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We have, then, in the revised table, the percentage of moral causes in 1843, 58 per cent.; in 1848, 43 per cent.; in 1863, 11 per cent.; in 1866, 4 per cent. For the four years since 1866, there have been 1,427 cases admitted, whose previous history was known, from all parts of the State, from every variety of natural endowment and social condition, with, every form and degree of insanity, and not a single one originating in moral causes. Connecting this fact with what is affirmed repeatedly in connection with the statistics, viz., that in the increasing light thrown upon the causation of insanity, by improved means of pathological research, and more comprehensive views in the profession, the retroactive inference is unmistakable, that had these been brought to bear upon the cases of earlier record, the moral causes would have been equally wanting.

May it not be asserted, then, that this paper, if it proves any thing, proves that all cases of insanity, when properly investigated, will be found to have had their origin in physical causes?

Subordinate to the main argument of the paper is a statement of the sequences in the phenomena of insanity. The following, he thinks, "experience warrants us in assuming as fundamental starting-points." And herein I think that his views may correspond with those of many of his professional brethren. Thus, insanity more frequently has its primary origin in pathological states outside of the brain than in primary diseases of the brain, though the reverse order of physical causation may be true. But the insanity is not manifested until the brain is actually involved. That there are physical signs and symptoms, by which experience enables us to trace the progress of cerebral disease, anticipating its successive features, is very certain. But every thing in the paper, in the way of doctrine or suggestion, hinges upon the invariability of the dependence of insanity upon brain-disease for its origin and nature. But, is this proved? First, as to the causes. Let us take the question as he found it. Dr. Brigham, the first Superintendent of the New York State Lunatic Asylum," held, with Pinel, Esquirol, and Georget, that moral causes were far more operative than physical in the production of insanity. In 1851, Dr. Jarvis, in an exhaustive paper upon the subject of the causes of insanity, sums up the statistics then accumulated, with this remark: "The moral causes are, according to the record, almost as abundant as, and probably they really are more abundant than, the physical causes."

Dr. Griesinger (in the second edition of his work, 1861) says: "The psychical causes are, in our opinion, the most frequent and the most fertile sources of insanity, as well in regard to preparation, as especially and principally the immediate excitation of the disease. We recognize, meanwhile, that this view rests not only on statistics, but also on the collective impression of many observations, which are often concealed in their most important details, or this impression would probably be a still stronger one." We have, then, on the one hand, looking at the opinions of alienists as a body, a pretty general belief that the moral causes are the predominating ones; or, at least, very commonly the sources of insanity. We have, on the other, a few members of the profession, of whose views Dr. Gray is the exponent, who deny the existence of moral causes in producing insanity.

To accept the views of causation set forth in this paper, we must either concede that the facts presented are more conclusive, or else that the arguments offered are more convincing than those which he at the foundation of the other belief referred to.

To follow the order of the paper, let us first examine the facts presented. The fallacies that may lurk even in the table given, showing the "analysis of causes," may arise from three or four, not to mention other causes: a preconceived theory in the mind of the parties who controlled the records upon which the table is based; the difficulty in getting at the facts precisely; and, finally, in the arrangement of the facts and in the inferences drawn from them.

The bias of the mind that guided, during the last twenty years, in the collection of the statistics here embodied, can hardly be questioned. Dr. Gray frankly says, at the very outset: "I early observed that, in those cases of which full and reliable information could be obtained, the physical cause was generally found; that some change in some part or parts of the organism preceded the earliest manifestations of mental disturbance; that in those cases some diseased condition of the body, outside of the brain, generally preceded the cerebral symptoms and the consequent insanity." (When he says here cerebral symptoms, he means, of course, symptoms of cerebral disease.) The logical temper of mind, if I may so express myself, which he brings to the investigation of the subject and collation of facts, may be seen in the following passage: "We hold that it is not necessary, in order to establish the physical origin and nature of insanity or other cerebral diseases" (meaning psychical symptoms), "to show that every case is of such origin and nature. If, in a single case, insanity is shown to come on as the result of a well-recognized bodily disease, and the mental disturbance disappears pari passu, with the physical restoration, the argument is invincible." (I shall return to this quotation hereafter.)