From whatever cause this disease may be produced in women, it is considered as very unfavourable to recovery, if they are worse at the period of menstruation, or have their catamenia in very small or immoderate quantities.

At the first attack of the disease, and for some months afterwards, during its continuance, females most commonly labour under amenorrhœa. The natural and healthy return of this discharge generally precedes convalescence.

From the following statement it will be seen, that insane persons recover in proportion to their youth, and that as they advance in years, the disease is less frequently cured. It comprizes a period of about ten years, viz. from 1784 to 1794. In the first column the age is noticed, in the second the number of patients admitted; the third contains the number cured; the fourth those who were discharged not cured.

Age between Number admitted. Number discharged
cured.		 Number discharged
uncured.
10 and 20 113 78 35
20 and 30 488 200 288
30 and 40 527 180 347
40 and 50 362 87 275
50 and 60 143 25 118
60 and 70 31 4 27
1664 574 1090
Total admitted. Total cured. Total uncured.

From this table it will be seen, that when the disease attacks persons advanced in life, the prospect of recovery is but small.

From the very rare instances of complete cure, or durable amendment, among the class of patients deemed incurable, as well as from the infrequent recovery of those who have been admitted, after the complaint has been of more than twelve months standing, I am led to conclude, that the chance of cure is less, in proportion to the length of time which the disorder shall have continued.

Although patients, who have been affected with insanity more than a year, are not admissible into the hospital, to continue there for the usual time of trial for cure, namely, a twelvemonth, yet, at the discretion of the committee, they may be received into it from Lady-day to Michaelmas, at which latter period they are removed. In the course of the last ten years, fifty-six patients of this description have been received, of whom only one has been discharged cured. This patient, who was a woman, has since relapsed twice, and is, at present, in the hospital.

When the reader contrasts the preceding statement with the account recorded in the report of the committee, appointed to examine the physicians who have attended his majesty, &c. he will either be inclined to deplore the unskilfulness or mismanagement which has prevailed among those medical persons who have directed the treatment of mania in the largest public institution, in this kingdom, of its kind, compared with the success which has attended the private practice of an individual; or, to require some other evidence, than the bare assertions of the man pretending to have performed such cures[5]. It was deposed by that reverend and celebrated physician, that of patients placed under his care within three months after the attack of the disease, nine out of ten had recovered[6]; and also that the age was of no signification, unless the patient had been afflicted before with the same malady[7].

How little soever I might be disposed to doubt such a bold, unprecedented, and marvellous account, yet, I must acknowledge, that my mind would have been much more satisfied as to the truth of that assertion, had it been plausibly made out, or had the circumstances been otherwise than feebly recollected by that very successful practitioner. Medicine has generally been esteemed a progressive science, in which its professors have confessed themselves indebted to great preparatory study, and long subsequent experience, for the knowledge they have acquired; but in the case to which we are now alluding, the outset of the doctor’s practice was marked with such splendid success, that time and observation have been unable to increase it.