Quite contrary to the usual impression, rather extensive and well-managed institutions for the care of the insane came into existence during the Middle Ages, and continued to fulfil a very necessary social and medical duty. For the unspeakable neglect of the insane which is a disgrace to civilization, we must look to the centuries much nearer our own than those of the Middle Ages. Above all, the Middle Ages did not segregate the insane entirely from other ailing patients until their affections had become so chronic as to be certainly incurable, and they took the insane into ordinary hospitals to care for them at the beginning of their affection. This mode of procedure has many advantages, mainly in getting the patients out of unfavourable environments and putting them under skilled care early in their affections, so that a definite effort is being made to restore what is called the psychopathic ward in the general hospitals in our time. Only a careful study of the details of actual historical references to the medieval care of the insane will serve to contradict unfortunate traditions which have gathered around the subject entirely without justification in real history. The traditions of medical knowledge with regard to the insane inherited by the early Middle Ages from the ancients were of the best, and the books written at this time have some interesting material on the subject. Paulus Aëgineta (Aëginetus), who wrote in the seventh century--and it must not be forgotten that already at this time some 200 years of the Middle Ages have passed--has some excellent directions with regard to the care and treatment of patients suffering from melancholia and mania. He says, in his paragraph on the cure of melancholy: "Those who are subject to melancholy from a primary affection of the brain are to be treated with frequent baths and a wholesome and humid diet, together with suitable exhilaration of mind, and without any other remedy unless, when from its long continuance, the offending humour is difficult to evacuate, in which case we must have recourse to more powerful and complicated plans of treatment." He then gives a series of directions, some of them quite absurd to us, apparently in order to satisfy those who feel that they must keep on doing something for these cases, though evidently his own opinion is expressed in the first portion of the paragraph, and in the simple laxative treatment that he outlines. "These cases are to be purged first with dodder of thyme (_epithymus_) or aloes; for if a small quantity of these be taken every day it will be of the greatest service, and open the bowels gently."