The 1845 Lunacy Acts had established the Lunacy Commission, the national body for asylum oversight, and ways to collect information from asylums through annual statistics returns. Stricter requirements to keep accurate records were placed on asylums, as well as legal requirements to provide a diagnosis at the point of admission. Together these factors established the bureaucratic frameworks that opened the opportunity for asylum statistics to be collected, collated and published. The chapter demonstrates how the debates on clinical classification discussed throughout this volume found their origins in these bureaucratic developments. The chapter then discusses a classification developed by David Skae that attempted to merge psychological diagnostic categories with suspected causes of insanity, with the aim to formulate a scientific foundation to classification. Skae’s classification was partly formulated in response to the perceived shortfalls of the terms recommended by the Lunacy Commission, which he considered vague, confusing and unscientific. Skae’s work would attract a sizeable following within British medical circles, and resonated especially with those who that wanted a more scientific basis to classification and diagnosis, and garnered enough support to become a serious contender to replace the Pinelean forms included in the Table of the Forms of Insanity.