Egidio Priani

This open access book explores the history of pellagra, a vitamin deficiency disease brought about by a shift in agriculture to maize, which ravaged Italy from the 1760s. With a focus on the insanity that was caused by the disease, the authors examine how thousands of patients were treated in Italian psychiatric asylums, shedding light on the sufferer's point of view. Setting pellagrous insanity in a wider context of man-made or societal (anthropogenic) disease, where poverty, diet and disease meet, the book contributes to the history of medicine and science, the history of psychiatry, economic and social history, agrarian history, and food and nutrition history. Additionally, the authors aim to transnationalise Italian history by making comparisons with related issues, such as tertiary syphilis in the UK. Drawing from a wide range of printed and archival sources, including the writings of Italian medical investigators and patient records, the book examines how medical and scientific research was carried out during the long nineteenth century and the uncertainties that this engendered, in terms of classification, explanation, diagnosis and treatment. Offering a unique perspective on an endemic illness which came to be known as the disease of the four ds-dermatitis, diarrhea, dementia and death-this book provides an engaging account of one of the most perplexing causes of mental illness.

The debate on the causes and the nature of pellagra in Italy during the nineteenth century resembles and evokes the similar debate on General Paralysis of the Insane (GPI) that was growing at the same time in the United Kingdom. Pellagra and GPI had a massive and virulent impact on the populations of Italy and the UK, respectively, and contributed to a great extent to the increase and overcrowding of the asylum populations in these countries. This article compares the two illnesses by examining the features of their nosographic positioning, aetiology and pathogenesis. It also documents how doctors arrived at the diagnoses of the two diseases and how this affected their treatment.

Résumé
Cet article est issu d’un projet de recherche mené entre 2006 et 2009 aux archives de l’ancien asile psychiatrique de l’île vénitienne de San Servolo. Le but de ce projet, initié et dirigé par Mario Galzigna, titulaire des enseignements d’histoire de la pensée scientifique et d’épistémologie clinique à l’université Ca’ Foscari de Venise, était d’analyser le fonctionnement de l’asile pendant la période 1840-1904. L’étude que nous présentons ici prend en considération une période de temps plus limitée (1840-1877) et elle explore, dans la perspective de l’histoire conceptuelle, trois dimensions étroitement liées entre elles : 1. la taxonomie psychiatrique et les procédures de diagnostic ; 2. les traitements adoptés ; 3. la vie et les histoires cliniques de certains internés. La première partie de l’article est consacrée à la description matérielle des archives de San Servolo, aussi bien qu’à la présentation du cadre méthodologique de la recherche. Notre examen du contexte scientifique de l’asile de San Servolo se concentre, en particulier, sur les influences médico-psychiatriques venant de France et d’Allemagne. Une partie importante de la recherche est consacrée également à l’analyse de la réalité asilaire de San Servolo à la lumière du contexte social et culturel de la région de la Vénétie. De manière plus spécifique, l’étude que nous présentons se fonde sur l’examen systématique des dossiers cliniques et des documents administratifs conservés dans les archives de l’asile.
Mots clés
archives ; asile ; dossier médical ; pellagre ; nosographie ; traitement moral
Abstract
This article origins from a research project conducted between 2006 and 2009 in Venice at the Archives of the ancient Mental Asylum, located in the isle of San Servolo. The principal investigator of the research project was Mario Galzigna, lecturer in History of Scientific Thought and Clinical Epistemology at Ca’ Foscari University of Venice. The aim of the research project was to analyse some specific aspects of the Asylum functioning during the period 1840-1904. My article, in adopting a conceptual history perspective, examines a more limited time frame (1840-1877) and deals with three dimensions which are closely related : 1. psychiatric taxonomy and the diagnostic procedures ; 2. applied treatments ; 3. life and clinical stories of some inmates. In the first part of the article I describe the Archives and I outline the methodological framework of my work. The scientific background consists in the European theoretic medicalpsychiatric influences, in particular those coming from French and German areas. At the same time, a crucial role is played by the social and cultural characteristic features of the Veneto Region society. My work is mainly based on the systematic examination of the clinical records and on the analysis of the primary sources which are guarded in San Servolo Archives.
Keywords
archive ; asylum ; clinical record (file) ; nosography ; pellagra ; moral therapy
Citation
Egidio Priani, « Les archives de l’ancien asile psychiatrique de San Servolo (Venise), 1840-1877 : Trames, classifications, sujets », Revue d'histoire des sciences (2/2017), pp. 299-326, Armand Colin. Disponible sur : http://www.revues.armand-colin.com/histoire/revue-dhistoire-sciences/revue-dhistoire-sciences-22017/archives-lancien-asile-psychiatrique-san-servolo-venise-1840-1877-trames

Egidio Priani, 'Shrouded in a dark fog': comparison of the diagnosis of pellagra in Venice and general paralysis of the insane in the United Kingdom, 1840–1900. The debate on the causes and the nature of pellagra in Italy during the nineteenth century resembles and evokes the similar debate on General Paralysis of the Insane (GPI) that was growing at the same time in the United Kingdom. Pellagra and GPI had a massive and virulent impact on the populations of Italy and the UK, respectively, and contributed to a great extent to the increase and overcrowding of the asylum populations in these countries. This article compares the two illnesses by examining the features of their nosographic positioning, aetiology and pathogenesis. It also documents how doctors arrived at the diagnoses of the two diseases and how this affected their treatment.

Symposium on the doctor-patient relationship 
University of Oxford 24 March 2017

Egidio Priani – University of Leicester

Abstract: The doctor – patient relationship and the conceptualization of diseases: the case of “pellagrous insanity” in late nineteenth-century Italian medical debates.
My paper will highlight and analyse the link between the doctor-patient relationship and the conceptualization of diseases. The way in which this relationship is put into practice is often decisive in conceiving diseases. At the same time the conceptualization of a specific disease influences the concrete doctor-patient relationship and treatment.
To demonstrate this nexus, I will retrace the fierce Italian medical scientific debate between the two schools of thought which, in the late nineteenth century, competed for the discovery of the causation of “Pellagrous insanity”, an effect of epidemic pellagra, itself caused by the poor maize-based diet of the peasants and day-labourers in northern Italy.
The school headed by Dr Cesare Lombroso supported the theory of food poisoning due to the maize toxin. The other school, led by Dr Clodomiro Bonfigli, asserted that the origin of the insanity was to be found in the intrinsic maize nutritional deficiency.
These two opposing positions were rooted in different and sometimes antithetical perspectives regarding the doctor-patient relationship. On the one hand, Lombroso argued for the primacy of an objective and positivist knowledge, based on incontrovertible laboratory tests and in direct causal links. According to this approach, the relationship between the doctor and the patient was ancillary and directed at confirming underlying assumptions. 
On the other hand, Bonfigli was very close to the “old” clinical approach, orientated towards listening, observing and describing. The doctor and the patient had established a direct contact and the dialogue between them was unfiltered and honest.  The doctor had also to consider carefully the patient’s social and economic conditions. 
My paper will demonstrate how those deep differences in the conceptualization of the doctor-patient relationship were translated into two opposing aetiological ideas.

On 2 December 1902 an interview with Cesare Camillo Minoretti appeared in the Corriere della Sera, Italy’s most important newspaper. In the interview, Minoretti, priest in the Fatebenefratelli order, medical doctor and director of the Venetian male insane asylum of San Servolo, sought to defend himself against the defamatory accusation directed at him in a report by Prof Ernesto Belmondo, commissioner in charge of inspecting the Venetian asylum. In his report, Belmondo described San Servolo in terms of a Dantesque hell, in which the nurses acted like prison guards and the patients were kept in shackles and chains, sometimes for years at a time.

The public indignation caused by the ‘Minoretti scandal’ signalled a turning point in the history of Italian psychiatry, setting the conditions for the comprehensive reform of the asylum system, enshrined in law in 1904. That said, the scandal was not an isolated event in the history of nineteenth-century Venetian psychiatry, but emerged out of deep-seated theoretical approaches to the treatment of insanity which had their roots in the 1840s.
My paper aims to analyse the complex network of social and cultural factors which led to the ‘Minoretti scandal’. These cannot be pinned directly or solely on specific individuals, but were also the result of institutional policies towards insanity that had resulted in the concentration of a range of diverse diseases in single institutions, which made the targeted provision of care impossible. My analysis is based on the archival records of San Servolo, in particular patient files, the Rendiconti Statistici (published institutional accounts by asylum directors), and the testimony of foreign doctors, such as the American E. T. Wilkins and the Australian G. A. Tucker.

“Italian Fringes: Pellagra between psyche and soma in Venetian asylums, 1840-1920”

Egidio Priani
(Research Assistant, ESRC ‘Rough Skin Project’, School of History and Centre for Medical Humanities, University of Leicester, UK)

My paper will explore category work in psychiatry through an analysis of the diagnosis and treatment of pellagra patients at the twin Venetian asylums of San Servolo (men) and San Clemente (women) during the second half of the nineteenth century. At the time, the aetiology of pellagra was hotly debated by Italy medical investigators; what they agreed upon was the epidemic nature of the affliction, the fact that it mostly affected poor peasants, that it was linked to a maize-based diet, and that, left untreated, it lead to insanity, with the hospitalisation of thousands of pellagrins.

If pellagra’s organic causes were still little understood, there was as much discussion about its psychopathological effects. Its early stages consisted of skin peeling, diarrhoeia, extreme lethargy and dizziness; while the later stage produced agitation, mania, aggressiveness (more frequently in men), and melancholy, apathy, stupor, low mood (more frequently in women). As a result, pellagra had a hybrid epistemological status.

My analysis is based on over two thousand patient files at the two Venetian insane asylums of San Servolo and San Clemente and makes use of both qualitative and quantitative methodologies. I argue that pellagra represented a great question mark for nineteenth-century doctors when it came to diagnosis and treatment. Although they were able to recognise the signs of pellagra, the disease resembled a liminal phenomenon, unclear and hard to place, either among the organic diseases or among the mental illnesses proper. Physicians considered it fleeting and elusive, not only from an aetiological point of view but, primarily, because of its ambiguous nosographic positioning. I will try to understand the genesis and the epistemological meanings of what seem at first glance to be bizarre diagnoses: “chronic pellagrous chronic mania”, “intermittent mania due to pellagra”, “monomania due to pellagra and anguish”, and so on.

The asylum doctors’ classifying efforts and their tendency to include the singular in the categorical, found in pellagra a great cognitive challenge; but, at the same time, a hindrance in the construction of the epistemological apparatus of rising psychiatry in Italy.

Towards an Iconography of Pellagrous Insanity in Venice, 1873-1912

How was a comparative iconography constructed and how this related to the parallel development of psychiatric nosology with regard to pellagrous insanity? My paper illustrates the link between the use of photography and the history of pschychiatric knowledge and practice in the context of the Venetian insane asylums of San Servolo (men) and San Clemente (women). It covers the period from 1873, when the use of photography began in the two institutions, until the first decade of the twentieth century, coinciding the Crispi law for the reform of psychiatric hospitals and the lessening of the pellagra epidemic.
Pellagra is a deficiency disease, which in northeastern Italy was caused by a subsistence on maize polenta and which decimated the rural population. In its latter stages it leads to insanity, with the result being that around a third of all asylum inmates of affected regions were victims of ‘pellagrous mania’, as it was labelled at the time. Situated halfway between organic and and psychic affliction, pellagrous insanity was then the source of much heated debate, not only theoretical and clinical, but socio-economic as well.
I reconstruct the scientific assumptions and intentions behind the introduction of photography in the two Venetian asylums and analyse the extent to which it affected clinical practice, the image of patients, representations of mental illness and wider beliefs associated with it, all in the context of a developing Venetian psychiatry. In particular, I focus on the use of photography in patient records. This allows us to explore pertinent and intersecting dimensions of clinical practice, such as concepts of objectivity, and the dialectic of latent/manifest and visible/invisible, in the framing of disease.

“Mais, pellagra e pazzia: i pazienti del Polesine nei manicomi di San Servolo e San Clemente a Venezia, 1840-1910”

David Gentilcore e Egidio Priani
University of Leicester – School of History and Medical Humanties
Economic and Social Sciences Research Council, research grant ES/K010212/1: “Maize, Pellagra and Society in Italy”.



Il nostro intervento si articola in due parti tra loro integrate. Nella prima parte il Prof. Gentilcore presentera’ il progetto di ricerca “Rough Skin: maize pellagra and society in Italy”; verra’ tracciato un quadro complessivo circa l’insorgenza, lo sviluppo e il graduale venir meno della pandemia pellagrosa nell’Italia centro settentrionale, tra la fine de XVIII e i primi decenni del XX secolo. Saranno evidenziate le fondamentali componenti storiche e socio economiche che hanno prodotto il fenomeno e al tempo stesso verranno presi in analisi due emblematici casi di pazienti polesani affetti da pellagra, giunti presso gli asili veneziani di San Servolo e San Clemente.
La seconda parte dell’intervento si focalizza sull’esposizione del data base, quale parte integrante del progetto di ricerca. Il D.B. censisce la popolazione manicomiale dei due asili veneziani; verranno messe in luce alcune delle principali  dimensioni metodologiche e di contenuto implicate nella costruzione del D.B.: tra queste ultime, il ruolo della cartella clinica, la problematica dei processi diagnostici, i rimedi farmacologici.  Ci soffermeremo, sulla base dell’ attuale stato di avanzamento del D.B., su taluni rilievi statistici collegati  alla popolazione del Polesine.

How did home-grown expertise acquired in the field of the aetiology and treatment of pellagra in Italy interact with areas such as psychiatry where many of the dominant ideas originated from elsewhere in Europe? How can we reconstruct the reception of these schools of thought?
My paper addresses these questions  by looking at a specific aspect of the pellagra pandemic in Italy, that of the insanity that occurs in its final stage. My source consists of several thousand patient files at the Venetian mental asylum of San Servolo, from 1840 to  around 1910. The province San Servolo served was one of the most hard-hit by the pellagra epidemic. From an examination of clinical files, I consider the manner and modality of admission and the typologies of treatments reserved for patients.
Patient records provide an icomparably rich source, allowing a comparison of clinical practice with theoretical models. In particular, I analyse the diagnostic processes and underlying models of medical ‘rationality’ to shed light on centre-periphery relations in the diagnosis and treatment of pellagra. Diagnostic intersections between pellagra and psychiatric symptoms led to hybridisations such as ‘pellagrous melancholy’, ‘pellagrous frenzy’, ‘raging frenzy’, and so on. These refer to French nosography, initiated in the beginning of the so-called ‘Alienstic’ period, a nosography was recognised at San Servolo. It was considered a fixed point of reference, attested to by explicit quotes and  references in the clinical files, annoted by the hospital’s doctors. Here Italian expertise in the field of pellagra was conditioned by French dominance in the field of psychiatric medicine. Then, as my study of the nomenclature used in the patient records suggests, from the 1870s and 80s the dominant diagnostic model shifted to the German school of biological psychiatry, which continued to dominate until the early twentieth century at San Servolo.

"The paper presents the data set related to the research project: “Rough Skin: Maize, Pellagra and Society in Italy, 1750-1930” funded by the Economic and Social Sciences Research Council (UK).

The project reconstructs and analyses the effects of the introduction of maize cultivation
in northern Italy, in all its aspects, with the focus on its most deleterious: the 150-year-long pellagra epidemic. Pellagra was the disease of the four 'd's: dermatitis, diarrhoea, dementia and death. Because of the insanity that pellagra caused in sufferers, an estimated one-half of asylum patients in the latter 19th century were pellagrins, and it is the records generated about them that will form the basis of the data set.

More specifically, the data set is based on the clinical files of pellagrins hospitalised from 1860 to 1904 in Venice at San Servolo (men) and San Clemente (women), two of the main mental asylums in Italy at that time. The data set aims to collect material in order to answer questions about the construction of disease categories relating to mental illness over the period and the treatment strategies employed. It aims also to provide a key source for the understanding of changing patient treatment and the social origins of pellagrins.  There is no similar set of hospital records anywhere in Italy, which can be used to shed light on the treatment of pellagrins in the 19th century within the broader contexts of the classification of mental illness and socio-economic conditions. The data set is crucial also in that it will allow comparison between the extensive work on ‘insanity’s archive’ in the English-speaking world and Europe, with the much less studied Italian experience.

P. I. : Professor David Gentilcore
R. A.: Egidio Priani,
(both School of Historical Studies and Centre for Medical Humanities, University of Leicester, UK)
"
Location: 'Collecting, Organizing, Trading Big Data': Swiss Science, Technology and Society Meeting, 20-21-22 February 2014, University of Lausanne
More Info: co-authored with Egidio Priani

The one-day workshop aims to analyse the themes of pellagra and the related mania, from an eclectic and multidisciplinary perspective. The different talks will indeed bring together quantitative and qualitative research methods, so as to highlight both the local dimension (Venice and the neighbouring Regions) and the wider international debate about pellagra and " alike " diseases. Some topics which will be focused are:  The iconography and the visual representations of pellagra  The scientific debate amongst physicians in Italy and in Europe  The spread and the circulation of the medical knowledge about pellagra in Europe during the nineteenth century  Local detailed studies concerning pellagra in specific northern Italy areas, such as Polesine and Ferrara Province

In autumn 2006, Professor Mario Galzigna (Department of Historical Studies, Ca’ Foscari University, Venice) started a historical-epistemological research project at the Archives of the Foundation IRSESC (Social and Cultural Emargination
Research and Studies Institute: http://www.fondazionesanservolo.it/html/fondazione.asp), formerly seat of the old mental asylum of Venice (which closed
on 13 August 1978 after 250 years).
The Foundation’s heritage comprises a very large archive including the following sections: administrative; sanitary; accounting; photographic. In addition, it includes the book collections of the old psychiatric hospitals of San Servolo,
San Clemente (feminine section: 1873–1987) and provincial civil Hospital SS. Giovanni e Paolo of Venice (mental hospital section). There is also material relating to San Servolo’s pharmacy.The main aim of the research so far – by means of a systematic examination of a selection of clinical records – has been the reconstruction of the psychiatric apparatus
of San Servolo from 1840 to 1904, in its multiple forms, and the analysis of the network of relations between the asylum and other main institutions, with particular attention to those with political, sanitary and judicial power in the Veneto region of the period. Now we would like to enlarge the perspective of this research by setting the psychiatric experience of San Servolo into the historical, institutional and scientifi c European context from the point of view of both psychiatric practice
and clinical nosography (evolution in diagnostical approaches; assessment of the infl uence of European scientifi c production on these practices and theories).
At present, we are looking for European or non-European sponsors and partners and fi nancial support in order to continue our work in a wider, international perspective and context.

Sullo scenario della seduta individuale si presentificano, oltre al terapeuta e al paziente, una pluralità di soggetti tra loro in relazione. In tale contesto, che forme potranno assumere i legami inconsci di coppia e familiari? Che qualità di ascolto possono ricevere dal terapeuta e come questi se li rappresenta nella propria mente? In che modo tali rappresentazioni si tradurranno in parola e in concreta azione terapeutica? A sua volta, quali  cambiamenti indurrà quest’ultima?
Il nostro intervento intende evidenziare come alcune delle concettualizzazioni chiave elaborate da P.C. Racamier possano non solo orientarci nella lettura e interpretazione dei quesiti menzionati, ma anche fornirci dei concreti ed efficaci strumenti di lavoro terapeutico. Nozioni fondamentali quali:  antedipo, incestuale,  segreto, feticcio, ingranamento ecc., investono infatti i legami in prospettiva transgenerazionale, dilatando in tal modo i confini strettamente soggettivi o diadici delle matrici eziopatogenetiche.
Proporremo pertanto il caso emblematico di un uomo di mezza età che, a partire dalla rottura della relazione con la compagna e dal conseguente crollo narcicistico, precipita in una condizione psichica ed esistenziale regredita ed informe.
Attraverso il nostro paper, vedremo come i concetti di cui sopra ci guideranno e ci illumineranno nel corso del lavoro terapeutico.