“The paroxysm resembles epilepsy, and sometimes closely, but it differs in essential particulars. The difference is not one only of degree, neither is it to be determined by the relation of hysterical convulsion to pain, nor solely by the nature of the spasm. The diagnosis is to be based upon a combination of features. The paroxysms follow hysteric prodromata. At their onset there is constriction of the throat and epigastrium; there are plaintive cries, sobbings, or laughings, which reappear at the close; _sensibility, perception, and volition are rarely, if ever, completely lost_; the face undergoes little change; there is a twinkling movement of the eyelids; there is no marked dilatation of the pupil; _there is rarely foaming or bitten tongue_; the attacks are of long duration; respiratory movements are disorderly, but there are no evidences of marked asphyxia; the pulse is small; there is no stupor, but only general exhaustion after the attack; and although the paroxysms may recur for many years, and be followed by a peculiar kind of mania, they are rarely followed by dementia.” I fully agree with Dr. Reynolds that what are called the “diagnostic signs of hysteria,” as frequent micturition of clear pale urine, tympanitis, nausea, &c., have no value in aiding our inquiry as to the nature of these fits: they may be witnessed, and with as great frequency, after epileptic seizures. One practical point exists; namely, that in hysterical epilepsy the patient seldom, I believe never, in falling hurts herself, whereas true epileptics frequently suffer considerable bodily injuries. CASE XXII. NINE YEARS’ ILLNESS—EPILEPTIFORM ATTACKS—THREE YEARS’ DURATION—OPERATION—CURE. G. M., single; admitted into the London Surgical Home December 18, 1860. _History._—For the last nine years has suffered greatly and regularly during the menstrual periods. Has been much worse for the last three years, during which time has, at each menstrual period, been frequently taken in a fit, dropping down suddenly and fainting right off; this state lasting for two or three hours. Being in service, this has caused her much trouble, as none of her employers would keep her. For the last six months has suffered severe pain over right ovary, increased by exercise or pressure, and at the menstrual period. Believing that the dysmenorrhœa and fits both arose from the same cause, on January 3, clitoris was cut down to the base. After this operation she never had a fit, and all untoward symptoms left her except the dysmenorrhœa; she was therefore re-admitted May 27, 1861, and there being some narrowing of the cervix, it was incised with the hysterotome. June 21, catamenia came on without pain, and continued to do so regularly. In July she was well enough to return to service.