The observations that naturally suggest themselves on this case on the efficiency of mild treatment, are so obvious, that it would be obtrusive particularly to state them. I cannot, however, omit adverting to the fact of the probability of his having lost his toes by exposure to cold, because it illustrates the remark made in observation V. Patients, in former times, were kept naked in loose straw; and from their exposure to cold, mortifications in the extreme parts were common; and then writers on insanity say, that mortification of the extreme parts and insensibility to cold, are symptoms of mental derangement!!—See also observation 12th. _No._ 19.—_Admitted_ 1800. Nothing on record. He was a respectable tradesman. He is constantly muttering and talking to himself, apparently busy in making calculations, holding in his hand something he calls an almanack, made by himself, as well as some pieces of money he has polished. He repeats something, seemingly as a duty imposed upon him, perhaps meant as a prayer. Though the shrivelled and decayed scraps of mind that remain, look only like the apparitions of his previous habits of life; yet they so wholly engross his attention, that he never notices passing and external objects around him. Sometimes, however, he can with great difficulty be for a moment diverted from his object, and while roused, will answer questions with considerable point and shrewdness, but returns as quickly into the same uniform abstracted state. He is evidently of a contented and happy disposition. There is something in his appearance and countenance which seems to say, “I have been a respectable and good-natured fellow.” OBSERVATION X. The only observation here is one which I shall notice more particularly when I come to treat on the efficacy of moral management—viz. that, notwithstanding the deranged state of his mind, and the imaginary objects which occupy his attention, still he can be roused for a moment to something like a proper use of his faculties. _No._ 20.—_Admitted_ 1801. Nothing satisfactory on record. Said to have been a violent maniac. He was kept naked on loose straw. Since that time it is said he was improved by a seton; but still he was to the last a stupid, heavy, idiotical looking man, and in reality was so. {168} That he was less dirty, and kept himself dressed, was owing to better habits, into which proper management had gradually moulded him. But his mind was irrecoverably gone; he was motionless and silent, unless spoken to, or urged to some action. His replies were merely monosyllabic, and these only correct when they referred to something he had formerly best known; he was, however, drilled into some degree of usefulness, in helping about the wash-house. He was removed by his friends in April, 1821. [Picture: No. 20 page 168] _No._ 21.—_Admitted_ 1801.