Of all the subjects legitimately belonging to the specially of psychiatry, or immediately connected with it, no one has, for the last few years, occupied a more prominent position in the United States, or called forth a larger number of words, oral, written, and printed, than the proper provision for the custody, care, and cure of the insane.

In the preceding papers I have endeavoured to review what is at present known of the clinical history of aphasia; having first ventured critically to analyse a certain number of cases recorded by independent observers in various parts of the world, I have then minutely detailed several cases which I have myself had the opportunity of personally watching.

The subjoined case owes its chief interest to the question of diagnosis involved in its consideration. The outline of the case is as follows:—

William G., set. 57, single, labourer, admitted into the Cambs. Asylum, Aug. 10, 1868. He was said to have had a previous attack of insanity at the age of 22, but to have kept well till within a few days of his admission, when he became noisy and excited. It was also stated that he had had four epileptic fits, but at long intervals.

The theories which have hitherto been advanced regarding the nature of the morbid process in general paralysis of the insane are based essentially on actual or supposed anatomical changes in the brain and its membranes. The spinal cord was, as a rule, very seldom examined. In the many records of post mortem examinations which have been published, it is scarcely ever referred to; and only in a few isolated, carefully-observed, and well-described cases (especially by H. Hoffmann), which remain almost unnoticed, has—if we exclude the uncriticisable cases of “softening”—any palpable disease of the spinal cord been established. Thus it came to pass that in the framing of theories regarding the nature of the paralysis, the spinal cord was either entirely ignored, or the purely cerebral character of the disease was expressly and emphatically inculcated as distinguishing it from other spinal affections.