ered thirty-three times, an average of more than six recoveries to each.

At the Worcester (Mass.) Hospital, one woman (the one above mentioned) was discharged recovered twenty-two times.

At the Bloomingdale Asylum, New York, prior to 1845, a woman was admitted twenty-two times, and discharged recovered every time; and for another woman (the one who recovered six times in one year) forty-six recoveries were reported in the course of her life, and she died upon her fifty-ninth admission; and those forty-six recoveries are to this day published, unexplained, in the tables of the reports of that institution, as available material for all persons who wish to demonstrate, by the absolute infallibility of mathematical figures, which "cannot lie," the proportion of persons attacked with insanity who are again restored, by recovery, to health and to usefulness. When the Bloomingdale Asylum had been in operation fifty years, it had treated 6,325 patients, and the whole number of recoveries was 2,796. This one woman furnished 1.66 per cent, or one sixtieth part, of all these recoveries.

At the Frankford Asylum, Pennsylvania, the aggregate of the recoveries of five persons was fifty-two, or more than ten recoveries to each person; and yet no less than three of those persons subsequently died in the asylum.

At the Worcester Hospital, in 1877, seven women had recovered ninety-two times, an average of more than thirteen recoveries to each; but nevertheless two of those women had died insane in that hospital; two of them were then present in the hospital, both of them insane, and one of them hopelessly so; and one was in another hospital, hopelessly insane. How admirably might those same ninety-two recoveries be used to point a moral, or adorn a tale"!

At the Vermont Asylum, the report for 1878 says, "Of the number discharged, fifty-two recovered." Had the reporter stopped there, according to the invariable custom at that asylum for at least forty years, the unenlightened reader might reasonably have inferred that that number of persons, afflicted with insanity for the first time, had been sent to their homes and firesides permanently cured. But the reporter proceeds: Twenty-eight recovered from a first attack, nine from a second, three from a third, four from a fourth, two from a fifth, two from a sixth, one from a seventh, one from a tenth, one from a fourteenth, and one from a fifteenth."

How wonderfully a little explanation may sometimes alter appearances! Twenty-four of those persons, instead of being permanently cured from a first attack, have already had an aggregate of one hundred and eleven recoveries; and, judging of their future by their past, many more similar recoveries are in store for themand for the statistics of insanity.

At the New Hampshire Asylum, in the course of the official year ending April 30, 1878, there were thirty-five recoveries. Only fifteen of them were from the first attack. Of the other twenty patients, seven recovered for the second time, seven for the third time, two for the fourth time, one for the fifth time, one for the seventh time, one for the tenth time, and one for the thirty-fifth time. The twenty persons have furnished one hundred recoveries, to say nothing of what they will furnish hereafter. In the thirtysix years since the asylum was opened, the whole number of recoveries of its patients is 1,526. These twenty persons have supplied one hundred, or 6.31 per cent, of all those recoveries; and yet it is improbable that either one of them is permanently cured.

If we consider that these are the multiplicate recoveries of the patients discharged in only one year, and remember that every year will furnish its quota of them,' we may measurably conceive how very large a proportion of the whole 1,526 recoveries, since the hospital was opened, are of the same delusive character, mere repetitions of the temporary recoveries of a comparatively small number of persons.

By such deceptive statistics as these, more or less of which are found in the reports of all institutions for the insane that have been in operation two or three years, the public mind has been seriously led astray. And it will continue to be thus more or less deluded, until all the superintendents shall conclude to follow the example of the few who, by such explanations as are given above, convey to the reader a clear understanding of the nature of the recoveries. The old way, still followed by the majority, savors

1 Since this paper was read before the Conference, I have received the report of the New Hampshire Asylum for the official year ending April 30, 1879. The recoveries at that institution, in the course of the year, were twentyseven; but only eleven of them were from the first attack. Of the remaining sixteen patients, four recovered for the second time, eight for the third time, one for the fifth time, one for the ninth time, one for the tenth time, and one for the thirty-sixth time. The sixteen persons have contributed ninety-two recoveries to the statistics of insanity.

too much of the ad captandum methods of a still grosser character, pursued to some extent in years gone by, by which the statistics were presented in such form, that, in the words of Dr. Bates, they were "received with wondrous admiration by that portion of the public who are better pleased with marvellous fiction than with homely truth; " and it tends to sustain and demonstrate the justice of the remark of the late Sir James Coxe, when he wrote of "that spirit of inflation which is a too prevalent characteristic of writers on this branch of medicine."

Of 1,061 cases of recent insanity treated at the Frankford (Penn.) Asylum, the proportion of recoveries was 65.69 per cent. But, by an analysis of these cases, it has been shown that the recoveries of persons were only 58.35 per cent; and that, of those that recovered, there were so many relapses that the permanent recoveries were but 48.39 per cent. Had it been pos

sible to trace all the persons, and obtain their history, it is not at all improbable—it is, indeed, only too probable—that the number of permanent recoveries would have been reduced to forty per cent. These are the most reliable of all American statistics in regard to the results of treatment of so-called recent

cases.

Of the true results of treatment of all the persons received into institutions, irrespective of the duration of the disease, the most valuable statistics are those for which we are indebted to Dr. Arthur Mitchell of Edinburgh, and the late Dr. John Thurnam, for many years superintendent of the Wiltshire Asylum at Devizes, England.

Dr. Mitchell informs us that, in the year 1858, 1,297 persons were admitted, for the first time, into the asylums in Scotland. Twelve years afterwards, in 1870, the intermediate history of 1,096 of them was ascertained. Of those 1,096, no less than 454 had died insane, and 367 still lived insane; total, 821, or 74.91 per cent insane. And 78 had died not insane, and 197 still lived not insane; total not insane, 275, or 25.09 per cent. In general terms, three-fourths were insane, and one-fourth not insane.

Dr. Thurnam, having obtained the history until death of 244 persons admitted into the Retreat at York, deduced from the results the following general formula: "In round numbers, then, of ten persons attacked by insanity, five recover, and five die sooner or later during the attack. Of the five who recover, not more than two remain well during the rest of their lives; the other

three sustain subsequent attacks, during which at least two of them die."

This formula, and the statistics from which it was derived, were published some thirty years ago; but in this country nearly all of the writers upon insanity have shunned them as if they were the fructified germs of pestilence.

Another mistake, or, more properly, a blunder, a species of error condemned by politicians as more censurable than crime, has been made in the enterprise for the treatment of the insane. From the initiation of that enterprise, the great ultimate object has been to provide, for all the insane requiring humane guardianship, adequate accommodations in either hospitals, asylums, or other places where such oversight and direction would assuredly be rendered. It was for a long time hoped to accomplish this object by well-equipped hospitals alone; and this hope was encouraged, and perhaps stimulated into expectation, by the constant iteration and reiteration of the assertion of the eminent curability of the disease. If ninety, or eighty, or even seventy-five, of each hundred of insane persons could be permanently cured, and such was the impression given, - public benevolence would certainly properly provide for the comparatively small remainder, the more certainly so because it could be done at trifling expense. For these reasons the establishment of curative institutions, and curative institutions alone, was almost universally advocated, not merely by the medical superintendents, but by other interested persons as well. In these establishments the curable could be cured, and the incurable domiciled for life.

Then arose the not illogical argument, "The better the hospital, the greater will be the number of persons cured." But most unfortunately, not for the enterprise alone, but for the treasuries of States and the purses of the payers of taxes, the word "better" in this proposition was in some places practically interpreted more costly." Under this rendering, the ambition of architects, the pride of commissioners and superintendents, and the universal extravagance of the people during the years next following the close of the late civil war, strongly fortified and assisted this argument; and the practical consequences are now apparent in that class of hospitals-professedly charitable institutions which have cost from twenty-five hundred to four, or perhaps five, thousand dollars for every patient to whom they can offer a comfortable domicile.

As a direct consequence of the mistake and the blunder which have just been passed under review, the State of Massachusetts has recently opened, at Danvers, a hospital the cost of which, in appropriations and interest upon those appropriations, was, at the date of its opening, very nearly eighteen hundred thousand dollars; and yet that hospital, unless crowded beyond the number of patients for which it was designed, cannot accommodate the actual increase of patients within the State during the time occupied in its construction. Hence, notwithstanding eminent authorities have asserted, and other authorities have repeated it to the echo, that from seventy-five to ninety per cent of the insane are curable, yet during the last few years it has cost the Commonwealth of Massachusetts a thousand dollars a day, sabbaths included, to supply the shelter of a hospital (to say nothing of support) to the mere current increase in the numbers of its insane; and this cumulative cost will continue so long as she continues the construction of hospitals requiring an expenditure so exorbitant. It is submitted that no nation or state ever has been able to afford, and that no one ever will be able to afford, such expenditure for public charity from the public treasury until that millennial day in which all the ordinary laws of industry and trade, and all the present principles of the true philosophy of practical human life, shall have been changed. The wealthy may, and can, bear it; but its burden weighs grievously and oppressively upon thousands and tens of thousands in the humbler spheres of society. The life's blood of many is drawn, under the forms of law, in providing an ostentatious charity for a few, as "millions died that Cæsar might be great."

The scientist, the political economist, the statesman, the philosopher, or the moralist, who recalls the comfortable simplicity in which, forty-five years ago, Drs. Wyman and Todd and Woodward lived amid the scenes of their labors, and who now beholds the contrast presented at some of the more modern institutions, and remembers that during the intervening period the average proportion of reported recoveries at the hospitals has diminished not far from twenty-five per cent, will not long hesitate in his decision whether the greater progress has been made in the direction of the perfection of science, or in that of the luxurious display which, in olden times, was a precursor of the decay and the downfall of the Roman Empire.

Such is a cursory view of the past. We come now to the