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História, Ciências, Saúde-Manguinhos

versão impressa ISSN 0104-5970versão On-line ISSN 1678-4758

Hist. cienc. saude-Manguinhos vol.23 no.4 Rio de Janeiro out./dez. 2016

https://doi.org/10.1590/s0104-59702016000400005 

ANALYSIS

Travel and professional networks in the origins of Spanish psychiatry

Enric J. Novella1 

1001Professor, Institut d’Història de la Medicina i de la Ciència López Piñero/Universitat de València. Plaça de Cisneros, 4. 46003 – Valencia – Spain. enric.novella@uv.es


Abstract

This article examines the importance of travel and professional networks in the origins of Spanish psychiatry. After reviewing the early alienists’ Enlightenment predecessors and their therapeutic and professional trajectories, it describes the trips to foreign psychiatric institutions made during the second third of the nineteenth century by a group of exiled Spanish doctors, commissioners and pioneers. Later, as they became more socially, institutionally and professionally established, some figures of Spanish psychological medicine cultivated their connections and international profile by organizing or attending conferences and other scientific events. This case illustrates the important role of international relations and scientific and professional networks in the spread of psychiatric discourses and practices.

Key words: travel; mental health care; professional networks; Spain; nineteenth century

Resumen

Este artículo examina la importancia de los viajes y las redes profesionales en los orígenes de la psiquiatría en España. Tras una revisión de los antecedentes ilustrados y los periplos terapéuticos y profesionales en el primer alienismo, se describen los desplazamientos a instituciones psiquiátricas extranjeras, durante el segundo tercio del siglo XIX, de un grupo de médicos exiliados, comisionados y pioneros españoles. Posteriormente, con su afianzamiento social, institucional y profesional, algunas figuras de la medicina mental española estrecharon sus vínculos y su proyección internacional organizando o asistiendo a congresos y otros eventos científicos. Su caso ilustra así el importante papel desempeñado por las relaciones internacionales y las redes científicas y profesionales en la difusión de los discursos y prácticas psiquiátricas.

Palabras-clave: viajes; medicina mental; redes profesionales; España; siglo XIX

In Spain, a major reform of the science of phrenopathy required a kind of groundwork, and we believe it can be found in the contacts that prominent, experienced figures made abroad.

J.B. Ullersperger (1871)

As we know, the rise of modern mental health care and the creation or reform of specifically psychiatric institutions occurred relatively late in Spain compared to other countries such as France, Germany or England. In fact, it was not until the mid-nineteenth century that the discourses and practices of the new alienism began to spread, thanks to a series of pioneering figures with differing degrees of involvement (in the field) who created a rapid succession of brand-new institutions for the care and confinement of the insane and demented – Leganés (1851), Sant Boi de Llobregat (1854), Nueva Belén (1857) etc. (Espinosa Iborra, 1966). This process has been studied from various standpoints, giving rise to a series of narratives that link the birth of psychiatry in Spain to various factors like the introduction or reception of psychopathological knowledge from outside the country (Rey, 1981), the economic and social requirements of the bourgeois capitalist order (Álvarez-Uria, 1983), the slow and uneven development of modern state institutions (Comelles, 1988), or the gradual implantation of the epistemological and cultural coordinates that led to the emergence of a new “psychological” branch of medicine that dealt with madness (Novella, 2013). In recent years, there have been more detailed studies on the circulation and assimilation of psychiatric ideas, the life and work of some pioneers and the founding stages of some emblematic institutions; special attention has been paid to the strategies for promoting and gaining social legitimacy for the emerging profession of psychiatry.

An interesting and so far little-studied aspect of this issue is the role played by international relations in this process, and the incipient scientific and professional networks being established among medical men in Europe (Ernst, Müller, 2010; Roelcke, Weindling, Westwood, 2010). On the one hand, it is well-known that some of the first Spanish psychiatrists made various trips abroad in order to visit other institutions and familiarize themselves with innovative ways of providing care, to attend scientific conferences or to meet their European colleagues. And, inversely, there is evidence that many European alienists took an active interest not only in the history, state or organization of asylums in Spain, but also in the spread, promotion and legitimization of mental health care in the country. In fact, after Philippe Pinel’s praise for the Hospital de Nuestra Señora de Gracia in Zaragoza (Pinel, 1804, p.311-313) and the rather critical remarks of his disciple Jean-Étienne Dominique Esquirol (1818, p.60), there were relatively frequent reports on Spanish asylums – famous for their antiquity and alleged priority in the differential treatment of lunatics1 – in German, French, English and even American psychiatric publications during the second half of the nineteenth century (Desmaisons, 1859; Fraser, 1879; Jelly, 1885; Robertson, 1868; Schmitz, 1885; Seguin, 1883a; Ullersperger, 1871; Urquhart, 1892). In some notable cases, such as the Frenchman Alexandre Brierre de Boismont (1797-1881), the influence of foreign alienists went even further, as they played a role as scientific and professional references that was very valuable to their Spanish colleagues, directly affecting the fate and subsequent development of mental health care in Spain (Novella, Huertas, 2011).

The goal of this article is to examine in detail the importance of those trips and professional networks in the origins of psychiatry in Spain. After reviewing the Enlightenment background and the role played by therapeutic and professional travel among early alienists, I describe the voyages of a group of exiled doctors or commissioners and some Spanish pioneers to foreign psychiatric institutions, and their contacts with European colleagues during the second third of the nineteenth century. Subsequently, once they became socially, institutionally and professionally established, certain leading figures in Spanish mental health developed their international relationships and reputation by organizing or attending conferences and other scientific events. Thus, their case illustrates the important role played by international relations and scientific and professional networks in the early spread of psychiatric discourses and practices.

Travel in early psychological medicine

As the Czechoslovakian writer Milan Kundera (1987, p.21) suggested some years ago, modernity has always seen itself as a historical and cultural viewpoint intended to “eradicate the other, alterity.” In the mid-eighteenth century, the [French] court and Parisian salons showed a striking combination of arrogance and curiosity in their attitude towards an exhibit of indigenous people recruited by naturalists and travelers, while idle Londoners went to the old Bedlam Hospital and payed modest sums to contemplate the grotesque and ineffable spectacle of insanity (Foucault, 1967, p.228; Byrd, 1974). A few decades later, the experience of racial, social and cultural differences arising from geographical discoveries, the appearance of a new interest in other civilizations and the popularization of the grand tour and “mature tourism” moved the Enlightenment elites to question the naturalness of social distinctions, to relativize their own condition and to ponder the common nature of all mankind (Pimentel, 2003). Under those circumstances, it is no surprise that madness, one of the classic figures of “otherness” in Western culture, aroused renewed interest, to the extent that, as the German historian Doris Kaufmann has shown (1995, p.111-130), central European travelers popularized visits to hospitals and lunatic asylums as an important stage of their Bildungsreisen or formative travels at the end of the eighteenth century.2

Contrary to the classic interpretation of Michel Foucault, for whom viewing confined lunatics or attending the famous theatrical spectacles featuring the mentally ill at Charenton asylum in the early nineteenth century symbolized the way madness had become “a thing to look at, no longer a monster inside oneself” (Foucault, 1967, p.231), Kaufmann (1995, p.112) argues that “more than any other institution in public opinion during the Enlightenment, the madhouse aroused not only fascination and fear, but also consternation and the desire for reform.” Many visitors, in fact, saw lunatic asylums as privileged places for broadening one’s knowledge of human nature, and texts describing their experiences contain many allusions to the value of familiarizing oneself with one’s own and others’ intimate, night-time side (Nachtseite).3 Here it is worth noting, for example, the well-known case of Francisco de Goya, who painted in 1794 his sinister Yard with Lunatics after having witnessed many scenes of neglect and mistreatment of patients in the famous Zaragoza asylum (Baticle, 1995, p.143). Significantly, madness appeared repeatedly in his work from then on, not only as a motive for chilling representations exalting the “terrible sublime” popularized by Romantic aesthetic (Klein, 1998), but also as a figure evoking a dark, shadowy vision of the human condition that appealed directly to the observer’s own irrational side.

If, as the Italian philosopher Sergio Moravia suggests (1980, p.260-265), psychological medicine can be seen as one of the “sciences of difference” with which the new bourgeois society “decided to confront otherness with the weapons of knowledge,” it seems obvious that the practices specific to Enlightenment travel (to conquer barbarism), Romantic travel (in pursuit of the exotic) and internal exploration (in search of self-knowledge) are explicitly linked to the cultural constellation that oversaw the new medical and moral regime represented by psychiatry and the madhouse.

Be that as it may, it is clear that travel played a very important role in framing the activities of the first alienists, and it soon became a very important part of their professional culture. Thus, on the one hand, some notable pioneers such as Esquirol argued that travel had significant therapeutic potential because the “change of scenery” it provided could complement the isolation of patients in an institution where they would be safe from the impressions that had led them to become deranged and their minds would be subjected to an environment filled primarily with healthy stimuli (Goldstein, 1987, p.289). According to the principles of moral treatment, going to an unknown location could be used to prolong the asylum-style isolation of the convalescent – especially when they were accompanied by a stranger and not by their friends or relatives – and, specifically, to facilitate the transition “between being deprived of their liberty and returning to full use; between being kept away from society and going back into the world” (Esquirol, 1847, p.341). It is worth pointing out that there are documents recording the tournées of many of the French doctor’s patients; on some occasions, he even had some of his disciples accompany and care for a particularly wealthy client (Goldstein, 1987, p.145).4

But apart from such “therapeutic” trips, throughout psychiatry’s foundational period, people traveled mostly for professional reasons, including (1) to assess the state of the network of facilities in each country, (2) to visit model or prestigious asylums – usually foreign ones – in order to acquire or exchange knowledge, (3) to establish contacts and set up professional networks, and (4) to legitimize and promote activity in the field of diagnosis and treatment of mental illness. Once again, Esquirol was unquestionably the most notable practitioner of this type of travel among the early alienists, although it should be emphasized that among their most famous (French) forebears, the military doctor Jean Colombier and his colleague François Doublet began touring all the prisons, workhouses, hospitals and asylums of the kingdom in 1777; this voyage, proposed by Luis XVI’s minister Jacques Necker, culminated in 1785 with the famous report Instruction sur la manière de gouverner les insensés et de travailler à leur guérison dans les asyles qui leur sont destinés, which proved an extremely valuable source of information for Pinel when he began his psychiatric work at Bicêtre (Weiner, 2002, p.109-110). Esquirol (1847, p.170), who was more systematic and more conscious of his role in establishing psychiatry as a profession, took three trips in 1810, 1814 and 1817 that he paid out of his own pocket, touring “all the towns in France to visit establishments where lunatics are confined.” In September 1818, he presented a report to the minister for the Interior, and also published a lengthy article on the subject that same year in the important Dictionnaire des sciences médicales, edited by C.L.F. Panckoucke (Esquirol, 1818). Significantly, his travels helped him to outline a sort of “program or basic manifesto” for the new specialty; the principal points included (1) public recognition of the need for specially trained doctors to treat the insane in specific institutions, (2) the preeminent role of Paris as the source of new discourses and practices, (3) the urgent need to build specialized hospitals throughout the country and (4) the full medicalization of the care for the insane (Goldstein, 1987, p.130-133).

Ever zealous, Esquirol did not skimp in his efforts to compile information on the state of the most important lunatic asylums in other countries; he was particularly interested in the cases of England, Holland, Germany, Austria, Switzerland, Italy and Spain, and he maintained a small network of colleagues who kept him informed about each of those countries.5 Some of his most active disciples – who were, like their master, convinced of the overwhelming superiority of France (or rather Paris) in the international field – subsequently traveled abroad to see for themselves the institutions described by their informants. Thus, for example, Brierre de Boismont, mentioned earlier, traveled to Italy, Poland and Germany in order to visit the most reputable public and private asylums and drafted a Mémoire pour l’établissement d’un hospice d’aliénés, that won an award from the Société des Sciences Médicales et Naturelles in Brussels in 1834 (Brierre de Boismont, 1836). But inversely, it was above all foreign (medical) professionals who traveled to France – especially Paris – to inspect the famous hospitals and familiarize themselves with the innovations of the great French masters. Pinel, for example, alludes, in the second edition of his Traité médico-philosophique sur l’aliénation mentale ou la manie (Medical-philosophical treatise on insanity, 1809), to the large number of “distinguished travelers” he received at the Salpêtrière (p.193); among others, the young Esquirol remembered illustrious European medical figures of his time, such as the German Johann Peter Frank, who visited Pinel in 1804 before embarking for England after having confirmed the greater efficacy of French institutions in curing madness (Esquirol, 2000, p.66-67). And, naturally, leading Spanish physicians interested in the “alienist doctors” and their new methods also visited France and considered whether to follow suit and modernize their own country’s institutional management of madness.

Exiles, commissioners and pioneers

On January 2, 1844, the Catalan doctor Félix Janer (1844, p.5) began a curious lecture on “medical voyages” in the Academia de Medicina y Cirugía of Barcelona by remarking that

both in Spain and in other countries, people have generally believed that physicians who left the country to visit foreign nations, observe their medical establishments, listen to their most famous professors, and return perhaps with new doctrines and cures, were more wise and perfect.

In reality, because of Spain’s War of Independence against the Napoleonic invasion (1808-1814), permanent conflict between political factions and the economic and organizational collapse of the former regime’s asylum facilities, many of the Spanish doctors who visited “foreign nations” in the early nineteenth century did so as exiles (Guerra, 1969). And indeed, along with translations, formal academic contacts and the circulation of foreign medical journals, the departure of these doctors – who were almost all liberals – was a decisive factor in preventing any interruption in the spread of European medicine’s main theories and innovations (López Piñero, 1963).

Among the exiles, two leading figures, who did not go into sustained professional practice in the area of mental health care but who nevertheless maintained a notable interest in the field and did a great deal to publicize it, were the Catalans Pedro Felipe Monlau (1808-1871) and Pedro Mata y Fontanet (1811-1877). Monlau, for example, went into exile in Paris from 1837-1839 due to an incident related to his progressive beliefs (Campos, 2003), and wrote that he established contact there with Esquirol himself; he accompanied him in Charenton asylum for a few days (Monlau, 1862, p.1041). Mata, meanwhile, had to go into exile for similar reasons at least twice during the same period, first in Montpellier and later in Paris, where he attended lectures and courses (perhaps also with Esquirol) and became a disciple of the pioneering toxicologist Mateo Buenaventura Orfila (Corbella, Martí Amengual, 1980). On his return, the City of Barcelona asked Monlau to translate Brierre de Boismont’s Memoria (Report), which had won an award in Brussels; some years later, Monlau developed a close personal relationship with him after attending the first International Sanitary Conference (1851-1852) and became one of the first foreign associates of the French Société Médico-Psychologique (Novella, Huertas, 2011). As regards Mata, in 1843 he won a professorship at the Universidad Central and shortly afterwards published the first edition of his important Tratado de Medicina y Cirugía Legal (Treatise on Medicine and Forensic Surgery); he was one of the strongest supporters in Spain of Esquirol’s doctrine on monomania, and systematically defended the exclusive competence of doctors to make specialized determinations of madness (Martínez Pérez, 1995).

In the mid-1840s, after a period of greater political and social stability had begun,6 and when both the authorities and public opinion in the country were more concerned with the (appalling) conditions in which lunatics were treated and confined both in traditional institutions and elsewhere (Novella, 2013, p.52-66), more trips abroad were made to visit the most reputable institutions, acquire “phrenopathic” knowledge and establish professional contacts. Thus, for example, in early 1846, El Heraldo and other papers reported the return to Madrid of the surgeon and future professor of the Universidad Central José Calvo y Martín (1814-1904), who had been commissioned by the Instituto Médico de Emulación (Medical Emulation Institute) to examine various hospitals and homes for lunatics in England, France and Germany: “It is to be desired,” the paper remarked, “that this examination should not prove fruitless, for the betterment of the dreadful state currently seen in establishments for the housing and cure of unhappy creatures who are deprived of reason” (Gacetilla…, 1846, p.4). According to his own testimony, Calvo – who had also gone into exile in the 1830s in Montpellier and Paris, where he met Esquirol – was especially favorably impressed by the new Hanwell asylum on the outskirts of London (under John Conolly, the pioneer of non-restraint), by the “new Charenton,” and by the recently-opened Illenau asylum, near the Black Forest, where he was surely received by its founder Christian Roller (Calvo y Martín, 1846, p.503).

Following the example of the multitalented Ramón de la Sagra (1798-1871), who – imitating Tocqueville – traveled around the USA and Europe in the 1830s and 1840s in order to become acquainted with the principal reforms in educational institutions, penitentiaries and hospitals (Rodríguez Caamaño, 1999),7 other non-medical professionals were also interested in foreign lunatic asylums at that time. Thus, for example, the newspaper La Época reported on April 6, 1850 that the Interior minister had commissioned the Madrid lawyer Lino Saldaño “to study establishments for lunatics and the various systems known abroad so as to improve those established in Spain” (Noticias…, 1850, p.4). It would appear that this appointment, which likely took place in the context of preparations for the opening of a model asylum in the Spanish capital (Villasante, 2003), never actually resulted in a voyage by the commissioner. The same thing must have happened that year in the bizarre case of the Catalan physician Manuel Soler y Espalter (1809-1880), the details of which have recently been documented by Antonio Rey and Enric Jordá. A resident in Madrid who had held various civil service posts, Soler offered himself motu proprio to the Minister of Public Education at the time, Manuel Seijas Lozano, to be chair of the new “department of mental diseases” that the government was proposing to create during the introduction of so-called “specialties” in the university training of medical students. Seijas himself responded favorably to the request and also offered him the directorship of a new lunatic asylum to be set up in Madrid with the explicit condition that he should “go to France and study that special subject for two years doing clinical work at Bicêtre or some other important hospital” (Rey, Jordá, 2011, p.87). Soler must have initially accepted these conditions, since a Royal Order dated October 28, 1850 commissioned him “to study mental disorders abroad,” but everything indicates that he did not meet them; only a year later, his commission was officially suspended and he was even ordered to refund the 1,500 reales he had been advanced for his move to Paris (p.88).

In general terms, then, it can be said that – when they actually happened – almost none of these voyages made an appreciable difference to the effective spread of the discourses and practices of the new field of alienism within Spain. Certainly, none of the protagonists had – or could have – any prior experience in “clinical [care] of mental disorders,” nor did any of them subsequently focus their activities in the field, so that, apart from some isolated publications, their contribution was in fact scarce. That being so, it is hard not to second the conclusions of Janer (1844, p.9), mentioned earlier, who pointed out the limitations of these trips by ambitious but ill-prepared professionals:

What use can be made of a voyage, perhaps a short one, by some young men barely initiated in the first ministrations of the art of medicine who, having not yet entered into the common exercises of that art, are in no state to make proper comparison of the new and hitherto unknown methods with the old ones, to benefit from conversations with the most famous physicians and report correctly and reliably upon whatever they may be asked about pertaining to the authorization [of such methods] in their own country?

The first (relative) exception to this rule was the physician Francisco Campderá y Camin (1793-1862) of Girona, who studied medicine from 1814-1819, in Montpellier, with a grant from the Joan Bruguera Foundation; in 1844, he founded the “Lunatics’ Tower” in Lloret de Mar. Although small, it was the first private asylum opened in Spain (Fuster i Pomar, 1964).8 During his student years, Campderá became acquainted with André-Pamphyle-Hyppolite Rech (1793-1853), who became an intern under Esquirol (Goldstein, 1987, p.144, 385). Campderá visited him in 1847, in his private sanatorium, in Pont-Saint-Côme in the course of a tour to French asylums, during which he also received the plans for the future Asyle d’Aliénés in the Department of Rhône from the alienist Alexandre Bottex in Lyon. The medical press reported these activities with admiration, painting a distinguished portrait of Campderá as a true pioneer and acknowledging the fundamental role of travel in his acquisition of knowledge:

When a man of talent and knowledge devotes 20 years to curing mental illnesses, and studies all the books, and visits the most famous hospitals abroad, and tries out all the treatments in his own [hospital], and concentrates all his intellectual faculties upon a single idea, his experience must be of the most illustrious nature, a rich and comprehensive fund of observations (Descripción…, 1850, p.277).

But it is clear that, even though his institution would remain open under different names for a period of almost a century and a half, Camperá’s dedication (to the field) was nowhere near this great – strictly speaking, he was more interested in botany and the education of the blind than in clinical psychiatry –, so his contribution had barely any impact on the beginnings of psychiatry in Spain.

The voyages of Emilio Pi y Molist and Antonio Pujadas

In reality, the first Spanish physicians to play an important role in introducing new discourses and psychiatric practices and whose professional trips abroad significantly influenced their contributions were also Catalans: Antonio Pujadas (1812-1881) and, above all, Emilio Pi y Molist (1824-1892).9

Pi, who showed an early interest in the field of mental pathology, had won a public contest held by the Sociedad Económica Barcelonesa de Amigos del País (Barcelona Economic Society for Friends of the Country) on “the most feasible way to erect an asylum, hospital or home for lunatics of both sexes, outside the city walls” (Memoria…, 1885, p.7), and shortly afterwards he joined the department for mental patients at the venerable Santa Cruz Hospital in Barcelona, whose wretched conditions had been repeatedly criticized for some years, with various plans suggested for reforming or moving it (Comelles, 2006, p.59-69). In this role, the Most Illustrious Administration (MIA) of the hospital commissioned him in May 1854, after having filed the necessary report on the “importance and need for the voyage,” to “travel to various foreign countries in order to study their most famous and justly accredited homes for lunatics” (Duran y Obiols, Pi y Molist, 1854, p.1).10 Advised by the eminent Barcelona physician Raimundo Duran y Obiols (1792-1858), Pi justified the trip by claiming that the “sum of practical knowledge” required for his enterprise could not be acquired in Spain, “where unfortunately there is currently not a single lunatic asylum worthy of the name,” so that it was “indispensable to go and seek it in other countries,” in particular France, Italy, Germany and England. Laying out an ambitious schedule of visits that included a large number of institutions in those countries and a rigorous “order of execution” (involving “overall inspection, part material, part hygienic and part therapeutic or curative”), he prophesied that

with the presence of the infinite amount of data collected, there will undoubtedly be built in Barcelona a lunatic asylum which, thanks to the solidity and beauty of its construction, its excellent location, its conscientious care and its perfect regime in both clinical and economic terms, will be able to compete with the best asylums abroad and be the admiration of our fellow countrymen (Duran y Obiols, Pi y Molist, 1854, p.7).

After completing the requisite administrative paperwork and reiterating his zeal and readiness to carry out the mission with which he had been entrusted, Pi left for France on May 28, 1854 and wrote to the MIA just three days later from Montpellier, where the Spanish consul accompanied him to the asylum attached to the ancient Saint Eloi hospital. He reported that

To facilitate the inspection of lunatic aslyums, both as regards their clinical and their economic side, using a logical, clear and precise method, I have set out for my own use a plan or rule, which I promise myself will shorten my visits to [these] establishments, without thereby overlooking any matter of importance (Pi y Molist, 31 mayo 1854, p.2).

On June 10, he sent a further letter from Lyon, relaying his impressions of visits to the old Antiquaille hospital and the Maison de Santé de Saint Pierre et Saint Paul, built in 1824 and run by the Hospitaller Order of Saint John of God; while he felt that the first “was far from [living up to] the brilliant description I read of it somewhere, and as regards space and cleanliness ... it almost outranks the current warehouse in Barcelona,” he was most favorably impressed by the second, pointing out the “care and kindness with which the insane are treated, and the efforts made to keep all the wards, outhouses and dormitories perfectly clean” (Pi y Molist, 10 jun. 1854, p.3). On July 3, a day before leaving for London, he wrote to the MIA again, from Paris, reporting on his visit to the Maison Impériale de Charenton, the Salpêtrière and Bicêtre hospitals and the private asylum founded by Esquirol, which had been moved, in 1827, to Ivry-sur-Seine and was being run at the time by Jules Baillarger and Jacques-Joseph Moreau (de Tours). This time, especially as regards Charenton, his comments were very admiring; he insisted on the obvious superiority of the institutions in Paris over the ones he had visited earlier, and concluded:

Nothing that might help the cure, relief, comfort, safety, rest and entertainment of the insane is forgotten [in these institutions]. Large courtyards, vast gardens, woodland, fountains; common rooms with pianos, billiard tables, chess, checkers, dominos etc.; libraries or reading rooms, with various books, newspapers, geographical maps, illustrations of natural history; gymnastics schools. In short, everything proves how well understood and advanced this interesting branch of charity care is here (Pi y Molist, 3 jul. 1854, p.2).

After his tour of France, Pi also spent over two months visiting English, Belgian, German and Italian asylums, and did not return to Barcelona until September 13, 1854 (MIA, 1854). With the large amount of information gathered, on January 18, 1855 he presented the MIA “a rather voluminous little work” (Pi y Molist, 1860, p.XI) – the manuscript of which has, unfortunately, not been preserved – in which he listed the results of his voyage in a Description of various lunatic asylums in France, England, Belgium, Germany and Italy visited in the months of June, July, August and September 1854 and, six months later, a detailed report on the Colonia de orates de Gheel (Colony for the Insane at Gheel, Belgium) (Pi y Molist, 1856), which was published a year later. In this report, Pi presented an admiring “historical-medical description” of this unusual place near Antwerp in which, from time immemorial, the insane were taken in by peasant families and worked alongside the community (Huertas, 1988; Müller, 2004); in his opinion, the Gheel colony thus offered “indisputable advantages, inherent to its nature, that the best lunatic asylum would be hard put to match” (Pi y Molist, 1856, p.74).11

Apparently satisfied with the “accomplishment of his mission,” his valuable knowledge and his undeniable dedication, the hospital administration graciously thanked him for his services (MIA, 1855) and, on July 3, 1855, they named him head physician of the institution and director of the wards for the insane. Once the ecclesiastic council and the city hall had been officially notified of “the usefulness of constructing a new asylum” (MIA, 1856, p.1), on June 25, 1857, the MIA appointed him to draw up the project in collaboration with the architect José Oriol y Bernadet, with whom, in August of that year, he went abroad once again, this time “at his own expense,”

to study the [asylums] build since 1854, [which], because they are very recent, ought to present the result or application of the most modern principles of the science of phrenopathy as well as the [type of] architecture relating to the construction of [such] establishments (Pi y Molist, 1860, p.XIII).

Altogether, over the course of his two voyages, Pi visited a large number of institutions all over Europe, including, apart from those already mentioned, in France, the asylums in Marseille, Toulouse, Bordeaux and Auxerre, the sanatorium of Pont-Saint-Côme founded by Rech and the Providence asylum in Niort set up by Jean-Baptiste-Maximien Parchappe, the Inspector General of establishments for the insane and prison health services; in England, the famous Bedlam Hospital, Saint Luke’s (Hospital for Lunatics), founded in 1751 and directed initially by William Battie, the Hanwell Insane Asylum and the “immense new” asylum in Colney Hatch (north of London); in Belgium, the asylum in Ghent – constructed according to the plans of Joseph Guislain – and the Maison de Santé le Strop; in Holland, the “impressive” Meerenberg Asylum near Haarlem; in Germany, the Eichberg and Halle asylums and the Charité hospital in Berlin, directed by Karl Wilhelm Ideler; in Austria, the “monumental” asylum in Vienna; in Switzerland, the Waldau asylum near Bern, the Préfargier asylum on the outskirts of Neuchâtel, and the Geneva asylum; and lastly, in Italy, the three insane asylums in the city of Milan (Senavra, Senavretta and Dufour), and those in Turin and Genoa (Pi y Molist, 1860, p.XIV-XV). “It is no boast,” Pi declared, that he had returned “with a rich fund of new ideas, both psychiatric and architectural,” and it is true that his Proyecto médico razonado para la construcción del manicomio de Santa Cruz (Reasoned medical project for building the Santa Cruz asylum in Barcelona) – which was finally published in 1860 – provides a very detailed and systematic account of the institutions he visited, to the point that he had established a different typology for the three basic models (French, Anglo-American and German). Thus, as had been planned from the beginning, the new Santa Cruz asylum could be built based on the best of each of them,12 and its construction – which was not completed until several decades later (Comelles, 2006, p.91-100) – can certainly be interpreted as a fairly direct (although delayed) consequence of Pi’s voyages.

As regards Antonio Pujadas, his first trip abroad was during the period of 1836-1844, when he presumably trained in Montpellier with Rech and then lived in London and other European cities (Ausín Hervella, 2000, p.15). After setting up various foster and convalescent homes for mental and “nervous” patients in Barcelona, Pujadas decided to purchase an old convent in Sant Boi de Llobregat, and in 1854 set up an asylum there, where he soon attempted to institute a therapeutic regime and infrastructure fully comparable to any European institution. With that objective, among others, he secured an appointment as “royal commissioner” from the minister for the Interior, José Posada Herrera, in order to visit various establishments for the insane across the continent, and shortly thereafter he began a long voyage around France, Belgium, Switzerland, Holland, England, German and even Russia (Ausín Hervella, 2000, p.113).

Unfortunately, Pujadas did not leave a written report of his trip, and we only have isolated and indirect testimony about it; thus, for example, we know from Brierre de Boismont that the Catalan physician visited him in Paris in mid-April, 1860 and met with a large group of French alienists, who gave him a great deal of information about the asylums of their country (Novella, Huertas, 2011).13 Those contacts would turn out to be extremely useful, for that same year – just like Pi in 1859 – Pujadas was named foreign associate of the Société Médico-Psychologique and, a little while later, Brierre de Boismont and other colleagues showed their express support when he was arrested and imprisoned for the alleged wrongful commitment in his asylum of Juana Sagrera, an upper-middle-class Valencian woman (Cuñat, 2007). In this case, which caused a great stir and was very important to the process of institutionalizing psychological medicine in Spain (Huertas, Novella, 2011), Pujadas’ professional conduct was endorsed by prestigious foreign physicians, and he was eventually exonerated and even awarded a medal by Queen Isabel II. Some years later, as the founder of the first private asylum of any stature to be opened in Spain, he would have the occasion to thank his colleagues in person when he attended the (first) International Congress of Alienists at the Universal Exposition in Paris in 1867.

Building international contacts

In one sense, Pujadas’ presence among the conference attendees – confirmed by the proceedings published at the Annales Médico-Psychologiques, the principal French psychiatric journal14 – can be seen as a symbolic turning point in the trajectory of Spanish psychological medicine. We know that psychiatry did not become socially, institutionally and professionally established in Spain (as a whole) until after 1875, but that, at least in Catalonia, this was starting to occur in the latter years of Queen Isabel II’s regime, which ended in 1868 (Novella, 2013, p.169-179). Thus, the activity of pioneers like Campderá, Pi, Pujadas and a few others such as Tomás Dolsa and Pablo Llorach, who founded the Phrenopatic Institute in Gracia (a district of Barcelona), and above all Juan Giné y Partagás (1836-1903), led, during the early years of the Bourbon monarchy’s restoration (1874-1931), to a series of initiatives aimed at building professional knowledge and, more specifically, to the first attempts by Spanish alienists to generate international contacts (Huertas, 2002, p.96-101).

In this context, one of the most noteworthy events was undoubtedly the Primer Certamen Frenopático Español (First Spanish Phrenopathic Contest) held on September 25-28, 1883 in the Nueva Belén asylum near Barcelona. Led by Giné, who was at that time the medical director of the asylum and a professor of clinical surgery, a small group of disciples and colleagues promoted the event with a series of announcements in the (recently founded) Revista Frenopática Barcelonesa and other journals; they managed to secure a sizeable number of presentations on aspects such as administration, patient care, forensics and clinical therapy (Villasante, 1997). One of the factors that helped to publicize the contest and contributed to its success was the participation of prestigious foreign specialists such as the Frenchmen Valentin Magnan, Emmanuel Régis and Joseph-Guillaume Desmaisons and the American Edward C. Seguin. Magnan and Régis sent work on “bilateral hallucinations” and forced feeding of patients, while Seguin provided a valuable and well-documented paper on the (dire) state of psychiatric care in Spain, which he wrote after a tour to the principal asylums of the country a few months earlier.15 Desmaisons, the medical director of Castel d’Andorte, a private sanatorium for mental patients in Bourdeaux, and author of Recherches historiques et médicales sur les asiles d’aliénés en Espagne (Desmaisons, 1859), which won a prize from the Spanish government, was the only one who actually came to Barcelona to attend the sessions. He was named honorary president of the conference, despite not having given a presentation.

Given Pujadas’ precedent, and bearing in mind the lack of continuity after the event organized by Giné and his group, the new generation of Spanish psychiatrists who came of age during the twentieth century were noticeably more present at and interested in international conferences, which were undergoing a period of great splendor (Porter, 1997, p.526). Thus, for example, José María Esquerdo (1842-1912), owner and director of the Carabanchel Sanatorium and a central figure of the so-called “Madrid school” (Gracia, 1971), chaired the Section for Neuropathies, Mental Illnesses and Criminal Anthropology at the 14th International Medical Congress in Madrid, April 23-30, 1903. Esquerdo, who held a banquet for the conference attendees at his sanatorium (Fiesta…, 1903), ended his inaugural speech with a highly significant reference to the enormous value of conferences in terms of social recognition and legitimation of the profession:

Thanks to these great solemnities, public estimation of mental health practitioners is growing, although society still regards with both amazement and enormous complacency a legion of men dedicated to defending the human mind from being invaded by madness and flung from its sacred fortress, … raising alienists to the august rank of liberators of an enslaved nation, similar to God himself (Esquerdo, 1904, p.13).

Similarly, Giné’s disciples Arturo Galcerán Granés (1850-1919) and Antonio Rodríguez Morini (1863-1937) attended the International Congress on the Care of the Insane in Milan in 1906, and even supported creating an “international institute” to study the causes of mental illness (Huertas, 2002, p.101). That same year, Rodríguez Morini also participated in the 15th International Medical Congress in Lisbon, where he gave an important presentation on progressive general paralysis (Villasante, 2000).

Final considerations

From all of the above we may conclude, then, that “professional” travel and the establishment of international relations also played a vital role, firstly in the spread of the discourses and practices of psychological medicine in Spain, and later, in the long and complex process of institutionalization of the specialty. Thus, it is possible to argue that the traditional view of Spain and its late-medieval hospitals as the “cradle of psychiatry” (Bassoe, 1945; Dieckhöfer, 1975) and the inveterate persistence of Jofrism (see note 1) for years prevented any appreciation of alienism as a historical break with the past in terms of managing and administering madness; but there is no doubt that the (precarious but gradual) process of consolidating that change across the country owed a great deal to the efforts made by its most active pioneers to expand their knowledge, to emulate (what they saw elsewhere) and to bring themselves “up to date.”

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1 Focusing on the figure of the Mercedarian friar Joan Gilabert Jofré (1350-1417), founder of the famous Hospital dels Folls e Innocents in Valencia (1409), Cándido Polo (1996) has defined as “jofrismo” (Jofrism) the belief that, based on this long tradition and supposed prioritization (of the care for the insane), there was no need in Spain for any substantial innovation in the management and institutional handling of madness.

2 Despite the interest of certain Enlightenment figures such as Cabarrús, Jovellanos or Meléndez Valdés in the conditions of hospitals and prisons, it is not possible to confirm whether this practice was widespread in Spain. In fact, the majority of testimonies available on the state of Spanish establishments for the insane in the eighteenth and early nineteenth centuries comes from foreign travelers (Espinosa Iborra, 1984).

3 It is highly significant, therefore, that Esquirol himself (1816, p.151-152) begins one of his early articles on madness with the following statement: “How many meditations are offered to the philosopher who, retiring from the tumult of the world, walks through a lunatic asylum! There he will find the same ideas, the same errors, the same passions, the same misfortunes: just as in the world itself. But, in an asylum, the characteristics are stronger, the nuances more pronounced, the colors brighter, the effects clearer, because mankind is shown in all his nudity, because he does not cover up his thoughts, because he does not conceal his defects, because he does not lend his passions a seductive charm, or his vices a deceitful appearance.”

4 This was the case, for example, of Jacques-Joseph Moreau (de Tours), who, prior to his appointment at Bicêtre in 1840, managed to travel to Malta, Egypt and Turkey, where he began his studies on the psychological effects of cannabis and took the opportunity to visit various lunatic asylums such as the famous Maristan of Cairo (Moreau de Tours, 1843).

5 In the case of Spain, besides reproducing the data already mentioned by Pinel, Esquirol turned to Doctor Manuel Hurtado de Mendoza (Esquirol, 1818, p.55) and Doctor Ignacio Ruiz de Luzuriaga (Esquirol, 1829, p.111), who gave him information about the (deplorable) state and (low) occupancy of hospitals in Toledo, Granada, Córdoba, Valencia, Cádiz, Barcelona, Zaragoza and Madrid.

6 This period essentially coincided with the so-called Moderate Decade (1844-1854) of Isabel II’s long reign (1833-1868), which was characterized by political and social stability, allowing the construction of the liberal state to proceed. On this period, see Fontana (2007) and Burdiel (2010).

7 De la Sagra described his travels in various works such as Cinco meses en los Estados-Unidos de la América del Norte (París, 1836), or Relación de los viajes hechos en Europa bajo el punto de vista de la instrucción y beneficencia pública, la represión, el castigo y la reforma de los delincuentes, los progresos agrícolas e industriales y su influencia en la moralidad (Madrid, 1844).

8 Located in an idyllic plot beside the sea, and intended for affluent clients, the facilities and the therapeutic regime of the “Lunatics’ Tower” were met with unanimous approval by the public at the time, to the point that the director was consulted by the City of Barcelona during the process of redesigning the Santa Cruz Hospital. This was reported, among other places, in the Madrid newspaper El Heraldo in the May 25, 1850 issue.

9 On both these authors see, as an introduction, the now classic bio-bibliographical studies by Antonio Rey (1983, 1984). On Pi y Molist, see also Comelles (2006, p.71-93) and on Pujadas, Ausín Hervella (2000).

10 All the documentation related to Pi y Molist’s voyages can be found in a file held at the Arxiu Històric del Hospital de la Santa Creu i Sant Pau in Barcelona, which includes various handwritten letters from Pi to the MIA and vice versa. I would particularly like to thank Pilar Salmerón, the archivist, for finding and reproducing these valuable documentary sources.

11 It was little wonder that Gheel became a genuine site of pilgrimage during the first half of the nineteenth century for European alienists, who left accounts of their visits and opinions in a stream of notes and publications beginning with Esquirol’s Notice sur le village de Gheel (1822) – he had visited the colony the previous year with his disciple Félix Voisin – and followed by a series of accounts by the Belgian Joseph Guislain (1837), the Italian Giovanni Stefano Bonacossa (1838) and, once again, the Frenchmen Moreau de Tours (1842) and Brierre de Boismont (1846).

12 Pi stated that his project “matches the French [model] in placing general services in the center of the building; in assigning curability a secondary role in classification…, in the contiguity of the wards for the sections; in having a ground floor and an upper floor in all the buildings … From the Anglo-American system it uses the distribution of general services on separate axes for both sexes and, in part, in restricting the pathological classification principles to the states of calmness, agitation and slovenliness … And lastly it resembles the German [system] by being both an asylum for curing [the insane] and home for long-term care, and by using common dormitories as the main element in housing inmates” (Pi y Molist, 1860, p.347).

13 Apparently, Pujadas also visited the pioneering asylum for cretins and idiot children run by the Swiss physician Johann Jakob Guggenbühl on the Abendberg mountain near Interlaken, since on his return to Sant Boi he records that it inspired him to create specific wards for “idiots, epileptics and the elderly” (Ausín Hervella, 2000, p.113).

14 The three-day event ran from August 10-14, 1867; Paul Janet and Brierre de Boismont were the presidents. It has gone down in history as the first international conference on the new specialty, and it was attended by a small delegation of foreigners, most notably Christian Roller and Wilhelm Griesinger (Germany), Thomas Harrington Tuke (England) and Cesare Lombroso (Italy). The proceedings can be consulted at the Annales… (1867, p.491-540). As shown there, Pujadas was accompanied by José Martí y Artigas, a Barcelona physician and pharmacist who held various positions at Sant Boi and became one of his main followers (Ausín Hervella, 2000, p.145).

15 Seguin, son of the famous French doctor Édouard Seguin (1883b, p.458), emigrated to the United States at an early age. A pioneering neurologist, he roundly condemned the “general backwardness of the specialty in Spain,” describing the level of the physicians in charge of the different institutions he visited as follows: “with the exception of perhaps half a dozen, the doctors I found in charge of the insane had very little phrenopathic knowledge. … Almost without exception, they were incapable of reading the extensive, valuable literature on mental illnesses available in German or English, and beyond a vague skepticism about non-restraint, they knew nothing about the admirable way of treating the insane in countries beyond France.”

Received: May 2015; Accepted: July 2015

Translated by Catherine Jagoe.

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