A small town of the dead hides in a crypt beneath the Ospedale Maggiore, a public hospital in central Milan, where, from 1637 to 1693, the bodies of around 10,000 patients were dumped and buried. Created in 1456, the establishment, nicknamed the Great Factory, had a mission: to provide aid to the sick and injured, particularly the poorest.
“Unlike religious institutions of the time, it welcomed people of all ethnic origins or religions, marking a significant shift towards a more universal approach to healing,” explains historian Folco Vaglienti, of the University of Milan.
In 2018, bioarchaeologist Mirko Mattia of the University of Milan and a research team began examining the remains of the tombs. Since then, they have studied the bones found in the crypt to better understand the health, diet and drug use of the inhabitants of Milan in the 17th century.
The medical services of the Grande Fábrica, with pioneering treatments and therapies, were unparalleled throughout Europe. Its four wings were built around a central church, the Chiesa della Beata Vergine Annunziata, providing thousands of patients with specialized care in separate wards for fractures, tuberculosis and other ailments.
The hospital was equipped with its own infrastructure, including a sewage system, kitchens, laundry and pharmacy. In the 17th century, a crypt was built under the church. Made up of 14 chambers all measuring approximately 2.1 meters high, the tombs cover an area of over 362 square meters.
The burial chambers formed a sort of underground cemetery for the poor. After a granite cover was removed from one of the holes in the church floor, the bodies were dumped into one of the brick-lined graves. Over time, the corpses piled up and formed a funnel-shaped pile.
These remnant pyramids grew over time, widening at the base and narrowing until reaching a point at the top. When they reached the ceiling and could no longer receive any more bodies, a new underground crypt was used.
Unlike the lower layers, which contained individual skeletons, the upper layers were a chaotic mixture of bones from numerous patients, as well as a dark, dirt-like residue of human tissue and microscopic bone dust. This mess was due to the prolonged use of the crypt and the hospital’s constant struggle to make room for more bodies.
By combining patient records from the Great Factory with the city’s Mortuorum Libri, a death record held in the State Archives since 1451, the research team discovered that the ossuary contains the remains of men and women of all ages, from fetuses to elderly people. Early estimates suggest a high number of men.
The initial purpose of the crypt was thwarted by its environment. It was intended to serve as a holding place for corpses until they were decomposed enough to be transferred to a cemetery on the outskirts of town. But decomposition was hampered by high humidity and poor ventilation, the result of periodic flooding and proximity to an aquifer.
Several factors led to the closure of the crypt in 1693: the unusual conservation of corpses in cold and damp rooms; challenges related to their recovery; and a smell so repulsive that it made the nuns in the church faint. In 1697 a new burial site was opened, the Rotonda della Besana, which remained in operation for half a century.
Researchers from the hospital and the University of Milan began examining the tombs in 2010; excavations began eight years later. Artifacts were rare; In its time, the Great Factory was known for selling the clothing and other goods of the dead. Mattia and his colleagues were then surprised to discover under the skeletons a set of five 400-year-old gold coins from Venice, Spain and France.
Mattia ruled out the possibility that the money came from a pocket or purse; dead patients were stripped naked and wrapped in sheets before being lowered into the rooms. He theorized that a street vendor, fearing being robbed while hospitalized, had swallowed the loot, a fatal attempt at a cover-up.
“What makes this strange is that the Big Factory only treated the most deprived,” explains Mattia. “Before being admitted, patients went through a screening process in which they had to provide documentation of their poverty and declare: ‘I am poor.’
Robert Mann, a forensic pathologist at the University of Hawaii at Manoa who examined the Great Factory crypt but is not a direct participant in the study, says the site provides a more complete picture of the history and evolution of trauma, medical treatment, infectious diseases and survival rates of that period.
Mattia says analysis of more than 300,000 of the crypt’s approximately 2 million bones revealed a population of patients suffering from disease and malnutrition. There was evidence of surgeries, autopsies and treatments using lead, mercury and other heavy metals. There were also traces of drugs, including Cannabis and coke.
Fossilized plaque on the teeth provided clues to the patients’ diet, which included common grains such as wheat, barley, sorghum, rice and millet. It also contained potato starch, highlighting the early influence of New World foods, and spores of horsetail, a fern with green, non-flowering stems that can be toxic in large quantities. This discovery confirms contemporary accounts of people who, desperate from hunger, ate grass and died with their mouths dyed green.
“We know more about the commoners of ancient Rome than we do about the average person in the 17th century,” says Mattia. “History tends to focus on major political and military events, ignoring the lives of ordinary citizens.”
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