Abstract
This was the first paper by the Italian alienist Eugenio Tanzi (1856–1934). It surveyed existing works and provided an analysis of clinical categories such as monomania, sensory madness, moral insanity, Wahnsinn, Verrücktheit and systematized delusions, which had been used in France, Germany, Britain and Italy since the early nineteenth century to deal with paranoia. As pointed out by Tanzi, discrepancies and discontinuities in diagnostic concepts affected both psychiatric nosology and practice. Paranoia (from the Greek παρά and νοια) made for greater clarity in psychiatric terminology, and denoted a broad category, including both acute and chronic delusional states which were considered to be distinct from mania and melancholia, and usually not to lead to mental deterioration.
Introduction
Eugenio Tanzi was born on 26 January 1856 into a family of Italian irredentists in Trieste, which at that time was part of the Austro-Hungarian Empire. After studying medicine at the Universities of Graz and Padua, graduating in 1880, he was forbidden to practise medicine in Trieste, for political reasons (Lugaro, 1934; Zalla, 1934). In 1883, Tanzi went to Reggio Emilia, where he trained under Augusto Tamburini at the Asylum San Lazzaro. He continued his career at the Psychiatric Clinic of Genoa, subsequently moving to Turin to work under Enrico Morselli, and then following him back to Genoa.
In 1891, Tanzi worked in the laboratory of the physiologist Luigi Luciani, and became Professor of Psychiatry at the University of Cagliari in 1893, then professor at Palermo and Modena, before joining Florence University in 1895, where he held the chair of Psychiatry until his retirement. Tanzi was also appointed Superintendent of the Florentine Asylum of San Salvi, which he helped to develop into a renowned institution, and where he had as assistants Enzo Lugaro, Vito Maria Buscaino and Mario Zalla. Jelliffe (1934) visited Tanzi’s clinic and remarked that ‘the younger psychiatrists flocked to Florence in a manner comparable to the migration to Kraepelin at Munich’.
Tanzi was a leading figure in Italian psychiatry and an early proponent of Kraepelin’s scientific method (Lugaro, 1916). His textbook of mental diseases first appeared in 1905; it was translated into English in 1909 (Percy Smith, 1910), and complemented by the publication of Psichiatria Forense in 1912. Lugaro assisted in the second and third editions of the textbook. Tanzi was also the co-founder, with Morselli, of the psychiatric journal Rivista di Patologia Nervosa e Mentale in 1896.
Tanzi’s main interests were in clinical psychiatry, as attested by a number of important contributions on the association of ideas (Tanzi, 1888), hallucinations (1901), hypnotism (1887), paranoid states (Tanzi and Riva, 1886), experimental brain atrophy (1893), and the 1904 Mental Asylum Law Reform (1903). He is also known to have influenced modern thinking about synaptic plasticity and memory (Boeri, Peccarisi and Salmaggi, 1994; Sotelo, 2003). Drawing on Ramón y Cajal’s neuron theory, Tanzi (1893) claimed that recurrent stimuli bring about changes in neural junctions and facilitate transmission, a view later supported by Sherrington’s description of synapse.
Furthermore, Tanzi rejected Lombroso’s (1876) theory of ‘moral insanity’ and developed the nosological concept of ‘constitutional immorality’, subsuming the varied clinical forms of intellectual feebleness, which he considered to be secondary to infantile cerebral palsy and epilepsy (Lugaro, 1916). At the 1929 London meeting of the Royal Medico-Psychological Society, Tanzi was elected Honorary Member along with the Nobel Laureates Charles Sherrington and Ivan Pavlov.
Tanzi died at Salò on Lake Garda on 18 January 1934. 1
The Classic Text
‘Paranoia and its historical development’ (1884) was Tanzi’s first published paper, and it reveals his broad erudition, original thinking and critical acumen (Lugaro, 1934). The main questions it addresses are: whether paranoia constitutes a primary delusional disorder or is secondary to other conditions; and how the diagnostic concepts used in different psychiatric traditions since the early nineteenth century to deal with paranoia have affected psychiatric nosology and practice. Tanzi noted that, while British and Italian psychiatry had long revolved around Esquirol’s (1838) monomania and secondary systematized delusions, in France Morel (1860) dismantled the concept of partial insanity and placed paranoia among the degenerative states. The same happened with Griesinger’s (1845) partielle Verrücktheit in Germany, where Snell (1865) described Wahnsinn (primäre Verrücktheit) as a category distinct from mania and melancholia. Mendel (1883) later used the term ‘paranoia’, borrowed from Heinroth (1818), to designate both acute and longer-lasting delusional states seldom leading to mental deterioration; so did Kahlbaum (1878), Meynert (1881) and Kraepelin (1883). Although Tanzi’s account inevitably left several questions unanswered, its value extended beyond its historical contribution, and paved the way for the empirical studies on delusional states which he conducted with Gaetano Riva at the Asylum San Lazzaro in Reggio Emilia (Tanzi and Riva, 1886), and have established themselves as classic works in Italian psychiatry (Del Pistoia, 2002).
Tanzi’s paper was written in a rather complicated style, typical of the period, which does not lend itself easily to rendition in modern academic English. What follows is, therefore, sometimes in the form of a simplified paraphrase.