order of their entrance into the specialty were in active service each during a part of that decennium, and, at one period, all of them simultaneously. Such a body of men, acting at a time in which the enterprise for the insane was in its most plastic and impressionable stage, could not fail to leave upon it the lasting evidences of their ability.

But the imperfection, and consequently the fallibility, of human nature are such that the conduct of an enterprise, even though it be for charitable purposes, can no more be wholly free from mistakes than can the conduct of each individual life. And thus it happened, that, in the early history of our specialty in this country, the zeal and the rivalry of those by whom it was prosecuted gave to the public mind a false impression, from which sprang hopes and expectations that could never be fulfilled.

As early as 1827, by a combination of fortuitous and favorable circumstances, Dr. Todd, of the Hartford Retreat, was able to report the recovery of twenty-one out of twenty-three recent cases of insanity received into that institution. This remarkable result was reduced to a formula; and the percentage (92.3) thus derived from less than one quarter of a hundred of cases was published, and became more or less a criterion by which to measure the possibilities in all recent cases.

Dr. Woodward, at Worcester, adopted the fallacious method of calculating the proportion of recoveries upon the number of patients discharged, instead of upon that of the number admitted, and in this way had succeeded in reporting a percentage of 841 in 1836. Early in the following year Dr. Bell took charge of the McLean Asylum, and Greek met Greek upon the arena of the professional specialty. The decennium last noticed was soon entered upon, and the several superintendents above mentioned came successively into the lists. Before each of them stood the stimulating, the provocative precedent, of erroneous percentages; and around each of them was the competitive ability of his colleagues in the specialty. It is no cause for marvel, that, under these circumstances, a public opinion was formed upon the curability of insanity, too favorable to be sustained by the experience of the future. This opinion was enunciated by a few superintendents at an earlier date; but, considered as an established idea in the minds of the people, it was the fruitage of the decennium in question, more than of any other in the whole history of the past; and thenceforward it has very generally been claimed, that, of all cases

of insanity of less duration than one year, from seventy-five to ninety per cent are susceptible of cure. For more than forty years in respect to a few, and more than thirty years in respect to many, this has been the shibboleth of the superintendents of the hospitals, and of other writers upon the subject of mental alienation; and especially has it been depended upon as one of the crowning arguments in favor of the establishment of new hospitals and the enlargement of old ones, and of appeals to hesitating and reluctant legislatures for additional appropriations of money for the completion of unfinished ones, for which the purse of the commonwealth had already been taxed beyond the bounds of reason and of patient endurance.

But recent investigations have demonstrated the fallacy of the claim to a degree of curability so extensive. The experience of the hospitals during the last forty years has given to the statistician the results of a number of cases sufficiently large to form a basis of somewhat reliable general conclusions. In no single instance of the treatment of a thousand recent cases, has the recovery of even sixty-six per cent been reported. And in the most valuable and reliable statistics upon the subject, even the proportion reported was attained, in large measure, by the repeated recoveries of a few individuals from a multiplicity of attacks. The deceptive nature of the word cases was thus exposed. The superintendents reported the recovery of cases. The unprofessional readers of the reports, thoughtless of the technical use of the word, believed that case is equivalent to person, and, consequently, that the number of cases represented an equal number of persons. When the Bloomingdale Asylum reported, without explanation, six recoveries in one year, all of which were furnished by one woman, who was again brought to the asylum before that report was in print, and who finally died there, the public necessarily inferred that six different persons had recovered; and the same is true as applicable to the Worcester Hospital, when it reported, without explanation, seven recoveries in one year, of a woman whom it had reported as recovered no less than nine times in the course of the next preceding two years, making sixteen recoveries in three years.

In order to impress the mind with an accurate estimate of the recoveries as annually reported at the hospitals, without analyzation or explanation, permit me to adduce a few further facts.

At the Northampton (Mass.) Hospital, five persons have recov

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 them - and 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 possible 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, more than two remain well during the rest of their lives; the other

not