“The pathognomonic symptom is the persistence of the limbs in a state of balanced muscular contraction, so that they retain the position in which they were placed at the commencement of the attack. The limbs may be readily moved by the observer, but they retain the attitudes in which they are left, and these sometimes for hours, sometimes for days. “Perception and volition are lost; the condition resembles that of ‘brown study;’ the circulation and respiration are uninterrupted.” Catalepsy seems to rank between tetanus and epilepsy, and, according to Dr. Jones, depends on the simultaneous morbid affection of various nerve centres which, when separately affected, produce but one disorder,—hysteria, tetanus, or epilepsy. CASE XXIX. HYSTERICAL CATALEPSY—MANY YEARS’ DURATION—OPERATION—RELIEF—REMARKS. MRS. ——, æt. 33, widow; admitted into the London Surgical Home May 5, 1865. _History._—Never had any children, and but one miscarriage. Menstruation began when she was fourteen, and she was then first attacked with fits. From the patient’s description, they would seem to have then been of a cataleptic character; there was no loss of consciousness. From the age of 21 up to the present time, besides slight convulsive attacks in the daytime, she has been subject to fits at night, occurring irregularly, but averaging one a week, and always after each menstrual period. They commence with a strong convulsion, which lasts for a few minutes, and is succeeded by perfect rigidity of the body and unconsciousness for half an hour or more. Are preceded by headache during the day. Catamenia appear regularly, but are scanty. Acknowledges constant peripheral excitation, and says that, during marriage, she never had pleasure _in coitu_. The dilated pupil, hot skin, moist palm, and other unmistakable symptoms, plainly pointed to the cause of her disorder. May 6. Excision of clitoris and the very elongated nymphæ. Free hæmorrhage was allowed before the wound was dressed. The operation was, in this instance, only successful in diminishing the frequency and intensity of the fits. The following is the description given by the house-surgeon of an attack some days after the operation:— “While conversing with the house-surgeon this morning, she had a slight convulsive attack, not lasting more than thirty seconds, and characterized by the following phenomena:—No loss of consciousness, rigidity of limbs, with tonic contraction of the flexor muscles, and strong contraction of the orbicularis palpebrarum.” Whenever visited, and frequently when the wound was dressed, these fits recurred; but towards the end of the month the number considerably diminished. She was discharged on June 15th, very much improved in health, and decidedly relieved by the operation. CASE XXX. HYSTERICAL CATALEPTIC FITS OF LONG DURATION—OPERATION—CURE.