The Bonifacio Hospital: reforming psychiatric hospital care

Panagiota Kitsantas, PhD
George Mason University, Fairfax, Virginia

 The Bonifacio Hospital, Florence, Italy

In 1369-1377 Bonifacio Lupi, mayor of Florence and Captain of the People, founded the Bonifacio Hospital (Ospedale di Bonifacio) dedicated to St. John the Baptist. In the sixteenth century, the hospital admitted patients suffering from syphilis, known as the “French disease,” spread by troops of Charles VII returning from Naples. Later the Grand Duke Gian Gastone de “Medici” (1671-1737) restricted admission to the hospital to the disabled poor and elderly; and in 1774 the Grand Duke Pietro Leopoldo turned it into a hospital for mentally-ill patients. He was a young man of the Enlightenment, a social and economic reformer, and his reforms included the rehabilitation of juvenile delinquents, the abolition of the death penalty, smallpox inoculation, and the humane treatment of the mentally ill.

Leopoldo’s 1774 “Law on the Insane” constituted the first legal statue in Europe that ensured institutional care for the mentally impaired, and he reconstructed a wing of the Bonifacio Hospital for that purpose.1The first mentally-ill patients were admitted in 1788; some were transferred from other hospitals in the surrounding areas of Florence. To lead the hospital, Leopoldo chose the young physician Vincenzo Chiarugi (1759-1820), who had studied medicine in Pisa and later had worked at the hospital of Santa Maria Nuova in Florence. As Chiarugi’s second specialty was dermatology, patients with skin diseases were also treated at the hospital.

Chiarugi introduced new humanitarian regulations for caring for the patients along with rules on staff conduct and procedures for admissions and patient records. He insisted on high hygienic standards, detailed record-keeping, and abolished the use of chains and physical punishment. No force could be used on patients, and only strait jackets and cotton strips were allowed if the patient had to be restrained. He separated women from men, and designed the rooms and furniture so as to protect the patients. He thus was a pioneer in establishing humanitarian regulations that later led to the “Moral Movement.”1 Modern policies and regulations of humane treatment of the mentally ill are a reflection of Chiarugi’s rules:

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.

Chiarugi published several works on mental illnesses. In On Insanity and Its Classification he described the therapist as one who would display sensitivity and prudence beyond the ordinary and guide patients to understanding and reasoning by kindness:

The therapist must conduct himself in a philosophical manner, displaying sensitivity and delicacy and prudence beyond the ordinary. He should refrain from opposing the mad ideas, as the ordinary person might do with unconcealed animosity, menace or blows. Such tactics disturb these unfortunates and enhance their stubborn adherence to their delusions. To the contrary, one must guide them to the understanding of what is true by kindness, by indirect means, instilling reason drop by drop.

Chiarugi’s psychiatric theories, teachings, and publications on mental illnesses were not widely translated or disseminated. This was partly due to distracting effects of the French revolution, and also because there was no natural successor to continue and disseminate his work.1,2 But in the twentieth century, Chiarugi’s psychiatric works were translated and recognized as important milestones in the history of psychiatry.

At the end of the nineteenth century, a new psychiatric hospital was built outside the Florence city center, and Bonifacio Hospital began to admit patients with different conditions. Later it became an educational center, and since 1938 it has served as the local headquarters of the Florence police. Today visitors may be unaware of the original purpose of the building, but on its walls a few inscriptions can be found indicating its previous function and commemorating the reformer Grand Duke Leopoldo and the pioneer Chiarugi.

1. Mora, G., Vincenzo Chiarugi (1759-1820) and his psychiatric reform in Florence in the late 18th century (on the occasion of the bi-centenary of his birth). J Hist Med, 1959. Oct 14: p. 424-33.
2. Gerard, D.L, Chiarugi and Pinel considered: Soul’s brain/person’s mind. J Hist Behav Sci, 1998. 33(4): p. 381-40.

PANAGIOTA KITSANTAS, PhD, is an associate professor of Epidemiology/Biostatistics at George Mason University, Fairfax VA. She conducts research in maternal and child health.