As it is just twenty years since I first became connected with this asylum—a considerable slice out of what should be the most active part of my life, and the period during which my judgment ought to be maturing—it occurred to me that a résumé of the changes and new departures which have been made here during that time, together with a statement of the views I now entertain of their utility, and the opinions which experience has led me to form for my future guidance, might not inopportunely form the subject matter of a paper this afternoon.

Notwithstanding all the elaborate researches that already have been conducted upon the cerebellum, much controversy yet exists as to its physiology, and a complete account of its functional relations, with the rest of the central nervous system, cannot yet be given. Rapid strides have been lately made, and many doubtful points elucidated by direct experiment upon lower animals, but the deductions drawn from them cannot be regarded as absolutely applicable to man until they have been confirmed by pathological observations on the human brain. With this in view, the case about to be related has been thought worthy of publication.

The subjoined notes are those of a case mentioned at the Association's meeting at Worcester, in connection with Dr. Bond's paper.

In a paper I had the honour of reading before you last December I called attention to the high percentage of patients who died of general paralysis of the insane showing post-mortem signs of disease of the kidney. The task I then set myself was to find out, if possible, what was the pathological relation between the two. The arteries seemed to me to be the only connecting link. I then proceeded to point out that a diseased condition of the cerebral arteries occurred in those dying with granular kidneys, very similar to, if not identical with, what is found in those dying of general paralysis of the insane. And, finally, I called attention to three possible explanations of this apparent relationship.

The term “insanity” conveys to the minds of lawyers and physicians two different meanings, based on two divergent methods of testing its presence, and a clear recognition of this fact would go far to prevent many misunderstandings which arise solely from the logical error of equivocation. The term insanity as used by each should of course be accurately defined, and the difference of meaning thereby made plain; but this has not been done, for to prepare an accurate and satisfactory definition of insanity appears to surpass the wit of man. Even had it been done in a theoretically perfect manner it would probably be of little or no value, for, like Mr. Herbert Spencer's definition of life, it would of necessity be so abstract as to give no assistance in practice. For my purpose here it will be sufficient if I indicate the lines on which the legal and medical definitions of this term would run.

The last time that I had the honour of reading a paper before this Association, I was told with some asperity by one of the subsequent speakers that the subject was not new, and that he himself had dealt with it some years before. It is better, therefore, that I should at once proclaim that the subject that I propose to deal with in the present paper is by no means new. It has been dealt with years ago by a sister Society, and it is dealt with every year by our own Association in our statistical tables. I venture to submit, however, that there is no necessary obligation upon any member of this or of any other learned body to confine his attention to matters that have never been dealt with before. It is not competent, I submit, to any member to draw a line round any department of knowledge, and to cry to all comers “Hands off! This is my preserve, and trespassers will be prosecuted.” Surely if we think, however presumptuously and erroneously, that we can see a way to advance knowledge in any particular direction or by any particular method, we need not be deterred from doing our best by the knowledge that the field we propose to till is not wholly unreclaimed ground, but has already been under cultivation to some extent.

General paralysis of the insane seems to have been first recognized and described by Willis, in 1672. It was fully described and established as a definite disease by Bayle, in 1822. It received its present title from Calmeil, in 1826.