H. L., æt. 25, single; admitted into the London Surgical Home January 27, 1864. _History._—This patient was sent to me by Dr. Pennefather, of Tottenham, with the following letter:— “Dear Sir,—The girl —— was some time since suffering from religious monomania; she is of hysterical habit and weak constitution, ever complaining of abdominal pain or uneasiness.” She also gave the following additional account of herself:— “Began to feel unwell about twelve months since. Had a very bad fever about five months ago, which left her perfectly prostrated. Always felt weak, and more or less subject to fits. Menstruation regular and never profuse. Great pain in the back and bearing-down feeling in the lower part of the body. Complains of great pain in defecation. Sea-bathing has benefitted her temporarily. Is incessantly crying without cause or power to prevent herself.” The day following admission she had a fit of a cataleptic nature, and lasting twenty-five minutes. After the fit the patient was left very prostrated. In addition to symptoms of pudic irritation, there was a small fissure of the rectum. January 24. Clitoris excised, and fissure divided. There was considerable secondary hæmorrhage in the excising, which, however, seemed to have a beneficial effect, as after it the patient expressed herself as more comfortable, and slept quietly. Feb. 14. Much more cheerful; has had no cataleptic attack or symptom of hysteria since the operation. Feb. 28. Has improved daily, and leaves the Home this day cured. CASE XXXI. CATALEPTIC FITS—TWO YEARS’ ILLNESS—OPERATION—CURE. M. N., æt. 17; admitted into the London Surgical Home September 4, 1861. _History._—Was perfectly well up to the age of fifteen, when she went to a boarding-school in the West of England. In the course of three or four months she became subject to all symptoms of hysteria, and from that time gradually got worse, having fits, at first mild in character and of rare occurrence, but gradually mere severe and frequent, till she became a confirmed cataleptic. For several months before admission, she had been attacked with as many as four or five fits a day, and during the whole journey from the North of England to London she was unconscious and rigidly cataleptic. She was seen immediately on arrival, and there was no doubt that it was a genuine case of this disease. So sensitive was she, that if any one merely touched her bed, or walked across the room, she would immediately be thrown into the cataleptic state.