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HISTORY |
From the Department of Pediatrics, Washington University School of Medicine. St. Louis, Missouri
For 60 years, the drawing of the infant in swaddling clothes has been a familiar symbol to fellows of the American Academy of Pediatrics (Fig 1). It is derived from 1 of 10 brightly glazed terra cotta bas-reliefs sculpted by Andrea Della Robbia1,2 that adorn the "Ospedale degli Innocenti," or Foundling Hospital on the "Piazza della SS. Annunziatia" in Florence, Italy. There is historic and symbolic importance to this sculptured infant, but pediatricians might well be interested in the greater significance of the building, the "Ospedale degli Innocenti." It is the oldest known institution continuously devoted to the welfare of children. Historians of architecture identify it as the first truly Renaissance structure.3–5 It was also the first commission of Filippo Brunelleschi, the extraordinary architect and engineer of the early Italian Renaissance. Finally, the building itself and how it came into being represents an important social and cultural landmark of Humanism during the "quattrocento."
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THE "OSPEDALE DEGLI INNOCENTI"
In 1294, the General Council of the Florentine Population delegated responsibility for the care of the "innocenti" to a powerful guild in the city, the "Arte della Seta," or Silk Guild. For more than a century, the guild had had substantial experience in providing sanctuary for foundlings. In 1419, they requested and obtained the right to a bequest of 1000 florins to build a facility entirely for children. "Arte della Seta" planned to present the "Ospedale degli Innocenti" to Florence as a grand demonstration of their beneficence to the city. It also reflected the importance they assigned to the care of abandoned infants "deserted by their parents contrary to the law of nature".3
According to Saalman, "Ospedali" in Florence date back to the 13th century. Although "ospedale" or its diminutive, "spedale," may suggest a facility related to our modern hospital, it was closer to a hospice for the sick poor or a sanctuary for the abandoned or dispossessed, both young and old. Revenue came from bequests of money and land. The major "ospedali" were among the largest landholders of Florence in the 15th century.
Designs of "ospedali" were derived from the typical elements of a monastery. The main components were a "chiesa," or church, and an "abituro," or dormitory, for the inhabitants along with service rooms. These surrounded a column-lined courtyard, or "cortile." Privacy and limited entry are requisite to the cloistered nature of a monastery. However, the functions of "ospedali" required greater traffic by patients, visitors, and workers. Thus a "loggia," a long open portico along the side of the structure, could allow entry to any area of the building and provide a place where the occupants could visit and watch the activities on the adjacent street, or "piazza."
The Silk Guild chose Brunelleschi, one of their own members since 1404, to be the master builder, or "capomaestro." By 1419, Florentines knew him well as an inventor, a scholar of ancient architecture, and a sculptor and goldsmith.6 They were well aware of his model for the proposed dome of the Florence Cathedral, "Santa Maria del Fiore."
Both Battisti and Saalman provide excellent detailed accounts of the construction of the "Ospedale degli Innocenti." Brunelleschi’s design derives from the Tuscan Romanesque style but modified by "all’antica," a style derived from ancient Roman architecture. He was the first architect to organize a structure into a unified whole with all elements of the building including the spaces, walls, and supporting and supported members integrated by related measurements. In 1419, at age 41, Brunelleschi with the "Ospedale degli Innocenti" introduced a new concept of architecture into the Italian Renaissance.
Figure 2 shows Brunelleschi’s reconstructed floor plan. (None of Brunelleschi’s drawings have survived.) It is a symmetrical building with the church on one side of the courtyard matched by the dormitory on the other. A long loggia presents the "Ospedale" to the piazza. Broad steps extending along its full length function as a transition between the piazza and the loggia and then to the building itself. The loggia is famous among architects and is clearly the prominent feature of the "Innocenti." Figure 3 shows a reconstruction of the elevation of Brunelleschi’s original design. Its 9 arches supported by 10 Corinthian columns present a perfectly proportioned, elegant welcoming entry to the building.
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Many changes occurred to the interior as well as the exterior of the building over the centuries. In the 1970s, the "Ospedale" was restored with modifications aimed at returning the building to some degree to its early 15th century state and at the same time modernizing it for current usage. Despite all of the alterations over the centuries, the loggia today retains the grace and elegance essentially as Brunelleschi designed it (Fig 4).
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THE "OSPEDALE" AS AN EXPRESSION OF HUMANISM
The "Ospedale degli Innocenti" is more than an architectural milestone. It has provided care of infants and children continuously for more than 5
centuries. Beginning with its sponsorship and through its services as well as its architecture, the "Innocenti" represents the evolving humanistic views of Florence of the early Renaissance. The "Arte della Seta" demonstrated their understanding and compassion for the foundling infants. For them and for us, it was an important social statement. They mounted their insignia in a noble gesture over the central arch of the loggia. (The insignia of the "Arta della Seta" was replaced in the 16th century with the bust of Cosimo de Medici.)
Gavitt’s history of the "Innocenti" reflects the emphasis of the institution’s approach to the welfare of children7:
"the boundaries between sacred and secular had undergone rapid alterations in the late 14th and early 15th centuries. Charity elevated urban, civic, and political life to a level of sanctity that once only the cloister could compel." (p. 143)
The first "innocente" was left at the "spedale" on February 5, 1445, 10 days after the official opening. Viazzo et al8 described the process:
"In the beginning, children who were not handed over directly to hospital officials were abandoned in a sort of basin situated on the right side of the front portico, beneath a window that opened into an inside room where a woman was on permanent duty waiting for an infant’s first cry. This basin was removed around 1660, when a wheel was built on the left side of the same portico." (p. 70)
Infants were left in the wheel until 1875. Viazzo et al8 quoted an epigraph written on the occasion of its closure by a distinguished Florentine, Isidoro Del Lungo: "For 4 centuries this was the wheel of the Innocents, secret refuge from misery and shame for those to whom charity never closed its door." Until the building of the "Ospedale degli Innocenti," the disposition of many unwanted children was erratic. Sometimes a foundling was left in a public place where chance alone decided his or her fate. In addition to those who were illegitimate, there were many infants whose parents were unable to provide their care. Battisti3 reported that many were offspring of slave mothers who were the property of powerful families in Florence (p. 46). He also reported that as soon as 1467, the "Innocenti" was caring for 600 children and housing 200 orphans, foster mothers, or wet nurses and men. After 2 centuries, in 1647, records show that "there were 1091 children in foster care, 28 nursing infants in the hospital, 21 wet nurses, 642 infants, children and mothers of all ages, 98 other children, 40 priests and other ministrants, the prior, and an additional 25 infants sent to S. Gimignano" (p. 346). According to Viazzo et al8, the "Ospedale" has accepted 375 000 infants and young children.
The burdens of so large a responsibility through the centuries were accompanied by a huge mortality rate7,8 ranging from 15% to 20% in 1445 to almost 90% in the 1480s. Plague, smallpox, and intestinal diseases took a huge toll.9 The "Ospedale" diminished the crowded conditions with a beneficial impact by sending infants out to wet nurses.
The "Innocenti" policy established foundlings as individuals deserving the respect of society. Care sometimes continued for several years. Typically, an infant was nursed at the facility until it was feasible to transfer him or her to a wet nurse in the countryside. After weaning, the infant was returned to the "Innocenti," where he or she might remain until ready for transfer to a foster home. Often they were placed with a family where they might learn a trade. Girls might stay at the "spedale" until they could be provided with a dowry from a donor or public source. For others, it became a training school to prepare children for their future occupations.
The architecture of the building reflects the humanist tradition. Architectural historians emphasize that this first Renaissance building has no structural reference to church architecture. Brunelleschi was religious but chose to emphasize the secular nature of the function of the "spedale" as separate from church influence. Here again, the loggia is the influential feature. It invites the involvement of the quotidian affairs of the outside world with the foundlings whom that world produced.
Currently, the "Ospedale degli Innocenti" serves as a child care center and provides community child welfare services, including placement in foster care and monetary support. It continues to fulfill its original mission.
THE BAMBINI OF ANDREA DELLA ROBBIA
When people looked at the building during its early years, they saw 10 blank roundels, concave circular frames set within the spandrels, the spaces created between the arches. Then in 1487, 4 decades after Brunelleschi’s death, the 10 "bambini" by della Robbia1,2 were mounted in the roundels. In 1845, 2 additional pairs of "bambini," reproductions of some of the originals, were installed at either end.
Exactly when della Robbia created the "bambini" is obscure, but Marquand1 suggested 1463 to 1466, several years before their installation. Each of the originals is singular. Seven are fully swaddled from thorax to toe, and 2 are depicted with the swaddling clothes still tied but sagging below the waist or knees.
One "bambino," the seventh from the left (Fig 5), shows the swaddling clothes untied and falling away from the infant. It is the only one with unbound feet. What della Robbia had in mind with this one variation is hard to say. Perhaps the loosened swaddling clothes represent liberation from the constraining stigma of the foundling origins of the "bambino." Modern pediatricians might consider it a symbol of emancipation from health care practices based on ignorance. Some might consider the unwrapped swaddling clothes as liberating children from illness. In any event, this "bambino" is robust and free. Ultimately, under the leadership of Henry Helmholz, President of the American Academy of Pediatrics (AAP) in 1939, the AAP chose this "bambino" for its insignia.
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"As I said, happiness cannot be gained without engaging in good, just, and virtuous deeds. Good and just deeds are those which not only harm no one but help many.... In fact, Nature decreed that you complement me in the qualities I lack, and a third supplement your own deficiencies. Why did Nature do this? So that I shall need you, you will need another, and he another, who in turn will need me so that this mutual need might be a bond and a reason for our staying together in friendship" (p. 143).
Of the "bambini" that adorn the "Ospedale degli Innocenti," the liberated "bambino" best reflects Alberti’s humanistic view of the world. The AAP chose well.
FOOTNOTES
Received for publication Nov 26, 2001; Accepted Mar 5, 2002.
REFERENCES
This article has been cited by other articles:
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  T. D. Koepsell Masaccio (1401-1428): St Peter Distributing Alms to the Poor (ca 1425) Arch Pediatr Adolesc Med, April 1, 2003; 157(4): 316 - 316. [Full Text] [PDF]
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