Santa Casa de Misericórdia, Hospício São Pedro and madness: notes on the origins of psychiatry in Porto Alegre

ABOUT THE COVER

Santa Casa de Misericórdia, Hospício São Pedro and madness: notes on the origins of psychiatry in Porto Alegre

Luís Guilherme Streb

Editorial Board, Rev Psiq RS. PhD in Medicine, Free University of Berlin

The cover images, photographs taken at the Documentation and Research Center of Santa Casa de Misericórdia, aim at providing continuity to the idea put forward by the Editorial Board of the Journal of increasing the perspective we have of the history of psychiatry in Rio Grande do Sul, but directing our eyes towards the future, as demonstrated by the content of this issue.^*

There is no available clinical documentation prior to Hospício São Pedro, inaugurated in June 1884; the photographs illustrate parts of the Register Book and annual reports of Provedoria da Santa Casa, which have been available since 1839. The photographed text above is part of the 1872 report, written by the purveyor, General Lima e Silva. As can be seen, the situation at that time was very difficult; there was lack of resources, many people were already "lifelong," abandoned by their families. There were 47 interns, the so–called "immundos [filthy]," occupying first–floor accommodations. According to this description, the need of another space, more adequate, to care for those poor people is evident. These reports are the main source of information on medicine of that time in Porto Alegre and on the process that led to the foundation of Hospital São Pedro and, after that, to the birth of psychiatry in our state. Providing care for patients was a difficult situation, without any mention to medical treatment; actually, the "Misericórdias" tried to provide support to poverty, more than medically treat it. At that time, there were two physicians caring for 850 hospitalized people, who were given care especially by religious women and nurses.

The patients were distributed by nurses according to social (income, for example) and behavioral criteria (furious or non–furious, filthy or non–filthy patients). Many of them were taken from the streets or taken by the police.

Based on that material, one can try to reconstruct the origins of our specialty here in Porto Alegre. In the Register Book there is information about name, cause and time of hospitalization and an idea of the diagnostic categories used at that time – such as "brain congestion," for example. At those times, prevalent systems were those by Esquirol with five large categories (lypemania, monomania, mania, dementia and idiocy), Falret (paralytic, circular, epileptic, alcoholic and persecutory madness) and Morel (hereditary alienations, by intoxication, idiopathic, sympathetic, nevrosis and dementia).

From the reports we can obtain the history of Santa Casa as a shelter for "madmen," in their cells located in the underground, and the need of a specific place for them, which would originate the movement that built Hospício São Pedro.^†

As a result of the first medical schools in Brazil, founded in 1832 in Rio de Janeiro and Salvador, the public power started being influenced in the sense of organizing care to the population and providing public health measures. In Porto Alegre, a Code of Postures was created in 1847, with sanitary and hygienic guidelines: "Medicine helped the government organize society".^‡

In the early 1870's, there was a movement to remove the interns from Santa Casa and provide them proper place and conditions to receive care. José Antonio Coelho Junior was the main character in that attempt. After many ups and downs, difficulties to find resources and a site, the wonderful building at Estrada do Mato Grosso was inaugurated in 1884. Its first director, Carlos Lisboa, a 25–year–old physician graduated in Rio de Janeiro, ex–intern at Hospício Pedro II, reported to Santa Casa and managed the therapeutic practices of the new asylum, following the norms of that time: physical, hygienic and moral treatment. He died 4 years later. The following directors succeeded him: Ramiro Barcellos, Olinto de Oliveira, Francisco Dias de Castro, Tristão Torres and Deoclécio Pereira. In 1926, Jacintho Godoy takes office and then, under his wise guidance, the third and essential stage of consolidation of psychiatry in the state begins, extending until the 1960's.^§

I believe one of the reasons that lead us to look at the past is trying to visualize how patients were seen and treated, as an attempt to associate our ability and efforts with those whom we admire. If we now have more technical, personal and institutional resources, it is important not to forget that we are also submitted to social and economic circumstances that have distanced us from our patients, in an atmosphere marked by a vainly materialistic mentality.

In this sense, "(...) do not believe that human participation should disappear when scientific research begins. Major humanitarian questions still have to be answered in Psychiatry; great thoughts come from the heart; head and hands will work better if we keep a tender compassion for suffering." These words by Griesinger,³ uttered more or less at the time those facts took place, could still guide us in times when much is known about memory, but little is remembered about those who preceded us.

References

1. Wadi YM. Palácio para guardar loucos: uma história das lutas pela construção do hospital de alienados e da psiquiatria no Rio Grande do Sul [dissertação]. Porto Alegre: UFRGS; 1996.

2. Godoy J. Psiquiatria no Rio Grande do Sul. Porto Alegre; 1955.

3. Griesinger W. Vortrag zur Eröffnung der psychiatrischen Klinik zu Berlin, am 2. Mai 1867. Eur Arch Psych Clin Neurosci. 1868;1(1):143–58.

*

Special acknowledgement to Adriane Raimann, at Santa Casa, for her support with the material of the Documentation and Research Center at Santa Casa de Misericórdia.

†

This history was the subject of an interesting master's thesis, from which those data were obtained, by Yonissa Marmitt Wadi: "Palace to store madmen: a history of the fights to build an asylum and psychiatry in Rio Grande do Sul" (Graduate Program in History, Universidade Federal do Rio Grande do Sul, 1996).

¹

‡

I thank my colleague Ana Luiza Wolf for being kind to provide a summary of the aforementioned study, of which some data were also used.

§

Important and indispensable source:

Jacintho Godoy. Psiquiatria no Rio Grande do Sul (Porto Alegre, 1955).

Publication Dates

• Publication in this collection
  06 Sept 2007
• Date of issue
  Apr 2007