Welfare in an Italian City-State: Siena and the Hospital of Santa Maria della Scala
By Ann Katherine Isaacs
The Welfare State: Past, Present, Future, edited by Ann Katherine Isaacs (University of Pisa, 2001)
Introduction: This chapter traces the history of a significant welfare institution, the Spedale di Santa Maria della Scala (“Hospital of Saint Mary of the Stair”) over a very long period of time – nearly 1000 years. In a volume which aims at bringing historical perspective to bear on current strategic issues, in this case the welfare state and its future, it seems useful to ask whether and how the needs which the welfare state is intended to satisfy were dealt with in earlier times.
Often we find it said that the welfare state took over functions that were carried out formerly (inadequately) by the family or the church. This is an oversimplification. Not only in contemporary Europe and in antiquity, but in the middle ages and the early modern period as well, European cities and states directly assumed complex functions in order to care for the ill and the needy, to organise provisioning and deal with personal and collective emergencies: famine, dearth, plague, siege and natural disasters – and they too built up or lost political consent in the process.
The case which we will examine here, that of the principal welfare institution of the Tuscan republic of Siena, for many centuries constituted a successful and constantly evolving model, first church-based, then run by a lay order, later directly governed by the city itself. Subsequently it continued to carry out welfare functions in novel political and welfare frameworks as Siena became part of larger state structures: the Grand Duchy of Tuscany, the Napoleonic Empire, the Kingdom of Italy and, finally, the Italian Republic in its European context.