What is astonishing about this anonymous opera, which was rediscovered in the Marciana Library in 2003 by musicologist Naomi Matsumoto and superbly presented here by Solomon’s Knot baroque collective, is that Abati’s biting invective is so strikingly modern, and topical. With NHS junior doctors set to go on strike three times next month, issues such as the state funding of the health service, doctors’ pay and working hours, and patient waiting times have never been more hotly disputed in the UK. Moreover, the creeping privatisation, fragmentation and destabilisation of the NHS, in the guise of euphemistically termed ‘efficiency savings’, has brought the ‘profitability’ debate to the fore, and left many fearing that those unable to pay for healthcare will be vulnerable to growing health inequality. As Abati’s libretto asks, ‘Who can find a cure for poverty and desperation?’

The action takes place in an ospedale, a type of charitable institution which in seventeenth-century Italy formed part of the ‘welfare system’: ospedali were usually attached to churches, and they housed and treated those with ailments and social conditions that made them undesirable to the rest of society - such as lepers, syphilitics, abandoned children and orphans, prostitutes and the homeless. (Fittingly, one role of the ospedali was to educate their patients, and this involved musical education; musical ensembles, cori, were formed and these gave performances designed to raise funds and attract sponsors, with the result that in the in the seventeenth and eighteenth centuries the grandest of the ospedali were at the core of Venetian culture.)

In Abati’s shabby ospedale, four patients languish amid squalor, seeking cures for their varied ailments: unrequited love, professional disappointment, mental deficiency and poverty. (It says much for the potency of the purse in quelling the wealthy hypochondriac’s neurosis that it is only the last of these four ailments which proves truly incurable.) They await the arrival of a new doctor whose medications and remedies will, they hope, restore them to health; but the charlatan’s idiosyncratic treatments have unexpected and unwished-for side-effects, and the sufferers risk losing more than their money.

This is Solomon’s Knot’s first fully staged production. Director James Hurley’s staging updates the action to the present, as immediately confirmed by a supplementary Prologue in which we seem to be eavesdropping on a disingenuous circumlocution by the Minister for Health to the House of Commons, as he justifies the need, in this age of austerity, for reductions to the health budget, and calls for greater efficiency within the NHS as well as an enlarged role for the ‘Big Society’ in order to alleviate the potentially adverse effects of the government’s reforms. (The Minister returns in an Epilogue, to announce his resignation in the light of the first-rate achievements of professional medics.)

The production was sung in Italian with English surtitles, and I found myself wishing that my own Italian was less rudimentary so that I might have a better appreciation of how far the double (even triple), entendres were evidence of Amati’s wit, or were the result of the ‘transcriptions, translations and workshop projects’ which Solomon’s Knot have undertaken during the past two years to bring the opera ‘back to life’. Either way, the satire was certainly au courant, the gags inventive, and the polemic provocative.

Wilton’s Music Hall was the perfect venue. Situated in the historic East End, it is the world’s oldest music hall. For many decades the Hall has been afflicted with damp and dereliction; a flyer for a 1997 production of The Wasteland, directed by Deborah Warner and performed by Fiona Shaw, advised mid-winter visitors to the unheated hall to ‘please dress warmly’, to which a journalist added ‘wear hard hats’. But, despite the welcome completion in September this year of long-running renovations, the makeover has retained the genuine historic fabric and, sitting in the dimly lit, smoke-filled hall (lighting by Ben Pickersgill) it was easy to imagine oneself in an insalubrious infirmary - historic or modern. Rachel Szmukler’s set consisted of a curtained hospital bed, towering piles of orange garbage bags containing medical waste (and new ‘inmates’’ personal belongings), and a trolley laden with urine samples. The harsh glare of strip lights and a glowing vending machine - peddling sugar foodstuffs unlikely to nourish the needy - spread an unforgiving glare. Performing in the round can have its pitfalls though, and while the sight-lines from my seat were superb, others seated on the opposite side of the arena may have found the frequent drawing of the curtain around the operating couch to be frustratingly obstructive.

The quack doctor - actually the disguised Minister for Health, undertaking secret scrutiny of his ailing health care system - attends to the four patients in turn. Rebecca Moon light, clear soprano conveyed profound depths of passion during Innamorato’s melodramatic tale of unreciprocated lesbian desire (presumably the role was originally sung by a castrato?); her lovelorn lament matched Monteverdi for rhetorical urgency, but the doctor was not touched by her distress, basically advising that she should ‘get over it’. Overlooked for career advancement, Cortigiano may be suffering from work-related stress, but tenor Thomas Herford did not let the City boy’s anxieties infect his own lyrical elegance. Countertenor Michal Czerniawski’s Matto was the embodiment of hyper-manic instability, fluctuating between insight and insanity, the latter moments enhanced by some inane shrieking. Nicholas Merryweather displayed characteristic dramatic confidence and vocal sureness as Povero, whose inability to pay the doctor’s fees exposes the latter’s avarice. Merryweather’s well-centred baritone made for a pleasing contrast with Czerniawski, and provided a strong foundation in the lively ensembles. As the fraudulent physician, Jonathan Sells showed considerable comic nous, while Lucy Page demonstrated a crystalline soprano as the put-upon hospital orderly, Forestiero.
The score alternates arias - madrigals, laments, balletti - arioso, ensembles and spoken dialogue, and is melodious, briskly energetic and inventive. To the mix were added two madrigals by Gesualdo, whose bitter-sweet dissonances and chromatic lamentations perfectly complemented the mood of emotional disturbance and anguish. James Halliday drew superb playing from the small instrumental ensemble: rhythmically alert, vigorous and colourful.

Music, medicine and madness are a potent mix. Indeed, my guest for the evening was a retired psychiatrist who has just published a study of operatic heroes who might be considered to exhibit a range of personality disorders (and who, ironically, undertook his training at the nearby London Hospital). This production by Solomon’s Knot perfectly balanced satire and silliness; it was an earnest critique of the medical profession, historic and modern, and also exuberant fun. It took risks, and while not all of them came off, it communicated directly and with thought-provoking candour.

Claire Seymour

Forestiero - Lucy Page, Povero - Nicholas Merryweather, Matto - Michal Czerniawski, Innamorato -Rebecca Moon, Cortigiano - Thomas Herford, Medico - Jonathan Sells; Director - James Hurley, Musical Director - James Halliday, Designer - Rachel Szmukler, Lighting Designer - Ben Pickersgill.