Oct. 1. Progressing most favourably. Oct. 22. Leaves quite cured. 1866. This lady married, and was delivered August, 1865, of a living child. She is still quite well. It will have been observed that one very prominent symptom in many of the foregoing cases is sleeplessness, or perhaps more properly, frequent wakefulness at nights, and constant restless movements in the day. These are the cases which, if left to go on, are very liable to terminate in insanity. The three following are instances in which the hysteria was verging on this state, and as they can hardly be classed under the head of insanity, I prefer narrating them here. CASE XII. HYSTERIA—MENTAL ABERRATION, AND TENDENCY TO MELANCHOLIA—EIGHT YEARS’ ILLNESS—OPERATION—CURE. In December, 1861, a single lady consulted me, giving the following history of her illness:— Has not been well for seven or eight years; has felt languid, and not so lively as formerly. For the last two years has menstruated every three weeks, and the flow has lasted four or five days. There is considerable white discharge from the vagina after each period, lasting for a week. Great irritation about vulva, perinæum, and anus before and during each menstrual period. For the last five or six years had had occasional irresistible and unaccountable fits of depression; thinks that it is her mind—if her mind were as strong as her body she would be pretty well: her memory is good, but mind weak. Has suffered from great pain at lower part of the back; says she cannot rise from a chair without great difficulty, on account of a feeling of stiffness in hips and trembling of the legs (this is probably owing to a swelling of the hip-joint, as all the joints of her fingers and ankles are swollen). Says she can sit quietly to crochet or needlework, but cannot sit quietly to think, or compose her mind to write a letter: has not written a letter properly for three years. Has been subject to attacks of melancholy and weeping, without any tangible cause, but which she cannot resist. Suffers from want of sleep, and at night frequently lies awake four or five hours together. Appetite good; bowels costive. In appearance is fresh-coloured and plump, but she says she is thinner than formerly; dark eyes; large dilated pupils. _On examination_ there was evidence of great irritation about the vulva, and constriction of the anus, with a very small fissure. Dec. 21. I divided the fissure, and performed my usual operation. Dec. 31. Very much improved; swelling of the joints much less. Jan. 1. She sat up, and feels much better. Her spirits are improved; has no pain in the joints; sleeps well. In another month she returned home quite well, and has continued so to the present time. CASE XIII. EXTREME HYSTERIA, VERGING ON INSANITY—FIVE YEARS’ ILLNESS—OPERATION—CURE.