<P> A very different background to the moral approach may be discerned in Scotland . Interest in mental illness was a feature of the Edinburgh medical school in the eighteenth century, with influential teachers including William Cullen (1710--1790) and Robert Whytt (1714--1766) emphasising the clinical importance of psychiatric disorders . In 1816, the phrenologist Johann Spurzheim (1776--1832) visited Edinburgh and lectured on his craniological and phrenological concepts, arousing considerable hostility, not least from the theologically doctrinaire Church of Scotland . Some of the medical students, however, notably William A.F. Browne (1805--1885), responded very positively to this materialist conception of the nervous system and, by implication, of mental disorder . George Combe (1788--1858), an Edinburgh solicitor, became an unrivalled exponent of phrenological thinking, and his brother, Andrew Combe (1797--1847), who was later appointed a physician to Queen Victoria, wrote a phrenological treatise entitled Observations on Mental Derangement (1831). George and Andrew Combe exerted a rather dictatorial authority over the Edinburgh Phrenological Society, and in the mid-1820s manipulated the de facto expulsion of the Christian phrenologists . </P> <P> This tradition of medical materialism found a ready partner in the Lamarckian biology purveyed by the naturalist Robert Edmond Grant (1793--1874) who exercised a striking influence on the young Charles Darwin during his time as a medical student in Edinburgh in 1826 / 1827 . William Browne advanced his own versions of evolutionary phrenology at influential meetings of the Edinburgh Phrenological Society, the Royal Medical Society and the Plinian Society . Later, as superintendent of Sunnyside Royal Hospital (the Montrose Asylum) from 1834 to 1838, and, more extravagantly, at the Crichton Royal in Dumfries from 1838 to 1859, Browne implemented his general approach of moral management, indicating a clinical sensitivity to the social groupings, shifting symptom patterns, dreams and art - works of the patients in his care . Browne summarised his moral approach to asylum management in his book (actually the transcripts of five public lectures) which he entitled What Asylums Were, Are, and Ought To Be . His achievements with this style of psychiatric practice were rewarded with his appointment as a Commissioner in Lunacy for Scotland, and by his election to the Presidency of the Medico - Psychological Association in 1866 . Browne's eldest surviving son, James Crichton - Browne (1840--1938), did much to extend his father's work in psychiatry, and, on 29 February 1924, he delivered a remarkable lecture The Story of the Brain, in which he recorded a generous appreciation of the role of the phrenologists in the early foundations of psychiatric thought and practice . </P> <P> A key figure in the early spread of moral treatment in the United States was Benjamin Rush (1745--1813), an eminent physician at Pennsylvania Hospital . He limited his practice to mental illness and developed innovative, humane approaches to treatment . He required that the hospital hire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them on regular walks . He also suggested that it would be therapeutic for doctors to give small gifts to their patients every so often . However, Rush's treatment methods included bloodletting (bleeding), purging, hot and cold baths, mercury, and strapping patients to spinning boards and "tranquilizer" chairs . </P> <P> A Boston schoolteacher, Dorothea Dix (1802--1887), also helped make humane care a public and a political concern in the US . On a restorative trip to England for a year, she met Samuel Tuke . In 1841 she visited a local prison to teach Sunday school and was shocked at the conditions for the inmates and the treatment of those with mental illnesses . She began to investigate and crusaded on the issue in Massachusetts and all over the country . She supported the moral treatment model of care . She spoke to many state legislatures about the horrible sights she had witnessed at the prisons and called for reform . Dix fought for new laws and greater government funding to improve the treatment of people with mental disorders from 1841 until 1881, and personally helped establish 32 state hospitals that were to offer moral treatment . Many asylums were built on the so - called Kirkbride Plan . </P>

Who brought the reforms of moral therapy to the us