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Enlargement of the hospital

The fresco has prompted various interpretations regarding the identification of the figures and their roles, although there is no disagreement about the general theme of the scene. The legend, which may have been altered in the 18th century, has influenced these readings. The scene depicts a construction site related to the hospital complex, featuring an octagonal building in the background, a classical portico on the right, and a worksite on the left where several laborers are engaged in their tasks. A master builder stands in the center, while a worker operates a winch above the scaffolding. An oblate, in a gesture of deference, receives a donation for the construction work. A procession rich with figures, some on horseback, is seen on the left side. The bishop is a debated figure: some believe he is riding a mule, while others argue he is not actually depicted in the fresco, but only referenced in the legend, which emphasizes the connection between the hospital and the Cathedral. The figure making the donation has been subject to different interpretations either as a layperson or a cleric. One hypothesis links a knight in the foreground to Niccolò Piccinino, who was in Siena during the stay of Pope Eugene IV.