Organisational and accounting change at the Great and New Hospital of Palermo: Enlightenment reforms and institutional logics in early eighteenth-century Sicily

Abstract

The 1722 renovation of Palermo's Great and New Hospital marked Sicily's first modern healthcare reorganisation, departing from mediaeval models. Using archival sources and the institutional logic lens, this study examines the evolution of accounting at this hospital in the early Enlightenment, providing richer information for decision-making. The merchant rector played a key administrative role within the hospital. This was because the merchants held significant influence over the governance of Palermo. This renovation occurred within the Italian Enlightenment, initially under the House of Savoy and later the Austrian Habsburgs, predating Bourbon-era studies in the European context.

Keywords

accounting change institutional logics hospital Palermo eighteenth century

Introduction

Since the 1980s, numerous studies have shown that accounting and its environment influence each other (Hopwood, 1987; Hopwood and Miller, 1994). For this reason, historical research requires the contextual analysis of the social, economic and political factors of the period under investigation (Previts and Bricker, 1994) and shows that changes in accounting techniques are linked to wider social changes (Bhimani, 1994; Carmona et al., 2004; Miller, 1991). Consequently, accounting may be studied within its social perspective, due to its role as creator of thought structures in its environment. This article studies how the change in the accounting of the Great and New Hospital of Palermo (hereinafter, GNHP) was facilitated by the new enlightened ideas of the eighteenth century (Scott, 2001). Besides, we will see that this change may be explained by the change in the political, professional, social and managerial institutional logics (Anessi-Pessina and Cantù, 2019; Besharov and Smith, 2014; Conrath-Hargreaves and Wüstemann, 2019; Maran and Lowe, 2022; Thornton et al., 2012).

The article reconstructs the GNHP in the first quarter of the eighteenth century as a key moment in the process of rationalising the city's welfare system. According to Carmona et al. (2004), the conclusion is richer if we focus on the breaking points. Therefore, the article analyses the changes that took place in the hospital according to the institutional logics at a key historical moment in Sicily, the 1720s. Furthermore, the research shows that the change in accounting was a consequence of the reformist movements characteristic of the Enlightenment, which ultimately aimed to improve the happiness of the population (Sarrailh, 1957).

Moreover, the reform of the GNHP regulations during this period coincided with a transitional period in Sicilian history. At the end of the War of the Spanish Succession (1701–1713), Sicily was ceded to the Duchy of Savoy (under the reign of Vittorio Amedeo II) by the Treaty of Utrecht (1713), but in 1720 the Crown of the Kingdom of Sicily passed from the Savoys to the Austrian Habsburgs as a final adjustment following the Spanish War of Succession. In this phase, the organisation of the hospital was redesigned according to the institutionalised principles of the Enlightenment. The municipality, the main funder of the hospital, tried to develop the management of the hospital by improving its control mechanisms, and these changes can be explained by the rational principles of the European Enlightenment that were emerging on the continent.

The period of study of the hospital begins with the promulgation of a decree in 1722 for its organisational and accounting transformation. This change took place in a turbulent period due to the transfer of sovereignty over the island, first to the Savoy until 1720, and then to the Austrians. The changes in the hospital, therefore, took place in the context of a general reorganisation of the administrative structures of Sicily, which also coincided with a period in which the ideas of the Enlightenment were spreading throughout Europe (Benigno and Giarrizzo, 2003a; Gallo, 1996; Martini, 1907; Sarrailh, 1957). Institutional sociology is used as a theoretical reference lens through which to understand the accounting changes that occurred within the GNHP during this period (Besharov and Smith, 2014; Maran and Lowe, 2022; Scott, 2001).

From now on, the article is structured as follows. The next section presents the literature review on institutional sociology and accounting change. The third section presents some representative studies on management, administrative and accounting changes in hospitals that will allow us to find the gap for the present research. The fourth section describes the methodological approach of the study. Then, it is studied what the hospital system was like in the Middle Ages and the beginning of the eighteenth century (the case study; GNHP section). In the changes in the GNHP in the eighteenth century from the institutional logic section, the changes that happened in the GNHP are analysed from the institutional logic perspective, using the four logics mentioned above. The article ends with a discussion and a conclusion.

Institutional logic and accounting change

Institutional logics refer to the beliefs, norms and practices that guide the behaviour of institutional actors, such as organisations, institutions or individuals, in any context or field of activity. These logics include aspects such as rules, social norms, common expectations and beliefs embedded in institutions and organisations. These logics influence the structure and functioning of institutions and can be determinant of the behaviour of actors within a specific institutional system (Conrath-Hargreaves and Wüstemann, 2019; Scott, 2001). Institutional logics are seen as ‘models’ or sets of ideas, structures and practices that influence the behaviour of actors within a specific field (Besharov and Smith, 2014). These logics are therefore dynamic and can evolve in complex ways over time. Understanding how these logics interact and transform is fundamental to analysing the evolution of institutions and organisations in different contexts.

This perspective adds a political lens to the understanding of how organisations interact with their institutional context. Besharov and Smith (2014) proposed four primary institutional logics: (i) Political Logic, according to which actors guided by this logic are primarily concerned with gaining and maintaining power, advancing their interests and achieving their objectives through negotiation, coalition-building and strategic manoeuvring. (ii) Professional Logic, where actors operating within this logic adhere to professional standards, codes of conduct and disciplinary practices, emphasising the importance of specialised knowledge, skills and credentials in guiding decision-making and behaviour. (iii) Social Logic, according to which actors operating within this logic are guided by cultural norms, values and expectations, prioritising social cohesion, solidarity and collective well-being in their interactions and decision-making processes. And finally (iv) Managerial Logic, where actors operating within this logic are concerned with optimising resource allocation, coordinating activities and achieving desired outcomes through planning, organising, directing and controlling organisational processes and activities.

The concept of institutional logics provides a framework for understanding how organisations are influenced by the broader institutional environment, shaping their beliefs, behaviours and decision-making processes. Managerial logic encompasses the thought processes, decision-making patterns and strategies employed by managers in the pursuit of organisational goals. Understanding managerial logic involves considering how managers interpret and respond to institutional pressures, societal expectations and political dynamics in their decision-making processes (Alsharari et al., 2015). While prior literature emphasises the potential for conflict among institutional logics, this study demonstrates that, in the case of the GNHP, the political, professional, social and managerial logics operated in a complementary and mutually reinforcing manner, a convergence made possible by the shared Enlightenment framework that aligned diverse objectives around the broader aim of rational governance and public welfare. The following section describes how hospital management and accounting have been studied to date and the contribution of this case.

Literature review

The study of hospitals is not new in Accounting History. For example, for the United Kingdom, Howie (1963) wrote a seminal study, for the period 1747–1827, on the case of the Salop Infirmary. The author focused on the administrative-financial description of the hospital. Meanwhile, Berry (1997) studied the reports published by English provincial hospitals between 1765 and 1815. She examined the different approaches taken by hospital directors to finance their institutions. Funnell et al. (2014) and Holden et al. (2009) examined the role of cost accounting at the Newcastle Infirmary, a hospital founded in 1751. The authors find evidence that sophisticated cost accounting systems were used to demonstrate good hospital management. Meanwhile, Miley and Read (2016) studied the London Foundling Hospital. This hospital was a charitable institution established to transform the children of the poor into virtuous members of society. The United Kingdom's voluntary hospitals in the nineteenth century have been studied by Robson (2006). Jackson (2012) analyses the ways in which the managers of the Edinburgh Royal Infirmary utilised the disclosure of the names of charitable givers in its annual reports to encourage philanthropic behaviour during the nineteenth century. The historical emergence and development of accounting practices within the hospital system have been the subject of study by Gebreiter and Jackson (2015), while the transformations led by the National Health Service with a departmental costing system has been studied by Gebreiter (2016). Finally, Jackson et al. (2013) examined the emergence of medical audit in the United Kingdom's hospitals in the twentieth century. The accounting practices of US hospitals during the twentieth century have been studied by Preston (1992).

The findings contribute to the historiography of hospital management by demonstrating that accounting practices in healthcare institutions are not merely technical but are deeply embedded in the socio-political structures of their time. In Italy, the case of the Hospital of Santa Maria Nuova in Florence has been studied by Park and Henderson (1991). These authors made a description of this hospital and its way of running. Bracci et al. (2010) studied the accounting changes at Saint Anna's hospital in Ferrara, changes that were driven by a broader environmental change when the Duchy of Ferrara was transferred to the Papal State in 1598. For their part, Lazzini and Nicoliello (2020) worked on Hospital Galliera of Genoa. These authors show how, in an environment of misconduct, accounting practices are perceived as a government technology that allows the exercise of power.

Some studies have also been carried out on the French hospitals. Lacombe-Saboly (1997) describes hospital accounting practices between the seventeenth and nineteenth centuries in three hospitals and shows how the accounting model adopted was suited to the structure of the hospitals. Baker (2016) studied hospital accounting practices in France during the fifteenth to seventeenth centuries and shows the similarity in accounting practices for two different types of institutional structures. On the other hand, Lapsley and Robbins (2008) examined the success and failure of voluntary hospital organisations in Ireland during the twentieth century and the early years of the twenty-first century. The study shows that many religiously owned hospitals have followed a predictable path to failure, culminating in closure or transfer to public sector ownership.

For the Spanish hospitals, Salvador and Ruiz (2011) studied the administrative organisation and the accounting method used by the Charity Hospital of Coruña in the eighteenth century. The managers of the hospital were accountable to a board of charity. The authors conclude that an incomplete vision of the patrimonial situation was shown, as it exclusively reflected treasury movements. Baños and Carrasco (2019) studied the change in the Constitutions of the Hospitaller Order of San Juan de Dios in eighteenth-century Spain. These authors used the concept of institutional entrepreneurship to analyse the role of the individuals in the spread of accounting in a religious organisation.

A wider analysis of charity hospitals in Europe before the settlement of the welfare state was conducted by van Bavel and Rijpma (2016). These authors studied poverty alleviation in Italy, England and the Netherlands over the long term (1400–1850). They showed that a significant portion of gross domestic product was spent on relief during this period. The authors showed the causes underlying these patterns. Felix and Parkinson (2022) investigated the strategic change at the hospital Saint-Jacques at Le Roeulx in Belgium. The original hospital objective was to hold the poor and the pilgrims. However, few pilgrims availed themselves of its facilities, and its mission was reviewed. In the seventeenth century, the Augustinian Sisters administered the hospital, and this has given us a picture of the organisation for the period 1625 to 1627.

Although various hospitals in different eras and countries have been studied, many of these studies have been rather descriptive. Few have sought to explain the reasons for the evolution of their internal organisation, particularly regarding non-Anglo-Saxon case studies. In other words, we identified a gap in hospital studies, which failed to explain the reasons behind accounting developments in hospitals. This article contributes to the existing accounting literature on hospital management and accounting by examining the institutional logic and accounting changes within the historical context of the GNHP in the first quarter of the eighteenth century. Consequently, we examine how changes in political and economic governance have affected accounting practices and financial accountability in hospital management.

Furthermore, by situating the hospital within broader Mediterranean commercial networks and the fiscal policies of governing authorities, the study emphasises the interaction between mercantile influences and the municipal health administration. The article discusses the role of merchants in hospital oversight, noting that commercial interests were indirectly represented through the role of the Rector Mercader (merchant) and were different from the municipal ones. This is consistent with institutional logic theory, which suggests that different sectors of society, such as business and government, shape accounting practices through their embedded norms and power structures (McWatters and Lemarchand, 2013).

The research also examines the impact of the Savoyan and Austrian reforms on financial accountability, particularly the obligation to report hospital accounts to the Tribunal of Real Patrimonio (Royal Assets). The article also provides insights into how accounting mechanisms, such as apothecary ledgers, reflected broader economic changes, including tax policy and government intervention in economic affairs. By integrating institutional logic with historical accounting change, this work advances scholarly understanding of how external political and economic factors shape internal accounting systems.

Methodological considerations

The case study is analysed within the theoretical framework of institutional logic. In addition, the case of GNHP is analysed through primary sources and shows how the change in organisational logic affects the management of the hospital. This influence is more visible in times of political-institutional change (Carmona et al., 2004; Lounsbury and Crumley, 2007).

The research is based on archival documentation kept in the State Archives of Palermo, the Real Patrimonio (Royal Assets) Court Fund. This court was an administrative-accounting magistracy, in operation since the early modern age in the era of Spanish domination, which had the task of revising the accounts of the administrations and, more generally, of all the subjects subordinated to the power of the viceroy. The documentation preserved in the archive consists, above all, of accounting statements submitted by the GNHP administration over time. From this perspective, archival sources and accounting books are useful for understanding how organisational and managerial changes within the GNHP were driven by political and dynastic shifts in Sicily (Hernández, 2010). This illustrates the change in institutional logic that occurred during the period under study and led to the GNHP's reorganisation.

Nevertheless, in 1593, a fire destroyed the archive of the GNHP, and a subsequent devastation due to neglect or war and natural events almost destroyed most of the documentary heritage of the hospital, consisting of ledgers, journals, account books, quantity books, patient records and salary records (BCP, Ms. QqH101). Fortunately, a part of this documentation is preserved in the archives of the University Hospital of Palermo (Giordano, 1991). Accordingly, the research was conducted using mainly ancillary, related documentation, in particular the decrees which initiated the reorganisation of the hospital and the surviving final balance sheets of the eighteenth century sent to the Palermo Senate at the end of each financial year. The documentation kept in the Historical Archive of the Municipality of Palermo – relating to the action of the municipal senate on the GNHP, as on all existing institutions in the city – confirms the existence of an institutional logic, in competition with that exercised by the sovereign through the Real Patrimonio (Royal Assets).

Another element of the research is the secondary sources, in particular the organisational regulations of the GNHP that were published in 1625 and 1725. These two documents are suitable for understanding the functional development of the GNHP. The 1625 regulation, in manuscript form and preserved in the Municipal Library of Palermo, is the first organic act desired by the city administration to standardise the management and organisational practices of all the hospitals operating in the city. Such an operation was intended to impose a bureaucratic-organisational logic aimed at controlling the various hospital bodies. The 1725 regulation not only reconstructs the GNHP's organisational systems prior to that date but also highlights the emergence of management techniques characterised by greater organisational complexity. Both primary and secondary sources were analysed through the lens of institutional logic.

The case study: GNHP

The birth of hospitalisation and health care

Between the eleventh and fifteenth centuries, hospital assistance was associated above all with religious orders, which, with the spread of great pilgrimages and the crusades, worked to offer hospitality to travellers. Hospitals were to be considered a kind of hospice, places where assistance was given indiscriminately to both the sick and to poor, abandoned people. This was mainly due to changes in city urbanisation in the Middle Ages, which affected all of Europe, when cities were unable to contain the high number of poor people (Riva and Cesana, 2013; Stevens Crawshaw, 2012). Hospitals were the prerogative especially of nobles and bishops, who wanted to display their charitable desire towards the poor, but also of social groups such as bankers, merchants and guilds, who, along with various religious confraternities, participated in the creation of hospitals that consisted mostly of small buildings located near convents or churches (Picardi, 2010).

With the advent of further advances in the medical field and, above all, with the spread of large epidemics, hospitals, which were mostly outside the city walls, began to have specialised purposes, such as lazarettos or leprosariums, which provided greater assistance to people suffering from specific pathologies and to guarantee an adequate quarantine. Hospital assistance in the Middle Ages was often available from different hospitals in the same city, some under the direct management of municipal administration, while others were under religious brotherhoods, offering both general and specific care. The demand for assistance was high, encompassing a broad spectrum of those in need, such as the poor, orphans, the insane and lepers, especially in urban centres, due to poor hygienic conditions and a high rate of poverty.

However, one of the basic requirements for the running of a hospital was the provision of financial resources. Therefore, when the hospital was established, the founder donated land, which provided the resources to maintain it. These assets could later increase by donations and bequests from private citizens, ecclesiastical bodies, nobles or even sovereigns. This type of management, common in many European hospitals, continued throughout the late Middle Ages until the beginning of the sixteenth century, when city administrations began to be more interested in public health, giving rise to a new way of organising the hospitals (Bracci et al., 1994; Servalli, 2013).

The hospital system in Palermo

Sicily's strategic position in the centre of the Mediterranean (see Figure 1) provided a health framework consisting of numerous hospitals close to the port. By the end of the twelfth century, because of the rapid economic development of the city thanks to its flourishing trade, different social groups had established different hospitals in the city, but until the fifteenth century government bodies only took an occasional interest in their running (Günther, 2001).

Figure 1.

Map of Sicily (1745 ca.).

In Palermo, during the Middle Ages and the early modern age, 15 hospitals were operating (Pirri, 1723) (see in Figure 2 some of them). Successive waves of plague occurring from the fourteenth century meant that most of the city's hospitals became insufficient. The institutions located near the ports were particularly affected. They became increasingly crowded until they reached a deep state of saturation. In such confined spaces, the mixing of infected and non-infected patients rapidly increased the number of casualties across the island. However, the most significant setback occurred decades later when epidemics had been almost eradicated, and the city of Palermo was the centre of a wide urbanisation process. With the proliferation of intense trade and the development of the manufacturing sector, the population grew steadily, and consequently the capital of Sicily had to widen its borders with the creation of new neighbourhoods and residential areas. In this context, hospitals began to show the first signs of what would have turned out to be a real crisis in the welfare system at the beginning of the fifteenth century (Alfani, 2010).

Figure 2.

Map of Palermo (1830).

Although primarily due to a rapid rise in the population of Palermo (Aymard, 1971), the deterioration of several hospitals, like those of private foundations, was also due to the lack of funds from benefactors and decreases in rents. Furthermore, often these institutions were victims of poor management and inefficient administration by the rector or founder. A cause was the lack of participation by the political power in public health problems. To solve this, health measures were developed to safeguard public health, investing many resources to improve the hygienic conditions of the population.

At the beginning of the fifteenth century, there was a major turning point in the field of welfare, through the establishment of lay administrations that dealt with the management and control of hospitals. However, this mechanism highlighted the conflict between the ecclesiastical and scientific-curative character of the hospitals. The Catholic Church claimed sovereignty over the institutions it founded, giving priority to aspects of the ‘care of souls’, while the municipal administrations pushed to improve the welfare aspects (Riva and Cesana, 2013). The result was an innovation in hospital systems, accentuating the medical-health elements. Furthermore, to improve the management, changes were made in the accounting of hospitals with the introduction of ledgers and reports to improve the verification activity by the institutions responsible for the various hospitals.

Genesis of the GNHP: Foundation and internal layout

As we have seen, the recurring epidemics and the high poverty rate at the beginning of the fifteenth century meant that Palermo's hospitals were unable to cope with the growing medical needs of the population. There was an urgent need to establish a single large building for efficiency purposes. This building made it possible to bring together all the small hospitals in the city to meet the needs of the population of Palermo (see Figure 2). The foundation of the GNHP was made possible by the intervention of the Benedictine friar Giuliano Majali, of the monastery of San Martino delle Scale. He enjoyed the support of King Alfonso of Aragon to such an extent that the sovereign offered him the splendid palace built by the noble Matteo Sclafani (ASCP, AS 1429; Giunta, 1948) (see Figure 3). The palace would have become a convent, but Majali refused the offer, proposing instead that the sovereign use it for the foundation of a great city hospital. The request of the friar was accompanied by a similar request by the city Senate. Also, the archbishop of Palermo, Ubertino de Marinis, supported the request of the Dominican friar, with a letter to the king of 24 April 1429. Soon after, on 21 August, Alfonso of Aragon, king of Sicily, authorised the foundation of the GNHP (ASP, RSI, 5435).

Figure 3.

The Ospedale Grande e Nuovo of Palermo.

Therefore, seven smaller hospitals were incorporated into the GNHP: San Bartolomeo; Sant‘Antonio; San Giovanni; Santa Maria La Racomandata; Santa Maria La Nuova; Santa Maria La Mazzara and San Dionisio (see Figure 2). Despite their small size, they were the most important hospitals existing in Palermo at that time, but they could no longer guarantee enough beds for the growing number of sick and dying. The rents available to these hospitals were also transferred to the GNHP (ASCP, Giuliana, 1524). The building, which became the new headquarters of the hospital, had three floors and a square plan, which, at the same time, facilitated the control aims (see Figure 4).

Figure 4.

Hospital (nineteenth century).

With regards to the internal distribution, the Pharmacy (Aromataria) leads to a cloister with a fountain, then a chapel, inside which the medical assistants would visit the sick and complete the hospitalisation documentation to make sure that the sick person had received the sacraments. After acceptance, the patient was transferred to a ward and entrusted to a curcamalati, a type of nurse, waiting to be visited by a surgeon, who had to verify that the illness that the patient was suffering from was the responsibility of the hospital. Once the surgeon's authorisation was obtained, the patient was cleaned by a nurse (curcamalati) and put to bed. On the left side of the courtyard, a staircase led to the upper floors.

On the first floor, there was the women's ward, with a separate ward for pregnant women. Next to these spaces, there were six infirmaries in which patients were hospitalised suffering from fevers, with wounds or who were at the last stage of a disease. There was a chart in each infirmary indicating the diet allowed for each patient (Mazzè, 1992). On the same floor was the residence of the hospitaller and that of the elderly orphan girls (proiette) who were abandoned at the entrance of the hospital and who, once grown, became part of the hospital staff. There was also a kitchen where meals were prepared.

On the second floor, there was the male pavilion with its infirmaries, which presented the same distribution as that of the female area. In total, the beds made available by all the infirmaries were eight hundred, divided into three sections for both men and women. Two of these sections were managed by two senior doctors (Maggiori Fisici) and one by the principal surgeon (Maggiore Chirurgo). A small blackboard, on which the doctors noted every detail about the patient's illness, was hung on each patient's bed (ASP, MA, SII, 64).

Changes in the GNHP in the eighteenth century from the institutional logic

In this section, the changes that occurred in the GNHP in the eighteenth century will be analysed from the four institutional logics, that is: (i) political logic; (ii) professional logic; (iii) social logic; and finally (iv) managerial logic (Besharov and Smith, 2014).

While the boundaries between social and managerial logics may at times blur – particularly where social cohesion and welfare objectives are pursued through efficiency-driven reforms – this study frames its analysis specifically around accounting transformations, and therefore interprets institutional change primarily through logics as they manifest in governance and control mechanisms; accordingly, the professional logic is centred on administrative and accounting roles rather than clinical personnel, and the social logic is evidenced not through clerical functions but through secular organisational restructuring aimed at formalising collective welfare within Enlightenment rationalities.

Political logic

The actors operating within political logic are primarily concerned with gaining and maintaining power, advancing their interests, and achieving their goals through negotiation, coalition-building and strategic manoeuvring. We will see this acquisition of power primarily through the norms issued in 1722. The beginning of the eighteenth century was a time of key political changes for Sicily and for the whole of Europe. In that same year, following the Treaty of The Hague (1720), Sicily, which had been assigned to Savoy after the Spanish Succession War, passed to the Habsburgs of Austria (Benigno and Giarrizzo, 2003b). This change entailed a rewrite of all the administrative practices of the Kingdom of Sicily, including the GNHP.

The main aim of political reforms in the first half of the eighteenth century was to control finances through central bodies. The rationalisation process initiated by the House of Savoy in the Piedmont territory at the beginning of the century, and continued by the Austrians, was aimed, above all, at distributing the tax burden and limiting local powers in this area. The census of landed property was crucial to the reorganisation of the tax system, to rationalise the distribution of taxes and reduce the numerous feudal and ecclesiastical immunities. In addition, the concept of public happiness began to spread (Sarrailh, 1957), which also appears in the prologues of many legislative measures. During this period, some monarchs, based on their political power, undertook reforms aimed at improving the living conditions of their populations (Di Marzo, 1871). The Austrian government, while practising a Spanish-style fiscalism, with continuous requests for donations and the sale of honours and royalties, continued the policy of reforms initiated by the Piedmontese (Szabo, 2018). It was aimed at radically changing the organisation of the Sicilian economy, strengthening the new class of producers and merchants to free themselves from the hegemony of the baronage (Gallo, 1996).

The intervention of the state in economic life was not limited to taxation, military spending and the management of the public debt, but an enlightened economic policy was implemented, which gave impetus to research projects to improve the cultivation of wheat, olives and mulberries, cattle breeding, and textile manufacturing; new industries (such as paper, soap and glass) were introduced alongside traditional activities in order to bring about real economic development (Barone, 2018).

Besides, in the eighteenth century, the regeneration of the economy was considered as a central aspect of political life and its resolution would have to face the administrative organisation of the State; furthermore, economy became a new way to rule, centralise the power, re-affirm the power of monarchy and redistribute privileges and power among the elites (Di Vittorio, 1984; González Enciso, 2003; Perez Sarrion, 2011). The change also affected the management of the GNHP, whose rules were modified in 1722. The preamble of the new regulation stated that:

…Since all things in the world are subject to the vicissitudes of time … the Rectors and the Hospitaller asked the Citizens’ Senate to intervene and issue new rules for the operation of the GNHP. (Nuovi Capitoli, 1725)

The Senate promptly committed itself to the approval of the new rules, which were to be ‘addressed to the greater service of God, the Work, and the Public’. Remarkably, the emphasis for ‘the Public’ things was a characteristic of the Enlightenment. The reference to the public and the population becomes a constant in the writings of the Enlightenment. The population is beginning to be considered an indispensable element to produce wealth, and at the same time, the best redistribution of this would stimulate the creation of new wealth. The explicit reference of the monarch to the eradication of the old customs, contrary to the ‘public happiness’, is characteristic of the eighteenth century (Sarrailh, 1957), and in this sense, the government of the population (the administration) becomes a key element for the prosperity of the people (Filangieri, 1782).

Professional logic

Actors operating within this logic adhere to professional standards, codes of conduct, and disciplinary practices, emphasising the importance of specialised knowledge, skills and credentials in guiding decision-making and behaviour. The 1722 rules of the GNHP were arranged by Ferdinando Maria Tomasi (prince of Lampedusa), Simone Arias Giardina, Ignazio Migliaccio (prince of Malavagna), by the rectors, Giovan Battista Scasso and Collis, and Giovanni Francesco Restano, and by the hospitaller Giuseppe Amezaga were validated on 10 April 1725. They consisted of two separate parts and concerned both the GNHP administration board, composed by the three rectors (Deputazione Universale), and the internal articulation of the personnel with the various professional duties and responsibilities (Deputazione Particolare) (see Appendix 1 and 2). The GNHP's Board of Directors (Deputazione Universale) oversaw all decisions regarding the administration, management and matters concerning the staff of the hospital (Nuovi Capitoli, 1725).

The first group of rules concerned the establishment and functioning of the Deputazione Universale. As already established in a rule of 1610, the three rectors would have represented three social categories: the nobility, the citizen patriciate, and the mercantile bourgeoisie. The election would have taken place by extracting a name for each category from three different boxes. The substantial difference with respect to the practice used in the past was that the names that were to be inserted in the three urns, from which would be extracted the new rectors, would have been proposed by the previous rectors and by the hospitaller, with the idea of ensuring administrative continuity to the hospital. Moreover, the rules explicitly stated that they could not be elected merchant rectors with more than 50 debtors or persons who had pending lawsuits with the GNHP, stressing the ethical position of the administrator (Walker, 2019). The newly elected rectors would have sworn during a mass to fulfil their task with honesty, and the assignment would last one year. Immediately afterwards, the new rectors would go to the viceroy to ask for protection and to expose the situation of the hospital (Nuovi Capitoli, 1725).

The 1722 rules also established that the Deputazione should meet every Monday to review the current affairs of the GNHP. The attorney, the razionale (accountant), the consultor, the lawyer, the accountant (controscrittore), the cashier and the agent had to attend the meeting; the archivist was also present, but he had to remain in the archive, to be always ready to take any necessary documents. In the first meeting after the appointment of the new rectors, the Deputazione Universale would have summoned all the GNHP officers, and the agent would have read to them the tasks for which they were intended according to the rules in force. The treasurer (razionale) oversaw fixing the various topics to be discussed during the meeting of the Deputazione in a special register, which was then kept in the archive. He also had to keep another register in which to record all the wills of the benefactors, and the use of earnings derived from bequests and inheritances. This register had to be shown at each session of the Deputazione, to inform the rectors and the hospitaller of the commitments that had to be discharged by the hospital in relation to the orders given by the testators (Nuovi Capitoli, 1725).

The first part of the rules sets out in a precise manner the functions and tasks of the rectors. First, the new rectors had to be given a report on all the assets of the hospital with debts and credits, so that they had a clearer view of the economic status and the possibility to propose correct resolutions. Previously, at the beginning of their mandate, the rectors had to visit the whole hospital. They also had to establish a day to visit the patients, the pharmacy (spezieria), the bakery, the asylum (reclusorio) of the orphan girls, the warehouse, and all the other structures of the GNHP. The rectors had to provide the hospital with supplies and view the accounting books to verify their actual status. This verification had to be registered as a public deed by the notary. The rectors had to sign all the payments with the corresponding mandates. In the event of their absence, this task was given to the razionale (accountant) or the accountant (controscrittore). It was established that the rectors could not take, for themselves or their relatives, goods from the GNHP. The rectors had the personal and patrimonial responsibility to collect all the GNHP credits and to replace those officers who had left their jobs because they were assigned to another job (Nuovi Capitoli, 1725).

Professional logic represents the guiding principles and normative standards that shape the conduct and decision-making of professionals. It is manifested in the knowledge bases, ethical codes and cultural practices that professional groups adopt, and it plays a crucial role in both the internal identity of organisations and their external legitimacy (Besharov and Smith, 2014). The rules describe in minute detail the behaviour expected of the rectors in carrying out their office because of inefficiencies and embezzlement that had occurred in the past. It was forbidden to have two official positions unless for exceptional reasons and with permission of the city Senate. Payment in kind was prohibited, a practice used until then, and was rebadged to give focus to the supplies of goods and services to GNHP in order not to create inconvenience to the patients.

The rules also prohibited making payment orders when there was insufficient cash. The entire administrative activity of the GNHP was subjected to the verification of the Palermo Senate's rationale, which, every year, had to check the hospital's accounting records, then inform the Senate of the results. In the event of wrongdoing, the Hospital rational was dismissed from his office. Finally, the Deputazione had to swear an oath to all the GNHP officers regarding respect for the rules. This oath, registered with a notarial deed, had to be renewed every year and kept in the Archive. In addition, every three years the rectors and the hospitaller had to propose to the city Senate three names for the post of the rational GNHP.

Following the 1725 statute, the nobleman rector (rettore titolato), after his election, with the knight rector, the rector merchant (former rector mercadante) and the hospitaller, together with the main surgeons, had to visit the infirmaries (men’s and women’s), the female orphan asylum (reclusorio), and the pharmacy (spezieria), to verify the status of places and communicate it to the city administration (Deputazione). All three had to check the account books, the amount of the debts and annual revenues. The nobleman rector had to take care of all the incomes of the GNHP, convene once a week (usually on Friday) the cashier, the accountant (controscrittore), the secretary (curiale), attorney and the debt collector, to verify their work, so that in the subsequent convocation it was possible to check the actual income and expenses, comparing them with the cash book. He had to convoke the Deputation one day a week (preferably on Monday) together with the other rectors, the hospitaller and other GNHP officers to discuss all that was necessary for the hospital.

The knight rector was in charge of all legal matters about GNHP and represented it in the law courts. He had to keep the court bill together with the prosecutor and the agents. He had to convene an assembly every week to discuss the sums of money obtained from the rents of houses and shops that had to be recorded in the Book of Rationale. The role of the merchant rector within the management of the GNHP in the eighteenth century was crucial for maintaining financial oversight and ensuring effective hospital administration. As highlighted, the merchant rector acted as a bridge between the mercantile community and hospital governance, reflecting the broader influence of commercial practices on public institutions. His primary responsibilities included reviewing financial records, particularly the Cuadernos de Botica (pharmacy ledgers), which tracked the procurement and production of medicines. This function demonstrates the application of mercantile accounting techniques in hospital management, aligning with broader trends in institutional change.

The involvement of the Rector Merchant in financial supervision aligns with the theory of professional logic within the framework of institutional logic. This theory posits that different professional groups introduce distinct normative, cognitive and material practices into organisational settings (Thornton et al., 2012). His presence ensured that the GNHP incorporated the rigour of merchant bookkeeping, which emphasised double-entry accounting, systematic audits and clear documentation – practices that contributed to good management and financial transparency. The role of the Merchant Rector illustrates how accounting practices evolved in response to both mercantile and state-imposed controls, reinforcing financial discipline while adapting to changing regulatory environments. His function underscores the broader historical phenomenon of hospitals adopting business-like financial management long before the emergence of modern healthcare administration. By integrating merchant expertise into hospital oversight, the GNHP exemplifies how institutional logics shaped accounting evolution, demonstrating that effective management of public health institutions often relied on the professional logic of commerce and trade (Lee, 2021; Rodrigues and Sangster, 2013; Silvestri, 2020).

Social logic

Actors operating within this logic are guided by cultural norms, values and expectations, prioritising social cohesion, solidarity and collective well-being in their interactions and decision-making processes. This logic is detected by analysing the organisational structures established in the norms of 1722. The diagrams related to the management and organisational models deriving from the rules (Capitoli) represent the degree of visibility given to the practices (Hopwood, 1990).

The changes made by the 1722 rules, as shown in Figure 5, are considered an adaptation of the organisational model to the new needs of rationalisation of administration typical of Enlightenment thought (Bhimani, 1994). With the new rules and the creation of new figures in the hierarchical structure of the GNHP, all areas of activity of the hospital were made controllable. With the new accounting system, not only are the quantities consumed and produced monitored, but also the performance. Doctors, surgeons and pharmacists must draw up specific records in which patients, pathologies, discharge from the hospital, and/or the medicines used are recorded. Thus, the management of GNHP was always able to know the number of patients, sex, age and pathologies in addition to the type of therapy adopted. The use and implementation of statistical registers for patients, already partially in use since the seventeenth century, but supplemented with information on diseases, patient characteristics and all other information necessary to outline their characteristics, constitute a step forward towards a more complete formalisation of the hospitalisation model.

Figure 5.

Organisation chart of GNHP 1722.

The creation of the GNHP as a public foundation of the City of Palermo required that the role of the priests was always marginal. In 1442, only one priest was expected for all the sacred offices, but two centuries later, the rules do not report the presence of any clergy. This does not mean that the GNHP did not have a priest; some Capuchin friars worked in the pharmacy, and probably the hospital chaplain did not have a codified role and did not receive a salary from the GNHP administration. The rules (Capitoli) 1722 reported the presence of nine doctors (main doctors, surgeons, and assistant doctors) and only two chaplains, besides the Capuchin friars assigned to the pharmacy, distributed over two daily shifts for the needs of the hospital. This indicates that the hospital had grown considerably in terms of patients and demonstrates the secular nature of the institution, with the predominance of clinical functions over those of care. By identifying these changes, the logic of efficiency implies a social change.

New organisational roles substituted or limited the autonomy of previous ones. First, with the previous rules of 1610, it was established that the rectors are representative of the urban elite. The three rectors were chosen among the noblemen, the city magistrates and the merchants. Therefore, it is no longer a question of a mere expression of the Senate, but of a proportional representation of urban power. This mechanism was further strengthened in 1722 with rules that included specific responsibilities and tasks for each of the three rectors. Accounting, therefore, became increasingly institutionalised within the organisation (Burchell et al., 1980).

The organisational diagram relating to the year 1722 shows just the main figures operating within the GNHP (see Figure 5). Those functions that are subject to direct or indirect control are represented, which become accountable thanks to the use of accounting books. Continuous lines represent direct hierarchical control, while the thick lines represent the accounting control. Therefore, they indicate the official to whom to render the accounts for the verifications established by the rules (Capitoli).

Managerial logic

Actors operating within this logic are concerned with optimising resource allocation, coordinating activities and achieving desired outcomes through planning, organising, directing, and controlling organisational processes and activities. This logic is shown by analysing the accounting changes that happened at the GNHP. The analysis of the statute allows us to reconstruct the evolution of the GNHP organisational model, considering that this process was part of a context of political, social and economic transformations concerning Sicily and the whole of Europe. Also, we have analysed how these changes were facilitated by three factors: a new building, new rules, and a new organisational structure.

Over the course of three centuries, the expectations relating to the function of the hospital evolved, from a care facility according to the mediaeval model, to a place of health assistance. This process meant a change in the management of the hospital. It was during this process, in 1624, that the first attempt was made to regulate the accounting within the GNHP by adopting a double-entry bookkeeping system. That year, new regulations were drawn up which concerned exclusively the keeping of the accounting books, in particular the work of the treasurer and the accountant (controscrittore) in drawing up the ledger (Libro Grande) in which the accounts and movements relating to purchases were registered and obligations contracted by the hospital. Appendix 3 summarises the rules to be followed in the hospital.

Later, the rules of 1722 were promulgated in a delicate phase for Sicilian history, just two years after the passage of the Island from the House of Savoy to the Habsburgs of Austria. In fact, the advent of the Enlightenment brought with it the use of government tools and technologies typical of the time. The aim of efficiency and the need for accountability were raised. In this perspective, it is understandable to use an accounting system based on making all administrative processes and figures explicit within the hospital, making them accountable (Burchell et al., 1980; Hopwood, 1992; Hoskin, 1996). For this the hospital used 17 accounting books, six more than in 1624 (see Figure 6).

Figure 6.

GNHP accounting system scheme (1722).

As an institution directly controlled by the city's elite through the Senate, the administration of the GNHP was certain to carry considerable political weight. Concurrently with political control, the Senate of the city of Palermo exercised administrative and accounting control over the GNHP. Therefore, each year, the rectors were obliged to prepare and send a summary balance sheet of assets and liabilities.

The accounting report sent to the Senate for the years 1720–1722 consists of a register of 114 pages. The report opens with a note prepared by Domenico Candia, treasurer and rational of GNHP, in which he explains how the accounts are represented (ASP, TRP, 2065). The document is composed of six sessions in which the various account items are grouped by type (see Appendix 4). Key information was provided on GNHP's operating expenses, such as food, firewood for heating, beds, linens, medicine and staff salaries. These data allow us to better understand the nature of GNHP in the eighteenth century, with clear evidence of the institution's health care role and its clinical nature. The data are also interesting for understanding the wage levels of skilled and unskilled workers and the standard of living in a large Mediterranean city.

As accounting information provides valuable insights into organisations (Hernández, 2010), we will now present some of the characteristics of the GNHP that have been obtained from its accounting records. Therefore, as shown in the Table 1, over half of the Hospital budget revenues came from the ownership of the Bronte fiefdom and rents generated by properties of the two city hospitals of Vicaria and San Giovanni dei Lebbrosi and approximately 36 per cent of the revenue was guaranteed by bequests, inheritances and donations, with only the remaining part made up of rents fromreal estate owned by the hospital.

Table 1.

GNHP Revenues (1720-1722)

Item	Annuity(Amount in Sicilian ounces)	(%)
Fief of Bronte and Rents of Hospital of Vicaria and of San Giovanni dei Lebbrosi	5,288.22	(52%)
Bequests, Legacies, and Donations	3,671.50	(36%)
Houses and Other Real Estate	1,723.17	(17%)
Partial Amount	10,682.89
Bad debts	- 585.15	(-6%)
Total	10,097.26

Source: ASP, TRP, 2065

The operations of the asylums are clearer with the reports on costs. So, the costs associated with the poor orphan girls’ home, as shown in Table 2, are calculated for 120 female inmates. The balance sheet data provide us with a picture of the feeding and management of the body of orphans, indicating the bio-political aspects of the governmentality that are typical of the hospital institution and that during the eighteenth century characterise workhouses, lunatic asylums, and prisons (Lazzini and Nicoliello, 2020). For its part, Table 3 shows the items of expenditure of the infirmary of the Capuchin friars. Both the orphan girls and the sick admitted to the infirmary enjoyed the same diet and similar treatments.

Table 2.

GNHP Orphan Poor Girls’ Asylum Maintenance Costs (1720-1722)

Item	Amount	Annual cost(In Sicilian ounces)
Bread	8 ounce per day	365.00
Meat	3 times a week 36 rotolo per time	187.00
Fish	2 times a week 1.6 rotolo per time	16.24
Vegetable and meat soup	1 time a day, 3 ounces per time	328.15
Wine	1 quartuccio of wine per day	71.27
Olive Oil	8 rotolo per day	9.22
Meals for the Religious Holidays		12.00
Vinegar	annual consumption: 1 barrel	3.60
Wood		9.18
Charcoal	24 once per year	6.12
Chickens	2 per day	60.25
Sugar	2 livres per month	2.24
Soap	2 livres per month	24.00
Medicaments for the Inmates		9.00
Soup for the Ill Girls		3.24
Small Expenses		24.00
Dowries		140.00
Total		1,270.51

Note: 1 rotolo = 0,79 Kg; 1 ounce = 66,11 gr; 1 quartuccio = 0,429 lt; 1 barrel = 42,98 lt; 1 livre = 317,36 gr.

Source: ASP, TRP, 2065

Table 3.

GNHP Capuchins Friars Infirmary Maintenance Costs (1720-1722)

Item	Annual Cost (In Sicilian ounces)
Meat (annual consumption)	168.00
Poultry and Eggs	48.00
Bread	104.00
Wine (2 barrels per month)	151.90
Olive Oil	12.00
Sugar	2.24
Vinegar	1.18
Wood	10.20
Charcoal	9.18
Semolina and Pasta	7.18
Medicaments for the Ill	44.00
Canvas for Pillows and Mattress	36.00
Total	595.17

Source: ASP, TRP, 2065

Table 4 provides information on the pharmacological practices used in the GNHP, showing that herbs were used as both sedatives and as stimulating products to be used as shock therapy for some pathologies. The costs for the maintenance of the sick people, as seen in Table 5, are calculated on the average presence of 200 patients. In this case, the diet is like that of the poor girls and is based mainly on bread, pasta and meat, while a further caloric intake is represented by the consumption of wine, which is still normally provided. The use of wood and charcoal demonstrates that patients were hospitalised in heated rooms and, probably, hot water was used, a case quite unusual for the population of the time, except for the nobility and the richest groups. The data on ecclesiastical personnel (Table 6) and auxiliary staff (Table 7) allow us to know their activity in the hospital and its cost. Therefore, this information allowed hospital administrators to monitor financial flows (resulting from wages and functional costs) and monitor the activity of all employees.

Table 4.

GNHP Pharmacy Operating Costs (1720-1722)

Item	Annual Cost (In Sicilian ounces)
Sugar	144.00
Mineral Drugs	76.00
Manna	15.00
Honey	5.00
Roses (to Prepare Sedatives)	24.00
Violets (to Prepare Stimulants)	18.00
Cooked Wine	4.00
Fruit (Cedars, Apples, Pomegranates, Medlars)	4.00
Medicinal plants	12.00
Sweet Almond Oil	15.00
Oil for Liniments	12.00
Butter	3.00
Wax for Liniments	2.00
Charcoal, Wood, Jars	9.00
Salary for Pharmacist	56.14
Salary for Two Assistant Pharmacists	39.18
Total	438.33

Source: ASP, TRP, 2065

Table 5.

GNHP Patients Maintenance Costs (1720-1722)

Item	Annual Cost(In Sicilian ounces)
Durum Wheat for Bread	433.10
Wheat	405.00
Costs for Bread Production	255.00
Salary for the Baker	60.25
Total for Bread	1.153.35
Costs for Bread Charged to: Poor Girl Asylum, Hospital of Vicaria; Hospital of San Giovanni dei Lebbrosi		-550.11
Total for Bread	603.24
Meat	594.40
Poultry and Eggs	593.50
Wine (Six Barrels per Month)	173.16
Vinegar	9.20
Sugar and Candies	70.60
Beans	15.00
Semolina and Pasta	119.19
Olive Oil	74.10
Little and Extraordinary Expenses	438.00
Charcoal	46.10
Wood	50.17
Partial amount	2,183.42
Total	2,786.66

Source: ASP, TRP, 2065

Table 6.

GNHP Salaries (Cost) of Ecclesiastic Staff (1720-1722)

Position	Salary (In Sicilian ounces)
Chaplain (Two)	70.00
Assistant Chaplain (Two)	70.00
Sexton	19.24
Cost for Sacred Services Charged to Noto’s Bequest		-18.00
Total for Ecclesiastic Personnel	141.24

Source: ASP, TRP, 2065

Table 7.

GNHP Salaries (Cost) of Auxiliary Staff, Named la Famiglia (the Family) (1720-1722)

Position	Salary (In Sicilian ounces)
Wardrobe	30.00
Buyer	29.00
Remediante (Auxiliary staff)	33.00
Barber	13.15
Assistant Barber	16.24
Retiree Barber	9.00
Coking Staff	16.24
Cook Assistant	16.24
Captain	24.18
Sub-Captain	12.00
Convalescentario (Assistant for Recovering People)	16.24
Superintendent for Male Patients	16.24
Assistant for Female Infirmary	16.24
Assistant for Male Infirmary (Six)	100.24
Superintendent	16.24
Sub-Supplier	18.00
Nurse	17.18
Assistant to Wounded Infirmary (Two)	32.00
Janitor	15.18
Farmer (Three)	50.12
Assistant Nurturer	3.00
Nurse for Women	18.00
Female Auxiliary Staff (Four)	84.00
Midwife	3.60
Midwife Assistant	0.60
Total	655.33

Source: ASP, TRP, 2065

It is noteworthy that the treasurer and the accountant (controllership) had the highest salaries in the GNHP, higher than the hospitaller (see Table 8). Thus, as in other organisations (Carmona et al., 1997, 2002), it can be concluded that they were key figures in the hospital. The accounting department of the GNHP was well endowed with nine appointments: treasurer, accountant (controscrittore), deputy treasurer, deputy accountant (controscrittore), cashier, secretary of treasurer, secretary of accountant (controscrittore), and two retired book accountants that were still salaried by GNHP. The accounting and administrative organisation was a form of economic rationality aimed at the optimal allocation of resources, to monitor and manage assets and consumption in a more efficient way.

Table 8.

GNHP Salaries (Cost) of Administrative Staff (1720-1722)

Position	Salary (In Sicilian ounces)
Hospitaller	50.00
Attorneys (Two)	36.00
Special attorney for legacy of countess of Villalba	15.00
Solicitor	21.00
Second Solicitor	15.00
Special solicitor for legacy of Arias Giardina	12.00
So1icitor	10.00
Notary	12.00
Agent	30.00
Treasurer	91.00
Secretary of Treasurer	10.00
Accountant (Controscrittore)	62.00
Secretary of Accountant (Controscrittore)	10.00
Cashier	39.00
Deputy Treasurer	32.00
Deputy Accountant (Controscrittore)	30.00
Book Accountant (Retiree)	30.00
Book Accountant (Retiree)	10.00
Archivist	24.00
Office Boy	28.00
Second Office Boy	6.00
Superintendent for Maintenance	10.00
Fields Supervisor	9.00
Employee	8.00
Superintendent for Water Supply	6.60
Officer (accountant) for the Fief of Bronte	12.00
Notary for the Fief of Bronte	4.00
Total	622.60

Source: ASP, TRP, 2065

The accounting report for 1720–1722, provided below as Table 9, indicated the medical power. Health discourse, which includes both knowledge produced by the medical profession and popular health discourse, acquires scientific rigour with the formalisation of medicine and the medical professions. Accounting information reveals the specialisation of medical knowledge and the creation of specific fields such as surgery, physiology and urology.

Table 9.

GNHP Salaries (Cost) of Medical Staff (1720-1722)

Position	Salary (In Sicilian ounces)
Main Doctor	53
Main Physician	50
Main Surgeon	40
Physician (Two)	38
Surgeon Physician	21
Urologist (Medico per mal d’urina)	8
Operating Room Nurse	2
Surgeon Assistant (Prattico)	18
Third Surgeon Assistant (Prattico)	12
Total	242

Source: ASP, TRP, 2065

The final account related to the operating costs of the GNHP, as shown in Table 10, provides information on the structure and organisational model. Patient care costs account for about 29 per cent of total expenses, and the poor orphanage accounts for about 18 per cent. The 370 nurturers received salaries for a total yearly amount of 1,110 ounces, which is an index of the number of infants abandoned at the hospital. The salaries of the auxiliary staff amounted to 5 per cent of the total expenses, those for the administrative staff represented 6.5 per cent, and, finally, the doctors’ salaries were equal to 2.5 per cent. Lastly, Table 11 shows the positive results of the hospital in the period 1720–1722 (Revenues, Table 1 minus Expenses, Table 10).

Table 10.

GNHP Expenses (1720-1722)

Item	Annuity (Amount in Sicilian ounces)
Debts on Noto’s Bequest	7.26
Orphan Poor Girls Asylum Maintenance Costs	1,724.17
Salaries for Nurtures	1,110.00
Capuchins Friars Infirmary Maintenance Costs	595.17
Expenses for Capuchins Friars	122.3
Costs for Real Estate Maintenance	118.21
Pharmacy Operating Costs	386.20
Costs for maintenance of Hospital of Vicaria	194.11
Costs for Maintenance of Hospital of San Giovanni dei Lebbrosi	330.29
Patients’ Maintenance Costs	2,787.25
Charges for Litigations	300.00
Costs for the Chapel	151.00
Salaries of Ecclesiastic Staff	141.24
Salaries of Auxiliary Staff (la Famiglia)	507.90
Salaries of administrative staff	636.60
Salaries of Medical Staff	242.00
Charges on Debt Collection	160.00
Bed Maintenance Costs	362.18
Salaries for Laundresses, Mattress Makers, Carpenter	338.18
Total	10,215.19

Sicilian ounces: The Sicilian ounce was the official coin of account in use in eighteenth century Sicily. During the reign of Charles VI of Habsburg, the Sicilian ounce weighed 4,40 gr. of gold (22 carats). The ounce, in turn, was divided in 30 tarì and 600 grani.

Source: ASP, TRP, 2065

Table 11.

GNHP Summary Budget (1720-1722)

	(In Sicilian ounces)
Revenues (see Table 2)	10,097.26
Expenses (see Table 10)	10,215.19
Balance Deficit	-117.93

Source: ASP, TRP, 2065

Discussion and conclusion

An enlightened minority of the eighteenth century sought the general happiness of the population. This ideal led them to face with enthusiasm multiple barriers that until that time had been considered insurmountable (O’Flaherty, 2019). This minority tried to remove old prejudices and, with a new perspective, began to recognise underdevelopment and propose solutions that would overcome this backwardness. Enlightenment was an interiorised system of values that guided politicians, civil servants, and the main actors in the institutional field. In this context, as in other countries, the value of rationalism and education guided the Italian Enlightenment. Both were supposed to be a social obligation for the enlightened managers in their respective organisations and meant to govern their organisation based, in a certain sense, on a new and altruistic moral perspective. This moral way of governing meant a general improvement of the efficiency of the hospital, in the belief that this efficiency will rebound in the general welfare of the population (Sarrailh, 1957).

A novelty of this article is that it shows that the principles of the Enlightenment were widely spread across the continent. As is well known, many articles have associated the principles of the Enlightenment with the Bourbon dynasty (see, e.g. Carmona et al., 1997; Miller, 1994), but it has not been shown that these changes also occurred in other European houses, such as the Italian Savoy and further under Habsburg rule in Sicily (Evans, 2008).

This research has focused on the realignment of the organisational model of the GNHP. To this end, the accounting changes (Hernández, 2010) and changes in hospital management regulations, as set out in and issued in 1722, were analysed. The study has identified the elements that characterise this transformation and the logics (political, professional, social and managerial) to which they have responded. Thus, a correlation was found between changes in the management system and a greater need for accountability of the GNHP's actions, implementing the control capacity of the municipal government, which was the hospital's main funding body (political and social logics) (Anessi-Pessina and Cantù, 2017; Besharov and Smith, 2014; Conrath-Hargreaves and Wüstemann, 2019; Maran and Lowe, 2022; Thornton et al., 2012). This regulation described the roles of health professionals, demonstrating, in some ways, the greater formalisation of medical science and the definition of the competences of health personnel.

The study also shows that the accounting change was not only due to external and contextual change, that is, social and political changes, but also that this change was favoured by internal organisational changes. These changes have been able to be explained using institutional logic. According to political logic, the geographical and architectural reorganisation of the hospital can be explained. The new hospital was purpose-built in a new building. Besides, several small and dispersed hospitals were united in a single ex novo building specifically designed to provide a more efficient service (see Figures 2 and 4). Secondly, using the lens of professional logic, greater professionalisation of the hospital is deduced from the new rules given for the different hospital positions (see appendices 1 and 2). Thirdly, the new organisational structure is explained from social logic. As can be seen in Figure 5, the organisational structure was increasingly oriented towards ever more rational objectives, which in turn implied increasingly rational economic objectives based on a more complex accounting system (see Figure 6). Thus, each time there were more structural positions specialised in the rational and economic control of the hospital. And, fourthly, the changes mentioned above favoured, from the perspective of managerial logic, an increasingly complex accounting system (see Figure 6 and appendices 3 and 4). This new accounting system allowed them to obtain useful economic information for a better decision-making process (Tables 1 –11).

It is noteworthy that one of the three rectors (see Appendix 2) of the hospital, the merchant rector, was responsible for the administration and accounting of the hospital. This shows how highly administration was valued. It should also be noted that the accounting staff were among the highest paid in the hospital (see Table 8). Merchants were highly valued on the island, as Palermo was a major hub for Mediterranean trade at the time and played a significant role in commercial activities (Bottari, 2018; Lentini, 2004; Siviero and Torrisi, 2022). The importance of mercantile experience and knowledge in shaping public accounting during the modern age cannot be overstated. As commercial activities expanded in the seventeenth and eighteenth centuries, the need for systematic financial record-keeping and accountability grew exponentially. Mercantile practices became foundational to public accounting systems (Chatfield, 1977). Merchants, with their firsthand experience in trade and finance, brought practical insights into the development of accounting standards and practices, ensuring that these systems were both robust and adaptable to the complexities of modern economies (Edwards, 1989; Parker, 1986). Furthermore, the mercantile emphasis on transparency and accuracy laid the groundwork for regulatory frameworks that reinforce contemporary public accounting, highlighting the enduring influence of mercantile expertise on the profession (Previts and Merino, 1998).

The study shows the organisational and accounting changes of the GNHP through the influence of different institutional logics (political, professional, social, and managerial). These changes are framed in the reform context of the Italian Enlightenment, governed at the beginning of the eighteenth century by the House of Habsburg in Sicily. This is a novelty with respect to the works that have focused on the case of the House of Bourbon, which show how the process of modernisation and reform, completed in the nineteenth century under the Bourbon kings, began at the beginning of the eighteenth century, first with the Savoy and then with the Habsburgs of Austria. As future lines of research, it is proposed to analyse whether the efficiency of the hospital was improved when the House of Bourbon governed the island from 1734.

Footnotes

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Roberto Rossi

Fernando Gutierrez Hidalgo

Archival Sources

Archivio di Stato di Palermo (ASP)

Real Segreteria, Incartamenti, voll. 5434; 5510

Miscellanea Archivistica (MA), Serie II, vol. 64. Francesco Serio e Mongitore, Historia Magni et novi hospitalis Sancti Spiritus, Urbis Panormi (18^th century)

Tribunale del Real Patrimonio, numerazione provvisoria (TRP), vol. 2065

Archivio Storico Comune di Palermo (ASCP)

Atti del Senato year 1429

Giuliana year 1524

Biblioteca Comunale di Palermo (BCP), manuscripts:

Ms. QqH101. Antonio Giuseppe Cafora. Gli incendi svegliati. Memorie della fondazione dell'Ospedale Grande e Nuovo di questa città. 1697.

Ms. QqD187 Fondazione et origine dell'ospedale Grande e Nuovo di questa città secondo le notizie che s'hanno potuto cavare dopo l'incendio seguito nel 1592.

Ms. 3QqE62. Giuliana delle bolle pontificie lettere reali, ordini viceregi es altri attinenti all'ospedale Grande e Nuovo di questa città di Palermo, cavate dal libro dei privilegi, conservato nell'archivio di detto ospedale. (1^st half 18^th century).

Ms. 4QqD51. Istruzioni generali dello stabilimento dell'Ospedale Grande di Palermo e sue dipendenze (1st half 19th century).

Ms. QqH59 n. VI. Ordinazioni per gli ospedali, in Raccolta di originali scritture e stampe sulla peste di Palermo dagli anni 1624 e 1625, oltre alcune di altre pestilenze. (17th century).

Nuovi Capitoli per il buon governo dell'Ospedale Grande e Nuovo di Palermo, Palermo: Regia Stamperia Antonio Epiro 1725

Appendices

Appendix 4.

Sections of the accounting reports sent to the senate (1720–1722).

Number	Description
1. Assets	Within this section, all the real estate assets of the GNHP are listed, with the relative income and the debts bearing on each asset. In addition to the fief of Bronte, there are other important fiefdoms such as Giardinello, two mills and the patrimony of the Hospital of Vicaria and San Giovanni dei Lebbrosi (dependent by GNHP).
2. Incomes	In this section, all the GNHP debtors are listed in alphabetical order. Next to the name is the amount of debt and the share of debt relating to the current year.
3. Debts	In this section, all the GNHP creditors are listed in alphabetical order. Next to the name is the amount of debt owed by the hospital for the current year.
4. Legacies, bequests, donations	In this section, all the legacies and donations made to the GNHP are indicated. On the left-hand pages are reported the share of annual competence collected with the name of the donor, while on the right are the debts bearing the donation or inheritance with the information relating to the creditor and the annuity.
5. Expenditures	This section contains a great deal of useful information to understand the functioning of the GNHP that interfaces with those provided by the rules. Expenditures mainly relate to: consumables of the reclusorio, that is food, linen, wood for heating; wages paid to nurses to feed orphaned children; expenses for the infirmary of the reclusorio (consumables and staff salaries); salaries and maintenance costs for five Capuchin friars who assist the sick; the costs incurred for the maintenance of GNHP-owned apartments; expenses for the hospital's general infirmary (salaries and consumables); expenses for the hospital of the Vicaria and of San Giovanni dei Lebbrosi (dependent by the GNHP); expenses for the maintenance of the sick (food, clothing, linen, wood for heating); expenses for the maintenance of the chapel; wages for chaplains; salary costs for administrative staff (referred to as ‘the family’); expenses for salaries of lawyers, attorneys and secretarial staff; salaries for doctors and surgeons; expenses for fees to be paid to the debt collectors; costs for the maintenance of the beds and, finally, expenses for auxiliary staff.
6. Ristretto (Summary budget)	This section summarises the expenses and revenues detailed in the previous sections.

Note: GNHP: Great and New Hospital of Palermo.

Source: ASP, TRP, 2065.

References

Alfani

(2010) Il Gran Tour dei Cavalieri dell’Apocalisse. L’Italia del “lungo Cinquecento” (1494–1629). Venezia: Marsilio.

Alsharari

Dixon

El-Azi Youssef

(2015) Management accounting change: Critical review and a new contextual framework. Journal of Accounting & Organizational Change 11(4): 476–502.

Anessi-Pessina

Cantù

(2019) Multiple logics and accounting mutations in the Italian National Health Service. Accounting Forum 41(1): 8–27.

Aymard

(1971) In Sicilia: Sviluppo demografico e sue differenziazioni geografiche, 1500–1800. Quaderni Storici 6(2): 417–446.

Barone

(2018) Storia mondiale della Sicilia. Roma, Bari: Laterza.

Benigno

Giarrizzo

(2003a) Storia della Sicilia. Dal Seicento ai giorni nostri. Roma, Bari: Laterza.

Benigno

Giarrizzo

(2003b) Storia della Sicilia. Dalle origini al Seicento. Roma-Bari: Laterza.

Berry

(1997) Balancing the books: Funding provincial hospitals in eighteenth-century England. Accounting, Business & Financial History 7(1): 1–30.

Besharov

Smith

(2014) Multiple logics in organizations: Explaining their varied nature and implications. Academy of Management Review 39(3): 364–381.

10.

Bhimani

(1994) Accounting enlightenment in the age of reason. The European Accounting Review 3(3): 399–442.

11.

Bottari

(2018) Merchants and trade between Naples, Sicily and England in the sixteenth and seventeenth centuries. Nuova Rivista Storica CII(2): 543–580.

12.

Bracci

Maran

Vagnoni

(2010) Saint Anna's Hospital in Ferrara, Italy: Accounting and organizational change during the devolution. Accounting History 15(4): 463–504.

13.

Burchell

Clubb

Hopwood

, et al. (1980) The roles of accounting in organizations and society. Accounting, Organizations and Society 5(1): 5–27.

14.

Carmona

Ezzamel

Gutiérrez

(1997) Control and cost accounting practices in the Spanish Royal Tobacco Factory. Accounting, Organizations and Society 22(5): 411–446.

15.

Carmona

Ezzamel

Gutiérrez

(2002) The relationship between accounting and spatial practices in the factory. Accounting, Organizations and Society 27(3): 239–274.

16.

Carmona

Moreno

Ezzamel

, et al. (2004) Accounting history research: Traditional and accounting history perspectives. De Computis: Revista Española de Historia de La Contabilidad 1(1): 24–53.

17.

Chatfield

(1977) A History of Accounting Thought. Huntington, N.Y.: Krieger Publishing.

18.

Conrath-Hargreaves

Wüstemann

(2019) Multiple institutional logics and their impact on accounting in higher education: The case of a German foundation university. Accounting, Auditing & Accountability Journal 32(3): 782–810.

19.

Di Marzo

(1871) Diari della Citt à di Palermo dal sec. XVI al XIX pubblicati sui manoscritti della Biblioteca Comunale. vol. IX. Palermo: Pedone Lauriel.

20.

Di Vittorio

(1984) Ancora a proposito di storia della dominazione austriaca a Napoli, 1707–1734. Archivio Storico Italiano 142(4): 607–622.

21.

Edwards

(1989) A History of Financial Accounting. London: Routledge.

22.

Evans

RJW

(2008) The origins of Enlightenment in the Habsburg lands. In: Evans

RJW

(ed) Austria, Hungary, and the Habsburgs: Central Europe c.1683–1867. Oxford: Oxford Academic, 36–55.

23.

Felix

Parkinson

(2022) Strategic change at the hospital Saint-Jacques at Le Roeulx (Belgium), from the account book of Sister Magdelaine Delcourt. Accounting History 27(2): 277–296.

24.

Filangieri

(1782) La Scienza della Legislazione. vol. II. Venezia: Presso Giovanni Vitto.

25.

Funnell

Holden

Oldroyd

(2014) Costing in the Newcastle infirmary, 1840–1888. Accounting, Auditing & Accountability Journal 27(3): 465–488.

26.

Gallo

(1996) L'alba dei gattopardi. La formazione della classe dirigente nella Sicilia austriaca (1719–1734). Roma: Donzelli.

27.

Gebreiter

(2016) Comparing the incomparable: Hospital costing and the art of medicine in post-war Britain. British Accounting Review 48(2): 257–268.

28.

Gebreiter

Jackson

(2015) Fertile ground: The history of accounting in hospitals. Accounting History Review 25(3): 177–182.

29.

Giordano

(1991) L'Archivio storico dell'Ospedale Civico e Benfratelli di Palermo, in Struttura e funzionalità delle istituzioni ospedaliere siciliane nei secoli XVII e XIX. In: Salute e Società, Atti del 3 seminario di Studi (Palermo 26–28 ottobre 1989). Palermo: Centro italiano di storia sanitaria e ospitaliera Sicilia, 299–312.

30.

Giunta

(1948) Fra’ Giuliano Mayali agente diplomatico di Alfonso il Magnanimo. Archivio Storico Siciliano III(II): 153–198.

31.

González Enciso

(2003) El Estado económico en la España del siglo XVIII. Memoria y Civilización 6: 97–139.

32.

Günther

(2010) Italian hospitals of the Early Renaissance. In: Ottenheym

De Jonge

Chatenet

(eds) Public Buildings in Early Modern Europe. Turnhout: Brepols Publishers, 385–396.

33.

Hernández Esteve

(2010) Accounting history, a privileged way to approach historical research. An illustrative case: The war of France and the Holy See against Spain, 1556–1559. De Computis, Revista Española de Historia de la Contabilidad 7(13): 162–190.

34.

Holden

Funnell

Oldroyd

(2009) Accounting and the moral economy of illness in Victorian England: The Newcastle infirmary. Accounting, Auditing & Accountability Journal 22(4): 525–552.

35.

Hopwood

(1987) The archaeology of accounting systems. Accounting, Organizations and Society 12(3): 207–234.

36.

Hopwood

(1990) Accounting and organisation change. Accounting, Auditing & Accountability Journal 3(1): 7–17.

37.

Hopwood

(1992) Accounting calculation and the shifting sphere of the economic. The European Accounting Review 1(1): 125–143.

38.

Hopwood

Miller

(1994) Accounting as Social and Institutional Practice. Cambridge: Cambridge University Press.

39.

Hoskin

(1996) The ‘awful idea of accountability’: Inscribing people into the measurement of objects. In: Munro

Mouritsen

(eds) Accountability: Power, Ethos and the Technologies of Managing. London: Thomson Business Press, 265–282.

40.

Howie

(1963) Finance and supply in an eighteenth-century hospital (1747–1830). Medical History 7(1): 126–146.

41.

Jackson

(2012) The collector will call: Controlling philanthropy through the annual reports of the Royal Infirmary of Edinburgh 1818–1852. Accounting History Review 22(1): 21–46.

42.

Jackson

Paterson

Pong

CKM

, et al. (2013) Doctors under the microscope: The birth of medical audit. Accounting History Review 23(1): 23–47.

43.

Lacombe-Saboly

(1997) Hospital accounts and accounting systems: A study in the French region of Toulouse from the seventeenth to the nineteenth century. Accounting, Business & Financial History 7(3): 259–280.

44.

Lapsley

Robbins

(2008) Irish voluntary hospitals: An examination of a theory of voluntary failure. Accounting, Business & Financial History 18(1): 61–80.

45.

Lazzini

Nicoliello

(2020) Accounting as an instrument of power: The case of an Italian hospital in the late nineteenth century. Accounting History 26(2): 236–254.

46.

Lee

(2021) Edinburgh accountants in public practice pre-collective organisation: 1757–1834. Accounting History Review 31(2): 165–191.

47.

Lentini

(2004) Dal commercio alla finanza: I negozianti-banchieri inglesi nella sicilia occidentale tra XVIII e XIX secolo, Mediterranea. Ricerche Storiche 1(2): 105–122.

48.

Lounsbury

Crumley

(2007) New practice creation: An institutional perspective on innovation. Organization Studies 28(7): 993–1012.

49.

Maran

Lowe

(2022) Competing logics in a hybrid organization: ICT service provision in the Italian health care sector. Accounting, Auditing & Accountability Journal 35(3): 770–800.

50.

Martini

(1907) La Sicilia sotto gli austriaci (1719–1734). Da documenti inedita. Palermo: Alberto Reber.

51.

Mazzè

(1992) L’edilizia sanitaria a Palermo dal XVI al XIX secolo: L’Ospedale Grande e Nuovo. Palermo: Accademia delle scienze mediche.

52.

McWatters

Lemarchand

(2013) Merchant networks and accounting discourse: The role of accounting transactions in network relations. Accounting History Review 23(1): 49–83.

53.

Miley

Read

(2016) Go gentle babe: Accounting and the London Foundling Hospital, 1757–97. Accounting History 21(2–3): 167–184.

54.

Miller

(1991) Accounting innovation beyond the enterprise: Problematizing investment decisions and programming economic growth in the U.K. in the 1960s. Accounting, Organizations and Society 16(8): 733–762.

55.

Miller

(1994) Accounting as social and institutional practice: An introduction. In: Hopwood

Miller

(eds) Accounting as a Social and Institutional Practice. Cambridge: Cambridge University Press, 1–39.

56.

O’Flaherty

(2019) Utilitarianism in the Age of Enlightenment. In: The Moral and Political Thought of William Paley. Cambridge: Cambridge University Press, 1–32.

57.

Park

Henderson

(1991) The first hospital among Christians: The Ospedale di Santa Maria Nuova in early sixteenth-century Florence. Medical History 35: 164–188.

58.

Parker

(1986) The Development of the Accountancy Profession in Britain to the Early Twentieth Century. New York: Garland Publishing.

59.

Perez Sarrion

(2011) Más Estado y más mercado. A modo de prefaciò. In: Perez Sarrion

(ed) Más Estado y más mercado: absolutismo y economía en la España del siglo XVIII. Madrid: Sílex, 9–15.

60.

Picardi

(2010) Birth in Rome of the first hospital in the history of Europe. Further development of the Roma’s hospitals. Annali Italiani di Chirurgia 81: 329–335.

61.

Pirri

(1723) Sicilia sacra. Disquisitionibus et notitiis illustrate. vol. II. Palermo: Apud heredi Petri Coppolae.

62.

Preston

(1992) The birth of clinical accounting. A study of the emergence and transformations of discourses on costs and practices of accounting in US hospitals. Accounting, Organizations, and Society 17(1): 63–100.

63.

Previts

Bricker

(1994) Fact and theory in accounting history: Present mindedness and capital market research. Contemporary Accounting Research 10(2): 625–641.

64.

Previts

Merino

(1998) A History of Accountancy in the United States: The Cultural Significance of Accounting. Columbus: Ohio State University Press.

65.

Riva

Cesana

(2013) The charity and the care: The origin and evolution of hospitals. European Journal of Internal Medicine 24: 1–4.

66.

Robson

(2006) The road to uniformity: Accounting change in UK voluntary hospitals. Accounting & Business Research 36(4): 271–288.

67.

Rodrigues

Sangster

(2013) The role of the state in the development of accounting in the Portuguese–Brazilian empire, 1750–1822. Accounting History Review 23(2): 161–184.

68.

Salvador Montiel

Ruiz Lamas

(2011) El régimen administrativo y contable del hospital de caridad de la coruña en el siglo XVIII. De Computis. Revista Española de Historia de la Contabilidad 8(14): 156–178.

69.

Sarrailh

(1957) La España ilustrada de la segunda mitad del siglo XVIII. Madrid: Fondo de Cultura Económica.

70.

Scott

(2001) Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care. Chicago: University of Chicago Press.

71.

Servalli

(2013) The interface of power and charity in the government of the poor. Accounting, Auditing & Accountability Journal 26(8): 1306–1341.

72.

Silvestri

(2020) Too much to account for. The crown of Aragon and the collapse of the auditing system in late-medieval Sicily. Accounting History Review 30(2): 171–206.

73.

Siviero

Torrisi

(2022) Insularity and international trade: The case of Sicily. RIEDS - rivista italiana di economia, demografia e statistica. The Italian Journal of Economic, Demographic and Statistical Studies 76(3): 17–28.

74.

Stevens Crawshaw

(2012) Plague Hospitals. Public Health for the City in Early Modern Venice. London: Ashgate.

75.

Szabo

FAJ

(2018) Cameralism, Josephinism, and Enlightenment: The dynamic of reform in the Habsburg monarchy, 1740–92. Austrian History Yearbook 49: 1–14.

76.

Thornton

Ocasio

Lounsbury

(2012) The Institutional Logics Perspective: A New Approach to Culture, Structure, and Process. Oxford: Oxford University Press on Demand.

77.

Valenti

(1982) Un’ inchiesta del 1760 all'Ospedale grande di Palermo. Palermo: Società Siciliana per la Storia Patria.

78.

van Bavel

Rijpma

(2016) How important were formalized charity and social spending before the rise of the welfare state? A long-run analysis of selected western European cases, 1400–1850. The Economic History Review 69(1): 159–187.

79.

Walker

(2019) Locating moral boundaries in the early accountancy profession. Accounting History Review 29(2): 171–198.