Experiencing the Asylum

Abstract

Here (and in Chapter 9), we shift our gaze to the asylum experience of pellagra, focusing on Venice’s two insane asylums: San Servolo (for men) and San Clemente (for women). The two chapters are organised around the ‘life cycle’ of male and female sufferers at the two asylums: from local referral and admission, through to treatment, and ending either with release back into the community or death. Being photographed upon admission became a standard part of the patient experience and we shall see how the patient photograph became a clinical tool. The photographic record can help us restore patient agency to the asylum experience. Who were the pellagrous insane represented in these sometimes harrowing photographs? What can a patient typology tell us about the nature of the disease and how it compares to ‘regular’ or non-pellagrous insanity? To answer these questions we look at the gendering of pellagrous insanity, as well as other factors such as age, social status and geographical origins, before turning to the treatments offered—diet, medicines and work-related activities—and the notion of ‘curability’.

Introduction

In the previous chapter, we noted that the Australian George Tucker visited the Venetian mental hospital of San Clemente in 1884, whilst on his asylum tour of Europe. His comments were far from generic: ‘I never heard more noise in any asylum. In a day room at the end of the corridor a perfect pandemonium existed. Fifty women were fastened in various ways—straps, jackets, hobbles, etc.—their feet being blue with cold’ (Tucker 1887, p. 1307). Practices of no restraint, much supported by Tucker, evidently did not have much purchase in Italy. Such circumstances did not figure in the sanitised official reports published by director Cesare Vigna about San Clemente (1877, 1887). Nor did Vigna remark on the overcrowding there, which saw the number of resident patients virtually double over two decades—from 585 in 1873 to 1,010 in 1892. The number of patients each asylum doctor was responsible for went from 138 to 332 (Salviato 2002, pp. 920, 923). As we noted in Chapter 6—and also observed for other parts of Europe (Wright 1997; Smith 2012)—this expansion was driven less by the desire to ‘confine’ insanity than by increasing poverty, exacerbated here by epidemic pellagra.

The asylum experience of pellagrous insanity, for patient and ‘alienist’ alike, began with admission and institutionalisation. The first step was diagnosis, a less than straightforward process, as we observed in the previous chapter. When it came to the nature of pellagrous insanity, the then-director of San Servolo, Dalmazio Battanoli, simplified things for his report. Battanoli wrote that pellagrous insanity could ‘present itself in all forms [of insanity], beginning with cheerful mania to mania with frenzy, from simple depression to melancholy with stupor, to mania with persecution, to hypochondriacal, sensory and paralytical insanity’. And he added: ‘We have had the occasion to observe it in all these forms’ (Battanoli 1884, p. 185). To judge by the patient records, the most common form at the two Venetian asylums—according to the illness categories used in Italy at the time (Sarteschi et al. 1994)—were a group of afflictions that included mania, monomania and frenosi (a generic term). These accounted for most cases of pellagrous insanity: 67% of male cases and 75% of female ones. Diagnoses characterised by depressive states, labelled melancholy and lipemania, were similar for both sexes, at around 19% of cases. Finally, a third group of illnesses, which included dementia, imbecility and idiotism, affected men twice as much as women, accounting for of cases 14% in men and 6% in women.

In theory, patients were to be divided up according to their illness type, following an examination upon their arrival. In practice, however, separation at San Servolo seems to have been mainly functional, according to whether patients were deemed dangerous or not (agitati or tranquilli). At San Clemente, director Vigna would have preferred an institution made up of a network of separate pavilions for different categories of sufferers, which he referred to as an ‘essential rule for the difficult management of these sick people’ (Vigna 1887, p. 53). As he did not have this luxury, Vigna got around this limitation thanks to the large size of San Clemente, which permitted patients to be separated into different areas of the building. New arrivals were placed in an observation ward, where they remained for two weeks, ‘before being placed in the respective sections according to the dictates of psychiatry [freniatria]’ (Vigna 1877, pp. 62–63). By this, Vigna meant housing ‘tranquil’ cases towards the front of the building, which was also where the staff had their offices, and the more serious and chronic cases towards the back. There is no indication that pellagrous insanity was dealt with any differently from other forms. Evidently, pellagra was the disease’s causation, not its manifestation; and patients were housed according to their behaviour and conditions.

Patient Photography as Clinical Tool

Pietro Bregolato has the sad honour of being the first San Servolo patient to be photographed upon admission, on 14 April 1874, and this portrait attached to his patient file (Fig. 8.1). Otherwise, there is little to set him apart from the many pellagrous insane who were admitted during the final decades of the nineteenth century. Pietro was a thirty-eight-year-old carpenter diagnosed with ‘intermittent hereditary mania’. According to his patient record, he was:

Admitted to the hospital in Vicenza several times with suicidal tendencies, threatening to kill his wife. He is the picture of sadness, always taciturn, tending to isolate himself from the other patients, hiding himself away in a corner. Interrogated, he struggles to reply and offers words of desperation. [Diagnosis:] Pellagra and a downturn of fortune, having gone from a rather comfortable condition to poverty.

Fig. 8.1

Pietro Bregolato’s patient file. San Servolo Servizi Metropolitani di Venezia

The asylum doctors described Pietro as ‘melancholy, with a suspecting look, taciturn’. This impression is borne out by the attached photo, which is more portrait—indeed it is almost a portrait of melancholia—than police-style mugshot. Pietro repeatedly asked why he was admitted, given that in his mind ‘he is healthy and can work to help his family’. Pietro would remain in San Servolo for 271 days, before perishing there from gastroenteritis.

Being photographed upon admission was about to become a standard part of the patient experience. And yet, as sources for the history of mental illness and its treatment, patient photographs have been underused. Katherine Rawling has described the fluidity, ambiguity and diversity of asylum photographic practices in the nineteenth century; the different ways in which ‘patient photographs were handled, displayed, cropped, and arranged on casebook pages’ (Rawling 2021, p. 259). Here, we explore this diversity and function in the context of the two Venetian asylums. At San Servolo and San Clemente, the patient photograph became a clinical tool, an integrated part of the patient’s case history as well as a means of identification. As such, the photographic record can help us restore patient agency to the asylum experience, by examining them as part of the patient-doctor encounter and the links with diagnosis and treatment.

The practice of photographing patients upon admission to San Servolo began with that institution’s perhaps most prestigious director, Father Prosdocimo Salerio. Director from 1857 till his death in 1877, Salerio was attentive to the scientific developments of his time and demonstrated a notable clinical and human sensitivity. This is evident not only in the patient files Salerio carefully redacted, in his miniscule hand, but in his early clinical use of photography. Salerio does not mention the practice in his reports, since the last of these dates from 1873, the year before the practice of photographing patients began. This fell to his successor, Dalmazio Battanoli, who wrote in his report for the years 1877–80:

The father pharmacist, in addition to carrying out his pharmaceutical obligations, continues with the photographic work initiated by the late Father Salerio, taking portraits of all the insane admitted to the asylum. This work is of great usefulness, for, in addition to reproducing the characteristic features of the different forms of insanity, it allows for helpful comparison between the appearance of the patient upon admission to the institution with that of when he leaves it, cured. (Battanoli 1881, p. 7)

In the first three years, the patient portraits are ‘stranded’ off to the side of the patient file. But from 1877, the pre-printed forms used for patient files contain a dedicated space for it, giving it pride of place top-centre, just under the patient’s name. Occasionally, a second photograph of the same patient might be attached, taken perhaps as he was about to be discharged—although this is not referred to in the case notes themselves.

San Servolo’s sister asylum, for women, located on the adjacent island of San Clemente, which opened its doors in July of 1873, did not begin attaching photographs to patient files until 1882. Perhaps this delay was due to the situation of overcrowding that accompanied San Clemente right from the start. The 1880s was also when photographing patients upon admission started to become standard practice in asylums in the UK (Rawling 2021). But it is also worth noting here that the two Venetian institutions were organised separately: San Servolo was run by the religious order of the Brothers Hospitallers of St John of God, known in Italy as the Fatebenfratelli, whilst San Clemente was a secular institution.

The director of San Clemente, Cesare Vigna—pupil of Salerio’s, musicologist and physician to the opera composer Giuseppe Verdi—made up for lost ground by hiring a professional photographer, Oreste Bertani, with a studio in Venice, to undertake the work. It is unusual to be able to give a name to an asylum photographer, but the superb records of San Clemente contain correspondence, contracts and invoices involving Bertani. In his report of 1882, Vigna recognised the ‘very great importance of having a photographic studio in the institution, to bring together all of the portraits of the insane with their nosological histories, and preserve them as quite instructive scientific documents’ (Vigna 1882, p. 67). Bertani’s patient photographs are full-fledged portraits: at once eloquent, emotive and intimate. Bertani continued photographing the female inmates of San Clemente until the end of Vigna’s term as director, in early 1891.

In addition to the individual portraits affixed to each patient file, the photographers at both institutions produced a series photographic albums: two for the male patients of San Servolo and five for the female patients of San Clemente. The albums are of two types: patient register, on the one hand, and comparative before-and-after shots, on the other. With regard to the former type, the ‘illustrated register album’ (‘Album delle presenze figurate’) for San Servolo contains 619 patient portraits, covering the period from 1874 to 1902. Under each portrait is the patient’s name and surname, as well as the date of admission (at least up to page 20), but no other information, such as diagnosis. Each page of the album consists of 25 portraits. It would seem that this album functioned strictly as a means of identifying patients. Included with it is an index of photos, listing the surnames of the patients in alphabetical order and date of admission, along with the outcome of their stay—either ‘discharged’ or ‘deceased’. The portraits are basic, taken against a neutral background, like identity card photos. At the same time, they are quite strong emotively, animated and enlivened by the intense and painful expressivity that emerges from the patients’ faces.

The first San Clemente album is labelled ‘Photographic portraits of the female insane’ (‘Ritratti fotografici delle dementi’). It consists of 1,578 patient portraits, women admitted between the opening of the asylum in 1873 and Bertani’s arrival as photographer in 1882 (Fig. 8.2). Bertani must have been busy in his first few months! There are twenty portraits per page, following one another in quick succession, with Bertani’s studio logo at the bottom of each page. The portraits depict vivid faces, intensely expressive; the tones and contrasts clear and well-defined. The second album covers the period 1883–85, and is organised more systematically, with a patient number (referring to the patient file) and outcome of stay (discharge or death) under each. The third, covering the years 1886–87, contains patient name and surname written by hand under each portrait, as well as patient number. The fourth album takes us to 1888–90, with an evident improvement in photographic technique and with patient name and surname added in print letters. The fifth and final album takes us to 1902 and no longer the work of Bertani—probably someone already employed at San Clemente in another capacity, as indeed was already the case at San Servolo.

Fig. 8.2

Oreste Bertani, album of ‘Photographic portraits of the female insane’, San Clemente, 1882. San Servolo Servizi Metropolitani di Venezia

The portraits contained in these albums are the same as those attached to the patient files. However, the final three albums often contain more than one photograph per patient. Where this was done, they are either different images taken at the same time, from which the most ‘useful’ or ‘representative’ was perhaps chosen for the patient file; or else they represent different stages of the patient’s treatment or stay—admission and (perhaps) discharge—even if the criteria used for inclusion in the album are unclear.

This latter possibility leads us to the more explicitly ‘comparative album’ produced at San Servolo. More curious, and possibly unique, it covers the period 1875 to 1887 and consists of side-by-side portraits of patients, one taken upon admission and the second upon discharge (Fig. 8.3). Along with the dates of admission and discharge under each pair of photographs, the patient’s diagnosis also appears—although the latter does not always correspond exactly to the diagnosis in the patient’s file. The photographs may not be up to the technical and aesthetic standards of Bertani’s at San Clemente, but they nonetheless possess an evocative power and a scientific and explicatory function that Bertani’s lack. There is also a curious attempt to improve on the patients’ appearance in the ‘after’ pictures. In addition to being well-groomed for the occasion, and occasionally smiling, they sport elegant jackets, head coverings, neckties and flowers. They are more evidently staged than the admission portraits. One wonders to what extent the patients were active participants in these latter photographs, in the knowledge that they were about to be discharged.

Fig. 8.3

The ‘Comparative album’, San Servolo, 1875–87. San Servolo Servizi Metropolitani di Venezia

What purpose could the ‘comparative album’ possibly have served? The album is painstakingly put together and expensively bound. The propaganda function seems clear; perhaps something to display to visiting dignitaries or medical colleagues. It served to bolster both the institution (San Servolo) and the profession (psychiatry). By means of these patient photographs, illustrating their passage through the asylum, it was possible to document the therapeutic efficacy of the institution and the knowledge that guided its actions. Nascent psychiatry was able to demonstrate its successes, gaining credit in the medico-scientific community. It helped it overcome its marginal status with respect to the other medical disciplines, and perhaps go some way to remedying the profound diagnostic limitations we discussed in Chapter 7. Venetian asylum doctors placed themselves squarely within the late nineteenth-century knowledge ideal rooted in practices of ‘visualisation’, based on their faith in the ‘objectivity’ of the image. This was considered a faithful reproduction of its object, analogous to the pictorial naturalism of the period (Mazzolini 2010). Photography, in the words of Oliver Wendell Holmes (1859), was ‘a mirror with memory’. It was synonymous with objective knowledge and linked to a fascination with the physiognomy, comparison and taxonomy of subjects, especially if considered deviant (Sekula 1986; Hargreaves and Hamilton 2001).

The patient photographs clearly performed an important function in the two Venetian asylums, one that went far beyond practical questions of identification. The century’s obsession with classification was accompanied by the use of statistical and mathematical tools, graphs and tables. The two asylums were part of this cultural climate. If follows that patient portraits may have helped clarify somatic identification, as in cases of pellagra or general paralysis. And yet, beyond the statements of principle made by Battanoli and Vigna as to the worth of patient photography, asylum doctors nowhere explicitly conceptualised a link between photographic evidence and broader questions of diagnostic categories, nosography or physiognomy. The patient portraits were clearly considered important, but it remains difficult to link them directly to the case histories and asylum experiences. Face and clinical history, portrait and existence, clearly resonate with one another, but the nature of this resonance remains unclear, at least for the asylum doctors.

The Patients: Origins, Curability and Treatment

Who were the pellagrous insane represented in these sometimes harrowing photographs? What can a patient typology tell us about the nature of the disease and how it compares to ‘regular’ or non-pellagrous insanity? In the rest of this chapter, we look at the patients admitted to our two Venetian asylums whose diagnosis was shaped by pellagra.

One of the most salient features of both pellagra and pellagrous insanity—noted by the earliest investigators—was the gendering of the affliction, in that they struck women more than men. The rigours of repeated child-bearing and nursing made women more vulnerable to the disease, exacerbated by the practice of feeding any available nourishing foods first to the labouring men of the family. When Santa Fabio, a 50-year-old peasant woman from Boara Polesine (Rovigo), was referred to San Clemente in 1887—for the third time in as many years—she had given birth to seventeen children, fourteen of whom had died in their first year of life.

Age was also a factor. Historians have found that the close links between mental ill-health and the domestic economy meant that people were more vulnerable at in certain stages in the family life cycle. This made adults with a young and growing family particularly susceptible and liable to be committed (Smith 2012). And in fact, the 21–50 age group accounted for 70% of admissions to our two Venetian hospitals amongst the ‘regular’ or non-pellagrous insane. However, when we consider only pellagrous patients, those aged 21–50 made up a slightly smaller percentage—60%. This was largely due to the higher number of elderly pellagrous insane admitted to the asylum. Pellagra itself could become chronic and so affect the elderly in high numbers, which was combined with the inability of poor families to look after the elderly insane.

The difference between the pellagrous and ‘regular’ insane is particularly evident when the patients are broken down according to occupation and geographical origin. Close to half of the regular insane men at San Servolo were artisans, shopkeepers, labourers and domestic servants (49%). To this, we can add a range of other occupations—businessmen, policemen, soldiers, public officials and teachers (12%)—and even the occasional landowner, professional and cleric. Just under a quarter of the regular insane were employed in agriculture (24%). When it came to the regular female insane at San Clemente, a fifth (21%) came from the ranks of artisans, shopkeepers, labourers and domestics; over a third were identified as housewives (37%); and just over a quarter as agricultural labourers (28%). In terms of their geographical origins, the regular insane tended to come from the city of Venice itself—50% of the men and 42% of the women. The rest came from the other six provinces of the Veneto, as well as further afield.

Pellagrous insanity overturned these proportions. Over three-quarters (77%) of the pellagrous insane were agricultural labourers of some sort, men and women. They were predominantly drawn from the rural poor: peasants, tenant farmers, field hands and day labourers. Many of the rest of the pellagrous men were identified as artisans, shopkeepers and labourers (19%), and many of the rest of the women as housewives (11%). The proportion of men reduced to begging for a living amongst the pellagrous insane (2%) was twice that of the regular insane. The patients’ geographical origins confirm the rural nature of pellagrous insanity: over four-fifths (83%) of the pellagrous insane were admitted from the six provinces of the Venetian Terraferma. The rest came from Venice and its province, with only a handful coming from outside the Veneto region. The high number of provincial pellagrins was made possible by the fact that the provincial authorities paid the costs of pauper patients and each province in the Veneto was allocated a different number of beds in the two asylums (Statuti 1873, pp. 17, 19). When these ‘provincial’ beds were unavailable, it was the patient’s municipality which had to bear the costs of hospitalisation, negotiated on a case-by-case basis.

For logistical reasons, and perhaps to save on costs, municipalities often sent their patients in consignments of two or more. For instance, on 3 June 1887 the Rovigo authorities sent husband-and-wife sufferers Rosa Davì and Pietro Azzolini together to Venice, she to San Clemente and he to San Servolo. Touchingly, Rosa’s morale was given a boost two months later, when she was told that her husband had been discharged fully cured (see ‘Interlude’).

The wretchedness of the low-lying town they both came from, Castel Bariano in the province of Rovigo, accounted for numerous asylum admissions. Not only did the province of Rovigo account for a percentage of admittances far in excess of its population, but patients from the province also had a slightly higher index of mortality in the two Venetian asylums (Gentilcore and Priani 2015). Happily, though, most emerged ‘cured’. All of this is illustrated by the following admission. A father and son from Castel Bariano were both sent to San Servolo in the same consignment in January 1882 (Figs. 8.4 and 8.5). Bortolo Basaglia, the father, was suffering from the usual ‘pellagrous mania’, and his case notes give a vivid idea of conditions in the town: ‘For around a year he has been suffering from pains to his head, chest and stomach. He staggers continuously so that he cannot be left alone’, and he had threatened both himself and others. Bortolo was described as ‘wretched’ (miserabile), weak and malnourished, with him and his family surviving entirely on maize polenta. Their dwelling was a damp hovel, located in a malarial area. Bortolo’s mother and father had both suffered from pellagra and his three sons (aged 23, 16 and 8) were all described as pellagrous: an indication of how pellagra could run in families. Indeed, one of the sons, 23-year-old Rocco, previously a victim of malaria, was being sent to San Servolo in the same consignment. Their dire poverty is clearly evident from their patient file photographs.

Fig. 8.4

Photograph of Bortolo Basaglia from his patient file. San Servolo Servizi Metropolitani di Venezia

Fig. 8.5

Photograph of Rocco Basaglia from his patient file. San Servolo Servizi Metropolitani di Venezia

Remarkably, both father and son were discharged from San Servolo, ‘cured’, after just three months’ stay. And this is another feature which differentiates the pellagrous insane from the general ranks of the insane: their curability. It has been noted how nineteenth-century psychiatry was a science of the mind via the body, where the body served as a means of gauging the alterations of the mind (Re 2014, p. 192). This physicality was particularly evident in the pellagrous insane, as we noted in the previous chapter. If patients’ conditions improved, they did so relatively quickly. The restorative diet offered by the two asylums was often enough to restore the physical and mental health of the pellagrous insane. Thus, Achille Menegatti, suffering from religious mania induced by pellagra, whose condition was so serious that the prefect of Rovigo requested his referral by telegram in 1878, was nevertheless calm and on his feet within weeks of his arrival at San Servolo.

Of course, this also was true of the insane in general, not just pellagrins. European asylums were far from being ‘a last-ditch repository for difficult, dangerous and unwanted members of society’; rather, poor families might use them as a form of short-term respite (Smith 2006, p. 111). For instance, most patients admitted to Santa Maria della Pietà in Rome spent less than a year there before being discharged, countering the commonplace ‘that saw in the mental patient an eternal inmate’ (Fiorino 2002, p. 94). Nonetheless, this pattern is even more pronounced in pellagrous insanity. At the time, the working definition of a ‘cure’ was that patients became physically healthy enough to return to work and social life, and no longer posed a danger to themselves or to others. The more humane approach offered by moral therapy perceived the asylum itself, with its particular physical space and social environment, as a source of this cure, even the cure itself. This was even more so in the case of pellagrous insanity, where the special habitat of the asylum differed so markedly from the wretched living conditions and poor diets that had caused the illness.

The result was that almost two-thirds (63%) of male pellagrous insane spent fewer than nine months in San Servolo—compared to 53% for the non-pellagrous insane. At the other end of the time scale, only one in ten pellagrous males became a chronic patient, staying for four years or more, compared to closer to one-fifth of the non-pellagrous (18%). As for women, they tended to remain in the asylum longer than men; but even so, female pellagrous spent slightly less time in the asylum than their non-pellagrous counterparts. Two-fifths (41%) of pellagrous women spent nine months or less in San Clemente, compared to over a third of non-pellagrous women (38%). Significantly more female than male pellagrous insane were chronic cases, a quarter of women spending four years or more in the asylum (25%). But it was even higher for non-pellagrous cases: almost a third (31%).

If the pellagrous insane were housed indiscriminately with the regular insane, as we saw at the start of this chapter, there was segregation of another sort, based on social status. This was a reflection of the world outside and was standard practice in European asylums. At San Clemente social distinction was structural, with the very poor (miserabili)—which would have meant most of the pellagrous insane—accommodated on the ground floor. The first floor was reserved for those who had fallen on hard times but whose social origins Vigna did not consider compatible with those of the peasants below. Finally, the second floor was reserved for the better off, complete with music room, wooden panelling and terrazzo floors (Willms 1993, p. 25). This was also reflected in the regular diet on offer. At San Servolo, there were three ‘classes’ of food served, according to the patient’s ability to pay (Salerio 1865, pp. 88–90). The pellagrous insane, as the poorest inmates, whose stay was paid for by the provincial authorities, had access only to the first or ‘general’ level of regimen—but this was often fortified as part of their therapeutic regimen.

Even so, it was probably a more substantial and varied diet than they had ever had in their lives. Despite this, the Australian Tucker judged the inmates of San Clemente ‘insufficiently nourished’, on the basis of their appearance (Tucker 1887, p. 1309).

Treating Pellagrous Insanity

If the asylum habitat and the better diet on offer were (quite rightly) considered part of the cure, what other forms of treatment were used? In the previous chapter, we explored attempts to understand the nature and causation of pellagrous insanity; how did this affect the way they treated the pellagrous insane? Cesare Lombroso—founder of the influential toxicozeist school of thought—dismissed the idea that diet alone could cure it. He relied instead on ‘a few medicinal substances, such as arsenious acid and above all like lead acetate, [which] can bring the most resistant pellagrous manias to a complete cure’ (Lombroso 1868, p. 137). And indeed asylums made abundant use of drugs in general practice, as we shall see further in Chapter 9. San Servolo was even recognised as a ‘pharmaceutical asylum’ because it was equipped with its own pharmacy and made extensive use of drugs, including trials on patients (Salerio 1865, p. 61).

In addition to diet and medicines, work was also regarded as therapeutic, dignified with the label of ergotherapy. This had its roots in Chiarugi’s more humane approach to the treatment of asylum inmates (referred to in Chapter 2). Just a few years after Chiarugi, the German doctor Johann Gaspar Spurzheim—better known to posterity as a controversial populariser of phrenology—would propound the idea that work constituted the most effective ‘moral cure’ of the insane. This was especially so when work was introduced gradually, by choice and by the emulation of other patients, rather than forced upon inmates (Spurzheim 1817). By the middle of the nineteenth century, this had become standard in Venice and elsewhere. In the form of agricultural production and a range of crafts, it was important not only in the asylum economy, but also served to focus the mind away from delirious thoughts. The bourgeois work ethic functioned in being able to lay down a norm or rule capable of overcoming the chaos of madness. When it came to the pellagrous insane, their ability and willingness to work and perform tasks was seen as something of a milestone: a sign that they had regained the ability to ‘function’ and were well on their way to discharge and integration back into their communities of origin.

At San Servolo, this labour consisted primarily of market gardening, which provided the institution’s vegetables, as well as a limited range of other trades (Salerio 1865; Tucker 1887). At San Clemente, it was on a larger scale. Its textile mills and spinning looms, intended to occupy between 500–600 women, were virtual factories. Ironically, this included making the straitjackets used in both asylums. Patients were also involved in needlework and lace-making, as well as activities linked to the running of the asylum itself, such as cooking, baking, laundry, gardening and animal husbandry (Vigna 1887, p. 60) (Fig. 8.6). Coercion was never far away: leather-covered fetters apparently hung in the laundry, to which patients would be shackled if they refused to work (Tucker 1887, p. 1307).

Fig. 8.6

The laundry room at San Clemente, c. 1880. San Servolo Servizi Metropolitani di Venezia

Both the willingness and ability to work were linked to cure and eventual discharge from the asylum. Institutional aims for the patient—restoration of health by therapy and diet and the return to work—met those of the patient and his or her family, who depended on the sufferer’s ability to work. Indeed, the demands of families ‘for certain types of care shaped the structure of institutions that were still developing’, as has been noted for late nineteenth-century Paris (Prestwich 1994, p. 809). If asylums functioned as part of a system of social control, patients and their families also knew how to make use of what public and charitable resources were available as part of a survival strategy (Fiorino 2002). The poor may have been wary of asylums but they broadly supported them. Given the often relatively quick discharge rates for pellagrous insanity, confining a family breadwinner—for what was hoped would be a short period of time—was an investment in the family’s future. That said, committal of a family member remained an extreme measure, a necessary expedient for families. This was especially so in the case of our two Venetian asylums, because of their greater distance from the patients’ homes and their hierarchical function as institutions for the more dangerous cases.

If the families of the pellagrous insane participated in the institutionalisation and discharge of patients, as has been found elsewhere in Europe, in the case of our two Venetian asylums this participation was rarely straightforward and was always mediated by various levels of officialdom. In the case of 26-year-old Maria Poloni, it was her father who desperately wanted her released from San Clemente. On 20 November 1882, the mayor of Maria’s hometown of Pedavena (in the province of Belluno) wrote to the asylum to inform them that Maria’s father Giobatta would be coming shortly to collect her, ‘even if the poor young girl is not perfectly cured’, because the family had made arrangements to emigrate to the United States, sailing on the ‘Frankfurt’ from Genoa on 5 December. But it was not so easy. From San Clemente, Dr Brunetta replied (21 November) that although Maria ‘is much improved, completely calm and laborious’, ‘one must bring to the father’s attention that exposing her, now that she is convalescing, to the discomforts of such a long voyage, is not wise’. The mayor was forced to plead (12 December), insisting that it was better to discharge Maria even though she was not fully cured, given the trouble and expense Giobatta was going to in order to come and collect her ‘and much less leave, abandoning her here alone where she has no relations who can take charge of her disease and care’.

Maria’s case reminds us that there was a close co-relation between pellagra and emigration, which both have their highest rates in the Veneto of the last quarter of the nineteenth century, as we saw in Chapter 1. Maria was finally discharged on 14 December. One can only wonder if she either made or survived the long and arduous ocean voyage, the conditions of travel in steerage being what they were (Molinari 2002). And even if she had managed to survive, would she have passed muster before the doctors at US immigration—even ten years before the opening of Ellis Island and the regular deportation of the diseased and the insane (Szejnert 2020, pp. 136–137; Birn 1997)?