In 1745 Francis I of Habsburg-Lorraine gained the crown of the Holy Roman Empire and in 1765 his second son, Peter Leopold, inherited the title of Grand Duke of Tuscany. On September 13th of the same year, Leopold and his spouse entered Florence. Among the many reforms introduced by Peter Leopold there was an interesting ordinance dated January 23rd 1774 that prescribed the institutionalization of the insane. Such a by-law, also known as the «Legge sui Pazzi», has been generally lauded by historians as the first statutory provision in the Western world attempting to provide a system of humane care for mad people regardless of their economic condition (Conti, 2015; Weiner, 2011b).
Within the Florentine healthcare system, people deemed insane were hosted together with sick, poor, and homeless in several hospices (Tombaccini et al., 2008). Despite an unknown number of individuals who lived at home with their relatives, insane could be found in a section of the general hospital of Santa Maria Nuova, in a shelter for the poor at San Bonifazio, and in the hospice of Santa Dorotea. Although the practice of confinement seemed to be more or less diffused in eighteenth-century Florence, there was no unique location dedicated to the insane.
It is in this context that the 1774 Ordinance came out with the explicit aim to address the situation of the insane. The original version of the decree appeared in a one-page circular letter printed in Florence signed by the Representative of the community for the demented (Soprassindaco a’ Cancellieri delle Comunità relativa a’ Dementi). In a concise form, it outlined the power consented by the Grand Duke to the Soprassindaco to admit all «maniacs of the state» to the hospital of Santa Dorotea (Camera delle Comunità dei Dementi, 1808, p. 203).
It is important to note that the Ordinance targeted outbursts of violence. Contrarily to other European poor laws that regulated the confinement of an undifferentiated group of people such as poor, disabled, sick, insane, and convalescents, the Ordinance of 1774 specifically addressed the problem of insanity and its liberty. The Ordinance, moreover, formally recognized the medical authority over institutionalization. To this regard, the original text clearly indicated that whenever a “maniac” was found at large, he/she must be immediately examined by «pubblici professori» to ascertain whether he/she meets the conditions for confinement (Camera delle Comunità dei Dementi, 1808, p. 203). The Soprassindaco confided in «doctors’ faith» (alla fede de’ medici) for the effective application of the decree (ibid., p. 204). The 1774 Ordinance directed the institutionalization of the insane solely to the hospital of Santa Dorotea. After 1774 the geography of madness in Florence started to mutate: from a plurality of locations to the preference of a dedicated space. Until the reformation of 1788, in fact, Santa Dorotea became the elective place for maniacs with a capacity of at least sixty people (Cantini, 1808, p. 206).
One of the most well-acknowledged parts of the Ordinance also stated that as soon as an individual was declared to be insane, his/her means of support must be determined and, in case of poverty, he/she should be supported as a pauper at the expense of the community (Camera delle Comunità dei Dementi, 1808, p. 204). This collective support of the poor insane has led historians to highlight the humanitarian theme of the Ordinance (Conti, 2015; Mora, 1975, 1987; Weiner, 2011b). However, by looking at the legislative context of the time it is possible to advance a different interpretation of this regulation.
To start with, it must be noted that the writer of the circular letter was neither Peter Leopold himself nor the director of Santa Dorotea. Indeed, the signing author was the aforementioned Soprassindaco of the community of the demented. What kind of role was this? Following the new legislative reform proposed by Peter Leopold in May 1774, Tuscany’s population was to be divided in 101 municipalities (Cantini, 1808, p. 217). For each municipality there was a variable number of offices depending on the size. One of these offices was that of the Soprassindaco who had the duty of calibrating and coordinating the collection of taxes (Maran, Castellini & Bisman, 2013, p. 33). Hence, the author of the Ordinance was an administrative figure dedicated to fiscal issues rather than medical or charitable initiatives. Throughout the Ordinance of 1774, in fact, there is no reference to ethical or philanthropic concerns whatsoever. The Soprassindaco is charged of dealing with a pragmatic issue: how to «exactly and punctually» restrain the tuscan maniacs «avoiding any inconvenience deriving from a delayed admission» (Camera delle Comunità dei Dementi, 1808, p. 204). From this perspective, we can see the great attention paid to he economical aspects of confinement. Not only maniacs should be interrogated in regards to their financial means but they should also be differentiated in «classes» according to the rate they could afford (ibid., p. 205). Such price ranged from a maximum of 41 monthly lire to a minimum of 26 and it included hospital stay, clean linens, shaving, and two meals a day. The upper classes benefited from a richer diet although wine was always watered down and everyone had to take care of clothing and «noble medicaments» (ivi).
Today we can read a reprinted copy of the «Legge sui Pazzi» as included in the thirty-first volume of the «Illustrated Legislation of Tuscany» dated 1808. This collection represents the effort to gather all tuscan laws promulgated from April 27th 1532 until March 15th 1799 (Cantini, 1808, p. IV). A further benefit of this source is the critical discussion offered at the end of each decree by the lawyer Lorenzo Cantini who was in charge of the entire research and writing.
Camera delle Comunità dei Dementi, (1808). Lettera Circolare del Soprassindaco a’ Cancellieri delle Comunità relativa a’ Dementi del mese di Gennaio 1774. Estratta da un Esemp. stampato in Firenze nella Stamp. Grand. In L. Cantini, Legislazione Toscana raccolta e illustrata dall’avvocato Lorenzo Cantini (Tomo Trentesimo Primo). Firenze: Stampa Albizziniana da S. Maria in Campo per Giuseppe Fantosini con Approvazione. (pp. 203-206).
Cantini, L. (1808). Legislazione Toscana raccolta e illustrata dall’avvocato Lorenzo Cantini (Tomo Trentesimo Primo). Firenze: Stampa Albizziniana da S. Maria in Campo per Giuseppe Fantosini con Approvazione.
An English translation of the Ordinance can be found in Mora’s paper of 1975 but unfortunately, the American psychiatrist did not provide any reference regarding the original source. Here George Mora’s English translation:
To the Most Illustrious and Most Excellent Chairman,
Whereas His Royal Highness has graciously consented to entrust me with the power of admitting to the Hospital of S. Dorotea without previous knowledge of H. R. H., but following the necessary verifications, the insane residing in the state (including those residing in the area of Pistoia), and of notifying of this those responsible for their care, so to avoid any inconvenience deriving from a delayed admission of such insane, I warrant you that each time someone affected by such condition will be found in the towns of this country, he will be immediately examined by public specialists to ascertain whether he really needs to be shut up into such Hospital. In the meantime, every effort will be made to promptly and accurately determine whether he has relations or means of support in order to obtain in this case from those in charge of him a reasonable agreement in proper and official form, in which it will be clearly stated the kind of treatment that the insane will receive according to the rate given below. In case his relative will not be able or his means will not be sufficient to take care of his support, the Representatives of the community will have to come to a proper decision as to whether or not he should be supported as a pauper at the expense of the same community. In both cases, either through the agreement or through the above decision, the insane will be transported as quickly as possible to the above mentioned Hospital of S. Dorotea where he will be accepted on the basis of your certificate addressed to the Keeper of such Hospital. Later on, the admission will be confirmed by an order of mine to be transmitted to the proper addresses which you will furnish to me. All this will have to be accomplished very exactly and punctually in order to avoid the possible criticism which this procedure may elicit. From the Chamber of the Community, January 1774.
Conti, N. A. (2015). Vincenzo Chiarugi: La pazzia y el Reglamento de Bonifacio en los orígenes de la psiquiatría moderna. Asclepio, 67(2).
Maran, L., Castellini, M., & Bisman, J. (2013). Peter Leopold’s Reform of Tuscany (1774): management, organization and regulation at the local level. Management and Organizational History, 9(1), 26-44.
Mora, G. A. (1975). The 1774 ordinance for the hospitalization of the mentally ill in Tuscany: A reassessment. Journal of the History of the Behavioral Sciences, 11(3), 246-256.
Mora, G. (1987). Introduction. In V. Chiarugi, On Insanity and its Classification. Canton, MA: Watson Publishings International. (pp. IX-CXLI).
Tombaccini, D., Lippi, D., Lelli, F., & Rossi, C. (2008), Florence and its Hospitals: A History of Health Care and Assistance in the Florentine Area. Firenze, Firenze University Press.
Weiner, D. B. (2011b). The Madman in the Light of Reason. Enlightenment Psychiatry. Part II. Alienists, Treatises, and the Psychologic Approach in the Era of Pinel. In E. R. Wallace & J. Gach, History of psychiatry and medical psychology: With an epilogue on psychiatry and the mind-body relation. New York: Springer. (pp. 281-303).