Confinement is always necessary in cases of insanity, and should be enforced as early in the complaint as possible. By confinement, it is to be understood that the patient should be removed from home. During his continuance at his own house he can never be kept in a tranquil state. The interruptions of his family, the loss of the accustomed obedience of his servants, and the idea of being under restraint in a place where he considers himself the master, will be constant sources of irritation to his mind. It is also known, from considerable experience, that of those patients who have remained under the immediate care of their relatives and friends, very few have recovered. Even the visits of their friends, when they are violently disordered, are productive of great inconvenience, as they are always more unquiet and ungovernable for some time afterwards. It is a well-known fact, that they are less disposed to acquire a dislike to those who are strangers, than to those with whom they have been intimately acquainted; they become therefore less dangerous, and are more easily restrained. It frequently happens, that patients who have been brought immediately from their families, and who have been said to be in a violent and ferocious state, become suddenly calm and tractable, when placed in the hospital. On the other hand, it is equally certain, that there are many patients, who have for a length of time conducted themselves in a very orderly manner under confinement, whose disorder speedily recurs after being suffered to return to their families. When they are in a convalescent state, the occasional visits of their friends are attended with manifest advantage. Such an intercourse imparts consolation, and presents views of future happiness and comfort. Many patients have received considerable benefit by change of situation, and this sometimes takes place very shortly after the removal. In what particular cases, or stages of the disease, this may be recommended, I am not enabled by sufficient experience to determine. MEDICINE. It is only intended, in this part of the subject, to speak of those medicines which I have administered, by the direction of Dr. Monro, the present celebrated and judicious physician to Bethlem Hospital, (to whom I gratefully acknowledge many and serious obligations) without descending to a minute detail of the hospital practice, or of the order in which they are commonly exhibited. Of the effects of such remedies, I am able to speak with considerable confidence, as they have come immediately under my own observation.