Vincenzo Chiarugi

Vincenzo Chiarugi (1759–1820) was an Italian physician who helped introduce humanitarian reforms to the psychiatric hospital care of people with mental disorders.

His early part in a movement towards moral treatment was relatively overlooked until a gradual reassessment through the 20th century left his reforms described as a landmark in the history of psychiatry.

[1] From 1785 to 1788, Chiarugi was director of the Santa Dorotea hospital in Florence, where he outlawed chains as a means of restraint for psychiatric patients.

Leopoldo also directed his attention to the mistreatment and neglect of the mentally ill, which was continuing despite progress in other areas of medicine and science.

A wing of the public hospital, the Bonifacio, was rebuilt for the purpose, and the young physician Chiarugi was put in charge.

There was a hospital in Florence run by the Brothers of Charity providing custodial care for the mentally ill, which Leopold had attempted to subordinate to the Santa Maria Nuova.

[3] Chiarugi employed three major diagnostic categories from a classification scheme by William Cullen that was in common use at the time: melancholia, mania, and dementia (terms used differently from today).

At the Bonifacio Hospital, he helped implement the new rules (Regolamento) covering the approach to custody and care, the conduct of all staff, and procedures for admissions and record-keeping.

This can be seen in parts of the Regolomanto such as (294–376):[2] The patient is to be treated with respect; not put to work (with the exception that those accustomed to such work may be expected to help in cleaning); no physical pain to be inflicted under any circumstance—and the director shall be vigilantly observant of this; the application of restraints, often necessary in the treatment of mania, must be applied in accord with humanitarian and hygienic practices; patients are to have access to the grounds to walk, play, or exercise; they are to be bathed regularly, even if they must be tied down while this is being done; they will be fed in their closed rooms while observed through a small grated window; visiting by friends or family is extremely unwise—when it occurs, it must be closely supervised.Chiarugi recommended cloth and leather restraints, partly strengthened with iron, applied in a way that prevented sores or lacerations.

In "On Insanity", he advised that patients with mania should be confined to a secure room without furniture or anything that could be dangerous, and with nothing too stimulating such as pictures, noise, light or items reminiscent of home.

Have him go on voyages where he will have the opportunity to converse with wise and genial companions, which will distract him from his preoccupations and allow new ideas and concerns to enter his mind.

This can be done by taking him by surprise with the manforte [literally, a support; a crook or crutch-like implement] and with it drag him to a seclusion room" (from Della Pazzia II, p74).For suicidal patients, Chiarugi advised the use of religious arguments for the value of life.

He examined post-mortem brains of patients and claimed to observe some pathological abnormalities, arguing that others might not be visible to the naked eye.

[2] Overall, Chiarugi's treatise on insanity and its classification has been described as learned – drawing on over 50 ancient, German, Swiss, French, British and Italian texts – but narrowly traditional in content and perspective.

[2] In addition, the support Chiarugi had enjoyed from the state of Florence faded, and he had no natural successor to continue to develop and publicise his work, by contrast to Pinel in France and William Tuke in England.

[1] It has also been noted that while Pinel expressed empathy and admiration for his patients and enlivened his work with individual case material, Chiarugi's writing, while never disdaining the mentally ill, did not highlight his humanitarian reforms and was characterized by a benign impersonality.

He became recognised as an early contributor to a movement that became known as moral treatment and his work said to "constitute a major landmark in the history of psychiatry".