The Renaissance hospital constitutes a space in which rational organization confronts, conceals, and controls socially constructed objects of contamination and contagion. At the core of its architectonic function, Milan’s Ospedale Maggiore works to purify the impure body through a masquerading act, which disturbs and detaches the immaterial subject from its contaminated embodiment. Architects and humanists conceive of complex sanitary networks that permeate the building’s space, while remaining hidden, or closeted, behind porous walls. Extending the hydraulic metaphor to relations of bodies in space, one understands the hospital’s power relations as constituted by mechanisms that permit and block certain objects from freely flowing through predetermined or natural channels, while constructing a false sense of security through separation. Employing Henri Lefebvre’s trialectic and discursive analysis, I explore the intertwining spatial practices, representations of space, and spaces of representation that produce Milan’s Ospedale Maggiore as a social space. First, I propose an historical analysis that recognizes the hospital’s and contagion theory’s gradual development with relation to cultural values. As Lefebvre says of Venice, “it was not planned in advance. It was born of the sea, but gradually, and not, like Aphrodite, in an instant.” Next, I construct a spatial representation regarding the latrines, pipes, closets, and canals from Alberti’s and, more clearly, Filarete’s treatises. Both are representation of space with significant consequences for the hospital’s practical and symbolic spaces. Drawing from Mark Wigley and Georg Simmel, my analysis here seeks to uncover the hospital in its imaginary, yet real multidimensionality. Filarete’s sanitary network, I argue, bespeaks a masculine desire to mask socially constructed objects of contamination through rational architectonic structures. The Ospedale Maggiore, in general, serves to benefit Milan’s “infirm, both men and women, and of children born out of wedlock,” while simultaneously maintaining a hidden, yet precarious patriarchal order.
Necessary to an adequate understanding of the socially produced hospital is a project that first seeks to uncover a history of struggle between the city, its officials, the plague, various charitable institutions, and competing cultural ideals. Regarding the Ospedale Maggiore’s execution, Evelyn Welch warns against attributing to Francesco Sforza what were “only extensions and adaptations of plans that had been debated for almost a century.” To understand the space that produced the Ca’ Grande, one ought to look to 1360, when the plague finally seeped into Milan. Historians note that the Lombardy city, geographically located inland, avoided both the Black Death and the second plague waves. However, subsequent famines and epidemics rocked the city’s population, killing roughly 40,000 of its 100,000 inhabitants. Monastic and other independent hospitals reigned supreme at this time, asserting Christian charity and piety, which benefited the sick and the poor. Welch explains, “For the truly dedicated, service to the poor was equivalent to service to Christ and physical contact could not be shunned even by the wealthiest members of society. Such piety attracted donations from those unwilling or unable to make similar commitments.” At this early stage, physical contact with perceived contaminated individuals was a pious, if dangerous gesture enacted by devotees to Christ, which secured for them a place in Heaven. At the same time, growing reservations concerning disease outbreak and its association with physical contact with the poor and sick bolstered a new charitable era that gave rise to the Ospedale Maggiore and its contemporaries. Legacies and wills funneled into dispersed hospices, as wealthy individuals fulfilled their civic and spiritual duties, while keeping a safe distance from potential contagion points. Why risk one’s own health with proximity to the sick and poor when one can donate from a distance and reap the same spiritual benefits?
One glimpses the shifting attitudes towards hospitals, poor relief, and contagion in Milan, as Duke Bernabò Visconti issued the first quarantine laws in Italian history. Ann Carmichael, in “Contagion Theory and Contagion Practice in Fifteenth-Century Milan,” notes that the duke’s 1374 laws concentrated “on the restriction of movement from plague-stricken territories into the ducato, the lands controlled by the duke of Milan.” Categorizing certain territories as sources of contagion, the duke simultaneously identified his own territory as separate from, and purer than, those others. “Contagious” individuals, marked by their geographic origin, as much by their disease, were barred entry into the duchy. Carrying his predecessor’s engagement with contagion a step further, Duke Giangaleazzo Visconti initiated a diffused program to control the disease’s spread. He demanded, for instance, exhaustive registries to include every sick individual and death throughout the city; he created a new office, the commissario, that administered all health regulations throughout the duchy; and he intervened in the hospitals’ resource allocations to the sick and poor, regulating the communes’ administrative processes. During the Ambrosian Republic’s reign, furthermore, Milan established its first lazaretto, or pest house, for quarantining plague victims. These dukes’ strategies recall Michel Foucault’s opening to his seminal chapter in Discipline and Punish, “Panopticism,” in which he expounds the disciplinary mechanism at play within the plague-stricken town. He writes, “The registration of the pathological must be constantly centralized. The relation of each individual to his disease and to his death passes through the representatives of power, the registration they make of it, the decisions they take on it.” At once banishing the plague victim to lazaretti and implementing regimented, hierarchical, and dispersed surveillance and registration strategies, Milan predates Foucault’s nineteenth century fusion of the leper’s exclusion and the plague-victim’s discipline. Yet, not until the Ospedale Maggiore’s conception was this fusion fully realized within a single architectural object.
Duke Sforza, wrestling power over Milan from the republic, secured his success, in part, by arriving at a time in which plague and famine devastated the city and its resources. The Ospedale Maggiore, founded in 1456, emerged amid this century of disease and debate over the use and abuse of charitable funds and hospital legacies. In an effort to assert his dominance over Milan’s monastic institutions and the residual Ambrosian Republic, Francesco Sforza determined to construct a building that simultaneously completed efforts at centralizing Milan’s hospitals, while symbolizing the benefits of Sforza rule. Proceeding with the grand hospital’s construction required Sforza to resort to nominating his own half brother as archbishop, making impossible financial promises to rectors, and exploiting Pope Pius II’s cry for help during his Turkish crusade program. This centralizing movement impacted the city’s topography, which in turn fed back into the symbols and knowledge that produced notions of contagion. With the various political elements in order, Sforza commissioned an architect to draw up the building’s spatial dimensions.
Contagion, as a Renaissance concept, was the product of the representations of space propounded by medical professionals, civic authorities, and even contemporary architectural treatises. Edward Soja defines this prong in Lefebvre’s trialectic as, “’dominating’ spaces of regulatory and ‘ruly’ discourse, these mental spaces, are thus the representations of power and ideology, of control and surveillance…[and the] primary space of utopian thought and vision.” Fourteenth-century plague tractates, like Pietro Curialti da Tossignano’s Consilium pro peste evitanda, maintained Galenic principles involving proper balance between an individual and her humors, and, importantly, the avoidance of humid and putrid air. They inscribed medical ideology into Milan’s social fabric, informing architectural treatises and the ways in which people negotiated the built environment. Indeed, John Henderson relates, “It was believed that disease could actually be created in the air through the escape of noxious fumes into the atmosphere from the ‘putrefaction of things and matter,’” and, therefore, architects emphasized a building’s height to promote a safe, ventilated atmosphere for humans to heal and thrive. Olfactory sensations not only signaled disease’s presence, but also served as vehicles for transferring disease between individuals and contaminated spaces. As such, they collaborated with other factors to produce spacious hospitals, like the Ospedale Maggiore, and other ideological representations of space.
Spatializing Galenic principles in his De Re Aedificatoria, Alberti expresses the importance of maintaining separation and proper circulation within a building. He opts for “healthy places, with wholesome breezes and the purest water, so that the rate of recovery would be enhanced by a combination of divine assistance and local benefits.” Subscribing to the view that proper architecture conditions the bodies and souls that it houses, Alberti’s formulations provide a representation of space in which one ought to separate the diseased from the pure, subjecting both to architectural mechanisms that either distance one from the other or promote circulation and Aristotelian means to balance and transform bodies. He proceeds, “those with contagious diseases should be kept well away not only from the city but also from any public road,” and, “In addition, the women, whether patients or nurses, should be kept apart from men.” Controlling contagion, Alberti suggests, requires excluding its source, barring it access to the city’s network through spatial distance and obstructing public roads. Contagion’s space, moreover, remains isomorphic with the chaste female’s position within the private house: containment and privatization promote and sustain order. Eunice Howe notes, “[Alberti] groups women together, regardless of physical condition and occupation, as though their gender alone carried the seeds of contamination.” Medicalizing the female and subjecting her to containment and control equates diseased and contagious bodies with women’s bodies. Mark Wigley holds that Alberti’s preoccupation with hygiene and separation exceeds the desire to avoid plague-like contagion. He writes, “[Alberti] is concerned to control the refuse of the body by isolating it from the building because it literally threatens the structure of the building, both its physical structure (urine, for example, is to be channeled away from walls because it deteriorates them) and its abstract order.” This identifies a further extension within the woman-contagion group: the body and its excrement. Alberti’s treatise employs architectural organization to enact Renaissance ideals that promote the masculine soul’s detachment from the body—or, the detachment of the body from architecture—thereby achieving a false sense of immaterial purity by symbolically distancing abject and feminine materiality. Filarete’s Treatise on Architecture performs a similar, yet different distancing act. I turn first to his conduit system, which I imbue with symbolic meaning in light of the above discussion and Georg Simmel’s “Bridge and Door.”
In his 1997 short essay, “Bridge and Door,” Georg Simmel distinguishes between two architectural and aesthetic representations of the human will: the bridge and the door. Simmel’s bridge visually represents the desire to unify separate, mentally constructed entities, while his door “becomes the image of the boundary point at which human beings actually always stand or can stand.” Beyond their mere functionality within perceived space, the bridge and door codify into spatial representations, or a “visualizing of something metaphysical,” within human synthetic apparatuses. I propose analyzing the conduit as an altogether different aesthetic manifestation; rather, the conduit is a kind of anti-aesthetic. If the bridge “becomes an aesthetic value insofar as it accomplishes the connection between what is separated…in making it directly visible,” the conduit renders separate what, in reality, is continuous and fluid by making it invisible. It presents itself as a hole in a wall, a void from and into which objects appear and disappear, disconnected from their unified origin. Instead of arresting the “physical and mental life process in which the reality of humankind takes place,” the conduit’s representation enacts a false freedom, permitting the bifurcation between subject and object. As with the door, the conduit gains its metaphysical weight in relation to the wall. Precisely because of its hidden structure behind an unstructured wall, the conduit achieves its disappearing/appearing act that lies at the core of its “teleological emotion.” Cashing out the present detour, I turn Filarete’s Ospedale and explore its power relations with respect to invisible and visible structures.
Filarete’s Treatise on Architecture devotes unprecedented energy toward articulating the building’s hydraulic sanitary network. Not only does he note the utilitarian value in the site’s proximity to the city’s moat, he proceeds to position and measure each braccio in accordance with a given space’s relationship to the internal waterways and gravitational force that drive them. He ensures the reader, “No bad odor whatsoever can be caused, because [the canals] are so well arranged that they are always covered and always washed and cleaned by the water.” Indeed, he elaborates a vertical hierarchy to the tune of contemporary medical practitioners’ Galenic concepts. Seemingly untainted rainwater falls from the sky and into canals that line the walls, purifying what would otherwise remain stagnant, vile cesspools. At the same time, Filarete positions apertures between patients’ beds, which “communicate” with vaulted latrines that carry bodily waste down, past the corpses, and out to the building’s exterior. Spiracles penetrate the conduits, enabling bad odors to freely flow up and out the building’s roof. A hidden structure, fluid, yet contained, labors behind walls to purify the hospital and its inhabitants. It encompasses, contains, and renders detritus invisible by subjecting it to a highly ordered and rational hygienic system, an architecture hidden to perceived space. As Wigley explains, “By detaching architecture from the body, these [sanitary] services make the representation of immaterial order possible.” Closeted conduits enact a privatization, or separation, that purifies the hospital inasmuch as they divide masculine, immaterial purity from feminine materiality. However, Filarete’s ideal representation of space contradicts the hospital’s perceived space. An issue stemming from rainwater and sewage damage in the walls’ vents “may have been one of the causes of Filarete’s falling out with the Ospedale’s committee, or deputies, and the grounds for criticism by rival Lombard architects and engineers.” The utopic project to separate the body from the soul through division and containment ultimately proved futile, indeed perilous, as material refuse eroded the buildings’ structures, both physical and symbolic. The building’s walls, more porous than the humanist architect wanted to believe, no longer upheld its masking role.
Similarly, Filarete clothes his hospital under the guise of spatial equality between the sexes, while women negotiate a perceived space that consists in labor to purify and maintain the hospital. He writes, “There is another place for the children who are to be educated [in the women’s ward], and this is ordered in such a way that no man can enter without permission. In another [arm] there are the places necessary to the hospital, a kitchen, laundry, baths, and other things.” Eunice Howe, in “The Architecture of Institutionalism,” meets Filarete’s “separate, but equal” representation with warranted skepticism, explaining, “the open areas abutting the female cruciform accommodate messy business such as the care of orphans and hospital maintenance that would have crammed these spaces with what was classified as women’s work.” Filarete’s double crucifix, “the hall-mark of his design,” masquerades as a clean break from patriarchal dominance, but the symbol crumbles under closer scrutiny. For instance, Filarete employs the same iron grating design that denies access between women and priests to contain and separate the hospital’s dead bodies. He equates, as does his contemporaries, women’s bodies with the abject materiality that parallels contagion theory through the representation of an iron grating. Women in his ideal Ospedale are subsumed under the same purifying, laborious, and hidden structure that courses behind the void in the wall. Women never inhabited their cruciform ward; instead, they crammed into one arm from the men’s side, rendering more tangible, or visible, the hidden patriarchal disparities behind Filarete’s “equalizing” act. Again, the Ospedale’s perceived space diverges from its representations of space, divulging symbolic, and always precarious, power regimes.
Filarete’s conduit system performs a disappearing/appearing act that produces an ultimately unstable division between masculine immateriality and feminine materiality. A century of plague, hospital and hygienic reform, and developing cultural values, like piety and charity, formed a space in which contagion theory was mapped onto Renaissance gender constructs and enacted in representations of space. Alberti’s and Filarete’s treatises seek to closet away, or privatize, perceived danger in the form of a female-disease-detritus complex through structural organization and separation. The bodily realm threatened the very structure of the building, which required separation and containment to defend its symbolic status. Filarete staged this program in his utopic plans for the Ospedale Maggiore, constructing complex waterways, which undoubtedly offered practical, utilitarian ends. Given my understanding of the conduit in relation to Simmel’s work, however, Filarete’s hygienic waterways present themselves in perceived space as a void in the wall into which materiality disappears and appears, but always disembodied. I call this an anti-aesthetic to emphasize that its visual representation does not contain the whole picture; indeed, it forgoes arrest in favor of false freedom. This mechanism further divides masculine immateriality and feminine materiality, which helps shed light on Filarete’s division among the sexes. Here, too, one witnesses a disappearing act, as Filarete’s double cruciform plans render invisible an inequality between the sexes and their spaces. Filarete’s conduit system eroded the Ospedale’s walls, and his equal and separate spaces never came to fruition. Instead, within perceived space, both crumbled to the ground under their unstable ideological structures.
Alberti, Leon Battista. On the Art of Building in Ten Books. Cambridge, Mass: MIT Press, 1988.
Carmichael, Ann G. “Contagion Theory and Contagion Practice in Fifteenth-Century Milan.” The University of Chicago Press on Behalf of the Renaissance Society of America 44, no. 2 (Summer 1991): 213–56.
Filarete. Filarete’s Treatise on Architecture. Vol. Volume 1: The Translation. New Haven and London: Yale University Press, 1965.
Foucault, Michel. Discipline and Punish: The Birth of the Prison. 2nd Vintage Books ed. New York: Vintage Books, 1995.
Henderson, John. The Renaissance Hospital: Healing the Body and Healing the Soul. New Haven, Ct: Yale University Press, 2006.
Howe, Eunice D. The Architecture of Institutionalism: Women’s Space in Renaissance Hospitals. Edited by Helen Hills. Women and gender in the early modern world. Aldershot: Ashgate, 2003.
Lefebvre, Henri. The Production of Space. Nachdr. Malden, Mass.: Blackwell, 2011.
Mateer, David. Courts, Patrons and Poets. Edited by The Open University. The Renaissance in Europe, a cultural enquiry / The Open University ; 2. New Haven: Yale Univ. Press, 2000.
Simmel, Georg. “Bridge and Door.” In Rethinking Architecture, 66–69. New York: Routledge, 1997.
Soja, Edward W. Thirdspace: Journeys to Los Angeles and Other Real-and-Imagined Places. Cambridge, Mass: Blackwell, 1996.
Welch, Evelyn S. Art and Authority in Renaissance Milan. New Haven: Yale University Press, 1995.
Wigley, Mark. Untitled: The Housing of Gender. Edited by Beatriz Colomina and Jennifer Bloomer. Princeton Papers on Architecture 1. New York, N.Y: Princeton Architectural Press, 1992.
 Henri Lefebvre, The Production of Space, Nachdr. (Malden, Mass.: Blackwell, 2011), 76.
 Filarete, Filarete’s Treatise on Architecture, vol. Volume 1: The Translation (New Haven and London: Yale University Press, 1965), 137.
 Evelyn S. Welch, Art and Authority in Renaissance Milan (New Haven: Yale University Press, 1995), 125.
 Ann G. Carmichael, “Contagion Theory and Contagion Practice in Fifteenth-Century Milan,” The University of Chicago Press on Behalf of the Renaissance Society of America 44, no. 2 (Summer 1991): 215; Welch, Art and Authority in Renaissance Milan, 126.
 Welch, Art and Authority in Renaissance Milan, 126.
 Carmichael, “Contagion Theory and Contagion Practice in Fifteenth-Century Milan,” 215.
 Ibid., 218.
 Michel Foucault, Discipline and Punish: The Birth of the Prison, 2nd Vintage Books ed (New York: Vintage Books, 1995), 196-197.
 Eunice D. Howe, The Architecture of Institutionalism: Women’s Space in Renaissance Hospitals, ed. Helen Hills, Women and gender in the early modern world (Aldershot: Ashgate, 2003), 64.
 Welch, Art and Authority in Renaissance Milan, 136.
 Ibid., 137.
 Edward W. Soja, Thirdspace: Journeys to Los Angeles and Other Real-and-Imagined Places (Cambridge, Mass: Blackwell, 1996), 67.
 Carmichael, “Contagion Theory and Contagion Practice in Fifteenth-Century Milan,” 226.
 John Henderson, The Renaissance Hospital: Healing the Body and Healing the Soul (New Haven, Ct: Yale University Press, 2006), 158.
 Leon Battista Alberti, On the Art of Building in Ten Books (Cambridge, Mass: MIT Press, 1988), 130.
 Ibid., 130–31.
 Howe, The Architecture of Institutionalism: Women’s Space in Renaissance Hospitals, 66.
 Mark Wigley, Untitled: The Housing of Gender, ed. Beatriz Colomina and Jennifer Bloomer, Princeton Papers on Architecture 1 (New York, N.Y: Princeton Architectural Press, 1992), 344.
 Georg Simmel, “Bridge and Door,” in Rethinking Architecture (New York: Routledge, 1997), 66–69.
 Ibid., 69.
 Ibid., 67.
 Filarete, Filarete’s Treatise on Architecture, Volume 1: The Translation, 137.
 Ibid., Volume 1: The Translation, 138.
 Ibid., Volume 1: The Translation, 144.
 Ibid., Volume 1: The Translation, 138.
 Wigley, Untitled: The Housing of Gender, 344.
 David Mateer, Courts, Patrons and Poets, ed. The Open University, The Renaissance in Europe, a cultural enquiry / The Open University ; 2 (New Haven: Yale Univ. Press, 2000), 110.
 Filarete, Filarete’s Treatise on Architecture, Volume 1: The Translation, 143.
 Howe, The Architecture of Institutionalism: Women’s Space in Renaissance Hospitals, 71.
 Filarete, Filarete’s Treatise on Architecture, Volume 1: The Translation, 141.
 Howe, The Architecture of Institutionalism: Women’s Space in Renaissance Hospitals, 72.