Those of us who have kept our attentions directed to the insane poor of Middlesex—to say nothing of outside counties—must have been struck with their largely increased and increasing numbers year by year. Whilst it is a high source of satisfaction to us to know that there are diseases, neither few nor far between, which it is in our power to very materially modify and diminish, if not entirely to eradicate—whilst, in other words, typhus and cholera and other bodily ailments succumb, in so material degree, to light, air, and water—it must be and is with deep regret we are compelled to confess our inability to contend, with anything like a parallel success, against the dominant and proximate causes so painfully rife among us throughout the length and breadth of this land, and within the small area of the county of Middlesex more especially, of the mind's disorders and irregularities of action. The art and science of hygiene embraces, it may be said (to speak critically), but the outside conditions, the accessory or predisposing phenomena, which lead to insanity; it takes cognisance of the distal links in the chain rather than of those proximal—of the remote and not the near or immediate cause of madness, ln what, then, it may be asked, does this proximate or immediate source or starting-point of this dire malady, as it exists among the unfortunate classes alluded to, consist? The reply is a brief one; a single word can embrace it in all its entirety, and that word is—” POVERTY.” Poverty, of which it has been truly said “it eclipses the brightest virtues, and is the very sepulchre of brave designs” It is, indeed, the boast of modern medicine to prevent disease—to strangle it at the birth. It is our pride to develop that condition of things in the physical world with which preventible disease is incompatible; but how and where shall we find the clue to the removal of poverty ? Is there no hope ? Can it be said that poverty is a normal state of things ? Is it not true, rather, that it is the mere product of a civilisation only spurious and unreal—of a Christianity only theoretical ? I am disposed to believe this, and hence it is I am sanguine that the beneficent results of a reformed and progressive legislation, dictated by the really good and truly wise among men, will, ere very long, so greatly diminish poverty that insanity will decline to no small extent among us. But pending such a state of things, and accepting the fact as it stands, let us see if we cannot lessen somewhat the evil complained of, i. e. attack the effects of poverty, or, what is the same thing, reduce more or less the great numbers of insane poor in Middlesex, for whom to this time there has never been, and is not now, the necessary asylum accommodation.