Among the structural changes which may cause the phenomena observed in insanity, physiology leads us to the conclusion that they must be connected with, firstly, the nerve tissues, and, secondly, the blood. It teaches us that upon the action that takes place between these elements the phenomena of mind depend.

Man is born with a nervous system of the highest type, and in accordance with what we know concerning the laws of hereditary transmission, with one which—though at the time of birth so far advanced morphologically as clearly to foreshadow its future excellence—we are entitled to believe possesses within itself certain potentialities of organic development, definite enough and powerful enough to ensure its evolution in given directions, so long as its different parts are acted upon by those stimuli to which they have been accustomed in the preceding individuals of the parent race. To a certain extent the infant is even born already possessing capabilities of receiving impressions and of executing movements—corresponding parts of its nervous system being more advanced than others in histological development. And it may be stated generally, that these capabilities and these powers are gradually strengthened and extended in a definite order, as particular parts of the nervous system advance towards a more perfect development of tissue—that is to say, as nerve-cells and communicating nerve-fibres gradually arise out of the less specialised embryonic tissue which formerly occupied their place.

Shakespeare has used the character of “Achilles” to pourtray in vivid language his own conception of a malady of the mind which modern pathologists choosing to consider have made familiar to us under the term of “General Paralysis.” Doubtless, the recognition of this as a distinct phase of insanity necessitating confinement in an asylum dates from comparatively recent times, but Shakespeare not only remarked and described the chief symptoms, but also noted them as constituting a disease of the mind, though probably he would not have classed those so afflicted with the rest of “Bedlam Beggars.”.

In the dominion of Canada and the adjacent provinces, embracing a population of three and a half millions, there are eleven asylums and hospitals for the insane. The smallest of these accommodates forty patients—the largest, six hundred. Their character, as curative institutions, varies equally with their capacity. The annual reports of the greater number present very satisfactory returns as to the proportion of recoveries, the rate of mortality, and their economical administration. No one institution will be found to excel on all these points, but the statistics of those best managed will compare favourably with those of the leading asylums of Britain or America.

The constitution of man is tripartite; his well-being depends upon the soundness of his physical, mental, and moral condition. These three conditions are quite distinct, though they do not exist separately; a combination of them all in their different degrees and relations is necessary to the right exercise of their respective functions. They are all material, that is, they are essential conditions of the structures which represent them, and on the integrity of which their existence depends. There may be some hesitation in admitting this statement as regards the moral qualities, at the same time there is a wide difference between the feelings and passions which man possesses as a creature, and the principles of justice, mercy, and truth which are the attributes of the Creator. Mere feelings and passions belong to animals as well as to man. It is the association of these with the higher principles of which man's nature is capable that constitutes the emotions. The distinction between his moral qualities and the higher principles with which man has been endowed in order to guide them is, that the former move him in so much as they affect his physical condition, the latter simply raise and elevate his whole character. Thus, the passion of anger may excite a man and flush his face, disappointment may depress him, and fear blanch his features, but the exercise of justice, mercy, and truth do not disturb him; in proportion as he possesses these qualities he rises above his natural condition, and in proportion as he is deficient in them is his tendency to become degraded.

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.

The volume of the Irrenfrennd commences with an article on the writing of the insane. The following conclusions are quoted from a pamphlet by Dr. Th. Güntz :— “1. The writing of the insane exhibits various deviations from what is normal, both as regards quantity and quality. 2. These deviations are important in so far as they frequently give the first indication of the commencement of insanity. 3. They often give the best key to the aetiology, genesis, and duration of the disease. 4. They frequently complete or correct our conception of the nature of the disease. 5. They furnish a certain test of the advent and progress of convalescence.”

In the remarks which I am about to address to you, my aim is not to contribute any new facts to the clinical history and the pathology of the condition known as aphasia, but to weigh the bearing of the facts already recorded, to examine how far these support the theories that have been based upon them, and to set forth as definitely as may be possible the kind of conclusions warranted by the state of our knowledge. It appears to me that inquiry into this obscure subject has arrived at a stage when little or no further profit can accrue from an aimless accumulation of observations, and that what is now needed is a digestion of the material which lies at hand.