It is being found out that cases of insanity may of themselves fall naturally into two classes: the first comprising those who get well, and the second those who do not. To the first class belong the deliriums of fevers and other like diseases, and also certain acute manias and melancholias and the so-called generalized insanities. In the second class are included the insanities which last indefinitely, or, if seemingly cured, which, in the proportion of from twelve to fourteen per cent, come back again one or more times, and finally do not recover. Says Regis: "Out of all forms of mental alienation or insanity only the generalized types--i. e., mania and melancholia--are curable. The systematized insanities are essentially chronic and recover only exceptionally" (Practical Manual of Mental Medicine, page 54). The latter are known by such specific names as paranoia, chronic mania, chronic melancholia, insanity of doubt, circular insanity, hereditary insanity, and the like. What makes such a division of insanities into these two classes significant is not only that those of the first class get well and the others do not, but that, generally speaking, these latter are so founded in the constitution of the individual that they can not recover, let everything as yet possible be done for them as it may. Probably there are exceptions to this; but, if so, they are not very often met with. All these cases seem to be doomed from the very first either to follow a slowly downward grade to the very end, or else to manifest a series of alternate better and worse stages, which, while giving rise to bright hopes of ultimate recovery, nevertheless just as surely tend more or less rapidly downward, in pretty strict accordance with the rule. In passing, it may be noted that not only the tragedy of such alternations of emphatic despair and delusive hope constitutes not the least of the wretchedness involved in the history of these cases, but that it is by no means the easiest thing about them to manage; for, in the earlier stages, it is almost impossible to make associates or relatives understand the full meaning of the disease, or to take a correct view of its probable outcome. Even much later on they cling to the possibility of recovery, which is as delusive as it is painful, for the disease goes on, nevertheless, with varying stride and manifestation, until it finally becomes evident that hope is almost absolutely without any real foundation.