Florence: Luigi Carlieri, 1793-1794.
First edition of perhaps the greatest rarity in the history of psychiatric literature. “Chiarugi’s reformed system of treatment of the mentally ill was given full expression in his Della pazzia, in which he classified insanity into melancholia, mania and dementia, and gave a system of diagnosis and treatment for each. The work also presents Chiarugi’s observations on hundreds of cases (many supported by autopsies), and contains the first illustration of the straitjacket.” (Norman)..
First edition of perhaps the greatest rarity in the history of psychiatric literature. Based on his practical experience at the hospital of S. Bonifazio in Florence, in Della pazzia Chiarugi (1759-1820) discussed the causes and treatment of insanity. Chiarugi’s work and the reforms he instituted at S. Bonifacio represent “the first application of the principles of psychiatric treatment which are at the basis of psychiatry even today” (Mora, p. 431). Chiarugi’s “work constitutes a major landmark in the history of psychiatry” (ibid., p. 433). Published in three volumes, “Della pazzia does not primarily concern treatment, but rather the conceptualization, diagnosis, and classification of mental illness … Volume one dealt with the nature, cause, course, and general treatment of madness; volume two dealt with signs, causes, and effects; volume three dealt with nosology. Appended were one hundred case histories, and in sixty-two of these Chiarugi reported on his dissections of the brain … Chiarugi’s definition of madness excluded many kinds of pathologic behaviors: children and the aged should not be judged by the ordinary standards of sanity, nor drunks, nor sleepwalkers; nether hysteria, satyriasis, nor nymphomania qualified. Madness, he wrote, ‘proceeds from errors of judgement and reasoning caused by an ideopathic affection of the sensorium commune [that invention of Aristotle’s, located in the medulla oblongata], without fever or comatose affections’ … For diagnosis he adhered to the traditional four temperaments and the three categories of melancholia, mania, and amentia, but he also incorporated John Brown’s concept of nervous excitation” (Wallace & Gach, p. 288). “Chiarugi’s reformed system of treatment of the mentally ill was given full expression in his Della pazzia, in which he classified insanity into melancholia, mania and dementia, and gave a system of diagnosis and treatment for each. The work also presents Chiarugi’s observations on hundreds of cases (many supported by autopsies), and contains the first illustration of the straitjacket. Chiarugi’s reforms anticipated by several years the ones instituted by Pinel [in his Traité médico-philosophique sur la manie, published in 1801], which paralleled Chiarugi’s in nearly every respect. Chiarugi’s ideas failed to attract the attention they deserved, possibly because of the obliquity of his writing style, or because the work was published in an especially small edition” (Norman). In addition to urging safe and healthful surroundings and little or no restraint for the mentally ill, Chiarugi advocated respect for insane individuals as persons, pleasant as well as authoritative behavior on the part of the physician, and the use of tact and understanding in an effort to lead patients back to truth and reason. ABPC/RBH list only two copies.
Provenance: Dr. Olinto Cianelli (bookplate on front paste-down); Dr. Pándy Kálmán (1868-1945), Hungarian doctor, neurologist, and psychiatrist (ink stamp, twice, on title to first volume). Pándy recieved his medical degree in 1893 at Pázmány Péter University, Budapest. He started his academic career in 1892 at the Psychiatric Clinic of the University. In the meantime he earned several scholarships to visit foreign institutions, for example in Stockholm. After graduation he was the head of psychiatry in the hospital of Gyula. In 1905 he was promoted to head of department in Lipótmező, the best known Psychiatric institution in Hungary from 1868 to 2007, founded by Franz Joseph. From 1911 he was the director and chief medical officer of the National Psychiatry Institute in Nagyszeben. He was a pioneer in laboratory diagnostics. In 1910 he published ‘Pándy’s reaction,’ a test performed to detect elevated levels of proteins in the cerebrospinal fluid, which is diagnostic of several neurological conditions.
Vincenzo Chiarugi “was born in Empoli, near Florence, in 1759. After graduating summa cum laude from the medical school of Pisa in 1780, he moved to Florence and did postgraduate work in the hospital of Santa Maria Novella. In 1788, three years after being placed in charge of the planning of the Hospital Bonifacio, the hospital was officially opened to take care of about 125 patients. The following year, in 1789, the Regulations of the Hospital Bonifacio were ready, and in 1793-1794 Chiarugi’s main work, his three volumes ’On Insanity’ was published in Florence. Following this, Chiarugi was appointed professor of dermatology and mental diseases in 1802, and later on, of physiology, pathology, and materia medica in the newly established medical school of Florence. In spite of the political changes which occurred there at the beginning of the nineteenth century, he continued his work of reform and teaching until his death in 1820 …
“Chiarugi accepts the concept that perception is a state induced by the action of external objects on the ‘sensorium commune’, but it also requires the active functioning of the soul. Soul, on the other side, is the determining agent of movement and thought, but it needs for its functioning either the material offered by the perception of external objects or by the fantasy (formed by traces of previous perceptions). The ‘sensorium commune’ (which is the highest level of operation of the nervous system) is the mediating organ between senses and soul, in that it is influenced by the senses on one side and by the soul on the other. Every idea experienced by the soul is accompanied by a sense of good or bad, of pleasure or displeasure, which constitutes the emotions. The effects brought about by these emotions are known as passions or affections of the soul, and – manifesting themselves through facial expressions and other appearances of the body – are of primary importance for the recognition of mental diseases. In other words, while at an organic level the ‘sensorium commune’ is the mediating agent between senses and intellect, at a psychological level passions are the mediating agent between soul and body.
“In summary, Chiarugi’s concept of man as attempting to establish a ‘trait d’union’ between body and soul constantly fluctuates between the Aristotelian-tomistic and Cartesian views, without disregarding Platonic influences … Similarly, the essence of insanity, based on an ‘impairment of the physical structure of the brain’ (thus clearly influenced by Morgagni’s teaching of pathology) is at other times considered as due to purely psychological events (‘between passions and insanity there is only a difference of degree and duration’) …
“Closely following William Cullen’s ideas, Chiarugi postulates a division of insanity into three main categories: melancholia, mania, and amentia. Melancholia (true, false, or violent) is characterised by ‘fixation of the mind on one of a few distorted ideas, while the other intellectual functions remain untouched.’ Mania is ‘a generalised insanity accompanied by violent and impetuous actions.’ Dementia (congenital or acquired) ‘is general insanity characterised by abnormal actions of both the intellect and the will, performed without any show of emotions.’
“As causes of insanity, congenital and acquired factors are considered and among the latter, environmental forces are predominant because ‘through education a man’s character is moulded, his senses develop. And even his inclinations may be modified.’
“In describing the diagnostic principles, Chairugi emphasized the importance of considering ‘the external signs and the general phenomena which accompany insanity,’ and the frequency of a cyclic pattern in the course of many psychiatric conditions. His discussion of prognosis also reveals his insight, in that he states that conditions due to acute or physical causes have a better outcome than long-term ones, especially if these latter are combined with defective education.
“All these points made by Chiarugi in his book, although an expression of contemporary views, are worth noting for their soberness and clarity, in contrast to the obscurities and meaningless classifications frequently found in other writers. They are, however, collateral to Chiarugi’s main contribution to psychiatry, his reform of the treatment of mental patients … A detailed history was required for each patient admitted to the hospital. The hospital was built to meet high hygienic standards, men were separated from women, and the rooms and furniture offered full protection to the patients. However, under no circumstances could force be used on patients, and the only methods of restriction allowed were strait jackets and strips of reinforced cotton, in order to prevent impairment in the patient’s blood circulation. The essence of Chiarugi’s reform lies, however, in the direct treatment of the patients, for which nothing is better than to quote him directly. ‘It is a supreme moral duty and medical obligation to respect the insane individual as a person.’ ‘It is especially necessary for the person who treats the mental patient to gain his confidence and trust. It is best, therefore, to be tactful and understanding and to try to lead the patient to the truth and to instil reason into him little by little, in a kind way.’ And later on: ‘The attitude of nurses and doctors must be authoritative and impressive, but at the same time pleasant and adapted to the impaired mind of the patient.’ ‘Generally it is better to follow the patient’s inclinations and give him as many comforts as is advisable from a medical; and practical standpoint.’ ‘It is absolutely forbidden to make patients work for the hospital, except by a special prescription of the physician, in cases where certain activities are indicated as a form of therapy or relief.’
“In considering Chiarugi’s reform now from an historical perspective, there is no question that it constitutes the first application of the principles of psychiatric treatment which are at the basis of psychiatry even today. There is no evidence in the history of psychiatry of any other reform of similar type prior to Chiarugi. It is important to emphasize that such a reform involved not only the organization of a new hospital and new facilities, but the cooperation and dedication of a large staff, and – even more important than this – the overcoming of all kinds of prejudices and misunderstandings concerning the mentally ill. This gives an indication of the depth and significance of Chiarugi’s reform. Being a modest man, Chiarugi seemed almost unaware himself of the importance of his work. In his three-volume book there is no reference to the novelty of his conception. Nothing is more striking, for the medical historian, than to compare Chiarugi’s treatise to Pinel’s Traité médico-philosophique sur la manie which appeared in 1801. Certainly Pinel’s book is impressive for its clarity of concepts and style, so characteristic of French scientific literature. But in their essential lines, in the presentation of the principles of the classification, etiology, diagnosis, prognosis, and treatment of mental diseases, there is almost no difference between the two works. Instead, the difference, and very marked it is, lies between the above-mentioned unassuming attitude of Chiarugi and the emphatic, dramatized attitude of Pinel. The short and harsh judgement that Pinel passed on Chiarugi’s work has unfortunately been accepted by many historians and psychiatrists in spite of its lack of critical validity.
“Such a judgement, however, cannot alone account for the oblivion that Chiarugi’s work underwent throughout the nineteenth century. Several factors must have contributed to this situation, such as the difficulty of finding his book, and then of reading the text in a little-known language, also the long-continued interference with scientific progress caused by the wars of independence in nineteenth century Italy. Perhaps even more important than this must have been the fact that, unlike William Tuke’s work in England and Pinel’s work in France, both initiating an illustrious tradition of psychiatry, Chiarugi’s influence ceased at his death because of lack of a successor” (Mora, pp. 428-432).
Garrison-Morton 4921; NLM/Blake, p. 87; Norman 475. Mora, ‘Vincenzo Chiarugi,’ Journal of the History of Medicine 14 (1959), pp. 424-433. Wallace & Gach (eds.), History of Psychiatry and Medical Psychology, 2010.
3 vols. in 1. 8vo (182 x 122 mm), pp. Vol. I:  i-vii , 1-231  (mispagination 243 for 143); Vol. II: [i-ii] iii-iv, 1-223 (i.e., 219)  and one folding engraved plate (mispaginations 197-223 for 193-219); Vol. III: [i-ii] iii , 1-240 and one folding engraved plate. Contemporary Italian half calf over marbled baords, gilt spine lettering, front and rear upper hinge with tear, some loss of surface material to upper part of spine, entirely untouched. A very fine and completely unsophisticated copy with good provenance. A Hungarian export license for this copy is issued.