The proper care of the insane is usually looked upon as a very modern phase of humanitarian evolution. Most people think that until the last hundred years the insane have been hideously neglected, when not treated with absolute barbarity, and that the rule has been simply to put them away so that they could not injure themselves or others, confining, manacling, and otherwise hampering their activities, regardless of their health or the mental effect on them. In this once more, as in most of the historical ideas with regard to humanitarian development, the erroneous notions are due to the fact that the care for the insane was at its lowest point during the eighteenth and the early part of the nineteenth century, and that there has been a magnificent improvement since, though it must not be forgotten that there has not been a single generation since when there have not been very serious complaints deservedly uttered of awful neglect of the insane in some part of the civilized world. We have had revelations with regard to the care of the insane in the country districts of even our Eastern States which have been almost incredible. The conditions that we have come to learn as existing in the South in the care of the insane, which have been brought to light by the recent investigation of pellagra, have been of a similar character. The epithet mediaeval which is applied so often to these conditions is absolutely unwarranted by our present knowledge of old-time care of the insane. It has been concluded that, since care for the insane was so neglected in the eighteenth century, it must have been almost infinitely worse in preceding centuries. The same fallacy lies at the root of a great many false impressions with regard to mediaeval and Renaissance history. The eighteenth was the lowest of centuries in art, literature, education, and humanitarian purpose. The preceding centuries exhibit some very interesting developments of care for the insane, some of which anticipate our most modern ideas. At Gheel in {203} Belgium, from the earlier Middle Ages, they cared for defectives on the village plan. Similar institutions were not infrequent. They developed the "open door" system of caring for the insane and insane institutions were mainly in connection with monasteries, well out in the country, and under good conditions, since they were never crowded. It is always crowding that brings serious abuses with it and leads to what seems to be barbarity, but is really an inability to cope with the large problem with inadequate means.