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Cause, if known. 6th. If hereditary, name the relationship of those who have been similarly affected. 7th. Now under Treatment. Stating the number of months. 8th. Discharged improved. Stating the number of months since. 9th. Discharged unimproved. Stating the number of months since. 10th. Private means. This may be stated fractionally as 1, J, f , &c. 11th. Partly at public expense. This may also be stated in fractions if desired. 12th. Wholly upon public expense. 13th. Able to earn a living by... his or her own labor. This may be stated fractionally as 1, J, f , so as to express the degree of a liability. 14th. Living in poor or alms houses. 15th. Accustomed to solicit alms. 16th. Remarks. Under this head to be entered any peculiarity which the infirmity may present. Of the insane, the character* istic halucination or tendency, as gentle, violent or destructive, whether confined or at large, whether continuous or paroxysmal, &o. Of the Idiots, whether parents were blood relations, and if so, to what degree, &o.
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