Annie P., æt. 35 years, had been an inmate of Rainhill Asylum for 12 years. She was subject to attacks of recurrent mania, in the intervals between which she would be quiet, orderly, and rational; the attacks usually lasted some months, and were attended with great restlessness and loquacity, but not with much incoherence. She was at these times very mischievous and destructive, and was indeed a very troublesome patient — generally appearing to have a very good notion of what she was about, and seeming to commit many of her destructive acts on purpose to give trouble, though this apparent capacity for self-restraint was doubtless illusory. In April, 1883, she had been for upwards of 18 months in a maniacal condition, which attack had thus been not only unusually prolonged, but had also been in some respects exceptionally severe. On May 1st following she did not appear very well, but exhibited at that time no special symptoms beyond a little mental dulness and some delay in responding to questions. These symptoms gradually increased, and though there were no physical signs of disease, patient called out at times when moved; she took her food fairly well, but had to be fed, and her bowels were freely relieved after medicine. At 2.15 p.m., on the 5th inst., a great change was observed in her; her face was noted to be livid, conjunctivae insensitive to touch, pupils much dilated, being each about 6 mm., and did not respond to light; respirations slow; pulse 80, full; temp. about 95° (the index did not rise at all, and the thermometer did not register lower); limbs flaccid; plantar reflex, very slightly marked, as also were the knee jerks. She was, in fact, deeply comatose, and presented all the symptoms of cerebral hæmorrhage, a diagnosis of which was, with some confidence, made. Two drops of croton oil were given, and an enema, but neither had any effect. At 5 p.m., in addition to deepening coma, there was distinct drawing of the angle of the mouth to left. The eyes were directed straight forwards, or with a very, slight external deviation in each. At 10 p.m. every muscle in the extremities appeared absolutely flaccid, and the reflexes were completely abolished. Pupils as before. Respirations irregular, with mucous rattling in throat. Pulse 110, bounding. Temp, about 95° (the index, as before, would not rise at all). 11.45 p.m., died.