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This fresco is located in the 3rd bay on the east wall of the Pellegrinaio in the Spedale di Santa Maria della Scala. The Pellegrinaio, situated on the ground floor of the hospital, is a fourteenth-century room which took the form of a long vaulted hall.
Here we are shown the erection of new buildings for the hospital. A group of men on horseback occupies the foreground, they are the bishop's canons. Masons are at work in the right-hand foreground, as is a man seen from the back and holding a compass - obviously the architect. On the far right a ladder leads up at an angle from the bottom edge of the painting. This scene is depicted with a lively realism. The background is dominated by a tall, polygonal structure decorated in the rich forms of Sienese Gothic.
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