Ripa Grande also played a central role in Christian pilgrimage routes to Rome in the medieval period. Travelling up the Tiber River from the port in Fiumicino, pilgrims poured into the Ripa Grande and, most likely, travelled along Via Lungaretta to visit Rome's sacred spaces. Overtime, and particularly during Jubilee years, the influx of pilgrims transformed the Ripa Grande from a lively urban neighborhood into a hectic hub of religious and commercial activity. For this reason, the Ripa Grande was appropriately nicknamed the "Pilgrim's bank."

Today, unfortunately, nothing remains of this important medieval site. The embankment project in 1880 led to the demolition of the port's ships, docks, and infrastructure. Nonetheless, key locations in the port's history remain intact. The Marmorata Port, for instance, has been remarkably well preserved on the left bank after its excavation in the late 19th century. Additionally, constructed into the Aurelian wall during the ancient period and frequently used during the medieval period, the Porta Portese on Via Portuense still stands. Most importantly, we may walk along the steps in front of the Institute of San Michele complex on Porto di Ripa Grande and imagine the galleys and rowboats that populated the Tiber River and this flourishing harbor, serving as an important reminder of this port's location and medieval past.

The change in name, however, is an interesting story that occurred during the Middle Ages. Outside the gate — a five minute walk today — is the basilica of San Pancrazio that was built over the buried body of the martyred St. Pancras, a teenager who according to legend was killed by the Romans for his conversion to Christianity. Additionally, there is an extensive network of catacombs — or underground burial sites — under the basilica. During the Middle Ages, the relic of St. Pancras was an important destination for religious travelers. Thus, due to its proximity to the basilica, the gate was changed from its ancient title, Porta Aurelia, to its Christianized name, Porta San Pancrazio. In the late Middle Ages, then, Porta San Pancrazio would not only have functioned practically, but would have also carried religious meanings for both the pilgrim and Roman walking through its gates. Like many other sites across Rome, the Porta San Pancrazio is an example of how Romans negotiated between their ancient past and new Christian identity during the medieval period.

Archaeological surveys have enabled historians to date the repairs made on the walls based on the materials used in different sections: in the period 750-850 CE, blocks of tufa (the volcanic bedrock of the Eternal City) were used to repair walls and other buildings. If archaeologists can confidently date a church that uses this tufa repair method, they can then date similarly-repaired sections of the Aurelian walls with confidence. Emphasizing the regularity and logistical complexity of these repair programs, Robert Coates-Stephens argues that “the extent of the restorations gives an idea of the efficiency of the papal organization of public building in the early medieval city.” Based on Coates-Stephens’ synthesis of previous archaeological research and his own archaeological surveys, it has become clear that the 19km wall around the city has been consistently maintained and appreciated throughout the medieval era and into the nineteenth century.

In 1473, Pope Sixtus IV decided to reconstruct the bridge slightly downstream to provide alternate routes of foot traffic for the 1475 Jubilee, and named the ponte after himself. Jill E. Blondin argues that Sixtus undertook his urban restoration work to promote himself, and to communicate "the message of his secular and sacred authority to observers" (1). In her analysis of both the bridge and Sixtus's other public works, Blondin finds that Sixtus emphasized both his own greatness and the greatness of antique and contemporary Rome. Blondin concludes that Sixtus "drew on antique symbols, sculptures, and buildings to create a glorious, new Christian Rome fashioned to represent him squarely in charge of the civic and spiritual dimensions of the city" (24). With Blondin's reminder of the continuing power of ancient Rome throughout the medieval and Renaissance periods, we may begin to imagine the Ponte Sisto as a site that, due to its ancient origins, may have continued to have symbolic significance even when it was in pieces in the Tiber.

Innocent built the hospital as an expansion of the Schola Saxonum compound, a former complex dedicated to the British pilgrims of Rome. The Schola Saxonum had existed since 725, alongside many other similar communities dedicated to pilgrims coming to Rome to visit the tomb of St. Peter. In 1208, after the Norman Conquest effectively put a hold on English pilgrimages to Rome, the complex was officially decreed to be a hospital. Unfortunately, little remains of the original structure, as much of it decayed during the fourteenth century during the Avignon Captivity due to the lack of papal support.

In 1474, Pope Sixtus IV completely renovated the hospital, creating the structure we see now. The long, rectangular building is topped by an octagonal bell tower and is also attached to a ward known as Corsia Sistina. The modern hospital is still attached to this structure, which now functions as a conference center and church. The ward, now a courtyard, attaches to another square bell tower. It has been noted that this bell tower survived Sixtus’ reconstruction, implying that it was built in the medieval times, perhaps even in the hospital’s first construction.

There are two courtyards between the medieval ward and the modern hospital, that were used to house the monks and nuns who lived and worked for Santo Spirito. Both cloisters have fountains in the center; the fountain in the nuns’ cloister is decorated by charming Renaissance-style dolphins. Today, these cloisters are part of the modern hospital. Despite all of its changes, the Ospedale di Santo Spirito still seems to parallel its medieval form as it continues to serve the people of Rome in different ways.

The façade is from the twelfth century, and can be identified as medieval by its incorporation of multiple arches and its use of long and thin bricks. The columns that support the arch are spoils from Roman antiquity, which is commonly used in medieval structures. Since the 900s the complex has been continuously used and built upon (and around). The former monastery was converted into a hospital in the 19th century and it is now where the Ospedale Nuova Regina Margherita resides.