Vincenzo Chiarugi

Did You Know?

• Chiarugi outlawed chains as a means of restraint for psychiatric patients while director of the Santa Dorotea hospital from 1785 to 1788.
• A prior attempt to remove chains at Santa Dorotea had been made in the 1750s, but chains softened with canvas strips were reintroduced.
• The Bonifacio Hospital had existed since the 14th century and also took in invalids and patients with skin conditions.

Enlightenment context

When Chiarugi was starting out, Florence was under Grand Duke Pietro Leopoldo, a ruler shaped by Enlightenment ideas who pushed for broad social and economic changes. He ended torture and capital punishment, and also focused on how the mentally ill were treated. In 1774, Leopoldo enacted Europe’s first law on the insane, which made it possible to hospitalize people deemed insane. A section of the Bonifacio public hospital was rebuilt for this purpose, and the young doctor Chiarugi was placed in charge. The government then issued new humanitarian rules for the Santa Maria Nuova and Bonifacio hospitals, with ten pages covering psychiatric patients. While Chiarugi helped shape those guidelines, whether the work should be credited solely to him is debated.

Clinical practices

Chiarugi employed three major diagnostic categories from William Cullen's classification: melancholia, mania, and dementia, which he saw as distinct but fluid. At the Bonifacio Hospital, he helped implement the Regolamento, which covered custody, staff conduct, admissions, and record-keeping. A detailed history was required for each patient, and men were separated from women. The rules, described as bureaucratic and paternalistic, expressed a novel concern for welfare: patients were to be treated with respect, not put to work unless accustomed to cleaning, and no physical pain was to be inflicted. Restraints, often necessary for mania, had to be applied humanely and hygienically. Patients could walk, play, or exercise on the grounds, were bathed regularly (even if tied down), and were fed in closed rooms observed through a small grated window. Visiting was discouraged and closely supervised. Chiarugi recommended cloth and leather restraints with iron reinforcement, applied to prevent sores, preferring ties and handcuffs that allowed mobility over straitjackets. For manic patients, he advised confinement in a secure, unfurnished room without stimulation. Although beating was prohibited, he suggested whipping around the waist could sometimes work for "arrogant" manic patients thought rational enough to be sedated by fear. Brief cold-water submersion was used, but not near-drowning; he did not employ food withdrawal to near-starvation but prescribed different diets for different conditions.

Theoretical assumptions

Chiarugi's published writing is primarily neurological, merged with philosophical perspectives on brain, mind, and soul consistent with Catholic theory. He argued that moral or physical forces disrupted the nervous system, involving an interplay between passions, reasoning, and the brain. He conceived neural functioning as involving force and hydrodynamic fluids, with blood flow to the brain adding to neural fluid pressure. Disorder was seen as either over-excitement or under-excitement of the brain and nervous system, with signs of the former indicating sedation and the latter stimulation. He argued that the soul remained perfect even if the mind was led astray due to its integration with the brain. He examined post-mortem brains and claimed to observe pathological abnormalities, though others might not be visible to the naked eye. His treatise has been described as learned, drawing on over 50 ancient and contemporary texts, but narrowly traditional; he did not mention John Locke, whose associationist ideas were controversial with Catholic doctrine, and it is said he did not enable a full psychological understanding of clinical issues.

Recognition

In Italy, Chiarugi was better remembered for his theories and teaching than for his humanitarian side. His writings on mental illness saw little translation or circulation abroad, though the first part of "On Insanity" did appear in German. He never gained the fame of Philippe Pinel, who enacted comparable changes a few years later. One reason is that revolutionary France drew more international notice. Also, Chiarugi lost backing from the Florentine state and had no obvious successor to carry his work forward, unlike Pinel or England’s William Tuke. Pinel showed empathy for patients and filled his accounts with individual stories, while Chiarugi’s tone, though never dismissive of the mentally ill, stayed benignly impersonal and downplayed his own reforms. The Bonifacio hospital later became a general hospital, then an education office, and since 1938 has housed Florence’s police headquarters. Over the 1900s, his contributions were gradually reassessed. New translations appeared, Italian editions were reissued, and his work came to be seen as a major milestone in psychiatry. The Regolamento’s key significance may be that it helped turn the mental patient into a modern public figure.