“A respectable tradesman, between fifty and sixty years of age, of temperate habits, was knocked down during an electioneering contest, and struck his head on the ground. He was stunned for a few minutes by the shock, and slightly bruised above the right temple, but experienced no further inconvenience, and the circumstance was considered of no consequence. “About six months after the event, he was seized, one evening, with rigors and a pain over the right brow; a smart reaction took place, which terminated in perspiration, and the following morning, the symptoms disappeared. A similar paroxysm came on daily for five or six days; the attack was considered intermittent, and, I believe, bark was freely administered. At the end of a week, the patient was well. After this period, he was subject to occasional pain over the right brow, accompanied with great mental despondency, the prevailing apprehension being that of eternal damnation. This state would continue for an uncertain time, the duration varying from a few days to three weeks; and by slow degrees he would lose all trace of disease, regain his accustomed cheerfulness, and be able to transact the affairs of an extensive business. “About two years from the occurrence of the accident, I saw him, at the request of his friends, while he was labouring under great despondency, which his relations assured me arose from some religious opinions he had imbibed; and I found that the medical treatment had been in accordance with such a notion. My inquiries led to the detection of the injury he had received two years previously, but neither the patient nor his friends would allow that there was any connexion between the blow and the symptoms under which he now suffered. Both general and local bleeding appeared to me necessary; a strict regimen was adopted, and he regained his usual flow of spirits, and expressed himself much better than he had been for years. The occasional use of leeches, and a rigid abstinence from fermented liquors, spirits, and stimuli of all kinds, maintained this favourable condition for a considerable time; but his occupation led him to occasional excess in diet, and a moderate quantity of wine or beer invariably brought on despondency and its accompanying hallucination; in other words, when the system was kept in a tranquil state, the cerebral functions were not impaired; but when excited, the morbid manifestations of the mind were produced. “During one of these attacks he cut his throat, and expired in the course of a few hours. A short time previous to his death, when greatly exhausted by the loss of blood from his wound, his intellect was unclouded, and he expressed to me his astonishment at what he had done, and assured me he had no reason for acting thus; but it was an impulse which he could not resist.