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A few towns had towers where madmen were kept (called Narrentürme in German, or "fools' towers").
The ancient Parisian hospital Hôtel-Dieu also had a small number of cells set aside for lunatics, whilst the town of Elbing boasted a madhouse, the Tollhaus, attached to the Teutonic Knights' hospital.
In Spain, other such institutions for the insane were established after the Christian Reconquista; facilities included hospitals in Valencia (1407), Zaragoza (1425), Seville (1436), Barcelona (1481), and Toledo (1483).
The former lunatic asylum, Het Dolhuys, established in the 16th century in Haarlem, the Netherlands, has been adapted as a museum of psychiatry, with an overview of treatments from the origins of the building up to the 1990s.
The rise of the lunatic asylum and its gradual transformation into, and eventual replacement by, the modern psychiatric hospital, explains the rise of organized, institutional psychiatry.
This growth coincided with the development of alienism, now known as psychiatry, as a medical specialty.
Nonetheless, medical historian Roy Porter cautions against idealising the role of hospitals generally in medieval Islam, stating that "They were a drop in the ocean for the vast population that they had to serve, and their true function lay in highlighting ideals of compassion and bringing together the activities of the medical profession." In Europe during the medieval era, the small subsection of the population of the mad who were housed in institutional settings were held in a variety of settings.
Porter gives examples of such locales where some of the insane were cared for, such as in monasteries.
In the Islamic world, the Bimaristans were described by European travelers, who wrote about their wonder at the care and kindness shown to lunatics.
In 872, Ahmad ibn Tulun built a hospital in Cairo that provided care to the insane, which included music therapy.Various forms of outdoor relief were extended by the parish authorities to families in these circumstances, including financial support, the provision of parish nurses and, where family care was not possible, lunatics might be 'boarded out' to other members of the local community or committed to private madhouses.