The history of Italian neuropsychiatry and the role of Onofrio Fragnito (1871-1959)

In 1904, the XII Congress of the Italian Phreniatric Society (30 years later, it would be named the Italian Psychiatric Society) debated the question of whether the neurosciences should constitute an independent field from psychiatry. Three years later, the Italian Society of Neurology was established and was presided over by Leonardo Bianchi (1848–1927), a Member of Parliament, physician, and Professor of the Clinic of Nervous and Mental Diseases at the University of Naples. His pupil, Onofrio Fragnito (1871–1959), despite having a passion for histology and general physiology, which were taught by Giovanni Paladino (1842–1917), decided to follow the discipline of Bianchi, whom he considered his mentor. After a few years at the University of Sassari, Fragnito was appointed clinical professor of nervous and mental diseases at the University of Siena. He remained in Siena from 1912 to 1924, where he also held the positions of Dean of the Faculty of Medicine and Surgery and Rector. After leaving Siena for Catania, he subsequently moved to Naples in 1927 on the death of his master. During his years in Siena, Fragnito personally witnessed the separation between psychiatric studies and neurological studies; the former remained in the city asylum, while the latter were transferred to the new clinic that was set up within the polyclinic of the university. Fragnito was the first professor to devote himself entirely to university research without simultaneously holding the position of Director of the Asylum. He made such a choice in the wake of his master’s teachings and with the support and approval of the President of the “Hospital Commission”, the Sienese Luigi Simonetta, a future senator of the Italian Kingdom, and of the hygienist Achille Sclavo. This choice further increased the distance between psychiatry and neurology; while psychiatry was relegated to the Asylum, which was destined to become an increasingly important institute for chronic illness, neurology exploited university research into acute cases and cases of scientific interest. In this setting, Fragnito carried out research on young men traumatized by war who were hospitalized in the Sienese Neurological Center for nervous injuries. As a result of this research, knowledge of the physiology and pathology of the nervous system was updated, as were the studies on encephalitis lethargica and postencephalitic parkinsonism (PEP) conducted by Fragnito himself. By looking at Onofrio Fragnito and his work, the authors trace the difficult pathway that led to the separation of neurology from psychiatry, whereby the neuropsychiatry clinic would become a place of research and the asylum a facility for chronically ill patients. This was the beginning of a long process that led the asylum to lose its function of study and research into mental illness, thus initiating the slow decline of this institution.