Directly opposite the cathedral stands Santa Maria della Scala, which, for centuries, was the city's main hospital. It gained its name from its position, 'ante gradus maioris Ecclesiae' (before the step of the largest church).
The Spedale di Santa Maria della Scala was founded to give assistance to the many pilgrims who passed through the city on their way to and from Rome. Siena was an important stop on the Via Francigena, once the busiest pilgrimage route in Europe. The hospital, which also cared for abandoned children, is first mentioned in a document, dated March 29th, 1090.
However, according to a medieval legend, the hospital was founded in 898 by a pious local cobbler called Sorore, whose mother had had a vision of babies ascending a ladder into heaven, where they were received into the arms of the Virgin Mary. The hospital's emblem was a ladder (scala) surmounted by a cross.
One of the most impressive rooms in Santa Maria della Scala is the grand Pellegrinaio (Pilgrims' Hall), which was decorated with frescoes between 1440 and 1444. The wall paintings, which are the work of Domenico di Bartolo (1400-45), Lorenzo di Pietro (1412-80, better known as il Vecchietta) and Priamo della Quercia (1400-67), are noted for their detail and realism.
In 1995 Santa Maria della Scala opened to the public as a museum.