Asylums

In the archive of this city’s Council we found a reference to a request made by the Funchal Senate (senado, the municipal council) in 1493 for the construction of a Tronco, the name then given to the house intended for the detention of the insane. We believe that this request was not granted by the government in mainland Portugal or by the grand mastership of the Order of Christ (Ordem de Cristo). We do not know where the unfortunates afflicted by mental illness, particularly the poor and destitute, might have been confined, if indeed a house specially devoted to that humane purpose ever existed.

The regulations (regimento) of this city’s Civil Hospital (Hospital Civil), drawn up in 1816, were an excellent piece of work for their time and extremely thorough, at times descending into unnecessary detail. Yet they make no reference at all to the hospitalisation or detention of the insane, which leads us to suppose that such people were not then admitted there. The same is true of the regulations of 1834. It is only in the Regulation of 1844 that we first find an express provision for ‘some secure rooms for the insane, which must be separate from the other wards...’. Until the Câmara Pestana Asylum (Manicómio Câmara Pestana) was built, the poor insane were kept in some outbuildings of the hospital, and the inhumanity with which the hospital’s nurses and servants treated them became proverbial here.

Councillor (conselheiro, honorary title of the royal council) José Silvestre Ribeiro, who as head of the administration of this district sought to meet every public need, wrote to the Administrative Committee (Comissão Administrativa) of the Holy House of Mercy (Santa Casa da Misericórdia). He set out the reasons in favour of building a suitable edifice for the hospitalisation of the insane and promised his full support for this important improvement. The founding of an asylum went the same way as the removal of the old gaol and the construction of the quay, the Pontinha (‘little point’) mole, the theatre and the fruit and vegetable market: they were stock subjects of the local press, especially at election time or when a shortage of news led the journalist to brew Tolentino’s tea once again.

What had long been regarded as an important improvement to be made, however, became the answer to a pressing and urgent need. The proportion of people afflicted by mental illness grew alarming, above all for the reasons we briefly set out in the article Agricultural Board (Junta Agrícola), where we spoke of the need to curb alcoholism by the strictest restriction of the production of spirit (aguardente, distilled from sugar cane or wine). The press intensified its campaign in view of the well-founded refusal to admit the insane to our hospital, the repugnant crowding of these wretches in the foul cells of the police station, and the large number of them wandering the streets and roads. The public then felt a deep compassion for this human misery and, at the same time, a general indignation at the criminal neglect to which the authorities abandoned the insane who were poor and lacked the means to be placed in suitable nursing homes. Madeira contributed to the official hospitalisation of the insane, but the Rilhafoles asylum refused to admit patients sent from this island, no doubt for lack of the necessary accommodation. A distinguished alienist who passed through this city vigorously condemned the distressing situation of the poor insane, and so brought into sharper relief the need to found a hospital to house those deprived of the light of reason.

A committee was then formed to put this altruistic and humane idea into practice. It began its work at once, and its efforts were crowned with complete success. Dr António Jardim de Oliveira was one of the first here to suggest the idea and became one of its most strenuous advocates. An asylum in Madeira is today a happy reality. Although this establishment does not fully serve its purpose, above all for want of more spacious accommodation and better nursing, it is without doubt a hospital that is rendering most valuable services and has met one of the most urgent and pressing needs felt among us. (1921)

When Dr Luís da Câmara Pestana died in Lisbon on 15 November 1899, the idea immediately arose, both on this island and among the Madeiran community in the capital, of raising a monument in Funchal to perpetuate the memory of the distinguished bacteriologist and illustrious son of this land. It was the Ateneu Comercial, a society that ceased to exist long ago, that took the initiative here in Madeira to realise this idea. It delegated to its honorary members the Viscount of Cacongo, Luís de Freitas Branco, Henrique Vieira de Castro, António Rodrigues Leitão and Nicásio de Azevedo Ramos full powers to ensure that the tribute to the eminent man of science became, without delay, a deserved and tangible reality.

These gentlemen formed themselves into a committee, with the first as chairman and the last as secretary, and the Viscount of Cacongo proposed founding an establishment for the hospitalisation of the insane. This would also serve as the monument to Dr Câmara Pestana and would bear the name of our illustrious fellow countryman. Another committee was joined to this one: it had been organised in this city to collect donations for the flood victims of the Azores and was made up of Dr António Jardim de Oliveira, the Count of Ribeiro Real, Dr João Augusto Teixeira and Canon Manuel Correia de Figueiredo. That committee held about two contos, and this sum became the nucleus or fund of the Câmara Pestana Asylum committee.

The committee worked with great zeal and ardour, but the Madeirans failed to respond to its diligent efforts. A public subscription raised only about eight contos de réis (conto: one million réis), a sum far from sufficient for the undertaking, not only for constructing the building and installing the hospital but above all for running the establishment properly, even though only a small number of patients were to be admitted. Various proposals were put forward for the site of the hospital building, with particular preference for the convent grounds of the former Convento da Encarnação (Convent of the Incarnation). Despite the efforts made, however, the central government could not be persuaded to cede a plot of land for the construction. Housing it in part of the Hospital dos Lázaros (lepers' hospital) was also suggested, and one of the outbuildings of the Misericórdia building was likewise considered, but it was later recognised that these premises were unsuitable for properly accommodating an asylum, even if the indispensable and costly adaptation works were carried out. In the end, after hearing the opinions of the health authorities, the committee resolved to acquire the Quinta do Rochedo (‘crag estate’), in the parish (freguesia) of São Gonçalo (‘St Gonçalo’). The purchase was completed on 28 March 1904 for the sum of five contos.

Shortly afterwards the committee offered the building, together with some donations it still held, to the District General Council (Junta Geral do Distrito). It did so not only because it was unable to meet the cost of maintaining the hospital, but also because that administrative body was responsible for the hospitalisation of the insane under the decree of 10 October 1902. The General Council accepted the grant with thanks, and this decision was confirmed by the central government on 10 May 1904. Doubts and some difficulties arose over the handover of the building at the Quinta do Rochedo because of the conditions imposed by the donor committee, and the final transfer took place only in 1907; in the meantime, however, the Council kept the hospital running normally.

Within the grounds of the Quinta do Rochedo, the founding committee had a pavilion built to house the patients and adapted the residence of the quinta (country estate) for the same purpose. There it set up the hospital, which it supported and maintained for some time.

The public subscription reached about ten contos and five hundred thousand réis (old Portuguese money of account; 1$000 = 1,000 réis, 1:000$000 = one conto = 1,000,000 réis), including the accumulated interest, the two contos from the flood-relief committee and a legacy of one thousand five hundred escudos (Portuguese currency from 1911, = 1,000 réis) from Dona Júlia Maria Torres da Costa. The benevolent committee applied these sums as follows: purchase of the quinta and the related tax, 5,656,000 réis; construction of the first pavilion, 3,393.00 escudos; linen and furniture, 627.00 escudos; and acquisition of the bust of Dr Câmara Pestana, 402.00 escudos.

The opening of the new hospital was a particularly solemn occasion, and the bronze bust of our illustrious and ill-fated compatriot was unveiled at the same time. Its base bears the following inscription: ‘This Asylum was founded by public subscription and is dedicated to the memory of the illustrious Madeiran bacteriologist Dr Luís da Câmara Pestana.’

The committee that took the initiative in founding this hospital consisted of the Viscount of Cacongo, Dr António Jardim de Oliveira, Henrique Vieira de Castro, Nicásio de Azevedo Ramos, the Count of Ribeiro Real, Canon Manuel Correia de Figueiredo, Dr João Augusto Teixeira, M. Nascimento de Ornelas, Sabino Joaquim Rodrigues and António Rodrigues Leitão. Justice and truth require us to state here that the Viscount of Cacongo, Henrique Vieira de Castro and Nicásio de Azevedo Ramos – respectively chairman, treasurer and secretary – were the members of the committee who showed the greatest zeal and dedication in bringing so altruistic and humanitarian an idea to fruition.

In 1908 the General Council bought some land adjoining the quinta, belonging to Captain Cândido Gomes, and in 1913 had a new pavilion built on it. The growing number of insane patients led the Council to build a third pavilion in 1915.

The Asylum was opened on 4 April 1906, and in the following May the physician-surgeons José Joaquim Mendes and João José Maria de Oliveira were appointed acting director and acting chief nurse, respectively, of the new hospital. Its present permanent director (1921) is Dr João Francisco de Almada, who took up the post in July 1907. The Regulations of the Câmara Pestana Asylum were drawn up by a committee delegated by the General Council and received the Council’s full approval at its ordinary session of November 1906.

At the end of December 1919 and 1920 there were 54 and 54 insane patients, respectively, in the asylum, and the expenditure on the patients’ upkeep in 1920 was 28,627.00 escudos.

On 21 May 1924, 38 male patients who were in the Câmara Pestana Asylum were moved to the Trapiche Nursing Home, established at the beginning of that year by the benevolent Brothers of St John of God. The female patients remained at the Câmara Pestana asylum, and their care was entrusted to a religious order.

From what has been said, it can be seen that from 1924 onwards the hospital services for the mentally ill underwent a remarkable transformation. This was not only because the male patients were housed in the Trapiche Nursing Home, leaving the building of the Câmara Pestana Asylum reserved solely for female patients, but also because of the great improvement in the treatment of the inmates. In both establishments this treatment became truly exemplary, and it need fear no comparison with similar institutions in our country.

From the book Paróquia de Santo António da Ilha da Madeira, some pages will now be extracted on the history and running of the Casa de Saúde de São João de Deus, established at the locality of Trapiche.

The idea of setting up a hospital for the insane in the houses at Trapiche predates the founding of the Câmara Pestana Asylum. It came from the diocesan bishop, Dom Manuel Agostinho Barreto, who made the most diligent and persistent efforts to bring it about. He persuaded the owner to cede the quinta (country estate) intended for that purpose and pressed the Brothers of São João de Deus to take charge of the asylum that was to be founded. His efforts were not successful at the time, for serious difficulties arose that could not be overcome. It should be clearly stressed that he ardently wished to endow this archipelago with a model hospital for the insane, and worked towards that end with the greatest dedication and enthusiasm. This is one more title of glory adding lustre to his eminent qualities as a benefactor and apostolic prelate.

The Câmara Pestana Asylum was created in 1906, and Dom Manuel Barreto still considered the founding of the Trapiche institution necessary, foreseeing that in the near future this further hospital would become absolutely indispensable. Around that time, and perhaps even earlier, some Brothers of São João de Deus, who had come to Madeira more than once to collect alms for the hospitals they maintained on the mainland, recognised how useful and fruitful their work could be on this island. They had in mind the considerable number of patients who needed to be admitted under the conditions required by science and in keeping with the precepts of true Christian charity.

Around 1920 there was talk of handing the management of the Câmara Pestana Asylum over to the Brothers of São João de Deus, which caused a great outcry in the press and at the sessions of the District General Council (Junta Geral). Meanwhile, the old idea of founding the hospital at Trapiche was taking shape. The diocesan prelate, Dom António Manuel Pereira Ribeiro, gave it his most unconditional support, and the dedication and selflessness of Dr João Francisco de Almada, combined with the well-directed efforts of some Brothers of São João de Deus, did the rest. The work would soon be a tangible reality. At the beginning of June 1922 the Brothers of São João de Deus occupied the houses of the Trapiche quinta. The installation was more than rudimentary, with difficulties arising on every side and putting the poor brothers’ spirit of self-denial and sacrifice to a severe test. They did not lack courage, and at once took in a few patients from this parish (freguesia), none of them insane. Their crusade of good works had begun.

The first patients deprived of reason were not admitted there until October 1923. The period between those two dates was devoted chiefly to collecting alms in various parts of the island and to acquiring the means indispensable for adapting the building to its new purpose. A considerable part of the manor house was in an advanced state of ruin, and it was moreover difficult to fit it out so that people suffering from mental disturbances could be housed there in safety. The brothers therefore had to struggle with great labour and sacrifice to prepare the building properly and make it fit to receive the first patients. Their number grew, and the notable and never surpassed services that the new institution was rendering were recognised from the outset.

In May 1924 the question of transferring the insane from the Câmara Pestana Asylum to the Trapiche Nursing Home was raised in the General Council. Within that body attention was drawn not only to the inadequate nursing, the cramped premises and the brutal and inhuman treatment given to the patients, but also to scandals of every kind occurring inside that ‘Bastille’, as the asylum at the Quinta do Rochedo was then called. The transfer of the patients to the Trapiche hospital had become absolutely imperative. The chief champion of this idea was Dr Domingos Réis Costa. Supported by the president of the General Council, Dr Vasco Gonçalves Marques, and by other members, he advocated with the greatest enthusiasm, both at the sessions of this administrative body and in the local press, the immediate admission of the asylum’s patients to the Casa de Saúde of the Brothers of São João de Deus. The transfer took place on 21 May 1924, when 38 male insane patients were moved from the Quinta do Rochedo to the Trapiche quinta. A great work of humanity had been accomplished.

The solemn inauguration of this asylum took place in August 1924, attended by the illustrious diocesan prelate, the provincial of the Order of São João de Deus and other persons of social standing.

For the legal maintenance of the Trapiche Nursing Home an association was formed, its statutes approved by the competent authority, named the ‘Associação dos Irmãos de São João de Deus’. From the founding of the hospital until 1928 its director was a member of the Order, Manuel Maria Gonçalves. Despite his simple manner, unaffected modesty and precarious health, he managed to guide and complete that work, which is a model institution of the purest charity towards the sick and, at the same time, a Calvary of the most heroic virtues on the part of its benevolent and unsurpassed nurses.

The valuable services rendered by the new home for the insane aroused lively enthusiasm everywhere. Alms and donations began to arrive, brought by what were called romagens, or pilgrimages. Very large groups of people of every age, sex and condition formed great processions, which went to lay their offerings of money, foodstuffs and household articles of every kind in the hands of those in charge. These pilgrimages began in this parish (freguesia) and continued here for a long time. Especially worthy of mention were those from the localities of Casas Próximas, Madalena, Preces, Três Paus and Boliqueme, which formed long and attractively picturesque processions in which the spirit of charity was admirably combined with the most interesting and typical originality. Other parishes also took the initiative of organising similar pilgrimages on an even grander scale, among which those of Monte, São Roque, Câmara de Lobos and Estreito stood out.

Of the many important improvements carried out by the Brothers of St John of God, special mention must be made of the motor road, which put the house at Trapiche in quick and direct communication with the locality of Boliqueme and therefore with the city; the connection of the house to the general telephone network; the piping of water; and the preparatory works for building new pavilions. This is without counting the adaptation of the old buildings to house the hospital, as we have already mentioned above.

The number of patients in this hospital since its foundation, as at 31 December of each year, has been as follows:

Year	Date	Patients
1923	on 31 December there were	2
1924	on 31 December there were	59
1925	on 31 December there were	79
1926	on 31 December there were	87
1927	on 31 December there were	88
1928	on 31 December there were	104

Like all similar institutions, this nursing home has a special religious service, directed by the establishment’s own chaplain. Although their religious work is intended mainly for the patients and the community that works there, the priests of the Brothers of St John of God have taken part in the various acts of worship held in this parish, proving the most excellent and selfless helpers of the parish priests. In their chapel they readily administer the sacraments to the faithful who seek them; they attend the sick in their homes with spiritual comfort, accompany the dead to their last resting place and perform in the Igreja Paroquial every service asked of them. The first chaplain was Father José Maria Antunes, who served there from February 1923 to July 1925. In August of the same year he was replaced by Father Lázaro Ribeiro, who is the present chaplain (1928).

The history of this model nursing home, from its foundation to the present day, apart from the ever-growing number of its inmates and the material improvements gradually introduced there, consists simply in this very plain thing, yet admirably beautiful and admirably holy too: always the same spirit of courage, self-denial and sacrifice on the part of the tireless nurses; always the most attentive and affectionate treatment of the patients; always the most devoted care for their material well-being. And this, likewise always, without weakness, without faltering, without discouragement, despite the difficulties, setbacks and struggles that must be faced from time to time.

The data and information transcribed above go no further than 1928. However, the progress made at that mental hospital in recent years is highly significant and deserves special record, and we shall give a brief account of it here.

Among other improvements, two large pavilions were built to house the patients, together with a spacious chapel, a residence for the staff and a dairy.

The two pavilions, that of São José for calm patients and that of São João de Deus for agitated patients, contain spacious dining rooms, recreation and games rooms, bathrooms, dormitories, private rooms, etc. Everything conforms to the rules of hygiene and to the latest findings of psychiatric science. Beside the pavilions are courtyards for the patients’ recreation, artistically laid out as gardens and planted with shade trees, from which there is a fine view over the city and much of its surroundings.

The treatment of the patients is constantly improving. Madeirans can be proud that they now have a house where our mentally ill enjoy both loving care and Christian charity and the latest requirements of psychiatry.

Anyone who ever visited the old Câmara Pestana Asylum, with its strict regime of surveillance, repressive measures and isolation, will be astonished at the life of this house, once thought impossible and unattainable.

Many patients live as if they were in good health. They no longer spend twenty, thirty or more years in a life of repression. Many work in the shoemaking, carpentry and locksmithing workshops, on the various building and repair works on the premises, in cultivating the kitchen garden and in looking after the domestic animals, such as cows, goats, pigs, rabbits and hens. It is they who clean the refectories and dormitories. The planting of the courtyards and gardens of the establishment is in their care. And everything is done as perfectly as if it were the work of people in excellent health.

In this way the worthy brethren of São João de Deus manage to occupy several hundred men who would otherwise be the cause of their own distress.

In addition, the distinguished psychiatrist Aníbal Augusto Faria and the eminent physician Dr William Clode visit the patients three times a week and apply the latest findings of psychiatric science, such as electroshock, etc.

The body known as the ‘Associação dos Irmãos de São João de Deus’, set up to provide for the legal maintenance of this mental hospital, ceased to exist in 1940. In that year the ‘Ordem Hospitalária de São João de Deus’ was granted legal personality under the Concordat concluded between the Holy See and Portugal. The house continued to be maintained by the District General Council (Junta Geral) of this district.

The number of patients at the ‘Casa de São João de Deus’ at the Trapiche over the last fifteen years was as follows:

Year	Number of patients
1929	118
1930	122
1931	143
1932	152
1933	162
1934	167
1935	175
1936	168
1937	180
1938	186
1939	189
1940	194
1941	215
1942	238
1943	239

These figures give the exact number of patients in the hospital on 31 December of each of the years listed.

Religious services, for the private use of the community and of those patients able and willing to attend, were held in the old chapel of the quinta (country estate) and then took place in rooms in one of the ‘pavilions’ until 1936. In that year the new church was inaugurated, dedicated to the holy founder of the worthy hospitaller order of São João de Deus. Although it is intended principally for the purpose stated above, it gives the inhabitants of that village (lugar, settlement rank below a town) and the surrounding localities the most valuable services in every form of religious care.

The period from 1906, the year the ‘Manicómio Câmara Pestana’ was founded, to 1924, when it came to be reserved solely for the treatment of female patients and all the male patients were transferred to the Trapiche Nursing Home, has already been described at length in the opening columns of this article on ‘Asylums’.

A year later, that is, from 9 May 1925, the ‘Manicómio Câmara Pestana’, in the parish of São Gonçalo, was placed under the management of the Hospitaller Sisters of the Sacred Heart of Jesus. To the present day they have carried out their demanding and arduous hospital work there with the greatest zeal, the purest devotion and the most accomplished skill. To the performance of these services we apply, without reservation, what we said above about the way in which they have been carried out at the ‘Casa de São João de Deus’ at the Trapiche, in the parish of Santo António.

The activity of the ‘Casa de Saúde Câmara Pestana’, devoted exclusively to the treatment of women, is clearly shown by the number of patients present there on 31 December of each of the following years:

Year	Number of patients
1926	64
1927	67
1928	77
1929	105
1930	117
1931	135
1932	153
1933	169
1934	183
1935	191
1936	201
1937	232
1938	249
1939	232
1940	260
1941	272
1942	283
1943	286