It will be seen, by this table, that the proportion of recent cases of less duration than one year, is small in comparison, being only twenty-eight of two hundred and thirty-six.

The number of recent cases remaining the same, there must be a change, at least, three times a year, to make a list of sixty-four recoveries annually. Were it not that provision has been made for removing the harmless and violent incurable cases, the Hospital would have long since been filled with incurables, almost to the entire exclusion of recent cases; notwithstanding that many such have been removed, particularly, all the paupers from the city of Boston to their new hospital, the proportion of old cases is greater at the close of this year, than the last. It is exceedingly desirable that all persons insane should find accommodations in hospitals; but, if any must be excluded, the old and hopeless cases, the demented and idiotic had better be with their friends, and in other places of security and comfort, to afford to the recent cases that may occur in the community the best chance to recover. Three curable cases occupy but the place of one old one, each year; on this rule, in the place of one old and hopeless case of insanity, occupying an apartment from the time the Hospital was opened, at least twenty recent cases would occupy the same room, and have recovered, and returned to friends and usefulness in society. While we should be careful, then, to retain all old cases that will be likely to suffer, and be neglected abroad, it is exceedingly desirable that all recent cases should find early admission to the Hospital, on the most favorable terms, that the greatest good may be done to the greatest number of sufferers, and society and families be benefited by the restoration of valuable members.

The Hospital commenced the last year with two hundred and twentynine patients, and closed with two hundred and thirty-six, a difference of seven. The average of the previous year was two hundred and twentythree, and a fraction: this year the average has been two hundred and twenty-nine, a difference of about sir.

There are, at present, fifty-one patients in the Hospital, who have been insane less than two years, and one hundred and eighty-five, who have been insane from two to thirty years.

All divisions of insanity into nosological classes, are somewhat arbitrary. In looking over our list, it is not easy to say, where many cases should be classed. Many cases commence with high maniacal excitement, and result in deep and distressing melancholy; others are dull, desponding, and gloomy, for a longer or shorter period, and then become greatly excited for a season before the mind assumes a proper balance.

So also many recent cases appear demented for some time, and come out gradually from a state, which, if it had existed long, would be considered utterly hopeless; such cases we do not class with the demented, although others may do so; many such cases recover, and return to perfect health and a sound mind.

There have been five hundred and eighty-five cases of mania in the Hospital, of which three hundred and seventy-five have recovered or are considered curable, which is sixty-five and three fifths per cent. There have been three hundred and seventy-five cases of melancholy in the Hospital, of which two hundred and fourteen have recovered, or are considered curable, which is about fifty-seven per cent. There have been in the Hospital one hundred and sixty-four cases demented, of which only eight have recovered, which is but five per cent. As before observed, others may class a different set of cases under dementia, which will make a great difference in the per cent. of recoveries in cases of this description.

It is interesting to know in what manner the seasons affect the insane, to ascertain which, this table was made out. No very important conclusions can be drawn from the records here presented.

The number of admissions has been greatest in spring, and the number of discharges equal or nearly so in spring and summer. Autumn has afforded the greatest number of recoveries, and spring and summer the greatest number of deaths.

The temperature of the Hospital is so uniform, that we are greatly exempt from the diseases arising from changes of temperature, and indeed, from most acute diseases.

With twelve hundred patients, we have had but three cases of pleurisy or lung fever in the Hospital; and of ninety deaths, ten only have been the result of acute febrile disease or inflammation.

There is no subject connected with insanity more interesting than the CAUSES of it. Of these the first inquiry is made in every case; its importance, both to the case itself and to the community, is not over estimated. There are difficulties connected with it, however, that increase the obscurity beyond that of most other dis

eases.

Insanity often comes on slowly and imperceptibly; the workings of disease are hidden from our view, and the real cause actually lies behind the apparent one. In this way intemperance, religious feeling, the solitary vice, and many others, are the supposed causes, when in fact they are only the effect of the first impulses of disease; so often is this true of the latter cause, that in my reports, (and I find some of my friends have done the same,) I have always said, "produced or perpetuated" by this cause.

That they all are fruitful causes of insanity, however, is undeniable, and perhaps, although they may sometimes be wrongfully accused, they may, nevertheless, not be more frequently applied than the truth will warrant. It is doubtless often true that one cause does not come alone in the production of insanity.

Ill health, the derangement of a man's affairs, misfortunes of one kind or another, afflictions, disappointments, often come in clusters, and their combined influence disturbs that condition of the brain and nervous system upon which the integrity of the mind depends.

There is another difficulty, hardly less formidable, in arriving at the true cause of insanity; it is the unwillingness of friends to disclose all they know of the origin and progress of the disease; this is particularly true of all causes which are considered disreputable. In all cases we get the best information in our power, and make our record accordingly.

Intemperance still stands at the head of our list, having produced one hundred and eighty-five cases in the whole, and added fourteen the last year, to the previous number.

To ill health are also attributed one hundred and eighty-five cases; this is rather a compound than a simple cause, embracing wounds of the head, and all varieties of disease that affect the nervous system, either directly or remotely. This is also a cause that is not considered disreputable, and we are able to get at it more easily than many others of a different description; for this reason it may sometimes be assigned as a cause, when in reality it is not so. The remarks applicable to ill health apply with equal propriety to domestic affliction, for under this term are also collected a number of influences, similar in effect, but unlike in kind; and if any serious evil of this kind has occurred to a patient, it may not unfrequently be assumed as a cause when some other less prominent influence has given rise to the disease.

The large number of cases denominated hereditary, require a passing remark; strong constitutional tendencies, derived from ancestors, affecting physical condition and mental and moral development, are discoverable more or less in all mankind; certain forms of disease affect certain families, and none more than insanity. This is what is, in these reports, denominated hereditary predisposition. It is not necessary to the existence of this influence upon the offspring, that the parents be actually insane, but that they, having peculiarity of nervous constitution, have entailed on their descendants this predisposition so strongly, that it exhibits itself in one or many of their descendants.

In many reports hereditary predisposition is placed, in some cases, as the sole cause of insanity; I question greatly whether this is ever true; in my opinion there must be some exciting cause in all cases to bring into action this latent constitutional principle before disease is actually developed; when individuals are predisposed to this, or any other disease, they should studiously avoid these exciting causes, by which course they may generally be safe; they cannot always do this