A fortnight later she was quite well, being entirely free since the operation from maniacal attacks; but she complained to my son, Mr. Boyer Brown, that I had unsexed her. He answered that nothing of the sort had been done, but that the operation had prevented her from making herself ill. From this time she steadily improved, and walked out with her husband every day, who called on me many weeks later to express his gratitude for the complete restoration of his wife to health; for whereas before his nights were passed in constant fear, rendering his life most wretched, his home was now one of comfort and happiness both night and day. CASE XLVII. ACUTE HYSTERICAL MANIA—FOUR MONTHS’ DURATION—OPERATION—CURE. Miss ——, æt. 23, was sent to me by Mr. Radcliffe, stating that she had been brought over from Ireland as an insane patient, and that everything had been settled for her admission to some asylum, when he was induced to consult me on the last day before her entering one. He stated that the paroxysms always came on at half-past five or six every evening: I replied, if the attacks depended on peripheral irritation, that an operation would at once prevent recurrence of the attacks. She was accordingly admitted into the London Surgical Home Feb. 6, 1864. When admitted, said she had taken no food for three days, and asked for a cup of tea, which was given her. Enema was also administered. 3.45 p.m. Was seized with a fit, throwing her arms up over her head, and then appearing as if comatose. In about twenty minutes revived: the lips began to quiver, and she gradually became conscious, saying, “I want a knife—I want blood!” She asked for the matron’s hand, that she might bite it off. [The fit coming on earlier on this day was doubtless due to excitement consequent on her removal.] 5 p.m. Mr. Baker Brown saw her; as soon as he came near her, she seized his shoulder with great violence; was wild, and would not answer questions; but gradually became soothed, and allowed an examination. _Externally_, the abdomen showed signs of a child having been born, and the mammæ had certainly contained milk. The _clitoris_ was enlarged and hard; the _nymphæ_ long and flabby; the mucous membrane roughened and discoloured. _Per vaginam_, the _uterus_ was found to be retroverted; there was also a fissure of the _rectum_. _Operation_, 5.30 p.m. Was very violent under the first attempts to administer chloroform. She was long in being brought under its influence, but when once thoroughly anæsthetized, bore it exceedingly well. The clitoris was excised, the elongated nymphæ removed, and the fissure of the rectum divided. The wounds were dressed in the usual manner, and the patient having had two grains of opium administered, was ordered to be constantly watched. In twenty minutes awoke from the chloroform. Was calm, and slept at intervals during the night.