She was married at 24. After a second confinement, at the age of 26, the patient had her first attack of manic excitement, from which she recovered in four months. She had, subsequently, at the ages of 28, 30, 32, 35, 43, and 45, other attacks of the same nature, each one lasting about four months. No precipitating cause was known for any of them. Only one of the attacks, the fifth, (none were well observed) seems to have shown features different from an elated excitement with irritability. At the end of this attack she was said to have been “dull” for a month. Her husband died four years before the present admission, evidently soon after her sixth attack. The present attack: About two months before admission the patient began, without appreciable cause, to be sleepless, complained of headaches and appeared downhearted and sad. She sat about. After a week she would not get out of bed and remained in bed until she was sent to the Observation Pavilion, getting up only to go to the closet. She said very little and would not eat much. About a month before admission she began to say that she did not want to live, begged her daughter to throw her out of the window. About two weeks before admission she began to insist that she heard the voice of her brother (living in Ireland) calling her. She got out of bed to look for him. At the _Observation Pavilion_ she was described as slow, looking about in an apprehensive manner, bewildered, dazed, saying “I am dead--there is poison in it (not clear in what)--I am dead, you are dead.” _Under Observation:_ 1. On admission the patient had a coated tongue, foul breath, constipation, lively knee-jerks and a pulse of 110. She appeared dull, inactive, lay in bed with her eyes closed. She would open them when urged but appeared drowsy and her face was strikingly immobile. At times she moaned a little. She could be made to respond in various ways such as shaking her head, or making some motions as though to indicate that she could not give any explanations. All movements were slow. She also responded to a few questions by “I don’t know.” Two days after admission the condition was not essentially different except that she was a little uneasy when urged to speak, corrugated her forehead, said “Everything is dark,” again “I am very sick,” or she turned away her head.