and Tessa Storey (Manchester: Manchester University Press, 2017), 237–261; Mirka Beneš, “Doctor’s Orders: Health and the Renaissance Garden,” LA+: Interdisciplinary Journal of Landscape Architecture 11 (2020), 12–19; Katherine M. Bentz, “Gardens, Air, and the Healing Power of Green in Early Modern Rome,” in Visualizing the Past in Italian Renaissance Art. Essays in Honor of Brian M. Curran, ed. Jennifer Cochran Anderson and Douglas N. Dow (Leiden and Boston: Brill, 2021), 235–267. 9. David R. Coffin, “The ‘Lex Hortorum’ and Access to Gardens of Latium During the Renaissance,” Journal of Garden History 2:3 (1982), 201–232. 10. Duccio Balestracci, “The Regulation of Public Health in Italian Medieval Towns,” in Die Vielfalt der Dinge: neue Wege zur Analyse mittelalterlicher Sachkultur: internationaler Kongress, Krems an der Donau, 4. bis 7. Oktober 1994: Gedenkschrift in Memoriam Harry Kühnel, ed. Helmut Hundsbichler, Gerhard Jaritz, and Thomas Kühtreiber (Vienna: Verlag der Österreichischen Akademie der Wissenschaften, 1998), 345–357.

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11. Georges Duby, The Age of the Cathedrals: Art and Society, 980–1420, trans. Eleanor Levieux and Barbara Thompson (Chicago and London: University of Chicago Press, 1981). For the medieval urban revival, see also Carlo M. Cipolla, Before the Industrial Revolution: European Society and Economy, 1000–1700 (New York: W.  W. Norton & Company, 1976), 139–145. 12. For health and disease in early modern Europe, see a good overview in Robert Mandrou, Introduction to Modern France, 1500–1640: An Essay in Historical Psychology (New York: Harper & Row, 1977), 33–48. 13. For the history and chronology of Florentine hospitals, a fundamental point of reference is still Luigi Passerini, Storia degli stabilmenti di beneficenza e d’istruzione elementare gratuita della città di Firenze (Florence: Tipografia le Monnier, 1853). Among more recent studies, see John Henderson, “The Hospitals of Late Medieval and Renaissance Florence: A Preliminary Survey,” in The Hospital in History, ed. Lindsay Granshaw and Roy Porter (London: Routledge, 1989), 63–92; Katharine Park, “Healing the Poor: Hospitals and Medical Assistance in Renaissance Florence,” in Medicine and Charity Before the Welfare State, ed. Jonathan Barry and Colin Jones (London: Routledge, 1991), 26–45. 14. Giovanni Villani, Nuova cronica, XII.94. 15. Ludwig H. Heidenreich, Architecture in Italy 1400–1500, rev. Paul Davis (New Haven and London: Yale University Press, 1996), 105. 16. For the orto of the Ospedale di Bonifacio, see Agostino del Riccio, Agricoltura sperimentale, Florence, Biblioteca Nazionale Centrale, MS Targioni Tozzetti, 56, I–II, fols. 231r and 326v. For the two orti of the Ospidale degli Innocenti, see Benedetto Varchi, Storia fiorentina, ed. Lelio Arbib (Florence: Società Editrice delle Storie del Nardi e del Varchi, 1838–1841), 2:101. 17. Esther Diana, “Struttura architettonica e patrimonio immobiliare cittadino tra XIII e XVIII secolo. Il contributo di Santa Maria Nuova alla formazione della città,” in La bellezza come terapia: arte e assistenza nell’ospedale di Santa Maria Nuova a Firenze. Atti del Convegno Internazionale Firenze, 20–22 maggio 2004, ed. Enrico Ghidetti and Esther Diana (Florence: Edizioni Polistampa, 2005), 68. 18. Cf. Varchi, Storia fiorentina, 2:106–107, who drew an explicit connection between these two types of structures.

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19. Del Riccio, Agricoltura sperimentale, fols. 274v–275r. For the connection between food and class, see Allen J. Grieco, “The Social Politics of PreLinnaean Botanical Classification,” I Tatti Studies in the Italian Renaissance 4 (1991), 131–149; Ken Albala, Eating Right in the Renaissance (Berkeley: University of California Press, 2002), 184–216. 20. Giovanni Targioni Tozzetti, Prodromo della corografia e della topografia fisica della Toscana (Florence: Stamperia Imperiale, 1754), 111–112. For the botanical garden of Ognissanti, see also Del Riccio, Agricoltura sperimentale, fol. 168v; Giovanni Targioni Tozzetti, Atti e memorie inedite dell’Accademia del Cimento, e notizie aneddote dei progressi delle scienze in Toscana (Florence: Giuseppe Tofani, 1780), 3:6. 21. Marcello Virgilio Adriani, Pedacii Dioscoridae Anazarbei de Medica materia libri sex … (Florence: Giunti, 1518), 232v (“Vidimus nos in maioris civitatis nostrae nosocomii hortis natam plantam”). 22. Agostino del Riccio, Agricoltura sperimentale, fols. 216v, 222r–223r. 23. Tchikine, “The Expulsion of the Senses,” 237. 24. Varchi, Storia fiorentina, 2:101. Numerous references to these hostels in Guido Carocci’s authoritative early twentieth-century guide to the environs of Florence give a sense of the abundance of such institutions in late medieval Florence. See Guido Carocci, I Dintorni di Firenze (Florence: Galletti e Cocci, 1907–1908), 1:7, 26, 163, 172, 181, 187, 192, 194, 200, 261, 314, 316, 349, 360; 2:70–71, 90, 98, 106, 146, 150, 180, 236, 293, 294, 306, 387, 395, 396, 433. 25. Carocci, I Dintorni, 1:314, 1:360. 26. Ibid., 2:387. 27. Ibid., 2:150. 28. Ibid., 1:194, 316. 29. Ibid., 2:71. 30. Ibid., 2:98; for other hospitals on the Via Aretina, see ibid., 2:90. 31. Ibid., 1:220, 254. 32. See Renato Pasta, “L’ospedale e la citta. Riforme settecentesche a Santa Maria Nuova,” in La bellezza come terapia, 271–293. 33. “Prospetto principale dello spedale unito d’infermi invalidi proietti, ed orfane eretto in citta di Castello e felicitato sotto gli auspici del sommo regnante pontefice Pio Sesto alle di cui glorie immortali umilmente lo consagra monsignor Luigi Gazzoli govenatore di Loreto e delegato perpetuo del medesimo spedale.” For the meaning of projetti as the poor, see

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Salvatore Battaglia, Grande dizionario della lingua italiana, ed. Giorgio Bárberi Squarotti (Turin: UTET, 1961–2009), 14:569 (“Chi è di modeste condizioni sociali”). 34. From the ending of Jonathan Swift’s Verses on the Death of Dr. Swift (1731). 35. For healthcare services in early modern Ireland, see James Kelly, “The Emergence of Scientific and Institutional Medical Practice in Ireland, 1650–1800,” in Medicine, Disease and the State in Ireland, 1650–1940, ed. Elizabeth Malcolm and Greta Jones (Cork: University College Cork Press, 1999), 21–39. For the differences in early modern hospital management between northern and southern Europe, see Ole Peter Grell and Andrew Cunningham, “Health Care and Poor Relief in 18th and 19th Century Northern Europe,” in Health Care and Poor Relief in 18thand 19thCentury Northern Europe, ed. Ole Peter Grell, Andrew Cunningham, and Robert Jütte (London and New York: Routledge, 2017), 3–14. 36. Michel de Montaigne, Essays, trans. J.  M. Cohen (London: Penguin Books, 1993), 136 (“On smells”). 37. Cesare D’Onofrio, Il Tevere: L’Isola tiberina, le inondazioni, i molini, i porti, le rive, i muraglioni, i ponti di Roma (Rome: Romana Società Editrice, 1980), 77–86. 38. Dante, Purgatorio, XIV.51; Eve Borsook, The Companion Guide to Florence (Bury of St. Edmunds: St. Edmundsbury Press, 1997), 139. 39. Steen Eiler Rasmussen, London: The Unique City, rev. ed. (Cambridge, MA: MIT Press, 1982), 116. 40. Paolo Squatriti, Water and Society in Early Medieval Italy, AD 400–1000 (Cambridge: Cambridge University Press, 1998), 17–18. 41. Fabio Bargagli Petrucci, Le fonti di Siena e i loro aquedotti, note storiche dalle origini fino al MDLV (Florence: Leo S. Olschki, 1906), 1:122–123. 42. For the restoration of ancient aqueducts in Rome, see Pamela O. Long, “Hydraulic Engineering and the Study of Antiquity: Rome, 1557–70,” Renaissance Quarterly 61:4 (2008), 1098–1138; Katherine Wentworth Rinne, The Waters of Rome: Aqueducts, Fountains, and the Birth of the Baroque City (New Haven and London: Yale University Press, 2010). 43. See Anatole Tchikine, “Technology of Grandeur: Early Modern Aqueducts in Portugal,” in The History of Water Management in the Iberian Peninsula, ed. Ana Duarte Rodrigues and Carmen Toribio (Basel: Birkhäuser, 2020), 140.

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44. Tchikine, “Technology of Grandeur,” 148–156. For the history of water management in Portugal, see also Luísa Trindade, “A água nas cidades portuguesas entre os séculos XIV e XVI: a mudança de paradigma,” in Patrimonio cultural vinculado con el agua: paisaje, urbanismo, arte, ingenieria y turismo, ed. María del Mar, Lozano Bartolozzi, and Vicente Méndez Hernán (Mérida: Editora Regional de Extremadura, 2014), 367–380. 45. Tchikine, “Technology of Grandeur,” 143. 46. Anatole Tchikine, “‘L’anima del Giardino’: Water, Gardens, and Hydraulics in Sixteenth-Century Florence and Naples,” in Technology and the Garden, ed. Michael G.  Lee and Kenneth I.  Helphand (Washington, D.C.: Dumbarton Oaks, 2014), 138–139. See also Emanuela Ferretti, Acquedotti e fontane del Rinascimento in Toscana: acqua, architettura e città al tempo di Cosimo I dei Medici (Florence: Leo S. Olschki, 2016). 47. Ibid. 48. Trindade, “A água nas cidades portuguesas,” 375–376. For bathing in the Middle Ages, see Squatriti, Water and Society, 44–63. 49. Giovanni Boccaccio, The Decameron, trans. G. H. McWilliam (London: Penguin, 1972), 668–669 (day eight, story ten). Paolo Viti’s suggestion that this episode takes place in thermal rather than regular baths is probably incorrect, given that the story is set in Palermo; see Paolo Viti, “Segreti delle acque,” in Segreti delle acque: studi e immagini sui bagni, secoli XIV-XIX. Atti del Seminario, Firenze, 8 novembre 2005, ed. Paolo Viti (Florence: Leo S. Olschki, 2007), 5. 50. Florence, Archivio di Stato, Mediceo del Principato, 6375, fols. 62r (June 12, 1565): “… per 4 barrili conpri … per far portar’ l’aqua d’Arno alle tinoze per la Ecc[ellentissi]ma S[igno]ra [Isabella de’ Medici] …,” “A spese diverse baiochi cinquantacinque per loro a 6 fachini porto a Crecenzio fachino … e sono per 8 barili d’aqua d’Arno portata per la Ecc[ellentissi]ma S[igno]ra al palazo de’ Medici …”; 63r (June 16, 1565): “A spese diverse g[i]uli quattro per loro a 4 facchini porto Fr[ances]co di Dom[eni]co … per 8 barili d’acqua d’Arno condotta al palazzo de’ Medici per far bangni [sic] per la Ecc[ellentissi]ma S[igno]ra N[ost]ra …”; 67v (July 6, 1565): “A spese diverse lire tre per aver portato 8 barili d’aqua d’Arno …,” “Alle dette lire dua per avere portato 8 barili d’aqua d’Arno per la Ecc[ellentissi]ma S[igno]ra …”

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51. See Viti, “Segreti delle acque,” 16–18. For pregnancy, see, for example, Franco Sacchetti, Novelle (Florence: s.n., 1724), 1:216–217 (novella 131); Domenico Burchiello, I sonetti del Burchiello, ed. Michelangelo Zaccarello (Bologna: Commissione per i testi di lingua, 2000), 127 (sonnet 127). 52. Substantial portions of this text in English translation are found in Philippe Braunstein, “Towards Intimacy: The Fourteenth and Fifteenth Centuries,” in A History of Private Life II: Revelations of the Medieval World, ed. Georges Duby, trans. Arthur Goldhammer (Cambridge, MA: Belknap Press, 1988), 603–606. 53. See Morgan Ng, “Terremoti artificiali. La sismologia aristotelica nella guerra sotterranea del Rinascimento,” in Material World: The Intersection of Art, Science, and Nature in Ancient Literature and Its Renaissance Reception, ed. Guy Hedreen (Leiden and Boston: Brill, 2021), 149–152. 54. See Dominique de Courcelles, “Montaigne d’eaux et de pierres,” in Segreti delle acque, 105–117. 55. For early modern medical advice on exercise, see Sandra Cavallo and Tessa Storey, Healthy Living in Late Renaissance Italy (Oxford: Oxford University Press, 2013), especially 145–178; Katherine M.  Bentz, “Healthy Exercise for Social Elites: Sport and the Early Modern Italian Villa,” in Landscapes for Sport: Histories of Physical Exercise, Sport, and Health, ed. Sonja Dümpelmann (Washington, DC: Dumbarton Oaks, 2022), 33–63. 56. Giuseppe del Rosso, “Considerazioni sulla convenienza degli ornamenti dei giardini italiani rapporto a quelli delle altre nazioni,” in Marco Lastri and Giuseppe del Rosso, L’osservatore fiorentino sugli edifizi della sua patria, 4th ed. (Florence: Giuseppe Celli, 1834), 14:64. 57. See Coffin, “The ‘Lex Hortorum’”; William Stenhouse, “Visitors, Display, and Reception in the Antiquity Collections of Late-Renaissance Rome,” Renaissance Quarterly, 58:2 (2005), 397–434. 58. See Mohammad Gharipour, “The Gardens of Safavid Isfahan and Renaissance Italy: A New Urban Landscape?” in Gardens of Renaissance Europe and the Islamic Empires: Encounters and Confluences, ed. Mohammad Gharipour (University Park, PA: Pennsylvania State University Press, 2017), 101–134. 59. One famous casualty was the young humanist poet Michele Verino (1469–1487), hit by a wooden ball. See Marco Antonio Lastri, L’osservatore fiorentino sugli edifizi della sua patria per servire alla storia

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della medesima (Florence: Stamperia dalla Croce Rossa, 1776–1778), 2.II:144–145. 60. Lorenzo Cantini, Legislazione toscana raccolta e illustrata (Florence: Stamperia Albizziniana, 1800–1808), 8:166. 61. Henry W.  Lawrence, City Trees: A Historical Geography from the Renaissance Through the Nineteenth Century (Charlottesville and London: University of Virginia Press, 2006), 32–33. For the original regulations governing the use of the Maliebaan in Utrecht, see Johan van de Water, Groot placaatboek vervattende alle de placaten, ordonnantien en edicten, der edele mogende heeren Staten ‘s Lands van Utrecht … (Utrecht: Jacob van Poolsum, 1729), 508–509. 62. See Domenico Montelatici, Villa Borghese fuori di Porta Pinciana con l’ornamenti, che si osservano nel di lei palazzo, e con le figure delle statue più singolare (Rome: Buagni, 1700). 63. Lawrence, City Trees, 34, 37. 64. Ibid., 38–39. For urban de-fortification, see Yair Mintzker, The Defortification of the German City, 1689–1866 (Cambridge: Cambridge University Press, 2012). 65. John Evelyn, “A Character of England,” in The Miscellaneous Writings (London: Henry Colburn, 1825), 157; Fumifugium: Or the Inconveniencie of the Aer and Smoke of London Dissipated (London: W.  Godbid, 1661), 25. 66. Nikolai Borisov, “Chiuma i vozvyshenie Moskvy” (“The plague and the rise of Moscow”), Rodina 5 (2014), 62. 67. Girolamo Gastaldi, Tractatus de avertenda et profliganda peste (Bologna: Typographia Manolessiana, 1684). For the plague of 1656–1657  in Rome, see David Gentilcore, “Purging Filth: Plague and Responses to it in Rome, 1656–1657,” in Rome, Pollution and Propriety: Dirt, Disease and Hygiene in the Eternal City from Antiquity to Modernity, ed. Mark Bradley with Kenneth Stow (Cambridge: Cambridge University Press, 2012), 153–168. 68. Ibid., 278. 69. Ibid., 181–182. 70. Ibid., 315–317, 319–320. 71. Ibid., 326. 72. Ibid., 335–337. 73. Ibid., 265–266.

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74. Carlo Celano and Giovanni Battista Chiarini, Notizie del bello, dell’antico, e del curioso della città di Napoli … (Naples: Stamperia Floriana, 1856–1860), 4:317. For the plague of 1656 in Naples, an indispensable source is still Salvatore de Renzi, Napoli nell’anno 1656 (Naples: Domenico de Pascale, 1867). See also Renato Ruotolo, Napoli nel ‘600: luoghi, avvenimenti, personaggi del secolo d’oro napoletano (Naples: Altrastampa, 2002), 39–43. 75. Carlo M. Cipolla, Faith, Reason, and the Plague in Seventeenth-Century Tuscany (New York and London: W. W. Norton & Company, 1979). 76. Harold Avery, “Plague Churches, Monuments and Memorials,” Proceedings of the Royal Society of Medicine 59:2 (1966), 10–16. 77. See Michel Foucault, “The Politics of Health in the Eighteenth Century,” in Power / Knowledge: Selected Interviews & Other Writings, ed. Colin Gordon (Now York: Vintage Books, 1980), 166–182.

Bibliography Albala, Ken. Eating Right in the Renaissance. Berkeley: University of California Press, 2002. Andreocci, Giuseppe. Breve ragguaglio di ciò che in genere di belle arti si contiene di più prezioso in Città di Castello. Arezzo: s.n., 1829. Avery, Harold. “Plague Churches, Monuments and Memorials.” In Proceedings of the Royal Society of Medicine 59:2 (1966), 10–16. Bargagli Petrucci, Fabio. Le fonti di Siena e i loro aquedotti, note storiche dalle origini fino al MDLV, 2 vols. Florence: Leo S. Olschki, 1906. Barry, Jonathan, and Colin Jones, eds. Medicine and Charity Before the Welfare State. London: Routledge, 1991. Bradley, Mark, with Kenneth Stow, eds. Rome, Pollution and Propriety: Dirt, Disease and Hygiene in the Eternal City from Antiquity to Modernity. Cambridge: Cambridge University Press, 2012. Boccaccio, Giovanni. The Decameron, trans. G.  H. McWilliam. London: Penguin, 1972. Borisov, Nikolai. “Chiuma i vozvyshenie Moskvy” (“The Plague and the Rise of Moscow”). In Rodina 5 (2014), 61–64. Carocci, Guido. I Dintorni di Firenze, 2 vols. Florence: Galletti e Cocci, 1907–1908.

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Cavallo, Sandra, and Tessa Storey. Healthy Living in Late Renaissance Italy. Oxford: Oxford University Press, 2013. Cavallo, Sandra, and Tessa Storey, eds. Conserving Health in Early Modern Culture. Bodies and Environments in Italy and England. Manchester: Manchester University Press, 2017. Celano, Carlo, and Giovanni Battista Chiarini. Notizie del bello, dell’antico, e del curioso della città di Napoli …, 5 vols. Naples: Stamperia Floriana, 1856–1860. Cipolla, Carlo. Faith, Reason, and the Plague in Seventeenth-Century Tuscany. New York and London: W. W. Norton & Company, 1979. Coffin, David R. “The ‘Lex Hortorum’ and Access to Gardens of Latium During the Renaissance.” In Journal of Garden History 2:3 (1982), 201–232. D’Onofrio, Cesare. Il Tevere: L’Isola tiberina, le inondazioni, i molini, i porti, le rive, i muraglioni, i ponti di Roma. Rome: Romana Società Editrice, 1980. De Renzi, Salvatore. Napoli nell’anno 1656. Naples: Domenico de Pascale, 1867. Duby, Georges, ed. A History of Private Life II: Revelations of the Medieval World, trans. Arthur Goldhammer. Cambridge, MA: Belknap Press, 1988. Evelyn, John. Fumifugium: Or the Inconveniencie of the Aer and Smoke of London Dissipated. London: W. Godbid, 1661. Ferretti, Emanuela. Acquedotti e fontane del Rinascimento in Toscana: acqua, architettura e città al tempo di Cosimo I dei Medici. Florence: Leo S. Olschki, 2016. Foucault, Michel. “The Politics of Health in the Eighteenth Century.” In Power / Knowledge: Selected Interviews & Other Writings, ed. Colin Gordon. New York: Vintage Books, 1980. Gage, Frances. “Chasing ‘Good Air’ and Viewing Beautiful Perspectives: Painting and Health Preservation in Seventeenth-Century Rome.” In Conserving Health in Early Modern Culture. Bodies and Environments in Italy and England, ed. Sandra Cavallo and Tessa Storey. Manchester: Manchester University Press, 2017, 237–261 Gastaldi, Girolamo, Tractatus de avertenda et profliganda peste. Bologna: Typographia Manolessiana, 1684. Gharipour, Mohammad, ed. Gardens of Renaissance Europe and the Islamic Empires: Encounters and Confluences. University Park, PA: Pennsylvania State University Press, 2017. Ghidetti, Enrico, and Esther Diana, eds. La bellezza come terapia: arte e assistenza nell’ospedale di Santa Maria Nuova a Firenze. Atti del Convegno Internazionale Firenze, 20–22 maggio 2004. Florence: Edizioni Polistampa, 2005.

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Granshaw, Lindsay, and Roy Porter, eds. The Hospital in History. London: Routledge, 1989. Grieco, Allen J. “The Social Politics of Pre-Linnaean Botanical Classification.” In I Tatti Studies in the Italian Renaissance 4 (1991), 131–149. Heidenreich, Ludwig H. Architecture in Italy 1400–1500, rev. Paul Davis. New Haven and London: Yale University Press, 1996. Kenda, Barbara, ed. Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited. London: Routledge, 2006. Kirk, Terry. The Architecture of Modern Italy, 2 vols. New  York: Princeton Architectural Press, 2005. Lawrence, Henry W. City Trees: A Historical Geography from the Renaissance through the Nineteenth Century. Charlottesville and London: University of Virginia Press, 2006. Long, Pamela O. “Hydraulic Engineering and the Study of Antiquity: Rome, 1557–70.” In Renaissance Quarterly 61:4 (2008), 1098–1138. Mancini, Giacomo. Istruzione storico-pittorica per visitare le chiese e palazzi di Città di Castello colle memorie di alcuni artefici del disegno che in detta città fiorirono. Perugia: Tipografia Baduel, 1832. Mandrou, Robert. Introduction to Modern France, 1500–1640: An Essay in Historical Psychology. New York: Harper & Row, 1977. Mannucci, Eugenio. Guida storico-artistica di Città di Castello. Città di Castello: Lapi, Raschi, 1878. Montaigne, Michel de. Essays, trans. J. M. Cohen. London: Penguin Books, 1993. Montelatici, Domenico. Villa Borghese fuori di Porta Pinciana con l’ornamenti, che si osservano nel di lei palazzo, e con le figure delle statue più singolare. Rome: Buagni, 1700. Passerini, Luigi. Storia degli stabilmenti di beneficenza e d’istruzione elementare gratuita della città di Firenze. Florence: Tipografia le Monnier, 1853. Rasmussen, Steen Eiler. London: The Unique City, rev. ed. Cambridge, MA: MIT Press, 1982. Rinne, Katherine Wentworth. The Waters of Rome: Aqueducts, Fountains, and the Birth of the Baroque City. New Haven and London: Yale University Press, 2010. Ruotolo, Renato. Napoli nel ‘600: luoghi, avvenimenti, personaggi del secolo d’oro napoletano. Naples: Altrastampa, 2002. Sanger, Alice E., and Siv Tove Kulbrandstad Walker, eds. Sense and the Senses in Early Modern Art and Cultural Practice. Farnham, Surrey, and Burlington, VT: Ashgate, 2012.

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Stenhouse, William. “Visitors, Display, and Reception in the Antiquity Collections of Late-Renaissance Rome,” Renaissance Quarterly, 58:2, 2005, 397–434. Squatriti, Paolo. Water and Society in Early Medieval Italy, AD 400–1000. Cambridge: Cambridge University Press, 1998. Ruggles, D.  Fairchild, ed. Sound and Scent in the Garden. Washington, DC: Dumbarton Oaks, 2017. Tchikine, Anatole. “‘L’anima del Giardino’: Water, Gardens, and Hydraulics in Sixteenth-Century Florence and Naples.” In Technology and the Garden, ed. Michael G.  Lee and Kenneth I.  Helphand. Washington, DC: Dumbarton Oaks, 2014, 129–153. Tchikine, Anatole. “Technology of Grandeur: Early Modern Aqueducts in Portugal.” In The History of Water Management in the Iberian Peninsula, ed. Ana Duarte Rodrigues and Carmen Toribio. Basel: Birkhäuser, 2020, 139–158. Trindade, Luísa. “A água nas cidades portuguesas entre os séculos XIV e XVI: a mudança de paradigma.” In Patrimonio cultural vinculado con el agua: paisaje, urbanismo, arte, ingenieria y turismo, ed. María del Mar, Lozano Bartolozzi, and Vicente Méndez Hernán. Mérida: Editora Regional de Extremadura, 2014. Varchi, Benedetto. Storia fiorentina, 3 vols., ed. Lelio Arbib. Florence: Società Editrice delle Storie del Nardi e del Varchi, 1838–1841. Viti, Paolo, ed. Segreti delle acque: studi e immagini sui bagni, secoli XIV-XIX. Atti del Seminario, Firenze, 8 novembre 2005. Florence: Leo S. Olschki, 2007.

Part I Dynamics of Isolation

2 Health, Architecture, and Urban Identity: The Hospital Real de Todos-os-­ Santos in Sixteenth-Century Lisbon Joana Balsa de Pinho and Edite Martins Alberto

The Hospital Real de Todos-os-Santos (All-Saints Royal Hospital) was the first public hospital—both as an institution and as a building—created in Portugal as a royal initiative. Founded in Lisbon by King João II (r. 1481–1495) in the end of the 1470s, it remained in use until its demolition in 1775.1 This important structure has been the subject of substantial scholarly interest. Studies that appeared in the 1980s and 1990s to celebrate the fifth centenary of the hospital’s founding were followed by a wealth of recent publications, which address the questions of its architectural form, sources for its design, and factors that dictated the choice of its location.2 This chapter furthers this discussion by explaining how the hospital’s function and architectural program as well as its role within the city conveyed health-promoting agendas that were predicated on the civic ideals of the time. Since this analysis focuses on the design of a lost

J. B. de Pinho (*) University of Lisbon, Lisbon, Portugal E. M. Alberto NOVA University of Lisbon, Lisbon, Portugal © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_2

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building, it belongs to the domain of what the Portuguese art historian Vítor Serrão described as “crypto-art history,” an approach intended to broaden the horizons of art historical research.3 For this reason, this chapter relies on building descriptions and artistic sources in addition to the evidence of political and administrative documents. It begins by examining the circumstances of the hospital’s founding, situating it in the context of the fifteenth-century reorganization of the healthcare system that meant more than merely raising the expectations as to the quality of urban sanitary conditions. The rest of this chapter addresses the hospital’s architectural form, functional characteristics, and its relationship with its immediate urban setting and the city at large. During the late medieval and early modern periods, the design of Italian hospitals provided architectural models for other countries in Europe, where the authorities sought to promote health reforms to improve the welfare of the urban population.4 The scholarly literature on early modern hospitals highlights the architectural and symbolic role that they played within the urban environment and their effectiveness in meeting the demands of the growing population during a period of social and economic change. The early modern hospital emerged to implement healing practices as opposed to medieval social assistance initiatives that had focused on providing poor relief, leading to the current understanding of hospitals as therapeutic spaces. This reconfiguring of the role and purpose of these institutions began during the late medieval period and was characterized by the increasing medicalization of services that hospitals provided, the presence of specialized healthcare staff, and the functional specialization of hospital spaces. The combination of the grandeur and sumptuousness in hospital architecture and a sense of civic identity that such buildings conveyed highlights the important symbolic role that they played in addition to their sanitary function. According to Isabel dos Guimarães Sá, “the great hospital [was] an essential element of modernity in the urban context.”5 The healthcare reform was driven by the increasing population, the urban economic and administrative growth, and a greater emphasis on the common good resulting in the obligation of political authorities to share wealth. The previous medieval system, based on a multiplicity of small and poorly endowed institutions that essentially provided poor relief, was

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deemed increasingly inefficient. As Gabriella Piccinni has observed, hospitals could provide a city with “something very important: a good reputation.”6 Hospitals built throughout Europe embodied regional civic ideologies. As Concepción Félez Lubelza has argued with respect to Spain, The Catholic Monarchs [Ferdinand of Aragon and Isabella of Castile] founded the Royal Hospital of Granada. But they also founded the modern state in Spain … We believe that the two cannot be separated. They start as the same project and assume the same ideological and social significance. The hospital is, therefore, a new feature emerging with the new state. In order to exist, it needs not only a new political reality, but also new social relations, and with them a new political ideology, a new artistic idiom, and so on.7

The significance of the Hospital Real de Todos-os-Santos in the Portuguese context and its patronage by Kings João II and Manuel I (r. 1495–1521) testify to the institution’s analogous role in the construction of the urban identity of Lisbon.

 ealthcare Reform and the Hospital’s H Founding The founding of the Todos-os-Santos hospital took place against a deep crisis of healthcare institutions in the city that at the time was undergoing a major urban transformation. Taking advantage of its position at the mouth of the Tagus River, fifteenth-century Lisbon was the main city in Portugal and, following Portuguese maritime voyages and territorial expansion, one of the most cosmopolitan capitals in Europe (Fig. 2.1). These social, cultural, and economic factors led to two major programs of urban expansion initiated by João II and pursued by his successor Manuel I.8 In the words of Helder Carita, “with the Tagus River being a fundamental structuring element, the city extended along its bank, following the dual logic of seeing and making itself seen” by facing the main point of entry into it from the ocean. This transformation of Lisbon into the

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Fig. 2.1  Panoramic view of Lisbon (Olisipo quae nunc Lisboa, civitas amplíssima Lusitaniae, ad Tagum, totis orientis et multarum insularum et Aphricaeque et Americae emporium), from Georg Braun’s Civitates Orbis Terrarum, V: Urbium Praecipuarum Mundi Theatrum Quintum, Fig. 2. (1598). Lisbon: Câmara Municipal de Lisboa, 1965. Câmara Municipal de Lisboa (available at https://rnod.bnportugal.gov.pt/rnod/winlibsrch.aspx?&pesq=3&doc=28795)

kingdom’s most important city and a privileged site for the display of royal power took place between 1498 and 1502.9 Further development after 1513 affirmed its status as the capital of the young empire. Lisbon’s healthcare and social welfare infrastructure at the time consisted of more than five dozen hospitals—or better, hospices—that survived from the medieval era: small, diverse in function, inefficiently managed, and with limited financial resources. In trying to modernize the healthcare system in Portugal, João II relied on his knowledge of hospitals in Spain and Italy, as evidenced by the

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reference to Siena and Florence in his will. With regard to the Todos-os-­ Santos hospital, the king ordered as follows: [T]hat the said hospital is built in the manner it has been started and that the governance of this hospital is ordained, as it seems fit to my executor. I wish [the hospital] more or less to follow the [hospital] regulations of Florence and Siena, and that all the hospitals in the city of Lisbon be conjoined in it with all their incomes, properties, and assets, as the Holy Father [the pope] has granted me permission to do in his bull.10

The king’s efforts were, therefore, supported by the papacy. The bull Ex debito sollicitudinis, issued by Sixtus IV (r. 1471–1484) on August 13, 1479, authorized “the construction of a large hospital in the city of Lisbon, enabling it to unite and incorporate other hospitals and care homes.”11 Another bull, Iniunctum nobis, by the pope’s successor Innocent VIII (r. 1484–1492), dated February 21, 1486, allowed the king “to unite various hospitals, including those for poor and abandoned children, in each city or notable settlement in his kingdom and domains in the largest hospital in each locality.”12 Sanctioned by the papacy, the centralization of the healthcare system was continued under João’s successor Manuel I, who was similarly aware of the social resonance and symbolic potential of such initiatives. The creation of the Todos-os-Santos hospital was one of the key aspects of this reform. A radical departure from the previous medieval system, it reflected the centralization of the royal power and consolidation of the early modern state, becoming a model for other Portuguese cities.13 In the words of Isabel Drumond Braga, healthcare institutions of the late medieval period suffered from “the lack of competent managers, the corruption of overseers and administrators, and failure to fulfil the promises or expectations of these institutions’ founders.”14 To address this situation, the political authorities sought to improve the hospital finances and administrative routine, for example, by implementing correct account management and bookkeeping practices and by replacing inefficient administrators, as well as by drafting precise hospital regulations. Further institutional reorganization was enabled by merging small-size hospitals or incorporating them into larger institutions, the creation of new

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specialized establishments, and the appointment of trusted officials selected by the government.15 The use of architectural or policy-related solutions to address the problems that plagued European hospitals became customary from the middle of the fourteenth century. The situation in Portugal was analogous to these broader European trends, with sporadic decisions made in anticipation future large-scale reforms. The earliest documented attempt to unify small healthcare institutions was undertaken in 1382 by Martinho, the bishop of Évora (in office 1368–1382), who ordered uniting the “properties and assets and rights and incomes” of the hospices of São Bento, São Francisco, and Santíssima Trindade under the Albergaria do Corpo de Deus (Corpus Christi Hospice). The reason was that many hospices in Évora were in a ruinous state, with their resources no longer directed to provide healthcare assistance; nor did “they carry out the Seven Works of Charity for which they had been instituted, ordered, and established by faithful Christians.”16 It was King Duarte (r. 1433–1438), first as co-regent and then as the Portuguese monarch, who launched a series of initiatives that sought to implement a consistent hospital policy. The first such action was a request to Pope Eugene IV (r. 1431–1447) on April 29, 1432, to nominate two general administrators to oversee the hospitals of the diocese and city of Lisbon to address their ruinous situation. The other was the decree of April 1, 1434, authorizing the mergers of poorly endowed or improperly managed hospitals or their takeover by the larger and wealthier institutions.17 These attempts to improve the healthcare system clearly foreshadowed João II’s reforms that would begin almost fifty years later.18 As the documents conserved in the Royal Chancellery demonstrate, Duarte’s successor, King Afonso V (r. 1438–1481), took further actions to promote the hospital reform, including the promulgation of regimentos (rules) regulating the management of individual institutions, the appointment of new administrators, the granting and confirmation of privileges, and the issuing of licenses for hospitals to accumulate assets.19 The reforms moved beyond the mere reorganization and merger of specific hospitals—giving them a new administrative structure, laying

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down rules for produce and managing property inventories and account books, and appointing hospital officials—by sanctioning the creation of Misericórdias (Confraternities of Mercy).20 The development of these confraternities “established the basis for a system of healthcare with distinct characteristics as compared to the rest of the European scene.”21 Taking advantage of the diminishing role of other confraternities in the matters of welfare, Misericórdias secured a monopoly on providing healthcare assistance. Given a wide reach of their operations both in the Portuguese provinces and overseas colonies and a significant social impact, Misericórdias became a model of lay organizations supported by the government but controlled by local communities. They effectively established an institutionalized healthcare network, affirming the importance of the laity in running the healthcare system.22 In 1564, the Misericórdia of Lisbon would take over the management of the Todos-os-­ Santos hospital. The founding of the Todos-os-Santos hospital involved a merger of about four dozen smaller hospitals in Lisbon, resulting in an institution with more resources and better management, able to provide treatment and support to those in need with greater efficiency. Added to this patrimony were capelas, private endowments made to religious institutions to say masses and prayers for the donor’s soul. From 1504 onward, by royal order, these funds were reviewed and many of them were put under the hospital’s administration. This process was coordinated by special regulations issued in 1514. Due to both government and local initiatives, the creation of similar large hospitals spread from Lisbon to other Portuguese cities, including Abrantes (1488), Beja (1490), Silves (1491), Évora (1495), Santarém (1498), Elvas (1498), Setúbal (1495), Coimbra (1508), and Braga (1508). It also made the king the key figure in promulgating the healthcare reform. In 1552, João Brandão, a courtier to King João III (r. 1521–1557), wrote that the hospitals of Lisbon only served the needs of the “craftsmen who lacked the strength to provide for themselves,” so that King João II, “as a pious prince, [had] wanted to endow and build” the much needed new hospital.23

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Architecture and Healthcare This complex process of consolidation and reorganization of hospital infrastructure had obvious artistic and urban implications, as it provided opportunities for artistic, architectural, and functional experimentation. Indeed, as Francesco Bianchi and Marek Słoń remind us, healthcare reforms spurred architectural innovation, with hospitals becoming important civic symbols in Italian cities such as Florence and Milan. As they wrote, “the same group of craftsmen worked simultaneously on the main city gate, a new large hospital opposite, and the town hall.”24 Although conceived by João II, the construction of the Todos-os-­ Santos hospital was carried out by his successor, Manuel I, who played a similarly important role both in the hospital reform and the urban renewal of Lisbon. Owing to his patronage, Portugal became a scene of new developments in architecture, painting, sculpture, and manuscript illumination, mobilizing its artistic potential to glorify the king and celebrate the new image of the kingdom that he ruled.25 The chronicle of the reign of João II by the humanist Garcia de Resende (1470–1536) includes a chapter entitled “The founding and beginning of the Great Hospital of Lisbon,” in which he describes the hospital’s origins: In the year fourteen hundred and ninety-two, on the fifteenth day of May, the king [João II] ordered laying the first foundations of the great hospital of Lisbon dedicated to All Saints, in the manner it is now built, where there used to be the kitchen garden of the Convent of São Domingos. And at the founding ceremony, the king, with his hand, threw many gold coins in honor of such a holy, great, and pious building; and on that day he walked around, seeing how it was coming along, and ate in the house of the Count of Monsanto, which is next to the kitchen garden of the said hospital.26

The hospital’s founding, its construction, and its representation in historical narratives transformed this healthcare building into a symbol of royal power. The symbolic connection between the hospital and the royal family would be reinforced by placing the insignia of João II—a pelican feeding its young, also featured on other parts of the hospital—alongside

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Fig. 2.2  Cross base, limestone, 1706, excavated by Lisbon Archeology Center (1999–2001) in Lisbon’s Praça da Figueira. Câmara Municipal de Lisboa—Centro de Arqueologia de Lisboa. Photo by José Vicente, CML|DMC|DPC

the royal shield and the armillary sphere, the emblem of Manuel I, on the façade of the hospital’s church (Fig. 2.2).27 Although the hospital’s construction had started around 1492, it was still in progress between 1497 and 1499, since fines incurred by Lisbon’s chaplaincies, hospitals, and confraternities for having failed to provide religious and administrative services “within the time allotted by the king” were channeled to subsidize this work.28 Future fines were meant to be used for the same purpose.29 The first group of the hospital’s staff was appointed by the king in 1502. It included an apothecary to oversee the pharmacy, a cook, a number of surgeons, laundresses, tailors, male and female nurses for men’s and women’s wards, respectively, and other personnel to fill administrative positions. In 1503, a door guard, a hospital keeper, a steward responsible for the pantry, a bleeder, a purveyor, and an accountant were added. The responsibilities and operations of this body of staff were governed by the regimento issued in 1504.30 The hospital’s cruciform plan was influenced by the design of the Ospedale Maggiore in Milan by the architect Filarete (Antonio di Pietro Averlino, 1400–1469) (Fig. 2.3). The wards forming a Greek cross, a

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Fig. 2.3  Todos-os-Santos Hospital as seen in the panorama of Lisbon (Olisipo quae nunc Lisboa, civitas amplíssima Lusitaniae, ad Tagum, totis orientis et multarum insularum et Aphricaeque et Americae emporium), from Georg Braun’s Civitates Orbis Terrarum, V: Urbium Praecipuarum Mundi Theatrum Quintum, Fig.  2. (1598). Lisbon: Câmara Municipal de Lisboa, 1965. Câmara Municipal de Lisboa (available at https://rnod.bnportugal.gov.pt/rnod/winlibsrch.aspx?&pesq=3 &doc=28795)

series of cloisters, and a portico at the front typified Italian Renaissance hospitals based on the model of Santa Maria Nuova in Florence. Similar plans, in addition to Filarete’s design for Milan (1448–1456), were used in the hospitals in Genoa (1447), Pavia (1448–1450), and Mantua (1449–1450).31 Since such buildings, from the outset, were intended to serve as hospitals, the emergence of this architectural type was an important aspect of the European healthcare reform. According to Bianchi and Słoń, for the first time, architectural models began to spread that were introduced specifically to organize hospital spaces in accordance with healthcare activities, whereas in the past hospitals had been generic structures and/or structures built for other uses that were amplified by adding new parts to preexisting buildings, often through their disorderly aggregation.32

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This new hospital architecture emerged in response to an increasing need for larger social and health services buildings along with the desire for monumental structures as symbols of urban identity.33 The distinctive appearance of Renaissance hospitals made them recognizable within the city, while the functional organization of space increased their efficiency. This medicalization of hospital services through the implementation of new architectural models, according to Bianchi and Słoń, produced the definition of a hospital as we understand it today.34 Contemporaries saw the Todos-os-Santos hospital as an exceptional building because of its opulent architecture and monumental impact rather than its sanitary function. The earliest among its descriptions is found in the bull Hodie a nobis (1516) by Leo X (r. 1513–1521), which allowed Manuel I to channel rents and tithes from islands and peninsulas on the Tagus toward funding this hospital, referring to it as “a very sumptuous work.”35 In 1554, the humanist writer Damião de Góis (1502–1574), in his book Urbis Olisiponis descriptio, described the seven greatest buildings in Lisbon, mentioning the Todos-os-Santos hospital after the church of the Santa Casa da Misericórdia: [A]nother example of mercy and humanity follows, which is a public shelter for the poor and the sick called the Todos-os-Santos hospital. … In front of the entrance portal of this hospital there is a vast square or field [Rossio] surrounded by a series of beautiful buildings, from where begin the Santo Antão and the Mouraria valleys … On the right of the hospital, towards the north and the west, is the church of São Domingos and a convent of great fame.36

Another sixteenth-century source described the hospital as a building that stood out among its surroundings, with a long facade of thirty-five arches facing the Rossio Square (there seems to be no agreement as to their exact number of the arches in contemporary sources) (Fig. 2.4).37 Góis, however, provides one of the earliest descriptions of the whole building that is consistent with its contemporary representations in prints and maps:

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Fig. 2.4  View of the Rossio Square (facing Hospital Real de Todos-os-Santos). Unknown author, oil on canvas, eighteenth century. Portugal, Álvaro Roquette/ Pedro Aguiar Branco Collection (available at https://commons.wikimedia.org/ wiki/File:Rossio_e_Castelo_de_S._Jorge_antes_do_Terramoto_de_1755.png)

[T]he building is divided into four cloisters with very pleasant gardens; it has thirty-four arches that surround it, leading to the magnificent interior with refectories and dormitories, conveniently provided with very clean beds and clothing. … Next to the hospital are houses or workshops for its different employees: accountants [tesoureiros], attorneys [procuradores], doctors, pharmacists, and others; thus, in any emergency or need, they are always available and able to provide service to patients, day and night, with diligence and efficiency.38

This description suggests that the hospital was large enough not only to serve the patients, but also provided additional spaces for different

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kinds of staff that it employed. These additional facilities enhanced the hospital’s use as a healing space. An inventory of its possessions dated 1564 lists several distinct spaces within the building: a chapel and an oratory, separate wards for men and women with fever, separate regular wards for men and women, wards for those with injuries, and, on the ground floor, another ward. The hospital also included a separate ward for the Capuchin friars, a pharmacy, kitchens, a pantry, a linen closet, and firewood storage.39 The hospital operated two separate kitchens, one of which was reserved for syphilitic patients along with the adjacent pantries and other storage facilities. Since food was one of the key elements in healing, these spaces and their equipment were essential for the hospital’s operations. Friar Nicolau de Oliveira (1566–1634), in his Livro das grandezas de Lisboa (1620), provides a general overview of the interior of the Todos-­ os-­Santos hospital, in which he describes its wards, kitchens, the pharmacy, and other facilities. He also offers a detailed description of the three wards—São Cosme, Santa Clara, and São Vincente—where “the beds are placed within alcoves defined by arches, so that the corridors stay free to make the cleaning easier.”40 Both Góis and Oliveira thus emphasize the cleanliness of the beds, linens, and corridor spaces, making it clear that hygiene was a primary concern for the hospital’s administration.41 Cleaning was a mark of health or at least of the absence of disease and was, therefore, associated to health preservation, which is why the building had to comply with strict sanitary requirements. Oliveira noted the essential role of cleaning facilities: This hospital, in terms of its structure and design, is built in the shape of a cross with four equal arms and four very large cloisters in between, which are paved with stone and have a well of water in the middle of each, except the cloister where the kitchen is, which has a well in the corner to clean it.42

To prevent the spread of disease among the sick, other hygienic measures involved creating an efficient sewage system, daily changes of bedlinen, and regular ventilation. To ensure its effective operation, the hospital employed a body of medical and nursing professionals, many of whom lived nearby.43

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In 1502, Manuel I made the first professional nursing appointment of Fernão Colaço, listing the cleaning duties among his other responsibilities.44 The hospital’s regulations of 1504 also emphasized the need for proper hygiene, specifying the functions of those responsible for cleaning the wards, latrines, and beds.45 Cleaning remained a fundamental concern throughout the hospital’s history, with further guidelines appearing in subsequent instructions and regulations. In 1695, the Misericórdia of Lisbon, which had been managing the hospital since 1564 ordered that bedlinen be washed by washerwomen in rivers rather than in enclosed tanks, presumably, to prevent any form of contagion.46 The proper discharge of wastewater and refuse was essential for the healthy maintenance of the hospital. Below the building, under the former grounds of the friary of São Domingos, there was a public sewer that operated from the middle of the fifteenth century. It channeled waste into a stream that flowed down the valleys under the current Avenida da Liberdade and Avenida Almirante Reis.47 During the reign of Manuel I, the entire city was provided with such basic sewage infrastructure. The hospital’s wards were laid out so that they could enable daily operations and, at the same time, provide some degree of privacy for the patients. The hospital’s regulations of 1504 suggest that the beds were arranged on either side of the wards, separated from each other by partition walls; a corridor with access doors to each cubicle ran behind these beds. Each ward also had a storage cupboard for the convenience of the patients.48 Latrines were located outside the wards, whereas the deceased were taken to the church through the cloisters via side doors, not to disturb the other patients. Wards for special categories of patients—the wounded, the convalescents, and those with fever—were isolated within the hospital complex. For example, the Casa das Boubas (House of Tumors), intended treating syphilitic patients, was planned from the beginning as being separated from other wards; in the basement, it provided treatment to beggars.49 Frei Nicolau de Oliveira gives further details as to the architecture of one of such wards: [I]f the disease requires a period of convalescence, [the patient] is taken to the convalescents’ ward, which is a very large, spacious, and cheerful room,

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and very suitable and convenient for convalescents because of being located at the top of the hospital and letting in sun as soon as it rises, with three wide windows through which the sun enters in the winter, while in the summer it does not enter through more than one, which faces east.50

A related concern with ventilation is reflected in a 1731 petition by the Misericórdia administrators. This document refers to the construction work on the lodgings for the wet-nurses, during which the roof had to be raised letting as a result “some air into the ward for the insane.”51 Following an inspection, the difference was considered minimal, and it was concluded that no damage was caused to “the ward for the insane, which extended across an entire arcaded corridor.”52 The work received a favorable assessment from the military engineer Manuel de Azevedo Fortes (1660–1749) and was allowed to continue. Documents also suggest a continual discussion of how accessible the hospital should be from the outside. In 1569, the surgeon Álvaro Dias, who both worked in the wards and examined the newly admitted patients, requested opening a new door between his home on the Rua da Betesga and the hospital to facilitate his timely arrival in the event of afterhours emergencies. This door was to be used exclusively by the surgeon, and anyone else entering through it was subjected to a fine of 100 reais.53 Over a century and a half later, Diogo de Mendonça Corte Real (ca. 1694–1771), Secretary of State to King José I (r.1750–1777), recognized the need for the hospital to open a service door “through the Rossio, under one of its arches,” to connect more closely to the immediate neighborhood. His letter specified that this door should “be opened in a place that is most convenient and be proportionate to the building, but that it should not be used by carriages or beasts, only the sick and other people who enter and leave the hospital.”54 The reason for this order was that some years earlier, in 1718, all the entrances to the hospital located under the arches facing the Rossio or through the Rua da Betesga and the hospital’s kitchen garden had been closed, leaving only one entrance door. This earlier decision was justified at the time as the most convenient arrangement for the hospital services.55 While separating pedestrian and carriage traffic, Corte Real’s solution, however, did not make provisions for separating the patients and visitors.

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Arcaded corridors, both as architectural features and spatial additions, were integral to the hospital’s design, creating an intermediate zone between its interior and exterior (see Fig. 2.4). In 1515, for example, a payment was issued to the king’s master carpenter for straightening the hospital’s “arcaded wall.”56 Another record from 1550 mentions the hospital’s facilities “that are located near the balcony in front of São Domingos.”57 A later document from 1569 refers to the dependencies belonging to the hospital “near the balcony overlooking the patio of the ward of the insane.”58 These relationships between the interior and exterior, the public and private spaces, became particularly important at a time when hospitals were recognized as buildings “conceived, by definition, as public, intended for everyone and anyone.”59 The hospital’s cruciform layout enabled several functional possibilities. They included access to and circulation between different wings through the corridors connecting the cloisters; the specialization of each of these wings in treating particular types of illnesses; and the accessibility of the church so that the sick from their beds could attend the celebration of the mass, a ritual that, in additional to its spiritual significance, was considered as part of the healing process.60 As Frei Nicolau de Oliveira wrote, “the church’s main chapel, very high and wide, is at the end of the cross [that makes] the hospital’s building, being located in such a way that through the three windows opened in it the sick can hear the mass celebrated at the main altar while laying on their beds.”61 There were also confession spaces for the patients arriving at the hospital before they entered the wards, including two chapels, each attended by a priest called a “door confessor.” Two other priests provided this service to the sick in the infirmary.62 Healing the soul was as important as healing the body.

Health, Architecture, and Urban Identity The founding and development of large hospital establishments by the royal, municipal, and ecclesiastical authorities was integral to the policies of good government throughout early modern Europe. Such buildings gained increasing visibility within the urban fabric, leading, in turn, to better funded and functionally improved healthcare services. In the words

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of Gabriella Piccinni, “The physical presence of the most important hospitals was, therefore, a contributing factor to civic pride, a matter of urban identity.”63 For this reason, the design of many hospitals incorporated the latest architectural innovations and was often enriched with various works of art. The creation of the Todos-os-Santos hospital had a marked urban significance, evident at different stages throughout its history. The hospital was instrumental in shaping the urban space from the beginning of its construction through the reconstruction of Lisbon after the 1755 earthquake. At the time of its founding, the hospital was located in a peripheral part of the city that was undergoing urban expansion, at a point of convergence of important traffic arteries. It was one of the most dominant buildings in the new square, the Rossio, which would become one of the most characteristic open spaces in Lisbon. Frei Nicolau de Oliveira left a description of the hospital’s location within the city: From the north, one enters the city through two valleys, which, as mentioned above, have on one side very noble houses and on the other very large and green kitchen gardens, and these two valleys lead to a large commons (recio), so called because of its exceptional size and beauty, in which a very large fair is held every week on Tuesdays.64

Sixteenth-century Lisbon had two main squares: the Terreiro do Paço, adjacent to the royal palace, and the Rossio. As it grew from the hilltop area of the São Jorge Castle, the city expanded toward the river. The Terreiro do Paço was created at the end of the fifteenth century with the construction of the new royal residence, the Paço da Ribeira, opposite the medieval Alcáçova Palace, located at a higher point within the castle’s precinct. In the sixteenth century, many government and commercial buildings that enabled the Portuguese expansion overseas were added along the riverfront. They included the Casa da Mina, which regulated the African trade; the Casa da Índia, the central colonial administration; the Taracenas, the royal shipyard; and the Celeiro do Trigo, the main warehouse. In addition to the Todos-os-Santos hospital, the Rossio included two other prominent buildings, the friary of São Domingos and the Estaus

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Palace, the headquarters of the Portuguese Inquisition (see Fig. 2.4). In the words of João Brandão, João II initiated the area’s urbanization: [S]eeing how that part of the Rossio was empty and was a good place to begin work as planned; but the place was given by the previous kings to [the friary of ] São Domingos, and since he did not wish to alienate their property, he asked for the space that it occupied, and the friars gave it to him, and in return he gave them certain wheat and barley mills and houses.65

The hospital was distinguished by its arcaded façade, as described by Oliveira: [B]oth this dormitory [of the friary of São Domingos] and the famous building of the Todos-os-Santos Hospital are located facing the Rossio, being supported by thirty-five arches of the strongest stone, behind which on the inner side runs a wide corridor about thirty feet wide.66

This arcade was a service space that facilitated access to and circulation within the building and also offered protection from the sun and rain.67 In 1688, in addressing the request of the Misericórdia for a piece of land to build a home for young women, the City Council of Lisbon stipulated that permission should only be granted if the building was carried on stone arches as elsewhere in the city, referring specifically to the arcades of the Todos-os-Santos hospital and the friary of São Domingos that allowed space for public use and free circulation.68 This arcade was also a space for socialization and commerce, where various fabrics and textiles were displayed and sold every Tuesday.69 In September 1745, the hospital’s head nurse and treasurer intended to demolish the grand staircase leading to the church and replace it with a new, smaller, one to open up space for thirteen more individual stalls that could be rented. This income was supposed to provide additional funds to cover the hospital’s expenses.70 The hospital occasionally hosted theatrical performances attended by the royal family and the court, transforming “the spaces of charity into ceremonial spaces by investing them with the court ritual.”71 One such performance that took place in 1518 in the hospital’s church was Auto da Barca do Purgatório (The Ship of Purgatory) by Gil Vicente (ca. 1465–ca.

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1536), known as the “father of Portuguese drama,” following the production of another play, Auto de São Martinho (Saint Martin), in the church of the Caldas da Rainha hospital in 1504. These plays did not always have to be religious in nature, as was also the case with the Pátio das Arcas located nearby, one of the first theatrical venues in Lisbon, and whose income reverted to the hospital. Several sixteenth-century authors commented on the hospital’s exterior, especially the church, admiring its splendor (see Fig. 2.5). Brandão, for example, referred to “the church façade with nineteen square steps, with its ornament, which is unlike anything else that one can see” (as with the arches, there seemed to be no agreement as to the exact number of steps).72 According to Frei Nicolau de Oliveira, One of the arms of this cross is occupied by a beautiful and large church, with a portal that overlooks the Rossio, which is accessible by going up a famous stone staircase with … twenty-one steps, the first of which, at the level of the Rossio, is seventy-six feet wide and sixty-four feet deep before it reaches the [hospital’s] wall. … One enters the church through a very ornamental and intricate portal, which must be one of the best among those that are Portugal.73

Fig. 2.5  A late Gothic portico base of limestone. Late fifteenth or early sixteenth century, excavated by the Lisbon Archeology Center (1999–2001) in Lisbon’s Praça da Figueira. Câmara Municipal de Lisboa—Centro de Arqueologia de Lisboa. Photo by José Vicente, CML|DMC|DPC (2020)

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These descriptions convey a strong scenic effect of the church’s portal; some of its pieces this portal has been able to recover in the archeological excavations of 1960s (Fig. 2.6). Contemporary representations of Lisbon, including the panoramic view by Braun and Hogenberg (ca. 1575), another one in the Crônica de D. Afonso Henriques de Duarte Galvão (1535–1545) attributed to António de Holanda, and the depiction of the city in the library of the University of Leiden, all feature the hospital.74 Its façade facing the Rossio also appears on a tile panel from the first half of the eighteenth century now in the Museu de Lisboa.75 A defining moment for the relationship between the hospital and the city concerned its reconstruction following the disastrous 1755 earthquake, when the building was partially destroyed, with the six wards ruined. Earlier maps, such as the one from 1750, preserved accurate records of the hospital’s original footprint (Fig. 2.6).76 There was a general acknowledgment of the insufficient capacity of the previous building, but

Fig. 2.6  Topographic map of Lisbon: Ilha em que estava edificado o Hospital Real de todos os Santos desta Cidade […]. Filipe Rodrigues de Oliveira, Guilherme Joaquim Paes de Menezes, 1750. Portugal, Biblioteca Nacional D.100R. (Available at http://purl.pt/22488)

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creating a larger edifice required financial investments that were deemed too high at the time.77 The winning proposal for the reconstruction of the Rossio sought to correct the square’s irregular shape and “amend the orientation and advance the construction of the buildings facing it, which highlighted the issue with the Dominican church, the only structure on that side to maintain its original alignment.”78 Several new streets were opened to connect the square to other parts of the city, while the façades of the buildings that surrounded it, including that of the hospital, were supposed to be made regular and standardized.79 The rebuilding of the wards began shortly after the earthquake. In March 1756, four single-story wards were rebuilt to receive the sick and the wounded who had been distributed among several other institutions.80 Carpentry work was also underway, since, in June 1761, the chief nurse was asked to certify that António Rodrigues Gil, the hospital’s master carpenter, had a boat to transport materials to the worksite.81 The construction work halted in September 1769, when, by the royal decree, the hospital was given the building of the Colégio de Santo Antão, the former Jesuit college north of the São Jorge Castle. An order sent to the Misericórdia by Sebastião José de Carvalho e Melo (1699–1782), the future Marquis of Pombal, commanded as follows: His Majesty [José I] informs Your Excellency that it will be convenient to create in the new building [of the Colégio de Santo Antão] the ­accommodations corresponding to the wards that lie on the western side of the old hospital, so that the land that will be freed can be sold, because it is most valuable by being in front of the Rossio.82

The stairs to hospital’s church were dismantled, part of the old building was demolished in the 1770s, and the construction materials were sold. Simultaneously, work on the Colégio de Santo Antão to adapt it to the new function progressed. The hospital’s transfer was complete when its patients were moved to the new site in 1775.

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Conclusion This chapter addressed three aspects of the architecture of the Todos-os-­ Santos hospital: its function as a space of healing, its layout and decoration, and its symbolic importance within the city as an embodiment of the civic ideal of good government. While highlighting the hospital’s pioneering role as a new type of healthcare institution, it also explained its significance in the context of the welfare infrastructure and urban development in early modern Lisbon and as an expression of the political power of the Portuguese kings. The Todos-os-Santos hospital was the most important healthcare institution in Lisbon and the city’s first truly modern hospital. It enjoyed royal patronage, which enabled it to become an effective healthcare facility and a place of medical training and also to wield significant economic and financial power. Its institutional history, however, was also closely tied to the context of early modern hospital reorganization and healthcare reform. The consolidation of small medieval hospitals into such large-scale institutions created the need for new architectural solutions, giving rise to new hospital models across Europe that would give such monumental structures a new prominence within the city. While incorporating the architectural traits that defined contemporary Italian hospitals, such as the cruciform plan, the façade of Todos-os-­ Santos hospital included an arcade, a characteristic feature of the architecture of sixteenth-century Lisbon.83 The result was a hybrid design that, while assimilating an imported Italian model, also incorporated other elements typical of the local building traditions. Originating in a peripheral location, this monumental building catalyzed urban development by raising the prestige of the Rossio Square and the adjacent neighborhood, which gained further importance during the city’s reconstruction after the 1755 earthquake. While playing a fundamental role in Lisbon as a healthcare institution, the hospital also became a model healing space that was replicated in other Portuguese territories, becoming, in the words of Isabel dos Guimarães Sá, “a hospital model at the scale of the kingdom.”84

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Notes 1. This chapter is based on two ongoing research projects: All-Saints Royal Hospital: The City and Public Health promoted by the Lisbon City Council in partnership with CHAM—Center for the Humanities (FCSH, Universidade NOVA de Lisboa) and coordinated by André Teixeira, Edite Martins Alberto, and Rodrigo Banha da Silva; and Hospitalis–Hospital Architecture in Portugal at the Dawn of Modernity promoted by European Institute for Cultural Sciences Father Manuel Antunes in partnership with ARTIS—Institute for Art History and coordinated by Joana Balsa de Pinho. 2. See, for example, Mário Reis de Carmona, Hospital Real de Todos-osSantos da Cidade de Lisboa (Lisbon: Published by the author 1954); Augusto da Silva Carvalho, Crónica do Hospital de Todos-os-Santos (Lisbon: Published by the author 1992); Fernando da Silva Correia, A Origem dos Grandes Hospitais Portugueses, Boletim da Assistência Social, 17–19 (1944): 191–194; Irisalva Moita, V Centenário do Hospital Real de Todos-os-Santos (Lisbon: Correios de Portugal, 1992); Paulo Pereira, ed., Hospital Real de Todos-os-Santos séculos XV a XVIII: Catálogo (Lisbon: Câmara Municipal de Lisboa, 1993); António Pacheco, “De Todos-osSantos a São José. Textos e contextos do ‘esprital grande de Lixboa’,” master’s thesis, Universidade NOVA de Lisboa-Faculdade de Ciências Sociais e Humanas, 2008); Anastácia Salgado, O Hospital de Todos-osSantos, Assistência à pobreza em Portugal no século XVI para o Brasil, Índia e Japão (Lisbon: By the Book, 2015); Rute Ramos, “O Hospital de Todos-os-Santos: história, memória e património arquivístico (séc. XVI– XVIII),” PhD diss., University of Évora, 2019. An edited volume that has originated as part of the research project “All Saints Royal Hospital: The City and Public Health” will bring together several dozen studies on different aspects of the hospital’s design and history. See Alberto, Edite Martins; Silva, Rodrigo Banha da; Teixeira, André (ed.), O Hospital Real de Todos-os-­ Santos: Lisboa e a saúde (Lisbon: Câmara Municipal de Lisboa, 2020). An English translation: Omnium Sanctorum – All Saints Royal Hospital of Lisbon public health (2021), avaiable in http://hdl.handle.net/10362/138719 3. See Vítor Serrão, A cripto-história de arte: análise de obras de arte inexistentes (Crypto-art history: analysis of non-existent works of art) (Lisbon: Livros Horizonte, 2001). According to the author, its focus is on the

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“missing or fragmentary works of art” or those that remained only in project form: “It is not enough for art history to study only extant works and, from them, reconstruct specific contexts and situations from the slow evolution of artistic production cycles. Contextualized references to recognizable losses are also needed, that is, monuments and works of art that are known to have existed at some point or survive as fragments or in ruins. The so-called dead works of art also have testimonial value, and it is imperative that they be included in the vast comparative and globalising process that scientific analysis calls for.” Vítor Serrão, “Iconoclastia e cripto-história da arte: Casos de estudo e acertos teórico-­metodológicos no património artístico português,” Artis-on 5 (2017–2018): 10. 4. See Gabriella Piccinni, “I modelli ospedalieri e la loro circolazione dall’italia all’europa alla fine del medioevo”, in Civitas bendita: Encrucijada de las relaciones sociales y de poder en la ciudad medieval, ed. Gregoria Cavero Domínguez (León: Universidad de León, Área de Publicaciones, 2016), 18. 5. Isabel dos Guimarães Sá, “A reorganização da caridade em Portugal em contexto Europeu,” Cadernos do Noroeste 11, no. 2 (1998): 44. 6. Piccinni, “I modelli ospedalieri,” 15. 7. Concepción Félez Lubelza, El hospital real de Granada: Los comiezos de la arquitectura publica (Granada: Editorial Universidad de Granada), 8. 8. See Annemarie Jordan Gschwend and K. J. P. Lowe, eds., A Cidade Global: Lisboa no Renascimento (Lisbon: Museu Nacional de Arte Antiga e Imprensa Nacional-Casa da Moeda, 2017). 9. Helder Carita, “Lisboa: da cidade medieval à cidade Manuelina,” in Lisboa 1415 Ceuta. Historia de dos ciudades, ed. André Teixeira, Fernando Villada Paredes, and Rodrigo Banha da Silva (Lisbon: Câmara Municipal de Lisboa, 2015), 31–36. 10. João II’s will, 1492. Gavetas, box 16, pack 1, n. 16, f. 2, Arquivo Nacional da Torre do Tombo (ANTT), Lisbon. All quotes and documents translated unless otherwise noted. 11. Portugaliae monumenta misericordiarum, ed. José Pedro Paiva (Lisbon: União das Misericórdias Portuguesas, Universidade Católica Portuguesa), 2:51, doc. 22. For earlier hospitals in Lisbon, see Paulo Jorge Rodrigues Lopes, “A assistência hospitalar na Lisboa medieval, anterior à instituição do Hospital Real de Todos-os-Santos (sécs. XIII–XV),” master’s thesis, Universidade NOVA de Lisboa-Faculdade de Ciências Sociais e Humanas, 2015.

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12. José Pedro Paiva, ed., Portugaliae monumenta misericordiarum (Lisbon: União das Misericórdias Portuguesas, Universidade Católica Portuguesa, 2003), 2:54, doc. 24. 13. Ibid., 2:20. 14. Isabel Drumond Braga, Assistência, saúde pública e prática médica em Portugal (séculos XV–XIX) (Lisbon: Universitária Editora, 2001), 11. 15. Maria Marta Lobo de Araújo, “Os regimentos quinhentistas dos hospitais de Arraliolos e Portel,” Biblos 77 (2001): 146. 16. Paiva, Portugaliae monumenta misericordiarum, 2:39–40, doc. 10. 17. Eduardo Nunes, “Política hospitalar de D. Duarte: Achegas vaticanas,” in A pobreza e a assistência aos pobres na Península Ibérica durante a Idade Média: Actas, tome 2 (Lisbon: Instituto de Alta Cultura, 1973), 685–687; António Domingues de Sousa Costa, “Hospitais e albergarias na documentação pontifícia da segunda metade do século XV,” in A pobreza e a assistência aos pobres na Península Ibérica durante a Idade Média: Actas, tome 1 (Lisbon: Instituto de Alta Cultura, 1973), 288. 18. Nunes, “Política hospitalar de D. Duarte,” 685. 19. See Joana Balsa de Pinho, “Assistance Reform: Antecedents and Components in Portugal at the Dawn of Modernity,” in ed. Alberto, Edite Martins; Silva, Rodrigo Banha da; Teixeira, André, O Hospital Real de Todos-os-Santos: Lisboa e a saúde, pp. 219, 231. 20. Ibid. 21. Sá, “A reorganização da caridade em Portugal em contexto Europeu,” 3. 22. Ibid. For a synthesis of the specificities of the activities of the Misericórdias during the early modern period, see José Pedro Paiva, ed., Portugaliae monumenta misericordiarum (Lisbon: União das Misericórdias Portuguesas, Universidade Católica Portuguesa, 2003), 1:11 and 1:38–42. 23. João Brandão de Buarcos, Grandeza e abastança de Lisboa em 1552 (ed. José Felicidade Alves, Lisbon: Livros Horizonte, 1990). 24. Francesco Bianchi and Marek Słoń, “Le riforme ospedaliere del Quattrocento in Italia e nell’Europa centrale.” Ricerche di storia sociale e religiosa 35, no. 69 (2006): 34. See also Antoni Conejo da Pena, “‘El orgullo y la vanidad han construido más hospitales que todas las virtudes juntas.’ Patronazgo artístico y patrimônio hospitalario en la corona de aragón (siglos XIV–XV),” Revista CECEL 18 (2018): 69–112. 25. For Manuel I’s politics and reforms, see Diogo Ramada Curto, ed., O tempo de Vasco da Gama (Lisbon: Comissão Nacional para as Comemorações dos Descobrimentos Portugueses, 1998).

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26. Garcia de Resende, Livro das obras de Garcia de Resende que tracta da vida & grandissimas virtudes & bondades, magnanimo esforço, excelentes costumes & manhas & muy craros feitos do christianissimo, muito alto & muito poderoso príncipe el rey dom Joam ho segundo deste nome […], vay mais acrescentado nocamente a este liuro huma Miscellanea em trouas do mesmo auctor […] (Évora: André de Burgos, 1554), f. 85r. 27. At least one engraving also portrays the fish net, the emblem of Queen Leonor, wife of King João II and sister of Manuel I, and the founder of the Misericórdia of Lisbon. 28. Manuel I, Royal Charter, 1499. Hospital de São José, Registos dos reinados de D. João II e D. Manuel, book 938, f. 16v, ANTT, Lisbon. 29. Manuel I, Royal Charter, 1499. Ibid., ff. 17v.–18. 30. Manuel I, Charters of Grace, 1502. Chancelaria de D. Manuel, book 2, ff. 43, 46, 48, 53v.; book 35, ff. 18v., 20v., 22, 22v., 28v., 33v., 34v. e 34v.a, 37v., 68, ANTT, Lisbon. 31. Sandro Boccadoro, “The History of the Organization of Healthcare,” in Santa Maria Nuova Through the Centuries: Medicine, Surgery, Healthcare, Art and Culture in the Hospital of the Florentines, ed. Giancarlo Landini (Florence: Edizioni Polistampa, 2019), 68; Esther Diana, “The Architecture and the Image of the Hospital,” in Santa Maria Nuova Through the Centuries: Medicine, Surgery, Healthcare, Art and Culture in the Hospital of the Florentines, ed. Giancarlo Landini (Florence: Edizioni Polistampa, 2019), 17–21; Boccadoro, “The History of the Organization of Healthcare,” 68. 32. Bianchi and Słoń, “Le riforme ospedaliere,” 17. 33. Ibid., 18. 34. Ibid., 18–19. 35. Paiva, Portugaliae monumenta misericordiarum, 3:49, doc. 13. 36. Damião de Góis, Descrição da cidade de Lisboa pelo cavaleiro português Damião de Góis, trans. José Felicidade Alves (Lisbon: Livros Horizonte, 1998), 47–49. Original edition in Latin Urbis Olisiponis descriptio per Damianum Goem equitem lusitanum (Évora: André de Burgos, 1554). 37. Cristóvão Rodrigues Oliveira, Sumario em que brevemente se contem alguas cousas (assi ecclesiasticas como seculares) que ha na cidade de Lisboa (Lisboa: Livrareiro do infante Dom Luís, [post. 1554]), ff. 46v.–47 38. Damião de Góis, Descrição da cidade de Lisboa, 48–49. 39. Inventory of the Todos-os-Santos Hospital, 1564. Hospital de São José, book 567, ff. 7–23v, ANTT, Lisbon; published by Pedro Pinto,

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“Inventário do Hospital de Todos-os-Santos (Lisboa) em 1564,” Revista de Artes Decorativas 5 (2011): 243–270. 40. Nicolau de Oliveira, Livro das grandezas de Lisboa, composto pelo padre frey Nicolao d’Oliveyra religioso da Ordem da Sanctissima trindade e natural da mesma cidade (Lisbon: Jorge Rodrigues, 1620), 119. 41. Damião de Góis, Descrição da cidade de Lisboa, 48; Oliveira, Livro das grandezas de Lisboa, 119. 42. Oliveira, Livro das grandezas de Lisboa, f. 118v. 43. See the Regulations (1504) in Regimento do Hospital de Todos os Santos (Lisbon: Laboratório Sanitas, 1946). 44. Manuel I, Royal Charter, 1502. Hospital de São José, Registo Geral, book 940, f. 24, ANTT, Lisbon. 45. See Regulations (1504) in Regimento do Hospital de Todos os Santos, 39–40, 71, 77–79, and 87. 46. Misericórdia of Lisbon administrators, Resolution, 1695. Hospital de São José, Portarias da Misericórdia, box 390, pack 1, n. 14, ANTT, Lisbon. 47. See Jacinta Bugalhão and André Teixeira, “Os canos da Baixa de Lisboa no século XVI: Leitura arqueológica,” Cadernos do Arquivo Municipal 2, no. 4 (2015): 93–94. 48. Rules (1504) in Regimento do Hospital de Todos os Santos, 72 and 75. 49. Ana Cristina Leite, “O Hospital real de Todos-os-Santos,” in Hospital Real de Todos-os-Santos: 500 anos, catálogo (Lisbon: Câmara Municipal de Lisboa, 1993), 11 50. Oliveira, Livro das grandezas de Lisboa, f. 135v. 51. Misericórdia of Lisbon administrators, Petition, 1731. Arquivo Histórico da Santa Casa da Misericórdia de Lisboa (AHSCML), Lisbon, CR-02-01-099. 52. Ibid. 53. D. Luís Fernandes de Vasconcelos, Resolution, 1569. Hospital de São José, Registo Geral, book 940, f. 267, ANTT, Lisbon. 54. Diogo de Mendonça Corte Real, Letter to the City Council, 1751. Arquivo Municipal de Lisboa (AML), Lisbon, Livro 1.° de registo de consultas e decretos de D. José I, f. 80v. 55. See Misericórdia of Lisbon administrators, Order, 1718. Hospital de São José, Registo Geral, book 942, f. 103v, ANTT, Lisbon. 56. Sebastião de Vargas, Provision, 1515. Corpo Cronológico, part 2, pack 62, n. 108, ANTT, Lisbon.

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57. King João III, Royal Charter, 1550. Hospital de São José, Registo Geral, book 940, f. 216, ANTT, Lisbon. 58. D. Luís Fernandes de Vasconcelos, Resolution, 1569. Ibid., f. 267. 59. Josep Barceló Prats, “Poder local, govern i assistència pública: El cas de Tarragona” (PhD diss., Universitat Rovira i Virgili, 2014), 17. See also Félez, El hospital real de Granada, 8. 60. Leite, “O Hospital real de Todos-os-Santos,” 14. 61. Oliveira, Livro das grandezas de Lisboa, 119v. 62. Obligations of Hospital Chapels, sixteenth to eighteenth century. AHSCML, IG/MS/05/01. 63. Piccinni, “I modelli ospedalieri,” 12. 64. Oliveira, Livro das grandezas de Lisboa, f. 117v. 65. Brandão, Grandeza e abastança de Lisboa em 1552. 66. Oliveira, Livro das grandezas de Lisboa, f. 118. See a similar description in Brandão, Grandeza e abastança de Lisboa em 1552. 67. Ibid. 68. Query to the Senate of Lisbon City Council about a Misericórdia of Lisbon administrators petition, 1688. Livro 9.° de consultas e decretos de D. Pedro II, ff. 289–294v, AML, Lisbon. 69. Oliveira, Livro das grandezas de Lisboa, 118. 70. Lisbon City Council, Decree, 1745. Livro 21.° de consultas e decretos de D. João V do Senado Ocidental, ff. 133–136, AML, Lisbon. 71. Sá, “A reorganização da caridade em Portugal em contexto Europeu,” 41. 72. Brandão, Grandeza e abastança de Lisboa em 1552. 73. Oliveira, Livro das grandezas de Lisboa, ff. 118v–119. 74. Duarte Galvão and António de Holanda, Crônica de D. Afonso Henriques, 1535–1545. Museu dos Condes de Castro Guimarães, MCCG-BIB-014; Leiden University Libraries, COLLBN J29-15-7831-110/30a-q. 75. Mestre P. M. P. (att.), MC.AZU.0074, Museu de Lisboa, Lisbon. 76. Planta topographica, e exacta do Sitio, que comprehende a Ilha em que estava edificado o Hospital Real de Todos os Santos desta Cidade, o Convento de São Domingos e Cazas asim do Ill.mo e Exm.o Marquês de Cascaes, como as dos particulares / a qual foi tirada na prezença do Sargento Môr Philippe Roiz de Oliveira, pello Ajudante Guilherme Joaquim Paês de Menezes, e o Discipulo Thomas Roiz da Costa a que assiatirão também outros Discipulos do dito Sargento Môr, 1750. D.1000 R., BNP, Lisbon; available at: http:// purl.pt/22488.

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77. See Hélia Silva and Tiago Lourenço, “A Ilha. História e urbanismo do grande quarteirão onde se implantou o Hospital Real de Todos-osSantos, ao Rossio (1750–1779),” Cadernos do Arquivo Municipal 2, no. 11 (2019): 111–112. 78. Silva and Lourenço, “A Ilha.,” 113–114. 79. Cartulário Pombalino [1778], AML, Lisbon. 80. Secretary of State, Letter, 1755. Hospital de São José, Registo Geral, book 943, fl. 13v., ANTT, Lisbon. 81. Jorge Machado de Mendonça, Ordinance, 1761. Hospital de São José, Registos do Enfermeiro Mor Jorge Machado de Mendonça, book 1104, f. 53, ANTT, Lisbon. 82. Sebastião José de Carvalho e Melo, Order to the Misericórdia of Lisbon, 1769. Hospital de São José, Registo Geral, book 943, ff. 137v.–139, ANTT, Lisbon. 83. Hélder Carita, “Da ‘Ribeira’ ao Terreiro do Paço: génese e formação de um modelo urbano,” in Miguel Figueira da Faria, ed., Do Terreiro do Paço à Praça do Comércio: história de um espaço urbano (Lisbon: Universidade Autónoma e Imprensa Nacional-Casa da Moeda, 2014), 26–27. 84. Sá, “A reorganização da caridade em Portugal em contexto Europeu,” 44.

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Pereira, Paulo, ed. Hospital Real de Todos os Santos séculos XV a XVIII: Catálogo. Lisbon: Câmara Municipal de Lisboa, 1993. Piccinni, Gabriella. “I modelli ospedalieri e la loro circolazione dall’italia all’europa alla fine del medioevo.” In Civitas bendita: encrucijada de las relaciones sociales y de poder en la ciudad medieval, edited by Gregoria Cavero Domínguez, 7–26. León: Universidad de León, Área de Publicaciones, 2016. Pinho, Joana Balsa de. “Assistance Reform: Antecedents and Components in Portugal at the Dawn of Modernity.” In Omnium Sanctorum. O Hospital Real de Todos-os-Santos e a Cidade, edited by Edite Martins Alberto, Rodrigo Banha da Silva and André Teixeira, 219–231. Lisbon: Câmara Municipal de Lisboa, 2021 (in press). Pinto, Pedro. “Inventário do Hospital de Todos-os-Santos (Lisboa) em 1564.” Revista de Artes Decorativas 5 (2011): 243–270. Planta topographica, e exacta do Sitio, que comprehende a Ilha em que estava edificado o Hospital Real de Todos os Santos desta Cidade, o Convento de São Domingos e Cazas asim do Ill.mo e Exm.o Marquês de Cascaes, como as dos particulares / a qual foi tirada na prezença do Sargento Môr Philippe Roiz de Oliveira, pello Ajudante Guilherme Joaquim Paês de Menezes, e o Discipulo Thomas Roiz da Costa a que assiatirão também outros Discipulos do dito Sargento Môr, 1750. National Library of Portugal [Biblioteca Nacional de Portugal], http://purl.pt/22488. [Prospect of Lisbon]. COLLBN J29-15-7831-110/30a-q, Leiden University Libraries, Netherlands. Ramos, Rute. “O Hospital de Todos os Santos: História, memória e património arquivístico (séc. XVI–XVIII).” PhD diss., University of Évora, 2019. Resende, Garcia de. Livro das obras de Garcia de Resende que tracta da vida & grandissimas virtudes & bondades, magnanimo esforço, excelentes costumes & manhas & muy craros feitos do christianissimo, muito alto & muito poderoso príncipe el rey dom Joam ho segundo deste nome […], vay mais acrescentado nocamente a este liuro huma Miscellanea em trouas do mesmo auctor […]. Évora: André de Burgos, 1554. Regimento do Hospital de Todos os Santos. Lisbon: Laboratório Sanitas, 1946. Sá, Isabel dos Guimarães. “A reorganização da caridade em Portugal em contexto Europeu.” Cadernos do Noroeste 11, no. 2 (1998): 31–63. Salgado, Anastácia. O Hospital de Todos -os-Santos, Assistência à pobreza em Portugal no século XVI para o Brasil, Índia e Japão. Lisbon: By the Book, 2015. Serrão, Vítor. A cripto-história de arte: Análise de obras de arte inexistentes. Lisbon: Livros Horizonte, 2001.

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Serrão, Vítor. “Iconoclastia e cripto-história da arte: casos de estudo e acertos teórico-metodológicos no património artístico português.” Artis-on 5 (2017–2018): 8–24. Silva, Hélia, and Tiago Lourenço. “A Ilha. História e urbanismo do grande quarteirão onde se implantou o Hospital Real de Todos-os-Santos, ao Rossio (1750–1779).” Cadernos do Arquivo Municipal 2, no. 11 (2019): 103–116.

3 Architecture and Plague Prevention: The Development of Lazzaretti in Eighteenth-Century Mediterranean Cities Marina Inì

The Italian word for a plague hospital, lazzaretto (pl. lazzaretti), originates from the name of the Venetian island of Santa Maria di Nazareth, on which the city’s first such hospital was built.1 Lazzaretto was used during the early modern period (ca. 1450–1800) to refer to different aspects of the same institution that can sometimes coincide, overlap, or differ. Indeed, it could be used to indicate both plague hospitals and quarantine sites established in different types of buildings: purpose-built or provisional in the form of seized buildings and makeshift barracks.2 In Venice, the Lazzaretto Vecchio and the Lazzaretto Nuovo were among the first permanent lazzaretti established during the fifteenth and sixteenth centuries. They were both used during plague outbreaks to cure the sick and isolate those suspected of being infected and as quarantine facilities for incoming travelers and goods in times when the epidemic abated. As the frequency of plague outbreaks diminished, however, the quarantine function took over, and, after the seventeenth century, the institution

M. Inì (*) University of Cambridge, Cambridge, UK e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_3

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progressively lost its charitable care function.3 As quarantine stations, lazzaretti constituted a form of long-lasting protection against the disease adopted on the western Mediterranean shores. Merchants, travelers, and goods were quarantined and disinfected inside vast complexes built in port cities and important trading posts on the most trafficked of the Mediterranean trade routes. This chapter focuses on eighteenth-century lazzaretti in their role as a preventative quarantine and disinfection institution. I therefore use the term lazzaretti to refer specifically to these quarantine stations, which I differentiate from plague hospitals, institutions with charitable purposes used during the emergency of an epidemic.4 The central argument of this chapter is that the architecture of lazzaretti was proactively employed to prevent plague transmission and potential disease outbreaks and to ensure healthy and salubrious quarantined conditions. I argue that this architecture reflected early modern notions of contagion and plague, based upon my analysis of Mediterranean lazzaretti from the Republic of Venice (including its territories in the Balkan peninsula), the Austrian Littoral, Malta, France, and the states of the Italian Peninsula. Architectural features and protocols observed in lazzaretti demonstrate an attentiveness to the senses of touch and smell and to the cleanliness of the built environment, both during outbreaks of disease and their everyday functioning in non-plague years.5 Plague control and quarantine legislation was first adopted in 1377 in Ragusa (modern Dubrovnik in Croatia) and later developed by the Venetian Republic, which started to establish a complex system of lazzaretti in its territories—including the Terraferma, the Balkan peninsula, and the Ionian Sea—between the sixteenth and seventeenth centuries.6 Gradually, other states in the Mediterranean region adopted this institution, creating a vast, transnational system that reached its full complexity during the eighteenth century. The aim was to allow safe commercial exchanges with cities occasionally hit by epidemics and, above all, with those territories—such as the Ottoman Levant and the Barbary Coast (the North African coast)—where plague was considered endemic. Each lazzaretto was managed by a local health office, which was in turn in contact with other health boards both within the same state and beyond its borders. Indeed, quarantine and its attendant procedures were based

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on shared information concerning the state of health in foreign lands to not only protect a single state or city, but also ensure the safety of the wider regional network. Measures adopted by different lazzaretti required consistency, and the system could only work by keeping track of localized plague outbreaks and by subjecting potentially plaque-infected areas to bans or stricter quarantine policies. Common architectural models and features of lazzaretti were adopted and shared throughout the Mediterranean region. For instance, Luigi Vanvitelli visited lazzaretti in Venice, Genoa, and Livorno prior to designing a pentagonal-shaped lazzaretto in Ancona (1733).7 Francesco Antonio Guadagnini, future priore (superintendent) of the lazzaretto of Santa Teresa in Trieste, visited the lazzaretti of Livorno and Marseille in 1768.8 Plans and regulations were shared between health boards, as demonstrated by the presence of copies of these documents in different archives. Specific architectural features related to theories of plague and contagion created architectural continuity across the transnational system of prevention. The institution of lazzaretti had been in use for almost three centuries and was well established when, during the eighteenth century, several new ones were built as part of the development of international free trade in major Mediterranean ports. These additions included the lazzaretto of Varignano (1723) near Genoa; one in Ancona (1733) on the Adriatic coast of the Papal States; the lazzaretti of San Carlo (1720) and Santa Teresa in Trieste (1769) in the Austrian Littoral; and the third lazzaretto of San Leopoldo in Livorno (1779) on the coast of the Grand Duchy of Tuscany (Figs. 3.1, 3.2, and 3.3). Previous scholarship has investigated lazzaretti by focusing on the management of this institution and its use in previous centuries. Although few works have analyzed the architectural form of lazzaretti in detail, they show that these sites were complex architectural mechanisms.9 It is therefore essential to consider the spatial characteristics of lazzaretti to understand these institutions and their impact. The study of the material culture of healthcare must be joined with the analysis of space in order to grasp the full complexity of cultural and medical practices, an approach successfully demonstrated by recent hospital studies.10 However, it is important to underline the preventative functions of lazzaretti, which differed crucially from hospitals in that they were not commonly used for

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Fig. 3.1  Plan of the Lazzaretto of Varignano, La Spezia, from J.  Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789), Plate 6. Getty Research Institute, Los Angeles (85-B11700)

healing or assistance purposes. Rather, they hosted mostly healthy subjects, including travelers, merchants, and sailors who had to be quarantined. Therefore, the practices that took place inside lazzaretti were principally aimed at tackling and preventing the occurrence and spread of the disease when no localized plague outbreak was taking place. Significantly, plague historiography has traditionally focused on periods of crisis, while preventative strategies put in place before and after such outbreaks have received less attention.11 Building on the work of historians such as Sandra Cavallo and Tessa Storey, who have focused on healthy preventative practices adopted inside the home, I first investigate lazzaretti and their protocols as places and mechanisms whose aim was primarily to prevent plague outbreaks rather than to provide care and healing.12 The next section analyzes early modern theories of plague and contagion, showing how related concerns were reflected in the architecture of quarantine centers. The following two parts focus on the architectural features that were adopted to manage the

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Fig. 3.2  Plan of the ground floor of the lazzaretto in Ancona, eighteenth century. Biblioteca Comunale Benincasa, Ancona

isolation of potentially infected goods and to ensure that passengers were quarantined in a healthy environment.13

 lague and Contagion in the Early P Modern Period The management and architecture of lazzaretti reflected early modern ideas about plague and contagion and the associated concerns with smell and touch. Miasmatic theory propounded the belief that “corrupt air” was the cause of disease outbreaks, while contagion theory was based on the assumption that disease was spread by close contact with sick and infected people.14 In the past, historians argued that the two theories excluded one another and that this disagreement was at the foundation of

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Fig. 3.3  Plan of the Lazzaretto of San Leopoldo, Livorno, from J.  Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789), Plate 7. Getty Research Institute, Los Angeles (85-B11700)

the dichotomy between early modern medical knowledge, which endorsed miasmas, and public health measures, which prioritized actions against contagion.15 Medical historiography has traditionally focused on the debate between the supporters of the two theories. Subsequent scholarship has overcome this division, and bad air and contagion are now rightfully analyzed not as two opposing ideas of how disease spread but as two complementary explanations.16 The two concepts coexisted for centuries, highlighting a certain continuity in the social and cultural construction of the plague. In this chapter, the notions of contagion and disease that characterized eighteenth-century lazzaretti are analyzed in connection with the previous centuries. The importance of bad air and contagion through direct and indirect contact was in fact emphasized from as early as the fourteenth century until at least the nineteenth.17 Despite overcoming the opposition of miasmic and contagionist theories, the scholarship has not completely rebalanced the attention toward the role of direct and indirect contact in the early modern conception of plague and above all in shaping the architecture of related institutions.18

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As I discuss below, lazzaretti regulated isolation and distancing by employing a vast array of architectural features and devices. The main frame of reference for early modern theories about plague and contagion referred back to the established dogma of antiquity.19 The Greek author Galen (AD 129–ca. 200) argued that plague was spread by the inhalation of miasmas. Galen also introduced the idea of the “seeds of the disease” to explain how plague entered the body.20 Galenic ideas were transmitted through the centuries. In the late medieval period, Pietro da Tossignano, in his treatise Consilium pro peste evitanda (1398), spoke of “reliquiae” (relics or remnants) left behind by the epidemic that could spread the plague once again.21 The Galenic “seeds” were recalled by Girolamo Fracastoro in his treatise De Contagione, Contagiosis Morbis et eorum Curatione Libri III (1546). Fracastoro explained transmission as effectuated in three different ways: direct contact, per fomitem (through contaminated surfaces), and at a distance by means of poisonous vapors.22 While Fracastoro was not the first to underline the importance of both direct and indirect contact, his tripartite explanation became very popular in subsequent centuries.23 The continuity of this explanation is evident in both scholarly treatises and in practices of disinfection inside lazzaretti and during plague outbreaks. Lodovico Antonio Muratori’s Del Governo della Peste, e delle Maniere di Guardarsene (1714) referred to Fracastoro’s notions of disease transmission and the role of direct and indirect contact, recording that “[i]t is possible to receive the pestilential poison in three ways, namely, by touching diseased bodies, or things and animals touched by the sick, or through the air surrounding them.”24 Patrick Russell, a physician in Aleppo who wrote extensively on plague and quarantine, wrote in A Treatise of the Plague (1791) that plague is a contagious disease that can be passed from a sick body to a sound one […] it is received either by immediate contact with a diseased body; or at some distance, through the medium of the air; or from substances which having imbibed the pestiferous miasmas, are capable of retaining them in an active state, and occasionally of communicating them, by contact or otherwise, not less malignant in power than when they issue from the original source.25

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In A Short Discourse Concerning Pestilential Contagion (1721), Richard Mead, who completed a medical degree in Padua, likewise observed that “contagion is propagated by three causes, the air, diseased persons, and, goods transported from infected places.”26 Russell considered contagion per fomitem to be the most dangerous type of contagion, since potentially infected goods could be transported across vast distances.27 He further explained that the miasmatic vapors could stick to different substances that had not been subject to ventilation and to merchandise that had been packed.28 Trade with plagued lands or suspected of infection, therefore, represented a great danger that necessitated lazzaretti, quarantine, and the disinfection of goods. Inside lazzaretti, objects were feared more than potentially sick people when it came to concerns about the spread of contagion. Disembarking passengers were usually healthy, and miasmas and effluvia from sick bodies were not believed to be propagated over long distances. Muratori stated that both the air exhaled by plague victims and the air surrounding them could spread the poison only to those standing within a few steps of the sick.29 Likewise, Mead acknowledged that those infected with plague could transfer contagion to persons in close proximity, but that the pestilential effluvia were soon safely dispersed.30 John Howard’s treatise, An Account of the Principal Lazarettos in Europe (1789), included a chapter in which the author listed different questions and answers pertaining to the plague he had heard during his travels. Howard recorded an answer provided by a certain Giovannelli, a physician at the lazzaretto of Livorno: If one speaks of an infected person shut up in an unventilated chamber, it may be said that the whole atmosphere is dangerous, but if one speaks of a patient exposed to open air, it has been proved that the sphere of infection does not extend beyond five geometrical paces from his body.31

Indeed, during the 1743–44 plague in Messina and Reggio Calabria, it was prescribed that beds inside plague hospitals should be spaced at a distance of eleven palmi (2.9 meters).32 The regulations of the lazzaretto of Ancona stated that its staff and quarantined travelers could only interact with passengers of an infected ship at double the standard distance,

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that is, sixteen paces apart.33 In other examples, distance was also prescribed between members of different quarantine groups. Many documents mention the so-called riguardi di sanità (namely, keeping distance to preserve health) when speaking about interactions between potentially infected passengers and medical personnel, such as doctors visiting people upon arrival, or visitors from outside. Lazzaretti and their regulations not only stressed the importance of isolation and avoiding direct contact with the ill, but also the quality of the environment. While Muratori noted that plague could be easily transported from other countries through commerce and the movement of people, the disease could also develop by itself due to the presence of marshy land and bad air.34 Mead suggested that the smell emanating from stagnant waters or rotting elements could be the origin of infectious diseases.35 Furthermore, he proposed that an “active spirit” emanated from the stench, which was able to change the nature of other fluids and to enhance the malignant power of the “seeds of disease.”36 In the late medieval and early modern periods, issues of public health regarding the quality of the air were the subject of strict regulations that involved the removal of waste and the installation of drains and sewers to avoid bad smells and purify the environment.37 As discussed below, the built environment of lazzaretti and their regulations also reflected the anxiety caused by the quality of the air. Specific architectural features and rules were implemented to reduce the presence of potentially harmful air and unpleasant smells. Ventilation, fresh air, smoke, perfumes, and strong scents were used to counteract the bad smells associated with miasmas that were believed to cause disease, both during plague outbreaks and as a preventative measure inside lazzaretti.38 Early modern ideas about plague and contagion contributed significantly to the institutional character and development of the architecture of lazzaretti. Fears of contagion and contact are less studied than the role of miasma in shaping the architecture of health-related spaces. Yet, the design of specific architectural features adopted to facilitate isolation and distancing demonstrate the defining role that the fear of contagion played for such institutions, and the measures undertaken against the bad air inside lazzaretti highlight the importance of odor and cleanliness in plague-related spaces.

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Isolation, Prevention of Contact, and Fear of Contagion The locations and architectural designs selected for lazzaretti signify the importance of touch—or rather its absence—through isolation and the fear of contact with potentially infected passengers. Lazzaretti were usually built outside densely populated areas, but not too far away from the center of the city, as were hospitals treating patients suffering from pox.39 As in the case of Split, lazzaretti could be built inside the city walls, although most were located just outside the city gates. Locations chosen for lazzaretti needed to be convenient for commerce, close to ports, trade routes, and waterways, yet safely distant from the main urban areas. Water, both in a physical and symbolic way, was often used to ensure isolation during the early modern period.40 Many of the lazzaretti analyzed here were entirely or partially surrounded by water, for instance, by occupying natural or artificial islands, such as the Lazzaretto Nuovo and the Lazzaretto Vecchio in Venice or lazzaretti in Ancona, Malta, Messina, Naples, and Corfu. Locations partially delimited by bodies of water were also chosen, such as promontories—as in the case of the lazzaretto of Varignano near La Spezia—and river bends, for example, in the lazzaretto of San Pancrazio in Verona. In Genoa, Marseille, Cagliari, and Split, lazzaretti were built outside the city but near the seashore. The isolation achieved by the placement of lazzaretti was further enhanced by their architectural layout. Typically, lazzaretti had only one or two entrances, which made the movement in and out easier to control. Contemporary visitors to the Venetian lazzaretti often compared them to castles. The high, fortified walls and towers of the lazzaretti built by the Republic of Venice on the Ionian islands of Corfu, Cephalonia, and Zakynthos clearly resembled castles designs.41 The lazzaretti in Livorno, Ancona, Marseille, Genoa, and Varignano featured double walls and sometimes moats. Despite the substantial need for isolation, lazzaretti operated with a controlled degree of permeability with the outside world in order to accept deliveries of supplies and incoming passengers and cargo. This approach parallels the efforts to preserve the sacredness and immaculacy

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of convent spaces from their contamination by the lay world, despite the practical need to receive supplies from beyond the walls. However, it was the outside world that the lazzaretti strove to protect from the danger of disease while also allowing a degree of communication. The periods during which potentially contaminated goods and likely infected passengers were brought inside the lazzaretto were regarded as very delicate and dangerous. The area immediately surrounding the lazzaretto presented a problematic liminal space. The castle-like double layer of walls found in many lazzaretti provided a buffer zone, removed from the outside world but not quite part of the dangerous quarantined space. Special precautions were taken upon arrival to prevent direct or indirect contact with newly arrived passengers and cargo. While captains and passengers were being interrogated about their journey and health passes were being checked, the risk of contagion through proximity to others and per fomitem was regarded as very high.42 In Marseille, the captain and crew were questioned while standing in a room with a large window covered with a grid, from behind which the health official would speak. Opposite that window but some distance from it was a shed with an open side facing the health official. Those who were being interrogated would stay in the shed, while the health official could remain at a safe distance, avoiding direct and indirect contact. The gap between the window and the shed provided both physical distance and facilitated protective ventilation. A similar room was used to visit the sick arriving by ship.43 In the same way, in Venice, the report was taken by an official behind a window, while the captain stood outside in an enclosed entry space.44 Lazzaretti had parlors where quarantined passengers could meet visitors from the outside and receive objects from them. As in convents, these meetings were strictly controlled, and only visitors with written authorization were permitted, thereby ensuring complete safety.45 The entrance door to the lazaretto of Marseille was flanked by two parlors, one for the porters working in the lazzaretto and the other for the passengers (Fig. 3.4). Each parlor consisted of two chambers placed on either side of the lazzaretto’s walls. Two gates and a metal grid prevented direct contact between passengers, staff, and visitors, including the passing of objects that might result in contagion per fomitem.46 As in the interrogation room, a wide gap between the chambers allowed the continuous

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Fig. 3.4  Detail of the parlor in the Marseille lazzaretto, from J.  Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789) Plate 1. Getty Research Institute, Los Angeles (85-B11700)

ventilation and exchange of air, separating the potentially infected passengers and the visitors.47 Lazzaretti employed ingenious architectural features to protect their interior from contagion in ways reminiscent of the nunneries, which used ruote (a sophisticated turning hatch) to keep the convent sealed off from contact while receiving deliveries.48 In Marseille, small objects for passengers were brought inside a separate building near the entrance. The controlled exchange of goods and supplies was only permitted by following a specific procedure, when visitors were let into the building with their goods and objects that were then deposited inside a large stone basin. After the visitors exited, passengers and porters were let in to collect these items, thereby preventing direct contact and proximity, as stone was considered less likely to transmit disease than other materials, especially those with porous surfaces such as wood and textiles.49 The same system was used when objects needed to be taken outside of the

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lazzaretto. Metal objects and money paid by passengers for their supplies were first disinfected in an iron basin filled with vinegar before being taken outside of the lazzaretto; letters were sprinkled with vinegar.50 Similar expedients and devices were considered in the design of the new parlor in the lazzaretto of San Leopoldo in Livorno (Fig. 3.5). A stone basin full of seawater placed between the quarantined and non-quarantined sections was thought capable of disinfecting money passed to the visitors or keys passed to the porters. In the same building, the canteen was planned to include a special serving hatch to protect staff from contagion. It had an opening through which food was served and two communicating basins full of seawater for the disinfection of cutlery and coins as they were exchanged.51 Despite the large variety of floorplans and forms, the architecture of lazzaretti shared some key design features, as already highlighted in the discussion of the choice of their locations. Lazzaretti required isolation

Fig. 3.5  Plan of the project for the chapel, canteen and parlor of the lazzaretto of San Leopoldo, 1785. The stone basin is labeled with N and the canteen is labeled with G. Livorno, Archivio di Stato di Livorno, Magistrato poi Dipartimento di Sanità, 153 (657/34.34.46(8), 19.05.2020)

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from the city, but close analysis of their floorplans reveals that segregation of workers and residents on the inside was also important. Lazzaretti were usually divided into enclosures dedicated to different quarantine groups. These groups were separated according to the danger of contagion as assessed and declared on the health pass, the number of quarantine days required, and, in the case of the lazzaretto in Split, the nature of the trade mission, that is, by land or sea.52 Among other examples, the Genoese lazzaretti in Varignano and Foce were designed as blocks of separated courtyards to contain passengers and goods coming from regions declared or suspected to have outbreaks of disease (Fig. 3.6) (see Fig. 3.1). In some examples, such as the lazzaretti of San Leopoldo and San Rocco in Livorno, seawater was used to create internal divisions. Canals acted as partitions between holding areas in order to keep quarantined goods and people from low-risk areas away from those arriving from the more dangerous plague-impacted regions (Fig. 3.7, see Fig. 3.3). In Messina, the warehouse for clean goods was separated from the main site of the

Fig. 3.6  Plan of the Lazzaretto della Foce, Genoa, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […], 1789), Plate 2. Getty Research Institute, Los Angeles (85-B11700)

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Fig. 3.7  Plan of the Lazzaretto of San Rocco, Livorno, from J.  Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T. Cadell […]: 1789), Plate 8. Getty Research Institute, Los Angeles (85-B11700)

lazzaretto by a canal with drawbridges (Fig. 3.8). Lazzaretti typically had several warehouses that were divided by double wooden gates to prevent contact between porters unloading cargo from different places of origin.53 The common use of double walls also played a crucial role in creating contagion-free routes for staff. The zones of safety between the walls were used as a path to access different quarantined courtyards or to move around the lazzaretto complex without coming into proximity with potentially infected passengers. In other cases, such as the lazzaretto in Split, separate paths were devised to access the various enclosures. A centralized plan adopted in lazzaretti in Verona, Ancona, Milan, and Bergamo provided another variation on this compartmentalization

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Fig. 3.8  Plan of the Lazzaretto of Messina, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T.  Cadell […]: 1789), Plate 11. Getty Research Institute, Los Angeles (85-B11700)

strategy. A central rectangular courtyard designed for the lazzaretto of San Pancrazio in Verona was divided into four sections by diagonal walls that intersected at the central chapel (Fig. 3.9). Each section of the courtyard was then further divided into three enclosures with wooden fences.54 A portico and rooms for passengers ran around the main courtyard, and access to each of the courtyard’s four sections was provided by an entrance in direct communication with the outside. The lazzaretto in Ancona also featured a centralized plan, shaped as a pentagon, with routes of access, travelers’ accommodation, and warehouses arranged along the courtyard with a chapel in the middle (see Fig. 3.2). However, the courtyard was not divided by walls or fences, as noted by the local health officials in Ancona, who communicated their concerns to the Sacra Consulta in Rome, the central authority for running the Papal States: [The building] would have been more convenient and safer to use if, instead of being of regular form, it was irregular, despite being unflattering to the

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Fig. 3.9  View of the lazzaretto of San Pancrazio, Verona. Archivio di Stato di Verona, Mappe e Disegni, Ospedale dei Santi Jacopo e Lazzaro alla Tomba, 2024, 1 (1370-A, 19.05.2020, license n. 12/2020)

eye, as the quarantines of thirteen warehouses and people from thirty accommodations have to disembark all in one, if vast, courtyard.55

Although the letter proceeded to describe the need to divide the courtyard, which would have added the benefit of reducing operational and staffing costs, such walls were never built, and the lazzaretto in Ancona maintained its previous system of control by using guards and prescribed distancing. The guards were equipped with long rods, which they used to prevent mingling among the quarantined groups and to ensure that a distance of eight paces was observed.56 Each of the quarantine accommodations and warehouses was controlled by such a guard. A total of forty-three were employed when the lazzaretto operated at full capacity.57 The same system of guards was generally adopted in other lazzaretti, even those that, unlike the one in Ancona, incorporated structural solutions to distancing measures. Separation from the outside and segregation inside were also key elements of the design of lazzaretti chapels. The plans for a new chapel in the

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lazzaretto of San Leopoldo (1785) in Livorno show that it was located in the buffer zone between two walls in order to give safe access to priests when they arrived from outside (see Fig. 3.5). Quarantined passengers and staff participated in the mass through a window with a double layer of iron bars that prevented any contact with the priest. A prominent architectural feature of lazzaretti, chapels, too, were designed with early modern theories of contagion in mind. The most common model for such chapels, adopted in the lazzaretti in Verona, Ancona, Cagliari, Genoa, Varignano, and that of San Rocco in Livorno, was a centrally planned structure supported by columns and placed in the middle of the central courtyard. Key features of chapels inside lazzaretti were their visibility within the complex and their ability to let sound travel to enable passengers and staff to follow and hear the mass from afar to avoid contagion through proximity to others. This typology was so successful that in eighteenth Messina it was recommended that a new octagonal chapel be built which was “open on each side” in the middle of the courtyard, instead of the old one in the corner.58 A similar approach involved placing altars at the crossing of the wards, based on a cruciform plan, in early modern hospitals, so that they could be easily seen from the beds lined up along the walls in all four wings.59 In general, concerns with security and visibility, along with the primary importance attached to the auditory aspect of religious service, applied to mass celebrations in times of plague both within and beyond the walls of lazzaretti. Church attendance and the celebration of the mass were forbidden to avoid the assembly of crowds. As a result, it became common to erect altars in the streets and to follow the service from windows or at a safe distance in open air settings. For instance, during a 1577 plague outbreak in Milan, Carlo Borromeo had altars built in the streets, so that people could attend the mass from their windows, announced by the ringing of the city’s bells.60 The same system was used in Florence during the plague of 1630–31.61 Accordingly, chapels inside lazzaretti were either built in the middle of a courtyard, where the mass could be attended in the open air, or designed with large openings in the form of arcades or windows and positioned in such a way that they could simultaneously provide access to the audience and protection from contagion for the priest.

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In the lazzaretto of San Leopoldo in Livorno, the main chapel was a circular building that incorporated parts of the wall that divided the quarantine courtyard from the burial grounds outside, which were open to the public (see Fig. 7.3). Safe access was provided for the priest through the part of the lazzaretto open to non-quarantined people, while travelers and staff inside the lazzaretto were able to follow the service through large windows on the first floor. The chapel in the passengers’ quarters of the lazzaretto of San Carlo in Trieste was designed in a similar way, being located on one side of the courtyard with large openings to enable participation in the mass. In the lazzaretto of Varignano, the chapel rose between two separated courtyards; it also incorporated large windows (see Fig. 3.1). In the lazzaretto of Santa Teresa in Trieste, the chapel was positioned between the passengers’ quarters and the docks, so that both the passengers within the lazzaretto and those who were quarantined aboard the ships could hear the service.62 In Valletta in Malta, the chapel served both the lazzaretto and quarantined ships through its ingenious positioning on St. Michael Counterguard, on the side of Marsamxett Habour opposite to the lazzaretto’s island.63 The mass could be heard through big arched windows. The chapel’s location precluded the risk of potential contagion between passengers and the priest or the transmission of disease beyond the lazzaretto. Anxieties concerning touch and the resulting strategies designed to prevent all forms of physical contact defined the form of Mediterranean lazzaretti. The safety of these structures was also controlled by ensuring the quality of air within the quarantine space. Architecture played a pivotal role in creating a clean and healthy built environment within these isolated, segregated, and airy buildings, thereby helping lazzaretti avoid potential plague outbreaks.64

Salubrious Environments and Physical Health In the early modern period, offensive odors were believed to enhance the poisonous powers of the “seeds of disease.” For instance, in 1760, the Venetian Health Office was extremely concerned about the stench of the marshes around the Lazzaretto Nuovo in Venice and commissioned

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several reports on the issue from engineers Tommaso Scalfarotto and Antonio Giuseppe Rossi.65 One document identified a ditch near the lazzaretto as the source of a “terrible smell, which increases, even more in these swamps, the dangers to health.”66 In another example, the priore of the lazzaretto of Split listed all the repairs required in 1786, highlighting the urgent need to clean the canals “to avoid […] fetid exhalations which carry the causes of infections.”67 Indeed, dirt, stench, and disease were closely connected in early modern thought. Margaret Pelling has drawn attention to the fact that the terms “infection” and “miasma” derive, respectively, from the Latin inficere and the ancient Greek miaino which both mean “to pollute, to stain.”68 As Mary Douglas argues in Purity and Danger, societies often use the categories of cleanliness and pollution to establish boundaries and hierarchies. Removing refuse is a deliberate act aimed at managing and organizing the environment.69 Indeed, in the context of lazzaretti, concepts of cleanliness and dirtiness were used to define hierarchies and to exercise control over plague and contagion. If dirt was and still is considered contrary to the norm, disease was (and surely is) an even greater form of social disruption. Thus, cleanliness was paramount inside the lazzaretto. The vocabulary found in contemporary sources enforced such notions. For example, the adjectives sporco (dirty) and brutto (ugly) were used to label plagued ships, their passengers, and objects they carried and were also applied to describe spaces or lazzaretti allocated to highly suspected passengers and cargoes. The adjective netto (clean) was used to identify objects, spaces, and people that had not come into contact with anything infected or were outside the quarantine area. The disinfection of goods and objects was described as purgare (to purge) or spurgare (to clean) in Italian and mettre en purge (to cleanse) in French.70 Lazzaretti thus tried to control contagion by imposing a high standard of cleanliness in order to manage the anxieties caused by both filth and disease. The choice of the right location for a lazzaretto aimed to provide isolation and a salubrious and clean environment. For an effective lazzaretto, Russell recommended a place that was “insulated, dry, healthy, and airy, with a source of water within itself or so near other sources as to be easily supplied from them.”71 The same was endorsed by the Health Office in Genoa, which stated that “lazzaretti have to be built away from the town,

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properly aired and hidden.”72 Air movement was important for preserving and promoting the health of passengers, visitors, and the occasional ill. The lazzaretto in Marseille was built around a hill that was made available to quarantined passengers so they might benefit from good winds that carried the cleansing scent of thyme that covered the slope.73 The infirmary was built on the same hill, with a beautiful view over the harbor that was expected to lift the spirits of the sick (Fig. 3.10).74 The same importance attached to the circulation of air and the avoidance of odor in lazzaretti was also reflected in contemporary hospital architecture that favored wards with high ceilings and windows to allow fresh air.75 In addition to the benefits of air circulation for passengers, lazzaretti adopted ventilation systems for the disinfection of imported goods such

Fig. 3.10  Plan of the Lazzaretto in Marseille, from J. Howard, An Account of the Principal Lazarettos in Europe (Warrington: William Eyres, T.  Cadell […], 1789), Plate 1. Getty Research Institute, Los Angeles (85-B11700)

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as cotton, wool, leather, and other porous materials, which were believed to retain the “seeds of disease.” Warehouses were designed with large, open windows or arches, positioned in such a way that they could take advantage of local winds. The health board in Trieste compiled a list of all the necessary characteristics for the new quarantine center of Santa Teresa, stressing the importance of having warehouses that were “exposed to a great amount of air and occasionally to free ventilation.”76 In the lazzaretto at Varignano, the superintendent (Commissario Sopraintendente) insisted on having windows in different parts of the building where goods were kept, noting that ventilation was “an essential requirement for the disinfection of goods.”77 However, wind also caused concerns about disease transmission. The hill within the quarantine complex in Marseille was praised as a means of stopping the wind from potentially spreading illness across the city, as it was believed that the wind could transport small particles of infected wool or cotton. In Trieste, the strong autumnal, north or north-eastern, wind called Bora was a factor in choosing the location for the lazzaretto of Santa Teresa. The fear was that Bora could prevent ships from docking and might also carry away contaminated fibers from goods such as textiles, cotton, wool, fur, and leather, thus posing a threat to public health.78 Another important consideration in the choice of the lazzaretti locations was the presence of fresh drinking water, which was seen as essential to ensuring a healthy environment.79 A common characteristic of several lazzaretti was the presence of numerous wells for drinking water and a system of canals and sewers. Each of the seven courtyards in the lazzaretto of Marseille had a fountain and a washhouse for the use of people under quarantine.80 The waters of the Adige River were diverted to the lazzaretto of San Pancrazio in Verona through a system of canals. The lazzaretto of San Jacopo in Livorno was built on the site of three different springs whose waters were carried around the building by an aqueduct. The lazzaretto of Messina, built on an artificial island in the middle of the port, had an aqueduct which supplied the complex with water from the mainland.81 In Livorno, San Leopoldo—the city’s third lazzaretto—had a cistern that could store around 1000 cubic meters of water, while the one in Ancona could store approximately 2050 cubic meters.82 The Health Board of Ancona was particularly proud of the cistern and of its

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water collecting system, which was deemed the best-designed part of the complex. The cistern collected water from the roofs of the warehouses, while the potentially contaminated water coming from passengers’ accommodations was discharged into the sea.83 Writing of the Lazzaretto della Foce in Genoa, John Howard remarked upon the convenient presence of a spring that “contributes much to its salutariness […] and it [is] very convenient for washing linen. Being also properly conducted through all the sewers, it prevents the rooms from being offensive.”84 Sewers played a pivotal role in keeping a lazzaretto free from human waste and smells. From inventories, plans, and descriptions of several lazzaretti, it is possible to establish that rooms were often equipped with latrines.85 Privies were so important that the lazzaretti in Ancona and Varignano had latrines inside both the passengers’ rooms and in the warehouses for the use of staff or merchants, who sometimes wanted to spend the quarantine keeping an eye on their goods.86 Latrines were considered important as they kept the environment free of bad odors.87 In their architectural treatises, both Filarete (ca. 1460) and Francesco di Giorgio Martini (ca. 1480) referred to the importance of latrines in both homes and public buildings. Filarete addressed the issue of privies extensively when describing his plans for the Ospedale Maggiore in Milan, which provided a privy for each patient between the internal walls of the open ward and the exterior walls of the building.88Filarete stressed the importance of abundant running water to flush out the sewers; the Ospedale Maggiore was built near the Navigli canal system for this purpose. The lazzaretto of San Pancrazio in Verona and those in Milan, Bergamo, and Genoa were designed in a similar way, with sewers and canals circulating a flow of water around the buildings so that waste and miasmatic smells from the latrines could be avoided in small rooms. The design of seats and openings to the latrines also played a key role in diverting pervasive odors from the wards to the canals.89 Francesco di Giorgio stressed that latrine design should incorporate good ventilation to avoid stagnant bad smells.90 It is notable that the latrines in the lazzaretto of San Pancrazio in Verona had lids to contain smells, as inspection documents highlight the lack of lids for many of the privies and the urgent need to install them.91 Fireplaces were other common features within lazzaretti. Used for cooking and heating, they were also believed to keep the environment

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healthy. Indeed, fire was thought to move and clarify the air, above all when used in conjunction with perfumes and herbs.92 Sandra Cavallo and Tessa Storey have shown that the importance of fireplaces in keeping the Renaissance house salubrious increased from the late fifteenth century onward.93 Smoke was believed to counteract and neutralize the power of smells.94 Muratori noted the use of scented fire to disinfect and avoid contagion during plague outbreaks, stating that “fire is one of the best corrective elements for pestilential air.”95 The engineer Antonio Giuseppe Rossi addressed the problems posed by the marshy and fetid water near the Lazzaretto Nuovo in Venice by proposing that furnaces be installed on the island.96 Indeed, the island of Murano in the Venetian Lagoon was believed to be particularly healthy due to the resident glass industry’s furnaces and the abundant smoke they generated.97 Smoke and perfumes were also used to disinfect the physical spaces of lazzaretti. Following epidemics, walls of plague hospitals in Venice were disinfected with smoke as part of a thorough cleaning of the whole building.98 In the lazzaretto of San Rocco in Livorno, rooms were usually perfumed after being occupied by the sick or convalescent.99 In the lazzaretti of San Leopoldo and San Rocco in Livorno, the parlor’s separate sections for quarantined passengers and visitors were divided by a corridor called affumatore (smoker), presumably used to blow smoke to disinfect the air. Perfumes and strong scents were used inside lazzaretti to disinfect textiles, papers, and other goods. Lazzaretti were provided with special rooms designed to facilitate the practice of fumigation in order to disinfect goods. In some cases, as in Livorno, Messina, and Trieste, special rooms fitted with fireplaces were used to disinfect letters, as paper was considered extremely contagious when contaminated. In Marseille, the fumigation rooms were provided with beams and hooks to suspend the goods, while perfumes and scents were thrown on the coals in a fire lit in the center of the room.100 The discussion of lazzaretti thus needs to take into account the olfactory environment as a response to cultural concerns about plague and miasmas.101 The overall design of lazzaretti and the presence of specific architectural features highlight the awareness of the presence of smells and their association with contagion and illness alongside the measures undertaken to avoid, eliminate, and prevent these odors.

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Conclusion Lazzaretti formed a system of preventative institutions founded in response to outbreaks of disease in the early modern Mediterranean region. They acted as a defense against the spread of the plague, safeguarding the health of the entire southern portion of Europe, especially those ports that engaged in direct and indirect trade with the Levant and the Barbary Coast. The system of lazzaretti ensured consistency and communication between different health offices, but the fight against contagion started inside each individual lazzaretto. Their architecture was designed to ensure healthy conditions in order to avoid contagion and the consequent spread of disease to cities and entire regions. Early modern notions of plague and contagion related to the anxiety surrounding odor and contact and informed the architectural form of quarantine centers. The disease was thought to be bred and harbored among bad smells and insalubrious conditions. Plague was believed to be spread through the air, transmitted by touching contaminated objects and people or by proximity to diseased and deceased plague victims. The movement of people and goods from potentially infected places was considered extremely dangerous. Thus, the key features in the architecture of lazzaretti were designed to isolate potentially diseased persons or objects and to ensure good air quality for the quarantine site. Lazzaretti were institutions designed to support commerce and facilitate the safe mobility of people and goods, so total isolation was not feasible. Permeability and isolation were balanced in their architecture through compartmentalization and separation. Lazzaretti mobilized the use of local wind patterns and water sources by building warehouses with open arches and windows for ventilation and by providing elaborate water collection and distribution systems. When combined with disinfection practices, these methods ensured the cleanliness of the built environment and the absence of insalubrious smells. The link between environment and health had a prominent role in the development of early modern hospital architecture. In the case of lazzaretti, their analysis not only shows the importance of considering olfactory factors in their design but also how contagion per fomitem

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played an equally important role in shaping the design of such institutions. The analysis of architectural contexts and the material culture of “physical distancing” is essential to understand how buildings were historically used to secure a healthy environment and prevent the spread of disease. Analysis of the built environment of lazzaretti reveals a critical degree to which their design was focused on health promotion and disease prevention rather than healing practices. The activities undertaken inside lazzaretti were drastically different from those undertaken inside other institutions, such as hospitals. Nonetheless, the protocols and the architecture of lazzaretti reflected practices and design features based on general medical knowledge. As other studies on early modern preventative medicine have emphasized, such measures played an important role in the everyday life of the period. The emergence of the COVID-19 global pandemic in 2020 further underlines the need for the study of quarantine as an historical preventative practice that can provide relevant insights into how societies have addressed the constant and widespread threat of disease.

Notes 1. The name was later corrupted to nazareth or nazaretto and then lazzaretto. See Jane L. Stevens Crawshaw, Plague Hospitals: Public Health for the City in Early Modern Venice (Burlington, VT: Ashgate, 2012), 20. 2. Jane Stevens Crawshaw highlights three classes of institutions and measures against the plague. The first class constitutes the subject of this chapter and consists of permanent and preventative institutions, also in use during plague-free years. The second class includes permanent institutions such as plague hospitals, used only during the epidemics to cure the sick and isolate suspected cases. Temporary facilities or seized buildings used only during the outbreak fall into the third class. Stevens Crawshaw, Plague Hospitals, 8–9. 3. Ibid., Introduction and Conclusion. 4. Ibid. 5. On how the study of the senses relates to the study of architectural history, see David Karmon and Christy Anderson, “Early Modern Spaces

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and Olfactory Traces,” in The Routledge Handbook of Material Culture in Early Modern Europe, ed. Catherine Richardson, Tara Hamling, and David Gaimster (London: Routledge, 2016), 354–70. 6. On quarantine in Dubrovnik, see Zlata Blazina Tomic and Vesna Blazina, Expelling the Plague: The Health Office and the Implementation of Quarantine in Dubrovnik, 1377–1533 (Montreal: McGill-Queen’s Press, 2015). For more in general on quarantine, see Alison Bashford, ed., Quarantine: Local and Global Histories (Basingstoke, Hampshire: Macmillan International Higher Education, 2016); John Booker, Maritime Quarantine: The British Experience, c.1650–1900 (New York: Routledge, 2016); Alex Chase-Levenson, The Yellow Flag: Quarantine and the British Mediterranean World, 1780–1860 (Cambridge: Cambridge University Press, 2020). 7. Archivio di Stato di Roma (ASR), Camerale III, 193, Mastrino delle fabbriche di Ancona, cited in Carlo Mezzetti, Giorgio Bucciarelli, and Fausto Pugnaloni, Il Lazzaretto di Ancona: Un’opera dimenticata (Ancona: Cassa di Risparmio di Ancona, 1978), 181 and 197. 8. Chiara Simon, “La Sanità Marittima a Trieste Nel Settecento (Da Carlo VI a Maria Teresa, 1711–1780),” Archeografo Triestino, IV, 64, (2004) 263–359, 308; Österreichischen Staatsarchiv (ÖStA), Finanz- und Hofkammerarchiv, Commerz, 532, Relazione Guadagnini. 9. See Daniel Panzac, Quarantaines et Lazarets: L’Europe et La Peste d’Orient, XVIIe–XXe Siècles (Aix-en-Provence: Edisud, 1986); NelliElena Vanzan Marchini, ed., Rotte mediterranee e baluardi di sanità: Venezia e i lazzaretti mediterranei (Milan: Skira, 2004); more broadly on quarantine and contagion, see Mark Harrison, Contagion: How Commerce Has Spread Disease (New Haven: Yale University Press, 2012); Bashford, ed., Quarantine: Local and Global Histories; John Booker, Maritime Quarantine: The British Experience, c.1650–1900 (New York: Routledge, 2016); Chase-Levenson, The Yellow Flag. 10. John Henderson, “The Material Culture of Health: Hospitals and the Care of the Sick in Renaissance Italy,” in Gesundheit, Krankheit: Kulturtransfer medizinischen Wissens von der Spätantike bis in die Frühe Neuzeit, ed. Florian Steger and Kay Peter Jankrift (Cologne: Böhlau, 2004), 155, 165. On medical preventative practices and the home, see Sandra Cavallo and Tessa Storey, eds., Healthy Living in Late Renaissance Italy (Oxford: Oxford University Press, 2013). On the architectural analysis of plague hospitals in Venice, see Stevens Crawshaw, Plague

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Hospitals, ch. 1. On the broad subject of hospitals, see John Henderson, Peregrine Horden, and Alessandro Pastore, eds., The Impact of Hospitals, 300–2000 (Oxford: Peter Lang, 2007); Christopher Bonfield, Jonathan Reinarz, and Teresa Huguet-Termes, eds., Hospitals and Communities, 1100–1960 (Oxford: Peter Lang, 2013); Bert O. States et al., eds., The Great Pox: The French Disease in Renaissance Europe (New Haven: Yale University Press, 1997). 11. On different health boards in the Mediterranean area, see Paul Cassar, Medical History of Malta (London: Wellcome Historical Medical Library, 1965); Carlo M. Cipolla, Cristofano and the Plague: A Study in the History of Public Health in the Age of Galileo (London: Collins, 1973); Carlo M. Cipolla, Public Health and the Medical Profession in the Renaissance (Cambridge: Cambridge University Press, 1976); Richard John Palmer, “The Control of Plague in Venice and Northern Italy 1348–1600,” PhD diss., University of Kent, 1978; Françoise Hildesheimer, Le Bureau de la santé de Marseille sous l’ancien régime: Le renfermement de la contagion (Marseille: Fédération historique de Provence, 1980); Carlo M. Cipolla, Fighting the Plague in SeventeenthCentury Italy (Madison: University of Wisconsin Press, 1981); Giuseppe Restifo, Epidemie e società nel mediterraneo di età moderna (Messina: A. Siciliano, 2001); Raffaella Salvemini, ed., Istituzioni e traffici nel Mediterraneo tra età antica e crescita moderna (Rome: Consiglio nazionale delle ricerche, Istituto di studi sulle società del Mediterraneo, 2009); Daniele Palermo and Paolo Calcagno, eds., La quotidiana emergenza. I molteplici impieghi delle istituzioni sanitarie nel Mediterraneo moderno (Palermo: New Digital Press, 2017). 12. See Cavallo and Storey, Healthy Living in Late Renaissance Italy. 13. The term “passenger” (passeggero, pl. passeggeri) will be used throughout the chapter to refer to people quarantined inside the lazzaretti in accordance with its use in the primary sources. 14. Annemarie Kinzelbach, “Infection, Contagion, and Public Health in Late Medieval and Early Modern German Imperial Towns,” Journal of the History of Medicine and Allied Sciences 61, no. 3 (2006): 370. 15. See Cipolla, Cristofano and the Plague; Cipolla, Fighting the Plague in Seventeenth-Century Italy; Ann G. Carmichael, Plague and the Poor in Renaissance Florence (Cambridge: Cambridge University Press, 1986). 16. See Vivian Nutton, “The Reception of Fracastoro’s Theory of Contagion: The Seed that Fell among Thorns?,” Osiris 6 (1990): 196–234; Richard

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John Palmer, “Girolamo Mercuriale and the Plague of Venice,” in Girolamo Mercuriale: Medicina e cultura nell’Europa del Cinquecento: Atti del convegno “Girolamo Mercuriale e lo spazio scientifico e culturale del Cinquecento (Forlì, 8–11 novembre 2006),” ed. Alessandro Arcangeli and Vivian Nutton (Florence: LSOlschki, 2008), 51–65; John Henderson, “Historians and Plagues in Pre-Industrial Italy over the Longue Durée,” History & Philosophy of the Life Sciences 25, no. 4 (2003): 488; Kinzelbach, “Infection, Contagion, and Public Health.” 17. Ann G. Carmichael, “Contagion Theory and Contagion Practice in Fifteenth-Century Milan,” Renaissance Quarterly 44, no. 2 (1991): 226. 18. On touch in the early modern period, see Carmichael, “Contagion Theory and Contagion Practice in Fifteenth-Century Milan”; Richard Sennett, Flesh and Stone: The Body and the City in Western Civilization (London: Faber & Faber, 1996), 212–49; Margaret Healy, “Anxious and Fatal Contacts: Taming the Contagious Touch,” in Sensible Flesh: On Touch in Early Modern Culture, ed. Elizabeth D. Harvey (Philadelphia: University of Pennsylvania Press, 2003), 22–38. 19. Samuel K. Cohn, Cultures of Plague: Medical Thinking at the End of the Renaissance (Oxford: Oxford University Press, 2010), 1–4. 20. Vivian Nutton, “The Seeds of Disease: An Explanation of Contagion and Infection from the Greeks to the Renaissance,” Medical History 27, no. 1 (1983): 6–7. 21. Quoted in Carmichael, “Contagion Theory and Contagion Practice,” 226. 22. Nutton, “The Seeds of Disease,” 21–22. 23. For some examples of earlier treatises, see Samuel K. Cohn, The Black Death Transformed: Disease and Culture in Early Renaissance Europe (London: Hodder Education, 2003), 234–35. 24. “In tre maniere si può ricevere il Veleno della Pestilenza cioè toccando i Corpi Appestati o le Robe e gli Animali da loro maneggiati e toccati ovvero l’Aria da essi o contigua.” Lodovico Antonio Muratori, Del Governo della Peste, e delle maniere di guardarsene (Modena: Bartolomeo Soliani, 1714), 47–48. 25. Patrick Russell, A Treatise of the Plague: Containing an Historical Journal, and Medical Account, of the Plague, at Aleppo, in the Years 1760, 1761, and 1762 (London: G. G. J. and J. Robinson, 1791), 296.

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26. Richard Mead, A Short Discourse Concerning Pestilential Contagion: And the Methods to Be Used to Prevent It (Dublin: George Grierson, 1721), 2; emphasis in the original. 27. Russell, A Treatise of the Plague, 298. 28. Ibid., 298–99. On the different materials subject to contagion, see Marina Inì, “Materiality, Quarantine and Contagion in the Early Modern Mediterranean,” Social History of Medicine (advance article online). 29. Muratori, Del Governo della Peste, 80. 30. Mead, A Short Discourse, 8–9. 31. John Howard, An Account of the Principal Lazarettos in Europe with Various Papers Relative to the Plague: Together with Further Observations on Some Foreign Prisons and Hospitals; and Additional Remarks on the Present State of Those in Great Britain and Ireland (Warrington: William Eyres, T. Cadell […], 1789), 34. 32. Archivio di Stato di Palermo (ASPa), Soprintendenza Generale della Salute Pubblica, 235, f. 31 r. On measures, see Tavole di ragguaglio dei pesi e delle misure già in uso nelle varie provincie del regno col peso metrico decimale approvate con decreto reale 20 maggio 1877, n. 3836 (Rome: Stamperia reale, 1877). 33. Archivio Comunale di Ancona (ACAn), Antico Regime, II, Ufficio di Sanità, 2, f. 171 v. 34. Muratori, Del Governo della Peste, 2–3. 35. Mead, A Short Discourse, 4. 36. Ibid., 11 and 13. 37. On the urban environment, public health, and prevention, see Carlo M. Cipolla, Miasmas and Disease: Public Health and the Environment in the Pre-Industrial Age (New Haven: Yale University Press, 1992); Richard John Palmer, “In Bad Odour: Smell and Its Significance in Medicine from Antiquity to the Seventeenth Century,” in Medicine and the Five Senses, ed. William F. Bynum and Roy Porter (Cambridge: Cambridge University Press, 1993), 61–68; Renato Sansa, “L’odore del contagio: Ambiente urbano e prevenzione delle epidemie nella prima età moderna,” Medicina e Storia 2, no. 3 (2002): 83–108; Douglas Biow, The Culture of Cleanliness in Renaissance Italy (Ithaca, NY: Cornell University Press, 2006); Mark Bradley and Kenneth R. Stow, eds., Rome, Pollution, and Propriety: Dirt, Disease, and Hygiene in the Eternal City from Antiquity to Modernity (Cambridge: Cambridge University

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Press, 2012); Carole Rawcliffe, Urban Bodies: Communal Health in Late Medieval English Towns and Cities (Woodbridge: Boydell Press, 2013); Jo Wheeler, “Stench in Sixteenth-­Century Venice,” in The City and the Senses: Urban Culture since 1500, ed. Alexander Cowan and Jill Steward (London: Routledge, 2016), 25–38; Guy Geltner, Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy (Philadelphia: University of Pennsylvania Press, 2019); John Henderson, Florence under Siege: Surviving Plague in an Early Modern City (New Haven: Yale University Press, 2019), 56–70. 38. Sansa, “L’odore del contagio,” 95–96; Wheeler, “Stench in Sixteenth-­ Century Venice,” 28. 39. On hospitals for “incurables,” see Robert Jütte, “Syphilis and Confinement: Hospitals in Early Modern Germany,” in Institutions of Confinement, ed. Norbert Finzsch and Robert Jütte (Cambridge University Press, 1997), 87–116; States et al., The Great Pox; Sharon T. Strocchia, “Caring for the ‘Incurable’ in Renaissance Pox Hospitals,” in Hospital Life: Theory and Practice from the Medieval to the Modern, ed. Laurinda Abreu and Sally Sheard (Oxford: Peter Lang, 2013), 67–92. On leper houses, see Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (Oxford: Oxford University Press, 1999). 40. On isolation, water, and impurity in the case of the Ghetto and other institutions in Venice, see Sennett, Flesh and Stone, 212–39; Stevens Crawshaw, Plague Hospitals, 55. 41. On the lazzaretto and its similarity to a castle, see Stevens Crawshaw, Plague Hospitals, 54–61. On the fortified aspect of lazzaretti, see Quim Bonastra, ‘Recintos sanitarios y espacios de control: Un estudio morfológico de la arquitectura cuarentenaria’, Dynamis 30 (2010): 17–40, 60 no. 1 (2008): 237–66. 42. On health passes, see Alexandra Bamji, “Health Passes, Print and Public Health in Early Modern Europe,” Social History of Medicine 32, no. 3 (2019): 441–64. 43. Reglemens du bureau de santé de Marseille (Marseille: Jean Mossy, 1797), 102–103. 44. Howard, An Account of the Principal Lazarettos in Europe, 19. 45. On convents and especially on parlors, see Mary Laven, Virgins of Venice: Enclosed Lives and Broken Vows in the Renaissance Convent (London: Penguin, 2003), 87–89.

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46. ÖStA, Finanz- und Hofkammerarchiv, Commerz, 532, Relazione Guadagnini, f. 9v. 47. Reglemens du bureau de santé de Marseille, 89–90. 48. Laven, Virgins of Venice, 87–89. 49. Inì, “Materiality, Quarantine and Contagion.” 50. Iron too was considered less susceptible to contagion. ÖStA, Finanz-­und Hofkammerarchiv, Commerz, 532, Relazione Guadagnini, f. 10 r. 51. Archvio di Stato di Livorno (ASLi), Magistrato e poi Dipartimento di Sanità, 153. 52. On hospitals, see Risse, Mending Bodies, Saving Souls; John Henderson, The Renaissance Hospital: Healing the Body and Healing the Soul (New Haven: Yale University Press, 2006); John Henderson, Peregrine Horden, and Alessandro Pastore, eds., The Impact of Hospitals, 300–2000 (Oxford: Peter Lang, 2007); Christopher Bonfield, Jonathan Reinarz, and Teresa Huguet-Termes, Hospitals and Communities, 1100–1960 (Oxford: Peter Lang, 2013); Abreu and Sheard, Hospital Life: Theory and Practice from the Medieval to the Modern; Stevens Crawshaw, Plague Hospitals. 53. Editto reale per i ristabilimento del lazzaretto di osservazione in Messina colle istruzioni per buon regolamento del medesimo e colla tariffa per l’esigenza de’ corrispondenti diritti pubblicato per ordine di Sua Maestà (Naples: Stamperia reale, 1786), 21. 54. Archivio di Stato di Verona (ASVr), Ufficio di Sanità, Carteggi, relazioni e atti diversi, 19, September 30, 1738. 55. “[L’edificio] sarebbe stato di un uso assai più comodo e sicuro se in luogo d’essere di forma regolare fosse stato di struttura inregolare, riuscendo cosa molto disdicevole alla vista, che le contumacie di 13 magazzeni, e le persone di 30 abbitazioni debbino sbarcare tutte in un solo benche vasto cortile.” ACAn, Antico Regime, II, Ufficio di Sanità, Copialettere dei provisori, 24, f. 265. 56. ACAn, Antico Regime, II, Ufficio di Sanità, 2, f. 171 v. 57. Ibid., ff. 267–68. 58. “Aperta d’ogni lato.” ASPa, Archivio Moncada di Paternò, Piante Geometriche e Topografiche, n. 6. 59. Henderson, The Renaissance Hospital, 148–49; Emanuel Buttigieg, Nobility, Faith and Masculinity: The Hospitaller Knights of Malta, C.1580–C.1700 (London: Bloomsbury Publishing, 2011), 96.

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60. Bellintani, Dialogo della Peste, 107; Christine Suzanne Getz, Mary, Music, and Meditation: Sacred Conversations in Post-Tridentine Milan (Bloomington: Indiana University Press, 2013), 70–71; Abigail Brundin, Deborah Howard, and Mary Laven, The Sacred Home in Renaissance Italy (Oxford: Oxford University Press, 2018), 308. 61. Henderson, Florence under Siege, 165. 62. Archivio di Stato di Trieste (ASTs), Intendenza Commerciale, 379, f. 231 v.; Regolamento di Sanità, di Pulizia e d’Economia per il Lazzaretto e il Porto Sporco di Trieste, 43. 63. Edward Said, “A Chapel on the Ramparts,” Arx 8 (2011): 74–75, 74. 64. On cleanliness and ventilation, see James C. Riley, The Eighteenth-­ Century Campaign to Avoid Disease (New York: Palgrave Macmillan UK, 1987), 129–32. 65. Archivio di Stato di Venezia (ASVe), Savi ed Esecutori alle Acque, 533. An earlier form of the Venetian Health Office was established and operated on a temporary basis during the fifteenth century in times of need during plague outbreaks. Plague control in healthy years was placed in the hands of the Salt Office. The Health Office became permanent in 1486 (archival documents indicate continued operations after 1490). The Office’s principal tasks included ensuring plague control (through lazzaretti and the growing transnational health system) and the quality of the food supplies and of the air of the city. See Palmer, “The Control of Plague in Venice and Northern Italy 1348–1600,” 50–68. 66. “[P]roduce cattivissimo odore, e maggiormente l’accresce in queste paludi il pericolo della salute.” ASVe, Provveditori e Sopraprovveditori alla Sanità, 388, June 12, 1749. 67. “[D]i evitare […] delle fettide esalazioni che tramandano il motivo all’infezioni.” ASVe, Provveditori e Sopraprovveditori alla Sanità, 392, November 27, 1786. 68. Margaret Pelling, “The Meaning of Contagion: Reproduction, Medicine and Metaphor,” in Contagion: Historical and Cultural Studies, ed. Alison Bashford and Claire Hooker (New York: Routledge, 2001), 20. 69. Mary Douglas, Purity and Danger: An Analysis of Concept of Pollution and Taboo (London: Routledge, 2002), 2. 70. On similar terminology in seventeenth-century Rome, see David Gentilcore, “Purging Filth,” 159. 71. Russell, A Treatise of the Plague, 104.

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72. “I lazzaretti devono essere situati [lontano] dall’abitato, ventilosi, e segreti.” Archivio di Stato di Genova (ASGe), Banco di S. Giorgio, Cancelleria, 479, May 11, 1762. 73. Reglemens du bureau de santé de Marseille, 97. 74. ÖStA, Finanz- und Hofkammerarchiv, Commerz, 532, Relazione di Francesco Antonio Guadagnini, ff. 10 v.–11 r. 75. See John D. Thompson and Grace Goldin, The Hospital: A Social and Architectural History (New Haven: Yale University Press, 1975); Henderson, The Renaissance Hospital, 157–59; Stevens Crawshaw, Plague Hospitals, 39–78; Karmon and Anderson, “Early Modern Spaces and Olfactory Traces,” 366–67; Henderson, Florence under Siege, 195–98. 76. “Che i Magazzini sieno esposti à molta aria ed all’occorrenza a libera ventilazione.” ÖStA, Finanz- und Hofkammerarchiv, Acta Lazareto Sporc, 1757; cited in Chiara Simon, “La sanità marittima a Trieste nel Settecento,” 303. 77. “[R]equisito essenziale all’espurgo delle merci.” ASGe, Ufficio di Sanità, 1283, October 25, 1760. 78. ASTs, Intendenza Commerciale, 380, f. 13 r. 79. On drinking water in the early modern period, see David Gentilcore, “From ‘Vilest Beverage’ to ‘Universal Medicine’: Drinking Water in Printed Regimens and Health Guides, 1450–1750,” Social History of Medicine 33, no. 3 (2020): 683–703. 80. Reglemens du bureau de santé de Marseille, 95. 81. Archivio di Stato di Messina (ASMe), Deputazione della Salute, 2, f. 21 r. 82. Howard, An Account of the Principal Lazarettos, see Plate 7; ACAn, Antico Regime, II, Ufficio di Sanità, 2, f. 62 r. 83. ACAn, Antico Regime, II, Ufficio di Sanità, 2, f. 62 r-v. 84. Howard, An Account of the Principal Lazarettos, 6. 85. ASVr, Ufficio di Sanità, Carteggi, relazioni e atti diversi, 26, November 29, 1742; ASGe, Ufficio di Sanità, 315, f. 8v.; Archivio di Stato di Firenze (ASFi), Miscellanea Piante, 147 b. Pianta del Lazzaretto di San Leopoldo; ACAn, Antico Regime II, Ufficio di Sanità, 2, f. 110 v.; Howard, An Account of the Principal Lazarettos, 6. 86. ACAn, Antico Regime, II, Ufficio di Sanità, 3, f. 51–52; ASGe, Ufficio di Sanità, 1280, Memorie per Giovanni Battista Montaldo.

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87. For the late medieval period, see Rawcliffe, Urban Bodies, 140–47; Geltner, Roads to Health, 43–44 and 159. On the early modern period, see Peter Thornton, The Italian Renaissance Interior 1400–1600 (London: Weidenfeld and Nicolson, 1991), 245–49; Biow, The Culture of Cleanliness, 4–9 and 144–81. 88. Thompson and Goldin, The Hospital: A Social and Architectural History, 33–34. 89. Filarete (Antonio di Piero Averlino), Filarete’s Treatise on Architecture. Being the Treatise by Antonio di Piero Averlino, Known as Filarete, ed. G. Kubler and J. R. Spencer (New Haven: Yale University Press, 1965), 137–39. 90. Francesco di Giorgio Martini, Il Codice Ashburnham 361 della Biblioteca Medicea Laurenziana di Firenze: Trattato di Architettura di Francesco di Giorgio Martini, Vol. 2, ed. Luigi Firpo and Pietro C. Marani (Florence: Giunti Barbèra, 1979), 38 (18 v). 91. ASVr, Ufficio di Sanità, Carteggi, relazioni e atti diversi, 19, January 23, 1739; October 15, 1738; f. 26, November 29, 1742. 92. Ibid. 93. Cavallo and Storey, Healthy Living, 94. 94. Wheeler, “Stench in Sixteenth-Century Venice,” 28. 95. “[I]l Fuoco è uno dei migliori correttivi dell’Aria pestilente,” Muratori, Del Governo della Peste, 146. 96. ASVe, Savi ed Esecutori alle Acque, 533, July 24, 1760. 97. Stevens Crawshaw, Plague Hospitals, 49; Wheeler, “Stench in Sixteenth-­ Century Venice,” 27. 98. Stevens Crawshaw, Plague Hospitals, 229. 99. ASLi, Magistrato poi Dipartimento di Sanità, 22, f. 28 r. 100. Reglemens du bureau de santé de Marseille, 121. 101. See Karmon and Anderson, “Early Modern Spaces and Olfactory Traces.”

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Bamji, Alexandra, “Health Passes, Print and Public Health in Early Modern Europe.” Social History of Medicine 32, no. 3 (2019): 441–64. Banco di S. Giorgio collection, Archivio di Stato di Genova, Genoa. Bashford, Alison, ed. Quarantine: Local and Global Histories. Basingstoke, Hampshire: Macmillan International Higher Education, 2016. Bellintani, Paolo. Dialogo Della Peste, edited by Ermanno Paccagnini. Milan: Libri Scheiwiller, 2001. Biow, Douglas. The Culture of Cleanliness in Renaissance Italy. Ithaca, NY: Cornell University Press, 2006. Bonastra, Quim, ‘Recintos sanitarios y espacios de control: Un estudio morfológico de la arquitectura cuarentenaria’, Dynamis 30 (2010): 17–40. Bonfield, Christopher, Jonathan Reinarz, and Teresa Huguet-Termes. Hospitals and Communities, 1100–1960. Oxford: Peter Lang, 2013. Booker, John. Maritime Quarantine: The British Experience, c.1650–1900. New York: Routledge, 2016. Brundin, Abigail, Deborah Howard, and Mary Laven. The Sacred Home in Renaissance Italy. Oxford University Press, 2018. Buttigieg, Emanuel. Nobility, Faith and Masculinity: The Hospitaller Knights of Malta, C.1580–C.1700. London: Bloomsbury Publishing, 2011. Camerale III. Archivio di Stato di Roma, Rome. Carmichael, Ann G. “Contagion Theory and Contagion Practice in Fifteenth-­ Century Milan.” Renaissance Quarterly 44, no. 2 (1991): 213–56. Cassar, Paul. Medical History of Malta. London: Wellcome Historical Medical Library, 1965. Cavallo, Sandra, and Tessa Storey. Healthy Living in Late Renaissance Italy. Oxford: Oxford University Press, 2013. Chase-Levenson, Alex. The Yellow Flag: Quarantine and the British Mediterranean World, 1780–1860. Cambridge: Cambridge University Press, 2020. Cipolla, Carlo M. Cristofano and the Plague: A Study in the History of Public Health in the Age of Galileo. London: Collins, 1973. Cipolla, Carlo M. Fighting the Plague in Seventeenth-Century Italy. Madison: University of Wisconsin Press, 1981. Cipolla, Carlo M. Miasmas and Disease: Public Health and the Environment in the Pre-Industrial Age. New Haven: Yale University Press, 1992. Cohn, Samuel K. The Black Death Transformed: Disease and Culture in Early Renaissance Europe. London: Hodder Education, 2003. Cohn, Samuel K. Cultures of Plague: Medical Thinking at the End of the Renaissance. Oxford: Oxford University Press, 2010.

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Deputazione della Salute. Archivio di Stato di Messina, Messina. di Giorgio Martini, Francesco. Il Codice Ashburnham 361 della Biblioteca Medicea Laurenziana di Firenze: Trattato di Architettura di Francesco di Giorgio Martini. Vol. 2, edited by Luigi Firpo and Pietro C. Marani. Florence: Giunti Barbèra, 1979. Douglas, Mary. Purity and Danger: An Analysis of Concept of Pollution and Taboo. London: Routledge, 2002. Editto reale per i ristabilimento del lazzaretto di osservazione in Messina colle istruzioni per buon regolamento del medesimo e colla tariffa per l’esigenza de’ corrispondenti diritti pubblicato per ordine di Sua Maestà. Naples: Stamperia reale, 1786. Filarete (Antonio di Piero Averlino). Filarete’s Treatise on Architecture. Being the Treatise by Antonio di Piero Averlino, Known as Filarete, edited by G. Kubler and J. R. Spencer. New Haven: Yale University Press, 1965. Geltner, Guy. Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy. Philadelphia: University of Pennsylvania Press, 2019. Gentilcore, David. “From ‘Vilest Beverage’ to ‘Universal Medicine’: Drinking Water in Printed Regimens and Health Guides, 1450–1750.” Social History of Medicine 33, no. 3 (2020): 683–703. Gentilcore, David, “Purging Filth: Plague and Responses to It in Rome, 1656–7.” In Rome, Pollution and Propriety, edited by Mark Bradley and Kenneth Stow, 153–68. Cambridge: Cambridge University Press, 2012. Getz, Christine Suzanne. Mary, Music, and Meditation: Sacred Conversations in Post-Tridentine Milan. Bloomington: Indiana University Press, 2013. Harrison, Mark. Contagion: How Commerce Has Spread Disease. New Haven: Yale University Press, 2012. Healy, Margaret. “Anxious and Fatal Contacts: Taming the Contagious Touch.” In Sensible Flesh: On Touch in Early Modern Culture, edited by Elizabeth D. Harvey, 22–38. Philadelphia: University of Pennsylvania Press, 2003. Henderson, John. Florence under Siege: Surviving Plague in an Early Modern City. New Haven: Yale University Press, 2019. Henderson, John. “The Material Culture of Health: Hospitals and the Care of the Sick in Renaissance Italy.” In Gesundheit, Krankheit: Kulturtransfer medizinischen Wissens von der Spätantike bis in die Frühe Neuzeit, edited by Florian Steger and Kay Peter Jankrift, 155–65. Cologne: Böhlau, 2004. Henderson, John. The Renaissance Hospital: Healing the Body and Healing the Soul. New Haven: Yale University Press, 2006.

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Part II Salutogenic Infrastructure

4 Architecture and Infrastructure: The Salutogenetic Plan for Karlsruhe Joaquín Medina Warmburg, Nina Rind, and Nikolaus Koch

Searching for health-related architecture and urban planning in Germany, one finds particularly striking case studies from the nineteenth century, when the approach to social and hygienic reforms anticipated the achievements of the architectural modernism under the Weimar Republic (1918–33). As a result, such a well-known example as Dammerstock-­ Siedlung (1929) in Karlsruhe by Walter Gropius, with its sun-oriented row houses, can be interpreted as an adaptation of the theory of solar architecture (Sonnenbaulehre), postulated as early as 1824 by the physician Bernhard Christoph Faust.1 Even earlier, however, in the beginning of the eighteenth century, architects and urban planners paid attention not only to sunlight, but also to a whole range of factors that were deemed important for healthy living. These efforts can be seen in the Residenzstadt— the princely residence and capital city—of Karlsruhe, built as the new seat of the court of the Margraviate of Baden-Durlach (from 1771, Baden) in southwest Germany beginning in 1715.

J. Medina Warmburg (*) • N. Rind • N. Koch Karlsruhe Institute for Technology, Karlsruhe, Germany e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_4

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At first glance, the Baroque geometry of Karlsruhe reveals a desire to control the city, its population, and the surrounding territory. The margrave ruled over the urban space and the rural surroundings from a panopticon-­like castle at the city’s center. What is less obvious, however, is the fact that this exercise of control was also meant to create a healthy living environment for the city’s inhabitants. In the beginning of the eighteenth century, the ancient Hippocratic doctrine of miasmas (vaporous putrid emanations) continued to hold sway. According to this theory, the air was the carrier of diseases such as malaria, which was the main threat in areas along rivers, as was the case with Karlsruhe. A healthy urban environment had to be exposed to fresh air and sun. Because of this belief, the planning of the city with its houses, parks, baths, and fountains came increasingly to the fore of architectural thinking as disease prevention measures. The medicalization of architecture and urban planning had helped prevent the spread of disease well before the modern theory of hygiene was born in the early nineteenth century in large industrial cities threatened by cholera, typhus, and tuberculosis. One even can argue that the definitive rejection of the long-standing theory of miasmas after the London cholera epidemic of 1854 was precipitated not only by the developments in the field of medicine, but also the architectural practice of the eighteenth century. With the help of archival evidence, this chapter examines the development of Karlsruhe from a salutogenetic point of view by focusing on three main aspects of its planning, architecture, and infrastructure. First, it discusses the importance of public green spaces in the city’s original plan from around 1718. Second, it addresses the role of the urban infrastructure, specifically the water supply, in relation to the larger territorial system. Finally, it analyzes the role of planning geometry and specific hygiene-related building regulations in shaping the model houses designed for Karlsruhe. Together, these three subjects illustrate how the city’s plan sought to align the ideas of public welfare and absolutist control—a goal not without problems and internal contradictions—in the interests of Karlsruhe’s inhabitants and their health, to foster the new town’s prosperity.

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 he Solar Plan, Artificial Climate, and Public T Green Space A popular legend that emerged toward the end of the eighteenth century describes the founding of Karlsruhe, attributing it to a dream that Margrave Karl Wilhelm von Baden-Durlach (r. 1709–38) had when, exhausted after hunting, he lay down to rest in a forest. He dreamt of a fan-shaped city plan with streets radiating from a circle like sunrays. Whether or not this legend is true, Karlsruhe’s name—meaning “Karl’s rest”—reflected its original purpose as the margrave’s recreational retreat. A healthy country environment was intended to facilitate the margrave’s recovery from the burdens of government. Beginning in 1715, a hunting palace was built as a three-winged complex facing the sun, according to the plans by the architect Jacob Friedrich von Batzendorf. The octagonal stone tower that marked the center of the entire plan was completed in 1716; and, in 1717, the construction of the wooden central building block (corps de logis) began. It was probably not until 1718 that the decision was made to transform this typical hunting château into the new capital of Baden. The pressing reason for this decision was that the existing palace in the medieval residence town of Durlach, 6  km from Karlsruhe, was damaged by war and could not be renovated or expanded in accordance with the new margrave’s wishes. As a result, he chose to move his residence to the newly founded city in the midst of the Hardtwald Forest. In addition to access to the urban amenities, several privileges were granted to attract new residents, including religious freedom and economic incentives. In 1718, the design for a fan-shaped layout was ready. Initially, only nine radial streets were planned. They were to extend from the central tower and evenly divide a quarter circle to the south of the palace, between the extensions of its side wings. The unusual idea of combining the ceremonial cour d’honneur with a pleasure garden (Lustgarten) also came into being during this early phase. The center of the city was conceived as an enclosed urban space with its own microclimate, as the garden district to the south was protected by the façades of the so-called circle houses (Zirkelhäuser). It was only two years later, in 1720, that another decision

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was made to complete the circle and thus connect the city with the forest, with the pleasure garden becoming the link between the two. The twenty-­ four avenues that cut through the forest, while representing Jagdstern or “hunting star” used by early modern hunters, symbolized territorial control. At the same time, this arrangement connected the city with the surrounding landscape, since Karlsruhe remained an open, unfortified, town (Fig. 4.1).

Fig. 4.1  Christian Thran, View of the city of Karlsruhe from the north (1739). Stadtarchiv Karlsruhe 8/PBS XVI 47

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Between 1722 and 1728, work on the pleasure garden to the south of the margrave’s palace began. Three orangeries were created in the extension of the palace’s west wing, with the additional fourth in the westernmost part of the circle houses. From 1724, the first greenhouses were built, including that by the architect Johann Carl Hemeling with its south-facing glass front, tiered and heated interior, and massive heat-­ retaining wall to the rear. By 1729, the new garden designed as a series of parterres had 2700 orange trees in addition to grottos, fountains, menageries for exotic animals, and aviaries, one of which housed 300 canaries. At that time, the glasshouse gardener Christian Thran (1701–78) produced two aerial views of Karlsruhe from the south and the north, which were published as engravings in 1739, a year after the city founder’s death. By around 1750, most of the wooden buildings in the pleasure garden fell into disrepair.2 The complex was renovated, expanded, and transformed in 1808, with the establishment of the botanical garden west of the former pleasure garden. Friedrich Weinbrenner (1766–1826), the city’s planning commissioner at the time, provided the overall design. It was to include side wings for orangeries as well as hothouses and cold frames to flank the central, Pantheon-like, plant house.3Weinbrenner’s ambitious plans, however, were not put into effect. The buildings that stand there today were based on the designs produced beginning in 1853 by the city’s head of public construction (Baudirektor) Heinrich Hübsch. He took on the task of creating orangeries, palm houses, conservatories, and greenhouses, initially in the Dutch tradition of wooden construction but ultimately based on more recent English iron frame models (Fig. 4.2).4 Decisive for launching the greenhouse-building tradition in Karlsruhe were the three trips that Margrave Karl Wilhelm made to the Netherlands in 1711, 1723, and 1729. His main objective was to visit Dutch gardens to acquire local gardening knowledge and purchase exotic plants and animals for the “margravial pleasure garden,” including monkeys and even a tiger. At the time, the Netherlands was the leader in glasshouse technology. Based on the simplest technical means and taking advantage of the “greenhouse effect,” such structures trapped solar energy in addition to the use of heating to create favorable living conditions for tropical plants and animals, so that they could survive in the European climate. The creation of glasshouses went hand in hand with advanced research in

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Fig. 4.2  Johann Carl Hemeling, Greenhouse for the Lustgarten [Pleasure Garden] in Karlsruhe (1724). Generallandesarchiv G Karlsruhe 139

botany and zoology, carried out between 1709 and 1730 in the garden of the University of Leyden under the direction of the physician, botanist, and chemist Herman Boerhaave.5 This work relied on the development of new types of orangeries, forcing frames, and greenhouses, which were instrumental for the cultivation and study of citrus fruits, coffee, and spices obtained from the Americas, Asia, and Africa. Christian Thran, who served as the glasshouse gardener in Karlsruhe from 1727, traveled to Algeria and Tunisia via France, Italy, and Malta in 1731–33.6 In 1733, the catalog of the margravial garden listed not only oranges but also pineapples and coffee. As in the case of Karlsruhe, this early modern taste for exotic plants and animals was not merely a harmless hobby. The exotic worlds of European glasshouses, which sought to reproduce the environmental conditions of the Americas, Africa, and Asia, aimed not only to achieve

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the scientific mastery of nature, but also to demonstrate the political, economic, and cultural hegemony over the rest of the world. Captive animals and tropical plants represented not only the confluence of scientific and economic interests, but also symbolized the rule over the regions where they came from. In this context, the idea of populating glasshouses with humans, put forward by the Edinburgh botanist, landscape architect, and a leading greenhouse specialist John Claudius Loudon (1783–1843), seems less absurd than it might appear at first glance. In his 1817 book Remarks on the Construction of Hothouses, he wrote: Perhaps the time may arrive when such artificial climates will not only be stocked with appropriate birds, fishes, and harmless animals, but with examples of the human species from the different countries imitated, habited their particular costumes, and who may serve as gardeners or curators of the different productions. But this subject is too new and strange to admit of discussion, without incurring the ridicule of general readers.7

The attention that Loudon gave to Karlsruhe after his visit there in November of 1828, during an extensive European trip, is particularly pertinent here. Until then, Loudon’s influential Encyclopedia of Gardening had kept the descriptions of the parks and gardens of Karlsruhe relatively short. Following his visit, however, he reported in detail his impressions of the city. In November 1828, for example, he criticized the outdated Dutch models for the wooden greenhouses in Karlsruhe in The Gardener’s Magazine. At the same time, he praised the contributions to botany by the eighteenth-century head gardener Thran and the contemporary directors of the botanical garden Karl Christian Gmelin (1762–1837) and Andreas Johann Hartweg (1777–1831).8 After his trip, Loudon repeatedly praised the Karlsruhe gardens as analogous to public parks, being accessible to all of the city’s inhabitants. As he wrote in the 1835 edition of his Encyclopedia of Gardening, All the gardens and park scenery at Carlsruhe [sic] are at all times open to the public; and they are rendered the more agreeable, during the summer season, by a band of music which perambulates the grounds, and is heard, at short intervals, from morning till night. … All the public have the

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enjoyment, not only of these orange groves, and of the public English garden, but of the park and gardens of the grand duke. Indeed, a prince in Germany enjoys nothing in the open air that is not partaken by all his people; and from this circumstance we in part account for the continued existence, at so advanced a period of society, of so many petty princes, each with immense palaces and extensive gardens. The people are highly taxed to keep up these gardens; but they have almost as much enjoyment of them as if they were their own. One of the finest circumstances in Carlsruhe is, that in two directions the forest of Hardtwald comes up to the gates of the city.9

Given Loudon’s appreciation of a close relationship between the town and the forest, one might even ask whether his own radial plan for the transformation and expansion of London may have been modeled on Karlsruhe.10 It presupposed developing the city as a series of concentric rings with green spaces in between—the “breathing places for the metropolis,” as he called them—to ensure the better quality of air for the benefit of the population. This plan was first published in 1829, shortly after the deadly cholera outbreak in London and only a few months after Loudon’s stay in Baden, although he never made the connection with Karlsruhe explicit. Yet, he acknowledged the considerable effort and costs that the implementation of this systematic plan would involve in a historic city like London, considering it more suitable for a new town, such as the capital for Australia. In the case of Karlsruhe, the formal and conceptual affinity between its layout and the precepts of colonial urban planning draws attention to the larger territorial strategy pursued from the time of the city’s founding, particularly its close relationship with the Hardtwald Forest and the Rhine River (Fig. 4.3).

 erritorial Organization, Water Infrastructure, T and Urban Space Since the margrave’s properties were composed mainly of meadows and forests between the Black Forest and the Rhine, the new city was founded on a wide plain bordering the river. The decision to build it only about

Fig. 4.3  John Claudius Loudon, Concentric expansion plan for London, alternating rings of urban development and greenery (1829). The Gardener’s Magazine, December 1829, 687

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8 km from one of Europe’s most important waterways may seem surprising today, but in the beginning of the eighteenth century it was well-­ advised. At the time, the topography between the Black Forest and the Rhine was fundamentally different. Due to the plain’s soft subsoil of gravel and sand, the river changed its course in the Upper Rhine Valley several times over the centuries. During the Roman period, it had skirted the edge of the Black Forest, but, due to the inflow of mountain streams, including the Rhine’s tributaries the Murg and the Alb, the riverbed gradually shifted westwards. According to the nineteenth-century hydraulic engineer Johann Gottfried Tulla (1770–1828), who was employed at Karlsruhe, The German [portion of the] Rhine changes its course little in some districts, in others very significantly, as between the Kinzig and the Murg, and below Malsch, where it is divided into several arms until it reaches the Neckar. In places where important rivers emerge from the mountains, its course was driven away from the foot of the mountains by the force of these rivers, as can be seen very clearly in the case of the Murg and the Alb.11

The Hardt Plains between the northern edge of the Black Forest and the Rhine were crisscrossed by multiple tributaries. According to Tulla, “All meadowlands, swamps, and quarries between the Hardt and the mountains are parts of the river basin of the German Rhine.”12 This geographical situation resulted in severe flooding during spring and autumn (Fig. 4.4). In Tulla’s words, Karlsruhe is located on the left bank of the German Rhine. This river’s tributary, which once extended to Gottesau and beyond until it was cut by roads, manifested itself by causing flooding between Beyertheim and Karlsruhe. The road from Karlsruhe to Beyertheim goes along the flattened, previously higher, banks.13

Swamps and stone quarries on both sides of the Rhine exuded stagnant and humid air, especially during the summer months. Malaria-spreading mosquitoes were also common. Due to these factors as well as the danger of flooding, only a small portion of the available land was suitable for the

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Fig. 4.4  Map of the riverbanks of the Kinzig-Murg-Rinne between the Black Forest and the Rhine. StadtAK 8/Bildstelle III 1236

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creation of a safe and healthy city. The area on the southern edge of the Hardtwald Forest, cooled by the trees, proved to be the best option. A large stretch of land to the west of the Gottesaue Palace, which grew out of a Benedictine abbey founded in 1094, was also protected from flooding. It was drained in 1588 by the Landgraben drainage canal, which formed the border between the Margraviates of Baden-Durlach and Baden-Baden until 1771, when the two were united (Fig. 4.5). According to a late nineteenth-century description, “Karlsruhe is … situated on a former island, the shoreline of which … is still clearly visible at the military hospital as well as the cemetery.”14 While this natural island protected the inhabitants of the young city from excessive humidity caused by persistent floods, other topographic considerations were of equal concern. In the words of Friedrich Weinbrenner, the architect in charge of urban planning in Karlsruhe from 1800, … The streets and alleys should be laid in such a way that the prevailing winds that are detrimental to health, such as the north-eastern winds …, do not blow in the same direction. … The terrain should not be damp or swampy, and have good drinking water … 15

In fact, the question of drinking water was easily resolved. Although Karlsruhe is situated 116 m above the sea, the level of groundwater at the time was 3 to 6 m below the surface. It could, therefore, be easily tapped by means of simple draw or pump wells. As a result, it was initially possible to supply the population with water without building a long and expensive aqueduct infrastructure. By providing land free of charge, the margrave made it possible for the city’s inhabitants to have a sufficient supply of water from private wells located in the courtyards of their houses. The residents, however, were responsible for the protection and maintenance of these structures, as keeping the shafts clean was an essential hygienic requirement. The adjacent areas had to be kept clear of refuse, manure, and sewage, as water contamination was difficult to detect and could result in spreading typhoid, dysentery, and cholera. Although flooding continued to remain an issue, another increasing concern was the navigability of the Rhine, as its many tributaries made

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Fig. 4.5  A comparison of the Rhine River’s course near Karlsruhe during the ancient Roman period and around 1900. Generallandesarchiv H-f/629 I

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the towing of barges along much of its length impossible. In 1804, the margrave commissioned Johann Gottfried Tulla to “correct” the course of the river. The effects of this major engineering project can still be seen today. In addition to making the Rhine navigable, the object of Tulla’s interventions was to demonstrate human control over the natural waterways. As he put it, “As a rule, in advanced countries, watercourses, rivers, and streams should be canals, and the management of waters should be under the control of the inhabitants.”16 In addition to being protected from flooding, the inhabitants of the Karlsruhe bank of the Rhine were supposed to enjoy the benefits of the improved climate: But if the [course of the] Rhine is rectified, everything along this river will be different; the motivation and activity of the inhabitants of the Rhine bank [of Baden] will increase in proportion to the protection given to their dwellings, their goods, and their income. The climate along the Rhine will become warmer and more pleasant and the air purer because of reducing the water surface to almost one-third due to the disappearance of the marshes and the resulting reduction of fog.17

The straightening of the Rhine had long-term ecological consequences, changing the region’s climate as well as its flora and fauna. Due to the realignment and reinforcement of the right bank, the velocity of the river’s flow increased and, with it, the withdrawal of water from the tributaries. The adjacent swamps and quarries were drained and could be converted to agricultural land. These measures contributed significantly to the eradication of malaria in the Upper Rhine region. At the same time, these ostensibly positive changes caused a massive drop in the level of groundwater.18 As a result, private wells that used to supply the individual households in Karlsruhe dried up, rendering the previous decentralized system of water supply no longer possible. It fell to the margrave’s government to remedy this situation. From the beginning of the nineteenth century, the personal responsibility of the city’s inhabitants for managing their supply of drinking water was handed over to the government with the creation of public waterworks. This change from the private to public system of water supply meant that the municipal authorities had to assume the task of controlling the quality and distribution of water. The original aqueduct planned by Weinbrenner

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for the Lammstraße, however, proved insufficient, since it could only supply the public wells in the Lange Straße. It was not until 1824, with the implementation of a new pipeline to conduct spring water from Durlach to Karlsruhe, that drinking water shortages were temporarily resolved. Only ten years later, however, by which stage Karlsruhe had grown into a city with 24,000 inhabitants, this additional supply also proved insufficient. To save water, in the summer of 1835, the decorative fountains in the palace district were shut down for the first time. While the city’s expansion and the increased number of inhabitants put constant pressure on the available water resources, its supply was also needed for fire emergencies. In the past, Karlsruhe had ensured fire safety by using water available from both public and private wells. After the devastating fire of the royal theater in 1847, however, a special commission was created to address this problem. The result was the construction of two separate aqueduct systems: one, in the Hardtwald Forest behind the palace, for the palace district, while the other, in the forest south of the town, serving other residential areas. It was not until the creation of this centralized system, which supplied both private houses and public fountains, that the drinking water problem was finally resolved. As a provision for fire safety, an extensive network of hydrants for the use by the fire brigade was set up. The palace district with the margrave’s residence and its various gardens was provided with an extensive system of water-related utilities, with several taps being installed for the first time within the palace building itself.19 Karlsruhe’s industries historically discharged their wastewater into neighboring streams. Although human feces were collected in individual cesspits until 1893, the increased use of plumbed toilet facilities in the course of the nineteenth century necessitated flashing out this excrement via the sewage system.20 As a result, parallel with the expansion of the water supply, a growing system of small sewers drained into the sixteenth-­ century Landgraben canal. In 1768, as the city grew, this watercourse was extended through the Steinschiffkanal as far as the Pfinz River to enable the transportation of building materials, making the Pfinz discharge into the Rhine more quickly in the event of flooding (Fig. 4.6). From 1794, the Landgraben effectively served to dispose the sewage into the Rhine. In the same year, however, a miller in Mühlburg, a town west of Karlsruhe

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Fig. 4.6  General plan of Karlsruhe and its surroundings with the Landgraben canal (1788). Stadtarchiv Karlsruhe 8/PBS XVI 102

on the upper reaches of the canal, obtained permission from the margrave to build a watermill on the Landgraben. This decision required that the canal, which even prior to that was slow-moving due to a small incline, be dammed to the height of about 1 m. As a result, it began to silt up and smell strongly, especially in summer, whereas during high water, it flooded the adjacent open areas and buildings. Because of that, Tulla, the engineer responsible for straightening the course of the Rhine, vehemently opposed in 1822 the building of mills along canals and moats, arguing that “the effect of the drainage canals was weakened by the construction of mills in a way that was extremely obscurant and hindered any progress.”21 When Weinbrenner worked on the development of Karlsruhe in the early nineteenth century, the Landgraben, now located within the city, had to be included in his plans. The result was the unusual, triangular, layout of some public squares, such as the Lidellplatz and the Ludwigsplatz.

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The pollution of the Landgraben as well as the Pfinz and the Alb Rivers, however, was the cause of fetid smells and increased risk of waterborne illnesses. To deal with this major hygienic issue, the Karlsruhe authorities, in 1815, decided to cover the canal, which traversed the city, turning it into an underground sewer, with work starting at the Lidellplatz. The vaulting over the canal was paid by the owners of the adjacent land, who, in return, received the right of ownership of the covered areas. In 1877, the city’s architect Hermann Schück was tasked with developing a new sewer system. In 1883, the deepening and widening of the Landgraben began, the previous damming issue having been resolved by purchasing the miller’s water rights. By 1905, with the last section of the Landgraben in the western part of the city complete, the health and odor issues became the problem for the villages downstream, closer to the Rhine.

 rban Geometry, Model Houses, and Hygienic U Building Regulations Karlsruhe has a very recognizable plan consisting of a circle about 874 m in diameter—which amounts exactly to 3000 Karlsruher Werkfuß or Karlsruher feet—from the center of which thirty-two streets radiate in all directions.22 The original nine rays spread southward like a fan, forming streets with townhouses arranged in rows. While extending these rays— which, theoretically, can be done ad infinitum—might have been the most consistent approach to the city’s expansion from the perspective of abstract geometry, it was neither practicable given the actual urban layout nor from the point of view of the city’s inhabitants. Beginning with the earliest plans for Karlsruhe, the avenue from Mühlburg to Durlach called the Landstraße was planned as a fixed east-west boundary, passing south of the circle (Fig. 4.7).23 The central axis starting at the margrave’s palace, originally called Carls Gaß (Karl’s alley), met it at a right angle. No buildings appear along the Landstraße in the city’s earliest plans, only green areas to the south and between the blocks of houses.24 A more detailed plan dated 1718 shows these gardens opening onto the street. A series of churches was originally planned to the south.25 One or two years later, rows of houses were planned to the left and right of these

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Fig. 4.7  Proposed naming for Karlsruhe’s radial streets by Margrave Karl Wilhelm (1718). Stadtarchiv Karlsruhe 8/PBS XVI 12

ecclesiastical buildings, lining only one side of the Landstraße and interrupted by the intersecting radial streets.26 To the east, more closed blocks of buildings were planned, defined by the geometry of the rays,

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illustrating the potential expansion of the city’s radial plan. They formed the Dörfle, which served as a settlement for the poorer parts of the population, mostly day laborers. Gardens of the earlier houses could still be seen from the street at that time. It was not until 1722 that these green spaces would be enclosed by another row of houses built along the perimeter of the block.27 The buildings on the city’s east-west axis, therefore, were not part of the original planning, with greater importance being accorded to gardens. This focus on the relationship between residential buildings and open green spaces was a means to support healthy living.28 In addition to their recreational function, urban gardens increased economic self-­ sufficiency of individual households. The decision to build new houses along the Landstraße marked a move toward adjusting the ideal geometry of the city’s layout to meet the growing number of the inhabitants.29 The fan-shaped layout of nine streets and adjoining plots established the matrix for developing the residential areas, with the earliest known model house for Karlsruhe having been designed by Friedrich von Batzendorf. Such blueprints regulated, among other parameters, the building materials to be used, the minimum width of the façade, and the shape of the roof. A new requirement was that the eaves face the street, a clear break with the tradition of half-timber construction of Baden and the Upper Rhine region. The earlier houses were gabled, with narrower façades and a much deeper footprint, as seen in the older town of Durlach.30 The aim of these regulations was to create a more homogeneous appearance with rows of uniform eaves, although related goals were greater durability and reduced fire risk.31 As Hans Detlev Rösiger explained in 1924: The houses were to be two-story, with the roof having eaves facing the street, so that each house would have air and light from the front and back. The harmful drains between the houses were to be avoided and each house was to have a yard with stables, so that manure could be kept in the yard instead of the street behind the house.32

While the minimum width was initially stipulated at forty Werkschuh— about 12  m—houses were later subdivided. Brick walls were used as

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partitions, to increase fire protection.33 The 1730 plan, however, shows that a clear division of open spaces could not be achieved in the same way, since the building blocks appear to have enclosed green areas without marked divisions between the gardens.34 Some entrances continued to be shared, as were courtyard service buildings, gardens, and wells, as well as the use of manure.35 The plan also shows that the city’s radial scheme resulted in polygonal and angled parcels of land. Friedrich Weinbrenner, the architect in charge of Karlsruhe’s early nineteenth-century expansion, excelled at designing polygonal ground plans for his model houses, paying attention to both lighting and ventilation (Figs. 4.8 and 4.9).36 Such buildings, however, had little green space available to them.

Fig. 4.8  Architectural drawings of a row of houses in the Amalienstraße 65, 67, 69 (1826). Generallandesarchiv G Karlsruhe 892

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Fig. 4.9  House with a narrow ground plan (Carlsstraße 41), with a well set on the property’s border (1812). Generallandesarchiv 422/508

Attempts to remedy this situation included carving out angled or conical plots for gardens and courtyards. By around 1801, the time when Weinbrenner was in  charge of the city’s planning, those willing to build new houses had to purchase their land.37 Right after the founding of Karlsruhe, however, housing plots and building materials, such as wood, had been freely available to the inhabitants for the construction of their homes. Through a provision introduced in 1754, building subsidies were granted, which motivated the building activity.38 This financing was calculated depending on the width of the street façade and whether it followed the rules for model houses, among other factors. This practice also meant that the city developed quickly, so it became common, especially early on, to cut wood from the neighboring forests and take it directly, without drying, to the construction site.39 In the case of smaller houses, building work usually began in spring to be completed in autumn, so that they could be immediately inhabited.40 As the population grew, however, by the end of the eighteenth century, it became clear that moving into newly built houses had a detrimental effect on health.41 Although new buildings with good ventilation and heating

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needed to be allowed to dry for at least a year, poorer families often moved into houses that were not properly ready, to “dry them as they live.”42 The use of chemical methods to reduce the drying period was considered.43 As early as 1804, Karlsruhe’s Stadtphysicus Dr. Christian Friedrich Schweickhardt—the city’s physician, whose position was comparable to the head of the public health department—clearly summarized the main hazards of living damp new buildings. As water evaporated from drying masonry, it carried caustic components of lime that built in the lungs. A similar danger concerned breathing the air in rooms where lime plaster was setting. Furthermore, lead-based oil paints could poison the air.44 In addition to proper ventilation and heating, the countermeasures that Schweickhardt proposed included slowly heating 1 lot (1/32 of a pound) of sulfuric acid with 1 lot of saltpeter buried in hot sand in a coffee cup, stirring the mixture quickly to create smoke to fumigate the interior for at least one hour with doors and windows closed. This operation had to be repeated once or twice a day, making sure that one did not inhale the smoke and protected their clothes and hands while handling the mixture.45 The city physician’s instructions illustrate the increasing awareness among the authorities of the need for medical and building regulations to prevent practices detrimental to human health. This concern was also reflected in the approach to planning. Weinbrenner’s textbook on architecture from around 1820 contains a section on building regulations. As he summarized his views, “On the whole, building laws are for maintaining and facilitating social living, where people from all classes live together. First, [one needs] to ensure proper construction. Second, [one needs good] maintenance. And third, [one needs] to maintain housing in a healthy manner.”46 He even mentioned sanitary building inspectors and dedicated several paragraphs to emphasizing the importance of healthy living.47 The orientation of house façades in Karlsruhe was determined by the geometry of the fan-like plan. Depending on the street, it could range between facing east or west and forty-five degrees north-east or north-­ west. The floorplans of these houses clearly reveal a repeated pattern. Despite the complicated geometry of some of the plots, a longitudinal wall in the middle divided the house into two equal parts. The façades were articulated vertically by the division of bays. The living room always

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faced the street and was heated by a stove, as shown in nearly all floorplans from the Weinbrenner era. The service areas located further toward the courtyard or garden—such as the staircase, the vestibule, the kitchen, and the toilet—were usually grouped together.48 The main rooms were connected by doors. On wider plots, a gateway was added, through which one could reach the staircase and access the courtyard. Polygonal plots of land that faced both the Waldstraße and the Lange Straße required custom-­made floorplans. The living rooms, however, always faced the main street, while toilets, without exception, were located toward the back. A passageway for coaches to enter the courtyard was always placed on the wider side.49 The actual points of the compass, surprisingly, did not seem to play much role in the creation of these floorplans.50 Rather, the focus was on the standardized character of the model houses, the orientation of the living spaces toward the street, and the integration of rows of buildings into the city’s layout. From the salutogenic point of view, however, the model houses maintained a comfortable standard of living. In addition to heated interiors, functional layouts, and courtyard service buildings that included laundry facilities, sheds, and work spaces, almost every property, as the floorplans indicate, initially had a well.51 As discussed earlier, these reservoirs of fresh drinking water ensured better hygienic conditions, although they had to be located far enough from manure pits, including those on the neighboring plots (Fig.  4.10). A dispute from 1831, which gives the dimensions of such pits, suggests that the distance of 3 feet from the wall of the neighboring house was considered sufficient.52 Such regulations clearly prioritized the hygienic aspect of living, although it is hard to say to what extent they were expected to counteract the spread of disease given the medical knowledge of the time.

Conclusion As the example of Karlsruhe demonstrates, the solar orientation as reflected in the city’s plan, the provision of fresh drinking water, and standardized housing governed by specific regulations were crucial factors

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Fig. 4.10  Ground floor with overlapping cellar floor plan (Waldstraße 77) showing vaulted manure pit, toilet, well, and laundry room. Generallandesarchiv G Karlsruhe 197

in the planning and development of the new eighteenth-century capital of Baden. It also shows the extent to which health considerations to ensure the wellbeing of the urban population permeated architectural discourse and practice of the period. Margrave Karl Wilhelm’s decision to abandon Durlach, the historic capital of his state, and build a new city in the midst of a forest based on the ideal scheme of a circle with rays not only symbolically conveyed the contemporary ideas of power and authority, but also reflected a fundamental desire to improve the living conditions for his subjects. This fusion of architecture and horticulture and urban and infrastructural planning was central to the new city’s conception, despite the obvious tension between the Enlightenment emphasis on individual self-determination and the underlying premise of absolutist control.

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Notes 1. Regina Prinz, “Sonnenbaulehre. Manifeste zur Veränderung der Gesellschaft,” in L’architecture engagée  – Manifeste zur Veränderung der Gesellschaft, ed. Winfried Nerdinger (Munich: Detail Edition, 2012), 52–61. Irmtraud Sahmland, Bernhard Christoph Faust, 1755–1842 (Bückeburg: Createam, 1992). 2. Arnold Tschira, Orangerien und Gewächshäuser. Ihre geschichtliche Entwicklung in Deutschland (Karlsruhe: Technische Hochschule Fridericiana, 1937), 109–117. 3. Städtische Galerie Karlsruhe, Friedrich Weinbrenner, 1766–1826. Architektur und Städtebau des Klassizismus (Petersberg: Michael Imhof Verlag, 2015), 308–309. 4. Uta Hassler, “Die Bauten für den Botanischen Garten,” in Heinrich Hübsch, 1795–1863. Der große badische Baumeister der Romantik, ed. Wulf Schirmer (Karlsruhe: Verlag C.F. Müller, 1983), 96–117. 5. John Hix, The Glass House (London: Phaidon, 1974), 12–16. 6. Peter Pretsch and Volker Steck, eds., Eine Afrikareise im Auftrag des Stadtgründers. Das Tagebuch des Karlsruher Hofgärtners Christian Thran 1831–1833 (Karlsruhe: Info Verlag, 2008). 7. John Claudius Loudon, Remarks on the Construction of Hothouses (London: Architectural Library, 1817), 49. 8. John Claudius Loudon, “Catalogue of Works on Gardening and Rural Affairs,” The Gardener’s Magazine, November 1828, 204–205. Carl Christian Gmelin, Über den Einfluss der Naturwissenschaft auf das gesamte Staatswohl (Karlsruhe: Christian Friedrich Müller, 1809). 9. John Claudius Loudon, “History of Gardening: Baden Gardens,” in An Encyclopedia of Gardening (London, 1835), 182, 184. 10. John Claudius Loudon, “Hints for Breathing Places for the Metropolis, and for Country Towns and Villages, on Fixed Principles,” The Gardener’s Magazine, December 1829, 686–690. Ulrich Maximilian Schumann was the first to point out the possible influence of Karlsruhe on Loudon’s plan in his Friedrich Weinbrenner: Klassizismus und praktische Ästhetik (Berlin/Munich: Deutscher Kunstverlag, 2010), 280–81. 11. Johann Gottfried Tulla, Der Rhein von Basel bis Mannheim mit Begründung der Nothwendigkeit, diesen Strom zu regulieren. Denkschrift (memorandum printed in Leipzig 1822), 12. Translation by Nina Rind. 12. Tulla, Denkschrift, 19. Translation by N. Rind.

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13. Ibid. 14. Reinhard Baumeister, Hygienischer Führer durch die Haupt- und Residenzstadt Karlsruhe (Karlsruhe: Gutsch, 1897), 6. 15. Ulrich Maximilian Schumann, Friedrich Weinbrenner, Architektonisches Lehrbuch, Friedrich Weinbrenner und die Weinbrenner-Schule, vol. 7 (Bad Saulgau: Triglyph 2015), 329. Translation by N. Rind. 16. Tulla, Denkschrift, 7. Translation by N. Rind. 17. Johann Gottfried Tulla, Ueber die Rektifikation des Rheins von seinem Austritt aus der Schweiz bis zu seinem Eintritt in das Großherzogthum Hessen (Karlsruhe: Müller Verlag, 1825), 52. Translation by N. Rind. 18. Versammlung dt. Forstmänner in Karlsruhe, Führer für die Excursion durch den Großh. Schloß- und Botanischen Garten in dem Großh. Hardtwald am 22. September 1891 (Karlsruhe: Braun Verlag, 1891), 4. 19. Gerlinde Brandenburger, Manfred Großkinsky, Gerhard Kabierske, Ursula Merkel, and Beatrice Vierneisel, Denkmäler, Brunnen und Freiplastiken in Karlsruhe 1715–1945 (Karlsruhe: Badenia Verlag, 1987), 90–91. 20. Tiefbauamt Karlsruhe, ed., Die Stadtentwässerung Karlsruhe (Karlsruhe: 2010), 9. 21. Tulla, Denkschrift, 21. Translation by N. Rind. 22. “Das Längenmaß Fuß,” GenWiki, accessed November 2, 2020, http:// genwiki.genealogy.net/Fu%C3%9F; Anton Wach, Gemeinnütziger Baurathgeber bei allen Arbeits- und Materialberechnungen im Baufache (Prague: Verlag von Friedrich Tempsky, 1863). 23. Ultimately the city’s layout happened to be slightly rotated by 4.3 degrees to the north and southeast. 24. Stadtplan mit Benennung der Straßen, Kopie von W.  Bender, 1716, Stadtarchiv Karlsruhe, Signature: 8/PBS XVI 12. 25. Stadtplan “Grundriss von Carols Ruhe,” 1718, Stadtarchiv Karlsruhe, Signature: 8/PBS XVI 14. 26. Stadtplan, “Carols-Ruhe, Den 17 Junii 1715, ist der Grundstein zu dem Schloß Thurn gelegt und der Orden ders Treue gestiftet worden,” 1720, Reprint 1883, Stadtarchiv Karlsruhe, Signature: 8/PBS XVI 16. 27. Gottfried Leiber, Friedrich Weinbrenners Städtebauliches Schaffen für Karlsruhe. Teil 1: Die Barocke Stadtplanung und die ersten Klassizistischen Entwürfe Weinbrenners (Karlsruhe: Verlag G. Braun, 1996), 52. 28. Leiber, Friedrich Weinbrenners, 44.

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29. Hea-Jee Im, Karlsruher Bürgerhäuser zur Zeit Friedrich Weinbrenners (Mainz: Philipp von Zabern, 2004), 64. 30. Im, Karlsruher Bürgerhäuser, 33. Horst Ossenberg, Das Bürgerhaus in Baden, Das deutsche Bürgerhaus, vol. 35 (Tübingen: Verlag Ernst Wasmuth, 1986), 51. 31. Im, Karlsruher Bürgerhäuser, 33. 32. Hans Detlev Rösiger, “Durlach und Rastatt, Ein Beitrag zur Geschichte des Städtebaus in Deutschland” (PhD diss., Techn. Hochschule Karlsruhe, 1924), 21. 33. Leiber, Friedrich Weinbrenners, 57. 34. Stadtplan, Grundriß der Stadt Karlsruhe, 1718, Generallandesarchiv (GLA), Abt. 357 Nr. 2813. 35. Christina Müller, “1765 und 1790: Zwischen Existenzgründung und residenzstädtischem Leben,” in Alltag in Karlsruhe, Veröffentlichungen des Stadtarchivs, vol. 10, ed. Heinz Schmitt (Karlsruhe: Badenia Verlag, 1990), 39. 36. Leiber, Friedrich Weinbrenners, 46. 37. Im, Karlsruher Bürgerhäuser, 19 and 53. 38. Ibid., 21. 39. Ibid., 36, 55. 40. Ibid., 21. 41. GLA, Abt. 206 Nr. 2567: “Das zu frühe Beziehen neugebauter Häuser in Karlsruhe”; Johann Andreas Buchner, Vollständiger Inbegriff der Pharmacie in ihren Grundlehren und praktischen Theilen. Ein Handbuch für Aerzte und Apotheker, Part VII (Nuremberg: Johann Leonhard Schrag, 1827), 563. 42. Schumann, Friedrich Weinbrenner, 330; Alexander Mohr, “1815: Im Schatten der neuen Prachtstraßen,” in Alltag in Karlsruhe, Veröffentlichungen des Stadtarchivs, vol. 10, ed. Heinz Schmitt (Karlsruhe: Badenia Verlag, 1990), 83. 43. A Berlin handbook of medicine from 1839 includes references to and instructions for this  practice. See Dietrich-Wilhelm-Heinrich Busch, Carl Ferdinand von Gräfe, and Christoph Wilhelm von Hufeland, eds., Encyclopaedisches Wörterbuch der medizinischen Wissenschaften, vol. 21 (Berlin: Harald Fischer Verlag, 1839), 596–97. 44. GLA, Abt. 206 Nr. 2567: “A few words about the harmfulness of inhabiting newly built houses too early,” Baden, July 24, 1804.

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45. GLA, Abt. 206 Nr. 2567: “Requirement to be able to live in newly built houses without disadvantage to health,” August 28, 1804 (?). 46. Schumann, Friedrich Weinbrenner, 324. 47. Ibid., 329. 48. Im, Karlsruher Bürgerhäuser, 22. 49. Ibid., 60. 50. Ibid., 23. 51. Ibid., 153–54, 71. 52. GLA, Abt. 422 Nr. 303: “Distance between dung pits and neighboring wells,” June 2, 1831; Im, Karlsruher Bürgerhäuser, 141.

Bibliography Badisches Landesmuseum Karlsruhe, ed. Karl Wilhelm Markgraf von Baden-­ Durlach, 1679–1738. Munich: Hirmer, 2015. Bräunche, Ernst Otto, ed. Atlas Karlsruhe. 300 Jahre Stadtgeschichte in Karten und Bildern. Karlsruhe: Emons, 2015. Hartweg, Johann Andreas. Hortus Carolsruhanus. Karlsruhe: P. Macklot, 1825. Plate, Ulrike. “Der Landgraben in Karlsruhe.” Denkmalpflege in Baden-­ Württemberg 27, no. 4 (1998): 239–43. Tulla, Johann Gottfried. Der Rhein von Basel bis Mannheim mit Begründung der Nothwendigkeit, diesen Strom zu regulieren. Denkschrift. memorandum printed in Leipzig, 1822.

Archival Colections Consulted Stadtarchiv Karlsruhe (StadtAK). Generallandesarchiv (GLA).

5 “Private Vices, Public Benefits”: Self-­interest and Salutogenesis in Early Modern York Ann-Marie Akehurst

The Italian Renaissance preoccupation with anatomia normale—knowledge of the healthy human body the better to understand God’s “divine architecture”—established a basis for the empirical medical enquiry of the early modern period.1 Medical teaching was conducted through the perigrinatio medica, a sort of Grand Tour of learning at Europe’s centers of medical excellence.2 Medico-scientific knowledge—generated, disseminated, and practised in a wide range of institutions—was underpinned by autopsies in purpose-built theaters, cultivated along with pharmaceutical ingredients in physic gardens, and discussed in professional circles.3 During the seventeenth and eighteenth centuries, the related interest in pathology developed: experimental or “morbid” anatomy, embodying for some doctors the search for the cause of death with the expectation of developing cure.4 Parallel with that, the increasing functional specialization of architecture contributed to the understanding of hospitals as loci for cure or, by analogy with the Cartesian

A.-M. Akehurst (*) York, UK © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_5

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iatromechanical conception of the body, machines à guérir (healing machines), as the philosopher Michel Foucault characterized them, rather than places for isolating the sick.5 In England, the cataclysms of the sixteenth-century Protestant Reformation shifted such spaces of health and care from monastic institutions to more secular settings, increasingly specialized to address a growing list of perceived corporeal, psychological, and social pathologies. From the early eighteenth century, regional voluntary hospitals provided new spaces in which medical professionals encountered each other and, in selected locales, established medical schools. Such hospitals, medical schools, and professional societies often gave rise to monumental architecture. These buildings celebrated the beneficence of their founders, conferred dignity on the associated professions, and demonstrated social responsibility of the authorities (though motivation for such philanthropic schemes was not always transparent, as we shall see). Similarly to the decontextualized pathogens inspected under a microscope, these medicalized institutions, divorced from the wider cultural context, have generally been the focus of architectural histories that concentrated principally on the planning and organization of spaces for the cure of the sick or injured body.6 Yet medico-scientific knowledge also continued to be generated and practiced outside such establishments. As the British Empire expanded, international travel broadened the experience of managing infectious disease; the exigencies of war honed the surgical skills of dealing with traumatic injury, and, with the rise of political radicalism, special drug dispensaries were established to address illness in the community. Moreover, long cultural traditions of wellbeing, such as balneology, persisted alongside medical institutions, predating the early modern pathologizing of the human condition. To redress this pathogenic bias in scholarship, this chapter looks beyond hospital architecture to examine a wider range of factors that promoted healthy living and the intellectual forces that drove them. It draws on the theory of salutogenesis developed by medical psychologist Aaron Antonovsky, who cast wellbeing as a positive health state, not simply the absence of disease.7 This chapter develops Antonovsky’s attempt to re-orientate the intellectual understanding of sickness and health by applying it to the analysis of early modern Britain, expanding the scope

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of wellbeing from the architecture of medical institutions to the urban environment at large. Historians such as Guenter Risse and John Henderson who studied European architecture of health over the longue durée emphasize the extent to which hospital design was rooted in religious and cultural practices of the time.8 From the Enlightenment onward, however, histories of the architecture of health have been related to the social history of medicine and, for this reason, shaped by the whiggish narrative of progress. In the case of Britain, formalist scholarship emphasized rationalized hospital planning and technological improvements, such as better water provision and ventilation. At the same time, the prevailing pathogenic orientation, which focused on the sick body requiring repair, has influenced interpretations of the social role of hospitals. Even publicly funded infirmaries— foci for local philanthropy and civic pride—became viewed as increasingly specialized in their attention to perceived social ills.9 Similarly, histories of British public health reflect the origins of these narratives in the radical politics of social welfare and the progressivist histories of sanitation and disease prevention. In contrast to these pathogenic accounts, the salutogenic emphasis of this chapter offers a fresh lens through which to interpret hospital architecture, bringing to the fore the positive health benefits of design and planning on the urban scale.10 It counters the long-standing European understanding of health-promoting environments, arguing that early modern “public health” was a privilege until the significant political and economic reforms of the nineteenth century. This chapter’s title alludes to the Fable of the Bees: Or, Private Vices, Public Benefits by Dutch émigré physician Bernard de Mandeville (bp. 1670, d. 1733), who asserted that vice was a necessary condition for economic prosperity while philanthropy concealed self-interest. “Pride and Vanity have built more Hospitals than all the Virtues together,” he wrote.11 Since effective public health pivots between large-scale authority empowered to impose and manage integrated systems and small-scale granular knowledge of place and context, this chapter addresses these issues in early modern Britain both nationally and locally. While focusing on York, it brings in the bigger picture through its comparison with London.

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 pidemiology and Public Health E in Eighteenth-Century England Since England’s medieval hospitals were generally connected to religious institutions, only three hospitals for the sick survived the Dissolution of the Monasteries in the 1530s, all located in London.12 One of them, St. Bartholomew’s, was remodeled in the 1720s by James Gibbs (1682–1754).13 Its location in the capital meant that the hospital’s governors were in close contact with the Royal College of Physicians and the Company of Barber Surgeons, both of which functioned as centers for the dissemination of new ideas.14 The Worshipful Society of Apothecaries and, from the 1660s, the Royal Society at Gresham College were also places for the exchange of medico-scientific knowledge.15 The desire of St. Bartholomew’s governors to improve the functionality and salubrity of the hospital’s buildings may have been prompted by the French 1719–20 plague epidemic centered on Marseille that killed 100,000 people. So serious was the threat that the British Quarantine Act (1721) stipulated that anyone found guilty of disobeying the imposed restrictions “shall suffer Death as a Felon, without Benefit of Clergy.”16 Popular interest in epidemic disease is evidenced by such publications as the sixpenny compilation A History of the most remarkable pestilential distempers that have appeared in Europe for three hundred years last past by physician Richard Brookes (fl. 1721–63), published in 1721, or the Treatise of the Plague (1721) by Robert Samber (bp. 1682, d. ca. 1745) that appeared pseudonymously in the same year.17 They were preceded by the more clinically informed Discourse Concerning Pestilential Contagion (1720) by a hospital governor, Dr. Richard Mead (1673–1754), which addressed the environmental factors regarding plague. These pathogenically orientated pamphlets sought to limit the terrifying effects of epidemic disease that remained a pressing concern at the time. Physicians were already aware of the risks of “gaol fever” (typhus), endemic in certain populations, and Mead’s study emphasized the preventative effects of “clean and airy habitations.”18 From his knowledge of previous epidemics, he inferred the need for segregation, most vividly demonstrated by European quarantine lazzaretti, enabling clean air to

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circulate around and between different spaces. Gibbs’s four-pavilion plan for St. Bartholomew’s achieved the same result and for the next century became emblematic of the rational salubrity of England’s oldest hospital.19 Perhaps more importantly, it enabled control of knowledge, space, and resources that was a necessary precondition for salutogenic design. St. Bartholomew’s was in a particularly favorable situation being administered by the Corporation (municipality) of the City of London, with Gibbs providing his designs free of charge, quarry-owner Ralph Allen supplying the Bath Stone for construction, and the hospital’s governors financing the rebuilding scheme within the existing property. Gibbs’s medically informed remodeling of St. Bartholomew’s was to become hugely influential, as evidenced by the design of the Royal Naval Hospital, Stonehouse. To what extent, however, could such knowledge influence urban planning more broadly? St. Bartholomew’s was located on the perimeter of the extent of London’s Great Fire of 1666, rendering it a rare medieval survival. Theoretically, the Great Fire, which followed the plague epidemic of 1665, presented an opportunity for urban renewal by creating a tabula rasa one-third of the size of London, whereupon a healthier city could be built. Many projects were presented immediately after the conflagration. The gentleman-polymath John Evelyn (1620–1706), uneasy about the healthiness of the capital, submitted a plan to relocate burial grounds outside the city walls. He had previously expressed concerns about the effects of coal smoke on the quality of London’s air and proposed the removal of polluting trades from the city.20 Nevertheless, Evelyn’s plan—alongside those of Christopher Wren (1632–1723), Robert Hooke (1635–1703), and others—was rejected in favor of tradition and pragmatism, as people were keen to restart their lives, particularly during a time of war.21 In 1678, Evelyn—then one of the City’s Commissioners of Sewers—together with Wren, produced a plan to redevelop London’s water supply and sewerage and improve flushing, but, when proposed to the Westminster Commission, it was rejected.22 Custom and practice, landownership patterns, and the limitations of a constitutional monarchy repeatedly held back the efforts to create a healthful environment in the British capital, irrespective of good intentions and medical knowledge.

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York, the Social Capital of the North York—equidistant from London and Edinburgh—was a significant regional center for the dissemination of the practice of medicine. For instance, A Treatise of the Plague by a Physician in York (London, 1721), published by the local physician “S. M.” (Morland), commented on the 1719–20 plague in Marseille, while new hospitals built during the eighteenth century complemented the city’s existing bathhouses and promenade walks. Knowledge, however, did not always translate into action. The example of York demonstrates that even in a place that pioneered epidemiological studies, the authorities often lacked the administrative machinery and control to adopt and execute such policies. Two later epidemiological tracts written by the York doctors—Clifton Wintringham’s Commentarius nosologicus, morbos epidemicos (1727) and Thomas Laycock’s Report on the Sanitary Condition of York (1844)—demonstrate the limits of the dissemination and influence of new ideas, showing that access to good health, despite the scholarly belief in medico-scientific progress, remained restricted by wealth. York—ancient Eboracum—was founded by the Romans in 71 CE as their administrative base for governing northern Britain. The establishment of the metropolitan diocese of York in the Middle Ages confirmed the city’s historical role as the regional capital of northern England. It was the county town of Yorkshire, England’s most extensive region, which also included such bourgeoning cities as Leeds that in the eighteenth century drove the country’s Industrial Revolution. Yorkshire’s territory, which stretched almost to the Irish Sea in the west, was bounded to the north by the River Tees, to the east by the North Sea, and to the south by the Humber Estuary and the Rivers Don and Sheaf. Within these boundaries lay mountains, littorals, fertile plains, and moorland. Unlike Leeds that by 1801 expanded to have 53,000 inhabitants, York’s population remained around 12,000 for much of the eighteenth century, rising only to 17,000 in 1801.23 As Dr. Francis Drake (bp. 1696, d. 1771), local historian and the Surgeon at the York County Hospital, wrote: “What has been, and is the chief support of the city, at present, is the resort to and residence of several country gentlemen with their families in it.”24

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Claiming its status as the social capital of the north, York was presented as a salubrious city in Nathan Drake’s mid-century painting The New Terrace Walk, York. The New Walk—a tree-lined riverside promenade— was built by the city’s Corporation in 1732 as part of civic improvements, bolstering its economy as a polite tourist destination (Fig. 5.1).25 In Drake’s print, people stroll beneath lime trees along the River Ouse to the medicinal Pikeing Well downstream, admiring en route the picturesque attractions of the medieval city. The image also captures England’s first purpose-built prison, opened 1702 and located at the York Castle at the confluence of the Ouse and Foss Rivers. This building was praised for its salubrity in 1777 by social reformer John Howard, who traveled throughout the country to assess the state of its prisons.26 This combination of antiquity and modernity was characteristic of early modern York. Despite some architectural innovations, the city’s governance and administration, like much of its architecture, reflected its

Fig. 5.1  Nathan Drake, The New Terrace Walk, York (1733–1756)

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early rise to prominence. The urban footprint represented on John Cossins’s New and Exact Plan broadly corresponded to the ancient liberty or jurisdiction of the City of York that obtained until 1884,27 honeycombed with small franchises, such as the Liberty of St. Peter—the province of the chapter of the Cathedral of St. Peter’s—and the Liberty of St. Mary’s Abbey (Fig. 5.2).28 Those living in the “privileged places” of St. Peter’s and other liberties answered to independent authorities being exempt from the city’s jurisdiction. In practical terms, this meant that local authority was subdivided into parishes and their vestries, precincts, and liberties. The role of the Corporation concerned the smooth running of the economy and the regulation of trade in this important market

Fig. 5.2  John Haynes and John Cossins, New and Exact Plan of the City of York (1748)

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town and port, connected with the sea via the River Ouse.29 Some of the Corporation’s income was channeled into maintaining the city’s ceremonial aspect, as represented by the Mansion House, the residence of the Lord Mayor, which appears in the top right margin of Cossins’s plan. In addition to public buildings, the Corporation was also in charge of the city’s infrastructure. This was a considerable responsibility: York was a transport hub, with its medieval streets and bridges requiring regular maintenance. From the 1750s, when England’s new system of turnpike roads connecting the major urban centers expanded, the streets urgently needed upgrading to accommodate heavier traffic. The bridges, particularly the one across the Ouse, were constantly in need of repair, as were the city’s medieval walls and gates. The Corporation—administered by a bicameral oligarchy of counselors and aldermen that went back to the medieval period—was anxious to encourage trade and develop industry, but also pressured to extend a limited range of public services despite its insecure finances, which would not be regularized until 1835. Although the city was a popular resort for the nobility and gentry, much of its population lived in poverty, with poor relief distributed by parish overseers and supplemented by charitable bequests.

York’s Water Supply Any healthy urban community required good water supply, not only because it needed water to drink and wash, but also because cholera—the epidemic disease that overwhelmed nineteenth-century England—was water-borne. The Romans built excellent waterworks, introduced public bathing, and valued the importance of clean water. Their aqueducts and fountains in Rome, which served to distribute this valuable resource, conveyed the soft power of control over the natural resources while symbolizing public beneficence. The ancient Eboracum also had both civilian and military bath houses and a cloaca maxima (main drain) to remove waste.30 After the Norman Conquest of 1066, King William I (r. 1066–87) turned York into his northern stronghold by establishing two castles, one of which stood at the confluence of the Rivers Ouse and Foss. The Foss

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was dammed to fill the castle’s ditches, which formed an important link in the urban defenses replacing parts of the city walls; it also drove the castle’s water mills positioned at the confluence with the Ouse.31 The flooded area, described in the 1086 Domesday Book survey as “a whole carucate of land” (around 120 acres or 49 ha), became a royal fishery. The medieval tradition of building fishponds for cultivating, breeding, and storing a sustainable supply of fish peaked in the twelfth century. Such ponds often included islands for fishing and resource management, as in the case of York’s Foss Islands clearly visible on Cossins’s plan (see Fig. 5.2). The use of these facilities, which declined after the sixteenth-­ century Dissolution of the Monasteries, was the privilege of monastic institutions, castle owners, and keepers of royal residences. By the nineteenth century, the King’s Pool, as that section of the Foss was sometimes known, was not drained and remained a source of infection due to the accumulations of silt, sewage, and filth. The two rivers, along with wells and bore-holes, supplied residents with water. Between 1616 and 1632, York witnessed an early attempt to create a piped water supply from the Lendal Tower that stands on the north bank of the Ouse. This engineering feat reflected the developments nationwide. In London, city fathers also implemented water-raising technology; the New River—a canal—was dug, and sixty percent of houses had piped water in 1677.32 In the late seventeenth century, bathing in steam rooms became popular. Indeed, in York, a bagnio was provided with running water. During the eighteenth century, this hydraulic technology gained further efficiency, with water being piped through elm trunks to some houses in the city, though the supply was limited and often interrupted by blockages because of sediment buildup.33 By 1780, public water pumps were located in several central streets; water supply was drawn from turncocks or by private service pipes from the mains. By the end of the century, each half of York was supplied for three days a week. During the busy race weeks, when the city was flooded with visitors attending the horseraces, water-bearers maintained a daily supply. Despite these ostensible “improvements,” as historian Mark Jenner has argued in the case of London, the transition to piped water supply was also a matter of urban politics. Water-bearers, who carried water to private dwellings, were among the lowliest of occupations, and many urban

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inhabitants chose to support them rather than contract with piped water companies.34 As a result, one should not assume that the greater availability of water brought immediate health benefits, since not everyone could take equal advantage from its provision. The quality could also remain an issue. The nineteenth-century chemical analysis of York’s water conducted by William Vernon Harcourt (1789–1871) revealed that the solid components of the deep springs and bores rendered it “harder than desirable for drinking or culinary use.”35 The Ouse water was judged “scarcely fit for washing,” though if filtered it was deemed suitable for both cleaning and drinking.36 Furthermore, York’s situation was exacerbated by crowded and unsanitary urban conditions. According to the miasma theory, diseases spread via foul-smelling rubbish, which made scavenging detritus and street cleaning essential for maintaining a healthy city. In 1763, a law was passed to provide lighting and cleaning for the streets. As early as in the 1660s, John Evelyn had advocated extramural burials for London. Other historic cities such as York, however, continued to use ancient churchyards until the accretion of bodies made interment difficult without disturbing previous burials, making well-water contaminated with drainage from them.37 It was only in the early nineteenth century that burial grounds were generally recognized as a public health risk and a new cemetery opened south of York outside the city walls. Another problem was the lack of recreational spaces. Half a century after the publication of Drake’s painting of the New Walk, most of the city’s residents could not readily access the Ouse waterfront still occupied by private and institutional properties. This built-up appearance was captured by the local artist Henry Cave (1779–1836) (see Figs. 5.1, and 5.3). Only three public rights of way provided direct access to the Ouse. In 1741, the New Walk was hedged; the following year, naked bathing in the river was prohibited.38 Cave’s image of First Water Lane fronted Thomas Laycock’s 1844 Report on the Sanitary Condition of York, which, among other sanitary violation, found that local tanneries and curriers discharged effluent into the Ouse upstream of the public waterworks (Fig. 5.4).39 At the time, the Waterworks Company supplied fewer than half of York’s houses, many of which had taps only in the yard. Filters were used privately by the

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Fig. 5.3  Henry Cave, On the River Ouse Looking Upstream (1795–1805)

upper- and middle-class residents. The poor drew water directly from the rivers, downstream of the waterworks, where the drains and sewers discharged. The dammed Foss was described as “stagnant water replete with vegetable and animal matters” from slaughterhouses, dung heaps, and pigsties. Wells were contaminated, some from burial grounds. While upper-class housing had water closets emptying into drains or cesspits, most sanitation was provided by privies. In the notoriously overcrowded and insanitary Water Lanes, residents defecated in the streets that ran down to the river, until the Act of 1825 empowered the commissioners to clean the courts and alleys of the poorest areas.40 Despite general concerns about these problems, England’s community management was still based on Elizabethan Poor Laws (1601) that directed health and social services for the poor at a parish level rather than distributing them centrally across the urban population. As York Corporation’s economic policies focused on the wealthy and educated classes, it was not until nineteenth-century government reforms that a unified approach to sanitation could be adopted citywide.

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Fig. 5.4  Henry Cave, Scene of First Water Lane in York, with figures in street and cart (1813)

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Clifton Wintringham’s Commentarius nosologicus Higher up the Ouse embankment was Lendal, a street that underwent massive development from the late seventeenth century. Its grandest dwelling was an imposing house with a carving of Aesculapius above the entrance that appears on the top left margin of Cossins’s map (see Fig.  5.2). It was built around 1720 for Sir Clifton Wintringham (bp. 1689, d. 1748), the King’s Physician. As York was a regional medical center, Wintringham practiced there throughout his life. He wrote extensively and, in his Treatise of Endemic Diseases; Wherein the Different Natures of Airs, Situations, Soils, Waters and Diets are Mechanically Explained and Accounted for (1718), pioneered the study of the relationship between the environment and disease.41 Believing that his contemporaries overlooked ancient knowledge, he cited Julius Caesar, Tacitus, and Vitruvius.42 He was also familiar with more recent works by Francis Bacon (1561–1626), Edmond Halley (1656–1742), Isaac Newton (1642–1727), and Robert Boyle (1627–1691), as well as physicians Martin Lister (bp. 1639, d. 1712) and Richard Mead. Among continental scholars, he read the microscopist Antonie van Leeuwenhoek (1632 –1723) and Marcello Malpighi (1628–1694), who was regarded as the father of physiology and embryology as well as the founder of microscopical anatomy and histology.43 There is evidence that Wintringham personally conducted autopsies of disease victims, which he described as “dissections of such as have died of these diseases.”44 He also engaged in medical polemics, criticizing John Freind’s (1675–1728) generally well-­ received History of Physick as inaccurate and partisan, which may have reflected either professional jealousy or political differences.45 From his reading and observation, Wintringham recognized manufacture of cloth and iron as a cause of urban air pollution. He analyzed different localities with respect to topography and soil quality and was aware of the influence of damp climate on incidence of colds. He followed the architectural recommendations of Vitruvius and the late antique horticultural theorist Palladius for the siting of his house on elevated ground above the Ouse. He also took notice of the different properties of water

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that passed through various geological strata, “such as through sand or gravel and stone, which are esteemed preferable to the rest,” and seemed aware of the effect of certain types of water on the formation of kidney stones. Long before the publication of Laycock’s report on the water situation of York in 1844, Wintringham wanted to make such knowledge broadly available.46 Wintringham’s most significant and innovative publication was Commentarius nosologicus (1739). Written in Latin, it was based on the data he had collected by observing endemic disease and death rates in York between 1715 and 1725. Records from parish registers showed an epidemic of typhus in 1718–19, of measles in 1721 and 1730, and of “miliary fever” or “sweating sickness” in 1727. Commenting on Wintringham’s treatise in 1844, Laycock emphasized the wealth of information that it provided: “from this essay it appears that York suffered constantly either from one epidemic or another. Smallpox appeared at three or four intervals during the 20 years over which his observations extend.”47 At the same time, Laycock criticized Wintringham for failing to draw theoretical conclusions from these occurrences, such as overlooking the cause of “malaria arising from the stagnant surface water in the streets, from the putrid contents of the sewers, and from the deposit on the shores of the river, and the effects of summer heat upon them.”48 A reason for these shortcomings was perhaps the fact that, although Wintringham’s observations were considered appropriate in the context of general epidemiological debates, they were socially sensitive as far as York’s authorities were concerned. His patients included important representatives of the local nobility and gentry, such as Charles Howard, Third Earl of Carlisle (1669–1738), who was resident in Castle Howard in North Yorkshire. As a social resort, York provided luxury accommodation and entertainments—including theater and public baths—for large assemblies of visitors particularly during the horseracing week in August. The gentry also congregated in town twice a year at the time of the Assizes or court sessions. As journalist and writer Daniel Defoe (ca. 1660–1731) has observed, an “abundance of good families live here, for the sake of the good company and cheap living; a man converses here with all the world as effectually as at London; the keeping up assemblies among the younger gentry was first set up here.”49 While Francis Drake also noted that York

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was “so much cheaper than London … even less expensive [for the gentry] than living in their own houses in the country,”50 the local economy depended on both residents and visitors who expected healthy urban conditions. The timing of Wintringham’s publication may also explain his discretion. Largely for the benefit of this fashionable public, the New Walk was laid in 1732, the same year that York Minster was repaved to designs by local magnate and architect, Richard Boyle, Third Earl of Burlington (1694–1753). He also designed the city’s Assembly Rooms, which, begun in 1731, opened in time for the August horseraces the following year. Alexander Pope’s (1688–1744) poetic “Epistle IV: Of the Uses of Riches” (1731), addressed to Lord Burlington, lauded his example to urge further private investment into public works. Where governance was so fractured, it was the duty of the nobility to step in to fill the breach. Wintringham’s detailed account of contagious diseases that plagued York especially during summer months hardly fitted the city’s salubrious image as conveyed by Cossins’s plan or alluded to in Drake’s Eboracum.51 The solution was to restrict these inconvenient truths to educated Latin readers until his concerns would surface more than a century later in Laycock’s report.

A Salutogenic City? The voluntary hospital movement was closely linked to local identities. Besides, York’s role as a regional medical center with its concentration of clinicians and a growing urban elite made it a prime choice for establishing the country’s third provincial hospital, the first in the north of England.52 Voluntary hospitals were funded by a subscription raised among prosperous members of the community including local nobility and gentry and the emerging professional classes invested in such projects. These contributions were publicly acknowledged and entitled the subscribers to refer patients. Though the city’s County Hospital was initially a partisan project, it soon became a focus for civic pride. Briefly located in a private house, by 1745 it was moved to a purpose-built edifice outside the city walls (Fig. 5.5). Wintringham—one of thirteen

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Fig. 5.5  John Haynes, The County Hospital in York (1743)

founding Trustees—was appointed a honorary physician.53 The hospital’s U-shaped plan, which reflected contemporary understanding of the need for good air circulation, was identical to the layout of the contemporaneous Liverpool hospital in every respect but one. The spaces at the rear, which in Liverpool housed a Salivating Ward for treating venereal disease, was allocated in York to a public bath, asserting the importance of therapeutic bathing repeatedly endorsed by Wintringham. In fact, hot and cold baths were built at the waterworks on the Ouse, while another cold bath was in use at Lady Well near the New Walk in 1749 and more were

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recorded in the 1790s.54 In 1779, over three decades after Wintringham’s death, medicated baths also opened in his former house. According to the 1743 annual report, which accounted for its first three years of operation, the County Hospital was funded by voluntary donations and annual subscriptions and staffed by honorary physicians and surgeons, who benefited by philanthropic association with the hospital’s benefactors.55 The number of patients that subscribers were allowed to recommend was proportionate to their donations. Patients required a note of recommendation from a subscriber, reinforcing the coalescing of the new urban elite by tying hospital admissions into the patronage network.56 The preamble to the hospital’s report makes clear the intention to provide support to economically active members of society as well as the injured and the disabled: But besides those who are entitled to parochial relief, these hospitals are intended for the reception of many others, who, though not reduced to take the alms of the parish, may nevertheless become great objects of charity, after having, by dint of industry, and hard labor, supported their families, by accidental hurts or sickness becoming a burden to those whom they formally maintained, and rendering a whole family miserable.57

The report also makes it plain which methods of treatment were deemed efficacious: In cases of illness a convenient Lodging, Nurses, diet, and several other things are absolutely necessary, and yet scarce ever to be had … These great evils cannot otherwise be cured than by establishing public hospitals for the sick and lame poor in which the care, neatness, lodging, and regularity of diet, will in all cases much facilitate the recovery; and, in the cure of some distempers, are more effectual than physic itself.58

Patients with acute symptoms were relieved by plain diet, clean beds, and a salubrious extramural environment; incurable chronic conditions, however, were beyond the hospital’s remit. As the 1743 report shows, of the 1708 patients admitted over the three-year period, 1335 were cured and 52 died, while 193 had to be discharged including 1 imposter, 2

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“lunatics,” 3 patients deemed “improper as having infectious diseases,” 50 incurables, and 17 people on account of certain “irregularity.”59 As the County Hospital, overall, proved a success, a similar campaign was launched in the 1770s for the establishment of the York Lunatic Asylum. Part of the local program of civic improvement, its founding also reflected a nationwide desire to curtail private madhouses.60 Architect John Carr (1723–1807) produced a lavish design for a capacious extramural site. His proposal presented a grander version of his Leeds Infirmary located twenty-five miles to the west, the design of which was praised by prison reformer John Howard.61 The York Asylum, however, was immediately criticized as a vanity project by the local press, which condemned it as too elegant and expensive.62 Moreover, a strong resemblance that it bore to Carr’s repertoire of both urban and countryside domestic architecture—as exemplified by Lytham Hall (1757–64) in Lancashire and Castlegate House (1762–63) in York—was perceived as a ploy to advertise his services.63 Carr was politically active as a Whig, so this criticism might have been partisan; nevertheless, the asylum was eventually established with a voluntary capital subscription, but without funding for patients’ upkeep. The wealthy inmates were, in effect, expected to subsidize the poor ones.64 Yet, despite the asylum’s imposing appearance— satirized as a “lunatic hotel” by one of Carr’s detractors—inspectors discovered patients lying in their excrement.65 It was partly in response to this state of affairs that the local Religious Society of Friends (Quakers) decided, with the help of their coreligionists across the country, to establish their own, architecturally more restrained, therapeutic York Retreat across town, which was originally restricted to members of their community.66 York’s hospitals appeared on both the reissued New and Exact Plan (1748) by John Haynes and John Cossins and Peter de Chassereau’s Plan de la ville et foubourgs [sic] de York: Capitale de la comté du meme nom (1750).67 Drawn by artists skilled in architectural representation, these city plans differed from other maps by detailing every notable structure. Such urban depictions conventionally combined street layout with bird’s-­ eye views of individual buildings. Cossins had used the same style of representation earlier in A New and Exact Plan of the town of Leedes (1727), the city that expanded from a chartered weaving town with a

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lively intellectual community into a center of the wool trade.68 Panoramic views of the urban skyline, such as those by Samuel and Nathaniel Buck of York, also became popular.69 These representations tended to celebrate monumental structures, usually identified in the legend at the side. Less distinguished parts of the city were shown as generic blocks of houses, while cross-hatching rendered whole areas as blank; this was where the poor people lived. While an important goal of these maps was to present the urban environment as salutogenic, the reality was often not the way they showed it. In the case of York, its epidemiologic scholarship and architectural improvements did little to address the living conditions of the poorest residents. Medical practitioners established their gentlemanly credentials by distancing themselves from the haptic aspects of the profession and by refusing to deal with cases of incurable or chronic disease. Hospitals needed to demonstrate their success for fundraising to continue, which, despite the underlying philanthropic drive, tended to favor projects that flattered civic or professional identities and bolstered the local economy. As historian Paul Langford reminds us, in the eighteenth century, “commercial interest was to the fore of the new [urban] planning.”70 In addition to that, a medieval governance system impeded any possibility of radical change.

The Health of the People as Supreme Law Public health was a slowly emerging concept that united clinical and economic concerns facilitated by political reforms that eventually catalyzed political will to act. During the nineteenth century, the increased international travel and demographic growth of the world’s leading industrial society generated favorable conditions for outbreaks of epidemic disease. England succumbed to the second and third Asiatic cholera pandemics of 1826–37 and 1846–60, which caused diarrhea, vomiting, and stomach cramping and, if left untreated, killed about half of affected individuals. Resulting from poor sanitation, it was transmitted through foods and river water contaminated with feces. In 1831, cholera entered Sunderland near Newcastle in the northeast of England and traveled south to York and London (Fig. 5.6).

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Fig. 5.6  William Heath, Microcosm, dedicated to the London Water Companies, Brought Forth All Monstrous, All Prodigious Thigs [sic.], Hydras, and Gorgons, and Chimeras Dire. Alternative title: Monster soup commonly called Thames water, being a correct representation of that precious stuff doled out to us!!! (ca. 1828)

As we have seen, eighteenth-century concerns about water contamination often ran contrary to local business interests. Rivers that continued to be an essential part of urban water supply often served as jurisdictional and regional boundaries, so that the authorities downstream had no control over the pollution upstream. During the first outbreak of cholera, a broadside circulated in London illustrated with an eye-catching cartoon by George Cruikshank (1792–1878), drawing attention to the responsibilities of water companies (Fig. 5.7).71 The title, Salus populi suprema lex esto (Let the Health of the People be the Supreme Law), alluded to the conflict of interest between business and governance. The broadside was addressed to John Edwards Vaughan (1772–1833), a controversial member of parliament who was also the owner of two of London’s south bank water companies.72 Lampooned as the “Water King of Southwark,” he was depicted sitting astride a close stool in the middle of the Thames at

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Fig. 5.7  George Cruickshank, Salus Populi Supreme Lex Esto. Heading to a printed broadside: “Royal Address of Cadwallader-ap-Tudor ap-Edwards ap-Vaughan, Water-­ King of Southwark, Sovereign of the Scented streams, … Protector of the Confederation of the (U)Rhine, … [&c. &c, a parody of Napoleon’s titles], To His Subjects of the Borough.” An attack on the Southwark Water Works, owned by John Edwards, Esq. A… (1832)

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Low Water near London Bridge, with an upturned chamber pot on his head and holding a goblet overflowing with sewage in one hand and a trident impaled with dead animals in the other. This regal figure was kept afloat by a dolphin—a sort of buoy—inscribed Source of the Southwark Waterworks. Slicks of raw sewage, including the culverted River Walbrook on the Middlesex Bank, were shown entering the Thames from both sides. On the opposite Southwark Bank, near Horse Shoe Alley, crowds implore: “Give us clean water!”; “Give us pure water!”; and “We shall all have the cholera!” The title conveyed the message of Cruikshank’s cartoon: the man whose primary responsibility as a public figure was the health of his customers and of the British population more broadly was shamelessly driven by self-interest and desire for profit. The image also graphically illustrated some of the administrative issues with managing public water supply. Edwards’s Southwark Waterworks drew drinking water directly from a sewage overflow on the north bank in the City of London that was in the County of Middlesex. Southwark was a separate jurisdiction from London, which, similarly to York, comprised a network of episcopal and borough jurisdictions. Officially, it lay in the County of Surrey, whereas its water arrived from upstream jurisdictions such as Lambeth on the south bank and Westminster on the north. Britain with its parish divisions lacked a unified governance system to deal with such large-scale issues until the Representation of the People Act of 1832 and the Municipal Corporations Act of 1835 would allow the authorities to address these concerns on a citywide basis.73 This new legislation created a uniform franchise in the boroughs consolidating the honeycomb of medieval jurisdictions into much larger units. In many ways, however, these legislative measures arrived too late. Water-borne cholera epidemics were a disaster that no known cures could counter. York’s water supply was compromised: the Foss was silted up with sewage, the Ouse was polluted with effluent from leather manufactories located upstream from the city’s waterworks. From 1831, the York doctors were increasingly aware of the presence of cholera in the neighboring towns of Selby and Goole. In Leeds, where the textile industry had generated huge disparities in wealth,74 the epidemic claimed more than 700 victims.75

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York, too, was primed for epidemic outbreak. The authorities took some precautions: lectures were delivered by York’s Medical Society,76 and the Board of Health was reconvened and authorized to levy a parochial rate (tax) for whitewashing houses, removing detritus, and providing funding for medicines, nurses, and other attendants for the temporary cholera hospital. Since many voluntary hospitals did not admit contagious patients, they rented isolated houses or identified burial grounds, which was cheaper than enlarging the County Hospital’s fever ward.77 These preventative measures, however, were inadequate to control the disease, and, despite all preparations, 185 people died, mostly the disadvantaged individuals who inhabited flood-prone areas close to the rivers: the three Water Lanes, Walmgate, and Skeldergate.78 The epicenter of cholera was at a slum court near the River Ouse, where historically previous epidemics had begun. One difficulty that the city faced was the lack of clear directions from its medical leadership, since epidemiological opinion was divided between the miasma and contagion theories.79 The division of authorities also meant that partisan thinking hindered decision-making.80 Furthermore, the epidemic took place against the background of national hysteria surrounding Resurrectionists who supplied anatomists with cadavers, after the recent execution in 1829 of William Burke (1792–1829), who, with his partner in crime William Hare (b. 1792 or 1804), murdered people to this end. Such rumors were not entirely fanciful, as the newly passed Anatomy Act (1832) would permit the use of unclaimed bodies from hospitals and workhouses for anatomical dissection. The scale of the epidemic took the authorities by surprise, with the tiny “cholera hospital” soon becoming overwhelmed and requiring additional space. Yet, after the epidemic, York’s Board of Health was dissolved. Drains that had been laid as part of disease-prevention measures were deemed cheap and insufficient. The unanimous decision in 1831 to build additional washhouses and public baths remained unrealized until after 1847. The city’s overcrowded burial grounds were recognized as a public health risk, with the York Public Cemetery Company founded in 1836 to address this issue. A new eight-acre cemetery was opened in the following year.81

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Mapping the Pathogenic City If, in the case of York, the city’s concentration of hospital buildings and presence of competent clinicians may have mitigated the worst effects of the epidemic, the disease required nationwide efforts and new legislation to galvanize change. The Municipal Corporations Act (1835) led to the establishment in 1844 of the Royal Commission for the Health of Towns, chaired by sanitary reformer Sir Edwin Chadwick (1800–90), the author of Report on the Sanitary Condition of the Labouring Population of Great Britain (1842), which detailed water and sewerage systems in the country’s fifty largest extra-metropolitan towns. Chadwick’s report, for example, included sanitation maps of London’s Bethnal Green as well as Leeds, showing the incidence of disease related to “less clean districts.”82 This greater public awareness of the urban health conditions stimulated the formation of the Health of Towns Association (1844–49), which had George William Frederick Howard (1802–1864), Viscount Morpeth and Seventh Earl of Carlisle, as one of its most active committee members. The Association’s York branch was among the most active, with physician Thomas Laycock contributing his already cited Report on the Sanitary Condition of York in 1844. It referred to the general public health conditions of the city, especially with regard to the poor, as lamentable, much as they had been during the cholera epidemic of 1832.83 Laycock’s analysis related claims of the Poor Law monies (poor relief ) to the altitude of the claimants’ housing above sea level, correlating low-lying areas, poverty, and reduced lifespan. York’s lowest lying district that housed the poorest communities was Walmgate Ward, located between the two rivers close to the putrid Foss Islands and routinely inundated. This attempt to connect ill-health to place—while tracing its origin to Aristotle’s De Aere, Aquis et Locis (On Airs, Waters, and Places), Vitruvius, and even fourteenth-century Venetian quarantine maps—was an important step toward creating a healthier urban environment.84 This enhanced understanding of the social topography of the city led to a new kind of cartography that was different from urban representations that we have discussed so far. Though maps that correlated sites of poverty and ill-health had previously been used to identify infected households in late eighteenth-century America, combining statistical

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data with cartography became a common practice among the Boards of Health in early nineteenth-century Britain.85 Mapping enabled authorities to see the distribution of epidemic outbreaks, relating them to poverty and overcrowding and more accurately tracking the spread of disease that was long known to follow trade routes. Chadwick’s 1842 report on the sanitary condition of Britain’s laboring population, for instance, cited the work of a certain Dr. Baker, who had prepared at Chadwick’s request a map of Leeds showing a correlation between poorly cleaned and badly drained areas and mortality rates.86 Sanitary maps of Leeds also revealed the extent to which the River Aire had shaped patterns of land use, with access to water that was key to many industries resulting in overcrowded housing.87 These efforts gained further momentum in the work of John Snow (1813–58), who was born in York in a particularly cholera-prone area next to the River Ouse. During the cholera outbreak of 1831–32, he was a medical student in Newcastle-upon-Tyne. Snow continued to be interested in cholera after his move to London in the 1830s. It was there that, during the century’s worst epidemic of 1849, he observed that fatality rates were particularly high in areas that depended on water from one particular source. Although Snow’s treatise On the Mode of Communication of Cholera (1849) received little interest at the time of its publication, it innovatively combined statistical analysis with mapping visualizations to substantiate his theory. It was republished after London’s Broad Street cholera outbreak of 1854 that had claimed over 500 lives in ten days. Validating germ theory, the new edition presented statistical tables of disease prevalence alongside maps of Soho, showing the relationship between the spread of cholera and the distribution of contaminated water.88 Snow argued for the need to keep drinking water separate from that serving to fill water closets.89 Together with the medical statistician William Farr (1807–83), he studied 300,000 cases of death in London, demonstrating that the use of water from the Southwark and Vauxhall Water Company made cholera casualties fourteen times higher as compared to water from the Lambeth Water Company, which drew its supply upstream of the polluted city.90 Their strong recommendation for water companies was to filter water and for the population to drink it boiled during cholera outbreaks.

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 alutogenic Engineering Versus the “Vanity S of the Architect” Epidemiological work on mapping the localities and spread of infections was not sufficient to promote healthy urban environments. Chadwick’s Sanitary Conditions of the Labouring Population of Great Britain recommended improving the quality of housing and urban layouts to counter the lowering of productivity caused by epidemic disease. It was not until the national Public Health Act of 1848, however, that a General Board of Health was established as a central authority to direct health policies to regional and local administrators. It proposed improved drainage, provision of sewers, and the removal of refuse from houses and streets. London’s Metropolitan Board of Works was the first body established in England to implement integrated sanitation, operating at the level of the city rather than individual parishes. Its chief engineer appointed in 1856 was Joseph Bazalgette (1819–91), an experienced surveyor whose groundbreaking work was enabled by newly consolidated political will and supported by immense resources. The contaminated Thames continued to release putrid smells from overflowing cesspits and night soil, the situation exacerbated by water closets disgorging into the main drain that received the waste of two million people. In June 1858, high temperatures generated “The Great Stink” as it was called at the time, shocking the politicians who fled from the recently rebuilt riverside Palace of Westminster.91 This was a call to action for Bazalgette, who displayed immense proficiency and insight in implementing a citywide network of sewers. For two decades from 1858, together with his assistants, he designed and built more than 1500 miles of sewers that cost £6.5 million—the country’s largest single expenditure to that date during times of peace. Despite the still partial epidemiological knowledge, one consequence of this project was the elimination of cholera and the reduced incidence of typhus and typhoid.92 Bazalgette’s specifications for the diameter of the piping, larger than it was required at the time, allowed the system to meet the future population increase. The Crossness Pumping Station (1862–65) on the south bank of the Thames and Abbey Mills (1865–68) on the north bank, both designed by architect Charles Driver (1832–1900), fused the latest technology of vast beam engines and cast

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iron work with ornamental forms derived from Byzantine and Venetian architecture as celebrated in J. M. Williams’s engraving titled, “Engine-­ house, Crossness: Outfall of the southern metropolitan sewerage. Erected under the direction of Mr. Bazalgette, engineer of the metropolitan board of works” of 1865 (Fig. 5.8). These pumping stations still stand today as enduring if flamboyant monuments of nineteenth-century sanitary engineering.93 Bazalgette’s interventions paved way for further salutogenic improvements. The acquisition of a stretch of land parallel to the Thames between Westminster Bridge and Blackfriars enabled the creation of the Victoria Embankment, which, opened in 1870, supported a broad tree-lined thoroughfare that connected the City of Westminster to the City of London. Its creation, in turn, facilitated the construction of low-level sewers and the burgeoning underground railway system that, while alleviating overground traffic, also reduced the dung deposits of thousands of horses.94 Across the Thames was the Albert Embankment, while the Chelsea Embankment further upstream, finished in 1874, protected the Royal Chelsea Hospital from flooding. Resulting in a reclamation of 52 acres of land, these three embarkments cost nearly £2.5 million.95 In the meantime, 8.5 acres of the Albert Embankment were sold to the Governors of St. Thomas’s Hospital to enable its relocation. Similarly to St. Bartholomew’s in the eighteenth century, the plan and interior of the new building, which opened in 1869, was influenced by contemporary epidemiological thinking, especially the ideas of the well-connected nurse Florence Nightingale (1820–1910). While her experience of infection control persuaded her of the need for good ventilation and cleanliness, she did not believe that architects necessarily prioritized these sanitary aspects in their designs: To have pure air, your house must be so constructed as that the outer atmosphere shall find its way with ease to every corner of it. House architects hardly ever consider this. The object in building a house is to obtain the largest interest for the money, not to save doctors’ bills for the tenants. But, if tenants should ever become so wise as to refuse to occupy unhealthy constructed houses, and if Insurance Companies should ever come to understand their interest so thoroughly as to pay a Sanitary Surveyor to

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Fig. 5.8  J. M. Williams, Engine-house, Crossness: Outfall of the southern metropolitan sewerage. Erected under the direction of Mr. Bazalgette, engineer of the metropolitan board of works (1865)

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look after the houses where their clients live, speculative architects would speedily be brought to their senses. As it is, they build what pays best.96

Nightingale’s polemical writings extended her authority to hospital design. In 1858, she published Notes on Hospitals, the first half of which addressed the general sanitary principles she advocated, defects in existing hospital plans and construction methods, and ways to improve them.97 Nightingale’s critical opinions were persuasive, because, similarly to John Snow, she supported her arguments with statistical data. She also showed familiarity with European models, including the Parisian Hôtel Dieu that, in turn, had been influenced by the Royal Naval Hospital, Stonehouse.98 Nightingale defined the mission of hospitals as “to restore the sick to health” in the shortest time and with the lowest mortality rate.99 “The question of a general hospital plan resolves itself, first of all, into obtaining the most healthy structure of the pavilion,” she wrote, most likely evoking Isambard Kingdom Brunel’s (1806–59) model Renkioi Hospital build on the Dardanelles during the Crimean War (1853–56).100 For this reason, she recommended low one- or two-story structures, drawing attention to the proportions of the wards as directly affecting the volume of air that had to be ventilated and specifying the optimal number of beds and their positioning. Nightingale was critical of the Royal Victoria Military Hospital, Netley, designed by R. O. Mennie (active 1856–63), because of its inadequate planning and ventilation.101 She even managed to convince the Prime Minister, Lord Palmerston (1784–65) of its flawed design, who wrote to Lord Panmure (1801–74), Secretary of State for War: It seems to me at Netley all consideration of what would best tend to the comfort and recovery of the patients has been sacrificed to the vanity of the architect, whose sole object has been to make a building which should cut a dash when looked at from the Southampton River.102

Nightingale made sure that these misplaced priorities would not be manifest in architect Henry Currey’s (1820–1900) design for the new St. Thomas’s Hospital (Fig. 5.9). While its Italianate towers echoed the Gothic silhouette of the Palace of Westminster directly across the Thames,

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Fig. 5.9  T. Sulman, Saint Thomas’s Hospital, Lambeth, seen from the south-east with the Palace of Westminster in the background, a plan and scale beneath (1871)

the internal spaces were organized into separate wards linked by low corridors that were intended to improve ventilation and segregate patients with infectious diseases.103 Nightingale recommended using washable walls of Parian cement, specially designed sash windows that facilitated air circulation, and an artificial system of ventilation with air extraction pipes, all aimed to maintain a healthy hospital environment.

The York Denouement Thomas Laycock concluded his 1844 report with the following observation: “The density and wealth in any given district will materially influence the health of the inhabitants; the two indeed are generally in an inverse ratio to each other; and with the density all the causes which aggravate the mortality of a district are increased.”104 Laycock was

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physician to York’s Dispensary for the Poor, which, established in 1788 in the medieval Merchant Adventurers’ Hall, had managed to acquire its purpose-­built premises only in 1829.105 The Dispensary supplemented the County Hospital by providing free services to the poor and addressing chronic health issues through out-patient surgeries, domiciliary maternity care, and home visits. In the first twenty years of its existence, it admitted around 17,000 patients. During the 1832 epidemic, it dispensed advice and medicines free of charge.106 In addition to Laycock’s sanitary report, another publication that originated in the Dispensary’s intellectual ambience was J. P. Needham’s Facts and Observations Relative to the Disease Commonly Called Cholera, as It Has Recently Prevailed in the City of York (1833). It detailed the progress of cholera and specified treatments offered at different stages of the disease.107 Needham’s observations confirmed that nineteenth-century physicians recognized a relationship between poverty and overcrowding, knew that certain urban areas were healthier than others, but were still unaware of the vectors of transmission of cholera.108 Ironically, it was the York Dispensary rather than the city’s upper-class hospitals, baths, and walks that in the most consistent manner promoted the equitable model of building a healthier environment. Salutogenic architectural interventions, celebrated as they were at the time, were, in other words, secondary to the delivery of public health. York’s early modern architecture of health accords with Bernard de Mandeville’s assertion put in the title of this chapter that good health remained a privilege of the wealthy until nineteenth-century parliamentary acts would provide a legislative basis for widescale administrative and social reforms, as the case of London demonstrates. Rather than providing disinterested service to the community, celebrated architectural schemes often masked self-serving political motives and business interests. The County Hospital’s subscription advanced benefactors into the patronage network, while the building of the York Lunatic Asylum may well have leveraged philanthropic building for the architect’s professional gain. The riverside promenade, the racecourse, and bathhouses, in the eighteenth century, were for paying customers. The piped water was also for the rich, and, as late as 1844, the poor still drew their drinking supply from contaminated rivers.

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Notes 1. Martin Kemp and Marina Wallace, Spectacular Bodies: The Art and Science of the Human Body from Leonardo to Now (London: Hayward Gallery and University of California Press, 2000), 11. 2. Andrew Cunningham, “The Bartolins, the Platters and Laurentius Gryllus: The Peregrination Medica in the Sixteenth and Seventeenth centuries,” in Centres of Medical Excellence? Medical travel and Education in Europe, 1500–1789, ed. Ole Peter Grell, Andrew Cunningham and Jon Arrizabelaga (Farnham: Ashgate, 2010), 3-16. 3. Andrew Cunningham, The Anatomist Anatomis’d: An Experimental Discipline in Enlightenment Europe (Ashgate: Farnham, 2010); Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (London: Harper Collins, 1997), 205–09. 4. For a detailed discussion of the intellectual positions and the rise of pathology, see Cunningham, Anatomist Anatomis’d, 186–222. 5. Alexander Tzonis and Liane Lefaivre, “The Mechanical Body versus the Divine Body: The Rise of Modern Design Theory,” Journal of Architectural Education 29, no. 1 (1975), 6; Michel Foucault, Les Machines à guérir aux origines de l’hôpital modern (Brussels: P. Mardaga, 1979). 6. One notable exception in the British context here is Christine Stevenson, Medicine and Magnificence: Hospital and Asylum Architecture 1660–1820 (New Haven, CT: Yale University Press, 2000). 7. Stress Reduction Through Joy of Life. The Salutogenesis Model by Aaron Antonovsky (GRIN Verlag, online, n.d.). 8. Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (Oxford: Oxford University Press, 1999); John Henderson, The Renaissance Hospital: Healing the Body and Healing the Soul (New Haven, CT: Yale University Press, 2008). 9. Ann-Marie Akehurst, “The Body Natural as well as the Body Politic Stands Indebted’: The Hospital—Foundation, Funding and Form,” in Architectural Theory and Practice, Companion to Architecture in the Age of the Enlightenment, ed. Caroline van Eck and Sigrid de Jong (Chichester John Wiley & Sons, 2017), 2. 10. Paul Langford, A Polite and Commercial People: England 1727–1783 (Oxford: Oxford University Press, 1992), 389–435; E. L. Jones and M. E. Falkus, “Urban Improvement and the English Economy in the

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Seventeenth and Eighteenth Centuries,” in The Eighteenth-Century Town 1688–1820, ed. Peter Borsay (London: Longman, 1990), 116–158; Joyce M. Ellis, The Georgian Town 1680–1840 (Basingstoke: Palgrave, 2001), 87–105. 11. Mandeville, Bernard. The fable of the bees: or, private vices, publick benefits. The second edition, enlarged with many additions. As also an essay on charity and charity-schools. And a search into the nature of society (Edmund Parker: London, 1723), 294. 12. Harriet Richardson, ed. English Hospitals 1660–1948: A Survey of Their Architecture and Design, (London: RCHME, 1998), 1–2. 13. Ann-Marie Akehurst, “St Bartholomew’s Hospital and Gibbs’ Role in Hospital Pavilion Planning,” Georgian Group Journal 27 (2019): 91–122. 14. Porter, Greatest Benefit, 188–89. 15. Anya Lucas and Henry Russell, The Livery Halls of The City of London (London: Merrell, 2018), 200–203. 16. Three clauses in the Quarentine [sic] Act, 1721, [London]: [1721]. 17. Richard Brookes, A History of the Most Remarkable Pestilential Distempers that Have Appeared in Europe for Three Hundred Years Last Past (London, [1721]), 37; Robert Samber, Treatise of the Plague. Being an Instruction How One Ought to Act […] (London, 1721), 5–10. 18. Richard Mead, A Discourse Concerning Pestilential Contagion (London, 1720), 39. 19. Akehurst, “St Bartholomew’s Hospital,” 98. 20. John Evelyn, Fumifugium, or, The Inconveniencie of the Aer and Smoak of London Dissipated Together with Some Remedies Humbly Proposed (London, 1661). 21. Christine Stevenson: The City and the King: Architecture and Politics in Restoration London (New Haven, CT: Yale University Press, 2013), 139–41. 22. Stephen Halliday, The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis (Stroud: History Press, 2009). 23. Galley, Demography, 41. 24. Francis Drake, Eboracum The History and Antiquities of the City of York, from Its Original to the Present Time […] (London, 1736), 240. 25. Borsay, The English Urban Renaissance, 163–64; Wilbert M. Gesler, Healing Places (Oxford: Rowman and Littlefield, 2003), 43–63. 26. John Howard, The State of the Prisons in England and Wales, with Preliminary Observations, and an Account of Some Foreign Prisons (Warrington, [1777]), 397.

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27. P. M. Tillott, “The City of York,” in A History of the County of York: The City of York, ed. P. M. Tillott (London: Victoria County History, 1961), 1. 28. Ibid., 38–40. 29. Ibid., 229–240 and 215–229. 30. Royal Commission on Historical Monuments (England), An Inventory of the Historical Monuments in City of York, vol. 1, Eburacum, Roman York (London: Her Majesty’s Stationery Office, 1962), xxix–xli. 31. Brown, R. Allen, Colvin, Howard, and Taylor, A. J. The History of the King’s Works, Volume 2, The Middle Ages, London HMSO: London, 1963, 889-91. 32. Mark Jenner, “From Conduit Community to Commercial Network? Water in London, 1500–1725,” in Londinpolis: Essays in the Cultural and Social History of Early Modern London, ed. Paul Griffiths and Mark S. R. Jenner (Manchester: Manchester University Press, 2000), 256–57. 33. Royal Commission on Historical Monuments (England), An Inventory of the Historical Monuments in City of York, vol. 2 (London: Her Majesty’s Stationery Office, 1962), xxix–xli; 108–10; Tillott, City of York, 160–65. 34. Jenner, “From Conduit,” 256–57. 35. William Vernon Harcourt, “Letter to the York Sanatory Sub-­ Committee” in Thomas Laycock, City of York: Report on the State of York, in Reply to Questions Circulated by the Health of Towns Commission Report ([London]: Royal Commission on the State of Large Towns, 1844), 1–3. 36. It was conducted in 1833 by J. Spence and reproduced by Laycock. 37. Laycock, Rep. on State of York (1844), 221. 38. Tillott, City of York, 245–50. 39. Michael Durey, First Spasmodic Cholera Epidemic in York, 1832, Borthwick Papers 46 (York: St. Anthony’s Press, 1974), 14; Laycock, Report on the State of York, 13. 40. J. B. Morrell and A. G. Watson, eds., How York Governs Itself (London: George Allen & Unwin, 1928), 109, cited in Katherine A. Webb, From County Hospital to NHS Trust: The History and Archives of NHS Hospitals, Services and Management York, 1740–2000, Borthwick Texts and Calendars 27, 2 vols. (York: University of York, 2002), 1: 115n5. 41. It was subtitled Wherein the different natures of airs, situations, soils, waters and diets are mechanically explained and accounted for. A second

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edition was published in 1733 in London, dedicated to Dr. Richard Mead, and a third edition appeared six years later. 42. Wintringham, A Treatise of Endemic Diseases (York, 1718), ch. 3. 43. Wintringham, Treatise of Endemic Diseases, 47; Wintringham, An Essay on Contagious Diseases […] and Pestilential Fevers (York, 1721), 5. 44. Wintringham, Essay on Contagious Diseases, 53. 45. Wintringham, Observations on Dr. Freind’s ‘History of Physick’ (London, 1726). 46. Wintringham, Essay on Contagious Diseases, preface. 47. Laycock, Report on the State of York, City of York, 43. 48. Ibid., 44. 49. Daniel Defoe, Tour Through the Whole Island of Great Britain, ed. Pat Rogers (Penguin: London, 1971), 520. 50. Drake, Eboracum, 240. 51. “[T]here are not many instances of people living to an extreme old age […] notwithstanding the natural healthfulness of the situation.” Drake attributed this to too much good living. Drake, Eboracum, 242. 52. Adrian Wilson, “Conflict, Consensus and Charity: Politics and the Provincial Voluntary Hospitals in the Eighteenth Century,” The English Historical Review 111, no. 442 (June 1996): 599–619. 53. Richard Warneford, Good Works the Proper Fruit of Good-will […] (York, 1743). 54. Tillott, The City of York, 460–61. 55. Anonymous, An Account of the Public Hospital for the Diseased Poor in the County of York (Ward and Chandler: York, 1743), 18. 56. Ibid., 19. 57. Ibid., 2. 58. Ibid., 2. 59. Ibid., 30. 60. Ann-Marie Akehurst, ‘Architecture and Philanthropy: Building Hospitals in Eighteenth-Century York’ (PhD diss., University of York, 2009), 154. 61. John Howard, An Account of the Principal Lazarettos in Europe; With Various Papers Relative to the Plague (Warrington, [1789]), 192. 62. Akehurst, “Philanthropy,” 162. 63. Brian Wragg, and Giles Worsley, Life and Works of John Carr (York: Oblong Press, 2000), 177 and 230–31. 64. Akehurst, “Philanthropy,” 184–86.

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65. William Mason, Animadversions on the Present Government of the York Lunatic Asylum (York; Blanchard, [1788]); Anne Digby, “Changes in the Asylum: The Case of York, 1777–1815,” Economic History Review 36 (1983): 218–39; Anne Digby, Madness, Morality and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge: Cambridge University Press, 1985). 66. Akehurst, ‘Philanthropy,’ 208. 67. Peter de Chassereau, Plan de la ville et foubourgs [sic] de York: Capitale de la comté du meme nom (1750), York Art Gallery (R2739). 68. Hugh Murray, Scarborough, York and Leeds: The Town Plans of John Cossins 1697–1743 (York: Ebor Press, 1997). 69. William Lodge, The Prospects of the Two Most Remarkable Towns in the North of England for the Clothing Trade […] published in Ducatus Leodiensis, or the Topography of the Town and Parish of Leedes (London, 1715) by the Yorkshire antiquary Ralph Thoresby., opposite 164; Samuel and Nathaniel Buck, The South and east Prospect of the City of York (1743) York Art Gallery, R3181. 70. Paul Langford, A Polite and Commercial People, England 1727–1783 (Oxford: Oxford University Press, 1992), 431. 71. Robert L. Patten, George Cruickshank’s Life, Times and Art, vol. 1, 1792–1835 (London: Lutterworth Press, 1992), 357–58. 72. T. Jenkins, ‘Edwards Vaughan, John’, in The History of Parliament: The House of Commons, 1820-1832, ed. D.R. Fisher (Cambridge: Cambridge University Press, 2009). 73. 2 & 3 Will. IV c. 45 and 5 & 6 and Wm. IV., c. 76, respectively. 74. Asa Briggs, Victorian Cities (University of California Press: Berkeley, 1963), 144. 75. Arthur H. Robinson, Early Thematic Mapping in the History of Cartography (Chicago: University of Chicago Press, 1982), 172. 76. Durey, First Spasmodic Cholera Epidemic in York, 5–6. 77. Ibid., 6. 78. Ibid., 8. 79. Ibid., 14–16. 80. Ibid., 21. 81. Tillott, City of York, 460–61. 82. Robinson, Early Thematic Mapping, 187 fig. 95. 83. Laycock, Report on the State of York, 222.

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84. Laura Vaughan, Mapping Society: The Spatial Dimensions of Social Cartography (London: University College London Press, 2018); Vitruvius, Vitruvius: The Ten Books on Architecture, trans. M. H. Morgan (New York: Dover Publications. 1960), 17 and 183. 85. Ibid., 783; Robinson, Early Thematic Mapping, 170–88. 86. Edwin Chadwick, Report to Her Majesty’s Principal Secretary of State for the Home Department from the Poor Law Commissioners, on an Inquiry into the sanitary condition of the labouring population of Great Britain: with appendices, Presented to both Houses of Parliament, by Command of Her Majesty, July, 1842 (London: Her Majesty’s Stationery Office, 1842), 160. 87. Vaughan, Mapping Society, location 857 Figure 22.3 shows the Kirkgate area of the Sanitary Map of the town of Leeds, 1842. 88. For a full account of Snow’s mapping see Robinson, Early Thematic Mapping, 176–79. 89. John Snow, “Drainage and water supply in connexion with the public health,” Medical Times and Gazette 16 (20 February 1858): 188–91, 191. 90. John Snow, “Cholera and the Water Supply in the Southern Districts of London,” British Medical Journal 2 (1857), 864; P. Bingham, N. Q. Verlanderb, and M. J. Cheala, “John Snow, William Farr and the 1849 Outbreak of Cholera that Affected London: A Reworking of the Data Highlights the Importance of the Water Supply,” Public Health 118 no. 6 (2004): 387–94. For Snow’s 1855 map relating to the two water companies, see Robinson, Early Thematic Mapping 179. 91. Halliday, The Great Stink of London, 71–73. 92. Ibid., 137–43. 93. Paul Dobraszczyk, “Historicizing Iron: Charles Driver and the Abbey Mills Pumping Station (1865–68),” Architectural History 49 (2006): 223–56. 94. Halliday, The Great Stink of London, 145. 95. Ibid., 148. 96. Florence Nightingale, Notes on Nursing (London, 1859), 24-5. 97. Florence Nightingale, Notes on Hospitals: Being Two Papers Read Before the National Association for the Promotion of Social Science, at Liverpool, in October 1858 (London: John W. Parker, 1859). 98. Akehurst, “St Bartholomew’s Hospital,” 103–106. 99. Nightingale, Notes on Hospitals, 5 and 26. 100. Ibid., 56. 101. Ibid., 37.

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102. Richardson, Hospitals, 92. 103. James Stevens Curl, Victorian Architecture (London: David and Charles, 1990), 232–33; Halliday, The Great Stink of London, 156. 104. Laycock, Report on the State of York, City of York, 14. 105. Katherine A. Webb, “One of the Most Useful Charites in the City: York Dispensary 1788–1988,” in Borthwick Paper 74 (York: St. Anthony’s Press, 1988); Tillott, City of York, 470. 106. Webb, “York Dispensary,” 17. 107. J. P. Needham, Facts and Observations Relative to the Disease Commonly Called Cholera, as It Has Recently Prevailed in the City of York (London: Longman, Rees, Orme, Brown, Green and Co., 1833). 108. Ibid., location 1092.

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Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Harper Collins, 1997. Pugliese, Patri J. ‘Hooke, Robert (1635–1703), natural philosopher.’ Oxford Dictionary of National Biography. 23 Sep. 2004; Accessed 14 Feb. 2021. https://www-­o xforddnb-­c om.sheffield.idm.oclc.org/view/10.1093/ ref:odnb/9780198614128.001.0001/odnb-­9780198614128-­e-­13693. Richardson, Harriet, ed. English Hospitals 1660–1948: A Survey of their Architecture and Design. London: Royal Commission on the Historical Monuments of England, 1998. Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals. Oxford: Oxford University Press, 1999. Royal Commission on Historical Monuments (England). An Inventory of the Historical Monuments in City of York. Vol. 1, Eburacum, Roman York. London: Her Majesty’s Stationery Office, 1962. Royal Commission on Historical Monuments (England). An Inventory of the Historical Monuments in the City of York. Vol. 5, The Central Area. London: Her Majesty’s Stationery Office, 1981. Robinson, Arthur H. Early Thematic Mapping in the History of Cartography. Chicago: University of Chicago Press, 1982. Saint, Andrew. Architect and Engineer: A Sibling Rivalry. New Haven, CT: Yale University Press, 2007. Samber, Robert. A Treatise of the Plague. Being an Instruction How One Ought to Act […]. London, 1721. Smith, Denis. “Bazalgette, Sir Joseph William (1819–1891), civil engineer.” Oxford Dictionary of National Biography. 23 Sep. 2004; Accessed 14 Feb. 2021. https://www-­oxforddnb-­com.sheffield.idm.oclc.org/view/10.1093/ref:od nb/9780198614128.001.0001/odnb-­9780198614128-­e-­1787. Snow, John. ‘Cholera and the Water Supply in the Southern Districts of London.’ British Medical Journal 2 (1857): 864. Snow, John. ‘Drainage and water supply in connexion with the public health,’ Medical Times and Gazette 16 (13 February 1858): 161-63. MTG 16 (20 February 1858): 188-91. Snow, Stephanie J. ‘Snow, John (1813–1858), anaesthetist and epidemiologist.’ Oxford Dictionary of National Biography. 23 Sep. 2004; Accessed 14 Feb. 2021. https://www-­oxforddnb-­com.sheffield.idm.oclc.org/view/10.1093/ ref:odnb/9780198614128.001.0001/odnb-­9780198614128-­e-­25979. Stevenson, Christine. The City and the King: Architecture and Politics in Restoration London. New Haven, CT: Yale University Press, 2013.

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Stevenson, Christine. Medicine and Magnificence: Hospital and Asylum Architecture 1660–1820. New Haven, CT: Yale University Press, 2000. Summerson, John. Architecture in Britain,1530–1830. New Haven, CT: Yale University Press, 1993. Thompson, John D. and Grace Goldin. The Hospital: A Social and Architectural History. New Haven, CT: Yale University Press, 1975. Tillott, P. M., ed. A History of the County of York: The City of York. London: Victoria County History, Oxford: Oxford University Press, 1961. Tzonis, Alexander, and Liane Lefaivre. ‘The Mechanical Body versus the Divine Body: The Rise of Modern Design Theory.’ Journal of Architectural Education 29, no. 1 (1975): 4–7. Vaughan, Laura. Mapping Society: The Spatial Dimensions of Social Cartography. London: University College London Press, 2018. Vitruvius. Vitruvius: The Ten Books on Architecture, translated by M. H. Morgan. New York: Dover Publications, 1960. Warneford, Richard. Good Works the Proper Fruit of Good-will […]. York, 1743. Webb, Katherine A. From County Hospital to NHS Trust: The History and Archives of NHS Hospitals, Services and Management York, 1740–2000. Borthwick Texts and Calendars 27, 2 vols. York: University of York, 2002. Webb, Katherine A. ‘One of the Most Useful Charites in the City: York Dispensary 1788–1988.’ In Borthwick Paper 74. York: St. Anthony’s Press, 1988. Wilson, Adrian. ‘Conflict, Consensus and Charity: Politics and the Provincial Voluntary Hospitals in the Eighteenth Century.’ The English Historical Review 111, no. 442 (June 1996): 599–619. Wilson, Van. York’s Golden Half Mile, The Story of Coney Street. York: York Archaeological Trust, 2013. Wintringham, Clifton. Commentarium nosologicum morbos epidemicos et aeris variationes in urbe Eboracenci locisque vicinis, ab anno 1715, usque ad finem anni 1725, grassantes complectens. London: J. Clark, [1727]. Wintringham, Clifton. An Essay on Contagious Diseases […] and Pestilential Fevers. York, 1721. Wintringham, Clifton. A Treatise of Endemic Diseases. York, 1718. Wintringham, Clifton. Observations on Dr. Freind’s ‘History of Physick.’ London, 1726. Wragg, Brian, and Giles Worsley. Life and Works of John Carr. York: Oblong Press, 2000.

Part III Spaces of Madness

6 Madness in the Early Modern City: Florence and the Public Health Nexus, 1642–1788 Elizabeth W. Mellyn

Along the right bank of the Arno River, a brief walk from Florence’s famous church of Santa Croce, stands a long-forgotten building. Given over now to private residences and professional offices and flanked on both sides by luxury hotels, one would never know that in the eighteenth century it was the site of the city’s premier mental hospital, which played a pivotal role in the city’s evolving system of public health. In 1754, after four years of extensive renovation, this building became the new home of Santa Dorotea, Florence’s first hospital devoted solely to the care of severely mentally ill men and women. By that time, Santa Dorotea was already over a century I presented earlier versions of this chapter at Harvard University’s Cartography Seminar and at the Weill Medical College of Cornell University’s Richardson History of Psychiatry Seminar. I am indebted to those communities for lively discussion and insightful questions. I wish to thank directly Katharina N. Piechocki and Daniel M. Fox for suggestions and comments. I am grateful also to Danielle Abdon and Caroline E. Murphy for helping me interpret aspects of Ruggieri’s architectural plans and suggesting scholarship on waste removal systems in early modern hospitals. Finally, I would like to thank Boston architect Ben Tulman for turning Ruggieri’s plans into 3D digital models.

E. W. Mellyn (*) University of New Hampshire, Durham, NH, USA © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_6

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old. From its founding in 1642 to its relocation in 1754, it had inhabited a smaller, less august space in an inner-city street a few blocks north. Yet even this inconspicuous site was conceived of as part of an evolving network of public health policies, infrastructures, and institutions that served to promote and maintain the city’s health (Figs. 6.1 and 6.2). Through a focused study of Santa Dorotea, in its two built incarnations and their place within an evolving landscape of medical and charitable institutions in Florence, this chapter reconsiders both the history of asylums and the history of public health in early modern Europe. During the last two decades, historians have adopted a new public health focus to transform our perspective on medieval and early modern cityscapes. Contrary to previous views that emphasized the squalor and disorder of

Fig. 6.1  Santa Dorotea, site 2, 1754–88, in contemporary Florence. Photo: Elizabeth W. Mellyn

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Fig. 6.2  Santa Dorotea, site 1, 1642–1754, in contemporary Florence. Photo: Elizabeth W. Mellyn

these places, recent studies have shown the lengths to which municipalities went in efforts to what Guy Geltner described as “healthscape” urban environments.1 We know now that, prior to the first catastrophic incidence of plague in the mid-fourteenth century, civic leaders were already

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issuing regulations to control in some measure the disposal of waste and the by-products of toxic industrial processes.2 They similarly tried to manage the maintenance of roads, bridges, and waterways.3 By the fifteenth century, many Italian cities boasted sanitation infrastructures and interconnected networks of institutions devoted to the management of health and hygiene. Hospital founders and architects by that time had agreed that properly built structures, regardless of whether or not a medical practitioner worked within them, were capable of preventing disease and bolstering health.4 In the sixteenth century, lay consumers of an increasingly prolific and rich vernacular literature on the art of healthy living began to order their domestic spaces in accord with theories of preventive health.5 More recently, historians have restored plague and syphilis houses to the European cityscape. These structures— some permanent, some temporary—emerged on the urban scene in the fifteenth and sixteenth centuries, respectively, coming to play important roles in a network of medical and charitable institutions designed to keep cities physically, spiritually, and morally clean.6 While scholarship has expanded our definition and understanding of what constituted public health in Europe between the fourteenth and eighteenth centuries, this chapter argues that we should broaden that perspective even further to include the history of mental institutions. With good reason, histories of these complex spaces are typically more about power, profit-seeking, and public order than they are about public health. Indeed, it is hard to ignore the fact that buildings designed to house mentally ill men and women involve the manipulation of space and the imposition of limitations on circulation within that space to control and manage difficult, dangerous, or inconvenient patients.7 Moreover, even if we take for granted that states of mental distress are objectively real, how people come to identify themselves or how they come to be defined by others as patients is shaped by a culture’s beliefs about what constitutes normal versus abnormal thought, feeling, and behavior.8 In other words, mental institutions and their architecture do have something to tell us about the history of power, power relations, and the conscious or unconscious enforcement of norms in human societies.9 Yet, the history of asylums like Santa Dorotea demonstrate that these institutions

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were animated as much by discourses of public health, charity, and poor relief as they were by social control and concerns over public order. Established in the wake of one of grand ducal Tuscany’s worst confrontations with bubonic plague (1630–33), Santa Dorotea and its founders were profoundly influenced by public health policies and practices that sought to create a city whose institutions and buildings simultaneously promoted health and prevented sickness. By means of the explicit creation of therapeutic architectures, they aimed to keep streets and households clean, moral, and orderly while offering, in the case of Santa Dorotea, a designated healing space for the treatment of the severely mentally ill. Santa Dorotea’s two sites represent important parts of efforts by early modern polities—political agents, social elites, and ordinary people included—to carve out purpose-built spaces to house and treat sick minds as a part of larger and ongoing efforts to create healthy cities.

Plague, Mental Illness, and Public Health While serving as chaplain in Florence’s Stinche prison in the late 1630s, a Carmelite named Alberto Leoni (1563–1642) noticed that many inmates seemed to be suffering from severe mental disorders.10 Abandoned by relatives, these men and women drifted from street to prison and prison to street in an endless cycle of poverty and neglect.11 Leoni envisioned a different place for them, a place with no other purpose than their care. With the help of the city’s governing elites, he realized his dream though he would not live to see its birth in the world. In the years immediately following his death, his collaborators opened Santa Dorotea a few blocks east of the Stinche prison, creating a charitable house that “could admit all those who are not of sound mind, commonly called ‘crazy,’” including, “men and women, clerical or lay, native or foreign [born].”12 Leoni was not a lone voice expressing concern for the effects of mental illness on sufferers and their families in Tuscany. Tuscans had long struggled to care for their disturbed kin. Archival evidence shows that they had been engaged in a more than 300-year struggle to craft legal accommodations designed to protect the physical and financial integrity of families as well as to shield the mentally ill from predatory or neglectful relatives.

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Families also often worked with magistrates and prison officials to find long-term care solutions for the criminally insane that acknowledged family hardship while respecting society’s concern for order. These legal remedies helped families successfully transfer the management of households and property from one relative to another or release the criminally insane from prison or capital punishment. But they also burdened families by making the household the legally sanctioned space for the care of agitated, distressed, suicidal, or violent relatives.13 Over the course of Leoni’s lifetime, the plight of the severely mentally ill intensified in Tuscany. The twenty years leading up to Santa Dorotea’s founding were extremely tough.14 Bad harvests, epidemic outbreaks of disease, and famine were morbid harbingers of what was to come in the 1630s when plague visited Florence twice, overcoming more than twelve percent of a population already weakened during its first visitation.15 Florence seems to have fared better than other Italian cities during this plague crisis. Venice, by contrast, is said to have lost thirty-three percent of its population, Milan forty-six percent, and Verona a crushing sixty-­ one percent.16 Moreover, a series of poor harvests between 1616 and 1620 sent many displaced rural men and women who relied on the agricultural cycle into Florence in search of work and sustenance. In 1620, an epidemic outbreak of typhus only exacerbated the situation, creating a perceptible crisis in the standard of living particularly for the city’s poor.17 The government responded by partnering with the city’s guilds, churches, convents, and hospitals to aid the poor by setting up a beggar’s hospital that would temporarily feed, clothe, and shelter this vulnerable and growing group while removing the destitute from the streets.18 Alberto Leoni was doing his pastoral work during these years of deprivation, sickness, and death. By the early 1640s, he was able to see the consequences of repeated health and economic crises in the prison population he served. Given this miserable context, the backstories of the severely mentally ill men and women described in Santa Dorotea’s founding documents as having been abandoned by families and forced onto the streets are surely not merely tales of abuse and neglect. The incarceration of the sick was not necessarily an overzealous policing action taken by the rich against the poor. Rather, in such grim and straitened times, it seems

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more likely that many of the ill had in fact lost caretakers to sickness, starvation, poverty, or death. One can further imagine that, at this time, a number of families were forced to perform a terrible kind of domestic triage. They had to weigh whether the continued care of a mentally ill relative was more important than the household’s long-term survival. Leoni and his collaborators knew the pressures families bore in the face of continued crisis. They established Santa Dorotea in part to alleviate these pressures by providing a custodial and therapeutic space for the region’s severely disturbed. Long-term and contemporary public health policies developed to fight plague gave them the impetus and model for such an endeavor.

Plague, Poverty, and Hippocratic Architecture The notion that therapeutic architecture was both possible and critical to the health of individuals and communities alike entered the Italian imagination at least in theory in the late thirteenth century. In his Trattato della agricoltura (1309), the Bolognese agronomist Pietro de’ Crescenzi (1233–1320) drew on Greco-Arabic medical theory and the works of Roman agricultural writers to argue that environmental factors like airs, winds, and waters played an important role in promoting or hampering the salubrious qualities of a house or garden.19 In practice, this idea reached maturity in the fifteenth century. The rediscovery of the ancient Roman architect Vitruvius’s Ten Books on Architecture opened the door. Vitruvius had argued that good architects should be well versed in the principles of medicine because the environment—including climate, air, and water—had a profound shaping influence on a building’s relative healthiness or unhealthiness.20 The medical tradition to which he referred was Hippocratic, meaning it was based on the idea that human bodies were composed of humors whose good or bad “temperaments” promoted health or caused illness. Unlike the modern biomedical paradigm, which sees sickness or wellness as two opposite and objective physical states, Hippocratic medicine, and the medieval medical culture that adopted it, conceived of health along an ever-shifting scale of greater or lesser equilibrium, the latter constituting wellness, the former sickness.21

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The maintenance of this equilibrium was by no means easy. It involved the regulation of factors affecting the body and mind that were not a natural part of the body itself, including the environment and climate (referred to collectively as air), diet, the evacuation and retention of bodily substances, exercise and rest, sleep and waking, and the passions of the soul. In the Middle Ages, these extra-bodily factors were called the six non-naturals.22 Individuals undertook their management through a range of lifestyle choices including where one lived, what one ate and drank, how one groomed or enhanced the body through cosmetics, how one socialized, rested, exercised, worked, played, prayed, and generally passed the time. Moreover, because this way of thinking so closely linked the relationship between body and soul, health also involved attempts at fostering an upright and balanced inner life within a hygienic and harmonious environment.23 In medieval and early modern Europe, that inner life was best enriched by acts of Christian devotion and the avoidance of sin. The fifth-century BC Hippocratic work Airs, Waters, and Places likened the natural environment to human bodies on the logic that it was composed of the same elemental materials that combined to form the body’s humors. The mixing of the airs and waters of a given location or environment could produce naturally toxic or salubrious conditions much like the mixing of humors in a body. Where stagnant bodies of water “breathed” putrid miasmas into the air, salutary winds could blow bad airs away. Vitruvius implied that, much like the human body, the built object was a Hippocratic space, shaped and affected by its environment. In On the Art of Building, the Florentine polymath and architect Leon Battista Alberti revived and emulated Vitruvius’s Hippocratic architecture, by asserting the vital role the air we breathe and the natural and built environments we inhabit play in maintaining and preserving life.24 Vitruvius also inspired Alberti’s Florentine contemporary Antonio Averlino, known as Filarete, who argued that buildings could be engineered to include their own mechanisms for removing waste and the noxious “humors” they generated. He would apply these ideas to the plans for Milan’s Ospedale Maggiore in the 1460s by proposing an elaborate sewage system.25 A sixteenth-century revival of the Hippocratic work Airs, Waters, and Places that underscored the relationship between health, disease, and

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environment would help make air the most significant of the six non-­ naturals alongside diet.26 The best air was considered to be temperate, that is not too cold, too hot, too moist, or too dry, and good, that is, bright, thin, clear, and sweet smelling as opposed to dark, thick, miasmic, or putrid.27 A growing and highly popular vernacular print culture championed the daily management of bodily health according to the careful regulation of the six non-naturals at home.28 Those who could afford it even went so far as to build their villas and palaces in accord with these environmental factors, creating a demand for domestic Hippocratic architecture.29 Neo-Hippocratic thinking in both architecture and healthcare helped change attitudes to cities and plague in late sixteenth-century Italy. Particularly in the wake of the 1575–78 plague outbreak, historians have noted an unprecedented focus among physicians on environmental and social determinants of illness.30 This period saw an escalation of literature that decried the pernicious effects of unsanitary urban conditions on the collective health of a city. If, as the Hippocratic tradition argued, good air promoted health, then bad air imperiled it. Everything from scholarly publications to cheap pamphlets instructed citizens to maintain streets clear of refuse and excrement specifically to prevent the spread of disease. Physicians were particularly concerned about poisonous vapors, which they believed caused plague. Among the principal sources of these harmful exhalations were unsanitary conditions prevailing in the poorest neighborhoods. Medical practitioners, civic magistrates, and city elites were quick to associate poverty with disease.31 Cities too had explicitly become Hippocratic spaces. In the seventeenth century, Italian states enacted far-reaching legislation and official policies relating to the urban environment that were intended to prevent and/or purify corrupt air. Some of the most transformative enterprises in Florence were the sanitary health surveys of urban and rural areas conducted by the city’s confraternities in collaboration with the health board, what we might call public–private partnerships in public health.32 When epidemic outbreaks struck, physicians were dispatched to study an area’s health conditions, to describe the diseases they confronted, and to determine what caused them. During the typhus epidemic of 1620–21, when doctors were sent to inspect the houses of the

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sick poor, they found the living quarters unbearably filthy. In response, the Florentine health board commissioned a comprehensive survey of the entire city with special focus on the poorer neighborhoods.33 As John Henderson notes, a surveyor’s description of the city’s unsanitary conditions led the health board to conclude that it was a miracle the situation had not led to plague. When plague finally arrived in 1630, the city’s physicians immediately made a connection between stench and sickness in the poor urban districts. Among the measures the health board undertook to combat plague was to cleanse the houses of the poor by clearing out trash, disinfecting furniture and personal affects, and removing mildewed sleeping pallets and replacing them with clean, new mattresses. Henderson reports that the two health surveys conducted in 1630 identified 114 leaky cesspits that had to be fixed and 656 rotten mattresses that had to be replaced.34 The next few years would see tremendous coordinated efforts by government, local elites, and medical practitioners to put the full strength of the state treasury and the good intentions of a philanthropic upper class in service of cleansing the city and supplying the poor with fresh bedding and charitable donations of food during quarantine.

Imagining a Hippocratic Architecture Santa Dorotea’s statutes, drafted sometime in 1643 by its first governing board, aimed to provide custodial, medical, and spiritual care to its patients. Its physical location and structure were meant to serve those ends. Before the founders even considered the role of medical practitioners, they envisioned the hospital as what one might call a “Hippocratic” environment, that is, a space that by its design was intended to promote health by attempting to control the external and internal factors that were thought to endanger it.35 The efforts of the hospital’s governing boards reflect both long-term trends in Florentine hospital construction and contemporary fixations on the link between environment and sickness. But since the hospital’s first site and the original building’s structure imposed immediate limitations, their efforts were realized more in extra-­ architectural aspects of care.

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The first task of the newly constituted governing board was to create a well-sited, well-ventilated building in which air circulated through interior spaces like breath or spirit through a body.36 That was a difficult task to accomplish in a dense urban setting where environmental conditions were not naturally salubrious. Moreover, the governing board had to be satisfied with the real estate that was on the market at the time they were site-hunting. Their only option was to repurpose a pre-existing building whether it embodied their therapeutic goals or not. The plot that presented itself ended up being “a large house in Via Ghibellina […] with two connected smaller houses (cassette).”37 Large though the pieced together hospital was, its location in a thickly populated, low-lying, inner-city street did not facilitate ideal air circulation. In the words of the governing board, Santa Dorotea was located at: a place where the air was denser (più grossa) than that of the city or borgo in which there would be a church and many lower- and upper-level rooms and with rather large oak bedsteads … The lower rooms were to have stoves for providing heat during the winter and also coverlets and straw pallets for the most raving (furiosi) and simple beds for the least raving (furiosi).38

In contemporary thinking, where a chapel, stoves, and bedding arrangements promoted health, the “dense” ambient air the hospital “breathed” by virtue of its location was a problem. According to a long tradition of learned and popular literature on the conservation of health, air was the most important of the non-naturals and varied a great deal in quality. Dense (grossa) air was universally considered to be unhealthy for the detrimental effects it had on the brain, heart, and pores.39 For Castore Durante, the author of the medical best-­ seller the Treasure of Health, air was the most significant environment factor for human life let alone health. “All other things can be avoided,” he remarked, “except the air, which surrounds us and changes our bodies more than any other thing, because we dwell constantly in it, and without breathing no one can live.”40 The healthiest air was “serene, clear, east-flowing air and not corrupted by fogs or vapors.” The air most destructive to health was “dense (grosso), thick, turbid, and polluted.”41 In

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addition to weighing on the head and blocking pores, Durante claimed that, “shadowy thick airs darken the heart, trouble the mind, harden the body, slow down concoction, and speed up old age.”42 Blocking the pores was an especially treacherous consequence of bad air since the pores were an important exit point for the body’s harmful vapors. The poor quality of the ambient air at Santa Dorotea’s first site made the hospital’s administrators’ hopes of fashioning a Hippocratic environment more theoretical than attainable in practice (Fig. 6.3). Yet, the same tradition that decried the pernicious effects of bad air also proposed solutions for “rectifying” or improving air quality even at less-than-ideal sites.43 The configuration of interior spaces had long been a climate control strategy. Early on, the administrators of Florence’s

Fig. 6.3  Approximate location of Santa Dorotea’s first site. “DECIMA: The Digitally Encoded Census Information and Mapping Archive,” accessed May 16, 2017, www.decima-­map.net

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grandest hospitals—Santa Maria Nuova, San Paolo, Bonifazio, and San Matteo—had housed patients side-by-side in rows spread along large open wards intended to promote the salubrious circulation of air by means of high ceilings, pitched roofs, and windows.44 As mentioned above, Filarete’s plan for Milan’s Ospedale Maggiore included a waste management system (destri) to ensure the removal of toxic vapors from the air.45 A bird’s eye view site plan drafted as part of a contract to expand the hospital in 1723 is one of two remaining illustrations identified so far that show Santa Dorotea’s first site. It is spare in detail but does tell us something about the fabric of the building (Fig. 6.4). One large and four smaller courtyards depicted in gray were likely intended to enhance the healthy properties of hospital space. Open spaces especially in urban homes were thought to facilitate the circulation of clean air. Alberti recommended courtyards ringed with attractive balconies and porticoes so that people could look outside and “stay in the sun and fresh air” depending on the season.46 No evidence remains to tell us whether patients had the freedom to move throughout the building. Given the severity of illnesses described in what extant admission documents there are for this earlier period, it is more likely that patients were restricted to their rooms and perhaps even to their beds with little to no chance of using courtyards to enjoy the sunshine or exercise or play games that might buoy their spirits. But that made salutary architectural features even more important since patients could not exercise or socialize as contemporary health regimens advised. Courtyards then were passive instruments of climate control, letting light and air penetrate the building’s interior. The governing board seems to have been aware of these environmental limitations. In 1723, they purchased another house, drawn in red on the plan, “for the greatest comfort and the greatest health through the sweating [releasing of water] of the air.”47 The suggestion here seems to be that a larger space would reduce the crowding of patients and improve their air quality by facilitating the air’s own process of purgation through condensation. Like hot air, humid air had the power to soften and dampen the body.48 These conditions opened the pores, those crucial vents through

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Fig. 6.4  Santa Dorotea, first site plan, bird’s eye view. Santa Dorotea Purchase Contract, 1723, Archivio di Stato of Florence, Santa Dorotea 23/40, no. 7. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze

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which corrupt humors normally exited the body. Neither the building’s site nor its size and floor plan were ideal for creating the kind of salubrious environment Florence’s other hospitals fostered, but the governing board sought to maximize the potential of the available property. Replicating the open ward layout was not the goal. A hospital that prioritized the separation of patients favored a cellular floor plan in which smaller rooms surrounding a central courtyard were more appropriate. Unlike Florence’s other hospitals, which tended to offer acute care to the sick poor, Santa Dorotea was a longer-term custodial and more complex social space. It welcomed men and women, rich and poor alike. But it did not necessarily put these groups together. Like other hospitals, in Santa Dorotea, men were separated from women to maintain order and decorum and the violent were separated from more docile patients. It is also likely that patients were separated in hospital by class. We know that wealthy patients paid premiums for a high standard of care.49 Records suggest that part of this standard included not having to suffer the dishonor or disgust of inhabiting the same space as a social inferior. In his article on the 1630 health surveys, Nicholas Eckstein vividly captured the affront to “aristocratic sensibilities” that elite surveyors experienced when confronted with the tragic conditions of extreme poverty they discovered on their route through the city’s neighborhoods. They expressed “genuine concern for suffering householders” and were driven by sincere Christian piety to help the poor who were the most deserving of such efforts on their behalf.50 But disease-bearing miasmas were thought to cling more readily to poor bodies largely because of their unhealthy living conditions. In Eckstein’s words, “[t]he poor were dangerous, and the [surveyors] were afraid of them.”51 To help the poor by cleansing their living spaces was one thing; living cheek-by-jowl with them was quite another. If inmate population growth required that patients share rooms, prevailing social hierarchies surely required that the poor—not the rich—bear the brunt of such discomfort and indignity since they were used to such conditions in their unfortunate lives outside the institution. Where Santa Dorotea’s original size did not allow for the creation of a truly Hippocratic architecture, the governing board used extra-­ architectural strategies to maintain and promote health. In the wake of

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the proximate epidemics of the 1620s and 1630s, which amplified concern over poisonous air and filth, Santa Dorotea’s first governors added stoves and mattresses to their salutogenic arsenal. By producing fire, stoves served the practical purpose of heating and purging the air. In contemporary thinking, this helped eradicate pestilential miasmas by ridding the air of malignant vapors. In his Trattato d’architettura, Filarete claimed that fire rendered the air “mobile, dissipating it, thinning and clarifying it.”52 Fire was also a weapon against cold air, which was thought to be especially damaging to the brain. Hot air had the power to open pores thereby facilitating passage across one of the body’s most important mechanisms for natural purgation. Cold air, by contrast, was thought to constrict and harden the body, closing the pores and preventing that critical flow of corrupt matter out of the body.53 In this way, the hospital’s first governors employed a strategy common among sixteenth- and seventeenth-­century Italian householders, whose domestic inventories show the ubiquity of objects related to fireplaces and fire.54 Furthermore, the recent public health efforts surrounding bedding— namely, to destroy soiled mattresses and to replace them with fresh ones—seem to have been on the minds of the governing board as they thought about patient life in the new hospital.55 This policy reflects a public health culture that believed clean mattresses and linens would prevent the accumulation of bad smells from disturbing the already fragile humoral balance of Santa Dorotea’s patients. To that end, much like what the Florentine government did during the plague, the hospital’s governors entered into an agreement with a mattress dealer to keep the hospital outfitted with a constant supply of clean straw pallets suitable for use on the floor or on bedsteads.56 If the quality and circulation of the air was not completely within the governing board’s power to regulate, other material and spiritual aspects of care were. Archival records describe the joint mission of healing the soul together with the body. In the four years leading up to Santa Dorotea’s official opening, the governing board built a chapel on the ground floor and had it consecrated.57 Moreover, statutes written by the first governing board mandated that governors elect a chaplain who would celebrate mass there every day. He was also required to administer spiritual comfort more generally and the sacraments to patients capable of receiving

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them. Given the severity of some cases, it is likely that the chaplain attended many patients at bedside. In return, he was given a monthly salary and room and board in the hospital.58 A doctor and surgeon were also part of the permanent staff, though they resided off the premises. Santa Dorotea’s first doctor, one Niccolò Buonaiuti, emphasized the hospital’s joint healing and spiritual mission. In his opinion, care of the sick body augmented care of the sick soul. To that end, Buonaiuti argued that one of the hospital’s most important therapeutic tools was the careful regulation of another critical factor among the six non-naturals, one’s diet. He conceded that an individual diet designed to accommodate each patient’s humoral constitution was impractical. He outlined instead a middle way (strada di mezzo) that took into account the fact that patients at Santa Dorotea by necessity led largely sedentary lives and included people of different complexion, age, and sex.59 The diet of all patients consisted of food that was known to soothe rather than exacerbate madness in a middling quantity so as neither to gorge those used to eating little nor starve those accustomed to enjoying hearty meals.60 This standard of care was by no means cheap. The high cost of care coupled with difficulty in collecting fees dogged Santa Dorotea from the moment it opened its doors. It is likely one of the reasons that the hospital quickly came to accept only high-paying patients. It was soon clear that Santa Dorotea would not rescue the poor inmates of the Stinche prison as it had originally intended. In fact, thirty years after Santa Dorotea’s founding, many mentally ill men and women were still languishing in the Stinche, a fact the director of Santa Maria Nuova—Florence’s largest and most celebrated hospital— believed he could not ignore. In 1687, he made plans to build a place in his hospital removed from the other wards for wildly insane (frenetici) men and only men. By 1688, he had set up 18 rooms with the capacity for approximately 80 beds, but even in 1745 the number of patients did not exceed 24. This space was collectively called the “Pazzeria” or the place for the mad (pazzi) (Fig. 6.5).61 Donors gave money to support the Pazzeria’s construction, but nothing toward the maintenance of its patients.62 The inability to subsidize care meant that the new ward could house “only a very few poor madmen without expense and others with a

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Fig. 6.5  Ground Floor Plan of Santa Maria Nuova, second half of the eighteenth century, Archivio di Stato of Florence, Santa Maria Nuova 592, IIr. The Pazzeria is located at number 23, which can be found directly above the plan’s key. The plan shows seven rooms, surrounding a small courtyard. here were likely more rooms directly above these on the second floor that are not represented. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/ Archivio di Stato di Firenze

monthly fee whose families were not poor.”63 Like Santa Dorotea, the Pazzeria was opened to serve the mentally ill poor, especially those suffering in prison; like Santa Dorotea, its hopes were dashed against financial shoals. The Pazzeria’s financial situation was no different thirty years later. In 1720, Santa Maria Nuova’s new director wrote to the grand duke arguing that Santa Dorotea’s presence in the urban charitable landscape conspired against his hospital’s mission to aid the severely mentally ill. The director asked that the grand duke enlarge the Pazzeria and turn Santa Dorotea

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into a private residence that could generate rental income. The grand duke rejected the proposal, but the financial challenges both hospitals faced in trying to fulfill their obligations to carve out healing spaces for the mad of the Tuscan state were becoming clearer.64

Designing a Hippocratic Building In 1737, the last Medici grand duke, Gian Gastone, died. The duchy passed to Francesco Stefano (r. 1737–65), the duke of Lorraine, soon to become the Holy Roman Emperor. Since he quickly left Florence after taking power, the daily running of the grand duchy fell instead to the Regency Council comprising Lorenese and Tuscan elites bent on reform. Like their forebears, these elites believed that coordinated institutional, environmental, and social strategies could be employed to maintain and promote the collective health of Tuscan cities and towns. But, if the fates of Santa Dorotea and the Pazzeria are any indication, they understood too that although it was relatively easy to build a hospital, it was much harder to pay for its operation and maintenance in the long term. In the spring of 1750, the Regency Council had received reports that severely mentally ill men and women were still wandering Tuscan streets, only to be ending up in Tuscan prisons.65 Evidently Santa Dorotea and the Pazzeria had been falling short of their missions and had been for some time. On November 12 of that year the Council published a decree to re-establish Santa Dorotea as the city’s premier hospital devoted, as originally intended, to the care and treatment of the grand duchy’s mentally ill. It ordered that Santa Dorotea be rebuilt under the same name on a larger site and at a grander scale, with the explicit aim of “serv[ing] the entire [Tuscan] state.”66 The final plans for relocation and renovation took the better part of the next year. After a study of the original site, the Council concluded that the properties in Via Ghibellina were inadequate to house more than twenty patients at a time and that the purchase of additional spaces at that site and their renovation was cost prohibitive.67 Moreover, the hospital’s location in a cramped and busy street had conspired against its therapeutic goals by producing noisy and unsanitary conditions in patient

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rooms. And so, on the recommendation of the Regency Council, Santa Dorotea’s governors purchased the old quarters of an institution situated along the Arno that had been combined in the sixteenth century to house orphaned girls and boys.68 The Regency Council commissioned the court architect Giuseppe Ruggieri (1707–72) to draw up renovation plans. In November of 1751, he submitted five architectural drawings accompanied by an extensive written description of the planned work and its costs (Figs. 6.6, 6.7, and 6.8). The Council quickly approved Ruggieri’s plans, and construction began immediately. The undertaking was immense, underscoring the lengths the Florentine government and hospital board were willing to go to build a real as opposed to an aspirational therapeutic and moral space that by its design reproduced principles of social order, humoral medicine, and Christian healing.

Fig. 6.6  Presentation plans for the ground floor of Santa Dorotea’s second site. From  Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 599r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze

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Fig. 6.7  Presentation plans for the first floor of Santa Dorotea’s second site. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 600r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze

The governing board likely instructed Ruggieri to maintain the first site’s cellular floor plan. To that end, he added walls—seen on the plan in red—to transform a more open plan into a series of cells that would facilitate the separation of patients by sex, status, and sickness. Similarity between the two buildings ended there. Santa Dorotea’s second location was enormous relative to its first. A very rough calculation of the first site’s area yields an estimate of about 6000 square feet. The second building’s footprint, by contrast, was nearly 20,000 square feet. Also, at its first site, Santa Dorotea had eighteen small rooms, fourteen of which patients inhabited. The second site had fifty-two designated patient rooms of varying sizes. Most were spacious, the largest being approximately 405 square feet, the smallest measuring 99 square feet. Moreover, the hospital’s ceilings were high, and its walls boasted numerous windows to facilitate the circulation of air and letting light into rooms. Ruggieri’s two cut-away cross sections, enhanced by an

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Fig. 6.8  Presentation plans for the second floor of Santa Dorotea’s second site. From  Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 601r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze

axonometric model of the building based on his plans, reveal more than forty light sources on the building’s exterior and more than thirty from the interior courtyards (Figs. 6.9 and 6.10). Every patient room had its own window. The few interior rooms that did not have windows onto the street or river opened onto one of the two interior courtyards. A look at the second floor also reveals that the building allowed light and air to penetrate the hospital’s rooms and corridors. Surely one of the most important salutogenic architectural features of the building was the waste management system (destri) that Ruggieri’s plans suggest existed to remove human excreta and to disperse the toxic vapors it produced. In his description of the proposed renovations, Ruggieri included fifty-two “platforms for latrines” (predelle per i luoghi comuni) that were to be built according to uniform specifications in each patient room.69 These features appear on his presentation plans in one

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Fig. 6.9  Presentation plans cross-section of Santa Dorotea’s second site. From Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto 341, 603r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze

corner of each room depicted by a diagonal slash representing the platform and a circle in red representing the hole (buca) for waste (Fig. 6.11). He did not spell out exactly how these latrines functioned, but their presence in other, earlier Italian hospitals suggest a possible configuration. Filarete’s proposal for Milan’s Ospedale Maggiore from the 1460s, for example, describes a sewage system in which vertical pipes flowed into an underground network of canals engineered to flush the sewage system clean. Small pipes connected “to each of the hospital beds,” drained into larger terracotta pipes that passed “inside some of the structural piers of the building” in two directions. Solid and liquid waste flowed down into canals located underneath the building to flush waste away, while fumes wafted up and out through the same pipes, extending through the roof.

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Fig. 6.10  Axonometric model of Santa Dorotea’s second site based on Giuseppe Ruggieri’s plans. Benjamin Tulman, HMFH Architects, Cambridge, MA

These pipes also doubled as gutters, allowing rainwater to wash the channels clean.70 It is unlikely that water from the Arno was diverted to run underneath Santa Dorotea the way Filarete’s plan used a canal to do for the Ospedale Maggiore. Upon examining Ruggieri’s plans, however, Danielle Abdon observed that the position of the latrines in a corner of each patient room, where waste pipes were typically found in Venice, coupled with the fact that they were positioned in the same corner of adjacent rooms and aligned across all three floors suggests the presence of some kind of vertical infrastructure for waste disposal.71 Three more latrines located at the end of a corridor on the second floor hanging over the river presumably

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Fig. 6.11  Detail of latrines in rooms along western wall of the ground floor. From  Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto, 341, 599r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze

allowed for the dumping of human waste directly into the river (Fig. 6.12). In theory, this system would have rid the building of its bad “humors” and cleansed the air. Santa Dorotea’s discursive, architectural, and extra-architectural features impart only a glimmer of the lived experience of being in its two sites. It is nearly impossible to know what daily life was like in its

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Fig. 6.12  Detail of latrines on the second floor emptying directly into the river. From  Giuseppe Ruggieri, Piante e Alzati della Nuova Fabbrica dello Spedale di Santa Dorotea di Firenze, 1751, Archivio di Stato of Florence, Regio Diritto, 341, 599r. Reproduced with permission of the Ministero per i beni e le attività culturali e per il turismo/Archivio di Stato di Firenze

corridors and rooms. And yet, we know that the new site was intentionally renovated to be a clean, well-lit, well-aerated place in which patients were regularly washed, fed, and given the sacraments. Still, the same features that would have promoted good ventilation and the penetration of sunlight or the repetitive and familiar murmuring of the liturgy would have simultaneously deprived patients of privacy. Each room had an interior barred window, and there is no mention of window coverings or shutters. Doubtless this feature made it easier for staff to check on patients, but it also made patients objects of surveillance. Moreover, it gave easy passage to the crying, screaming, yelling, or moaning of one’s near or distant neighbors. And the potentially pleasing smells of food preparation wafting from the ground floor kitchen (see Fig. 6.6, number 6) certainly intermingled with that of soiled bodies. Had patient numbers remained small, these features may not have caused them great discomfort. But the population grew and grew.

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Undermining a Hippocratic Building After 1770, patient numbers became unmanageable. In the century spanning Santa Dorotea’s foundation and its 1754 relocation, 348 patients moved in and out of the tiny hospital’s fourteen patient rooms, and the overall patient population at any given time never exceeded twenty-­ four.72 By stark contrast, Santa Dorotea’s last thirty-four years of independent existence, which were spent at its second more grandiose site on the Arno, saw at least 1891 patients pass through its fifty-two patient rooms. Within the first few years of its move to the Arno site, the hospital’s governing board sounded notes of alarm about the number of men and women whose families petitioned to have them admitted. Quality of care, they repeatedly stated, could not keep pace with increasing demand for beds, particularly by patients who needed free care. The hospital’s physical environment and income were increasingly squeezed. New financial strategies coupled with the tireless efforts of hospital physicians to evaluate every patient’s ability to return home could not staunch the flow of new admission requests. By 1780, whatever social and hygienic norms had shaped Santa Dorotea’s joint custodial, therapeutic, and religious aims were compromised, if not effaced, by lack of space and staff. The concerns of Santa Dorotea’s governing board did not go unheeded. The new grand duke Pietro Leopoldo (r. 1765–90) had spent part of the previous decade knitting the city’s network of hospitals more closely together. Between 1777 and 1788, he incorporated the patrimonies of six of Florence’s biggest hospitals, including that of Santa Dorotea, into Santa Maria Nuova, which became the administrative center of an interconnected public healthcare system.73 In 1783, the grand duke commissioned the director of Santa Maria Nuova to prepare statutes that accommodated the hospital’s new role as the nerve center of Tuscany’s healthcare system. This consolidation was surely on his mind two years later when he began to consider larger sites for Santa Dorotea with the hospital’s governing board. In 1788, the board settled on the Hospital of Bonifazio, which had, since its founding in 1387, constantly adapted to local health needs. Where it first housed only the sick poor, it grew over time to house those

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suffering from syphilis and, in times of epidemic, the plague. From 1788, it would add the mentally ill, the disabled, and those suffering chronic skin ailments. This consolidation offered a solution to Santa Dorotea’s crowding, but, at the same time, marked the hospital’s end as an independent institution. In June of that year, Santa Dorotea was closed and its patients were moved to the more capacious hospital of Bonifazio. Directorship of the hospital was given to Vincenzo Chiarugi (1759–1820), who had been to that point a promising physician at Santa Maria Nuova. In the preface to his 1793 treatise on madness, Chiarugi celebrated the beauty and grandeur of Bonifazio at the expense of Santa Dorotea, a place he said was more likely to cause death than recovery:74 When the shortage of space at the old hospital of Santa Dorotea … drew the attention of the paternal sovereign to the necessity of procuring for these miserable sick people a better place, a building was quickly erected, rich in comforts necessary for their cure or at least for making their life less uncomfortable and tortuous.75

This chapter has shown that making the lives of the mentally ill uncomfortable and torturous was exactly the opposite of what Santa Dorotea’s founders and subsequent governors had tried to do over the course of the hospital’s 145-year lifespan. Governors repeatedly and continually tried to adjust the building and its features to promote healing. Yet, where Chiarugi has enjoyed a privileged place in the early history of psychiatry, Santa Dorotea and its founders, administrators, and physicians have fallen into obscurity. Where Pietro Leopoldo has been celebrated for laying the groundwork of a liberal and progressive reform of Italian healthcare generally and mental healthcare in particular, Santa Dorotea’s history has remained unsung.76 The aim of this chapter has been to restore Santa Dorotea to Florence’s historical cityscape as a significant longer-term experiment in social welfare, public health, and mental healthcare.

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Conclusion During the 400 years that stretched from the fourteenth to the seventeenth century, Florentines and their magistrates sought solutions to the challenges that severe mental disorder unleashed in their houses and streets. For the entirety of that period, though, their care remained contingent on the presence, willingness, and ability of relatives to house and care for them. The foundation of Santa Dorotea offered a new solution. Like so many of Florence’s other charitable institutions, its founders acknowledged their Christian duty to shelter and offer medical and spiritual care to their charges. This duty served two purposes. Hospital founders were “bound by compassion and relief ” to protect an often overlooked, yet extremely vulnerable group, while a long-standing commitment to the rational ordering of the city bound them to take the heavy burden of care of the mentally ill off the shoulders of struggling Tuscan families, especially in the wake of epidemic crises. Like Florence’s other hospitals, Santa Dorotea aimed both to minister to the body and to the soul and, to the extent that it was possible, to make the building promote those ends. Santa Dorotea’s cellular layout and manipulation of space to confine and constrain patients embodied or expressed discourses of social control and public order. Yet, as Leslie Topp has observed of buildings more broadly, Santa Dorotea was a product of multiple authors who spoke with multiple voices. Its spatial configuration was shaped by philanthropic elites, pious reformers, and governing authorities whose intentions, goals, and assumptions were animated by both architectural and extra-architectural forces.77 Founded in a historical moment punctuated by economic and health crises, Florence’s first mental asylum did not, as Michel Foucault would argue for the eighteenth century, emerge as an embodiment of middle-class morality, but within a culture that had long believed that Hippocratic cityscapes, infrastructure, and architecture promoted the overall physical and moral health of a people.78 Santa Dorotea did not discipline bodies and minds so as to control them as much as it used the healing virtue of its spaces to restore bodies and minds to their natural equilibrium.79 Moreover, as the title of this chapter suggests, Santa Dorotea was not a lone institution, walled off from the rest of the

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city. On the contrary, it was in dialogue with other buildings that similarly embraced medical, spiritual, and charitable missions to care for the poor and vulnerable. The spirit of both collaboration and competition animated that dialogue. It is for this reason that one can see the hospital as a public health nexus. Santa Dorotea was an important node in an increasingly complex network of public health that knitted together charitable institutions across Tuscany with those in Florence. Far from being merely an instrument of the state, it united public and private efforts coordinated by philanthropic elites and individual reformers who founded and ran charitable institutions in concert with government agencies that supervised and gradually centralized the results of this work into a unified public health system.

Notes 1. I have borrowed the term “healthscape” from Guy Geltner’s two articles, “Healthscaping a Medieval City: Lucca’s Curia Viarum and the Future of Public Health History,” Urban History 40, no. 3 (2013): 395–415 and “Public Health and the Pre-Modern City: A Research Agenda,” History Compass 10, no. 3 (2012): 231–45. See also, Carole Rawcliffe, “‘Less Mudslinging and More Facts’: A New Look at an Old Debate about Public Health in Late Medieval English Towns,” Bulletin of the John Rylands Library 89, no. 1 (September 2013): 203–21. 2. Francesca Bocchi, “Regulation of the Urban Environment by the Italian Communes from the Twelfth to the Fourteenth Century,” Bulletin of the John Rylands Library 72 (1990): 63–78; Mark S. R. Jenner, “Underground, Overground: Pollution and Place in Urban History,” Journal of Urban History 24, no. 1 (November 1997): 97–110; Anne Marie Kinzelbach, “Contagion and Public Health in Late Medieval and Early Modern German Imperial Towns,” Journal of the History of Medicine and Allied Sciences 16, no. 3 (July 2006): 369–89; Anja Petaros, Ante Skrobonja, Tatjana Culina, Alan Bosnar, Verdan Frkovic, and Josip Azman, “Health Problems in the Medieval Statutes of Croatian Adriatic Coastal Towns: From Public Morality to Public Health,” Journal of Religion and Health 52, no. 2 (June 2013): 531–37.

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3. Duccio Balestracci, “The Regulation of Public Health in Italian Medieval Towns,” in Die Viefelt der Dinge: Neue Wege zur Analyse mittelalterlicher Sachkultur, eds. Gerhard Jaritz, Helmut Hundsbichler, Thomas Kühtreiber (Vienna: Verlag der Österreichischen Akademie der Wissenshaften, 1998), 345–57; Dolly Jörgensen, “Cooperative Sanitation: Managing Streets and Gutters in Late Medieval England and Scandinavia,” Technology and Culture 49, no. 3 (July 2008): 547–67. 4. See Peregrine Horden, “A Non-Natural Environment: Medicine without Doctors and the Medieval European Hospital,” in The Medieval Hospital and Medical Practice, ed. Barbara Bowers (New York: Routledge, 2007), 133-46. 5. See Sandra Cavallo, “Health, Air and Material Culture in the Early Modern Italian Domestic Environment,” Social History of Medicine 29, no. 4 (2016): 695–716; Sandra Cavallo and Tessa Storey, Healthy Living in Late Renaissance Italy (Oxford: Oxford University Press, 2013). 6. See Jane L. Stevens Crawshaw, Plague Hospitals: Public Health for the City in Early Modern Venice (Burlington, VT: Ashgate, 2012); Cristian Berco, From Body to Community: Venereal Disease and Society in Baroque Spain (Toronto: University of Toronto Press, 2016); John Henderson, Florence Under Siege: Surviving Plague in an Early Modern City (New Haven: Yale University Press, 2019). 7. See the rich scholarship of sociologist Andrew Scull, namely, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900 (New Haven: Yale University Press, 1993); Andrew Scull and Jonathan Andrews, Customers and Patrons of the Mad-Trade: The Management of Lunacy in Eighteenth-Century London (Berkeley: University of California Press, 2003). Reappraisals of Michel Foucault’s Madness and Civilization that appeared beginning in the 1980s generated more versatile interpretive tools for studying hospitals in general and mental institutions in particular. No longer a monolithic or monopolistic symbol of power, historians tend to see mental institutions now as experiments in social welfare whose successes or failures are shaped by the needs and expectations of families as well as states; the competence, qualifications, and intentions of professional caregivers; and the economic or political conditions that supported or stymied an institution’s mission. Notable studies within this literature for Europe include W. F. Bynum, Roy Porter, and Michael Shepherd, eds., The Anatomy of Madness: Essay in the History of Psychiatry (London: Tavistock Publications, 1985); Anne Digby,

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Madness, Morality, and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge: Cambridge University Press, 1985); Colin Jones, The Charitable Imperative: Hospitals and Nursing in Ancien Régime and Revolutionary France (New York: Routledge, 1989); Arthur Still and Irving Velody, eds., Rewriting the History of Madness: Studies in Foucault’s ‘Histoire de la folie’ (New York: Routledge, 1992); Colin Jones and Roy Porter, eds., Reassessing Foucault: Power, Medicine, and the Body (New York: Routledge, 1994); Ann Goldberg, Sex, Religion, and the Making of Modern Madness: The Eberbach Asylum and German Society, 1815–1849 (New York: Oxford University Press, 1999). More recent studies outside Europe include Leonard Smith, Insanity, Race, and Colonialism: Managing Mental Disorder in the Post-­Emancipation British Caribbean, 1838–1914 (New York: Palgrave Macmillan, 2014); Manuella Meyer, Reasoning against Madness: Psychiatry and the State in Rio de Janeiro, 1830–1944 (Rochester: University of Rochester Press, 2017); Martin Summers, Madness in the City of Magnificent Intentions: A History of Race and Mental Illness in the Nation’s Capital (Oxford: Oxford University Press, 2019). 8. For foundational discussions on the cultural embeddedness of the experience and classification of mental illness, see Arthur Kleinman and Byron Good, eds., Culture and Depression: Studies in the Anthropology and Cross-­Cultural Psychiatry of Affect and Disorder (Berkeley: University of California Press: 1985); Arthur Kleinman, Rethinking Psychiatry: From Cultural Category to Personal Experience (New York: Free Press: 1988); Byron Good, Medicine, Rationality, and Experience: An Anthropological Perspective (Cambridge: Cambridge University Press, 1994). 9. Leslie Topp re-evaluates studies of power and control in the spatial configuration of asylums in Freedom and the Cage: Modern Architecture and Psychiatry in Central Europe, 1890–1914 (University Park, PA: Pennsylvania State University Press, 2017). See also Leslie Topp, James E. Moran, and Jonathan Andrews, eds., Madness, Architecture, and the Built Environment: Psychiatric Spaces in Historical Context (New York: Routledge, 2007). 10. For more on Alberto Leoni, see Vittorio Biotti, “Il folle nella società Fiorentina e Toscana del XVI secolo e la nascità di ‘S. Dorotea de’ Pazzerelli,’” in Alberto De Bernardi, Follia, psichiatria, e società: Istituzioni

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manicomiali, scienza psichiatrica e classi sociali nell’Italia moderna e contemporanea (Milan: Franco Angeli, 1982): 171-210 at n. 103. 11. Archivio di Stato of Florence (hereafter ASF), Santa Dorotea dei Pazzerelli (hereafter SD) 23/14, n.p.; 42, fols. 1r; RD 341, fols. 508r-509r. See Graziella Magherini and Vittorio Biotti, L’isola delle Stinche et i percorsi della follia a Firenze nei secoli XIV–XVIII (Florence: Ponte alle Grazie, 1992); Graziella Magherini and Vittorio Biotti, eds., “Un luogo della città per custodia de’ pazzi”: Santa Dorotea dei Pazzerelli di Firenze nelle delibere della sua congregazione (1642–1754) (Florence: Casa Editrice Le Lettere, 1997); Lisa Rocscioni, Il governo della follia: Ospedali, medici e pazzi nell’età moderna (Milan: Bruno Mondadori, 2003). 12. The history of Santa Dorotea’s founding is recorded at the beginning of ASF SD 42. The extracts cited here can be found on 1v: “primieramente che in detta casa si possino rivecer tutti quelli che sono di non sana mente chiamati volgarmente pazzi … secondo, che si possa ricevere tanto maschi quanto femmine, sia ecclesiastici come secolari, e non solamente della città e dominio fiorentino ma anco qualsivoglia altro luogo e dominio”; 3r: “Già è noto a V.A. il negozio proposto sino in vita dal padre Alberto leoni carmelitano da Mantova di fondar in questa città una casa per ricevervi quelli che patiscono di non sana mente e pazzerelli …si volse allor sentire l’Auditor Fiscale e Provveditore delle Stinche dove ora si dà ricetto a detti infelici, che ambedue risposero non aver alcuna difficultà in lasciar fondar questa opera e consegnar loro detta gente, perchè per la strettezza del luogo di dete carcere e per altre ragioni stava là tanto male che era impossibile che non migliorasse mettendosi in altra casa dove non fussi altra occupazione che della cura di questi miserabili.” A copy of these documents can be found in ASF, Regio Diritto (hereafter RD) 341, 508r-21r. 13. Elizabeth W. Mellyn, Mad Tuscans and Their Families: A History of Mental Disorder in Early Modern Italy (Philadelphia: University of Pennsylvania Press, 2014), chs. 1 and 2. 14. The following discussion draws heavily on the descriptions of this period from Giulia Calvi, Histories of a Plague Year: The Social and The Imaginary in Baroque Florence, trans. Dario Biocca and Bryant T. Ragan, Jr. (Berkeley: University of California Press, 1989); R. Burr Litchfield, Florence Ducal Capital, 1530–1630 (New York: ACLS Humanities E-Book, 2008), 687–88; Nicholas A. Eckstein, “Florence on Foot: An Eye-Level Mapping of the Early Modern City in Time of Plague,”

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Renaissance Studies 30, no. 2 (2015): 273–97; Henderson in Florence Under Siege, ch. 3. 15. Daniela Lombardi, Povertà maschile, povertà femminile: L’ospedale dei mendicanti nella Firenze dei Medici (Bologna: Il Mulino, 1988), 35, 87; Litchfield, Florence Ducal Capital, 687; Henderson, Florence Under Siege, 42, 79. 16. Henderson, Florence Under Siege, 42–49. Henderson’s analysis suggests that the earlier estimate of twelve percent mortality might be higher. 17. Ibid., 48, 77. Henderson notes that historians have identified what contemporaries called “petechial fever” as enzymatic typhus. 18. On the beggar’s hospital, see Daniela Lombardi, Povertà maschile; Litchfield, Florence Ducal Capital, 687–95. 19. On Pietro de’ Crescenzi, see Pierre Toubert, “Crescenzi, Pietro de’,” in Dizionario Biografico degli Italiani 30 (Rome: Istituto dell’Enciclopedia Italiana, 1984). Accessed August 2021. I am grateful to Anatole Tchikine for bringing Pietro de’ Crescenzi to my attention. For this point in relation to gardens, see Tchikine “The expulsion of the senses: the Idea of the ‘Italian Garden” and the politics of sensory experience,” in D. Fairchild Ruggles, ed., Sound and Scent in the Garden (Cambridge, MA: Harvard University Press, 2017): 217-253 at 237. 20. Vitruvius, De architectura, I.1.10. I would like to thank Caroline E. Murphy for drawing my attention to this citation and supplying key bibliography on fifteenth-century Italian architectural treatises. See also Cavallo and Storey, Healthy Living, 80-83. 21. See Katharine Park, Doctors and Medicine in Early Renaissance Florence (Princeton: Princeton University Press, 1985) and Aaron Antonovsky, Health, Stress, and Coping (San Francisco, CA: Jossy-Bass Publishers, 1979). 22. I address the medieval preventive health paradigm in “Passing on Secrets: Interactions between Latin and Vernacular Medicine in Medieval Europe,” I Tatti Studies in the Italian Renaissance 16, no. 1/2 (Fall 2013): 289–309, which owes a great deal to Heikki Mikkeli, Hygiene in the Early Modern Medical Tradition (Helsinki: Finnish Academy of Sciences, 1999) and Sandra Cavallo, “Secrets to Healthy Living: The Revival of the Preventive Paradigm in Renaissance Italy,” in Secrets and Knowledge in Medicine and Science, 1500–1800, ed. Elaine Leong and Alisha Rankin (Burlington, VT: Ashgate, 2001), 191–212.

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23. Horden, “A Non-Natural Environment,” in The Medieval Hospital and Medical Practice, ed. Barbara Bowers (New York: Routledge, 2007), 134–40. See also Chiara Thumiger, “Ancient Greek and Roman Traditions,” in The Routledge History of Madness and Mental Health, ed. Greg Eghigian (New York: Routledge, 2017), 42–61 and, in the same volume, Elizabeth W. Mellyn, “Healers and Healing in the Early Modern Health Care Market,” 83–100. 24. Quoted from Ida Mastrorosa, “Leon Battista Alberti, ‘epidemiologo’: esiti umanistici di dottrine classiche,” Albertiana 4 (2001): 23. See also Vaughn Hart, “‘Paper Palaces’ From Alberti to Scamozzi,” in Paper Palaces: The Rise of the Renaissance Architectural Treatise, ed. Vaughn Hart with Peter Hicks (New Haven: Yale University Press, 1998), 1–32; Barbara Kenda, “Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited,” in Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited, ed. Barbara Kenda (New York: Routledge, 2006), 1–24; Cavallo and Storey, Healthy Living, 81. 25. Renzo Baldasso, “Function and Epidemiology in Filarete’s Ospedale Maggiore,” in The Medieval Hospital and Medical Practice, ed. Barbara Bowers (New York: Routledge, 2007), 108. 26. Henderson, Florence Under Siege, 16, 31, 57; Cavallo and Storey, Healthy Living, 81. 27. Cavallo and Storey, Healthy Living, ch. 3. 28. Ibid., ch. 1; Henderson, Florence Under Siege, 31. 29. Matthew Hardy, “‘Study the Warm Winds and the Cold:’ Hippocrates and the Renaissance Villa,” in Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited, ed. Barbara Kenda (New York: Routledge, 2006), 47–68. Cavallo and Storey, Healthy Living, ch. 3. 30. See Samuel K. Cohn, Jr., Cultures of Plague: Medical Thinking at the End of the Renaissance (Oxford: Oxford University Press, 2010). 31. Henderson, Florence Under Siege, 51–56. 32. Venice and Bologna also used public–private partnerships in administering public health and charitable policies. See Stevens Crawshaw, Plague Hospitals, 81; Nicholas Terpstra, Cultures of Charity: Women, Politics, and the Reform of Poor Relief in Renaissance Italy (Cambridge, MA: Harvard University Press, 2013). Both are cited in Eckstein, “Florence on Foot,” 276. 33. Henderson, Florence Under Siege, 59. 34. Ibid., 61.

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35. Horden, “A Non-Natural Environment”; Hardy, “‘Study the Warm Winds and the Cold.’” For the idea of “pneumatic architecture,” see Barbara Kenda, “Aeolian Winds.” 36. Kenda, “Aeolian Winds.” 37. ASF, SD 42 and 60: “Una casa grande in via Ghibellina detta al Canto alla Mela con due casette annesse a detta casa grande, che una in via di San Francesco et l’altra in via dei Pelacani.” 38. ASF, RD 341 fols. 514r: “Prima li Signori Deputatii eletti al governo doveranno eleggere il luogo ove sii l’aria più grossa di quella città o borgo nel quale vi doverà essere la chiesa e molte stanze superiori et inferiori con le sue lettiere assai grosse di rovere con le sue catene per le mani e piedi ben inchiodate alle stanze inferiori se li farà fare le sue stufe per tenerle calde all’invernata e anco li suoi sopertoni e pagliarizzi per li più furiosi et li letti per li men furiosi.” See John Henderson, The Renaissance Hospital: Healing the Body and Healing the Soul (New Haven: Yale University Press, 2006), ch. 5. 39. Cavallo and Storey, Healthy Living, 71-73; 87. 40. Castore Durante, Il Tesoro della sanità (Michiel Bonibelli: Venice, 1596), 2: “è a tutti viventi l’Aere necessario, che senza esso non si può conservare la sanità, nè meno racquistare; che tutte l’altre cose si possono schivare, eccetto l’Aere, che ne circonda, et muta I corpi nostril più che alcun’altra cosa, perche dimoriamo continuamente in esso, et senza respirarlo nessuno può vivere.” 41. Durante, Tesoro, 2: “si deve fare l’elettione di buono Aere, sereno, chiaro, volta ad Oriente, non corroto da nebbie nè da vapori … Si come il grosso, il denso, il turbido, et l’infetto la distruggono.” 42. Durante, Tesoro, “Et all’incontro l’Aere tenebroso et grosso, offusca il cuore, conturba la mente, aggrava il corpo, ritarda la concottione, et accelera la vecchiezza.” Cited in Cavallo and Storey, Healthy Living, 73. 43. Cavallo and Storey, Healthy Living, 91-103. 44. Ibid., 157–61. 45. Baldasso, “Function and Epidemiology,” 114. 46. Cavallo and Storey, Healthy Living, 90. 47. ASF, SD 23/38, no. 7: “per la più comoda e per la più salubre per il traspiro dell’aria.” 48. Cavallo and Storey, Healthy Living, 71. 49. ASF, SD 45, fols. 36rv. 50. Eckstein, “Florence on Foot,” 288.

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51. Ibid., 294, 296. 52. Cited in Cavallo and Storey, Healthy Living, 94. 53. Cavallo and Storey, Healthy Living, 71. 54. Ibid., 95. 55. Ibid., 275–76, 279, 286–87. 56. ASF, SD, 42. See also Eckstein, “Florence on Foot,” 276. 57. ASF, SD 42, fols. 7rv. 58. ASF, SD 23, 23/5; 23/6. 59. Ibid., fol. 519: “ma gli consideri come huomini che abbino a vivere senza fatica, senza toto e menare una vita sedentaria cioè priva d’ogni sorte d’esercizio.” 60. Ibid.: “il meno si può supire questi introppo con l’osservare una strada di mezzo ordinando il vitto con una certa mediocrità, che non sia notabilmente soverchia a chi per sua natura mangi poco ne molto sarsa a chi fosse di gran pasto.” 61. Antonio Cocchi, “Giornale della Deputazione degli Spedali,” 88. See BNCF, II.I.348, fols. 2r-7r, transcribed in Antonio Cocchi, Relazione dello spedale di Santa Maria Nuova di Firenze, ed. Maria Mannelli Goggioli (Florence: Casa Editrice le Lettere, 2000), 185–88. 62. ASF, SD 23/4, n.p. 63. Cocchi, Relazione, 126. 64. ASF, SD 23/4 n.p. 65. ASF, RD 341, fols. 448r–449r. 66. Ibid., 524r: “volendo provvedere ai molti inconvenienti ch’innocentemente cagionano nel pubblico I furiosi abbandonati, e vaganti per le strade; comanda che la casa di Santa Dorotea di questa città di Firenze s’eriga in spedale con l’istesso titolo.” ASF, RD 341, fol. 461. 67. Ibid., RD 341, fol. 457. 68. For more on these two institutions, see Nicholas Terpstra, Abandoned Children. 69. Ruggieri’s descriptions can be found in RD 341, 581/12. Patient rooms are marked by the numbers 9 in Figure 6.6, 5 in Figure 6.7, and 4 in Figure 6.8. 70. Renzo Baldasso describes this structure and its functioning in great detail in “Function and Epidemiology,” at 116–17 and includes a diagram he drew of the system on 118. 71. Personal communication, June 9, 2020.

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72. ASF, RD 341, fol. 457; Roscioni, Governo della Follia, 116–17. I’ve used Santa Dorotea’s admission and discharge records, the minutes of its various governing boards, and books of patient fees to create a patient database that counts a total of 2220 patient admissions from 1647 to 1788. 73. Marco Geddes da Filicaia, “Pietro Leopoldo, Santa Maria Nuova e la nascità dell’ospedale moderno,” in Regolamento dei regi spedali di Santa Maria Nuova e di Bonifazio, ed. Esther Diana and Marco Geddes da Filicaia (Florence: Edizioni Polistampa, 2010), x. 74. Chiarugi included a table that compared admissions, discharges, and deaths of patients over the course of four years at each hospital. In that period, Bonifazio admitted 81 more patients, discharged 165 more, with 84 fewer patients dying. Vincenzo Chiarugi, Della pazzia in genere e in specie: trattato medico-analitico (Florence: Luigi Carlieri, 1793), iv. 75. Chiarugi, Della pazzia, i. 76. This was the view of the famous nineteenth-century historian and genealogist, Luigi Passerini in Storia degli stabilmenti di beneficenza e d’istruzione elementare gratuita della città di Firenze (Florence: Le Monnier, 1853). George Mora echoed this view a century later in “Vincenzo Chiarugi (1759–1820) and his Psychiatric Reform in Florence in the Late Eighteenth Century,” Journal of the History of Medicine and Allied Sciences 14, no. 4 (1959): 423–33. No scholars have come forward to overturn it. 77. Topp, Freedom, introduction. 78. See Michel Foucault, Madness and Civilization (New York: Vintage, 1965). 79. See Michel Foucault, Discipline and Punish: The Birth of the Prison (New York: Random House, 1977).

Bibliography Antonovsky, Aaron. 1979. Health, Stress, and Coping. San Francisco, CA: Jossy-­ Bass Publishers. Baldasso, Renzo. 2007. Function and Epidemiology in Filarete’s Ospedale Maggiore. In The Medieval Hospital and Medical Practice, ed. Barbara Bowers, 107–120. New York: Routledge. Balestracci, Duccio. 1998. The Regulation of Public Health in Italian Medieval Towns. In Die Viefelt der Dinge: Neue Wege zur Analyse mittelalterlicher Sachkultur, ed. Gerhard Jaritz, Helmut Hundsbichler, and Thomas

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Kühtreiber, 345–357. Vienna: Verlag der Österreichischen Akademie der Wissenshaften. Berco, Cristian. 2016. From Body to Community: Venereal Disease and Society in Baroque Spain. Toronto: University of Toronto Press. Bocchi, Francesca. 1990. Regulation of the Urban Environment by the Italian Communes from the Twelfth to the Fourteenth Century. Bulletin of the John Rylands Library 72: 63–78. Bynum, W.F., Roy Porter, and Michael Shepherd, eds. 1985. The Anatomy of Madness: Essay in the History of Psychiatry. London: Tavistock Publications. Calvi, Giulia. Histories of a Plague Year: The Social and The Imaginary in Baroque Florence. Translated by Dario Biocca and Bryant T. Ragan, Jr. Berkeley, University of California Press, 1989. Cavallo, Sandra. 2016. Health, Air and Material Culture in the Early Modern Italian Domestic Environment. Social History of Medicine 29 (4): 695–716. ———. 2001. Secrets to Healthy Living: The Revival of the Preventive Paradigm in Renaissance Italy. In Secrets and Knowledge in Medicine and Science, 1500–1800, ed. Elaine Leong and Alisha Rankin, 191–212. Burlington, VT: Ashgate. Cavallo, Sandra, and Tessa Storey. 2013. Healthy Living in Late Renaissance Italy. Oxford: Oxford University Press. Chiarugi, Vincenzo. 1793. Della pazzia in genere e in specie: trattato medico-­ analitico. Florence: Luigi Carlieri. Cocchi, Antonio. Relazione dello spedale di Santa Maria Nuova di Firenze, edited by Maria Mannelli Goggioli, 71-181. Florence: Casa Editrice le Lettere, 2000. Cohn Jr, Samuel K. 2010. Cultures of Plague: Medical Thinking at the End of the Renaissance. Oxford: Oxford University Press. Digby, Anne. 1985. Madness, Morality, and Medicine: A Study of the York Retreat, 1796–1914. Cambridge: Cambridge University Press. Eckstein, Nicholas A. 2015. Florence on Foot: An Eye-Level Mapping of the Early Modern City in Time of Plague. Renaissance Studies 30 (2): 273–297. Geddes da Filicaia, Marco. “Pietro Leopoldo, Santa Maria Nuova e la nascità dell’ospedale modern.” In Regolamento dei regi spedali di Santa Maria Nuova e di Bonifazio, edited by Esther Diana and Marco Geddes da Filicaia, vii-lvi. Florence: Edizioni Polistampa, 2010. Geltner, Guy. 2013. Healthscaping a Medieval City: Lucca’s Curia Viarum and the Future of Public Health History. Urban History 40 (3): 395–415. ———. 2012. Public Health and the Pre-Modern City: A Research Agenda. History Compass 10 (3): 231–245.

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Goldberg, Ann. 1999. Sex, Religion, and the Making of Modern Madness: The Eberbach Asylum and German Society, 1815–1849. Oxford: Oxford University Press. Good, Byron. 1994. Medicine, Rationality, and Experience: An Anthropological Perspective. Cambridge: Cambridge University Press. Hardy, Matthew. 2006. ‘Study the Warm Winds and the Cold:’ Hippocrates and the Renaissance Villa. In Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited, ed. Barbara Kenda, 47–68. New York: Routledge. Hart, Vaughn. 1998. “Introduction: ‘Paper Palaces’ From Alberti to Scamozzi.” In Paper Palaces: The Rise of the Renaissance Architectural Treatise, edited by Vaughn Hart with Peter Hicks, 1–32. New Haven: Yale University Press. Henderson, John. 2019. Florence Under Siege: Surviving Plague in an Early Modern City. New Haven: Yale University Press. Horden, Peregrine. 2007. A Non-Natural Environment: Medicine without Doctors and the Medieval European Hospital. In The Medieval Hospital and Medical Practice, ed. Barbara Bowers, 133–145. New York: Routledge. Jenner, Mark S. R. “Underground, Overground: Pollution and Place in Urban History.” Journal of Urban History 24, no. 1 (November 1997): 97–110. Jones, Colin. 1989. The Charitable Imperative: Hospitals and Nursing in Ancien Régime and Revolutionary France. New York: Routledge. Jones, Colin, and Roy Porter, eds. 1994. Reassessing Foucault: Power, Medicine, and the Body. New York: Routledge. Jörgensen, Dolly. “Cooperative Sanitation: Managing Streets and Gutters in Late Medieval England and Scandinavia.” Technology and Culture 49, no. 3 (July 2008): 547–567. Kenda, Barbara. 2006. Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited. In Aeolian Winds and the Spirit in Renaissance Architecture: Academia Eolia Revisited, ed. Barbara Kenda, 1–24. New York: Routledge. Kinzelbach, Anne Marie. “Contagion and Public Health in Late Medieval and Early Modern German Imperial Towns.” Journal of the History of Medicine and Allied Sciences 16, no. 3 (July 2006): 369–389. Kleinman, Arthur. 1988. Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: Free Press. Kleinman, Arthur, and Byron Good, eds. 1985. Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press.

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Litchfield, R. Burr. 2008. Florence Ducal Capital, 1530–1630. New York: ACLS Humanities E-Book. Lombardi, Daniela. 1988. Povertà maschile, povertà femminile: L’ospedale dei mendicanti nella Firenze dei Medici. Bologna: Il Mulino. Magherini, Graziella, and Vittorio Biotti. 1992. L’isola delle Stinche et i percorsi della follia a Firenze nei secoli XIV–XVIII. Florence: Ponte alle Grazie. ———, eds. 1997. “Un luogo della città per custodia de’ pazzi”: Santa Dorotea dei Pazzerelli di Firenze nelle delibere della sua congregazione (1642–1754). Casa Editrice Le Lettere: Florence. Mastrorosa, Ida. 2001. Leon Battista Alberti, ‘epidemiologo’: esiti umanistici di dottrine classiche. Albertiana 4: 21–44. Mellyn, Elizabeth W. 2017. “Healers and Healing in the Early Modern Health Care Market.” In The Routledge History of Madness and Mental Health, ed. Greg Eghigian, 83–100. New York: Routledge. ———. Mad Tuscans and Their Families: A History of Mental Disorder in Early Modern Italy. Philadelphia: University of Pennsylvania Press, 2014. Mellyn, Elizabeth W. “Passing on Secrets: Interactions between Latin and Vernacular Medicine in Medieval Europe.” I Tatti Studies in the Italian Renaissance 16, no. 1/2 (2013): 289–309. Meyer, Manuella. 2017. Reasoning against Madness: Psychiatry and the State in Rio de Janeiro, 1830-1944. Rochester: University of Rochester Press. Mikkeli, Heikki. 1999. Hygeine in the Early Modern Medical Tradition. Helsinki: Finnish Academy of Sciences. Mora, George. 1959. “Vincenzo Chiarugi (1759–1820) and his Psychiatric Reform in Florence in the Late Eighteenth Century.” Journal of the History of Medicine and Allied Sciences 14 (4): 423–433. Passerini, Luigi. 1853. Storia degli stabilmenti di beneficenza e d’istruzione elementare gratuita della città di Firenze. Florence: Tipografia le Monnier. Park, Katharine. 1985. Doctors and Medicine in Early Renaissance Florence. Princeton: Princeton University Press. Petaros, Anja, Ante Skrobonja, Tatjana Culina, Alan Bosnar, Verdan Frkovic, and Josip Azman, “Health Problems in the Medieval Statutes of Croatian Adriatic Coastal Towns: From Public Morality to Public Health,” Journal of Religion and Health 52, no. 2 (June 2013): 531–537. Rawcliffe, Carole. “‘Less Mudslinging and More Facts’: A New Look at an Old Debate about Public Health in Late Medieval English Towns.” Bulletin of the John Rylands Library 89, no. 1 (September 2013): 203–221.

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Roscioni, Lisa. 2003. Il governo della follia: Ospedali, medici e pazzi nell’età moderna. Milan: Bruno Mondadori. Archivio di Stato of Florence. Florence, Italy. Regio Diritto. Archivio di Stato of Florence. Florence Italy. Ospedale di Santa Dorotea. Archivio di Stato of Florence. Florence, Italy. Ospedale di Santa Maria Nuova. Scull, Andrew. 1993. The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900. New Haven: Yale University Press. Scull, Andrew, and Jonathan Andrews. 2003. Customers and Patrons of the Mad-­ Trade: The Management of Lunacy in Eighteenth-Century London. Berkeley: University of California Press. Smith, Leonard. 2014. Insanity, Race, and Colonialism: Managing Mental Disorder in the Post-Emancipation British Caribbean, 1838–1914. New York: Palgrave Macmillan. Stevens Crawshaw, Jane L. Plague Hospitals: Public Health for the City in Early Modern Venice. Burlington, VT: Ashgate, 2012. Still, Arthur and Irving Velody, eds. Rewriting the History of Madness: Studies in Foucault’s ‘Histoire de la folie.’ New York: Routledge, 1992. Summers, Martin. 2019. Madness in the City of Magnificent Intentions: A History of Race and Mental Illness in the Nation’s Capital. Oxford: Oxford University Press. Tchikine, Anatole. 2017. “The expulsion of the senses: the Idea of the ‘Italian Garden’ and the politics of sensory experience.” In Sound and Scent in the Garden, ed. D. Fairchild Ruggles, 217–253. Cambridge, MA: Harvard University Press. Terpstra, Nicholas. 2013. Cultures of Charity: Women, Politics, and the Reform of Poor Relief in Renaissance Italy. Cambridge, MA: Harvard University Press. Thumiger, Chiara. 2017. “Ancient Greek and Roman Traditions.” In The Routledge History of Madness and Mental Health, ed. Greg Eghigian, 42–61. New York: Routledge. Topp, Leslie. 2017. Freedom and the Cage: Modern Architecture and Psychiatry in Central Europe, 1890–1914. University Park, PA: Pennsylvania State University Press. Topp, Leslie, James E. Moran, and Jonathan Andrews, eds. 2007. Madness, Architecture, and the Built Environment: Psychiatric Spaces in Historical Context. New York: Routledge.

7 Rationalization of Space, Rationalization of Madness: Louis-­Hippolyte Lebas and the Development of Psychiatric Hospitals in Nineteenth-­Century France Vassiliki Petridou

At the end of the eighteenth century, mental asylums, as a part of the modern state apparatus of many European nations, were forced to adapt to new society needs. As in the case of prisons and hospitals, evolving conceptions of social space influenced the development of architectural programs and helped determine their importance and function. Asylums evolved from their role as places of punishment and seclusion to institutions that the society used to redefine its ethical foundations. Indeed, as Michel Foucault has argued in Madness and Civilization, earlier in the eighteenth century “insanity” had been politicized and criminalized, resulting in the blurred notions of space, disease, and treatment that lumped together “lunatics,” political prisoners, and various criminal elements.1 By the turn of the nineteenth century, however, three people in France made a significant contribution to changing the mental V. Petridou (*) University of Patras, Patras, Greece e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_7

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asylum into a specialized institution by defining its structural and spatial configuration: medical doctor and royal inspector of hospitals and prisons Jean Colombier (1736–1789), physician François Doublet (1751–1795), and psychiatrist Philippe Pinel (1745–1826).2 Further important developments later in the nineteenth century, as this chapter seeks to demonstrate, were associated with Jean-Étienne Dominique Esquirol (1772–1840), the father of French psychiatry. The notion of the asylum as a place to accommodate a distinct category of patients was starting to take shape alongside new ideas about scientific and therapeutic needs of spaces intended for the mentally ill, reflecting the evolution of psychiatric practice. The role of psychiatric doctors was redefined so that they could take on administrative responsibilities for the reorganization and both spatial and functional reconfiguration of psychiatric departments. This reform, in turn, provided new opportunities for doctors to work with architects who could structure spaces that were adjusted to various manifestations of mental disease. Founded in 1641, the psychiatric hospital of Charenton in Charenton-Saint-Maurice (now Saint-Maurice, Val-de-Marne)— best known as a site of forced confinement of philosopher and libertine Donatien Alphonse François, Marquis de Sade (1740–1814)—was rebuilt in 1836 by the architect Émile-Jacques Gilbert (1793–1874). This building is considered an outstanding example of hospital design and one of the masterpieces of nineteenth-century French architecture in general.3 The scheme realized by Gilbert, however, is remarkably close to an earlier project made for a hypothetical psychiatric hospital by the architect Louis-Hippolyte Lebas (1782–1867). Developed between 1818 and 1822, it was based on the instructions by Esquirol. The study of mental asylum architecture and the Charenton hospital in particular by architect and historian Pierre Pinon revealed a lot of new information.4 This material documents the institution’s history from the time of its founding, including different stages of the hospital’s development under Gilbert, while also showing analogies between his designs and the work of Lebas. By contrast, the aim of this chapter is to highlight a close collaboration between Lebas and Esquirol in producing a mental asylum plan that can be related to Charenton, which dates as early as 1818. This analysis demonstrates that Lebas’s work was among the first

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innovative efforts to configure the structure of modern psychiatric hospitals, rationalizing the space of madness. Hence, I suggest that Lebas’s project remained a defining model for the organization of modern asylum spaces in France and, specifically, constituted a prototype for the architectural innovations that would find their first physical realization in Gilbert’s 1836 design for Charenton.

F rom the Treatment of Mental Disorders to a Psychiatric Hospital A new era of hospital architecture in France commenced with the work of Jean Colombier, a French military doctor, surgeon, and hygienist.5 His largescale reorganization and improvement of the system of public hospitals and prisons was part of the hospital reform initiated by Jacques Necker (1732–1804), the general director of finances to King Louis XVI (r. 1774–1792). Colombier, together with his younger colleagues François Doublet and Philippe Pinel, began to work on the classification of mental disorders, applying this new approach to the treatment of psychiatric patients.6 Jean-Étienne Dominique Esquirol was strongly influenced by Pinel in his methods of treating the mentally ill. In 1811, he joined as a doctor in the Salpêtrière Hospital, where he worked with Pinel. An early champion of clinical psychiatry in France, Esquirol dedicated himself to the study of madness. His reform efforts concerning medical education, administration, and practice were devoted to the treatment of mental disorders. As architectural historian Robin Middleton wrote, Pinel and Esquirol’s approach to madness was part of that late eighteenth-­ century tendency, evident especially in philosophy and science, to concentrate on particular aspects rather than on the whole, and to relate them, if at all, by no more than the most schematic of frameworks. Metaphysics was then at a discount. Their contemporary, F. J. V. Broussais, sought to link different types of mental illness with disturbances in different parts of the body; the distinction of Pinel and Esquirol was that though they adopted a similar approach—in that they accepted that different aspects of

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the mind might be connected with different parts of the body (Gall’s ­anatomical system)—they looked for the basis of madness in psychological rather than physiological disturbances. But they envisaged no disorder of the entire system.7

In 1818, Esquirol wrote and published an important essay, Des établissements consacres aux aliénés en France at les moyens de les améliorer, in which he referred to a plan drawn by Louis-Hippolyte Lebas “according to the information that [Esquirol] provided to him,” to improve the poor and inhuman conditions in which the insane lived.8 As Pinon explained, The fact that the existence of the asylum, its spatial organization, was considered by alienists [psychiatrists] to be a sine qua non condition for the cure of the insane placed asylum architecture squarely at the heart of the whole issue of how to cure madness.9

In 1825, Esquirol was appointed the chief doctor of Charenton. His leadership inaugurated a new era not only in the treatment of mental illness, but also in the architectural organization of institutions devoted to its cure. Since Esquirol had vast clinical experience, Lebas found himself dealing with a detailed program with precise spatial requirements. Even though the French legislation addressed the issue of mental asylums immediately after the French Revolution, the Asylum de Bicêtre and the Salpêtrière, two major institutions devoted to the treatment of mental illness in Paris, remained little more than huge warehouse-like buildings, where the insane were subjected to physical and psychological abuse. Yet even with the introduction of Pinel’s innovations that stressed the need to provide treatment and not merely to ensure social confinement of the mentally ill, new methods had to be practiced in the same inhumane environment. Following Esquirol’s call to regard madness as curable like any other illness and to treat the insane as patients rather than prisoners who needed to be punished with solitary confinement, the mental asylum started to be perceived as an institution where such therapeutic procedures could take place. It was re-envisioned as a temporary residence for people who

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could be healed to be reintegrated into the society. Esquirol considered everyday living conditions as “an instrument of cure” and argued that without spatial improvements to the patients’ quarters, every attempt at new treatments would be futile. In his 1838 treatise that included a summary of the 1818 essay, translated into English and published in 1845 as Mental Maladies: A Treatise on Insanity (which is considered as one of the first texts of modern psychiatry), he described the characteristics of a site on which an asylum should be built, including its orientation and the quality of the soil, air, and climate: In building a house for the insane, we should select a site, in our country, with a southeastern exposure; with an exposure to the west in warm countries; and to the south, in the north. The soil should be dry and light. The lodging rooms should be protected against humidity and cold; and favorably disposed for ventilation. It is a grave error to suppose that the insane are insensible to atmospheric influences. The greater part of them avoid cold, and desire warmth.10

Psychiatric Ideas and Architectural Projects Charenton was originally founded as a hospital for the poor. Following its conversion into a mental asylum in the beginning of the nineteenth century, it became a place where new forms of psychotherapy were practiced. Under the pressure of political circumstances in post-revolutionary France, many famous artists, musicians, scientists, and politicians were confined to Charenton among the mentally ill, including the author Marquis de Sade, who was forced to live there from 1801 until his death in 1814. At the time of medical reforms in the beginning of the nineteenth century, the area around Charenton, in close proximity to Paris, was considered a healthy place, whose hygienic conditions satisfied psychiatrists. The surrounding landscape was known for its pure air, easy access to fresh water, and stretches of open countryside, which made it suitable for walks. In the early nineteenth century, there were plans to redevelop the existing buildings and to enlarge the premises with new accommodations

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for the mentally ill patients who were able to pay for their board. By 1816, however, the facilities were in dire condition, making the architect Jean-Baptiste Leroux, who was responsible for the hospital until 1832, present three unsuccessful plans for its rebuilding between 1818 and 1823.11 Also in 1818, however, recognizing the need to reorganize such institutions according to the new principles of psychiatry under the auspices of humanist philanthropy, Esquirol commissioned Lebas to develop a project for a mental asylum, which marked the beginning of a collaboration between the doctor and the architect. Lebas entered the architectural field in 1794 by joining the studio of his uncle Antoine-Laurent-Thomas Vaudoyer (1756–1846) and completed his training under the famous architect of Napoleonic France, Charles Percier (1764–1838). In 1806, he was awarded the second Grand Prix de Rome and, on his return from Italy in 1811, was put in charge of the supervision and inspection of work on the Palais de la Bourse and the Expiatory Monument over the burial site of Louis XVI and Marie Antoinette. In 1823, he won the competition for Notre Dame de Lorette, the first church in Paris to be built after the French Revolution. In 1825, Lebas was chosen to design the model prison of Petite Roquette, which featured one of the earliest panopticon layouts (a prison building with a circular plan that allowed constant centralized surveillance by a single security guard). Due to his rising popularity, in the same year, he became a member of the prestigious Institut de France and was elected to the architecture section of the Académie des Beaux-Arts, of which he would become president in 1837. He was made knight (1836) and officer (1847) of the Legion of Honor and taught as a professor at the École des Beaux-Arts from 1840 to 1864. Between 1819 and 1864, he directed one of the most important private architecture studios in Paris, where he trained some of the leading protagonists of a next generation of French architects. Although Lebas’s project for a mental asylum produced in collaboration with Esquirol was known following the publication of latter’s 1818 essay, the proposed design took a long time to disseminate. This project was published again in 1840 by the psychiatrist Théophile Archambault in his French translation of William Charles Ellis’s A Treatise on the Nature, Symptoms, Causes, and Treatment of Insanity and appeared for the

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third time in 1853 in Maximilien Parchappe’s work on psychiatric asylums (Fig. 7.1).12 Another contemporary project for a mental asylum titled Projet d’hospice d’aliénés and dated 1822, in the collection of the École des Beaux-Arts (inventory no. 70936), has been traditionally attributed to the architect Léon Vaudoyer (1803–1872) (Fig. 7.2).13 At the time when this drawing was made, however, nineteen-year-old Vaudoyer—son of Antoine-Laurent-Thomas Vaudoyer and a cousin of Lebas—was in his third year as an architecture student at the École des Beaux-Arts.14 Léon was influenced by the drawings both by his father and cousin, as he borrowed several elements of their work to use them in his own projects.15 In the absence of documentary proof, the younger Vaudoyer cannot be definitively denied the authorship of the drawing for the hospice d’aliénés.

Fig. 7.1  H.  Lebas and J.  E. D.  Esquirol’s plan and façade for an insane asylum (labeled “project by M.  Esquirol”). (William Charles Ellis, Traité de l’aliénation mentale, ou De la nature, des causes, des symptômes et du traitement de la folie: Comprenant des observations sur les établissements d’aliénés [ouvrage traduit de l’anglais, avec des notes et une introduction historique par Th. Théophile Archambault, enrichi de notes par M.  Esquirol], trans. Théophile Archambault (Paris: J. Rouvier, 1840))

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Fig. 7.2  Projet d’asile, 1822 (attributed to Léon Vaudoyer). (École des Beaux-Arts collection (inventory no. 70936))  (Petridou, Vassiliki. “La doctrine de l’imitation dans l’architecture française dans la première moitié du XIXe siècle. Du néo-­ classicisme au romantisme à travers l’œuvre de Louis-Hippolyte Lebas (1782–1867).” PhD diss., Université de Paris–Sorbonne, Paris IV, 1992)

At the same time, it seems likely that this drawing was inspired by the documented project that Vaudoyer’s older cousin Lebas produced in 1818 at the request of Esquirol. The awareness of this project must have contributed substantially to the development of the asylum scheme that the drawing attributed to Vaudoyer represents. If this hypothesis is correct, then the plan of 1822, even if drawn by Vaudoyer, conveys Lebas’s architectural ideas based on the suggestions by Esquirol. It thus represents one of the earliest schemes for an asylum based on a spatial organization that was a product of collaboration between an architect and a psychiatrist.

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In early nineteenth-century France, architectural students who studied at the École des Beaux-Arts had an opportunity to receive training in the design of hospitals, asylums, and nursing homes and to develop such projects in the context of their private studios. This approach reflected the rational spirit of the age. For example, we can refer to the manuscript of lecture notes for the Cours d’Histoire de l’Architecture (Course on the History of Architecture) by Jean-Nicholas Huyot (1780–1840), professor at the École des Beaux-Arts, the teaching of which, after Huyot’s death in 1840, passed on to Lebas. In this didactic text, numerous references to hospital and asylum typologies are enriched with functional details and stylistic elements. The course begins with an in-depth analysis of hospital and asylum planning as seen in the spatial organization of the hospitals in Milan, Genoa, and Naples in Italy and those in Plymouth and Greenwich in England. The notes encourage visiting such buildings as the Hôtel des Invalides, the Palais de Justice, and the military hospital of Val-de-Grâce in Paris to study the morphology of galleries, stairs, corridors, and decorative features. The famous École de Chirurgie in Paris, designed by the architect Jacques Gondouin between 1769 and 1774, is referred to as one of the most interesting among these buildings because of its hemispherical anatomy theater.16 Furthermore, publications such as the entry on hospitals in the late eighteenth- to early nineteenth-century Dictionnaire d’architecture demonstrate that the designers of that period followed the same models and relied on analogous methodological principles, which included a theoretical and historical investigation of the building’s typology, description of its floor plans, and analysis of the architectural styles employed.17 While the 1822 drawing does not indicate the location of the hospice d’aliénés, its plan seems to correspond to the layout of Charenton. One parallel that can be drawn is between this plan and the plans for the new establishment at Charenton, dated 1823 and hypothetically attributed by Pinon to Leroux (Fig. 7.3). In both projects, the relative positioning of the entrance, the administration building, the chapel, and the kitchen is the same, although in the 1823 plans, the patients’ quarters for men and women are organized around a large courtyard.18 Around 1815, that is, before the creation of any of these drawings, Charenton held between 480 and 510 patients.19 The number of patients that it accommodated

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Fig. 7.3  Leroux(?)’s project for the new Charenton Asylum on the Val Dosne site dating from 1823. (Pierre Pinon, L’Hospice de Charenton: The Charenton Hospital (Liège: Mardaga, 1989), 84)

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according to the 1823 plans range from 550 to approximately 624, while the 1822 drawing shows housing for a minimum of 552 people, suggesting that the size of both projects was practically the same. A note at the top of the 1822 drawing refers to “a plot of 179,200 square meters plus the three semicircles,” with these quarters arranged within a rectangle 560 meters long and over 320 meters wide. These observations give further support to the hypothesis that, although attributed to Vaudoyer, the 1822 drawing most likely represents an earlier project produced in 1818 by Lebas at Esquirol’s instance. Indeed, the 1822 plan incorporates the spatial and architectural characteristics of a typical asylum as described by Esquirol in his theoretical essay. He proposed to divide the institution into two parts, placing the two-story administrative and services buildings, as well as the staff accommodations, in the center. On either side of that part, he wrote, and at right angles to it, separate blocks to accommodate the insane will be built, the men’s block to the right, the women’s to the left; these separate blocks will be of a sufficient number to accommodate all the categories of the insane. Running around them, there will be a gallery on to which the doors and windows will open. In our temperate climates, the gallery on to which the doors open will be an openwork construction and it will link all the separate blocks with each other and to the central building. The windows will look out on to a closed gallery.20

Indeed, the plan of 1822 shows separate blocks where the cells of the inmates were to be located, joined by a gallery that has both closed and open sections. The result is a square arrangement with a courtyard and a fountain in the center and rows of individual cells for the patients on two of the sides. Each square was supposed to host different categories of patients, projecting the categorization of the mental illness into space: In the middle of these buildings, and parallel to them, will be another group of separate buildings to be used as workshops, common-rooms, refectories, an infirmary, etc. All these buildings should have separate quarters for the violent insane, harmless maniacs, peaceful melancholics, noisy

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monomaniacs, the demented insane, those who are habitually unclean, epileptics, inmates suffering from other diseases, and finally for convalescents.21

As the 1822 drawing suggests, open galleries were supposed to connect these blocks to the central administration building. According to Esquirol’s theory, patients were supposed to be distributed around twelve courtyards—six for men and six for women—accessed from the ground level and surrounded by an expanse of open land large enough for a farm that the inmates could cultivate.22 Alongside the buildings that housed the cells also appeared workshops, separate spaces for patients who could afford to pay higher fees, and rooms for the convalescents.23 These rooms were placed in the center so that they would remain isolated, with their inhabitants not being disturbed by other patients. The resulting layout, therefore, categorized the inmates not only in accordance with their specific illness, but also their financial means. According to the 1822 drawing, the center of the complex, immediately after the forecourt, was occupied by the administration building, the chapel, accommodations for the doctors, the kitchen, the pharmacy, the laundry, and other service buildings. The chapel was designed in the form of a basilica with a porch accessed by steps, a nave with two aisles, and a semicircular choir. This plan resembles a basilica project that Lebas presented as a competition entry in 1801, while still a student in the École des Beaux-Arts. He later used the same design for the church of Notre Dame de Lorette in 1824.24 The chapel’s plan is another piece of evidence that allows us to situate the 1822 drawing firmly in the context of Lebas’s architecture.

Architecture and the Treatment of Mental Illnesses The plan and elevation publishedin 1840 by Archambault under the title Plan et façade d’un hopital pour les aliénés, which he attributed to “M[onsieu]r Esquirol,” bears similarities to the 1822 drawing, although the distribution of spaces differs from Esquirol’s project as originally

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articulated in 1818. Pinon notes variations between the two, 1818 and 1838, versions of Esquirol’s text, suggesting that “Lebas had developed the notion of the ‘quadrilateral,’ giving shape to a still vague idea of Esquirol. And then only later, with the architect’s plan in front of him, did the alienist [psychiatrist] expound the theory of the square quarters.”25 In other words, according to Pinon, the evolution of the design to include central courtyards surrounded by a gallery was due to the reworking by Lebas of Esquirol’s original project of 1818. Indeed, in the plan published in 1840, we find the same characteristics as in that of 1822. They include the division of the institution into the central compound for the administration, two wings with courtyards and rooms for the patients, open spaces left to separate these quarters, and the presence of a gallery connecting all these units to the main building. The 1840 plan, however, shows a change in the design of the patients’ quarters, which have buildings on three sides instead of two. It was in the 1838 version of Esquirol’s text that these quarters were supposed to be given the form of the “quadrilatères” (quadrilaterals). The 1822 drawing, however, allows us to reconcile the differences between Esquirol’s 1818 description of his project and the plan of 1840. A close examination, in fact, suggests that both the modified description published in 1838 and the plan of 1840 were actually reworkings of this earlier drawing. In other words, when Esquirol revised his project in 1838, he did that on the basis of the changes that Lebas had made to the 1818 project, as reflected by the 1822 drawing. Esquirol’s notes on Ellis’s work, published together with his updated project by Archambault in 1840, show that his ideas continued to evolve while affirming his adherence to the principles originally put forward in 1818.26 For example, the plan of 1840 conveys Esquirol’s continued opposition to multi-story structures for the mentally ill. Its comparison with the drawing of 1822 shows a tendency toward greater simplification while retaining the same architectural components, save for the separate blocks that become transformed into the quadrilaterals and the chapel’s bell tower, which disappears altogether. Another important element demonstrates his thinking as a psychiatrist: in the plan of 1822, a ditch (ha-ha) surrounds the entire asylum compound. Esquirol insisted that this feature be added in Gilber’s 1834 plan for Charenton, so that the inmates

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would not be oppressed by the feeling of confinement caused by a fence, to “keep the idea of captivity as far as possible.” He wrote: Railings create a gloomy impression which will undoubtedly affect the insane. Besides, they have a tendency to constantly remind the inmates of the fact of their sequestration, and this is something to be avoided. Consequently, we would like the courtyards to be enclosed on this side by a ditch, whose slope would be such that the patients ran no risk of dangerous falls.27

The idea of using a ditch, however, is already in evidence in the 1822 drawing and, therefore, dates back to this earlier attempts to rethink the organization of mental asylum spaces. From the second half of the eighteenth century, the desire to rationalize the hospital architecture involved efforts to standardize the classification of patients treated in these specialized facilities.28 Conceived in response to new challenges posed by the distribution and function of hospital spaces, this theoretical work, while still far from consistent, invited original architectural solutions. Esquirol’s program for the division of patients into categories followed the definition of the mental asylum put forward by inspector of hospitals Jean Colombier in 1785 and was based on the separation between men and women who were allocated separate quarters. Esquirol provided further instructions for organizing asylum space in relation to various categories of mental illness, insisting that patients “should be arranged in such a way that they neither hear nor see the other inmates and they should be near the central building.”29 Following these suggestions, the architect had to come up with a plan based on the principles of symmetry and proportion and, at the same time, introducing a system of circulation based on the separation of different blocks. The buildings were to provide abundant light and air with no humidity and allow maximum comfort. The architectural style was to be based on the purity of classical forms and offer a variety of uses for the space while maintaining overall symmetry. Charenton’s plan, as designed by Gilber in 1834, had the form of a cross with a chapel in the middle. This design, which conveyed both organizational and religious symbolism, also characterized the layout of

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the Ospedale di Pammatone in Genoa and the Ospedale Maggiore in Milan, as well as Bernard Poyet’s hospital design produced for the French Royal Academy of Sciences in 1786, as illustrated in Recueil et Parallèle by Jean-Nicolas-Louis Durand in 1801 (Fig. 7.4). These cruciform designs became sources for Lebas. Indeed, by the time he was assigned the asylum project by Esquirol in 1818, he had already traveled to Italy, visiting a hospital in Genoa, hospitals in Turin, numerous churches, and several convents. Lebas maintained the same principles that had been formulated in 1785 by Colombier and implemented by Charles François Viel (1745–1819) at the Hôpital de la Salpêtrière, according to which patients had to be housed in single-story buildings. In his essay of 1818, Esquirol insisted that in this way the inmates would be able to move safely and avoid the risk of accidents.30 Esquirol’s proposal to organize the asylum

Fig. 7.4  Hospital plans published by Durand in 1799. From left to right: Hospital of Genoa, of Milan, of Plymouth (1756), Saint-Louis in Paris (1607), the hospital by Poyet (1788), Hospital des Incurables, Paris. (J. N. L. Durand, “Hôpitaux,” in Recueil et parallèle des édifices de tout genre, anciens et modernes: Remarquables par leur beauté, par leur grandeur, ou par leur singularité, et dessinés sur une même échelle (Paris, 1799), plate 29. University of Heidelberg, Creative Commons license)

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space into isolated masses, however, was a radical departure from the enclosed cloister system that served as a model for eighteenth-century hospital building, as prescribed by Colombier. The 1822 drawing gives us a clear idea of architecture based on these principles, without overburdening it with excessive decorative detail. Just as Maximilien Parchappe recommended in his 1853 essay, architecture should impress the mentally ill with its both imposing and calm demeanor.31 As Lebas noted in his Cours d’Histoire de l’ Architecture that he taught at the École des Beaux-Arts in 1842: To invent in architecture is to produce an idea of a building that is not copied from any other. The invention will be good if the parts are arranged in order, proportion, and convenience, if the ornaments are distributed with elegance, and discretion. Finally, if the building as a whole and in parts responds well to the demands of the program that we have imposed and if it meets the requirements of structural firmness, the project is likely to progress to execution without difficulty and to satisfy people initiated in the principles of art.32

The 1818 plan, as developed in the 1822 drawing, expressed the unity between Esquirol’s organizational program and Lebas’s architectural concept, which relied on the same rules of uniformity and symmetry. Spatial rationality dominated the principles of utilitarian architecture, reducing the range of expressive elements to a minimum and giving the building a severe appearance. The arcaded gallery that circumscribed the patients’ quarters gave cohesion to the overall composition. Positioned on the central axis, the two-story administration building rose above the lower wings, being surmounted by the chapel’s bell tower as though to anchor the asylum’s layout. The same organization is also revealed by the neoclassical plan of Gilbert’s project for Charenton (Fig. 7.5). In Esquirol’s description of his asylum project published in 1840 by Archambault, the gallery becomes a simple portico, while the arcades, the bell tower, and the entrance porch are eliminated. By contrast, in the 1822 drawing, no common dormitories were planned, while patients were prevented from having access to the central administration building.

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Fig. 7.5  Émile-Jacques Gilbert’s project for the new Charenton Asylum, variant A, adopted in 1834. (Pierre Pinon, L’Hospice de Charenton: The Charenton Hospital (Liège: Mardaga, 1989), 113)

The 1822 plan maintained the courtyard design closed on two sides, being the closest to Esquirol’s description of 1818. Pinon highlights the relationship between this program and its subsequent architectural realizations, praising the ample knowledge that both Lebas and Gilbert had with regard to the functional aspects of an asylum: The plan which Gilbert worked up for Charenton, and the one which Lebas [worked on] for Esquirol, are not mere products of a brief, no matter how precise. The idea of a grid was never mentioned by the alienist, who contented himself with enumerating the quarters and made no suggestions as to their eventual layout. In the approaches of Gilbert and Lebas—which are inseparable—there is an enormous effort of composition based on guidelines in the brief, but also based on the prevailing formal models of the day.33

Yet, when architect and publisher César Daly discussed Charenton as rebuilt by Gilbert in his Revue Générale de l’Architecture in 1852, he made no reference to the project developed by Lebas, despite the obvious

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relationship between the two.34 Perhaps the reason why Lebas’s plans were never realized had to do with his failure to incorporate the full range of regulatory provisions for mental asylums as imposed by government authorities. His architectural thought drifted between the real and the ideal, between tradition and innovation. It was precisely this approach that allowed him, in the beginning of his career, to pursue ideal forms of classical architecture, while also becoming involved with one of the earliest building projects that followed a rational program in an effort to address the pressing social issue of treating mental illness. According to Pinon, the fact of a close collaboration between Lebas and Esquirol was not sufficient for the architect to become associated with the nineteenth-­ century Rationalism, as the logic of Neoclassical forms did not completely obey the functional program.35 Lebas’s involvement with a mental asylum project shows the extent to which the search for new architectural solutions in the first half of the nineteenth century was driven by scientific research and social reform. The spirit of rationalism encouraged the systematic organization of space, making architects recognize the new social role of architecture. In addition to that, the figure of the architect-technician opened architecture to new scientific thinking, leading its practitioners to engage in meaningful collaborations, especially with public administrators, and trying to redefine the goals of architecture itself.

Conclusion By the end of the eighteenth century, mental asylums needed to adapt to the new requirements and expectations of the European society. Questions of medical treatment of mental illness and architecture for the patients preoccupied politicians, doctors, and philanthropists and much as architects. Following the French Revolution, the reorganization of the state apparatus involved a complete administrative reform, resulting in further specialization of the architectural profession and, according to George Teyssot, contributing “to the standardization of the urban and territorial spaces, recomposed on the superimposed grids of safety, healthiness, and precision.”36 New solutions to hospital design circulated from 1830

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onward, with the first asylums for the insane appearing between 1821 and 1825 at Saint-Yon. Clear parallels between Gilbert’s architecture of Charenton and the earlier asylum project by Lebas show the enduring influence of the ideas articulated by Esquirol in 1818, which, encapsulated in the architect’s plan, provided a model for later designs realized in the following decades (Figs. 7.6 and 7.7). The architectural principles expressed by Charenton formed a rationalist basis for the design of psychiatric hospitals for the remainder of the nineteenth century.37 These principles included a symmetrical layout, the separation of buildings with different functions, the organization of space in accordance with the classification of mental disease, strict rules with regard to hygiene, and the orientation of individual buildings and the whole complex in relation to the natural features of the site. The reforms launched by Esquirol and the new architectural

Fig. 7.6  View of the Charenton Asylum chapel at the Charenton Asylum (as sein in 1989). (Vassiliki Petridou)

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Fig. 7.7  The convalescents yard at the Charenton Asylum (as seen in 1989). (Vassiliki Petridou)

solutions proposed by Lebas made the result of their collaboration an innovative and lasting model for mental asylum architecture in nineteenth-century France.

Notes 1. Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason (Folie et Déraison: Histoire de la folie à l’âge classique, 1961) (New York: Pantheon Books, 1965). 2. Philippe Pinel, Traité médico-philosophique sur l’aliénation mentale (Paris, 1809). See also Adams M. Thomas, “Medicine And Bureaucracy: Jean Colombier’s Regulation For The French ‘Dépôts De Mendicité’ (1785),” Bulletin of the History of Medicine, Winter 1978, Vol. 52, No. 4, pp. 529–541. 3. Claude Mignot, L’Architecture au XIXe siècle (Paris: Editions du Moniteur, 1983).

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For the architecture of the Charenton Hospital during the nineteenth century, see Gourlier, Biet, Grillou and Tardieu, Choix d’édifices publics projetés et construits en France depuis le commencement du XIXe siècle (Paris, 1825–1850); Nicolas Sainte-Fare-Garnot and Pierre Martel, L’architecture hospitalière au XIXe siècle, l’exemple parisien. Les dossiers du Musée d’Orsay, no. 27 (Paris: Musée d’Orsay, 1988). 4. Pierre Pinon, L’Hospice de Charenton: The Charenton Hospital (Liège: Mardaga: 1989). 5. Jean Colombier and François Doublet, Instruction sur la manière de gouverner les insensés et de travailler à leur guérison dans les asiles qui leur sont destinés (Paris, 1785); Philippe, Pinel, Traité médico-philosophique sur l’aliénation mentale, ou La manie (Paris: 1809). 6. Jean-Michel Leniaud, “Un champ d’application du rationalisme architectural: Les asiles d’aliénés dans la première moitié du XIXe siècle,” L’Information Psychiatrique 56, no. 6 (1980): 745–55; Jean-Michel Leniaud, “Plaidoyer pour l’architecture psychiatrique,” Monuments Historiques 114 (April-May 1981): 53–58. 7. Robin Middleton, “Sickness, madness, and crime as the grounds of form,” AA Files 25 (Summer 1993): 20. 8. “[D]’après les données qua je lui ai fournies.” Jean-Etienne Dominique Esquirol, Des établissements consacres aux aliénés en France at les moyens de les améliorer, Mémoire présenté au Ministre de l’Intérieur en Septembre 1818 (Paris, 1819), 3. Esquirol’s other publications include Mémoire historique et statistique sur la liaison Royale de Charenton (Paris, 1835) and Des maladies mentales (Paris, 1838). 9. Pinon, L’Hospice, 37. 10. Jean-Etienne-Dominique Esquirol, Mental Maladies; A Treatise on Insanity (Des maladies mentales, 1838), trans. Ebenezer Kingsbury Hunt (Philadelphia: Lea and Blanchard, 1845), 82. 11. Pinon, L’Hospice, 27, 71, and 240. See also Jeanne Mesmin D’Estienne, “La maison de Charenton du XVIIe au XXe siècle: Construction du discours sur l’asile,” Revue d’histoire de la protection sociale 1 (2008): 19–35. 12. Maximilien Parchappe, Des principes à suivre dans la fondation et la construction des asiles d’aliénés (Paris: Masson, 1853). The same project was illustrated in the publication by H. Loewenhayn, Considérations sur le traitement des aliénés (Saint-Petersbourg, 1833). 13. Barry Bergdoll, Léon Vaudoyer: Historicism in the Age of Industry (Boston: MIT Press, 1994). This drawing featured during the sale of drawings of

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Antoine, Léon, and Alfred Vaudoyer on April 10, 1986, at the Hôtel Drouot, Paris. See Anonymous, Dessins d’architectes XVIlle et XIX siecles, d’Antoine, Léon et Alfred Vaudoyer, Hôtel Drouot, Catalogue des ventes, Vendredi 11 avril 1986 à 14 h30, N° de catalogue 55: “Vaudoyer (Léon), Projet d’hospice d’aliéné, plan, plume et In/IS, déchirure, date de 1822, 70,3 x 59, 5.” The same drawing was also presented at the exhibition “Hospital architecture in the 19th century” which was held at the Musée d’Orsay in 1988. It appears in the number 43 of the exhibition catalog as: “Projet d’asile, 1822, esquisse pour le grand prix”, in Sainte-­Fare-­ Garnot, Nicolas and Pierre Martel. L’architecture hospitalière au XIXe siècle, l’exemple parisien. Les dossiers du Musée d’Orsay, no. 27. Paris: Musée d’Orsay, 1988. 14. It is important to underline that during the period of Léon Vaudoyer’s studies, the only architectural subject close to a hospital building requested for the competition of the grand prize was in 1820 the project for a School of Medicine, for which Gilbert won the prize. See D. D. Egbert, Beaux-­ arts Traditions in French Architecture (Princeton: Princeton University Press, 1980). 15. As proof of this, Léon Vaudoyer’s drawing for a public granary in 1824 (Collection Dominique Vaudoyer, Paris) is in fact a reworking of the project that his father, Antoine, had designed for the marché des Carmes in Toulouse (1813) and with which H. Lebas, Antoine’s main collaborator since 1817, was involved. Furthermore, it is well known that a close relationship existed between the Vaudoyer and Lebas family. See Bergdoll, Léon Vaudoyer, 50–52; Vassiliki Petridou, “La doctrine de l’imitation dans l’architecture française dans la première moitié du XIXe siècle. Du ­ néo-­ classicisme au romantisme à travers l’œuvre de LouisHippolyte Lebas (1782–1867)” (PhD diss., Université de Paris–Sorbonne, Paris IV, 1992), 61–79. 16. Jean-Nicholas Huyot, Cours d’Histoire de l’Architecture, s.d., Library of École Nationale Supérieure des Beaux-Arts (E.N.S.B.A.), Paris, cote 805 J 48. 17. For texts, see Jean-Nicolas-Louis Durand, Recueil et parallèle des édifices de tout genre, anciens et modernes: Remarquables par leur beauté, par leur grandeur, ou par leur singularité, et dessinés sur une même échelle (Paris, 1799); A. C. Quatremère de Quincy, “Hôpitaux,” in Dictionnaire d’architecture (Paris 1788/1825), 715–718. See also the entries “Hôpital” and “Hospice.”

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18. Pinon, L’Hospice, 80–85. 19. Ibid., 79. 20. Esquirol, Des établissements, 31; Pinon, L’Hospice, 49. 21. Esquirol, Des établissements, 32; Pinon, L’Hospice, 50. 22. William Charles Ellis, Traité de l’aliénation mentale, ou De la nature, des causes, des symptômes et du traitement de la folie: Comprenant des observations sur les établissements d’aliénés [ouvrage traduit de l’anglais, avec des notes et une introduction historique par Th. Théophile Archambault, enrichi de notes par M. Esquirol], trans. Théophile Archambault (Paris: J. Rouvier, 1840), 381. 23. Leniaud, Un champ, 752n25. 24. Petridou, La doctrine, 203–36. 25. Pinon, L’Hospice, 49n26 and 52n35. As “quadrilateral” does not mean a building with four sides but four buildings around a square, or three buildings and a gallery around the square. 26. Ellis, Traité de l’aliénation mentale, 492–495. 27. Bâtiments Civils Αrchives F13(1292) in Pinon, L’Hospice, 117. 28. For the work on standardizing urban and territorial spaces in the eighteenth and nineteenth centuries, see Georges Teyssot, “La ville-­ équipement, la production architecturale des bâtiments civils, 1795–1848,” Architecture-Nouvement-Continuite 45 (1978): 86–94; Michel Foucault, “La politique de la santé au XVIIIe siècle,” in Les machines à guérir: Aux origines de l’hôpital moderne (Mardaga: Brussels, 1979). 29. Esquirol, Des établissements, 32; Pinon, L’Hospice, 50. 30. Esquirol, Des établissements, 33–35; Pinon, L’Hospice, 53. 31. Parchappe, Principes à suivre, 270 and 285. 32. Lebas, H. Cours d’Histoire de l’Architecture, 1842, Bibliothèque de l’Institut, Paris, MS 4474, 2nd Lesson, 1842. 33. Pinon, L’Hospice, 213. 34. César Daly, “Maison de Santé de Charenton,” Revue Générale de l’Architecture et des Travaux Publics 10 (1852): 384–95. 35. Pinon, L’Hospice, 212–13. 36. Teyssot, La ville-équipement, 91. 37. Veronique Deblon, “Constructing the Illusion of Freedom: Architecture and Psychiatry in Nineteenth-Century Belgium,” Journal of Belgian History 48 (2017): 88.

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Bibliography Bergdoll, Barry. Léon Vaudoyer: Historicism in the Age of Industry. Boston: MIT Press, 1994. Colombier, Jean and François Doublet. “Instruction sur la manière de gouverner les insensés et de travailler à leur guérison dans les asyles qui leur sont destinés, 1785.” L’Evolution psychiatrique 1, no. 1 (1983): 225–41. ———. Instruction sur la manière de gouverner les insensés et de travailler à leur guérison dans les asiles qui leur sont destinés. Paris, 1785. César Daly, Untitled article, Revue Générale de l’Architecture et des Travaux Publics 10, (1852): 384–95. D’Estienne, Jeanne Mesmin. “La maison de Charenton du XVIIe au XXE siècle: Construction du discours sur l’asile.” Revue d’histoire de la Protection Sociale 1 (2008): 19–35. Deblon, Veronique. “Constructing the Illusion of Freedom: Architecture and Psychiatry in Nineteenth-Century Belgium.” Journal of Belgian History 48 (2017): 84–111. Durand, Jean-Nicolas-Louis. Recueil et parallèle des édifices de tout genre, anciens et modernes: Remarquables par leur beauté, par leur grandeur, ou par leur singularité, et dessinés sur une même échelle. Paris, 1799. Egbert, D. D. Beaux-arts Traditions in French Architecture. Princeton: Princeton University Press, 1980. Ellis, William Charles. Traité de l’aliénation mentale, ou De la nature, des causes, des symptômes et du traitement de la folie: Comprenant des observations sur les établissements d’aliénés [ouvrage traduit de l’anglais, avec des notes et une introduction historique par Th. Théophile Archambault, enrichi de notes par M. Esquirol]. Translated by Théophile Archambault. Paris: J. Rouvier, 1840. Esquirol, Jean-Etienne-Dominique. Des établissements consacres aux aliénés en France at les moyens de les améliorer, Mémoire présenté au Ministre de l’Intérieur en Septembre 1818. Paris, 1819. ———. Mental Maladies; A Treatise on Insanity (Des maladies mentales, 1838). Translated by Ebenezer Kingsbury Hunt. Philadelphia: Lea and Blanchard, 1845. ———. Mémoire historique et statistique sur la liaison Royale de Charenton. Paris, 1835. Anonymous. Dessins d’architectes XVIlle et XIX siecles, d’Antoine, Léon et Alfred Vaudoyer, Hôtel Drouot, Catalogue des ventes, Vendredi 11 avril 1986.

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Foucart, Bruno. “Au paradis des hygiénistes: L’architecture hospitalière au XIXe siècle.” Monuments Historiques 114 (1981): 43–52. Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason (Folie et Déraison: Histoire de la folie à l’âge classique, 1961). New York: Pantheon Books, 1965. ———. “La politique de la santé au XVIIIe siècle.” In Les machines à guérir: Aux origines de l’hôpital moderne. Brussels: Mardaga, 1979. Goldstein, Jan E. Console and Classify: The French Psychiatric Profession in the Nineteenth Century. Chicago: University of Chicago Press, 2001. Gourlier, Biet, Grillou, and Tardieu. Choix d’édifices publics projetés et construits en France depuis le commencement du XIXe siècle. Paris, 1825–1850. Grand, Lucile. “L’architecture asilaire au XIXe siècle, entre utopie et mensonge”. Bibliothèque de l’école des chartes 163, nο. 1 (2005): 165–96. Sainte-Fare-Garnot, Nicolas and Pierre Martel. L’architecture hospitalière au XIXe siècle, l’exemple parisien. Les dossiers du Musée d’Orsay, no. 27. Paris: Musée d’Orsay, 1988. Huyot, Jean-Nicholas. Cours d’Histoire de l’ Architecture (Course of the History of Architecture), s.d., Library of École Nationale Supérieure des Beaux-Arts (E.N.S.B.A.),Paris, cote 805 J 48. Lebas, H. Cours d’Histoire de l’ Architecture (Course of the History of Architecture), 1842, Bibliothèque de l’Institut, Paris, MS 4474, 2nd Lesson, 1842. Leniaud, Jean-Michel. “Asiles d’aliénés: Plaidoyer pour l’architecture psychiatrique.” Monuments Historiques 114 (April–May 1981): 53–58. Leniaud, Jean-Michel. “Un champ d’application du rationalisme architectural: Les asiles d’aliénés dans la première moitié du XIXe siècle.” L’Information Psychiatrique 56, no. 6 (1980): 747–61. Mignot, Claude. L’Architecture au XIXe siècle. Paris: Editions du Moniteur, 1983. Middleton, Robin. “Sickness, Madness, and Crime as the Grounds of Form.” AA File 25 (Summer 1993): 14–29. Parchappe, Maximilien. Des Principes à suivre dans la fondation et la construction des asiles d’aliénés. Paris: Masson, 1853. Petridou, Vassiliki. “La doctrine de l’imitation dans l’architecture française dans la première moitié du XIXe siècle. Du néo-classicisme au romantisme à travers l’œuvre de Louis-Hippolyte Lebas (1782–1867).” PhD diss., Université de Paris–Sorbonne, Paris IV, 1992. Pinel, Philippe. Traité médico-philosophique sur l’aliénation mentale, Seconde édition, entièrement refondue et très-augmentée. Paris, 1809.

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Pinon, Pierre. L’Hospice de Charenton: The Charenton Hospital. Liège: Mardaga, 1989. Quatremère de Quincy, A.C., Dictionnaire d’architecture. Paris, 1788/1825. Teyssot, Georges. “La ville-équipement. La production architecturale des bâtiments civils. 1795–1840.” Architecture, Mouvement, Continuité 45 (1978): 86–94.

Part IV Spa Cities

8 Cure, Leisure, and Exercise: The Emerging Spa Landscapes in Eighteenth- and Early Nineteenth-­Century Hungary Kristof Fatsar

The appeal of European spa townsas fashionable tourist attractions declined during the decades after World War II, succumbing to the allure of more exotic and faraway destinations. One of the reasons for their eclipse was the diminished attention to health benefits of thermal springs as compared to rapid advancements in other fields of contemporary medical research. Some of the most internationally significant spas managed to reinvent themselves as convention centers owing to their recognition as architectural heritage, but many closed down, with their unique landscapes irreversibly changed. A growing interest in spa towns that emerged during the 1980s was a response to this decline to prevent further loss of heritage assets. By the turn of the twenty-first century, however, spas once again became fashionable as pillars of the emerging wellness industry. There is strong evidence that spa towns developed into an urban typology in the eighteenth century. As Volkmar Eidloth argues in his overview

K. Fatsar (*) Manchester School of Architecture, Manchester Metropolitan University, Manchester, UK e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_8

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of their development, this phenomenon was based on their specific function, as in the case of mining or fortified towns.1 The evolution of spa towns further diversified during the nineteenth century, with the emergence of more varied medical treatments that they offered. In the context of urban planning, spa landscapes were traditionally seen as a subset of public park and other green spaces. In the German-speaking lands— which at the time included Hungary, at least as far as its intellectual elite was concerned—Christian Cay Lorenz Hirschfeld (1742–92), professor of philosophy and fine arts at the University of Kiel, was the most influential advocate of the new landscaping style generally known as the “English garden.” In the fifth and final volume of his seminal Theory of Garden Art (1785), he dedicated an entire chapter to the landscapes of spas, distinguishing them from public parks.2 Perhaps the most important of his recommendations was the creation of extensive routes extending from spa complexes for leisure and exercise, which had the practical consequence of connecting the town to its natural surroundings. In many ways, however, Hirschfeld’s recommendations reflected the already existing trends in spa development. According to Erika Schmidt, the eighteenth-century web of baroque avenues in Bad Pyrmont in Lower Saxony was an early example of uninterrupted green infrastructure that became widespread by the nineteenth century and was advocated by such important landscape designers as the Prussian Peter Joseph Lenné (1789–1866).3 Using Bad Pyrmont as an example, she considered it likely that “continuous open space systems were planned earlier and more frequently in spa towns than elsewhere because they facilitated the forms of movement that were desirable for therapeutic reasons as well as for public display.”4 In his brief overview of urban public green spaces of the Habsburg Empire, however, Géza Hajós could list only one Bohemian and one Austrian example of spa developments from the period prior to 1800, with none in Hungary.5 By contrast, spa landscapes discussed in this chapter demonstrate that they were a more widespread phenomenon, manifest even on the European periphery. If we attempt to identify the common characteristics of early spa complexes in Hungary, three aspects of their landscapes immediately come into prominence. First, the emerging spa town was not confined to its actual footprint with buildings, gardens, avenues, and parks, but engaged

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with the surrounding nature that served as a canvas for more ambitious landscape interventions. Such elements were always interconnected, creating early examples of integrated urban green infrastructure. Second, designed landscapes around spa towns were not only for the use of those who sought cure, but for the entertainment and physical exercise of all visitors. Indeed, spas were settings for many societal activities, including parties and family gatherings, which probably brought in more revenue than lone individuals who came for treatment. Walking was part of the healing experience in Bad Pyrmont, as prescribed by Johann Philipp Seipp (1686–1757),6 who became the spa’s official medic in 1713. It must have been, however, a longer tradition across different European spas, as testified by a 1676 description of the daily cure routine at Vichy.7 Contemporary accounts make it clear that spas were places to socialize, to which health benefits were often considered secondary.8 Finally, part of the spa town experience was about arriving at the spa, the process that was supposed to elevate the spirit and prepare the body for the healing that awaited it. In other words, landscapes around spas were to be experienced not only on excursions from these facilities, but were expected to have positive effects on the visitors still en route to them.9 This chapter examines the history of several eighteenth-century spa complexes in Hungary. The country has long been known for the abundance of its mineral waters and is still proud of its spa heritage. Indeed, an Internet search for the most important Hungarian tourist attractions regularly returns spas in top positions. A recent application for World Heritage status by a consortium of originally eleven towns under the name of “Great Spas of Europe,” however, does not include any examples from Hungary while featuring various sites from England to Italy and Austria to France.10 Although this list is by no means a true representation of the most prominent European spa towns from the eighteenth and nineteenth centuries—it omits such big names as Wilhelmsbad and Teplice, for example—Hungary’s absence is not surprising. The push for spa complexes as tourist attractions capable of luring a wide range of visitors came only at the very end of the eighteenth century, when the destinations of international spa tourism had long been established. Furthermore, Hungary’s location on the periphery of Europe meant that the country was not well positioned to attract the celebrities of the age.

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More importantly, its slow economic development and poor travel infrastructure made it a rather challenging destination, suited mainly for adventurous travelers.11 Despite these unfavorable circumstances, there was a clear desire to develop spas at certain thermal springs of local—and sometimes regional and even international—renown. This approach seems to have been widespread, with property owners behind such developments representing a cross-section of the Hungarian establishment, coming from aristocratic, religious, and crown estates as well as free cities. Their ambitions, at least initially, were limited: they mainly sought to attract members of the local or regional elites and only occasionally tourists from the neighboring countries. Design interventions that shaped the landscapes of these emerging spas followed the latest fashions in Hungary, although they often lagged behind the trends that swept across Europe, as this chapter will demonstrate.

 ungarian Thermal Springs H and Their Reputation Ancient Romans were the first to a ppreciate Hungarian mineral waters when they ruled over the province of Pannonia (ca. AD 100–350), in what today is the part of Hungary west and south of the Danube River. Klára Póczy, in her analysis of the water-related infrastructure of Pannonia, refers to the ancient use of thermal springs in Balf and Hévíz, both of which are still much visited spas.12 She also hints at the possibility of Roman baths being used as healing places in the provincial capital of Aquincum (now part of Budapest), where many unearthed tubs suggest that these baths were probably used for medicinal purposes.13 Archeological evidence indicates that the continuous use of thermal baths of Buda (the western part of Budapest) goes back to medieval times; they were also mentioned by fifteenth-century travelers. After 1541, during the 145-year long Ottoman occupation of the city, hammams were built above these springs, and several of them are still in operation today.14 These hammams might have inspired the Silesian-born Georg Werner

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(1490–1556), a humanist and Hungarian official, to write a book on Hungarian thermal springs and spas, first published in Basel in 1549. The success of this publication is attested by its seven editions that came out before 1600, which helped establish the country’s reputation as a spa tourism destination.15 There were other sporadic attempts to highlight the wealth of the country’s mineral waters, but it was not until the rule of Empress Maria Theresa (r. 1740–80) that the state decided to mobilize their use in the service of public health, perhaps also hoping to reap some economic benefits. In January 1763, the Governing Council (Helytartótanács) issued a decree ordering the Hungarian counties to survey all thermal springs within their jurisdictions and identify their chemical composition.16 Many counties, however, did not have competent personnel to carry out this chemical analysis, and the survey remained incomplete. In the end, it fell to the Viennese professor of medicine Heinrich Johann Nepomuk von Crantz (1722–99)—a pupil of Gerard van Swieten (1700–72), the public health reformer and personal physician to Maria Theresa—to survey the spas and healing springs of the Habsburg domains, including those of Hungary.17 The founder of modern balneology, Crantz believed that Hungary surpassed other European countries with respect to the number and potency of its mineral waters, similarly to its other natural resources, such as wine and grains, botanical rarities, and ore mines.18 These riches, however, remained underexplored, particularly by the larger scientific community, for which Crantz principally (and rightly) blamed the state of scientific institutions in Hungary that suffered from the shortage of trained academics. Despite this scientific neglect of thermal springs, Crantz’s account of Hungarian spas makes it clear that many of them were well known to the local population that regularly used them for bathing, without necessarily recognizing their healing properties. Originally published in Latin, Crantz translated his book into German to reach a wider audience. Although the general public may have been less concerned with the matters of chemistry than his fellow scientists, he made no concessions, declaring that he deliberately omitted such details as the “history of the wells, layout of the spas, descriptions of buildings, avenues, promenades, and other delights.”19 Such descriptions, argued Crantz, might be expected from a spa book writer, but, having read

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everything on the subject available to him, he professed disdain for those who associated the quality of a spa not with “Nature” (i.e., the actual properties of water), but the facilities that it offered. While chastizing these writers who did not concern themselves with such scientific matters, his narrow emphasis also showed the limitations of his own perspective. A champion of the Enlightenment, Cranz upheld its values in promoting public health, but completely left out important economic considerations, such as the opportunities to make profit.

 ungarian Spas Toward the End H of the Eighteenth Century Yet the very list of the “delights” mentioned by Crantz testifies to what a typical visitor would have expected to see at a spa complex. Parallel with the growing volume of publications on thermal springs by Hungarian doctors and naturalists, the last quarter of the eighteenth century saw a clear desire to increase the capacity of spas across the country. Despite many literary references to these developments, there are relatively few sources that illustrate how these ambitions were realized in spatial terms. Nevertheless, the evidence presented in this chapter demonstrates that projects for spas always connected thermal springs to the wider landscape. The mineral sources of Bártfa (now Bardejov, Slovakia)—a commercially important, mostly German-populated royal free city in the north of Hungary—were known beyond its immediate locality. Even in winter, they had visitors from Poland, according to Crantz. He also commented on their location and improved layout.20 The spa is found well outside the city, bordering on the immense forests of the Carpathian Mountains, but the thermal springs originated at the bottom of a farmed valley, which was distant from the woodland. Any potential development project had to address this problem. The solution proposed by the county’s official land surveyor, Vince Beér, was to clear a long strait avenue through the forest (as seen at the top of his drawing), which could be negotiated on foot, connecting it with both the large central hall and the sources of drinking mineral water by means of

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Fig. 8.1  Situation plan with proposed interventions to the layout of the spa at Bártfa (Bardejov, Slovakia), by Vince Beér, from the late eighteenth century. National Archives of Hungary, Budapest; OL, S 11, No. 1269

two new avenues, more or less perpendicular to it (Fig. 8.1).21 This arrangement created a clear grid, providing opportunities for future development of the spa complex. According to later land surveys, these avenues were indeed built and offered the basis for subsequent urban expansion. A similar solution was proposed for the early eighteenth-century spa at Félixfürdő (now Băile Felix, Romania), which belonged to the religious order of Premonstratensians at the time. A project from 1799 featured a canal to create a geometric bypass for a local stream and straight walkways in the neighboring woodland, all leading to the center of the spa (Fig. 8.2).22 Although the proposed rigid form for the canal was eventually rejected, the woodland was indeed opened up in a geometric manner to facilitate visitors’ walks. Just a stone’s throw away, the neighboring village of Hájó was the location of what later became the separate settlement of Püspökfürdő (Bishop’s Bath, today Băile 1 Mai, Romania). Its waters, known and used

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Fig. 8.2  Plan of a canal to regulate the local stream at the bath of Félixfürdő, c.1799. National Archives of Hungary, Budapest; OL, S 12, Div. VII, No. 8

since at least the medieval period, were mentioned in Werner’s sixteenth-­ century account of Hungarian thermal springs.23 A development plan for these baths, put forward around 1775, offers compelling insights into the thinking of the spa landscape designers in late eighteenth-century Hungary. Similarly to Bártfa, the springs were located in a valley crossed by a small stream, where the land was used for farming. The proposal aimed to transform parts of this low-lying agricultural area into a geometric network of walkways that connected the inner parts of the spa with the adjacent village, while also providing access to the surrounding woodland and countryside (Fig. 8.3).24 Here, as in previous examples, one can see an overriding desire to create a coherent system of interconnected green spaces, long before the

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Fig. 8.3  Development plan for the Püspökfürdő spa, c.1775. National Széchényi Library, Budapest, Map, Poster and Small Print Collection, Maps, TK 710

concept of green infrastructure would gain currency. While no ecological thinking in a true sense was possible in that period, spa designers’ desire to provide opportunities for uninterrupted walking by connecting different green infrastructure elements to the surrounding nature resulted in the creation of ecological corridors. The text that accompanies the Püspökfürdő drawing refers to the spa’s beautiful surroundings that would attract not only the sick, but also the healthy, stressing the health benefits of both this resort and the adjacent one at Félixfürdő (Fig. 8.4). The unknown author makes it clear that the spa needed to be embellished with avenues, not only for the enjoyment of the guests, but also to turn the then barren land into meadows to further increase the income of the estate.

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Fig. 8.4  The spas at Püspökfürdő (top right) and Félixfürdő (left) in 1860 on the second military survey of Hungary, Colonne XLIV Section 54. Österreichisches Staatsarchiv, Vienna

The Herlány Project The most elaborate development proposal for a Hungarian spa in the end of the eighteenth century was for the baths of Herlány (now Herľany, Slovakia) in the northeastern periphery of the country.25 Dated 1787, its geometric layout still followed the baroque tradition of landscape design, while also incorporating new ideals of the age of the Enlightenment. There had been previous plans to develop a spa using the thermal spring in that location. In 1763, a survey of the Peklény crown estate, to which Herlány belonged, recommended the creation of a spa, since the quality and the abundance of the thermal spring water far surpassed the rest of the region.26 Although these healing properties had been known for many decades prior to that, no development was implemented. When Crantz visited Herlány in September 1772, he noted that the cold mineral water was used both for drinking and bathing by the ill and healthy alike.27

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It was the county’s chief medical officer, Lajos Ernő Mayer, who in late 1786 tried to convince the authorities to invest in the spa’s development. Mayer was the owner of the pharmacy called “Hungarian Crown” in the royal free city of Kassa (now Košice, Slovakia) only a couple of hours of traveling by coach from Herlány, where he attained the status of a burgher in 1796.28 Since he had earned his medical doctorate in Vienna in 1771, he must have been a student of Crantz, trained to analyze mineral water in terms of its chemical composition and healing properties. Mayer not only supported the development of a spa at Herlány, but also seems to have exerted influence on its design, as acknowledged by Carl Heinrich von Geispitzheim, a Baron of the Holy Roman Empire (Reichsfreiherr), who produced the plans. A first lieutenant (Oberleutnant) in the Great General Camp Quartermaster Staff (Grosser General Feld-Quartiermeister Stab) of the Austrian army, Geispitzheim was stationed in Kassa and was experienced in military surveying and mapping; the project seems to have been assigned to him by his superior, Sergeant Major (Obrist Wachtmeister) von Waldau.29 Mayer went further than merely drawing attention to the chemical components of the mineral water at Herlány. Similarly to other medical authors who wrote before and after him, he emphasized the role of the landscape in contributing to the healing process. Mayer recognized the beauty of the spa’s location, which on every side was surrounded by greenery, with meadows and fields enveloped by shady woods. These amenities could facilitate walking and bodily relaxation, offering everything necessary for the revival of the spirit, according to Mayer.30 The spa experience, in other words, could benefit both physical and mental health. Indeed, the most striking feature of both the property survey and the Herlány plan by Geispitzheim is the large hillside forest that dominates the design. Its vastness is accentuated by the dark gray color that distinguishes it on the survey, and the coherent pattern of vistas and playful lettering imposed on the uninterrupted canvas of this woodland in Geispitzheim’s project (Figs. 8.5 and 8.6). The vistas and the adjacent groves and fields were supposed to reveal various landscape features named after carefully selected religious, mythological, historical, political, scholarly, scientific, and literary references, including allusions to some of the most distinguished characters of the age.

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Fig. 8.5  Situation plan of the baths at Herlány by Carl Heinrich von Geispitzheim, 1787. National Archives of Hungary, Budapest; OL, S 11, No. 1737/1

The longest vista that connected the Belvedere Pavilion on a little mound on the western edge of the spa with the wooded hill up above was named after Joseph II (r. 1780–90), the Holy Roman Emperor and King of Hungary. On the plan, his monogram was carved into the woodland right at the closing point of this vista before reaching the elevated plateau called “Joseph’s Rest,” where tents and huts could be erected for tired walkers. Around the monogram, which would not have been legible from ground level, the groves were named after Rudolph, Francis, and Elisabeth, the names commonly used by various members of the imperial family, but without indicating to whom they specifically referred. Open spaces outside the spa were divided by avenues into areas named, for example, the Welcome Field at the beginning of the Great Joseph Vista, and the Hope Grove and the Aspirational Field right after it, probably

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Fig. 8.6  “Ideal Project Plan” for the embellishment of the spa at Herlány by Carl Heinrich von Geispitzheim, 1787. National Archives of Hungary, Budapest; OL, S 11, No. 1737/2

alluding to the uphill direction of the walk. Other such names included Goodwill, Evening Rest, and Ideas. The groves in the beginning of the Great Joseph Vista, flanked by the Long Avenue of Heroes and the Short Avenue of Heroes, were named after famous military commanders. These names included references to Saint Stephen (the first king of Hungary), Alexander the Great, the Prussian king Frederick the Great, and Julius Caesar. These groves, arranged around a small square dedicated to the warrior archangel Michael, were to promote patriotic education. Perhaps more fittingly, given the character of the site, the groves to the north, along the Doctors’ Avenue, were dedicated to physicians and scientists who included Crantz’s teacher Gerard van Swieten, Albrecht von Haller (1708–77), the inventor Wolfgang von Kempelen (1734–1804), Samuel-Auguste Tissot

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(1728–97), Hippocrates, and, in a rather secluded position, the “Dutch Hippocrates,” Herman Boerhaave (1668–1738). The southernmost Avenue of the Philosophers provided entry to the groves dedicated to Newton, Leibniz, Voltaire, and Rousseau, from where, across the entire forest, ran the Spiritual Avenue, with groves named after the Jesuit Louis Bourdaloue (1632–1704), whose sermons were admired by Voltaire, and the English poet and cleric Edward Young (1683–1765), a great influence on the forerunners of German romanticism. The remaining groves to the north and east offered tribute to the literary figures of the German Enlightenment, including Christian Felix Weiße (1726–1804) and Johann Georg Zimmermann (1728–95), a physician known for his literary output as much as his medical works. Mixed in with them were ancient Roman classics Horace, Virgil, and Ovid, who welcomed into their circle John Milton (1608–74), a great influence on eighteenth-century gardening in England. The groves dedicated to Ovid and Milton were adjacent to another elevated plateau, which Geispitzheim renamed after Mount Parnassus in an allusion to many poetic spirits evoked in his design. Not surprisingly, the Poets’ Promenade that stretched across the northern edge of the forest, connecting the pavilion built above the thermal spring with Mount Parnassus, was bordered by the groves honoring German literary celebrities of the time, including Christian Fürchtegott Gellert (1715–69), Karl Wilhelm Ramler (1725–98, known as the “German Horace”), Johann Peter Uz (1720–96), and Friedrich Gottlieb Klopstock (1724–1803).31 Lastly, to add further mythological references, the stream that ran along the edge of the forest from the north was renamed after the Styx, the river that formed the boundary of the Underworld, which was joined by the Castalian Spring, regarded by the ancients as a source of poetic inspiration and located at the foot of Mount Parnassus. The positioning of Charon’s Ferry marked the point at which souls were taken across the Styx. Within this elaborate scheme, the purpose of the alleys cut through this woodland was not only to improve bodily health, but also to instruct the mind, serving an educational and even a patriotic purpose. The meaning of different landscape elements would have been lost on the visitors had their names not been clearly labeled: the trees along avenues were supposed to have small plaques, as no doubt were all the walks, groves,

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and other features. This method of conveying the overall program (including its patriotic emphasis), in the case of public parks, was advocated by Hirschfeld in the same volume of the Theory of Garden Art, in which he wrote about spa landscapes.32 Perhaps in contrast to Hirschfeld, Geispitzheim’s plan, however, did not refer to any explicit educational purpose, for he suggested placing names on trees merely as a “pleasant entertainment.”33 This lighthearted tone still might have concealed more serious intentions. Hirschfeld’s recommendations included decorating spa landscapes with statues of eminent physicians such as Boerhaave, Tissot, Zimmermann, and Berger, and Geispitzheim’s plan incorporated all of these names except the last one.34 The spa also had a separate pleasure garden, on its southern periphery, quite distant from the rest of the complex. It was divided into geometric flower beds, with a pavilion at the entrance and two ornamental fountains along the main axis. Its isolated location might be explained by the nearby theater, which could be quite a noisy place, uncomfortable for some of the guests. For other types of entertainment, Geispitzheim’s plan included a shooting range, a bowling alley, a merry-go-round, bird stands (Vogelstange), a swing, and grounds for Straffspiele (the word referring to an interactive game).35 The patriotic theme, prominently featured on the outskirts of the spa complex, resurfaces here with the suggestion to replace a pavilion with a pyramid adorned with the emperor’s bust.36Geispitzheim also made it clear that the spa was not intended solely for those in need of cure, but also for other visitors in search of distraction or amusement. Herlány could be a convenient place for meeting friends or a local venue for family entertainments.37Geispitzheim claimed to be familiar with nearly all prominent spas and healing springs in the German territories, the experience that must have proved useful for working out the details of his design.38 Increasingly involved in the spa’s development, Geispitzheim appears to have soon made its completion his personal mission. He pressed to start the construction and, assisted by either the leaseholder of a local bar (who was actually a gardener) or the estate gardener from nearby Peklény, made recommendations for the selection and planting of trees along the avenues. A few months later, Geispitzheim produced another document advocating his plan, adding more ideas and details. It gives further

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arguments to demonstrate the project’s viability, suggesting that the spa would attract visitors not only from Hungary, but the Russian Empire and Poland, diverting their traffic from Silesia and Germany.39 Geispitzheim’s new design vision linked the spa to the larger world, mapping its spatial layout onto the country’s network of trade routes. He recommended extending the main avenue—the Great Joseph Vista—in both directions to connect it to the important trading centers of Kassa and Homonna in the neighboring county, bringing his plans from a local to a regional level.40 He also argued that the road to Kassa should be as straight as possible, with trees planted on both sides, effectively projecting the spa’s avenues into the surrounding landscape.41 This new design, however, would have undermined the entire effort to provide calm walking environment for the spa guests, making the pavilion at the western end of the vista utterly redundant. In an age when livestock was transported on foot, Geispitzheim insisted that it must be kept away from the spa’s public spaces and the adjacent woods to maintain order and cleanliness.42 Increasingly frustrated, Geispitzheim continued to persuade the authorities of the feasibility of his project, adding further arguments concerning agriculture, forestry, mining, transport, and tourism.43 In response, he was asked to produce two sets of plans—one of which was intended as a gift for Joseph II—incorporating the additional design elements, such as the physician’s house, the fountains, and the pavilions (Fig. 8.7).44 His project was supported in both the government and professional circles. It was favorably viewed by the State Chancellor, Prince Kaunitz-Rietberg, and the Head of the Architectural Department of the Hungarian Royal Chamber, Joseph Tallherr, both of whom commented on the beauty of the layout that prioritized designed parkland.45 Despite these efforts, most of Geispitzheim’s plans were not put into effect, although some avenues were cut through the woods, including the Great Joseph Vista, as attested by later maps (Fig. 8.8).

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Fig. 8.7  Pavilion for the spa landscape at Herlány by Carl Heinrich von Geispitzheim, 1787. National Archives of Hungary, Budapest; OL, T 62, No. 1391/3

The Spa Landscapes of Rudolph Witsch At the turn of the nineteenth century, these earlier attempts to meet the growing demand for spas received additional impetus. For decades, Hungary, as part of the Habsburg empire, was involved in the Napoleonic Wars, which brought an increased demand for grain and wool, the country’s principal commercial products. The owners of the largest Hungarian estates were aristocrats who enjoyed a steady increase in their finances

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Fig. 8.8  The Herlány spa landscape (left) in 1819 on the second military survey of Hungary, Colonne XLII Section 38. Österreichisches Staatsarchiv, Vienna

until the end of the war, when the economic situation would change again, with their income returning to more modest levels. Some of these aristocratic landowners were open to progressive thoughts. Among them, Count Tódor Batthyány (1729–1812) was one of the most technologically minded entrepreneurs of his age, who had studied mechanics at the University of Vienna. Various improvements that he later introduced in his estates included opening new mines and establishing a cotton mill, a faience factory, and grain mills. His engineering projects concerned canal construction and regulating the course of rivers. He also showed a keen interest in shipbuilding and is known for a design of a ship that could travel against the stream, which he patented in 1793 and built in 1797.46 Already in his sixties by that stage, he showed no sign of slowing down in his pursuit of further developments for his estates. Among these efforts was the development of a spa in Tarcsafürdő (now Bad Tatzmannsdorf in Austria). The thermal springs there had enjoyed great popularity during most of the seventeenth century, with their water sold as far as Vienna, but the eighteenth century saw the eclipse of their fame. In 1772, water from Tarcsafürdő was examined by Crantz, who attested to its health benefits. The locals warmed it up and used it for

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bathing.47 From the source, water was passed through a wooden pipe and then heated in a tank, presumably made of copper, as was common at the time. These arrangements point to a very basic layout and technology, with no hint at any commercialization or aesthetic refinement. Work on this spa probably started in the mid-1790s. In 1802, when the Coblenz-born engineer Rudolph Witsch (ca. 1773–1826) published an account of this complex, he described well-developed parks and gardens for the enjoyment of the guests.48 From the notes he added to the text, it is clear that he designed the small Temple of Convalescence erected above the thermal spring in 1795 (Fig. 8.9). He did not, however, mention the name of the landscape designer. Given that in 1799 Count Batthyány’s brother, Cardinal József Batthyány, employed him to lay out what is today the Városliget Park in Budapest, it is almost certain that it

Fig. 8.9  The Temple of Convalescence erected above the mineral spring at Tarcsafürdő by Rudolph Witsch in 1795. Zeitschrift von und für Ungern zur Beförderung der vaterländischen Geschichte, Erdkunde und Literatur vol. I no. 2 (1802): 193; National Széchényi Library, Budapest, General Collection, Periodicals, H 26.485

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was Witsch who was responsible for the spa landscapes in Tarcsafürdő. Later, he would go on to design on some of the most famed Hungarian country house gardens of the period. Witsch’s work at Tarcsafürdő was his earliest known project that involved both architecture and landscape.49 In his later career, Witsch was responsible for creating new agricultural settlements in the south of Hungary, given the region’s depopulation following the long period of Ottoman occupation. What is distinctive of his designs is that they were not limited to the layout of the built-up area but included the surrounding agricultural land. In that, he adopted a remarkably holistic approach, which was quite unusual at the time, pointing in the direction of what we would now call integrated green infrastructure. Although the main factor that influenced his design was the need to stabilize areas covered with shifting sand, his method of laying out long avenues that were extensions of tree-lined streets, together with the diversified use of agricultural fields, resemble today’s ecological corridors. This complex thinking also informed Witsch’s description of the Tarcsafürdő spa and its environs (Fig. 8.10). His main purpose must have been to popularize this resort, which indeed gained new popularity later in the nineteenth century, owing to the spa’s further development. Characteristically, most of his description addressed the outdoor pleasures—including walks in the garden and the park and, even more importantly, the beauty of the long vistas and views over the surrounding landscape—rather than stressing the properties of the mineral water or mentioning any of the architectural facilities. Witsch’s account of the spa starts with the approach to the village from a neighboring town along the newly built paved road. Pausing on a hilltop, he invites the reader to look around and appreciate the views over the valley where the spa was located. After descending into the village, Witsch mentions a rocky hillside behind the manor owned by Count Batthyány, which “art transformed into a garden,” referring to landscape interventions that he most likely carried out himself. From the manor’s courtyard, a newly planted avenue led to the spa itself, with a detour to the picturesque mill on a stream that were part of the spa’s garden. Walking to the end of this avenue, the visitor arrived at the little temple built above the thermal spring, next to which were a guesthouse, a bar, and a Kaffeehaus.

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Fig. 8.10  The spa (top right) and the surrounding designed landscape at Tarcsafürdő (Bad Tatzmannsdorf) on the stabile cadastral map of Tatzmannsdorf of 1857. Bundesamt für Eich- und Vermessungswesen, Vienna

On the other side of the road was the large, English style garden, which offered rich opportunities for playing games and other bodily exercise and extended as far as the mill. The millstream formed its westmost boundary, beyond which stretched a meadow with a large woodland of coniferous trees named “Birdsong” rising above, all intended as natural amenities for the visitors. Describing a long walk through the garden up to the elevated Birdsong Wood, Witsch mentioned the owner’s son, Count Antal József Batthyány (1762–1828), as one who had discovered this pleasant walk in 1794. Given that building Witsch’s temple atop the spring the following year was the young count’s initiative, it is possible that the latter was in charge of the entire spa development, perhaps as an exercise in estate management undertaken with the encouragement of his father. According to Witsch, the best way to walk was by hiring a couple of porters to carry jars of mineral water that one could drink along the way. He recommended that from the bath house, one would take a long avenue on the northern edge of the garden, first crossing a branch of the

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stream, then the millstream, and finally walking uphill to reach the Birdsong Wood, where, in the shade of slender spruce trees, was a seat that offered views of the spa and, beyond it, the village. From there, a winding path led through the woodland, occasionally interrupted by small clearings with pavilions for visitors to repose. At one point, one could enjoy a long view that opened toward the neighboring village with a medieval church behind it and a hilltop castle towering up above, all belonging to the spa’s owner. Continuing along the path, one entered a mixed wood, where the darkness of firs contrasted with the whiteness of birch trunks. Surrounded by the sound of birds, one could walk further toward an elevated point among a grove of oaks, where a small banqueting hall with cooking facilities was planned to be built for the visitors. Reaching this place was conceived as the climax of the whole walk offering spectacular views over the landscape, an experience to enjoy in a company of educated friends eager to discuss the amenities of the design and the beauty of nature.50 Witsch’s stylistic approach to designing the landscape around the Tarcsafürdő spa was markedly different from the previous examples. Admittedly, he had the advantage of having studied new English trends in landscape design prior to his arrival in Hungary. Yet, despite the difference in style, the similarities among these spas, which were more or less contemporary with one another, are quite remarkable. Their designers strove to connect green areas and promenades with the natural landscape, providing opportunities for uninterrupted vistas and walks. Such avenues typically radiated from the location of the thermal spring as the source of healing, connecting it to the surrounding countryside. Witsch was also likely involved in the development of the spa at Trencsénteplic (now Trenčianske Teplice, Slovakia), which, from the late sixteenth century, was owned and gradually improved by the Illésházy family.51 It attracted visitors from other parts of the Habsburg Empire, mostly from neighboring Moravia, but also from more distant Bohemian and Austrian territories. This mineral water was well known to the scientific community: Crantz’s survey referred to an earlier balneological work by the local physician Pál Adámi (1739–95), who in 1766 gave an account of seven thermal springs at Trencsénteplic.52 Their temperature varied by only a few degrees. The hottest spring called the Brunnel was used only

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for drinking, while the rest were named in accordance with the social standing of their respective users: gentlemen, officers, burghers (their spring was also known as the New Spring), peasants or commoners, the Jews, and paupers. The bathing facilities at Trencsénteplic were free to use, and modest developments by the Illésházy family were financed from renting out cabins to stay in and by selling food and wine. The spa was principally a place of healing and provided little by way of amusements. Its detailed, but not very favorable, account from 1803 warned the potential visitors that this was not a place where tourists should come in search of entertainment,53 but the author also set out a clear plan of action as to how it could be improved.54 Witsch left a description of his travel to Trencsénteplic from Pozsony (now Bratislava) in May 1806 to pay his respects to the spa’s owner, Count Illésházy.55 In his dedication, he bemoans the loss of the count’s favor, the reasons for which he could not comprehend, suspecting a conspiracy of his ill-wishers. He may have hoped to restore his credentials through the publication of this description that could promote the spa among prospective visitors. If that was the case, his plan must have failed, as the manuscript did not reach the press. Witsch eventually published an account of his travel to Trencsénteplic in 1820, following another visit in August 1817.56 A substantial part of both descriptions concerns the actual journey to the spa. The earlier text conveys the excitement of traveling to Trencsénteplic, praising its landscape surroundings. The anticipation of reaching the spa becomes part of the healing process. The beautiful, picturesque landscape is a projection of the spa itself, a testimony to its therapeutic effects. In his later version, Witsch makes it clear that the art of landscape design could do little to improve this place, its natural qualities surpassing the expectations of any observer. The accuracy of either of Witsch’s accounts is hard to ascertain. A development plan for Trencsénteplic from 1826 does indeed show a rather haphazard arrangement of spa facilities, poorly integrated with the surrounding landscape.57 Substantial improvements were introduced only after 1835, when the banker and industrialist Baron Sina purchased the property, turning it into an attractive and celebrated establishment.

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Conclusion Count Illésházy’s cautious and piecemeal approach to improving his spa at Trencsénteplic illustrates the general trend among Hungarian landowners in dealing with such large-scale developments at the turn of the nineteenth century. This was not due to the lack of design vision: it is clear from our examples that designers were capable of producing—and perhaps were even encouraged to present—ambitious programs that would require substantial investment. The implementation of these schemes, however, was at the best partial and was often scaled back. This prudence was not unjustified, as it reflected the political and economic situation of Hungary in the broader European political and economic context. During the Napoleonic Wars, the country’s landowners made handsome profits from selling grain and wool to the imperial army. Although the economic consequences of this influx of cash require further study, it has long been recognized that this additional income fueled the building and renovation of many country houses, including designing gardens and parks that followed the latest artistic fashions. In the absence of a developed banking system or a consistent policy to encourage industrial developments in Hungary, and given the negative impact of war on long-distance travel, landowners spent sparingly on projects such as spas. They probably regarded such initiatives as modest additions to their investment portfolios, associating considerable risks with more ambitious financial ventures. For centuries, Hungarian thermal springs had been used by locals, rich and poor alike, as a key element in public health provision. Where several springs were present, as the case of Trencsénteplic, their users were segregated based on their occupation, social class, and even religion. Any spa owner had to deal with these realities, which, in an age that stressed social responsibility, would have rendered any attempt to alienate the historical rights by the poor to use thermal springs as morally reprehensible. As a result, developing a fashionable spa complex might not have been a profitable undertaking were the poor to continue to have access to these facilities. In fact, Witsch specifically referred to Count Illésházy’s development

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efforts as not aimed at profit but stemming from the owner’s generosity and goodwill.58 Another potential reason for this financial caution was the uncertain demand for such developments, which was due both to the potential competition from other spas, given the country’s abundance of thermal springs, and Hungary’s small, albeit growing, middle class. While the increasing demand for spa vacations is evidenced by the ambitious developments that we have discussed, such spa complexes primarily attracted the rural gentry, agricultural entrepreneurs, traders, and urban professionals. Members of the aristocratic high society preferred to travel outside Hungary, typically to Teplice in Bohemia and Bad Pyrmont in Germany. Since research on the social aspects of spa tourism among Hungarians at the turn of the nineteenth century is still in its infancy, such conclusions should only be taken as preliminary and tentative. The later decades of the nineteenth century saw a vast expansion of spa developments in Hungary. By the end of that period, all the bath complexes discussed here were exploited to their full potential, embellished with elegant architecture and surrounded by luxury villas and hotels. This golden age of balneology was largely enabled by an increasingly large and wealthy middle class that made spa tourism fashionable, with the healing potential of mineral springs being one among various social and economic factors behind the surge of their popularity, not unlike in the previous centuries. With the partition of the Hungarian kingdom at the end of World War I, much of this flourishing spa culture was lost. Spas continued to decline steadily during the twentieth century due to their diminishing medicinal value. Although spa culture is only a faint echo of the heyday that spa resorts used to enjoy in the nineteenth century, Hungary today enjoys a revival of spa tourism, directed in large part to historic sites such as those mentioned above.

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Notes 1. V. Eidloth, “Kleine historische Geographie europäischer Kurstädte und Badeorte im 19. Jahrhundert,” in Europäische Kurstädte und Modebäder des 19. Jahrhunderts, ed. V. Eidloth (Stuttgart: Konrad Theiss, 2012), 24. 2. C.C.L. Hirschfeld, Theorie der Gartenkunst. Vol. V. (Leipzig: Weidmann, 1785), 85-119. 3. E. Schmidt, “Kuranlagen des 19. Jahrhunderts in Deutschland: Landscahaftsarchitectur, Nutzungsabgebot, Beitrag zur Stadtstruktur,” in Eidloth, Europäische Kurstädte und Modebäder des 19. Jahrhunderts, 181. 4. Ibid., 183. 5. G. Hajós, “Die Stadtparks der österreichischen Monarchie von 1765 bis 1867 im gesamteuropäischen Kontext,” in Stadtparks in der österreichischen Monarchie 1765–1918, ed. G. Hajós (Vienna: Böhlau, 2007), 74. 6. D. Alfter, “Alleen als Ursprungformen von Kuraparkanlagen: Das Beispiel Bad Pyrmont,” in Between Healing and Pleasure: Spa Parks and Spa Gardens in Europe, ed. V. Eidloth, P. Martin, and K. Schulze (Stuttgart: Thorbecke, 2020), 94 and 96. 7. D. Renault, “Vichy, a Spa Town Constructed around Scenic Parkways— Sketch of a Spa Town,” in Eidloth, Martin, and Schulze, Between Healing and Pleasure, 151. 8. K. Schulze, “Kurgärten und Kurparks in Europa—ein Überblick zu Characteristika und Vielfalt ihrer Anlage und Gestaltung,” in Eidloth, Martin, and Schulze, Between Healing and Pleasure, 18; I. Formann, “Wilhelmsbad—ein Kurpark des 18. Jahrhunderts: Geschichte, Entwicklung, Bestand,” in Eidloth, Martin, and Schulze, Between Healing and Pleasure, 34. 9. V. Eidloth, “Die ganze Landschaft ein Garten? Historische Kurorte ‘… und ihre Umgebungen,’” in Eidloth, Martin, and Schulze, Between Healing and Pleasure, 179–97. 10. “Great Spas of Europe,” Great Spas of Europe, accessed January 25, 2021, https://greatspasofeurope.org/. 11. The sorry state of roads and travel facilities in Hungary was vividly described, among others, by the English naturalist Robert Townson. See R. Townson, Travels in Hungary (London: Robinson, 1797).

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12. See K. Póczy, Közművek a római kori Magyarországon (Budapest: Műszaki, 1980), 60 and 136n77, respectively. In Hévíz, an altar stone dedicated to Jupiter was unearthed near one of the mineral springs. 13. Póczy, Közművek a római kori Magyarországon, 110. 14. All the surviving four Turkish baths in Buda are hot spring baths (kaplıca or ılıca), which the Ottomans distinguished from steam baths (hamam); originally, their number was equal. Three out of these four currently have medieval origins, according to the archeological evidence; see Gőző Gerő, Az oszmán-török építészet Magyarországon (Dzsámik, türbék, fürdők) (Budapest: Akadémiai Kiadó, 1980). According to Balázs Sudár, in parts of Hungary occupied by the Ottomans, it was common to continue using medieval or earlier spas. See Sudár, Balázs, “Török fürdők a hódoltságban,” Történelmi Szemle vol. 44 no. 3–4 (2003): 213–63. 15. G. Werner, De admirandis Hungariae aquis hypomnemation (Vienna: Egidius Aquila, 1551). 16. Z. Szőkefalvi-Nagy, “Magyarországi gyógyvízvizsgálatok a XVIII. században,” Communicationes Ex Bibliotheca Historiae Medicae Hungarica vol. 25 (1962): 166–67. 17. H.J.N. von Crantz, Gesundbrunnen der Oesterreichische Monarchie (Vienna: Joseph Gerold, 1777). 18. Ibid., 131. 19. Ibid., 3. 20. Ibid., 185. 21. Vince Beér, Situation map of the spa of Bártfa and its environs, late 18th century, National Archives of Hungary, OL, S 11, No. 1269. 22. Unknown author, Hydraulic plan of the canal to be constructed to the spa at Félixfürdő, end of 18th century, National Archives of Hungary, OL, S 12, Div. VII, No. 8. 23. Werner, De admirandis Hungariae aquis hypomnemation, 12v. 24. Antal Mogyoróssy (copier/draughtsman), General plan for the layout of the hot spring spa in the diocesan estate of Nagyvárad, c.1775, Hungarian National Library, Map Collection, TK 710. 25. Carl Heinrich von Geispitzheim et al., Plans, designs, cost estimates and other supporting documents for and correspondence on the development proposal for the mineral spring spa at Herlány, mostly 1787, National Archives of Hungary, OL, E 128 1787, 427:1; OL, S 11, No. 1737/1-3; OL, T 62, No. 1391/1-5.

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26. Baron József Vécsey and János Norbert Zábroczky, Survey and register of the Treasury estate of Peklény, 1763, National Archives of Hungary, OL, E 156, Fasc. 149, No. 47, f. 9r. 27. Crantz, Gesundbrunnen der Oesterreichische Monarchie, 185. It is referenced under the name of “Rankotz,” which the author probably derived from the Slovakian name of the village, Rankovce. It was known as Rankowetz to the German population. 28. Molnár, B. Kassa orvosi története (Kassa: Wiko, 1944), 50 and 139. 29. Michael von Kraschenitsch, Letter to the Hungarian Royal Chamber Administration, 1787, National Archives of Hungary, OL, E 128, 1787, 427:1, f. 85v. 30. Lajos Ernő Mayer, Report on the chemical examination of the mineral water of Herlány, dated in Kassa on October 17, 1786, National Archives of Hungary, OL, E 128, 1787, 427:1, f. 68v. 31. The curious omission of Lessing and other, now better-known authors, is noteworthy. 32. Hirschfeld, Theorie der Gartenkunst, V: 68–74. 33. Carl Heinrich von Geispitzheim, Project proposal and cost estimates in support of his designs for the development of the Herlány spa, 1787, National Archives of Hungary, OL, E 128, 1787, 427:1, f. 4r. 34. Hirschfeld, Theorie der Gartenkunst, V: 88. The only physician omitted by Geispitzheim, Berger, was most likely the Danish court physician Johann Just von Berger (1723–91), rather than his half-brother, the Hanoverian court physician and colleague of Zimmermann there, Christoph Wilhelm von Berger (1727–63). 35. Carl Heinrich von Geispitzheim, Letter to the Imperial and Royal Chamber Administration in Kassa in support of his project proposal, 11 June 1787, National Archives of Hungary, OL, E 128, 1787, 427:1, f. 51v. 36. Ibid., f. 51v. 37. Ibid., f. 52v. 38. Carl Heinrich von Geispitzheim, Project proposal and cost estimates in support of his designs for the development of the Herlány spa, 1787, National Archives of Hungary, OL, E 128, 1787, 427:1, f. 7r. Geispitzheim reckoned that the Herlány water came very close to the famed carbonated mineral water of Selters an der Lahn in Germany, which gave its name to the modern carbonated or fizzy water often called “seltzer.” 39. Ibid., 30r.

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40. Ibid., f. 50v. 41. Ibid., f. 50v. 42. Ibid., f. 52r. 43. Ibid., ff. 56-. 44. Ibid., f. 90r. Five architectural designs, all by Geispitzheim, were drawn as part of this project and are in the Hungarian National Archive (MNL, OL, T 62, No. 1391/1-5). The Austrian National Archive also holds a design for the houses of the physician and the sculptor from 1787 (AT-OeStA/AVA PKF PS II A-XV-c/24), which were likely added as part of this project. Earlier, Geispitzheim attached a drawing of a new bath house, engraved by Johann Ernst Mansfeld in Vienna in the form of a fan (ff. 7r and 14r), presumably in an attempt to convey further improvements that he envisaged for Herlány. 45. Ibid., ff. 95–96 and 97–98, respectively. 46. Bíró, J. “Batthyány Tódor hajóépítő és hajózási kísérletei,” A Közlekedési Múzeum évkönyve vol. 1 (1971): 239–64. 47. Crantz, Gesundbrunnen der Oesterreichische Monarchie, 174–75. Crantz’s informant was a medical student that he referred to as Tolnay, almost certainly Sándor Tolnay (1747–1818), later an acclaimed veterinarian. Crantz, however, was not the first to examine the chemical and medical properties of the mineral water at Tatzmannsdorf, as this had been the subject of Ignatz Wetsch’s doctoral dissertation published in Vienna in 1763. 48. R. Witsch, “Der Gesundbrunnen von Tatzmannsdorf zur Kur-Zeit,” Zeitschrift von und für Ungern zur Beförderung der vaterländischen Geschichte, Erdkunde und Literatur vol. I no. 2 (1802): 193–201. 49. K. Fatsar, “European Travellers and the Transformation of Garden Art in Hungary at the Turn of the Nineteenth Century,” Studies in the History of Gardens & Designed Landscapes vol. 36, no. 3 (2016): 177–79; K. Fatsar, “Rudolph Witsch és a Batthyány-erdő: A Városliget közparkká alakítására tett egyik első komoly kísérlet” (Rudolph Witsch and the Batthyány Wood: One of the First Serious Attempts to Create a Public Park in the Városliget), Urbs: Magyar Várostörténeti Évkönyv vol. 13 (2019): 35–55. 50. Witsch also offered alternative routes and places to visit in the neighboring area, probably intended for those more interested in industrial sites. 51. It was also mentioned by Georg Werner. See Werner, De admirandis Hungariae aquis hypomnemation, 6v–7r. A bibliography of Werner with

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an analysis of his work was first published in L. Erdősi, “Wernher: De admirandis Hungariae aquis,” Communicationes Ex Bibliotheca Historiae Medicae Hungarica vol. 29 (1963): 103–68. 52. Crantz, Gesundbrunnen der Oesterreichische Monarchie, 140–42 referring to P. Adámi, Hydrographia Comitatus Trencsinensis (Vienna:Schulz, 1766). 53. A. Weissenbach(?), “Briefe aus den Bädern zu Töplitz im Trentschiner Comitate in Hungarn,” Patriotisches Tageblatt vol. 6 (1803): 422. The author of this account was a certain Aloys Carl, identified in 1826 as Aloys Weissenbach, most likely referring to the poet and professor of medicine in Salzburg, Aloys Weissenbach (1766–1821). His authorship, however, has not been authenticated. See A. Carl, Die Schwefelquellen zu Töplitz nächst Trentschin im Königreiche Ungarn (Preßburg: Belnay, 1826), 22. 54. Weissenbach(?), “Briefe aus den Bädern,” 465–66. 55. Rudolph Witsch, Reise in das Bad nach Töplitz, oder: Fragmentarische Schilderung des Töplitzer Bades, 1806, Hungarian National Library, Manuscript Collection, Fol. Germ. 27. 56. R. Witsch, “Bemerkungen auf einer Reise von Preßburg in das Teplitzer Bad bei Tretschin im August 1817,” Hesperus vol. 26 (1820): 17–22, 44–47. The account is predominantly about the practicalities and the sights on the journey to the spa. There is only a short description on the place itself at the very end of the text. 57. Carl, Die Schwefelquellen, Plan no. 1. 58. Rudolph Witsch, Reise in das Bad nach Töplitz, oder: Fragmentarische Schilderung des Töplitzer Bades, 1806, Hungarian National Library, Manuscript Collection, Fol. Germ. 27.

Bibliography Adámi, Pál. Hydrographia comitatus Trencsinensis. Vienna: Schulz, 1766. Alfter, Dieter. “Alleen als Ursprungformen von Kuraparkanlagen: Das Beispiel Bad Pyrmont.” In Between Healing and Pleasure: Spa Parks and Spa Gardens in Europe, edited by Volkmar Eidloth, Petra Martin, and Katrin Schulze, 93–100. Stuttgart: Thorbecke, 2020. Bíró, József. “Batthyány Tódor hajóépítő és hajózási kísérletei,” A Közlekedési Múzeum évkönyve vol. 1 (1971): 239–64.

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Carl, Aloys. Die Schwefelquellen zu Töplitz nächst Trentschin im Königreiche Ungarn. Preßburg: Belnay, 1826. Crantz, Heinrich Johann Nepomuk von. Gesundbrunnen der österreichische Monarchie. Vienna: Joseph Gerold, 1777. Eidloth, Volkmar. “Kleine historische Geographie europäischer Kurstädte und Badeorte im 19. Jahrhundert.” In Europäische Kurstädte und Modebäder des 19. Jahrhunderts, edited by Volkmar Eidloth, 15–39. Stuttgart: Konrad Theiss, 2012. Eidloth, Volkmar. “Die ganze Landschaft ein Garten? Historische Kurorte ‘… und ihre Umgebungen.’” In Between Healing and Pleasure: Spa Parks and Spa Gardens in Europe, edited by Volkmar Eidloth, Petra Martin, and Katrin Schulze, 179–97. Stuttgart: Thorbecke, 2020. Erdősi, Laura. “Wernher: De admirandis Hungariae aquis.” Communicationes Ex Bibliotheca Historiae Medicae Hungarica vol. 29 (1963): 103–68. Fatsar, Kristóf. “European Travellers and the Transformation of Garden Art in Hungary at the Turn of the Nineteenth Century.” Studies in the History of Gardens & Designed Landscapes vol. 36, no. 3 (2016): 166–84. Fatsar, Kristóf. “Rudolph Witsch és a Batthyány-erdő: A Városliget közparkká alakítására tett egyik első komoly kísérlet” (Rudolph Witsch and the Batthyány Wood: One of the First Serious Attempts to Create a Public Park in the Városliget). Urbs: Magyar Várostörténeti Évkönyv vol. 13 (2019): 35–55. Formann, Inken. “Wilhelmsbad—ein Kurpark des 18. Jahrhunderts: Geschichte, Entwicklung, Bestand.” In Between Healing and Pleasure: Spa Parks and Spa Gardens in Europe, edited by Volkmar Eidloth, Petra Martin, and Katrin Schulze, 31–44. Stuttgart: Thorbecke, 2020. Gerő, Győző. Az oszmán-török építészet Magyarországon. (Dzsámik, türbék, fürdők). Budapest: Akadémiai Kiadó, 1980. “Great Spas of Europe.” Great Spas of Europe. Accessed January 25, 2021. https://greatspasofeurope.org/. Hajós, Géza. “Die Stadtparks der österreichischen Monarchie von 1765 bis 1867 im gesamteuropäischen Kontext.” In Stadtparks in der österreichischen Monarchie 1765–1918, edited by Géza Hajós, 21–82. Vienna: Böhlau, 2007. Hirschfeld, Christian Cay Lorenz. Theorie der Gartenkunst. Vol. V. Leipzig: Weidmann, 1785. Molnár, Béla. Kassa orvosi története. Kassa: Wiko, 1944. Póczy, Klára. Közművek a római kori Magyarországon. Budapest: Műszaki, 1980. Renault, Delphine. “Vichy, a Spa Town Constructed around Scenic Parkways— Sketch of a Spa Town.” In Between Healing and Pleasure: Spa Parks and Spa

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Gardens in Europe, edited by Volkmar Eidloth, Petra Martin, and Katrin Schulze, 151–61. Stuttgart: Thorbecke, 2020. Schmidt, Erika. “Kuranlagen des 19. Jahrhunderts in Deutschland: Landscahaftsarchitectur, Nutzungsabgebot, Beitrag zur Stadtstruktur.” In Europäische Kurstädte und Modebäder des 19. Jahrhunderts, edited by Volkmar Eidloth, 173–85. Stuttgart: Konrad Theiss, 2012. Schulze, Katrin. “Kurgärten und Kurparks in Europa—ein Überblick zu Characteristika und Vielfalt ihrer Anlage und Gestaltung.” In Between Healing and Pleasure: Spa Parks and Spa Gardens in Europe, edited by Volkmar Eidloth, Petra Martin, and Katrin Schulze, 15–28. Stuttgart: Thorbecke, 2020. Sudár, Balázs. “Török fürdők a hódoltságban.” Történelmi Szemle vol. 44 no. 3–4 (2003): 213–63. Szőkefalvi-Nagy, Zoltán. “Magyarországi gyógyvízvizsgálatok a XVIII. században.” Communicationes Ex Bibliotheca Historiae Medicae Hungarica vol. 25 (1962): 162–82. Townson, Robert. Travels in Hungary. London: Robinson, 1797 Weissenbach, Aloys.(?). “Briefe aus den Bädern zu Töplitz im Trentschiner Comitate in Hungarn.” Patriotisches Tageblatt vol. 6 (1803): 406–08, 418–23, 434–40, 465–69. Werner, Georg. De admirandis Hungariae aquis hypomnemation. Vienna: Egidius Aquila, 1551 Witsch, Rudolph. “Der Gesundbrunnen von Tatzmannsdorf zur Kur-Zeit.” Zeitschrift von und für Ungern zur Beförderung der vaterländischen Geschichte, Erdkunde und Literatur vol. I no. 2 (1802): 193–201. Witsch, Rudolph. “Bemerkungen auf einer Reise von Preßburg in das Teplitzer Bad bei Tretschin im August 1817.” Hesperus vol. 26 (1820): 17–22, 44–47. Archives of the Hungarian Treasury, Oeconomica (E 128), National Archives of Hungary, Budapest Archives of the Hungarian Treasury, Urbaria et conscriptiones (E 156), National Archives of Hungary, Budapest Österreichisches Staatsarchiv, Vienna General Collection, Hungarian National Library, Budapest Bundesamt für Eich- und Vermessungswesen, Vienna Manuscript Collection, Hungarian National Library, Budapest Map Collection, Hungarian National Library, Budapest Maps of the Hungarian Royal Chamber (S 11), National Archives of Hungary, Budapest Maps of the Regency Council (S 12), National Archives of Hungary, Budapest Plans/designs of the Hungarian Royal Chamber (T 62), National Archives of Hungary, Budapest

9 Promoting Health Through Urban Planning: Spa Towns and Urban Development in Nineteenth-Century Greece Georgia Daskalaki

The healing properties of thermal water were valued in ancient Greece, as demonstrated by the archeological remains of elaborate bathhouses. Greek spa therapy practices were later adopted first by the Roman and then the Byzantine and Ottoman societies, becoming closely associated with these cultures. In eighteenth- and nineteenth-century Europe, the Enlightenment shift toward the scientific understanding of nature and the human body, coupled with the broader hygiene reform movement, prompted a renewed interest in thermal therapy and its scientifically driven applications. Leisure, as an emerging sign of modernity, was consequently merged with the age-old bathing traditions and scientific medical treatments made popular in European spa towns. Modern Greek spa therapy and the infrastructure and amenities that it involved were initially developed in the years following the successful Greek struggle for independence from the Ottoman Empire. The first

G. Daskalaki (*) University of Cyprus, Nicosia, Cyprus e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7_9

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governor or head of the Hellenic State, Ioannis Kapodistrias (1776–1831), was familiar with contemporary European spa towns and expressed an interest in adopting a similar approach in Greece.1 Kapodistrias was assassinated in 1831, and Bavarian and subsequently Danish sovereigns were placed at the head of the Greek monarchy. Their dynastic connections furthered the country’s links with other parts of Europe. Still, nineteenth-­ century Greece chose to turn to its great ancient past and the principles of Philhellenism—the nationalist intellectual movement that proclaimed antique legacy the basis for the modern Greek identity—as the foundation of the modernization process. This reappraisal of ancient Greek art, knowledge, and culture was accompanied by a renewed interest in ancient texts. The writings of the physician Hippocrates (ca. 460 BCE–ca. 370 BCE) and the popular myth of Asclepius, the Greek god of medicine, strengthened the association between the healing practices and thermal waters in the emerging rhetoric of health modernization. As a result, the incorporation of spas into the new culture of hygiene, adapted from the more economically advanced parts of Europe, explicitly connected bathing in hot spring waters with ancient Greek practices. This association of modern spas with antique origins, however, purposely obscured the vital cultural role previously played by Ottoman hammams. Built by Ottoman patrons in their distinct architectural idiom, these hammams were an indispensable part of Greek culture and social life under the Ottoman rule, and many of them continued to operate long after the Greek independence. The introduction of spa therapy as a modern health practice with requisite amenities, its origins now associated with ancient Greece, was thus also part of the broader efforts by the Greek state to erase the country’s recent Ottoman past, which was dismissed as “dirty” and “unhealthy.”2 This revisionist context, furthermore, poses the question of the country’s actual need for spa towns as opposed to centralized bath complexes. Spa towns in nineteenth-century Europe were built to counter the effects of industrialization and poor urban living conditions, becoming places where the bourgeoisie could socialize in settings close to nature while benefiting from the therapeutic powers of thermal waters. By contrast, the Greek bourgeois class, from which the Greek visitors to spa towns in Europe mainly came, had emerged only recently, and industrialized

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conditions did not yet exist in the predominantly rural Greek state. As a result, Greek spa towns were typically designed to serve clients from the country’s new urban centers. This chapter investigates how plans for the Greek spa towns of Edispsos, Kyllini, and Hypati reflected evolving ideals and hierarchies of modern health and leisure, as embedded spatially and symbolically in their design. The period of their construction between 1850 and the end of the nineteenth century was a time of urban transformation marked by the emergence of the country’s first spa clientele. This late nineteenth-century development of early spa town infrastructure in Greece was motivated by complex ideological, political, and socio-economic factors discussed above. The spas of Edispsos, Kyllini, and Hypati were the first to receive patients, and their respective towns soon became the first to benefit from the new urban development schemes. Their popularity was principally due to the proximity to the national capital, Athens, and easy access to their facilities afforded by sea and land routes. Contemporary aspirations toward becoming “modern” and “European” can, in fact, be traced back to this point in the history of modern Greece. Through the analysis of these three case studies, I argue that these spa towns, therefore, can be identified with the political strategy of de-Ottomanization pursued by the Greek state and its Bavarian and Danish monarchs specifically. My analysis draws on recent scholarship that applies postcolonial theory to modern Greek studies and architectural history.3 This work acknowledges that the nineteenth-century integration of Greece into the European context was framed by what Michael Herzfeld termed “latent” or “crypto-colonialism.”4 The rule of Bavarian and Danish kings until 1920 and continuous involvement of major European powers in the country’s modernization and state-building processes did not permit Greece to become a truly independent state. Indeed, scholars of modern Greece have pointed out that its integration into Europe was achieved through the selective connection of modern Greece with its ancient past, an effort caused and facilitated by nineteenth-century Philhellenism.5 Thus, the “rediscovery” or reinvention of Greece’s ancient past to assert its contribution to art, science, and culture was a means of integrating the so-called cradle of the European civilization into the European context. Drawing on this new reading of modern Greece enabled by postcolonial

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theory, my research builds on the growing body of studies that investigate the alternative ways of understanding the process of nation-building in the European periphery. My specific contribution to this work is an alternative history of nineteenth-century spa towns in Greece through the lens of postcolonial perspectives on health and urban planning.6

 ealth, Urban Planning, and Postcolonial H Politics in Nineteenth-Century Greece Led by Governor Kapodistrias (in office 1828–1831), the Greek state declared independence from the Ottoman rule in 1828. After his assassination in 1831, the three great European powers—Britain, France, and Russia—proclaimed the Kingdom of Greece following the 1832 London Conference and the ratification of the resulting London Protocol in the same year. The crown was offered to a Bavarian prince, who became King Otto (r. 1832–1862), deposed in 1862 and succeeded by King George I (r. 1862–1913), a scion of the ruling house of Denmark. The young state’s territory encompassed less than half of its current size, with new regions gradually added during the nineteenth century. Town planning was a primary concern of the Greek government, and planning policy became a cornerstone of national development. The country’s gradual expansion necessitated modernization initiatives, which included the creation of a railway network and road infrastructure and the adoption of new agricultural and industrial technologies and methods.7 Between 1828 and the start of the Balkan Wars in 1912, Greece went through a process of radical urbanization, during which 174 new plans were approved for large and small towns to be built on the mainland and the islands of the western Aegean Sea. This process of urbanization intensified during the reign of George I, when 147 new plans were approved. For comparison, as few as ten plans had been granted approval under Kapodistrias and only seventeen during Otto’s thirty-year reign. Several policies that underpinned the implementation of spa town design can be identified through the comparative analysis of towns for which these plans were produced.8 The provision of architectural drawings was considered an important step toward orderly development.

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Initially, plans were produced for all towns of considerable economic significance, including ports, commercial centers in the agricultural hinterland, manufacturing and industrial centers, important hubs within the road infrastructure, seats of local government, and towns with adjoining spas. The next phase of urban planning concerned the largest towns in the new territories that were gradually incorporated into Greece, many of which were designed from the ground up. Another group of plans included those for early company towns and worker settlements that housed the mining, railway, and other industrial or infrastructure laborers. A special category comprised towns and cities that had to be redesigned after severe earthquakes in various parts of the country. Finally, several plans were made to facilitate the formation of new communities constituted “either by Greeks who wanted to move into the new state from still unliberated Greek territories, or by local people who were looking for a better place to live.”9 Current scholarship of nineteenth-century town planning in Greece highlights the fact that the new planning policy was not implemented merely to meet current or future needs. Rather, in a number of cases, it imposed a specific layout model that effaced the existing Ottoman urban profile while adapting it to European designs.10 The traditional Greek town was considered irrational, outdated, and incoherent, a product of the Ottoman culture with winding roads that was deemed an obstacle to order and control.11 The orthogonal grid imported from European design schools was seen as the appropriate counter-model.12 The government gazette of 1830 clearly articulated this ideological turn in Greek planning policy: Architecture is all the time engaged in this aim, opening up streets, levelling and rectifying as much as possible everywhere, in order to correct the city’s former ugliness, which can please only barbarians, and to contribute here, indeed, to restoring the place.13

Although plans for new Greek towns varied, the orthogonal grid—the basis of Neoclassical town planning—became ubiquitous as a symbol of the modern state. In most of the drawn plans, the remaining Ottoman traces were shown as the background to new developments, palpably

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conveying their antithetical relationship to the imposed order of the orthogonal grid. The grid plan was widely used in post-disaster rebuilding of Italian and French cities. It was also employed in the new, post-Ottoman Balkan states, all of which were on a course of modernization and followed similar development patterns. What distinguished Greek town planning against this general trend was the belief that this imported model—in reality a product of the European Neoclassical tradition—had originated in ancient Greece. The promotion of these associations with antiquity created a notion that the orthogonal plan restored the country’s continuity with the past and reestablished the place of Greece among other “civilized” nations. Postcolonial analysis shows that even the choice of urban planning experts employed by the Greek government marked a clear desire to adopt current European practices.14 The planning committee was purposely staffed with military engineers from Europe and European-­ educated Greeks. French engineering officials and military geographers were employed during the Kapodistrias period; Bavarian architects staffed the government’s Architectural and Topographical Department during King Otto’s reign. Later, during the reign of George I, twenty-two foreign engineers were appointed to develop and implement public works projects as part of the French engineering missions of 1857 and 1882. Prioritized in the newly founded Greek state, the issue of health pervaded social and political discussions about development and modernization. In addition to the matters of urban planning, it motivated smaller-scale building projects and campaigns. The establishment and organization of new hospitals and healthcare institutions, which were mostly built in the capital, were supported by professors at the medical school in Athens, doctors to the royal family, and renowned scientists. Together, they published a series of theoretical essays offering guidelines for the design of new hospitals based on contemporary European trends. Following these instructions, the government commissioned French and Bavarian architects to design the new hospitals. Since similar concerns with health were prevalent in other European countries, they served both to strengthen the links between Greece and

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the rest of Europe and further to sever any remaining ties with the Ottoman past.15 Even buildings such as hammams and commercial hans, perceived as symbols of backwardness associated with the Ottoman society and culture, were demolished or repurposed as schools or other facilities deemed suitable for the country’s new European identity. The royal decree of May 15, 1835, “On the sanitary building of towns and villages,” remained in force until 1923, serving as the principal guide for the design of healthy cities in Greece.16 The law introduced contemporary European principles of urban planning, including the appropriate orientation of buildings and public spaces, the distribution of land for zoning within the city (residential, commercial, public, etc.), the creation of civic squares and public buildings, and urban beautification by means of tree-lined streets, in addition to other design guidelines. It also explained the advantages of an orthogonal grid for facilitating traffic, making the allocation of plots, and creating a desired orderly image of the city.17 Other laws and regulations, also significantly influenced by contemporary European legislation, were published as further amendments to the 1835 decree. In this way, health issues were incorporated into Greek town planning, with specific guidelines for “new healthy cities” used to justify the application of the orthogonal grid.

 pa Towns in Europe and the Promotion S of Health Eighteenth- and nineteenth-century European hydrotherapy practices were part of both a cultural movement toward modernization and contemporary health and hygiene reforms. As pharmacology and surgical medicine were still developing at that time, spa therapy was sought as a cure for often incurable diseases, including musculoskeletal, neurological, and gynecological conditions, as well as psychiatric disorders such as depression and neurasthenia. French and German spas ceased to be places to which one traveled merely to relax and socialize, as they had been during the sixteenth and seventeenth centuries. Instead, nineteenth-century culture promoted

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bodily health through the proximity to nature to counterbalance the unhealthy living conditions in crowded industrial towns. Spa-based exercise and hydrotherapeutic medicine quickly spread throughout Europe. This emerging spa culture cannot be separated from the medical literature of the time, which, from the seventeenth century onward, attempted to provide spa treatments with scientific credentials. The medical discourse on spa therapy and the consequent need for thermal establishments were both part of a broader turn toward the healthy body achieved through scientific study and the use of natural resources.18 Medical texts, such as John Floyer’s early eighteenth-century Ancient Psychrolousia Revived, often referred to the ancient bathing practices and praised the healing properties of thermal water.19 Spa medical theory and treatment practice developed rapidly. They included detailed descriptions of diseases and conditions that caused them and prescribed appropriate therapies—for example, hydrotherapy, sprinkling, or drinking of the mineral water—for each particular ailment, as well as specifying water’s appropriate (alkalic, metallic, or sulfuric) chemical composition (Fig. 9.1).20 Medical literature on spas soon developed into a new genre, taking the form of travel books. In these publications, scientists popularized chemical analyses of spa baths, explaining different types of thermal waters and their respective effects on the health of patients. These books also described the amenities, buildings, and leisure activities that spa towns offered. Owing to their earlier reputation as places of retreat, spa towns were supposed to provide social advantages in addition to medicinal benefits for the bourgeois and aristocratic classes that frequented them. In a suburban setting away from the pressures of the city, thermal therapy could be combined with socializing and relaxation. Indeed, spas in nineteenth-­ century France were conspicuously tied to the formation of the bourgeois identity, since medicalization was associated with anti-clericalism and represented a break with the tradition.21 As medical discourse dictated the design and typology of the bathing buildings, they gradually came to resemble hospitals, with simple individual baths set up in a row. Yet, apart from spaces reserved for medical practices and hierarchies imposed by the social order, health issues coexisted with informal leisure activities in the

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Fig. 9.1  Modern spa therapeutic practices in early twentieth-century France. (Aix-les-Bains, France: a circular shower in a thermal establishment. Photographic postcard, ca. 1920. Wellcome Collection)

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design of each spa. As a result, the building types associated with such activities—including casinos, restaurants, and pavilions—were gradually added to European spa towns (Fig. 9.2). Nineteenth-century bourgeoisie would travel en masse to the leading spa sites in France (such as Vichy and Aix-les Bains), England (Bath), and Germany (Baden-Baden and Wiesbaden) for “medicalized leisure.”22 Since few of the conditions under which spa towns flourished in nineteenth-­ century Europe applied to Greece, the country’s efforts toward their adoption and establishment come across as almost paradoxical. Greek spa towns could not have been seen as a means to counterbalance the negative effects of industrial living conditions, because the country remained predominantly rural, nor was the Greek bourgeois class of potential spa visitors sufficiently large to generate the demand for their creation.

Fig. 9.2  Casino in the spa town of Vichy, France, at the end of eighteenth century. (Institut français d’architecture, Villes d’eaux en France (Paris: Hazan, 1984), 65)

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 pa Therapy from Ancient S to Nineteenth-Century Greece Hippocrates, writing in the fifth or fourth century BCE, was the first Greek physician to examine and advocate the therapeutic properties of cold and hot water in his thesis On Airs, Waters and Places. His remarks establish him as the first known proponent of spa treatment.23 Over the centuries, the thermal bathing tradition spread across Greece and Anatolia (the western part of Asia Minor). After the founding of the Ottoman empire, baths became into an integral part of social life, including religious ablutions. Hammams were built throughout Greece after the arrival of the Ottomans.24 In terms of architectural style, mode of operation, and social significance, they represented Islamic baths, which, in addition to their hygienic function, were governed by a religious requirement to be publicly accessible buildings. As a result, hammams were open to all, including the local Greek population, irrespective of the economic, social, or religious background of their visitors. The Ottomans, however, did not have gymnasia as part of hammam design, which shows that the socio-­ cultural ambience of hammams did not involve physical exercise. The emphasis was on relaxation and resting, combined with the enjoyment of leisure in the company of friends.25 Many hammams remained in use in areas still under Ottoman rule following the declaration of Greek independence and the birth of the Greek state in the 1830s. Those within the liberated areas, however, were considered symbols of backwardness and oppression, and most of them were demolished. A characteristic example is the double hammam of Mustafa Pasha in the center of Thessaloniki, built between the fifteenth and sixteenth centuries. During the implementation of the new urban plan aimed to modernize the city in the aftermath of the fire of 1917 that destroyed the historic center, a debate arose regarding its future. The press vilified the building, characterizing its architecture as ludicrous, wretched, and morbid, its appearance presenting a barbarous relic.26 Ultimately there was a successful call for its demolition. With the Ottoman past largely erased from the Greek bathing culture, bathing was rebranded under the rubric of health. After 1830, Governor

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Kapodistrias and subsequently King Otto launched a campaign to use “thermalism” (thermalismos) as a term for a cure taken through natural thermal waters, to give it a “modern” ring. Kapodistrias even formed a committee of experts to examine and analyze the thermal waters of the island of Kythnos, showing the importance he attached to such efforts. Following such studies, scientists began to promote spa visits across Greece. Professors from the University of Athens, members of the government’s Medical Board, and in-house doctors at various baths produced an important body of research based on their fieldwork.27 The majority of these scientists—including Xavier Landerer (1809–1885), Ioannis Pyrlas (1817–1901), and Anastasios Damvergis (1857–1920)— had received their education in Europe and carried out their chemical analyses of spas or made recommendations for the treatment of patients by using European scientific methods.28 Soon this research was translated into popular guidebooks, articles, and advertisements for spas that were addressed to a general audience as much as the scientific community. The main goal of their authors was to emphasize the beneficial properties of thermal waters. In addition to scientific and chemical information, these texts, however, made frequent references to ancient Greek and Roman literature and mythology. For example, the Bavarian chemist Xavier Landerer referred to ancient authors including Herodotus, Pausanias, Strabo, and Pliny the Elder in his textbooks on the thermal springs in Kythnos, Santorini, and Thermopylai. Such mythological, historical, and geographical references asserted the existence and use of thermal baths in antiquity. Another authoritative source of reference was the French translation of Hippocrates’s On Airs, Waters and Places, rendered a few years later into modern Greek by nineteenth-century literary scholar Adamantios Korais.29 The principles of Hippocratic medicine continued to be influential through the rest of the nineteenth and early twentieth centuries, as shows the emergence of Neo-Hippocratism, a scientific movement popular after the First World War. Nineteenth-century medical discourse on spas in Greece thus relied on the reinvention and rebranding of thermal therapy by stressing its connections to ancient Greece and through the erasure of the more recent Ottoman bathing culture. As already argued, this strategy was part of a broader agenda to define the identity of independent Greece,

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instrumentalized through postcolonial practices. While Vilma Hastaoglou-Martinidis includes Greek spa towns among new settlements designed to bring economic prosperity, the issue of health that had initially inspired their development can also be seen as a precondition—or a pretext—for pursuing the postcolonial agendas of de-Ottomanization and modernization.30

The First Plans for Greek Spa Towns Guidebooks and articles published by doctors and scientists included comparisons between Greek thermal springs and those in use in the rest of Europe. The consensus was that Greek springs were inferior to their European counterparts, not because of their weaker therapeutic properties but the lack of facilities. As a result, initiatives were launched to provide spa areas with appropriate buildings, guest accommodation, and travel infrastructure. The first initiative of this kind was launched by Queen Amalia of Oldenburg (1818–1875), the wife of King Otto, who took a personal interest in the waters of Kythnos. She commissioned the royal Bavarian architect Christian Hansen to build there the first modern thermal establishment in Greece, its construction approved in 1837 by the royal decree. The early years of the reign of Otto’s successor, George I, marked the development of the first urban plans for purpose-built spa towns. An example was the Peloponnesian spa town of Kyllini, laid out in 1864, which became an important destination in that area. The first important effort to modernize the existing spa towns and foster the development of new ones did not occur until the end of the nineteenth century. It is associated with the visionary Prime Minister Charilaos Trikoupis (in office 1882–1895), who attempted to radically modernize the country’s infrastructure, industrial networks, and urban planning—including projects for new dams, railway networks, and city layouts—along with other administrative and educational reforms. Trikoupis, with the support of George I, made the design and creation of spa towns as the first health and leisure resorts in Greece part of his broader modernization agenda.31 Typical examples of plans for new spa town were those for Kyllini (1864), Edipsos (1889), Hypati (1890), and

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Loutraki (1880 and 1895) (see Figs. 9.3, 9.4, 9.5, and 9.6). The plan for Edipsos was reportedly assigned to Bavarian planners by Queen Olga (1851–1926), the wife of George I, who often visited the town and hoped it would have all the modern amenities characteristic of European spas

Fig. 9.3  Plan of Kyllini, 1840. (Ministry of the Environment and Energy, Cartographic Documentation Department)

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Fig. 9.4  Plan of Edipsos, 1896. (Ministry of the Environment and Energy, Cartographic Documentation Department)

that she had encountered on her travels.32 All these towns except Kyllini were close to Athens and easily accessed by both land and sea, making them well suited to such developments.33 Plans for these new Greek spa towns reflected European, particularly French influences. All these examples utilized the orthogonal grid, as was common for contemporary urban designs in Greece that adhered to the principles of the 1835 decree. The early plans took account of the local topography, including coastal or mainland locations, and left in the background traces of the Ottoman layout. They were, however, much more elaborate and meticulous than plans for other contemporary Greek towns that were not built around spas. A distinct feature of these designs was the presence of public gardens and other natural elements to surround important buildings. These plans reveal a uniform and pure vision of spa towns as models of healthy and leisurely living. The earliest among these case studies, the port of Kyllini was planned in the beginning of George I’s reign. The old thermal springs, where the spas were to be developed, were located in close proximity to the port. Kyllini’s design shows that the port was meant to serve as the access point

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Fig. 9.5  Plan of Hypati, 1890. (Ministry of the Environment and Energy, Cartographic Documentation Department)

to the whole complex, where one would arrive before visiting the springs. Since transportation and accessibility were important considerations, the two areas were to be connected by railway (Fig.  9.3). The plan also included private and municipal stores, a market, a school, and a hospital, all placed among carefully designed public gardens and tree-lined avenues. This use of natural features to embellish the principal streets as well as the distribution of fountains around public buildings distinguish designs for spa town from other contemporary Greek town plans, which were much more strictly functional. In the case of Kyllini, future developments moved away from the port, when, in the beginning of the twentieth century, French engineers designed hotels for the area around the thermal springs.

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Fig. 9.6  Loutraki’s urban plan of 1895. (Ministry of the Environment and Energy, Cartographic Documentation Department)

As the nineteenth century progressed and further knowledge concerning the functioning of spa towns was gained from the study of the European models, the development of such urban centers became a government priority, especially under Prime Minister Trikoupis. Later spa town plans revealed further incorporation of supplementary amenities and more complex landscape configurations. An example is Edipsos with its coastal location and thermal springs, where the local Greeks and Roman emperors were known to have bathed in antiquity. During the Ottoman occupation, these bathing resorts had been abandoned, but were later rediscovered by King George I and his wife, Olga. The ambitious 1896 plan for Edipsos shows many influences from European spa towns of the time (Fig. 9.4). It also reveals how, by the end of the nineteenth century, spas were meant to operate as autonomous towns dedicated to health and leisure activities, while capable of performing all the necessary urban functions. A complex of buildings allowed the visitors to Edipsos to combine health with leisure. Accommodations, thermal baths, hotels, water tanks, and a country club—a newly introduced feature—were all connected to the spa.34 The sprawling spa complex occupied almost a third of the town’s footprint and was bordered on the north by the curvilinear outline of the public gardens designed in an elaborate Baroque-inspired style.

322 

G. Daskalaki

Nearby, connected by tree-lined streets, were the City Hall and the market. By bringing together these features, Edipsos’s plan expressed the modern—and, specifically, bourgeois—way of combining health and leisure while being based on the imported models derived from the contemporary European spa culture. Apart from coastal towns, new spas were also developed in mainland Greece. The town of Hypati, situated close to Athens, had widely praised sulfuric waters. Because of that, the site was soon incorporated into the new development plan. The first town plan, which was limited to the spa resort, was designed in 1890 (Fig. 9.5). The design reveals how Hypati was conceived as a town clearly dedicated to the spa culture. The main urban axes led directly to the town’s primary spa facilities, such as hotels and the baths, which stood in a circular central square. Long blocks of buildings occupied triangular plots, which was unusual for other Greek town plans of the time. What distinguished Hypati from other coastal spa towns—such as Edipsos, Kyllini, and Loutraki (Fig. 9.6)—was an elaborately designed landscape. Its plan indicates that almost half of the town’s area was to be taken by various gardens, with pines, poplars, and evergreen shrubs; details of their layout and vegetation were elaborated in the appendix to the plan. In essence, Hypati’s plan demonstrated how the healing potential of thermal waters could be amplified if combined with promenades in the natural setting, with the whole urban layout contributing to their therapeutic effect. All the projects discussed so far testify to the fact that in nineteenth-­ century Greece spa towns were envisioned as new settlement models. Their designs differed from those of urban or industrial centers or even from the earlier suburban schemes that similarly promoted health through thermal water treatments. Such therapeutic settings were increasingly immersed in nature in the form of large public gardens.

Conclusion Nineteenth-century spa towns constitute a poorly known chapter in the architectural history of Greece, especially in relation to the nation-­ building agendas of the new state. The present analysis demonstrates how

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323

spa therapy was mobilized as a means to achieve several interrelated goals in the context of Greek town planning policy. It was integral to the politics of de-Ottomanization and contributed to modernization by promoting hygiene and health—specifically, through rebranding the ancient Greek practice of thermal bathing by making it a vehicle of modernity. Finally, it solidified the country’s links with the rest of Europe—especially in the context of latent colonialism—by adapting the same social customs and building analogous facilities. When compared to other contemporary projects for Greek towns built from the ground up, spa towns appear to have been much more meticulously designed, as they were intended as an embodiment of the healing powers of nature primarily in the service of the bourgeois attitudes to health and leisure. In this way, the first spa town plans both reflected and facilitated the rise of the Greek bourgeois class, testifying to the role of urban planning in creating social identities as well as promoting new ideologies. Nonetheless, Greek spa towns were not envisioned as resorts where one could come into direct contact with nature as was the case with their European counterparts. Instead, they offered an original model for cities that promoted health, advancing an alternative form of urbanism. Even though not all the projects discussed in this chapter were realized, with some of them remaining as blueprints in the Greek archives, spa towns like Edipsos and Hypati soon gain notable popularity. They reached their heyday in the years between the First and the Second World Wars, with buildings such as hotels, casinos, restaurants, and various additional leisure activities enhancing the modern image of these towns. All of them, with the exception of Hypati, were seaside towns, whose seafronts gradually became an integral part of the urban space, developing into the country’s first tourist resorts. Thus, spa towns in Greece also constitute important case studies in the context of twentieth-century tourist industry (Fig. 9.7). Addressing an intersection of architectural and social histories, the scholarship of spa towns in nineteenth-century Greece, therefore, offers valuable insights into such wide-ranging issues as nation-­building politics, exchange and adaptation of European design models, and new social dynamics and emergent trends.35

324 

G. Daskalaki

Fig. 9.7  Hotel at Hypati in the end of nineteenth century. (Hotel at Hypati in the end of nineteenth century. From Tryfon Evangelidis, Ta aftofii iamatika idata tis Ypatis (The natural thermal waters of Ypati), Athens: Raftani Papafeorgiou, 1907)

Notes 1. Melpomeni Kostidi, “The Medical Discourse on Greek Spas,” Postgraduate Journal of Medical Humanities 3 (2016): 60. 2. Vilma Hastaoglou-Martinidis, “City Form and National Identity: Urban Designs in Nineteenth-Century Greece,” Journal of Modern Greek Studies 13, no. 1 (1995): 106. 3. For an analysis of postcolonial theories applied to the case of modern Greek architecture, see Eleni Bastea, The Creation of Modern Athens: Planning the Myth (Cambridge: Cambridge University Press, 2000); Ioanna Theocharopoulou, Builders, Housewives and the Construction of Modern Athens (London: Artifice Books on Architecture, 2017). 4. Michael Herzfeld. “The Absence Presence: Discourses of Crypto-­ Colonialism,” South Atlantic Quarterly 101, no. 4 (2002): 899–926.

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5. Yannis Hamilakis, The Nation and Its Ruins: Antiquity, Archaeology, and National Imagination in Greece (Oxford: Oxford University Press, 2007); Artemis Leontis, Topographies of Hellenism: Mapping the Homeland (Ithaca, NY: Cornell University Press, 1995); Demetres Tziovas, Re-imagining the Past: Antiquity and Modern Greek Culture (Oxford: Oxford University Press, 2014). 6. Ljiljana Blagojević and Dejan Vlaškalić, Modernism in Serbia: The Elusive Margins of Belgrade Architecture, 1919–1941 (Cambridge, MA: MIT Press, 2003). 7. Vilma Hastaoglou-Martinidis, Kiki Kafkoula, and Nicos Papamichos, “Urban Modernization and National Renaissance: Town Planning in 19th Century Greece,” Planning Perspectives 8 no. 4 (1993): 440. 8. Ibid., 447. 9. Hastaoglou-Martinidis, Kafkoula, and Papamichos, “Urban Modernization,” 449. 10. Panagiotis Tsakopoulos, “Greek cities and neoclassicism. Greek urban planning in the 19th century,” Archaeology and Arts 65 (1997): 37. See also Bastea, The Creation of Modern Athens. 11. The traditional Ottoman town was only viewed positively when it was perceived in terms of the picturesque-exotic. 12. Hastaoglou-Martinidis, “City Form and National Identity,” 103. 13. Efimeris tis Kiverniseos [Greek Government Gazette], no. 16 (1830): 24. 14. Bastea, The Creation of Modern Athens; Theocharopoulou, Construction of Modern Athens. 15. Yorgos Koumaridis, “Urban Transformation and De-Ottomanization in Greece,” East Central Europe 33, no. 1–2 (2006): 216. 16. See Efimeris tis Kiverniseos [Greek Government Gazette], no 19 (15/05/1835). 17. Koumaridis, “Urban Transformation and De-Ottomanization in Greece,” 217. 18. Aggelos Vlachos, Tourismos ke dimosies politikes sth sighroni Ellada. I anadysi enos neoterikou fenomenou (1914–1950) [Tourism and Public Politics in Modern Greece. The Emergence of a Modern Phenomenon (1914–1950)] (Athens: Economia, 2016), 54. 19. Sir John Floyer and Edward Baynard, The Ancient Psychrolousia Revived: Or, An Essay to Prove Cold Bathing Both Safe and Useful: In Four Letters […] (London: Sam. Smith and Benj. Walford, 1702).

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20. Institut françcais d’architecture, Villes d’eaux en France (Paris: Hazan, 1984). 21. Douglas P. Mackaman, Leisure Settings: Bourgeois Culture, Medicine, and the Spa in Modern France (Chicago: University of Chicago Press, 1998), 85. 22. Those spas are part of UNESCO’s Spas of Europe network and have been declared world heritage monuments. 23. Kostidi, “Medical Discourse on Greek Spas,” 57. 24. Eleni Kanetaki, “Othomanika Loutra” [Ottoman Baths in Greece], Othomanika loutra, Epta Imeres, Kathimerini, May 20, 2001, 16–20. Today there are sixty surviving Ottoman hammams in Greece, most of which have been declared monuments of cultural heritage. 25. Evaggelia Balta, “To Othomaniko Hammam” [The Ottoman Hammam], in Othomanika loutra Epta Imeres, Kathimerini, May 20, 2001, 4–7. Hammams were also employed as common settings by the western European orientalist artists working in the eighteenth and nineteenth centuries. See, for example, the painting The Turkish Bath by JeanAuguste-­Dominique Ingres, 1852–62 at the Louvre, Paris. 26. Katerina Kousoula, Alexander Chatziioannidis, Georgia Zacharopoulou and Charilaos Gouridis, “A Lost Early Ottoman Bath in the Centre of Thessaloniki (The Double Bath of Gazi Çoban Bosnak Mustafa Pasa or Aya Sofya Hamami),” Scientific Annals of the History Centre of Thessaloniki City 8 (2013): 67–89. 27. Kostidi, “Medical Discourse on Greek Spas,” 61. 28. Ibid., 62. 29. Adamantios Coray, Traité d’ Hippocrate, des Airs, des Eaux et des Lieux (Paris: Baudelot et Eberhart, 1800). 30. Koumaridis, “Urban Transformation,” 218. 31. Vlachos, Tourismos ke dimosies politikes, 56. 32. Alexandros Kalemis, Periplanisis sto choro kai sto chrono: Voria Evia-­ Edispos [Wandering in Space and Time: North Evia, Edipsos] (Evia: Kinitro, 1999). 33. See also government gazettes for Kyllini, Hipati, Loutraki, and Edipsos. See Efimeris tis Kiverniseos [Greek Government Gazette] no. 28 (14/07/1869), no. 90 (12/08/1880), no. 28 (01/02/1890), no. 54 (29/05/1895), no.117 (2/07/1898) accordingly.

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34. One of the hotels was the Thermai Sylla, still in use, named after the renowned Roman emperor that bathed in the waters in Edipsos. When visiting Edipsos, Queen Olga stayed at the hotel. 35. Douglas Mackaman, following the work of Michel de Certeau, highlights the importance of studying such informal and seemingly “banal” locales. Mackaman, Leisure Settings, 2.

Bibliography Blagojević, Ljiljana, and Dejan Vlaškalić. Modernism in Serbia: The Elusive Margins of Belgrade Architecture, 1919–1941. Cambridge, MA: MIT Press, 2003. Balta, Evaggelia. “To Othomaniko Hammam” [The Ottoman Hammam]. Othomanika loutra, Epta Imeres, Kathimerini, May 20, 2001: 4–7. Bastéa, Eleni. The Creation of Modern Athens: Planning the Myth. Cambridge: Cambridge University Press, 2000. Coray, Adamantios. Traité d’ Hippocrate, des Airs, des Eaux et des Lieux. Paris: Baudelot et Eberhart, 1800. Dritsas, Margarita. “Water Culture and Leisure: From Spas to Beach Tourism during the Nineteenth and Twentieth Century.” In Water, Leisure and Culture: European Historical Perspectives, edited by Anderson Susan and Tabb Bruno, 196–203. Oxford: Berg, 2002. Efimeris tis Kiverniseos [Greek Government Gazette]: No. 16 (1830), no 19 (15/05/1835), no. 28 (14/07/1869), no. 90 (12/08/1880), no. 28 (01/02/1890), no. 54 (29/05/1895), no.117 (2/07/1898). Floyer, Sir John, and Edward Baynard. The Ancient Psychrolousia Revived: Or, An Essay to Prove Cold Bathing Both Safe and Useful: In Four Letters […]. London: Sam. Smith and Benj. Walford, 1702. Hamilakis, Yannis. The Nation and its Ruins: Antiquity, Archaeology, and National Imagination in Greece. Oxford: Oxford University Press, 2007. Hastaoglou-Martinidis, Vilma, Kiki Kafkoula, and Nicos Papamichos. “Urban Modernization and National Renaissance: Town Planning in 19th Century Greece.” Planning Perspectives 8, no. 4 (1993): 427–69. Hastaoglou-Martinidis, Vilma. “City Form and National Identity: Urban Designs in Nineteenth-Century Greece.” Journal of Modern Greek Studies 13, no. 1 (1995): 99–123.

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Herzfeld, Michael. “The Absence Presence: Discourses of Crypto-Colonialism.” South Atlantic Quarterly 101, no. 4 (2002): 899–926. Institut français d’architecture. Villes d’eaux en France. Paris: Hazan, 1984. Kalemis, Alexandros. Periplanisis sto choro kai sto chrono: Voria Evia-Edispos [Wandering in Space and Time: North Evia, Edipsos]. Evia: Kinitro, 1999. Kanetaki, Eleni. “Othomanika Loutra” [Ottoman Baths in Greece]. Othomanika loutra, Epta Imeres: Kathimerinh, May 20, 2001, 16–20. Kostidi, Melpomeni. “The Medical Discourse on Greek Spas.” Postgraduate Journal of Medical Humanities 3 (2016): 52–70. Koumaridis, Yorgos. “Urban Transformation and De-Ottomanization in Greece.” East Central Europe 33, no. 1–2 (2006): 213–41. Kousoula, Katerina, Alexander Chatziioannidis, Georgia Zacharopoulou and Gouridis, Charilaos. “A Lost Early Ottoman Bath in the Centre of Thessaloniki (The Double Bath of Gazi Çoban Bosnak Mustafa Pasa or Aya Sofya Hamami).” Scientific Annals of the History Centre of Thessaloniki City 8 (2013): 67–89. Leontis, Artemis. Topographies of Hellenism: Mapping the Homeland. Ithaca, NY: Cornell University Press, 1995. Mackaman, Douglas P. Leisure Settings: Bourgeois Culture, Medicine, and the Spa in Modern France. Chicago: University of Chicago Press, 1998. Theocharopoulou, Ioanna. Builders, Housewives and the Construction of Modern Athens. London: Artifice Books on Architecture, 2017. Tsakopoulos, Panagiotis. “Greek Cities and Neoclassicism. Greek Urban Planning in the 19th Century” Archaeology and Arts 65 (1997): 31–41. Tziovas, Dēmētrēs. Re-imagining the Past: Antiquity and Modern Greek Culture. Oxford: Oxford University Press, 2014. Vlachos, Aggelos. Tourismos ke dimosies politikes sth sighroni Ellada. I anadysi enos neoterikou fenomenou (1914–1950) [Tourism and Public Politics in Modern Greece. The Emergence of a Modern Phenomenon (1914–1950)]. Athens: Economia, 2016.

Index1

A

Abbas I the Great (shah of Iran), 22 Abrantes (Portugal), 55 Académie Royale des Sciences (Paris), 259 Accademia (Florence), 7 Acqua Felice (Rome), 16 Acqua Vergine (Rome), 16 Acquedotto Carolino (Caserta), 17 Acueducto de los Pilares (Oviedo), 16 Acueducto Los Arcos (Teruel), 16 Adámi, Pál, 294 Adige River, 104 Afonso V (king of Portugal), 54 Água de Prata (Évora), 16 Águas Livres (Lisbon), 16 Air pollution, 26, 168 Air quality, 107, 214, 215

Albergaria do Corpo de Deus (Évora), 54 Albergo dei Poveri (Naples), 2 Alberti, Leon Battista, 210, 215 Alb River, 143 Alcáçova Palace (Lisbon), 65 Alexis Mikhailovich (tzar of Russia), 26 Allen, Ralph, 159 Amalia of Oldenburg (queen of Greece), 317 Ancona (Italy), 85, 90, 92, 97–100, 104, 105 Antonovsky, Aaron, 156 Aqueduc Médicis (Aqueduc de Rungis, Paris), 16, 17 Aqueducts, 15–18, 39n42, 104, 138, 140, 141, 163 See also Bottini (Siena)

 Note: Page numbers followed by ‘n’ refer to notes.

1

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 M. Gharipour, A. Tchikine (eds.), Salutogenic Urbanism, https://doi.org/10.1007/978-981-19-7851-7

329

330 Index

Aqueduto da Amoreira (Elvas), 16 Aqueduto dos Arcos (Setúbal), 16 Archambault, Théophile, 250, 256, 257, 260 Aristotle, 179 Arno River, 203 Asclepius, 306 Asylum de Bicêtre (Paris), 248 Asylums, 173, 204, 206, 231, 234n9, 245–253, 255, 257–264 See also Mental hospitals B

Bacon, Francis, 168 Baden (margraviate), 127 Baden (Switzerland), 20 Baden-Durlach, Karl Wilhelm von (margrave of Baden), 127, 129, 138 Bad Pyrmont (Germany), 274, 275, 297 Bad Tatzmannsdorf (Austria), 290 Bagni della Porretta (Italy), 20 Bagni di Pertiolo (Italy), 20 Bagni di San Filippo (Italy), 20 Bagno Vignoni (Italy), 21 Băile Felix (Romania), 279 Balf (Hungary), 276 Balneology, 156, 277, 297 Bártfa (Bardejov, Slovakia), 278, 280 Bastille (Paris), 23 Bathhouses, 160, 186, 305 Bathing, 14, 18–21, 34, 35, 163–165, 171, 277, 282, 291, 295, 305, 306, 312, 315, 316, 321, 323

Baths, 18, 19, 21, 40n49, 128, 163, 169, 171, 172, 178, 186, 276, 280, 282, 293, 297, 299n14, 301n44, 306, 312, 314–316, 321, 322 See also Thermal baths Batthyány, Antal József, 293 Batthyány, József, 291 Batthyány, Tódor, 290 Batzendorf, Jacob Friedrich von, 129, 145 Bazalgette, Joseph, 181, 182 Beér, Vince, 278 Beja (Portugal), 55 Belgrand, Eugène, 17 Bergamo (Italy), 97, 105 Berlin (Germany), 23 Bishop’s Bath (Băile l Mai, Romania), 279 Black Death, 7, 8, 26, 30, 36n6 See also Plague Black Forest, 134, 136 Boccaccio, Giovanni, 5, 18 Boerhaave, Herman, 132, 286, 287 Bologna (Italy), 20, 237n32 Bombelli, Pietro, 1, 4, 5, 13 Borromeo, Carlo, 100 Bottini (Siena), 15 Boulevards, 25, 145 Bourgeoisie, 306, 314 Boyle, Richard (Third Earl of Burlington), 170 Boyle, Robert, 168 Braga (Portugal), 55 Brandão, João, 55, 66, 67 British Quarantine Act (1721), 158 Brookes, Richard, 158

 Index 

Broussais, François-Joseph-­ Victor, 247 Brunel, Isambard Kingdom, 184 Brunelleschi, Filippo, 8 Buck, Nathaniel, 174 Buck, Samuel, 174 Buen Retiro (Madrid), 24 Building regulations, 128, 143–150 Buonaiuti, Niccolò, 219 Burial grounds, 101, 159, 165, 166, 178 Burke, William, 178 C

Cagliari (Italy), 92, 100 Caldas da Rainha hospital (Lisbon), 67 Campo (Siena), 30 Canals, 14, 96, 97, 102, 104, 105, 138, 140–143, 164, 225, 226, 279, 290, 299n22 Cappella della Piazza (Siena), 30 Carr, John, 173 Carvalho e Melo, José (marquis de Pombal), 69 Casa da Índia (Lisbon), 65 Casa da Mina (Lisbon), 65 Caserta (Italy), 17 Castlegate House (York), 173 Castle Howard (North Yorkshire), 169 Cave, Henry, 165 Celeiro do Trigo (Lisbon), 65 Cephalonia, 92 Chadwick, Edwin, 179–181 Chaharbagh Street (Isfahan), 22 Champs-Élysées (Paris), 24

331

Chapels, 61, 64, 95, 98–101, 213, 218, 253, 256–258, 260, 263 Charles VI (Holy Roma Emperor), 30 Charles VII (Holy Roman Emperor), 2 Chassereau, Peter de, 173 Chiarugi, Vincenzo, 230, 240n74, 240n76 Cholera, 18, 128, 134, 138, 163, 174, 175, 177–181, 186 Ciaraffoni, Francesco Maria, 1–4 Circle houses, 129, 131 Città di Castello (Italy), 1–4, 13, 38n33 Coimbra (Portugal), 55 Colaço, Fernão, 62 Colégio de Santo Antão (Lisbon), 69 Colombier, Jean, 246, 247, 258–260 Company of Barber Surgeons (London), 158 Contagion, 33, 62, 84–102, 106, 107, 114n50 Contagion theory, 87, 178 Corfu, 92 Corpus Christi Hospice, 54 Corte Real, Diogo de Mendonça, 63 Cosimo I de’ Medici (grand duke of Tuscany), 17 Cossins, John, 162, 163, 168, 170, 173 County Hospital (York), 160, 170, 172, 173, 178, 186 Cours la Reine (Paris), 23 Courtyards, 2, 8, 96–101, 104, 138, 146, 147, 149, 215, 217, 220, 224, 253, 255–258, 261, 292 COVID-19, 5, 29, 108

332 Index

Crantz, Heinrich Johann Nepomuk von, 277, 278, 282, 283, 285, 290, 294, 300n27, 301n47 Crescenzi, Pietro de, 209, 236n19 Crossness Pumping Station (London), 181 Cruciform hospital plan, 57 Cruikshank, George, 175, 177 “Crypto-colonialism,” 307 Currey, Henry, 184 D

Daly, César, 261 Dammerstock-Siedlung (Karlsruhe), 127 Damvergis, Anastasios, 316 Dante (Dante Alighieri), 14 Defoe, Daniel, 169 del Massaio, Pietro, 8 Dias, Álvaro, 63 Diet, 172, 210, 211, 219 Disinfection, 84, 89, 90, 95, 102–104, 107 Don River, 160 Dörfle (Karlsruhe), 145 Doublet, François, 246, 247 Drake, Francis, 160, 169, 170, 190n51 Drake, Nathaniel, 161, 165 Driver, Charles, 181 Duarte (king of Portugal), 54 Dublin (Ireland), 13 Duby, Georges, 6 Durand, Jean-Nicolas-Louis, 259 Durante, Castore, 213, 214 Durlach (Germany), 129, 141, 143, 145, 150 Dysentery, 14, 138

E

École de Chirurgie (Paris), 253 École des Beaux-Arts (Paris), 250, 251, 253, 256, 260 Ecological corridors, 281, 292 Edispsos (Greece), 307 Ellis, William Charles, 250, 257 Elvas (Portugal), 16, 55 English (landscape) style of garden design, 274 Epidemiology, 158–159 Esquirol, Jean-Étienne Dominique, 34, 246–250, 252, 255–263 Estaus Palace (Lisbon), 66 Eugene IV (pope), 54 Evelyn, John, 26, 159, 165 Évora (Portugal), 16, 54, 55 Exercise, 22, 41n55, 102, 128, 210, 215, 273–297, 312, 315 F

Farr, William, 180 Faust, Bernhard Christoph, 127 Félixfürdő (Băile Felix, Romania), 279, 281 Ferdinand of Aragon (king of Spain), 51 Filarete (Antonio Averlino), 3, 8, 57, 58, 105, 210, 215, 218, 225, 226 Fireplaces, 105, 106, 218 Fischer von Erlach, Johann Bernhard, 30 Fishponds, 164 Florence (Italy), 6–8, 10, 12–14, 17, 19, 22, 24, 29, 34, 53, 56, 58, 100, 203–232

 Index 

Floyer, John, 312 Foce lazzaretto (Genoa), 96, 105 Fonteviva (Florence), 12 Fortes, Manuel Azevedo, 63 Fortifications, 25 Foss River, 161 Foucault, Michel, 156, 231, 245 Fountains, 6, 12, 18, 104, 128, 131, 141, 163, 255, 287, 288, 320 Fracastoro, Girolamo, 89 Freind, John, 168 Fuga, Ferdinando, 2 G

Galen, 89 Gall’s anatomical system, 248 Gardens, 8, 10, 12, 13, 16, 22, 23, 35, 56, 60, 63, 65, 129–134, 141, 143, 145–147, 149, 155, 209, 274, 287, 291–293, 296, 319–322 See also Parks; Villas; Urban recreation Gastaldi, Girolamo, 27 Gazzoli, Luigi (cardinal), 3, 4, 38n33 Geispitzheim, Carl Heinrich von, 283, 286–288, 300n38, 301n44 General Board of Health, 181 Genoa (Italy), 2, 58, 85, 92, 100, 102, 105, 253, 259 George I (king of Greece), 308, 310, 317–319, 321 Germ theory, 180 Gesù Nuovo (Naples), 27 Gian Gastone de Medici (grand duke of Tuscany), 221

333

Gibbs, James, 158, 159 Gil, António Rodrigues, 69 Gilbert, Émile-Jacques, 246, 247, 260, 261, 263, 266n14 Glasshouses, 131–133 See also Greenhouses Gmelin, Karl Christian, 133 Góis, Damião de, 59, 61 Gondouin, Jacques, 253 Graben (Vienna), 30 Great Fire of London, 159 Greece, 5, 34, 35, 305–324 Greenhouses, 131–133 See also Glasshouses Green infrastructure, 274, 275, 281, 292 Greenwich (England), 253 Gropius, Walter, 127 Guadagnini, Francesco Antonio, 85 Guglia di San Domenico (Naples), 31 H

Halley, Edmond, 168 Hammams, 18, 35, 276, 306, 311, 315, 326n24, 326n25 Hansen, Christian, 317 Hardtwald Forest, 129, 134, 138, 141 Hare, William, 178 Hartweg, Andreas Johann, 133 Haynes, John, 162, 171, 173 Health of Towns Association, 179 Healthscape, 205, 232n1 Hemeling, Johann Carl, 131, 132 Henri IV (king of France), 22, 24

334 Index

Herlány (Herl’any, Slovakia), 282, 299n25, 300n30, 300n33, 300n38, 301n44 Herodotus, 316 Héviz (Hungary), 276, 299n12 Hippocrates, 286, 306, 315, 316 Hippocratic medicine, 209, 316 Hirschfeld, Christian Cay Lorenz, 274, 287 Holanda, António de, 68 Hooke, Robert, 159 Hôpital de la Salpêtrière (Paris), 259 Hôpital Esquirol (Charenton, Saint-Maurice), 246 Horticulture, 150 Hospital General (Madrid), 24 Hospital Real de Todos-os-Santos (Lisbon), 33, 49–70 Hospital Real (Granada), 51 Hospitals, 1–8, 10, 12–14, 17, 26, 27, 30, 32–34, 49–51, 83–85, 90, 92, 100, 103, 106–108, 108n2, 138, 155–160, 170–174, 178, 179, 184–186, 203, 206, 208, 212–215, 217–225, 229–232, 233n7, 245–247, 249, 250, 253, 258–260, 262, 263 See also Lazzaretti; Mental hospitals; Plague hospitals; Psychiatric hospitals; Spedaletti Hôtel des Invalides (Paris), 253 Hôtel-Dieu (Lyon), 3, 184 Howard, Charles (Third Earl of Carlisle), 169 Howard, George William Frederik (Viscount Morpeth and Seventh Earl of Carlisle), 179

Howard, John, 90, 105, 161, 173 Hübsch, Heinrich, 131 Humor theory, 227 Hungary, 5, 34, 35, 273, 298n11, 299n14 Huyot, Jean-Nicholas, 253 Hydraulic technology, 164 Hydrotherapy, 311, 312 See also Spa therapy Hygiene, 61, 62, 128, 206, 263, 305, 306, 311, 323 Hypati (Greece), 307, 317, 320, 322–324 I

Illésházy family, 294, 295 Innocent VIII (pope), 53 Insanity, 245 See also Mental illness Integrated green infrastructure, 292 Isabella of Castile (queen of Spain), 51 Ivan IV the Terrible (Tzar of Russia), 26 J

Jervis Street Hospital (Dublin), 13 Jewish Ghetto (Rome), 27 João II (king of Portugal), 16, 49, 51, 52, 54–56, 66 João III (king of Portugal), 55 João V (king of Portugal), 16 José I (king of Portugal), 63, 69 Julius Caesar, 168, 285

 Index  K

Kapodistrias, Ioannis, 306, 308, 310, 316 Karlskirche (Vienna), 30 Karlsruhe (Germany), 33, 127–150 Kaunitz-Rietberg, Wenzel Anton, 288 King’s Pool (York), 164 Korais, Adamantios, 316 Kyllini (Greece), 307, 317–320, 322 Kythnos (Greece), 316, 317 L

Lambeth Water Company, 180 Landerer, Xavier, 316 Landgraben canal (Karlsruhe), 141, 142 Landstraße (Karlsruhe), 143–145 Largo del Mercatello (Piazza Dante, Naples), 27, 29 Latrines, 62, 105, 224–228 Laycock, Thomas, 160, 165, 169, 170, 179, 185, 186 Lazzaretti, 27, 33, 83–108, 110n13, 115n65, 158 See also Quarantine Lazzaretto Nuovo (Venice), 83, 92, 101, 106 Lazzaretto Vecchio (Venice), 83, 92 Le Nôtre, André, 24 Lebas, Louis-Hippolyte, 34, 245 Leeds (UK), 160, 177, 179, 180 Leeds Infirmary, 173 Leeuwenhoek, Antonie van, 168 Leisure, 273, 305, 307, 312, 314, 315, 317, 321–323 Lendal Tower (York), 164

335

Lenné, Peter Joseph, 274 Leo X (pope), 4, 59 Leone, Alberto, 207–209 Leopold I (Holy Roman Emperor), 30 Leroux, Jean-Baptiste, 250, 253 Liberty of St. Mary’s Abbey (York), 162 Liberty of St. Peter (York), 162 Lidellplatz (Karlsruhe), 142, 143 Lisbon (Portugal), 16, 33, 49–70 Lister, Martin, 168 Livorno (Italy), 85, 90, 92, 95, 96, 100, 101, 104, 106 London (UK), 14, 26, 128, 134, 135, 157–160, 164, 165, 169, 170, 174, 175, 177, 179–181, 186 London Conference (1832), 308 London Protocol (1832), 308 Longhena, Baldassare, 31 Loudon, John Claudius, 133–135 Loutraki (Greece), 318, 322 Ludwigsplatz (Karlsruhe), 142 Lupi, Bonifacio, 7 Luxembourg Gardens (Paris), 16 Lyon (France), 3 Lytham Hall (Lancashire), 173 M

Madrid (Spain), 24 Maglio (Florence), 22 Malaria, 128, 136, 140, 169 Maliebaan (Utrecht), 23 Malpighi, Marcello, 168 Mandeville, Bernard de, 157, 186 Mantua (Italy), 58

336 Index

Manuel I (king of Portugal), 51, 53, 56, 57, 59, 62, 74n27 Manzanares (Madrid), 24 Mapping, 179–181, 283, 288 Maria Theresa (Empress), 277 Marseille (France), 85, 92–94, 103, 104, 106, 158, 160 Martinho (bishop of Évora), 54 Martini, Francesco di Giorgio, 105 Mayer, Lajos Ernő, 283, 300n30 Mead, Richard, 90, 91, 158, 168 Measles, 169 Medical teaching, 155 Medici, Isabella de, 19 Medici, Marie de’ (queen of France), 16, 24 Mennie, R. O., 184 Mental hospitals, 34, 203 See also Asylums; Psychiatric hospitals Mental illness, 207–209, 247, 248, 255, 256 See also Insanity Messina (Italy), 90, 92, 96, 100, 104, 106 Metropolitan Board of Works (London), 181 Miasma theory, 165 Milan (Italy), 3, 8, 56–58, 97, 100, 105, 208, 210, 215, 225, 253, 259 Mineral water, 275–278, 282, 283, 292, 293, 300n30, 300n38, 301n47, 312 Misericórdias (Confraternities of Mercy), 55 Montaigne, Michel de, 14, 21 Montecatini Terme (Italy), 21

Montelupo (Italy), 29 Montpelier (France), 30 Monumental architecture, 156 Moscow (Russia), 26, 27 Mulino di San Niccoló (Florence), 19 Municipal Corporations Act (1835), 177, 179 Murano (Venice), 106 Muratori, Lodovico Antonio, 89–91, 106 Mustafa Pasha, 315 N

Naples (Italy), 2, 17, 21, 27, 29–31, 43n74, 253 Necker, Jacques, 247 Needham, J. P., 186 Neo-Hippocratism, 316 Netherlands, 131 New River (canal), 164 New Walk (York), 161, 165, 170, 171 Newton, Isaac, 168, 286 Nightingale, Florence, 182, 184, 185 Notre Dame de Lorette (Paris), 250, 256 Nursing homes, 13, 253 O

Ognissanti friary (Florence), 10 Olga (queen of Greece), 318, 321, 327n34 Oliveira, Nicolau de (friar), 61, 62, 64–67 Orphanages, 6–8

 Index 

Orthogonal grid planning, 309 Ospedale degli Innocenti (Florence), 7, 8, 10 Ospedale dei Castellani (Florence), 12 Ospedale del Bigallo (Florence), 12 Ospedale di Bonifacio (Florence), 7, 8 Ospedale di Fonteviva (Florence), 12 Ospedale di Pammatone (Genoa), 2, 259 Ospedale di San Florido (Città di Castello), 4 Ospedale di San Gallo (Florence), 12 Ospedale di San Matteo (Florence), 7, 8 Ospedale di San Paolo (Florence), 12 Ospedale di Santa Dorotea (Florence), 34 Ospedale di Santa Maria della Consolazione (Rome), 27 Ospedale di Santa Maria della Scala (Siena), 3 Ospedale di Santa Maria dell’Umiltà (Florence), 7 Ospedale di Santa Maria Nuova (Florence), 7 Ospedale di Santo Spirito in Sassia (Rome), 3 Ospedale Maggiore (Milan), 3, 8, 57, 105, 210, 215, 225, 226, 259 Ospedali Riuniti (Città di Castello), 1–4 Otto (king of Greece), 308, 310, 316, 317 Ouse River, 161, 163–165, 168, 171, 177, 178, 180 Oviedo (Spain), 16

337

P

Paço da Ribeira (Lisbon), 65 Palace of Westminster (London), 181, 184, 185 Palaces, 8, 28, 65, 129, 131, 134, 141, 143, 211 Palais de Justice (Paris), 253 Palais de la Bourse (Paris), 250 Palazzo Pitti (Florence), 17 Palladio, Andrea, 31 Pall-mall, 6, 22, 23 Pannonia, 276 Panopticon layout, 250 Parchappe, Maximilien, 251, 260 Paris (France), 3, 14, 16, 22–25, 34, 248–250, 253 Parks, 5, 22, 24, 128, 133, 134, 274, 287, 291, 292, 296 See also Gardens; Urban recreation Paseo de las Delicias (Madrid), 24 Paseo del Prado (Madrid), 24 Paseo de Recoletos (Madrid), 24 Pathology, 155, 156 Pátio das Arcas (Lisbon), 67 Pausanias, 316 Pavia (Italy), 58 Peklény (Hungary), 282, 287 Percier, Charles, 250 Pestsäule (Vienna), 30 Petite Roquette prison (Paris), 250 Pfinz River, 141, 143 Philanthropy, 157, 250 Philhellenism, 306, 307 Philip IV (king of Spain), 24 Pietro Leopoldo (grand duke of Tuscany), 21, 229, 230 Pinel, Philippe, 246–248 Pius VI (pope), 1

338 Index

Plague, 5, 7, 8, 26–33, 43n74, 83–108, 108n2, 115n65, 158–160, 205–212, 218, 230 See also Black Death Plague churches, 30–32 Plague hospitals, 27, 83, 84, 90, 106, 108n2 Plague monuments, 30, 31 Pliny the Elder, 316 Plymouth (UK), 253 Ponte alla Carraia (Florence), 14 Ponte Santa Trìnita (Florence), 14 Poor Laws, 166, 179 Pope, Alexander, 170 Porretta Terme (Bagni della Porretta, Italy), 20 Porta dello Spirito Santo (Naples), 28 Port’Alba (Naples), 28 Porte Montmartre (Paris), 23 Porte Saint-Honoré (Paris), 23 Postcolonial theory, 307–308, 324n3 Poverty, 163, 179, 180, 186, 207, 209–212, 217 Poyet, Bernard, 259 Premonstratensians, 279 Promenades, 6, 23, 25, 34, 160, 161, 186, 277, 286, 294, 322 See also Boulevards Psychiatric doctors, 246 Psychiatric hospitals, 245–264 Psychiatry, 230, 246, 247, 249, 250 Psychotherapy, 249 Public health, 5, 6, 88, 91, 148, 157–159, 165, 174, 178, 179, 186, 203–232, 237n32, 277, 278, 296 Public Health Act (1848), 181

Püspökfürdő (Bishop’s Bath; Băile l Mai, Romania), 279, 281 Pyrlas, Ioanis, 316 Q

Quarantine, 27, 29, 33, 83–86, 89–91, 96, 99, 101, 102, 104, 105, 107, 108, 158, 179, 212 See also Lazzaretti R

Ragusa (Dubrovnik, Croatia), 84 Rationalism (in architecture), 262 Recoletos friary (Madrid), 24 Recreational spaces, 165 Redentore (Venice), 31 Religious Society of Friends (Quakers), 173 Renkioi Hospital (Dardanelles), 184 Representation of the People Act (1832), 177 Rhine River, 134 Rivers, 6, 14, 18, 19, 24, 62, 65, 92, 128, 134, 136, 140, 164–166, 169, 174, 175, 178, 179, 186, 224, 226, 227, 286, 290 Roman baths, 276 Rome (Italy), 1, 3, 5, 12, 14, 16–18, 23, 27, 98, 163 Rossi, Antonio Giuseppe, 102, 106 Rossio (Lisbon), 33, 59, 63, 65–69 Rotunda hospital (Dublin), 13 Royal Chelsea Hospital (London), 182 Royal College of Physicians (London), 158

 Index 

Royal Commission for the Health of Towns (1844), 179 Royal Hospital Kilmainham (Dublin), 13 Royal Naval Hospital (Stonehouse), 159, 184 Royal Society at Gresham College (London), 158 Royal Victoria Military Hospital (Netley), 184 Ruggieri, Giuseppe, 222–224, 226 Russell, Patrick, 89, 90, 102 S

Sade, Donatien Alphonse François Marquis de, 246, 249 St. Bartholomew hospital (London), 158, 159, 182 Saint’Egidio friary (Florence), 8 Saint-Maurice (France), 246 Saint Patrick’s Hospital (Dublin), 13 Saint Peter’s basilica (Rome), 3 St. Thomas’ Hospital (York), 182, 184 Salerno (Italy), 15 Salutogenesis, 5, 156 Samber, Robert, 158 San Carlo lazzaretto (Trieste), 85, 101 San Domenico (Città di Castello), 4 San Giobbe (Venice), 30 San Giovanni di Dio (Florence), 7 San Pancrazio lazzaretto (Verona), 92, 97–100, 104, 105 Sanitary engineering, 182 Sanitary maps, 180 Sanitation, 5, 157, 166, 174, 179, 181, 206

339

San Leopoldo lazzaretto (Livorno), 85, 95, 96, 100, 101, 104, 106 San Paolo fuori le Mura basilica (Rome), 27 San Rocco (Venice), 30, 96, 100, 106 San Rocco lazzaretto (Livorno), 96, 100, 106 San Sebastiano (Venice), 27, 30 San Sebastiano church (Naples), 27 Santa Croce (Florence), 203 Santa Maria della Salute (Venice), 31, 32 Santa Maria Novella (Florence), 10 Santarém (Portugal), 55 Santa Teresa lazzaretto (Trieste), 85, 101, 104 Santíssima Trindade hospice (Évora), 54 Santorini (Greece), 316 Santo Spirito (Città di Castello), 3, 4 São Bento hospice (Évora), 54 São Domingos friary (Lisbon), 62, 65, 66 São Francisco hospice (Évora), 54 Scalfarotto, Tommaso, 102 Schück, Hermann, 143 Schweickhardt, Christian Friedrich, 148 Segovia (Spain), 16 Seine River, 23, 24 Seipp, Johann Philipp, 275 Setúbal (Portugal), 16, 55 Sewage, 6, 14, 18, 33, 61, 62, 138, 141, 164, 177, 210, 225 Sewers, 62, 91, 104, 105, 141, 143, 166, 169, 181, 182 Sheaf River, 160

340 Index

Siena (Italy), 3, 12, 15, 20, 30, 53 Silves (Portugal), 55 Simpson’s Hospital (Dublin), 13 Sina (Baron), 295 Sixtus IV (pope), 3, 53 Sixtus V (pope), 16 Smallpox, 6, 169 Snow, John, 180, 184 Solar architecture, 127 Soufflot, Jacques-Germain, 3 Southwark and Vauxhall Water Company, 180 Southwark Waterworks (London), 177 Spa baths, 312 Spa therapy, 305, 306, 311, 312, 315–317, 323 Spa tourism, 21, 275, 277, 297 Spa towns, 21, 35, 273–275, 305–324 Spedaletti, 10, 12, 13 Split (Croatia), 92, 96, 97, 102 Stefano, Francesco, 221 Steinschiffkanal (Karlsruhe), 141 Stinche prison (Florence), 207, 219 Strabo, 316 Swieten, Gerard van, 277, 285 Syphilis, 206, 230

Teplice (Bohemia), 275, 297 Terreiro do Paço (Lisbon), 65 Teruel (Spain), 16 Thames River, 14, 177, 181, 182, 184 Thermal baths, 21, 276, 316, 321 Thermalism, 316 Thermal springs, 20, 273, 276–278, 280, 282, 286, 290–292, 294, 296, 297, 316, 317, 319–321 Thermal therapy, 305, 312, 316 Thermopylai (Greece), 316 Thessaloniki (Greece), 315 Thran, Christian, 130–133 Tiber River, 3, 14 Tossignano, Pietro da, 89 Tourism, 288 Trenčianske Teplice (Slovakia), 294 Trencsénteplic (Slovakia), 294–296 Trikoupis, Charilaos, 317, 321 Tuberculosis, 128 Tuileries Gardens (Paris), 23 Tulla, Johann Gottfried, 136, 140, 142 Typhus, 128, 158, 169, 181, 208, 211, 236n17 U

T

Tacitus, 168 Tagus River, 51, 59 Tallherr, Joseph, 288 Taracenas (Lisbon), 65 Tarcsafürdő (Bad Tatzmannsdorf, Austria), 290–294 Tees River, 160 Temple, Henry John (Lord Palmerston), 184

Unter den Linden (Berlin), 23 Urban beautification, 311 Urban infrastructure, 5, 17, 32, 128 Urbanization, 66, 308 Urban planning, 35, 127, 134, 138, 159, 174, 274, 305–324 Urban recreation, 22–26 See also Boulevards; Gardens; Pall-mall Utrecht (Netherlands), 23

 Index  V

Val-de-Grâce (Paris), 253 Vanvitelli, Luigi, 16, 85 Varignano lazzaretto (Genoa), 85, 92, 96, 100, 101, 104 Vauban, Sébastien Le Prestre de, 24 Vaudoyer, Antoine-Laurent-Thomas, 250, 251 Vaudoyer, Léon, 251, 252, 255 Vaughan, John Edwards, 175 Venereal disease, 13, 171 Venetian Republic, 84 Venice (Italy), 14, 30, 83, 85, 92, 93, 101, 106, 208, 226 Ventilation, 61, 63, 90, 91, 93, 94, 103–105, 107, 146–148, 157, 182, 184, 185, 228, 249 Vernon-Harcourt, William, 165 Vicente, Gil, 66 Viel, Charles François, 259 Villa Borghese (Rome), 5, 23 Villa Lante (Bagnaia), 17 Villas, 5, 211, 297 See also Gardens Vitruvius, 168, 179, 209, 210 Votive churches, 30–31 W

Walkways, 279, 280 Waste management, 215, 224 See also Sewage Water supply, 14–21, 33, 128, 140, 141, 159, 163–166, 175, 177 See also Aqueducts; Fountains; Rivers; Wells Watermills, 142

341

Weimar Republic, 127 Weinbrenner, Friedrich, 131, 138, 140, 142, 146–149 Wellbeing, 12, 14, 150, 156, 157 Wellness industry, 273 Wells, 6, 18, 61, 104, 138, 140, 164, 166 Werner, Georg, 276, 280 Westmoreland Lock Hospital (Dublin), 13 Wilhelmsbad (Germany), 275 William I (king of England), 163 Wintringham, Clifton, 160, 163, 168–172 Witsch, Rudolph, 301n50 Worshipful Society of Apothecaries (London), 158 Wren, Christopher, 159 Y

York (UK), 34, 157, 160–166, 168–171, 173, 174, 177–180, 185–186 York Castle, 161 York Lunatic Asylum, 173, 186 York Medical Society, 178 York Minster, 170 York Public Cemetery Company, 178 York Retreat, 173 York’s Dispensary for the Poor, 186 Z

Zakynthos, 92 Zocchi, Giuseppe, 6, 14