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Recreational therapy- beginning to 1885

complied by Jeffrey A. Mansfield

2.6 million years ago, flaked stones found among the fossils of australopithecines indicate they were already exploring the possibilities of handicrafts, and fashioning simple tools from pebbles.

35,000 BC Homo Sapiens invents art

10,000 BC The first evidence of surgical treatment, trephaning.

2600 BC Chinese taught that disease was caused by organic inactivity and thus used physical training for the promotion of health.

2158-2008 BC Oldest medical text describes poultices in Sumerian tablet.

2000-1500 BC The Egyptians described diversion and recreation as a means of treating the sick. (Egyptian Kahun papyrus written approx. 1850 BC)

1700 BC Code of Hammurabi-Mesopotamia-Summerians (now Iraq)
282 malpractice laws concerning surgical procedures. Treatment by nonsurgical means was not covered by malpractice laws.

1000 BC Ancient Persians realized the beneficial effects of physical training and utilized it to fit their youth for military duty.

500 BC-500 AD Asclepius' Temple and Cult

460 BC Age of Pericles in Athens

420 BC The Greeks described diversion and recreation as a means of treating the sick.

400 BC Socrates and 347 BC Plato understood the relationship between physical status and mental health.

359 BC Hippocrates (460-361), the father of medicine, recommended that their patients exercise in the gymnasium as a means of recovering from illness.

340 BC Aristotle felt that the "education of the body must precede that of the intellect."

100 BC-4 AD The Roman Asclepiades advocated massage, therapeutic baths, and exercise for improving diseased conditions. He also recommended activity treatment for patients with mental diseases. This included diversions and entertainment, but only the diversional value was recognized.

130-201 AD Galen

476 End of Western Roman Empire

477-900 The Dark Ages, the mental and physical influences of play were regarded by the Church to be evil. (The first half of the Middle Ages, until the 10th century)

900-1453 The Middle Ages, Middle Eastern scholars protect and develop the ancient Egyptian, Greek, and Roman knowledge. 476-1453

1454-1605 The Renaissance, the mental and physical influences of play are again recognized after Arabic texts are translated into German.

1537-1543 Vesalius at Padua

1752 Pennsylvania Hospital is established in Philadelphia. Benjamin Franklin was involved in drafting the petition for its establishment. Inmates were provided with light manual labor such as spinning and carding wool for activity.

1780 Clement Joseph Tissot publishes the book "Gymnastique Medicinale et Churgicale" recommending "prescribed craft and recreational activities as therapeutic exercise for the treatment of disabled muscles and joints following disease or injury."

1786 Phillip Pinel introduced work treatment in the Bicetre Asylum for the Insane near Paris.

1798 Benjamin Rush, M.D., one of the signers of the Declaration of Independence, advocated work as a remedial measure for the treatment of patients in the Pennsylvania Hospital.

1801 Pinel publishes a book "Medical philosophical treatise on mental alienation" describing the method as "prescribed physical exercises and manual occupations." It is the first reference in literature to the medically prescribed use of activity for remediation.

1810 Rush, in an address to the Board of the Pennsylvania Hospital, advised that "certain kinds of labor, exercise, and amusements be contrived for them, which should act at the same time, upon their bodies and minds."

1803 Johann Christian Reil suggested the use of exercise and a special hospital gymnasium along with patient participation in dramatic productions and fine arts, in his book "Rhapsodies on the psychic treatment of the insane." This is evidence of one of the first uses of psychodrama in the treatment of the insane.

1816 Samuel Tuke, an English Quaker, established a Retreat Asylum for the Insane at York, England. He used work or occupation therapy as Pinel did but placed special emphasis on humane treatment or treating of patients as rational beings who have the capability of self-restraint. He called it "moral treatment." "...of all the modes by which patients may be induced to restrain themselves, regular employment is perhaps the most generally efficacious; and those kinds of employment are doubtless to be preferred which are accompanied by considerable bodily action, that are most agreeable to the patient, and which are most opposite to the illusions of his disease. ....every effort should be made to divert the mind of melancholias by bodily exercise, walks, conversations, reading, and other recreations. Those who manage the insane should sedulously endeavor to gain their confidence and esteem, to arrest their attention and fix it on objects opposed to their delusions...and to remember that in the wreck of the intellect the affections not unfrequently survive."

1817 Thomas Scattergood, a Quaker minister who visited Retreat, brought the principles of "occupation and nonrestraint" back to the US, and helped establish the Friends Asylum for the Insane in Philadelphia.

1818 McLean Asylum opens near Boston under the supervision of Rufus Wyman, M.D. He established, and was probably the first physician in the country to supervise, a program of occupational therapy.

1821 Thomas Eddy, New York merchant and member of the Society of Friends, was another visitor impressed by treatment methods at Retreat. He submitted suggestions for the "moral management" of the insane to the Governors of the Lunatic Asylum of the New York Hospital. As a result, Bloomingdale Asylum was opened in New York City and began moral management including "occupational therapy."

1840 F. Leuret wrote a book "On the Moral Treatment of Insanity." He said all psychiatrists recommend diversions and work to prevent the effects of idleness and boredom. He utilized exercise, drama, music, and reading along with manual labor. Nearly synonymous with occupation therapy, it is considered the first book entirely devoted to the subject. (Susan E. Tracy is credited with writing the first book on occupational therapy, titled "Invalid Occupations" in 1910)
(Dr. William Rush Davis, Jr. is credited with writing the first recreational therapy text titled "Principles and Practice of Recreational Therapy for the Mentally Ill" in 1936)

1840 Thomas Story Kirkbride, M.D. becomes superintendent of Pennsylvania Hospital, and begins a program of mental care that stressed occupation therapy. He said that the value of occupational therapy cannot be measured in dollars and cents but must be judged in regard to the restoration of comfort to the inmates of the hospital. Crafts, amusements, and hospital occupations were used therapeutically. He helped to organize the Association of Asylum Medical Superintendents, which later became the American Psychiatric Association. Through this association, Kirkbride influenced its members regarding the value of occupation therapy.

1841 The first structure for the Pennsylvania Asylum for the Insane was completed in 1841. The facility offered comforts, "humane treatment" philosophy, and mental health treatment programs that set a standard for its day. Unlike other asylums where patients were often kept chained in crowded, unsanitary wards with little if any treatment, patients at the Pennsylvania Asylum resided in private rooms, received medical treatment, worked outdoors and enjoyed recreational activities including lectures and a use of the hospital library. The facility came to be called "Kirkbride's Hospital."

1844 Amariah Brigham, superintendent of the Utica State Hospital in New York advocates the therapeutic value of occupying patients. The idea that only the therapeutic value should be considered in selecting the activity was a new and important advance toward a more scientific use of occupation as therapy.

1854 Florence Nightengale provides recreation to casualties of the Crimean War dubbing her the Mother of Hospital Recreation.

1860-1885 Economic pressures felt in all hospitals during and after the Civil War, busy physicians, lack of public interest and insight, and an underestimation of the therapeutic value of occupation as well as "the real returns as compared to the incidental returns or possible economic proceeds from the treatment," all contributed to the sudden decline and de-emphasis of the allied health therapies for more than 25 years.



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