“Miss E. R., æt. 34, single; no occupation, living with her friends; hair light reddish-brown; face set and vacant, with an occasional pained expression; eyes fixed and dull; extremities damp and cold; stature moderate and well formed. Has for several years past been looked on by her friends as different from others—strange and eccentric. Would go out and walk away into the country alone for miles, and come back exhausted. When friends called, would start up and run round the garden, or to the top of the house and back again, giving no reason for it but that she must do it. Always exceedingly irritable and passionate. Unless some excitement was going on, was listless and unable to rouse herself. When at parties, was so forward and open in her manners, that she was generally avoided by gentlemen. _Never had an offer of marriage._ Her mother died about a year and a half ago, but she took no notice of the occurrence, and was consequently remarked on by her friends. Since then she has been getting more strange and peculiar. About February last, a sister told her, in joke, that if she did not take care she would soon become a fit subject for Dr. Diamond, little thinking how soon it would happen. She recently made enemies of old friends, so that her brothers could not make out why they fell off. Would sit or stand without noticing them when they called; and asked them what they wanted that they came to her house (she was the eldest of the family). “I was consulted about her in the end of March, but had then none of her previous history. She was vacant and dreamy; talked of flowers which she called her friends; said ‘people’s faces were masks; that she was quite unable to rouse or employ herself, as she was changed;’ very uncertain in appetite, going a day without her food; not sleeping at night, and for the last few nights showing such great excitement and passion, that her sisters were required to sit up with her. “I recommended change along the south coast, with sea-bathing, &c. She did not improve; and the attendant informing me of a constant irritation of the vulva, lotions were used, but without benefit. Her general health and appetite improved; but not the mind. She could not sleep, and would not bear narcotics; _stimulants acted as narcotics_, but soon lost their effect. “Bowels regular; pulse small and slow; action of heart being irritable, and not corresponding at all times to the power or quantity of the pulse. She sits up in bed, nursing the pillow, and talking to it as if it were a baby; says ‘that she died last Sunday’—‘is lost’—‘is buried.’