His directions as to diet for those suffering from melancholia are all in the line of limiting the consumption of materials that might possibly cause digestive disturbance, for evidently his experience had taught him that the depression was deeper whenever indigestion occurs. He says: "The diet for melancholics shall be wholesome and moderately moistening; abstaining from beef, roe's flesh, dried lentils, cabbages, snails, thick and dark coloured wines, and in a word from whatever things engender black bile." Mania was to be treated very nearly like melancholia, with special warnings as to the necessity for particular care of these patients. "But above all things they must be secured in bed, so that they may not be able to injure themselves or those who approach them; or swung within a wicker basket in a small couch suspended from on high." This last suggestion would seem to be eminently practical, especially for young people who are not too heavy, and enforces the idea that the physicians of this time were thinking seriously of their problems of care for the insane and exercising their ingenuity in inventions for their benefit. Paul of Ægina seems, then, to have thought that mania and melancholia were definitely related to each other, and to have held a similar opinion in this regard to Aretæus, who declared that melancholia was an incipient mania. Both had evidently noted that in most cases there were melancholic and maniacal stages in the same patient. These early medieval students of mental disease, then, anticipated to a rather startling extent our most recent conclusions with regard to the essential insanities. They would have been much readier to agree with Kraepelin's term, manic-depressive insanity, than with the teaching of the hundred years before our time, which so absolutely separated these two conditions. All this represents an organized knowledge of insanity that could not be acquired by chance, nor by a few intermittent observations on a small number of patients, but must have been due to actual, careful, continued observation of many of them over a long period. Here is the presumptive evidence for the existence of special institutions for their care at this period in the Middle Ages. This presumption is confirmed by Ducange in his "Commentary on Byzantine History," in which he tells of the existence of a _morotrophium_, or house for lunatics, at Byzantium in the fourth century, and one is known to have existed at Jerusalem late in the fifth century. Further confirmation of the existence of special arrangements and institutions for the care of the insane even thus early in the Middle Ages is obtained from the _regula monachorum_ of St. Jerome, which enjoins upon the monks the duty of making careful provision for the isolation and proper treatment of the sick both in mind and body, whilst they were enjoined to leave nothing undone to secure appropriate care and speedy recovery of such patients.[16]