In 1861 William Arthur persuaded the WM Conference to send two missionaries to Italy to support work begun in Florence by a convert from Roman Catholicism, Bartholomeo Gualtieri. Henry J. Piggott spent 40 years there. A former priest, Benedetto Lissolo, was accepted for the ministry. The work was centred on Milan, Padua and Florence, and following the siege of Rome the first Methodist service in Rome was held on Easter Day, 1871. The degree of religious freedom enjoyed under Pope Pius IX diminished under his successor Leo XIII (1878-1903) and still further under Fascist rule, following the Concordat of 1929. The Mission launched by American Methodism in 1873, with its emphasis on educational institutions, suffered more than the British-based work. British and American work was united in 1946 to form the Chiesa Evangelica Metodista d'Italia, which remained a District within British Methodism until becoming an autonomous Conference in 1962. Ministers were trained at the Waldensian Seminary and in 1979 Italian Methodism entered into a covenant union with the Waldensian Church. In 1997 the Chiesa Evangelica Metodista reported 3,700 members and a total community of 6,500.
The Casa Materna children's home in Naples, founded in 1905 by the Methodist minister Riccardo Santi, received much support from British Methodism, especially through the Casa Materna Society (Great Britain); but in 2003 was forced to close through lack of funds.