March 1. Much improved; has written to her sister, and amused herself knitting and reading during the day. March 2. Allowed to dress; seemed to enjoy the change, and is very cheerful. March 4. Visited by her sister; has been quietly cheerful all day. Is certainly improving wonderfully. March 20. Took a walk, and enjoyed it. March 25. Spent the day away from the Home with her sister; returned looking quite well, and all the better for the change. April 2. Discharged quite cured. This patient remained perfectly well, and I hear has since been legally married. CASE XLVIII. INCIPIENT MANIA—ONE YEAR’S DURATION—OPERATION—CURE—SUBSEQUENT PREGNANCY. In 1863, Mrs. S. M., married, mother of three children, æt. 30, came under my care, because she had been suffering for more than a year from menorrhagia, which had gradually affected her mind, causing her to have a great distaste for her husband; so much so, that he and his friends were induced seriously to contemplate a separation. On the first examination, her face indicated mental disturbance, eyes restless, pupils dilated, and manner generally excitable. She told me that she could not sleep at night, complained of constant weary uneasiness in her womb, pain in her back, great pain on defecation, constant desire to micturate. She said she was glad to be away from home, as she made every one around her unhappy. Believed that she would be a permanently insane patient, and never expected to return to her family again. On more minute examination, I found irritable clitoris and labia, a painful fissure of the rectum, with great relaxation of the sphincter ani, which, on inquiry, was found to be caused by the frequent introduction of her finger, with a view to peripheral irritation. At her own request, she had long been separated _à mensâ_ from her husband, on account of her great distaste for him and cohabitation with him. I pursued the usual surgical treatment, which was followed by uninterrupted success; and after two months’ treatment, she returned to her husband, resumed cohabitation, and stated that all her distaste had disappeared; soon became pregnant, resumed her place at the head of her table, and became a happy and healthy wife and mother. She was in due time safely delivered, and has ever since remained in perfect health. _Remarks._—From observations of this case, one feels compelled to say, may not it be typical of many others where there is a judicial separation of husband and wife, with all the attendant domestic miseries, and where, if medical and surgical treatment were brought to bear, all such unhappy measures would be obviated?