Tens of Thousands Were Treated for a Deadly Disease While Confined to Psychiatric Hospitals on These Two Venetian Islands

Tens of Thousands Were Treated for a Deadly Disease While Confined to Psychiatric Hospitals on These Two Venetian Islands

In the 19th and 20th centuries, San Servolo and San Clemente housed patients suffering from pellagrous insanity, a condition caused by a vitamin deficiency

Venice, the capital of the northern Italian Veneto region, is arguably one of the world’s most famous island cities, entrancing visitors for centuries with its Gothic palazzos, romantic gondolas and colorful Carnival masks. In total, the city spans 118 islands in the Venetian Lagoon. While some, like Murano and Burano, are famed for their quaint streets and pastel-colored houses, the lagoon is also home to little-known isles that act as the silent custodians of the floating city’s more tragic history.

Two of these islands, San Servolo and San Clemente, are located a short ride south of St. Mark’s Square via vaporetto, the Venetian public water bus. Tucked almost entirely out of sight of the city center, they were once home to a pair of Italy’s largest and oldest psychiatric institutions. Both facilities treated patients for a variety of medical conditions, including epilepsy, alcoholism and mental illnesses, chief among them what was then known as pellagrous insanity—a symptom of the disease pellagra, which ravaged the region between the late 18th and early 20th centuries. The institutions are closely intertwined, and their histories provide invaluable insight into the way science, medicine and the human psyche were understood, diagnosed and treated in Italy at the time.

Veneto’s first psychiatric hospital

San Servolo, a rectangular island that extends across nearly 12 acres, was first settled by Benedictine monks in the seventh century. It remained a monastic settlement for the next millennium, until 1716, when the island’s buildings were repurposed into a military hospital staffed by a religious order that specialized in medical care. The first patient admitted for mental health treatment arrived in 1725, and over the course of the 18th century, the hospital started accepting other mentally ill patients from wealthy families who could afford to pay for their stay. But the majority of the population wasn’t so lucky.

“Those who were ‘mad’ and poor were sent to prison and considered to be criminals,” says Fiora Gaspari, head of the historical archive of San Servolo.

When San Servolo’s hospital opened, Venice was a republic—in fact, one of the world’s longest-lived. But the Republic of Venice fell to Napoleon Bonaparte in 1797, ushering in a new government that promoted egalitarianism and established legal equality for all citizens. While this equality was limited in many ways, it did provide for poor, mentally ill patients to be sent to San Servolo and treated at the expense of the state. Between 1797 and 1808, both rich and poor mentally ill patients, as well as the military, lived together on the island. By 1809, however, the military hospital had closed, with a psychiatric hospital for the provinces of Veneto, Dalmatia and Tyrol taking its place. The facility is “the oldest of its kind in northern Italy and among the oldest in the country,” says Gaspari, predating an uptick in such institutions during the mid- to late 19th century, when pellagra spread rapidly across Italy.

How pellagra ravaged northern Italy

Pellagra is a severe systemic disease caused by a deficiency of vitamin B3, or niacin. Northern Italy’s rural population suffered greatly from pellagra, as residents had a diet mainly composed of polenta, a dish made from boiled cornmeal that was cheap and filling but lacking in essential vitamins.

The symptoms of the disease manifested in stages known as the four d’s: dermatitis, diarrhea, dementia and death. First, the patient developed rashes and skin lesions, followed by persistent gastrointestinal problems. Then came an attack on the nervous system (referred to at the time as pellagrous insanity), which manifested as depression, dementia, and violence toward others and oneself. As a doctor at San Servolo wrote upon admitting a 35-year-old peasant named Santo Francescetto in 1857, “He says he is so melancholic and does not know the reason why, but that he feels in himself something extra-natural which keeps him in that state.” Finally, in the worst cases, pellagra could result in death.

In 1879, Italy recorded nearly 100,000 pellagrins, as patients were called. Of these, more than one-third were found in Veneto, write David Gentilcore and Egidio Priani in Pellagra and Pellagrous Insanity During the Long 19th Century. The region was a hotbed for the disease, with almost half of all deaths in Italy due to pellagra at the end of the 19th century occurring in Veneto.

Individuals between the working ages of 25 and 50 were the main group affected by pellagra, but it was women who suffered the most, says Priani, a clinical psychologist and researcher at the University of Leicester in England. “The level of impoverishment in women was even greater than in men,” he explains. “That’s because aside from also laboring alongside men in the fields, they had the added duty of taking care of the house and birthing children, which was taxing on the body.” This constant strain, exacerbated by chronic malnutrition and repeated pregnancies, weakened women and made them more susceptible to the disease.

In response to the growing number of pellagra cases among women, an institution exclusively dedicated to female patients opened in 1873 on the Venetian island of San Clemente, about a mile southwest of San Servolo, which transitioned to treating only men. Almost immediately, the new facility was overwhelmed: Between the year of its founding and 1887, 44 percent of the women admitted into San Clemente were pellagrous.

As more and more pellagrins were sent to the islands, overcrowding became a severe issue at both institutions, and they often housed double their capacity. By 1887, the number of patients each asylum doctor at San Clemente was responsible for had ballooned to 332, up from 138 in the mid-1870s. “Overcrowding naturally resulted in degeneration and mistreatment of the patients,” Priani says.

For the entirety of the 19th century, these island institutions “became the last resort for people who couldn’t be managed or cared for by regular hospitals,” says Gaspari. Pellagrous patients were brought to Venice by their provincial authorities, then shuttled to their respective institutions via boat or gondola. The majority of the afflicted peasants were used to rural farmland and had never seen a city or a body of water as large as the Venetian Lagoon before. This separation from mainland Italy triggered such severe anxiety and desperation that some patients attempted to escape or drown themselves, according to the Italian Encyclopedia.

Life at the San Clemente and San Servolo institutions

New arrivals to San Clemente and San Servolo were washed, combed and dressed in a standard asylum uniform. They then underwent a medical examination and temporary confinement for observation and official diagnosis. Beginning in 1874, patients were photographed upon admission and release. Staff placed these portraits in albums, which were organized into columns of “sick” versus “cured,” with captions noting the patient’s name, diagnosis, and the dates they entered and left the facility. While the photographs had a scientific purpose—namely, chronicling the progression and treatment of a disease—they were also used as advertisements for the benefits of being treated at the institutions, Gaspari says.

Some patients at San Servolo could eat alone in the refectory and go for walks unsupervised, while others needed constant surveillance and were not allowed any degree of autonomy, such as using utensils on their own, Gaspari explains. A small percentage of families could afford to pay for better living conditions, including housing in a separate area with access to better food and single or double rooms rather than dormitories. While San Servolo was first and foremost a psychiatric hospital for the poor who were treated at the state’s expense, “there was still a classist presence within these institutions,” says Priani.

Although many psychiatric hospitals of the era were custodial facilities where patients could be locked away for life, San Servolo and San Clemente were more often transitional. Institutionalized pellagrins ate a more balanced diet during their stay and could see their symptoms improve within a few months to a year. In some cases, however, pellagra proved to be a recurrent disease, flaring up again once patients returned home and resumed their polenta-heavy diet. It wasn’t uncommon, therefore, for patients to be admitted to San Servolo and San Clemente multiple times over many years.

One of the key indicators that a patient was ready to be released was their ability to work and contribute to the island’s upkeep. At San Servolo, this mainly involved gardening. At San Clemente, a much bigger operation tasked the women with lace-making, laundering, cooking and sewing the straitjackets that were used at both institutions.

Upon release, the stigma of institutionalization followed patients and made it difficult for them to resume a normal life. “They were labeled as former inmates,” Priani says. “This was considered by many to be a mark of shame,” creating a culture of silence and erasure that persists into the present. Over the past 20 years, Gaspari explains, visitors to San Servolo have often asked to view the clinical files of their admitted family members and ancestors. “They know that there was a family member who was sent away [to an institution], but they weren’t allowed to talk about it,” she says. “Now, they’re trying to reconstruct their family history.”

A radical national psychiatry movement

Conditions at the institutions fluctuated based on the era and its directors. Between 1857 and 1877, San Servolo was under the direction of Prosdocimo Salerio, who is widely regarded as the institution’s most prestigious director due to his attention “to the scientific developments of his time and … notable clinical and human sensitivity,” according to Pellagra and Pellagrous Insanity.

“There was an approach to the patient that was more humane, almost missionary,” during Salerio’s tenure, Gaspari says. Patients were encouraged to take walks, listen to religious music and visit with their family members. The archivist adds, “There was also less of a focus on using pharmaceuticals and physical restraints.”

Conditions were vastly different at San Clemente. “I never heard more noise in any asylum,” wrote the Australian doctor George Tucker after he visited the institution in 1884. “Fifty women were fastened in various ways—straps, jackets, hobbles, etc.—their feet being blue with cold.”

Nearly a century later, in the early 1970s, more than 100,000 people were institutionalized in psychiatric hospitals across Italy, often under inhumane conditions. It wasn’t uncommon for patients to be tied to their beds; confined in isolation cells; and subjected to aggressive treatments like electroconvulsive therapy and hydrotherapy, which uses showers and baths to calm manic patients.

By August 1978, however, San Servolo and many of its counterparts nationwide had shuttered on the heels of the passage of Law 180. (San Clemente only closed in 1992.) Known commonly as the “Basaglia Law,” after psychiatrist Franco Basaglia, who in many ways spearheaded the national movement to democratize psychiatry, the legislation advocated for the closure of psychiatric hospitals. It rejected the concept of institutionalization while promoting public mental health services and care that relied upon community. The timing of the shift paralleled a global push for deinstitutionalization, but Italy took it further in many ways, becoming the first country in the world to abolish its asylum system.

Today, the island of San Servolo has a new lease on life. It boasts a small university campus; a venue for hosting private parties, weddings and conferences; and a residential center for tourists. The island also houses a museum opened in 2006 to reconstruct the history of the psychiatric hospital. Equipment such as books, straitjackets, restraint chains and hydrotherapy machines, as well as seven photo albums (two from San Servolo and five from San Clemente), are all on display. San Clemente, meanwhile, was abandoned for several years after its closure but is now privately owned and home to a five-star luxury resort.

The 200-year history of Italy’s psychiatric hospitals is a rich tapestry that illuminates how the human psyche was understood in the country between the 18th and 20th centuries. San Servolo and San Clemente crystallize the most salient bits of this history, including the destructive spread of pellagra; the stigmatization that came with being admitted to and released from an institution; and the radical deinstitutionalization movement that changed the Italian public’s understanding of mental health. These are not distant, intangible concepts, nor unreachable ruins. Rather, they’re just a boat ride away from one of the world’s most famous cities.

Between Walls and Horizons - San Servolo: The Venetian Asylum