It will be recollected how, at the end of the chapter on Hysteria, I gave three cases of extreme nervous irritability, with sleeplessness, and tendency to an unhinging of the mental equilibrium. We now come to insanity itself. It would be vain to talk of the varieties of forms in which this state may be seen, when produced by abnormal peripheral irritation of the pudic nerve. It is, however, worthy of notice how each history seems to tell its own explanation of the cause; and after the first few days of treatment, when excitement, caused by irritation from the wound and a natural repugnance to restraint, has passed off, how rapid is the improvement, and how permanent is the result. I have no hesitation in saying that in no case am I so certain of a permanent cure as in acute nympho-mania; for I have never after my treatment seen a recurrence of the disease, whereas, under medical treatment, of how short duration is but too frequently the benefit. CASE XLIII. INCIPIENT SUICIDAL MANIA—MANY YEARS’ GRADUAL ILLNESS—OPERATION—CURE. R. T., æt. 39, single; admitted into the London Surgical Home Oct. 22, 1861. _History._—Has been ailing for many years, and given great trouble and anxiety to her friends. For some time past she has been very strange in her manner, very restless, never quiet, constantly wakeful, threatening suicide, talking to people, even perfect strangers, of her ailments and their causes, of which she is fully conscious. Was formerly modest and quiet. _On examination_, she is a fine woman, of restless appearance and manner; eye wandering and unsteady; pupil dilated. The cause of her mental derangement being obvious, on Oct. 24 the usual operation was performed. The improvement in her mental and bodily health was wonderful: she gained flesh, and became cheerful and modest. She was discharged six weeks after admission. When heard of in February, 1863, this patient continued quite well. The first case of actual insanity that came under my care was a patient of Dr. Warren Diamond, then resident in his private asylum. I cannot do better than transcribe the account which he sent me with the following note:— “Effra Hall, Brixton, S. “DEAR SIR,—A month having elapsed since you gave up your patient, I forward some particulars of the case, and shall be glad to answer more fully any special time or state you would like to know more about. You will, perhaps, be able to pick something out of this rambling account that may be interesting to you. Hoping you will excuse omissions, &c. “Believe me, yours faithfully, “WARREN H. DIAMOND.” “I. Baker Brown, Esq.” CASE XLIV. SEVERAL YEARS’ ILLNESS—TWO MONTHS’ INSANITY—OPERATION—CURE.