In 1870 the Romanian physician Nicolae G. Chernbach published a photographic atlas of the main types of mental alienation, a collection of twelve plates depicting mentally ill patients from the Marcutza Asylum in Bucharest. Each photograph included a diagnosis based on the clinical nosography and theories of the physiognomy of insanity acknowledged during the period. The publication of the atlas--just a few years after Hugh W. Diamond's initial use of photography for this purpose in Britain in the 1850s--means that the photographs were not only the first taken in Romania, but among the first photographs of the mentally ill. This study provides an insight into the origins of modern clinical psychiatry and medical advances in Romania, and the contemporary personalities in Romanian and Eastern European medicine.