The patient was a well-built man with florid complexion, 70 years of age. He had been in the Crichton Royal Institution for 18 months as a voluntary patient, and was subject to periodic attacks of nervous excitement, during which he was restless, unable to keep still for a moment, had spasmodic movements of the arms and legs, and lost his appetite. When free from excitement he was able to take long walks and never complained of dyspnóa. The action of the heart was usually steady and regular, but towards the end of an attack of excitement it became rapid and feeble. A mitral presystolic murmur had been present for some years. He died suddenly one morning during an attack of excitement. There was a history of gout.