<P> William Tuke led the development of a radical new type of institution in Northern England, following the death of a fellow Quaker in a local asylum in 1790 . In 1796, with the help of fellow Quakers and others, he founded the York Retreat, where eventually about 30 patients lived as part of a small community in a quiet country house and engaged in a combination of rest, talk, and manual work . Rejecting medical theories and techniques, the efforts of the York Retreat centred around minimising restraints and cultivating rationality and moral strength . </P> <P> The entire Tuke family became known as founders of moral treatment . They created a family - style ethos and patients performed chores to give them a sense of contribution . There was a daily routine of both work and leisure time . If patients behaved well, they were rewarded; if they behaved poorly, there was some minimal use of restraints or instilling of fear . The patients were told that treatment depended on their conduct . In this sense, the patient's moral autonomy was recognised . William Tuke's grandson, Samuel Tuke, published an influential work in the early 19th century on the methods of the retreat; Pinel's Treatise on Insanity had by then been published, and Samuel Tuke translated his term as "moral treatment". Tuke's Retreat became a model throughout the world for humane and moral treatment of patients suffering from mental disorders . </P> <P> The York Retreat inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat (now the Institute of Living). Benjamin Rush of Philadelphia also promoted humane treatment of the insane outside dungeons and without iron restraints, as well as sought their reintegration into society . In 1792 Rush successfully campaigned for a separate ward for the insane at the Pennsylvania Hospital . His talk - based approach could be considered as a rudimentary form of modern occupational therapy, although most of his physical approaches have long been discredited, such as bleeding and purging, hot and cold baths, mercury pills, a "tranquilizing chair" and gyroscope . </P> <P> A similar reform was carried out in Italy by Vincenzo Chiarugi, who removed the use of chains from the inmates in the early 19th century . Johann Jakob Guggenbühl in 1841 started in Interlaken a retreat for mentally disabled children . </P>

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