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A bit of history of healthcare in Lombardy: interview with Paolo Galimberti

Interview with Paolo Galimberti, archivist and head of the Policlinico Hospital Museum of Milan. 

MGM. Dr. Galimberti, in your opinion, how much do you think the Lombard and Milanese health care today must recognize to the history of the past centuries?

PG. Certainly if we have reached the current eminent levels in our region (as in others in Italy) this is also the result of a long history, in which we have always aimed high. Bonvesin de la Riva himself, writing around 1288, says the surgeons of Milan are “excellent because they continue to practice by ancient family tradition” so much so that “it is believed that they cannot have the same in other cities in Lombardy”. Obviously, looking at the past, the differences with the present are innumerable, and we must also take into account a very long period from the Middle Ages to today, but we must certainly recognise a continuity and deep roots.

MGM. The Policlinico hospital in Milan, when and how was it born, who were the financiers and the “governance”?

PG. The current Policlinico Ospedale Maggiore has its origins in the reform of the mid-fifteenth century which, on a Tuscan (mainly Sienese) model, saw the concentration in a single institution of numerous hospitals already existing in Milan since the ninth century. Francesco Sforza and Bianca Maria Visconti in 1456 donated the resources to complete the reform (on which they had been working for a long time) and build the Ca’ Granda. The entity, secular, is governed by administrators of civic appointment. Since the Middle Ages hospitalia and xenodochia (free hospices for strangers and pilgrims) have been pious institutions assisting the needy free of charge. Until the modern age the criterion for admission was the state of poverty: the wealthy people could have assistance at home or pay for a doctor. Consider the ever-present relationship between poverty and morbidity/mortality. The considerable costs for this free care (always borne by the city’s charity, still today when public intervention exists) are to be considered an intelligent investment in the health of the population, of the whole population.

With the 20th century the fantastic advances in medicine, in surgical technique, in hygiene have meant that treatments of a certain level can only be provided in a hospital: who can have an X-ray machine or a CT scan at home? But even maternity, a natural fact, can only take place in a hospital and minimize the risks.

MGM. When was the Lazzaretto built?

PG. When we talk about treatment it is immediate to think of hospitals, but we must also consider the city’s health regulations, which have been attentive to the wellbeing of the population since the Middle Ages; here too: a healthy urban environment makes people more resistant to disease: from the hygienic regulations of the statutes of the twelfth and fourteenth centuries, to the building regulations of the late nineteenth century and the construction of healthy neighbourhoods in the twentieth century. Here, too, the investment in the health of citizens is largely repaid.

Clear and rigorous provisions become vital in periods of epidemics and plagues, constantly recurring with relentless frequency: 1348, 1350, 1361, 1371-74, 1387-88, 1399-1400, 1422-25, 1430, 1451, 1467-68, 1476-79, 1483-86, the epidemics of Vaiolo, petechial typhus and cholera of the nineteenth century, the “Spanish” of 1918. Like Venice, Milan also has a Magistrate of Health.

The plague, with an unimaginable speed of contagion and mortality, was the obsession of past centuries, even though we are used to a mortality rate for illnesses much higher. Francesco Sforza, recently Lord of Milan, had to face it immediately in 1451: from that experience was born (first in the world) the series of the Registers of the dead, to evaluate, by the “Catelano” the coroner, the cause of the deaths and immediately give the alarm in case of plague.

In 1483, another plague made it impossible to postpone the realization of a Lazzaretto, in fact, the hospital of San Lazzaro, built in 1087 for lepers and then destined to the infectious, could not withstand the impact of thousands of hospitalized patients. In 1488 the construction of the Lazzaretto began at Porta Orientale in 1488: a huge enclosure of almost 400 metres per side, with 280 rooms and an area that could host temporary structures, made famous by Manzoni’s description in his Betrothed.

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Epidemiologist and counselor – 30 years of professional life in health care. Classic humanistic background, including the study of Latin and ancient Greek, followed by scientific academic studies, chemistry and pharmacology. First years of career, in private international environment. I worked in medical research, moved to health care organization, getting academic specialization in Epidemiology. Later, in consultancy and health care education. Counselor with transactional analysis orientation. Currently, director of Innovation in Health Care Area of Fondazione ISTUD, an independent not for profit Italian Business School with an humanistic approach acknowledged by the Italian Ministry of Researech.. Active member of the board of Italian Society of Narrative Medicine, tenured professor of Narrative Medicine at Hunimed, Milan, and in 2016, referee for World Health Organization for “Narrative Method in Public Health.” Writer of the book; “Narrative medicine: Bridging the gap between Evidence Based care and Medical Humanities,” edited with Springer and of international publications on narrative medicine in scientific journals. Last book “The Languages of care in narrative medicine: words, space and sounds in the healthcare ecosystem”. Lecturer in different international contexts from Academy to Public and Private Foundations.

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