Brief history of psychiatric institutions in Argentina.

From the closed Hospital to the open Hospital.

Rosa Falcone

HISTORY OF THE CONCEPT OF MADNESS

In ancient times, madness was conceived as the work of supernatural beings.

that were introduced into the body to disturb the soul. For more than a
For millennia, the mentally ill were considered to be possessed by the devil or
by evil spirits or witches or masters of witchcraft. Christian tradition
gather these ideas and it is proposed to drive away the demon that dwells in man
making the impure spirit depart from the possessed body. The theory of the
possession had different conceptions: some considered that what
he was possessed, it was the body and then they used fire to release him.
spirit, burning the insane for their liberation; others thought that the
possession was in the soul and in that way they performed an exorcism to
alleviate that suffering. Medicine was incorporated into the knowledge
from the church and therefore the only ones who could study these phenomena
they were the monks called alienists.

A lot of time also passed while the alignment remained under the instance.
from the Inquisition that controlled the practice of satanism through punitive measures, the

religious countercultures or mental illness encompassing all sectors

socioeconomic and cultural. The disease represented for centuries, a
of the most accepted explanations about crime, under the conviction that
who committed crimes externally showed their mental torment stemming from the
insanity that plagued him. It is no coincidence that the first prisons were populated by

epileptics, crazy people, tuberculars, syphilitics, lepers.

It is due to the initiators of psychiatry Philippe Pinel and his great disciple.
Jean Ettiene Dominique Esquirol the first humanitarian reaction against the

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called madmen. In 1792, the famous doctor of Bicetre, Philippe Pinel,
terrified by the unfortunate situation that the alienated were going through and
at the same time, filled with the triumphant democratic ideas in France,
proposes reforms in the assistance procedures for the alienated and the
right to be treated as sick men. He requested that it be abandoned the
inhumane use of chains and mistreatment. Pinel's liberating cry was
heard, not only in Paris, but also all over the world, wherever it
it spread, although not with the expected speed.

At the same time, a similar campaign was being carried out in England and
Germany by the work of Tuke, Reil, and Langermann respectively. Thus began
to shape social consciousness, which encouraged governments to think
seriously in the care issue of the insane and in legislation
corresponding.

What were the changes encompassed by this reform?

The first stage of changes was initiated by Pinel and involved hygiene,
the improvement in the food and clothing of the inmates, establishing a
treatment of humanity and sweetness in the old houses of Bicêtre and the
Salpêtrière. These initial changes were acts of repair and justice.
elevating those forgotten and dispossessed to the category of the sick.
heavy constructions, monumental, equipped with a large number of cells,
with high interior and exterior walls were subject to renovations
architectural, avoiding the discouragement that the alienated would fall into
subjected to a construction that resembled a convent or a prison.

A second stage of changes is beginning to take place in England, thanks to

the practice introduced by Conolly of no-restraint, or suppression of all means
of mechanical coercion. The use of force vests and restraints was banned.
every class, which were replaced by means of softness and benevolence.
The ongoing shouting and turmoil observed up to that point in the asylums,
they were replaced by order and calm.

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A third era that brought with it greater freedom was the no restraint.
decreasing the number of cells and establishing the principle of life
common. Entertainment and occupancy increased. There was a strong
boost to the work in land cultivation. These first trials were
made in France, (Bicêtre, Santa Ana and Fitz James) the same in Germany and
in Switzerland (St. Gall). Emphasizing this reform and as a corollary of no restraint
a radical reform takes place in Scotland mainly initiated by the
alienists Sibbald, Mitchel, Clouston, Rutherford and others. The walls come down
interiors and exteriors and the bars are removed leaving completely free the
horizon. The doors are left open during the day, the confinement is eliminated
and permission is granted to the sick to leave the asylum under the word of
they themselves to return to him. This method is called Open Door,
putting an end to the humiliation that the prison abduction represented that
contributed to fostering fury and chaos.

By the end of the 19th century, Germany was in first place in the use of these.
treatments although numerous countries had adopted this approach of the
madness that is both humanitarian and scientific.

THE FIRST MADHOUSES IN BUENOS AIRES.

Argentina, as is natural, followed the vicissitudes experienced by the majority.

of European countries around the same time. By the mid-18th century, the
The colonial village had a hospital called San Martín. In an adjoining ranch...
The hospital, colloquially known as El Loquero, housed the mentally ill.
The 'San Martín' was just a very modest infirmary with around a dozen and
average number of beds and a small number of doctors with greater goodwill
What aptitude. That hospital was run by Jesuit fathers, until 1748.
Six Bethlehemite priests arrived from Spain.

In 1734, Don Ignacio Bustillo y Zevallos donated part of his lands to the
Jesuit congregation (lands located today in the Alto de San Pedro, block
framed by Defensa, Balcarce, Humberto I, and San Juan). That plot was

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intended for the construction of a house for community work
with the exclusion of others (confessional, school-related), which in ecclesiastical language
It is understood as 'Residence'. The same property would include a neighboring farm.
Both Residence and Farm are named after Belén.

Shortly before the Jesuits were expelled (1767), their confreres...

religious of Our Lady of Bethlehem Betlehemites, in charge of the Hospital of
Saint Catherine, they managed to get the authorities to grant them not only
Residency and La Chacra, including some lands to the west,
purpose of building a pavilion to install a resting place there
It is supposed that from there comes its name La Convalecencia), which served to accommodate

sick people in recovery discharged from Santa Catalina who only

was responsible for admitting acute cases.

Since 1769, the Bethlehemites took charge of the properties of the

Jesuits moved the insane from the Hospital of Santa Catalina to the
Residence of Bethlehem which came to be called Hospital of The Convalescence and that

in fact, it had been established at the General Hospital for Men, successor of
Loquero. They designated the hospital for the internment of the incurable, the insane and
contagious.

In 1770, the Hospital of Santa Catalina, formerly San Martín belonging to the
Religious of Our Lady of Bethlehem begin to receive the insane that were
sent from the Cabildo (prison of Buenos Aires at that time). Here
they were employed as servants or nurses or in case they could not comply
those tasks isolated them in a ranch adjacent to the hospital called Loquero.
Since 1799, the residence was designated for the internment of incurables, madmen and

contagious cares or governed by a foreman who carried a whip in the

hand to strike them and only through fear did he earn respect and obedience. The
Loquerofue was the cradle of the current Borda Neuropsychiatric Hospital.

During Rivadavia's time (1823-26), coinciding with the nationalization of the

Church, it was thought to give hospitals a civil administration led by the
professors of the newly created School of Medicine (1821). Few doctors

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Until then, public health in the Río de La Plata depended on the
Real Protomedicato of Lima. In 1822, the closure of the Hospital is advised.
Saint Catherine intervening in the administration of the Bethlehemites and
I entrusted the doctors with the examination of all the people subjected to action.

police or judicial.

Under the reform initiated by Rivadavia, the beginning of a new

generation of doctors graduated from the School of Medicine of the University
from Buenos Aires who spoke in favor of counting as first
master to the prominent PH. Pinel. The first thesis of psychiatry that arises from
This school is that of Diego Alcorta, in 1827, under the title of The Acute Mania.
It was the first thesis published in the country and represents the aspirations of the
new faculty to generate changes in the situation of the alienated.
The thesis is inspired by the teachings of Pinel and gives importance to moral treatment.

all the importance it deserves.

The new generation of doctors was responsible for presenting at the

Legislature and the Municipality numerous building improvement projects in the
hospitals for the insane. These doctors, elected municipal officials, would have to be the

promoters of the reform for the treatment of asylum seekers that encompassed
the emancipation and humanitarian defense of the alienated. The first
The created commission had pointed out the difficulty of producing the reforms.
necessary while the problem of the chronically ill was not resolved. The tightness
from the location of the hospital towards the necessary widenings is impossible
to allow the admission of new patients. The presence of 7 or 8 inmates
in the same room it made surveillance impossible and therefore they could not be avoided
the excesses.

In the year 1859, Dr. Ventura Bosch commissions the presbyter G. Fuentes (priest of
the parish of San Miguel) the construction of a shelter for the sick to which it
he named it the San Buenaventura Hospice in honor of its initiator
this work. The building was erected on the grounds that currently belong to it.
belong to Rawson Hospital and began its functions on the 11th of
October 1863.

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The first Director of the Hospice was Dr. José María Uriarte. His commitment was
in instituting work, he founded workshops, and did not waver in the search for the
extension of the asylum. The hospice is inaugurated with a population of 123 inmates,
and they received them from all the provinces, because there was no other establishment of

charity for the treatment of the alienated. Around the same time, unlike
from Argentina, in France there were 99 asylums for the insane, a number that in 1869

rose to the figure of 103.

Between late 1863 and early 1864 - at the moment when Uriarte becomes
the position of the asylum management, the situation of the mentally ill is
describe it as follows: patients attacked by cholera, dining areas where
the chains that recalled the ancient prisons were still visible and that
they were used to join the tables by the legs, so that they would not
they would remove. The doctor attended the Hospice every day and most of the
employees did the same. At night, they locked the doors with a key
the rooms, leaving the alienated inside and they went back to their homes.
Meléndez tells us, 'it is hard to say that medical assistance was not possible (...)'
During the day, everything was in complete chaos and the unfortunate ones
alienated were the victims against whom the harsh and
inhumanitarian assistants who seemed to be hired to commit acts of
cruelty.” (Meléndez, 1880, p.9).

Although the situation improved somewhat with Uriarte's arrival, attendance at the
patients continued to be irregular. Their greatest effort was focused on passing the
nights in the Hospice, with the aim of disciplining and moralizing the service. He thought
in expansion works of the building, but the works were not carried out due to
lack of resources, meanwhile the prices were rising correspondingly
setback. Even though it was possible to achieve better nutrition for the alienated,
greater entertainment was sought in agricultural work and greater attention to
the medical treatment.

In 1873, after the passing of Dr. Ventura Bosch, the San Hospice
Buenaventura was named Hospicio de las Mercedes,1under the

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advocacy of the Virgin of Mercy, patron saint of prisoners and asylum seekers.
The Hospice of Our Lady of Mercy retains its name until 1949, when
change to the National Neuropsychiatric Hospital for Men. It is in 1967,
When it receives its current denomination Psycho-therapeutic Hospital

Interdisciplinary José Tiburcio Borda.

Meléndez and the Hospice of Las Mercedes.

In 1876, upon Uriarte's death, he takes over the direction of the Hospice.
Lucio Meléndez. A new era was opened with Meléndez's appointment.
This man of science, linked for several years to the teaching staff
from the Faculty of Medicine, made radical changes, widening the building
and putting it in increasingly favorable conditions. By 1879, the service
it was good, although the complaint about the lack of space continued. The building
Primitivo was built for 120 insane individuals and by 1881 it had 408.
patients.2The asylum seekers were increasing and as a result of this situation, fifty of
they were transferred to San Roque Hospital and the construction of
expansion works.

Dr. Meléndez requests the construction of isolated pavilions distributed

in such a way that they are separated from the old by gardens that serve
from recess to the unsane, allowing the entry of light and air of which today
lack" (Engineers, 1919, p. 205). In his plan, he demanded that the
acute aliens of the chronically ill, to the recovering ones from the agitated, to the
madness of the paralyzed, epileptic, semi-agitated, chronic. In the same
project also requests the creation of a Colony of the Alienated in a
provincial farm, a project that would be realized later (with the creation of the
Open Door in Luján). Their intention was to put an end to the overcrowding caused
due to the admission of mentally ill patients from the provinces, the same
It said 'the asylum had been born inadequate' (Melendez).

In 1883, three halls were completed and in 1885, the works were finished.
. In 1887, an Evaluating Commission of the hospice declares that in the

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the following departments functioned the same: calm pensioners,
semi-agitated, destructive, furious, alienated criminals, convalescing,
epileptics and paralytics. In addition to three barracks for chronic cases.

Ten years in charge of the direction of the asylum are necessary for Lucio
Meléndez after arduous efforts of dedicated humanistic vocation and
unmatched indifference would have satisfied their desires. The Hospice of las Mercedes
I was trying through this means to put an end to the centralization of the treatment of the

diseases.

We can illustrate these historical notes taking into account the variations
experienced buildings exemplifying three architectural moments of
Hospital. The oldest part from the time of Ventura Bosch, uncomfortable,
scant of light, air, hygiene reflecting the sad era in which coercion
violent was used to subdue the sick. The second construction that
it has advantages over the previous one, which responds to Meléndez's direction,
It consists of spacious bedrooms, dining rooms, infirmaries, etc.; and the last
stage, from Cabred, which according to the testimony of Engineers responds "the most
scrupulous demands of the psychiatric clinic. Everything is gathered in them:
surveillance and treatment, aesthetics and comfort, discipline and freedom" (Ingenieros,
1919, p.211.

The Hospital for the Insane (today Braulio A. Moyano)

In 1852, a "courtyard for insane women" was established at the General Hospital.
Women. The reduced capacity of the designated space and the growing number
of sick people that housed Mrs. Tomasa Velez Sarsfield,
inspector of the General Hospital for Women, to request the government to
authorization to create a Women's Correctional Facility in the building that
it existed known as "Convalescence."

Thus, on March 28, 1854, to the north and alley in between

Men's hospital, the Women's Asylum is created, initially with
a population of 68 sick women, transferred from the Women's Hospital. This

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it would have been the first women's mental hospital on the site where today

finds located the Braulio A. Moyano. At that time, medical attention

it was insufficient, as the direction of the asylum was entrusted to the Ladies of the
Charity Society, which delegated it to nuns. The doctors
they would visit in the morning, leaving the patients in the hands of the
religious for the rest of the day, who decided on the therapeutic measures to
apply in case of emergency. In 1880, it came to depend on the Government
National. There were then 384 patients. In 1894, the then director Dr.
Piñero summoned engineer C. Nystromer who made the plans for the hospital with
28 buildings and capacity for 1200 beds, with central kitchen, section of
agitated patients, calm ones, and retirees, which was inaugurated on July 31st
1908.

Until 1945, the Hospital was managed by the Ladies of Charity. In

that date due to disagreements raised with Mrs. Eva Perón were
expelled and the Hospital came to depend administratively on Social Security
Social. The medical residency system has been in operation since 1965. In 1967, it

proposes the name of Dr. Braulio A. Moyano National Hospital as a tribute

enduring in the memory of the eminent anatomopathologist.

The legacy of Domingo Cabred

In 1892, Dr. Domingo Cabred took over the direction of the Hospice of the
Mercedes, which at that time was still the only establishment
destined for the treatment of the alienated. Cabred did not rest influencing
about the circles of political power and public opinion until achieving the
sanction, in September 1897, of Law 3548, which orders the creation of the
first colony destined solely for mentally ill patients for the whole of
Republic. Thus, the National Colony of the Alienated is created in Luján, with
subject to the rules of the new Scottish system of hospitalization and assistance
doctor of the insane in the open-door asylums "Open Door". 1897.

The news of the creation of the ColoniaOpen Dooren Luján was received with
mistrust. Indeed, the aim was to host thousands of loose madmen in less than two

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leagues from the town. Terrifying prophecies spoke of invasions by madmen,
mass murders and even an attempt was made to create a popular movement
who firmly opposed the state project to bring such dangerous beings
as neighbors. The opinion of the neighbors regarding the "crazy" was nothing.
changed compared to previous times. But none of this was enough to stop
the project and on May 21, 1899, the ceremony was held
laying of the cornerstone, which was presided over by the Mr. President
of the Republic and godfather of the work, Lieutenant General Julio A. Roca.

Two years later, on August 11, 1901, with 109 beds, it was inaugurated.
officially the National Colony under the direction of Dr. Cabred. It began
as a colony for large-scale agricultural production. Its first
patients entered in the middle of the execution of works, and joined the
construction of them as bricklayers, blacksmiths, and carpenters. The
sick people worked on what they knew. In this way, they left.
putting into operation work activities, including bread and pastry manufacturing.
soap for internal use, that for the patients' clothing, a workshop of
foundry, another for tin work, etc. There was also a barrel to cover the
daily needs, a pig farm, another of birds. A field of 535
hectares, which were acquired not only to give the sick a sense of
freedom and the outdoors, but above all to attempt a return to normalcy,
through the healthiest distraction and therapy at the same time: work. Lucia
Iacoponi defines it as a Rehabilitation Center giving the true
scope of the project.

Financially, the Colony was a productive unit with very ...

positive. The public treasury would experience a significant relief, as it was expected to have

that the colony will generate important resources for its own maintenance. To
for a short time, the colony had an appearance similar to that of a town that managed to

almost self-sufficient. There were many savings because the production of

food and labor for construction were provided by the
patients.

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The Open Door colony consisted of villas or pavilions in the Swiss style.
French, surrounded by galleries of elegant architecture. These
buildings were separated from each other by wide spaces of gardens and
forests. The layout of the building was carried out in two sectors that
they determined different therapeutic and life practices. On one hand, there was the
Central Asylum sector granted to acute or chronic patients with episodes
they will need surveillance, temporary isolation, and clinical therapy. On the other hand,

it was the sector of the Colony proper, dedicated to the largest number
possible aliens that could adapt to the Open Door regime,
working in agricultural tasks, farming, and other workshops.

In each village there was a 'nurse guardian' in charge and one for every 10 insane people.

there was a "nurse or caregiver." Their role was to be the companion

permanent group in work, in play, in outdoor walks and in
the walks. They worked alongside the sick and had an active role in
the recreational or sports activities, so I had to be a nurse or
a person qualified for this purpose. The nurse had to intervene alongside the
group in all activities, playing in a way the role of
model. This should certify the presence of each patient on the list that
It was delivered upon everyone's return to the pavilion, since the villas were open from
day but closed at night. In addition to the list with the presences, the foreman
the nurse was supposed to carry another list signed by the doctor with the number of hours

from the work of each patient. Those who had full-time hours fulfilled a
8-hour workday, with a 3-hour break to rest. The activities were
group sessions, with a payment that compensated the patient's effort. The
tasks were very diverse, from agricultural tasks, breeding of birds and pigs,
brick factories and workshop activities.

Cabred intended to extend this system (Open Door) to all kinds of the alienated and
it emphasized that the function of the colony asylums was to provide assistance and

education. There were practically no leaks, due to the well-being I had in

sick. He emphasized the importance of a treatment where the sick person
will perform various outdoor tasks with the greatest amount of freedom

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compatible with its state and with the possibility of also carrying out countless
of supplementary tasks that will channel work skills3

Domingo Cabred remains in charge of the Colony until 1916, when he is

replaced by Javier Brandan, for the period 1916-21, and then Alfredo
Scarano between 1921 and 1930.

As time went by, disappointment was not long in coming. In 1918, the
the number of inpatients was 1,250, and five years later, the hospital is intervened to
end the generalized state of disorder and corruption. The staff
he was never fulfilling his duties and that is why he
many positions were dismissed. Administrative measures were then taken.
of discipline, which aimed at the reflection of the staff both inside
as it was outside the facilities. The situation was looming as
completely different: idleness, closed workshops, abandoned fields
or granted to individuals for personal profit, patients who wandered or
They were complaining, this asylum had become a dumping ground for the sick.

1930s. New projects in assistance of the

ALIENATED.

In 1927, the pre- began to be known in some very small circles.

project, presented by Fernando Gorriti, for the constitution of the League of
Mental Hygiene. The Hygiene League is the result of aspirations.
focused on the 'modernization of the treatment of the alienated' seeking
equalize the progress made in the field of general medicine. This
project is registered outside the borders of our country in the interest of
follow the guidelines of 'modern psychiatry' in the care of the
mental illness. After its primary function focused on prophylaxis of
mental illnesses, one of the most important objectives was
develop, with resources already established in Germany and France, the assistance
open psychiatric, in opposition to the asylum model, closed or of hospitalization.

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The same initiatives had begun to be raised in South American countries.
Americans previously; for example, Honorio Delgado, who presents, in
1922, a synthetic program of Mental Hygiene in Peru.

Although the pre-project for the creation of the League had been in existence for a few years.
Argentina's Mental Hygiene, its foundation was established in 1929, under the

address of Gonzalo Bosch and starts operating with his Consulting Rooms
Externals at the Hospice of Las Mercedes, in 1931. This initiative puts in
it highlights the insufficiency of the Charitable Societies and proposes
turn into a scientifically organized program, with suitable personnel and
trained. Its purpose was to propose open hospital practice, which as
new resource in our country, had already begun to be implemented
timidly in 1922, at the Asylum Hospital of Rosario and two years later
afternoon at the Asylum Hospital of Buenos Aires.

One of the most important functions of the League would have been to create the Services.
of Mental Hygiene accompanied by the Social Workers Service for
those patients who were of lesser severity. Within the program of the
League, and fulfilling their purposes, the social workers would carry out, with
preventive fines biotypological records, psychological records, and psychological profiles
social to arrive at a corresponding social diagnosis and treatment. The
visitor or assistant would inspect the applicant's home to collect the
information that would make the diagnosis possible. Social assistance would include
activities aimed at combating the causes of misery, poverty, and the
poverty and aimed at preventing disability, lack of resources,
food or accommodation.

These initial initiatives did not solely rely on goodwill and the
goodwill for the proper direction of charitable works, of
charity and philanthropic, but rather implied the need for knowledge
scientists to carry out the work. With this spirit, the
first tertiary courses for visitors and social assistants to start
to train these new professionals - differentiated in their tasks from the
activities of nursing staff.

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Social worker services, the opening of outpatient clinics and the
the activities of the visitors coincide with the general objectives of
open assistential practices. It was about avoiding asylum treatment
closed and to mitigate the insufficient hospital constructions they had.
negative consequences especially regarding the overcrowding of patients and the
insufficient treatments. The caregiving task from this moment opens
new perspectives in dealing with patients and its scope was expanding
until covering a wide field of action in control and assistance of the
population with an important sociological projection for the time.

Changes Starting from 1946

From 1946, an important change occurs in health matters as

The idea of the state as a provider while also being a planner begins to prevail.

hegemonic of the entirety of health services. This trend had been

gestating since 1943, when at the national government level the

National Public Health Directorate, under the Ministry of the Interior.

On May 23, 1946, a further step in the same direction is taken.

creating the Public Health Department with the status of a State Department,

assigning the senior official the rank of Minister. Dr. Ramón

Carrillo assumes as the first Secretary, with the rank of Minister. Carrillo

deepens important changes at the public health level. The new concept

of the state and its functions proposes to abandon charity and benevolence

to convert medical assistance into an obligation of the State towards

citizens.

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On October 11, 1957, following the line of these changes, the

National Institute of Mental Health (INSM) under the Ministry of

Social Assistance and Public Health.

Its purposes were:

a) prevent neuropsychiatric diseases,

b) promote scientific research on this subject;

c) Provide comprehensive assistance to the mentally ill

d) Contribute to the recovery and social rehabilitation of the sick

The National Mental Health Council was composed of Mauricio.

Goldemberg, Jorge García Badaraco and Raul Usandivaras. They prepared the

Draft of Organic Functional Regulation of the National Institute of

Mental Health. The project took into account the regulations in Health.

More advanced and modern minds. It was prepared taking into account the

recommendations and suggestions from the W.H.O. (World Health Organization)

Health.

The two essential cores of the reform were constituted by the project of

favor therapeutic communities in psychiatric hospitals and the

"Goldemberg Plan" for the Federal Capital. The latter proposes the creation of

Psychopathology services in General Hospitals and peripheral centers

Mental Health. The Goldemberg Plan achieved a reformulation of the asylum system that...

effects still endure.

In agreement with the reports of the Committee of Experts on Mental Health

(WHO) the new trend of social psychiatry emerges, in opposition to the

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closed asylums. Psychodramatic interpretative techniques are proposed.

(Moreno) and supportive, with the aim of studying the relational modality and the

social climate among the institutions; groups of mothers and children of schizophrenics

led by doctors and observers; the inclusion of the family in the treatment

of the mentally ill; groups of inpatients led by doctors and

observers, individual psychotherapy, the study of the functioning of

community, study of roles, etc.

In summary, the changes were many and involved another concept of

health and illness, a new role for psychiatry, and modifications

important at the institutional level. In the care area, the creation was encouraged

from independent Mental Health Centers or those incorporated into hospitals

General services such as Psychopathology. The first in this line was the

Ameghino Mental Health Center (1948), then the Psychopathology Service

of the Evita Hospital in Lanús, in charge of M. Goldemberg (1958). Thus

it was intended to minimize the hospitalization of the sick and promote their

attention for outpatient clinics. It becomes evident in a short time, due to a

side, the accelerated growth of hospital establishments in the sector

public, and on the other hand, the emphasis on prevention as an effective means to avoid the

appearance of pathologies.

The disease begins to be thought of from the healthy and not from the

sick. The care activity begins to have greater development in the

health promotion and disease prevention. The term 'Hygiene'

"Mental" is replaced by "Mental Health" closer to the new ones.

proposals. The processes of health and illness will be addressed as

social and collective phenomena.

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 Gradually, a multidisciplinary criterion begins to take hold.

gather valuable experiences and perspectives to work against confinement

tax imposed by the already "questioned" asylum psychiatry. The

mentality combining traditional medicine with sociology. Every time

that the demand for health is conceived as a need of the population

general and the teams manage to integrate into the community (Health Centers

Mental, Peripheral offices, Day hospital) is initiated a

a different conception of Mental Health. The goal will no longer be only

not just assistance-oriented but proposes as health programs.

These innovations coincide with a different formulation of the social in

counterposition to the naturalistic view of a unhealthy environment generating the

diseases. Social organization begins to be studied from the effects.

characteristics of the individuals that compose it. The new concepts that

they begin to circulate are community, group, institution, interaction, praxis.

GENERAL CONCLUSIONS

This article has attempted to present an overview of the history of the

assistance practices in Argentina and the importance of the changes that have occurred
since 1946 onwards in the field of health in Argentina. It has been placed in
it evidences the eminently 'palliative' nature of assistance in the early
decades of the last century, and the beginning of significant changes has been set
in response to overcrowding and the health and hygiene situation. Within
these changes have shown the importance of the movement of
modernization of psychiatric treatment that transforms the hospital into a
prophylaxis center in the 1930s. Within this conception
the idea of treating mental illness under the same principles prevails
precepts of general pathology equating the developments of medicine and
applying them to mental medicine. In this context, we emphasize the importance

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the training of visitors and social assistants as new professionals
suitable candidates that are starting to gain importance and to become the first

background of the 'open' assistance policy.

In summary, we highlight two moments:

Emphasis on the anatomic-pathological study as the cause of the symptom and the
presence of a theoretical nosography that classifies patients
mental. The doctor embodying the medical and social issue will assign
therapeutic value of isolation and confinement in Asylums. Assistance is
eminently palliative and only aims to remedy suffering
immediate effects of misery without investigating the causes.

2. A new period opens, where the old asylum structures,

based on anatomical and pathological prejudices, are absurd, anachronistic
and insufficient.

The new conditions are proposed:

- Investigate the causes and treat the patient in the same place where it has been
generated your disorder, if possible do not uproot it from its core
familiar, admit him only in extreme cases. Respect the belief that
Isolation increases alienation.
- Shift the heavy weight of psychiatric care from asylums
to general hospitals. Inaugurate the assistance practices
open and the training of new professionals (social workers,
hygiene visitors.
- Deepen the practices of prophylaxis or prevention and advance in the
formation of multidisciplinary care groups
composed of doctors, psychologists, anthropologists, sociologists,
nurses, social workers. Address mental illness as
a complex system and man as a whole with variables
social and individual. Create the conducive environment for work
multidisciplinary groups, family and institutional approach.

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General Bibliography

Ameghino, Arturo "The increase of madness in the Argentine Republic after the
War”, Journal of the Argentine Medical Association, Buenos Aires, Publication of the
Society of Neurology and Psychiatry, pp. 19 and following.
Open Door Shelter, pamphlet in Argentine Medical Journal, Vol. 2,
Year 1904.
Open Door Asylum (The work of Dr. Cabred), Anales de magazine
Military Health, pp. 770-784.
Avalos, María E.; Martí, Alicia and Haase, Gerardo "Yesterday and today of an institution"
Asylum. 137 years of the Hospital for the Insane in Vertex, Argentine Magazine
of Psychiatry, Vol. 3, No. 7, March, April and May 1992, pp. 57 to 65.
Notebooks of Achon. "History of the National Neuropsychiatric Hospital for Men"
ago. 1965, pp.3-11.
Cabred, D. (1894), Asylum Colonies for the Insane. Project, The Medical Week, Volume
T.XI, year 1894, p.545 and ss.
Cabred, Domingo "Inaugural Speech of the Works of the National Colony of
"Alienated", Library of the Faculty of Medical Sciences, Buenos Aires. Fe-4886.
Cabred, Domingo, "Memoir on the foundation and functioning of the Colony"
National of the Alienated in the first two years of its existence, The week
medical, T.XI, year 1904, p.545 and following.
Notebooks of Achon. “History of the National Neuropsychiatric Hospital for Men”
ago. 1965, pp.3-11.
Esquirol, E. On Mental Diseases Considered from Medical and Hygienic Perspectives
and Medical-Legal, Volume One, Paris, Chez J.B. Baillière, Bookseller of
The Royal Academy of Medicine, Lyon, 1838.
Iacoponi, Lucía "The Cabred Hospital and the Open Door Method", presentation at the Conference
scientific "Assistance and Rehabilitation of people with health disorders
mental", Colonia Domingo Cabred, 1996, Luján, Buenos Aires.
Madness in Argentina
Limited Editorial, 1920, in Complete Works of José Ingenieros, Vol. 12,
Buenos Aires, Elmer Editor, Buenos Aires, 1957.
Meléndez, Lucio. Memoirs of the Director of the Hospice of Mercedes to the Corporation
Municipal. Archive of the Faculty of Medicine, Graduate Library.
Orlando, J. C. "Borda Hospital: about Names and Places", Alcmeon2, 187-194, 1991.
Pinel, Ph. (1801) Medical-Philosophical Treatise on Mental Alienation, Paris, 2nd
edic., J. Ant. Brosson, Bookseller, 1809, own translation of Fourth Section,
Internal police and rules to follow in establishments dedicated to
alienated.
Stagnaro, J.C. 'Lucio Meléndez and the first disciplinary matrix of Psychiatry'
Argentina, in Topics of the History of Argentine Psychiatry, no. 1, Buenos Aires, ed.
War.
Stagnaro, Juan C. (1993) 'Barracas al sur... Background and historical notes of
"Loquero from Buenos Aires", Ed. Polemos.
Stagnaro, J.C.; Gonzalez Chaves, J.M. "Hospicio de las Mercedes", Edit.Polemos,
1st ed., Buenos Aires, November 1993.

19
Notes
1
Although date variations are recorded, some data found says that on May 8, 1887, it
draws up a document officially inaugurating the Hospice of Las Mercedes (Notebooks of Achon).
2
. In Engineers, J. (1919) Madness in Argentina, pp. 210.
3
Thanks to Cabred's management, law 4953 (1907) is also enacted, by which it was going to
to solve the serious hospital problem that arose from the insufficiency of facilities and the
crowding of patients. From this Law, numerous establishments were inaugurated.
The following establishments were inaugurated: Regional Mixed Colony for the retarded in Torres,
Mixed colony of the Alienated of Oliva, the Common Regional Hospitals of Resistencia.
Chaco, Bell Ville, Córdoba, Allen, Río Negro, Pte.Plaza, Posadas, Misiones, Santa Rosa, La Pampa,
J..J. de Urquiza, Concepción del Uruguray, Regional Hospital of the North, See Iacoponi, Lucía, (1999), "The
Interzonal Hospital Colonia Domingo Cabred and the open door method.

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