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1. The Hospital for the Incurable (directly below)    2.  Public Health & Hospitals under the Bourbons
                                                      3. Vaccinations in Naples under the Bourbons

1.
Charles VIII of France invaded Naples in the late 1490's. This attempt to take over southern Italy failed, and he was sent packing back to France. The kingdom of Naples then became part of the Spanish Empire for the next two centuries. The French left a small gift in Naples. It is called "the French disease" by Neapolitans. (Yes, I am aware that the French call it "the Neapolitan disease". At the time, the Neapolitans also called it the "Spanish disease"; Russians have called it the "Polish disease", and the Muslims have called it the "Christian disease".) Dispensing with jingoist slander, doctors call it treponema Pallidum, and thanks to a poem published in 1530 by Girolamo Fracastro about a poor shepherd with the disease, the rest of the world just calls it "syphilis".

The disease was so deadly that those who contracted it were considered beyond help and there arose almost simultaneously throughout Italy a number of institutions for those afflicted —the incurable. One of the first and best-known of these hospitals still stands today as a modern medical facility in Naples. It is the church/hospital complex of Santa Maria del Popolo degli Incurabili located one block into the old historic city from the Porta San Gennaro entrance at Piazza Cavour.

The "Incurabili" was built in 1521. The construction was the direct result of the work and influence of a Catalonian woman, Maria Longo, wife of one of the first Spanish viceroys in Naples. She was stricken with paralysis in the early 1500s; she was miraculously cured, and devoted the rest of her life to caring for the ill. The hospital grew as a church/hospital complex around a nucleus of small monastic communities all founded at the bidding of Maria Longo, who, herself, guided the work and administration of the "Incurabili" until shortly before her death in 1541.

The hospital was the first institution of its kind in an area of Naples that centuries later would become a modern hospital zone, the "Polyclinic" of Naples, housing a medical school, as well; many medieval buildings were razed to make room for the new medical facility, and, as well, some older buildings were converted to hospital use, chiefly the massive monastery of Sant'Andrea delle Dame at the very top of the hill above the "Incurabili". The "Incurabili" was originally larger than the hospital one sees today, having spread down the slope to the northern walls of the old city. That section was destroyed by bombardment in WW2, and in that breached section of wall now stands one of the ugliest buildings in Naples, the gigantic Salvator Rosa High School, a gray cement monolith so tall that from across the street at the National Museum, you'd never guess there was a hill behind it at all.

The "Incurabili" is still a hospital and because of its religious origins it houses a number of works of art by prominent artists of the Neapolitan Baroque, such as Belisario Corenzio (1568-1643). The facility also bears the signs of the large-scale reconstruction of 1730, designed by Domenico Antonio Vaccaro, the architect responsible for better known things in Naples, such as the spectacular courtyard of Santa Chiara. On the premises, as well, is a very interesting historical pharmacy (photo, above), the result of construction done in 1750. Of interest are the 400 unique jars and vases used in the pharmacy in the 1700s, as well as the majolica floor tiles. (As of this writing —August 2004— the pharmacy is being restored and is not open to the public.)

There is a very long list of notable doctors and humanitarians connected with the "Incurabili" hospital. Worthy of note most recently is Giuseppe Moscati (1881-1927). He was an early experimenter in the use of insulin to combat diabetes (from which he, himself, suffered); he was a prominent lecturer in medicine (a position that he gave up in order to devote more of his time to direct contact with patients); he was active in providing for victims of the great 1906 eruption of Vesuvius as well as in caring for the thousands of WW1 wounded sent to Naples for care. His benevolence was proverbial. Moscati was beatified by the Roman Catholic Church in 1975 and canonized in 1987.

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update: June 2014                          It will help to read the item above this one


2. Public Health and Hospitals under the Bourbons
That was the title of an essay by Gigi Di Fiore that appeared in April in the pages of the Neapolitan daily, Il Mattino. It calls attention to a fine exhibit of that same name running through mid-July on the premises of the Incurabili, the hospital described in item #1, above. The exhibit displays period medical instruments, documents and books on the state of public health during the Bourbon period (1735-1860). The exhibit is the brainchild of prof. Gennaro Rispoli, who has dedicated himself to rediscovering the history of the medical profession in Naples and in southern Italy in general.

Di Fiore makes the point that the idea of public health and hospitals was born with donations, primarily from religious sources, benevolent acts from noble families who "thus hoped to gain a piece of Paradise." That is why many of these sanitary structures had their beginnings on the premises of ancient monasteries and convents. In Naples these early hospitals were in the center of the old city and go back to the times of the Spanish vice-realm (1500-1700). Many of them still exist as working hospitals and may be visited, such as Incurabili, Pellegrini, Hospital della Pace, Ascalesi and Elena d'Aosta.  Further, "Naples was a city of doctors, innovative and experimenters in their fields: Domenico Cotugno, Domenico Cirillo, Antonio Sementini, Michele Sarcone, and, later, Camillo De Meis, Pietro Ramaglia, Francesco Semmola, Vincenzo Lanza, and Ferdinando Palasciano. "They brought with them the culture of the Enlightenment, had the support of the royal court and were open to new ideas." The exhibit at the Incurabili puts particular emphasis on that hospital. Colleagues came from elsewhere in Europe to see how the Incurabili handled obstetrics and urology. Here is where they used the first catheters, experimented with electrical analysis equipment and did pioneering work in forensic medicine and autopsies.

Ferdinand IV of Bourbon (king of Naples from 1759-1825) was among the first to tout the benefit of vaccination against small-pox. He and his queen consort, Maria Carolina, set the example for their subjects by getting vaccinated in order to convince them that there was no danger. In 18 years in the Kingdom of the Two Sicilies, there were two million such vaccinations. Central hospitals in the kingdom grew in number to 80. At the Incurabili,  there were three clinics: Obstetrics, Surgery and Ophthalmology plus the large and sumptuous Pharmacy (photo in the above entry). The Incurabili, as well, functioned as a mental hospital until 1812 when a special facility was built in Aversa . There were 23 doctors and 10 surgeons at the Incurabili making daily rounds. They were hired by examination after getting a degree in medicine, attested to by a certificate signed by the king. Upon the unification of Italy, those doctors were required to be re-certified through another exam. The new conqueror kingdom and unifier of the nation, the northern house of Savoy, demanded it of the defeated south. "Humiliating," says Di Fiore. Indeed.

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vaccines        added Jan 19, 2020 

First, Italy now has a science champion with a vengeance who has become a celebrity by fighting vaccine skeptics. He is Roberto Burioni, a virologist in  Milan, Italy. He showed up on a TV talk show to face off against two opponents of vaccines —a DJ and an actress. Burioni started simple and stayed that way: "The Earth is round, gasoline is flammable, and vaccines are safe and effective," he said. "All the rest are dangerous lies." A radio journalist called Burioni's rebuttal to the anti-vaccers "the most beautiful words heard on TV in the last year."

Disclaimer: This is not medical advice. If you are worried about smallpox, cowpox, chickenpox, bubonic plague, polio, tetanus, hepatitis, measles, leprosy, influenza, or any of the many preventable (or potentially preventable) infections or maybe just have a nasty boo-boo, please go to a doctor.

Specifically this entry is in reference to the last paragraph in the entry (just above the dotted line ) on health conditions and care in the old Kingdom of Naples. The line reads:

Ferdinand IV of Bourbon (king of Naples from 1759-1825) was among the first to tout the benefit of vaccination against small-pox. He and his queen consort, Maria Carolina, set the example for their subjects by getting vaccinated in order to convince them that there was no danger.

added Jan 22, 2020: (A sad note in this is that the king's personal physician —the one who gave him the vaccination!— was Domenco Cirillo (noted in the entry above this one), one of the true intellectual flowers of the French Enlightenment in Europe. He was a natural scientist, an acclaimed physician, a botanist and was widely respected and published. When the Neapolitan Republic overthrow the Bourbon monarchy, he was one who stayed in Naples to support the Republic. When the Bourbons returned a few months later, they hanged him.)

A medical professional I know questioned that date on vaccinations, wondering if it could be accurate given the state of what science then knew about what really causes diseases and presumably about how to cure them. Fair question. Perhaps there is an analogy in astronomy: for many thousands of years, mariners navigated the seas by watching the stars, astronomers devised functional calendars and accurately calculated even such things as the precession of the equinoxes -- all that, based on the "fact" that the sun goes around the earth. You can get a lot done even with facts that turn out not to be so "facty". It's a limited but useful and pragmatic way to get things done. Mariners sailed the seas and around the world long before they knew where they were in terms of longitude. They knew approximately where they were. They counted knots on a string.

And so it is with medicine. Sometimes you know, but sometimes you're just counting knots. The story about the king and queen of Naples getting vaccinated in the late 1790s is counting knots, but it really happened. By then, they knew in Europe that you didn't have to get smallpox. You could do something to stop it.

Because you live in the glorious 21st century, you may know the modern terminology: a vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future. Vaccines can be prophylactic (to prevent or ameliorate the effects of a future infection), or even therapeutic (such as possible vaccines against cancer).

They didn't know all that in the 1700s, but they did know that if you got some of that gunk from the pustule of a diseased cow in your system you wouldn't come down with what was killing thousands people. Edward Jenner (1749 – 1823) an English physician who was a contributor to  the smallpox vaccine popularized its use. In Jenner's time, smallpox killed around 10% of the British population, with the number as high as 20% in towns and cities where infection spread more easily.

Vaccination and inoculation are not exactly the same, but they are close enough for this brief comment, since my only purpose in this comment is to show that what the king and queen of Naples did in 1798 is easy to verify and not even that unusual. The practice is documented in America as early as 1721. There are reports at about the same time of inoculation in the Ottoman empire and, indeed, as far back as the tenth century in China (although that one is more difficult to verify).  Inoculation was impressively effective against a great scourge throughout much of the 1700s. Inoculation spread, unsurprisingly, first among the royal families of Europe, and was then followed by more general adoption among the people. All this without knowing how or why it really worked.

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