The Institutionalization of Asylum and Forensic Psychiatry in Bucharest, 19Th Century

The institutionalization of asylum and forensic psychiatry in Bucharest, 19th century. A historical outline

Octavian Buda1, Sorin Hostiuc2,*, Eduard Drima3, Laura Ghebaur4, Ionuţ Popescu5, Laurenţiu Staicu6, Corina Doboş7

______Abstract: This historical note focuses on the development of psychiatry and forensic expertise in Bucharest between c. 1840 and 1910 under the influence of the European Schools of Medicine of the time. During the 19th century, psychiatry became part of a larger medical agenda, which included the establishment of public and private hospitals and asylums, public health reforms and social legislation for the protection of mentally ill, family planning and ultimately law regulations regarding forensic psychiatry. To date, the history of Romanian psychiatry and forensic medicine in Romania has been neglected, although it proves very resourceful for the understanding the complex relationship between science, political ideals and national contexts, both at a regional and international level. This note provides an insight into the inception of modern psychiatry institutions and scientific advances in Romania, and to the medically trained personalities in Bucharest and Eastern European medicine. Key Words: Mental Institution, Eastern Europe, Forensic Psychiatry, 19th century.

tarting with 1820, Moldavia and Wallachia (Wallachia and Moldavia), their independence from the Sexperienced profound political, social, Ottoman Empire (1878), the creation of the kingdom of and economic upheavals, including the 1848 Liberal Romania (1881), the Balkan Wars (1912-1913), and the and Nationalist uprising in Bucharest and Jassy, the territorial enlargement following the First World War, in 1859 Unification of the two Danubian Principalities 1918. The history of Romanian medicine mirrored these 1) Assoc. Prof., "Carol Davila" University of Medicine and Pharmacy, Dept. of History of Medicine, (&) National Institute of Legal Medicine, Dept. of Forensic Psychiatry, Bucharest, Romania 2) Assist. Prof., "Carol Davila" University of Medicine and Pharmacy, Dept. of Legal Medicine and Bioethics, (&) National Institute of Legal Medicine, Dept. of Forensic Pathology, Bucharest, Romania * Corresponding author: National Institute of Legal Medicine, Sos.Vitan Barzesti 9, 042122, Bucharest 4, Romania, Tel. +40723791072, Fax +4021 3346260, E-mail: [email protected], [email protected] 3) Senior Psychiatrist, St. Pantelimon Psychiatric Hospital, Calea Călăraşilor 125, Brăila, Romania 4) Forensic Psychiatrist, National Institute of Legal Medicine, Dept. of Forensic Psychiatry, Bucharest, Romania 5) Lecturer, "Carol Davila" University of Medicine and Pharmacy, Dept. of Legal Medicine and Bioethics, (&) National Institute of Legal Medicine, Dept. of Forensic Pathology, Bucharest, Romania 6) Assoc. Prof., University of Bucharest, Dept. of Theoretical Philosophy, Splaiul Independenţei 204, 060024, Bucharest 6, Romania 7) PhD Student in History of Medicine, University College London, The UCL Centre for the History of Medicine, Division of Biosciences, Medical Sciences Building, Room 1MO1, Gower Street, London WC1E 6BT, United Kingdom, (&) University of Bucharest, Bucharest, Romania 79 O. Buda et al. The institutionalization of asylum and forensic psychiatry in Bucharest, 19th century historical changes, given its significant engagement Marcutza Asylum, an episode which symbolically marks with the nation-building process. the “medicalization” of insanity, by transferring it from In Romania, as elsewhere in Eastern Europe, byzantine monastic establishments to modern hospitals. the “health of the nation” was conterminous with the The Medical expenses for this institutionalization creation of a modern healthcare system. Together with were paid by a central medical care provider (the so- other medical professionals, psychiatrists and forensic called “Casa Centrală”), a structure under government doctors contributed to the creation of a network of regulation, whose administration was regulated by hospitals, asylums, institutes of research, and university Imperial Russian authorities under the “Regulamentul chairs, sharing the hope of providing remedies for the Organic” (Main Constitution) regime (1831). The 1839 social and medical illnesses prevalent in the country. financial report of the “Casa Centrală”, listing all the The process of institutionalisation of psychiatry expenses made with regard to the mentally ill patients as scientific discipline also played a fundamental role in including their displacement from the Malamuci changing its social status, from a peripheral discipline monastery to the new asylum, and the maintenance of of uncertain scientific status to a socially sanctioned the Marcutza Asylum included transactions for 14 and a profession able to provide the state with a standardized half months, as follows: (1) from August 27, 1838 until language to address medical and social concerns. August 12, 1839, when patients were accomodated in Most of the Romanian physicians received Malamuci and (2), between August 12, 1839, when they their medical education in France, and were heavily were moved to Marcutza, and December 31, 1839. A influenced, by French medical practices and ideas. The total amount of 16,216 lei (an equivalent of 540 Dutch history of modern psychiatry on Romanian territories Guilders) was provided for 25 ‘smintit’ patients [4,7]. started in 1838, when an important law on mental health The first director of the Marcutza Asylum, was issued. This law established that assistance for the Nicolae Gănescu (1799-1875) was trained at the mentally ill was the responsibility of ‘Eforia Spitalelor medical faculty of Moscow Imperial University. He was Civile’ (Association of Civilian Hospitals), an institution the director of the Macutza Asylum from 1840 until the that coordinated all hospitals in the city of Bucharest Wallachian Revolution of 1848, when Gănescu took part in the beginning of the 19th century [1,2] The French in the revolutionary events. Gănescu managed to improve Law for the Mentally Ill from 30 June 1838 provided the standards of personal hygiene, food and clothing of the background for the development of legal protection his inpatients, and enhanced the mechanical restraints for the rights of mentally ill in France [3]. In November for agitated mentally ill: instead of using a straitjacket 1838, five months after the French Law was enacted, for contention, he suggested using wide straps, lined Marcutza Asylum, the first modern insane asylum on with soft leather “in which there is wool filling”. As he Romanian territories, was created near Bucharest [4,5]. was interested in new medical developments of his time, The asylum was founded upon the existing Gănescu noted that the Pantelimon Hospital installed in premises of the Orthodox monastery of Marcutza, and 1846 a sort of “electromagnetic machine”. Accordingly, was specifically designed to host insane/mentally ill he sent some of his psychiatric patients form Marcutza patients. Based on the 1838 Romanian law, the so-called to benefit from the new therapeutic device [6,8]. “smintit” patients were admitted in this new institution, Since 1849, the Marcutza Asylum was led for housed in a building which was donated by Marcutza brief periods by I. Bren (1849-1851), Gheorghe Polizu Monastery, without any further financial contribution (1851-1852) – who later became Professor and Dean of from the monastery itself. the Bucharest Faculty of Medicine, founded 1857, and The Romanian notion of the insane at that Constantin Miniş (1852-1854), a graduate from Leipzig time was the word ‘smintit’, a term derived from the Medical University, with a dissertation on catalepsia [9]. Latin ‘ex mente’ (out-of-mind). Official documents Since 1854, the post of director was awarded of the time underlined that Marcutza Monastery was to Petre Protici (1822-1881), who led the Marcutza not linked with the nearby lunatic asylum. In this Institute until 1867. Protici, coming from a Bulgarian respect, the officials used the denomination “Spitalul family was born in Tîrnovo (or Şistov) and came sau Institutul smintiţilor de la Mărcuţa” (Hospital or to Wallachia in 1822. He did his medical studies in Marcutza Asylum for Insane). Other civilian hospitals, Paris, where in 1850 he defended his dissertation “Des like the Coltzea Hospital, founded in 1704 by the phlegmons de la fosse iliaque interne”. In 1857, Protici Phanariot boyar Mihai Cantacuzino (Cantacuzenos) was appointed Chair of Surgical Pathology at the newly or the Pantelimon Hospital were still directly linked to founded Romanian School of Medicine [10]. monastical structures [5,6]. Protici was involved in creating conditions A local ordinance issued August 12, 1839 by the to improve and modernize the specialized psychiatric Wallachian Prince Alexandru Ghica, relocated all the treatment. In an address sent in 1860 to Carol Davila ‘smintit’ patients from the Malamuci Monastery to the - General Inspector of Health Services, Protici asked

80 Romanian Journal of Legal Medicine Vol. XXI, No 1(2013) for modern methods of treatment: “I shall require new The examination commission was chaired by means to treat the patients... in a way consistent with the Augustin Grisolle and Louis Felix Jules Behier, both principles of humanity and hygiene and also to apply a Professors of Clinical Medicine at the Hôtel Dieu medical Regulation especially fitting their needs”. Hospital in Paris. Sutzu attended the seminars of the Protici introduced drug treatment methods Société Médico-Psychologique being influenced by the for psychiatric conditions and improved methods writings of Jean-Étienne Esquirol and Jean-Pierre Falret of occupational therapy by organizing special and especially by Benedict-Augustin Morel’s theory of workstations for the inpatients. He also introduced degeneration. Thus, Sutzu carried Morel’s theories to ergotherapy for mentally ill patients, which was a rather Romania and became directly involved with the so- revolutionary method at the time. Marcutza Asylum called ‘médicine aliéniste’, since 1866. Morel’s theory gradually developed into a well-organized hospital, of degeneration flourished in the 1860s in Romania, with procedures of medical admission, confinement and encouraging the view that environment can influence discharge of patients, adequate living conditions and certain diseases and giving new tools of interpretation treatment, proper hygiene, and different therapies. of the relationship between the social and biological The tasks of the medical staff, and primary background [13]. medical care attributions were rigorously expressed Psychiatrists accepted Lamarckian views, that in the “Regulamentul serviciului Institutului Mărcuţa” mental diseases were often a biological reaction to (The Medical Regulation Service of Marcutza specific environmental conditions. In Bucharest, Sutzu Institute), published in 1861 under the signature of started to teach ‘alienist medicine’ at Marcutza from Carol Davila and reissued, with minor amendments, in the academic year 1867-68. His course was designed 1864, in “Monitorul Medical” (the Medical Monitor) of for fifth-year medical students at the National Medical Bucharest [11]. School of Bucharest. Sutzu was appointed professor at The clinical nosography used at the Marcutza the Faculty of Medicine in Bucharest (1879), where he Asylum around 1860 is shown by the statistics published taught courses on psychiatry and on mental pathology by Protici in 1863, giving an overview of the patients and legal medicine [14]. confined in Marcutza Asylum. At the end of 1861, the Asylum had 67 male and 33 female inpatients and received 62 males and 28 females during 1862. In 1862, Marcutza discharged 28 male and 13 female patients, and 23 male and 15 female patients died. By the end of 1862, 78 male and 33 female inpatients remained confined. About 200 persons were treated each year at that time. The same statistics showed the psychiatric pathology [12] for the 1862 patients, as follows: Mania delirans (32 cases), furiosa (28), periodica (11), epileptica (21), alcoholica (4), cum hallutinationibus (5), praesumpta (3); Monomania (37); Amentia (19); Paralysia generalis (9); Simplicitas (1); Stupiditas (7), Stupiditas cum epilepsia (3); Idiotia (9), Idiotia cum epilepsia (1). Protici left Marcutza in 1867, and in 1880 he went to Bulgaria to undertake a high position in the Bulgarian Sanitary Council [10]. He died in Sofia in tragic circumstances in 1881. A modernizing approach in psychiatry was brought by Alexandru Sutzu (1837-1919), twice director of the Marcutza Asylum between 1867-1878 and 1880- 1909. Sutzu, or Soutzos, came from a Greek aristocratic family, which played an influential role in modern history of the country; three of his family members were Rulers during the Phanariot period of the country. Alexandru Sutzu (1837-1919) Sutzu began his medical career in 1856 in Athens, and defended his dissertation, entitled ‘Considérations sur Like Cesare Lombroso (1835-1909) in la dyspepsie essentielle’ at the Faculty of Medicine in Italy, Turin, Alexandru Sutzu was, simultaneously, Paris, on May 16, 1865. psychiatrist and a forensic pathologist, both, Professor

81 O. Buda et al. The institutionalization of asylum and forensic psychiatry in Bucharest, 19th century

works a scientific reasoning on the connection between psychopathological and treatment principles, on the one hand, and the institutional philosophy, on the other. Sutzu advocated for Darwinism, and the non-restraint methods of psychiatric therapy introduced in United Kingdom by John Conolly in Middlesex County Asylum at Hanwell, since 1839 [16].During Sutzu’s directorship, Nicolae Chernbach experimented with psychiatric photography, and published in 1870 a photographic atlas of the main types of mental alienation, a collection of twelve plates depicting mentally ill patients from the Marcutza Asylum in Bucharest. These photographs were not only the first taken in Eastern Europe, but among the first photographs of the mentally ill [17, 18]. In regard to the Marcutza Asylum (which had 950 beds by the end of the First World War), Sutzu claimed in the 1880s, that it represented only a transitional solution and that a more systematic construction of new hospitals was required [19,20]. He actively supported the adoption of a Law for the construction of two new Bucharest hospitals, including a new psychiatric one (1892), established modern forensic psychiatry (1877) and created 1905 together with Charcot’s pupil and Salpêtrière trained neurologist Georges Marinesco Mina Minovici (1858-1933) (1868-1938), the first Romanian scientific Society of Psychiatry and Neurology [21]. of Psychiatry and of Legal Medicine at the Bucharest Faculty of Medicine for nearly 20 years. It was not until 1897 that the Chair of Psychiatry and of Legal Medicine was divided into two separate, autonomous medical disciplines: psychiatry and legal medicine. Sutzu was appointed as Chair of the Psychiatry Department, while Mina Minovici (1858-1933) was eventually appointed as Head of the Legal Medicine Department. Sutzu also served as expert-witness in forensic investigations psychiatric and medical forensic investigations He published a number of articles and monographs on various themes of forensic interest. His treatise, “Alienatul în faţa societăţii şi a ştiinţei” (The Mental Alienation under the Scrutiny of Society and Science) was the first Romanian textbook of both clinical psychiatry and forensic psychiatry [15]. His clinical activity was intimately linked with the Marcutza Asylum, where he worked for more than 40 years (1866-1909). Sutzu carried out comprehensive analyses of the three major models of hospitalization for patients suffering from different forms of mental illness: asylums, the family system and settlements of the mentally ill. Sutzu was influenced by both the French and the English system of mental health institutions, and by the principles of moral hygiene proposed by several psychiatrists: Phillipe Pinel, Jean Esquirol, Alexandru Obregia (1860-1937) Jules Baillarger, Jean-Pierre Falret, and John Conolly. Similar to other European and North-American After Sutzu, by the end of 19th century, a psychiatrists of the time, one can discover in Sutzu’s new wave of modern psychopathology inspired by

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Kraepelinian Psychiatry, was brought to Bucharest by Concluding Remarks Alexandru Obregia (1860-1937). Obregia obtained his This short presentation of Marcutza Asylum’s medical diploma from the Medical Faculty in Bucharest institutional developments sets up the background upon (1888), with a thesis on experimental studies of motor which a substantive analysis of the emergence of the and visual cerebral-cortical centres [22]. psychiatric and forensic profession in Romania during Obregia spent four years (1888-1892) in several the 19th century can be built. In order to understand the prestigious neurological and psychiatric clinics and profound medical and social transformations Romanian laboratories throughout Germany and France (at Rudolf society experienced between 1840 and 1918, a closer Virchow, Siegmund Munk, Carl Friedrich Otto Westphal examination of how psychiatrists like Gănescu, Protici, in Berlin, Germany, and at Jean-Martin Charcot, Sutzu or Obregia envisioned the modernization of Valentin Magnan, Gilbert Ballet, and Benjamin Ball the Romanian society and of their role in establishing in Paris, France). Back in Bucharest, Obregia became institutions for health and welfare has to be carried senior psychiatrist at the Marcutza Institue, and in 1909 further. was appointed professor of psychiatry at the Medical Through professional organisations and Faculty in Bucharest [23]. specialised journals, Romanian psychiatrists pleaded Inspired by the Kraepelinian systematic for the improvement and sanitation of the nation. By nosology, he introduced a similar system in approaching the end of the 19th century, both medical professionals mental illness in Romanian psychiatry. Obregia was one and state bureaucrats hold the idea that only a strong, of the first European clinicians to define, for example, centralised state could infuse the medical career with a cyclophrenia as a clinical entity, and introduced improved new morality and assign doctors a socially responsible methods of psychiatric diagnosis and treatment. role. Referring to French, British and German medical Obregia’s clinical philosophy was standing sciences, Romanian psychiatrists and forensic doctors against the pessimistic and finalistic perspectives argued for a transformation of the national health prompted by the degeneration theory, by supporting system, forensic medicine and law enforcement. the idea of possibility of healing some forms of mental illness. In 1908, keen to experiment new biological Acknowledgement exploration methods in neurology and psychiatry, Obregia started to use the suboccipital puncture This work was supported by a grant of the as a diagnostic and therapeutic procedure to draw Romanian National Authority for Scientific Research, cerebrospinal fluid. CNDI– UEFISCDI, project number 215/2012.

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