One hundred thirty years of Dom Pedro II’s death: “The emperor of the tropics” and the beginning of Brazilian Psychiatry

ABSTRACT Objective: Associate Dom Pedro II’s life trajectory and the beginning of Brazilian psychiatry through the Pedro II Asylum. Methods: We conducted a narrative review of the literature on three search databases: Google Scholar, Pub Med, and Web of Science (SciELO). Results: The first Brazilian psychiatry institution, the Pedro II Asylum (1841-1889), was created by the number 82 decree on 18 July 1841. The launching occurred at Dom Pedro II’s coronation ceremony. It was a celebration that aimed at enhancing the Brazilian monarch’s power and at legitimizing the emperor’s adulthood at the age of fourteen. Throughout the 48 years of the Dom Pedro II empire, his cultural and science interests influenced the emergence of incipient Brazilian scientific research. In this regard, the Pedro II Asylum was portrayed not only as a health care institution but also undertook an effort to attend the social and cultural modifications promoted at the Brazilian imperial court after the Portuguese Crown family arrived in 1808. It also represented the influence of French psychiatry based on Phillipe Pinel’s (1745-1826) principles of moral treatment. Conclusions: Concisely, the Pedro II Asylum was a representation of Dom Pedro II’s personality as a patron of science, the emergence of Brazilian psychiatry, and the imperial society hierarchy.


INTRODUCTION
The "Emperor of the tropics", Dom Pedro II was considered an European monarch although he was born in America. Since his birth, he's had his trajectory outlined by the "different". As a child, he was portrayed as the future emperor and was raised to succeed his father Dom Pedro I after the Regency Period 1 . However, he became more than a Brazilian Emperor, and due to his great interest in a wide range of subjects, his legacy achieved a world recognition to the Brazilian science and culture 2,3 . Among this legacy, it is the foundation of the first Brazilian psychiatry institution in the city of Rio de Janeiro 4 .
The officialization of this foundation occurred one hundred eighty years ago, through the number 82 decree on 18 July 1841, the first day of Dom Pedro II's coronation ceremony 4,5 . This decree made the Pedro II Asylum emerge as a symbol of the monarchy power and the Brazilian civilization 1,6 . This was not a random decree, but an expression of changes that had occurred in Rio de Janeiro since the Portuguese Crown family's arrival escaping from Napoleon's troops in 1808 1 .
After Rio de Janeiro became recognized as the Crown's center, streets poverty and the city population increased 1 . Among the streets population were beggars, vagabonds, drunkards, and insane people 4 . Before medical and social transformations, these people were arrested only when aggressive; after, however, they started to be divided into two groups: the ones who needed health support and the ones who did not 7 . The group identified as patients (drunkards, insane people) was sent to the Santa Casa de Misericórdia do Rio de Janeiro. The institution, however, was not big enough to receive this high number of patients, which brought them unhealthy conditions 5 . If patients belonged to a privileged social group instead, their family needed to support them at home or in a specialized place 5 .
During the 1830's decade, French alienism based on Phillipe Pinel's (1745 -1826) and Jean Etienne Dominique Esquirol's (1772-1840) 8 principles of psychiatric moral treatment and theory's passion impacted the Brazilian medicine practice 5 . Adding the social context to the medical background, some medical personalities such as José Martins da Cruz Jobim (1802-1878), José Francisco Xavier Sigaud (1796-1856) and Luís Vicente de Simoni (1792-1881) claimed that it was necessary to have an asylum to address the psychiatric patients to 9 . In this context, Santa Casa de Misericórdia do Rio de Janeiro represented by José Clemente Pereira (1787-1854) donated an area at Saudade Beach to build the future Pedro II Asylum 7 . That time he was the provider's institution and had a central role since this donation to preserv the church influence in the Pedro II Asylum's administration 4 .
The purpose of our manuscript is to describe and discuss the relationship between Dom Pedro II trajectory and the Pedro II Asylum.

METHODS
We conducted a narrative review through three electronic search databases: Google Scholar, Pubmed and SciELO (Web of Science). The studies included were: thesis, books, chapter books, scientific articles and web pages. Additionaly, the bibliograph of the studies was reviewed. Besides that, the author C.M is a librarian specialized in Brazilian Psychiatry History.

Dom Pedro II: the emperor with an asylum
Dom Pedro II's coronation aimed at legitimate his adulthood at the age of fourteen. This political act occurred due to regional conflicts collapsing all over Brazil in 1841, which could represent a risk to the monarchy. Thus, it could have impacted not only the strengthening of the monarchy power, but could have also created an entity for public admiration 1,10 . Dom Pedro II remained in power until the Brazilian republic proclamation in 1889 and dedicated his time to science and culture 10 , contributing significantly in both scenes figure 1.
Across the globe, the emperor was known more for his culture than for his position as a monarch 1 . Between his interests was science, it might be evoked by their family common characteristics as hereditary prognathism, epilepsy, asthma, melancholy and psychotic episodes. These royal heredities were probably influenced by their high rates of inbreeding 1 .
Additionally, he dedicated his time to diplomacy. He aimed to achieve a shared knowledge between the international scientific community, and improve the incipient Brazilian science 1,3 . Regarding this topic, he sponsored the laboratory of Louis Pasteur (1822 -1895), which impacted the development of the rabies vaccine and also the beginning of a local microbiology 3 . In his first time in Paris, Dom Pedro II was personally introduced to Pasteur at the laboratory of the École Normale. Before this meeting, they started exchanging letters, which was essential to realize how much Dom Pedro II could interact with such an honored scientist 3 . Moreover, he was close to important scientists of his time, like Graham Bell, Thomas Edison, and Charles Darwin, among others 11 .
The emperor was not focused only on acquiring knowledge about his multiple interests, but also on the possibility of promoting a local science and a cultural identity to Brazil within the monarch's perspective 1 . He was a member of different scientific societies such as Societé d'Agriculture, Sociéte d'Hygiène, Sociéte de Zoologie, Sociéte de Geographie, Sociéte des Amis de la Science, French Society for animal protection, Royal Academy of Sciences, and an honorary member of the Institute of Anthropology 11 . Because he dedicated his time to culture and science, besides having been a polyglot and a correspondent of international scientific institutions, it was possible for him to leave Brazil an interesting legacy 1,2 .

Inside the Pedro II Asylum
In this context, the Pedro II Asylum emerged not only as a psychiatry institution, but also as a symbol of the monarchy power and the Brazilian civilization 4,6 . The asylum was built in ten years and it was inspired by a French neoclassical architecture of the Chareton's hospital 7,9 . The structure was a luxury palace divided into two floors. On the first one, there were the female section (Esquirol), the male section (Pinel) and the coutyards 6 . On the second floor, there were the administration centre and the chapel, which represented religion above science 12 . There was a paradox regarding the aim of characterizing the Brazilian civilization, an association between a high civilization development and the increase of insane people could be clearly seen at that time. This association was based on the principle that only a civilized culture could promote insanity influenced by the complexity and pressure involved 6 .
The number 1077 decree published on 4 December 1852 officialized the Pedro II Asylum's statute, and on the day after, the first Brazilian psychiatric institution with the total capacity of 350 patients 9 was inaugurated. The financial support came from the empire itself, the lottery, donations, charity, and some patients' payments. Just like in the monarch's society, there was also a class division inside the asylum. According to the social class and the amount of money paid, the patients were classified as first-class, second-class, third-class (slaves and freedman), army, poor people, and non-identified. The first-class patients belonged to privileged families, which meant they could receive special meals and private rooms. However, the amount of private patients was smaller than the non-paying one. This difference made it hard for the institution to bear the costs over the decades 4 .
During the 1850's, the most prevalent influence on the patient's treatment was the alienism based on Pinel's moral treatment, which highlighted the necessity of insane patients' isolation for recovery 4 . In the 1860's, Benedict Augustin Morel's hereditary theory started to be more prevalent among the medical class discussions. It defended the degeneration as the etiology of insanity, which could uphold the perspective of a high number of poor people in hospitals 4 . After the 1870's, alcoholic patients represented an increasing group of admissions. If at the beginning Pedro II Asylum's portrayed a luxury symbol of the monarchy, it was not the same in the 1880's. The proportion of private patients decreased over the years; some private psychiatry institutions were opened in Rio de Janeiro, which harmed the institution in terms of support costs. Additionally, the internments had a long-term duration that difficulty the number of new admissions, and also reduced the families' expectations about the cure after the patients discharge 4 .
There was a conflict between the religious directors and the medical authorities at the Pedro II Asylum. At that scenary, the treatment was more empirical than scientific 6,13 . However, after the improvement of a local psychiatry culture, the religious power decreased and some physicians started to control the institution. Among them, it was João Carlos Teixeira Brandão (1854-1921) 6 . In 1883, he became the first Brazilian psychiatrist approved by contest as an university professor and then, in 1887, he assumed the medical director position of the Pedro II Asylum. Teixeira Brandão had the main role of introducing a latter scientific project to Brazilian psychiatry 6,13,14 .

The end of Dom Pedro II's empire
The republic movement grew in Brazil, showing that the monarchy was coming to an end. If during the Dom Pedro II's empire the monarchy had assured a country unit, in the 1880's the opposite happened, with the latifundium economy decline and the increase of the slavery abolition movement 15 . Through his reign, Dom Pedro II was supported by the Brazilian elites. However, with the economy changes and Dom Pedro II's health problems, this support had disappeared 15 .
In 1883, the emperor developed some diabetic manifestations such as glicosury, peripheral neuropathies and vascular injuries, which culminated in an impairment to control his government 15 . Under a lot of pressure and health problems, Dom Pedro II traveled to France in 1887, when he was diagnosed by Jean-Martin Charcot (1825-1893) of surmenage psychico-physique (physical and psychological asthenia). He was treated in spas and water-cure clinics in France. These two important historical characters developed not only a professional relationship but also became friends 11 . Dom Pedro II was invited to Charcot's dinners as well to play billiards with him. The monarch recognized their friendship with a special gift, it was a small female monkey called Rosalie from South Africa 11 .
In 1889, the republic proclamation occurred, which caused Dom Pedro II to be deposed. After the event, he went to Paris and lived there until his death, in 1891. Charcot was responsible for his death diagnostic of pneumonia and the signature of Dom Pedro's death certificate 11 . He was not only responsible for the beginning of Brazilian Psychiatry but also became a patient of one of the most important neurologists in History. The trajectory of Dom Pedro II's life was surrounded by imminent historical characters, which could have been an important mark of his special contribution to Brazilian culture and science 11 .

Pedro II Asylum after the Republic Proclamation
In 1890, Pedro II Asylum became National Lunatic Asylum. However, the institution problems reimaned, specially the one related to the absence of a more strict selection process of the patients admissions 16 . Due to the overcrowded place and the continuous demand of street patients recquired by the police, it was created the Pavilion of Clinical Observation at an area close to the asylum by Texeira Brandão, in 1893 16 . It was a place for patients to be evaluated before their admission at the asylum. This pavilion also represented a possibility for clinical study of psychiatry and research, besides an instrument to develop the psychiatry science 16 .
In 1903, Juliano Moreira (1873-1933) assumed the direction of the National Lunatic Asylum 14 . He brought a lot of transformations regarding administration, infrastructure and the influence of German psychiatry based on Emil Kraepelin's (1856-1926) principles 14 . Later on, the federal decree number 8.834 changed the institution's name to National Hospice of the Alienated 9 , on 11 July 1911. Between the years of 1930 and 1940, psychiatry changed the objectives of the treatment to a free outside clinic and agriculture colonies, than the demand for this kind of institution decreased 14 .
The institution was overcrowded and the Urca branch was turned into a residential place 12 . In 1943, the National Hospice of the Alienated was shut down 12 . This emblematic building was donated to the Brazil University and nowadays it is the University Palace of the Federal University of Rio de Janeiro 12 (Figure 2). The psychiatric tradition and history continued to be preserved in that area by the Institute of Psychiatry originated from the Pavilion of Clinical Observation 16 .

CONCLUSIONS
Dom Pedro II's government and the Pedro II Asylum happened around the same period, and both of them represent an important period of Brazilian history and science. The emperor brought the possibility of a transition from monarchy to republic, without a Brazilian territory separation, and he also fomented the beginning of an incipient Brazilian science. Among Dom Pedro II's contribution to science, it is the first Brazilian psychiatry institution, which enabled the arise of the Brazilian psychiatry science.

CONFLICTS OF INTEREST
The authors declared no conflict of interest.