Patients were given laxatives, emetics, and were bled using leeches in an effort to bring the four fluids back to balance. Laxatives were created using specific ingredients from Europe and the Middle East. Tobacco from the Americas was commonly used to induce vomiting. Other treatments included bloodletting from the forehead, cephalic, saphenous, and/or hemorrhoidal veins to draw corrupted humors away from the brain. Custom diets were recommended. Treatment and care were generally left up to the family of the afflicted- due to shame and stigma, many families hid their mentally ill, kept them in pigpens, put them under the control of servants, or deserted them to the streets for a lifetime of begging. Stigma attached to mental illness was (and still is) very strong in countries that put an emphasis on family honor. Mentally ill were left to wander the streets if they were peaceful; if not, they were thrown in jail (sometimes for life). Particularly in Europe, beatings were administered as punishment for their behavior and as a means of “teaching” individuals out of their illness; others were flogged out of town.