The hospital de caridade was not an institution for the well-off. The Portuguese colonial system sorted care by class as a matter of policy: the wealthy were treated at home by private physicians, while the hospitais de caridade tended to the poor, the enslaved, the aging, the injured dockworker, the beggar in the Largo. Friar Antônio was from the Church of Nossa Senhora de Belém, itself one of Cachoeira's great colonial landmarks. He founded the hospital in 1729, and in 1754 it was donated to the Order of Saint John of God of Lisbon - the Hospitallers, a religious order formed in sixteenth-century Granada around the life of a Portuguese soldier who devoted his later years to caring for the mentally ill and the indigent. In 1826, four years after Brazilian independence, the hospital was transferred to the Santa Casa da Misericórdia, the lay Catholic charitable brotherhood that ran most of Portugal and Brazil's charity hospitals. It has remained part of the Santa Casa network since.

The current building dates from the second half of the nineteenth century - not the original 1729 structure, though the institution is continuous. It still follows the colonial Santa Casa plan: a central courtyard with the chapel on one side, rooms arrayed around the yard. The exterior, rebuilt in that later century, took on a neoclassical skin - plain lines, plain surfaces, the Baroque impulse subdued. Inside the chapel, though, the older instinct survives. The nave has a single side aisle and a transverse sacristy with a room above. Two rows of choir windows stack the front facade. One tower, where a second was planned but never built. The churchyard became a garden in 1912 - French-formal in layout, geometric flowerbeds edged by columns topped with ceramic pots, pine cones, dogs, and lions. A marble fountain with three dolphins anchors the center.

Cachoeira declined when the railroad bypassed it in the early twentieth century and the sugar economy stopped flowing through. That decline is why the town still looks, in parts, like a 1750 engraving of colonial Bahia - because nothing ever got rich enough to tear it down and rebuild. The hospital complex is part of that preservation. IPHAN listed the garden in 1940 as an archaeological, ethnographic, and landscape monument, and the chapel in 1943 as a fine arts monument. The listings were not honorific - they were legal protections, the kind that make it a crime to alter the building without federal approval. In a region where two-hundred-year-old structures were routinely demolished in the twentieth century for parking lots and banks, that paperwork is the difference between the hospital existing and the hospital being a photograph in an archive. Treatment continues in the modern ward behind the chapel. The poor of Cachoeira still go there for care.