These establishments have scarcely received their due share of attention and discussion in the pages of the ‘Journal of Mental Science.’ To account for this, the principal reason is, no doubt, that medical practitioners feel themselves less at liberty to write about private houses and private cases than about those large public institutions which have become necessary in almost every county. This is not to be wondered at, for charitable and pauper institutions, where the poor themselves pay nothing except through the regular assessments, have always been considered peculiarly the places where more extended observations could be made than amongst private patients. However, as there is much that is different in the management, and in the social, though not in the moral and medical treatment of the two classes of patients, the observations which I shall make will probably not be considered out of place.