Six days before admission she suddenly became excited, refused to eat, and began to talk, repeating phrases over and over. Then she became elated and excited.
After recovery the patient described the onset of her psychosis as follows: Six days before admission, after having been perfectly well and without any known cause, she was feverish and vomited, but slept well. Next day she felt nervous, and her thoughts were clear. She constantly thought of dead friends, heard them talking, when she tried to do anything the voices said, "Don't do that." She also thought somebody wanted to harm her people. Soon she started singing and felt happy.
Then she was sent to the Observation Pavilion, where she appeared to be in the same condition which was observed in the Institute.
Under Observation: 1. On admission she was in good physical condition, except for her skin seeming greasy. She presented for nine days the following picture: She was essentially elated, laughing, singing, jumping out of bed, good-natured and tractable, and very talkative. Her productions showed a good deal of sameness and a certain lack of progression. She spoke at times in a rather monotonous voice, but again often in very theatrical tones, with much, rather slow, gesturing. The following are very representative samples:
"I have been suffering from my own blood, my own blood sent all away from home. I just came from Bellevue. I left here last May (correct) a healthy girl. A sister is a sister—I wonder why shorthand is shorthand, a stenographer is a stenographer (seeing stenographer write)—a kind brother, Bill H.—why H. his wife is a sister-in-law to us, she has four children—four beautiful children—sister-in-laws and brother-in-laws—telephone ringing (telephone did ring)—dear Lord, such a remembrance—remembrance was remembrance, truth was truth—honesty is honesty—policy is policy—if she married him, she is my sister-in-law and he is my brother-in-law—Max knows me—she changed her name to Mrs. R.—two children who are Rosie and Maud, if names were given, names should not be mistaken—they are Julia, Lillian—Rosie and Maud—why should wonders wonder and wonders cease to wonder, why should blunders blunder and blunders still blunder; sleep is one dream and dream means sleep
—if move is moving, why not move?" When she accidentally heard the word wine, she said "Guilty wine is not in our house—wine is red and women are women, and women and wine and wine and women and wine and song." Again, "You are not Mr. Kratzberger, Mr. Steinberger, Mr. Einberger—you are not Mr. Horrid or Mr. Storrid—perhaps you are Mr. Johnson or Mr. Thompson—no, you are Dr. C." (correct).
She was quite clear about her environment.
Although the mood was throughout one of elation, on the ninth day in the forenoon she cried at times, wanted to see her mother, and spoke in a depressed strain (content not known). A few hours after that she suddenly became quiet.
2. Then for four days (March 14-17) she was markedly inactive, though at times got out of bed. She looked about in a bewildered manner, did not speak spontaneously, but could with urging be induced to make some replies. She did this now fairly promptly, now quite slowly. Questions were apt to bring on the bewilderment. Thus, when asked where she was, she merely looked more bewildered, finally said "Bellevue—I don't know," and questioned who the doctor was whom she had called by name in her manic state, she said, with some bewilderment, "Your face looks familiar." (Where have you seen me?) "In New York." She claimed to feel all right. There was no real affect. She made the statement that at home she heard voices saying "You will be killed."
3. Henceforth this bewilderment ceased, and for 16 or 17 days she was essentially inactive for the most part, for a short time with a tendency to catalepsy and some resistiveness, and at that time lying with eyes partly closed. As a rule she said nothing spontaneously, but replied to some questions, usually with marked retardation, again more promptly. She constantly denied feeling sad or worried, repeatedly said she felt "better," only on one occasion did she cry a little. When asked to calculate she sometimes did it very slowly, again fairly promptly. The simple calculations were usually done without error, the others with some mistakes. As to her orientation the few answers obtained showed that at times she knew the name of the place and the day, again she gave wrong answers (Bellevue). Once asked on March 23 for the day, she said April. She wrote her