After her last confinement, twenty-three years ago, she had puerperal mania, from which she did not completely recover for six months. About a year ago she began to show symptoms of mental derangement, first exhibited in religious subjects, she constantly declaring that her soul was irrevocably lost. About eight months ago she first tried to destroy herself, by endeavouring to jump out of the window, &c., and it was at this time thought advisable to place her in an asylum, where she was kept four months, and when she left she was for a time much better. While an inmate of the asylum, was made to take much exercise, for which her husband says she is always better. She gradually got worse, and came under the care of Dr. Forbes Winslow, to whom I am indebted for the case. Her husband says that for the last two or three months she has slept pretty well from 10 p.m. till 2 a.m., when she would suddenly wake, and warn him that a “frenzy” was coming on. This frenzy consisted in her rising up, fighting out with her arms, and scratching or tearing any one near her; in the paroxysm the desire was always to destroy her husband. After a few minutes the mania would subside, and be succeeded, first by a kind of stupor, and then very profuse perspirations. One peculiarity about her is, that when in this state she does or says anything foolish, she knows it, and is afterwards very annoyed and ashamed of her conduct. She has a great fear that she will be permanently mad. The appetite has always been good, though she has said lately that she cannot bear food, and that it always causes a horrid taste in her mouth. She has, in a desultory manner, read many medical works, and fancies that every one of her organs is in some way or other diseased. _On examination_, she had the appearance of a woman about 60. Her eyes, of a dark grey, were never quiet, and could not look you straight in the face; the pupil was much and constantly dilated. The tongue quite clean, and pulse good. Heart, lungs, and other organs seemed to be healthy. She owned with great shame to long-continued pernicious habits. Dec. 14. I performed my usual operation. Dec. 21. Has very much improved, and had no “frenzies” since the operation; sleeps well, and for many hours, but will not own to being better. Complains of her skin being dry, and “burning hot.” It is, however, moist and cool; at times she perspires freely. Dec. 26. Both husband and nurse consider her much improved. She has been up both yesterday and to-day; sleeps and eats well. She is, however, sulky; says she is very bad, and shall soon die.