Music therapy in the great wards of the Hospital reached across boundaries of status. The organist was the medium through which mere mortals, whether brothers of the Order or the sick poor, were enlivened by intangible intimations of the celestial. When it came to providing music in the church, it was a different matter, as the reformed liturgy had to be strictly observed. From the time of Urban VIII Barberini and throughout the seventeenth century, the Hospital of Santo Spirito, like all hospitals and churches in Rome, was subjected to the increasing scrutiny of Apostolic Visitations. Surviving documents indicate that conduct and procedures in various parts of the institution, from the dispensary to the church, were tightened. This chapter will consider papal attempts at control in general, before evaluating a decree from the mid-seventeenth century and a backward-looking eighteenth-century iteration of it.

Spada's Stato della Casa written in 1660 makes multiple references to Apostolic Visitations, and to the ways in which the institution had made changes to comply with instructions issued after such visits. The directives concerning the hospital were primarily targeted at ensuring that there were sufficient priests on hand to hear the confessions of patients, to teach them correct doctrine and to perform the last rites as and when necessary. Beyond that, the behaviour of the personnel caring for the sick was to measure up to the standards of Christian charity set out in the Rule of the Order of Santo Spirito. On the actual practice of medicine or the conduct of physicians, there is comparatively little, and most of it concerns standards of hygiene and dietary rules.

Paolo Zacchia was employed by the Hospital in the decade prior to Spada's incumbency (1648–1659), and presumably had to ensure these standards were met. Zacchia had by that stage in his career already published a significant number of books, including those on observing a Lenten diet without damaging one's health, and on ‘hypochondriac diseases’. The latter includes a chapter on the passions of the soul – a topic that remained important in medical practice.