Nine weeks before admission a messenger came into the shop where she worked and said, "Rosie, your father is dead" (the message was intended for a fellow worker). In spite of the fact that the matter was explained, she was upset and nervous enough to be taken home. Though she continued to work for over two weeks, she worried over many trivial matters and talked
much about this. She also said that everything looked queer at her home and complained of having difficulty in concentrating her mind. Finally she became elated and talkative. Nothing is known of any special ideas.
At the Observation Pavilion she appeared to be typically manic.
Then she was sent to an institution where she remained for six weeks. The report from there stated that she was for ten days "elated, excited, talkative, with flight of ideas." Then her condition suddenly changed to a marked reduction of activity, in which she neither spoke spontaneously nor answered questions. She "appeared to sleep," but was said to have talked to her people. When interfered with, she was resistive and sometimes let herself fall out of bed. On the other hand, she occasionally wandered about at night. It should be added that during the stupor an alveolar abscess developed which discharged pus. It was washed out and healed.
Then she was sent to the Manhattan State Hospital and admitted to the service of the Psychiatric Institute.
Under Observation: 1. On the first day she lay in bed with cyanotic extremities, weak pulse, grunting, moaning and not responding in any way when examined. After this the moaning and grunting ceased and she was essentially indifferent, and for the most part kept her eyes closed. Often she wet and soiled herself. She was resistive to any care or examination. She would not eat, as a rule, but again gulped down milk offered her. For a considerable time she had to be tube-fed. During the early part of this stupor she once took a paper from the doctor, examined it, and then gave it back without saying anything, or again she peered around silently, or asked to go home, or again, on a few occasions, answered a question or two or spoke some unintelligible words. Orientation could not be established.
2. After a few weeks she became more rigid, a condition which continued for six months. She let saliva collect in her mouth, and drooled. She had to be tube-fed. She lay very rigid, with very pronounced general tension, with her lips puckered, hands clenched, sometimes holding her eyes tightly closed, and often with marked perspiration. For one day she held her breath until she was blue in the face. On the same day she was extremely
rigid, so that she could be raised by her head with only her heels resting on the bed. Her eyes were tightly shut and she was in profuse perspiration. Sometimes she interrupted this by a deep breath, only again to resume the forcible holding of her breath. On another day towards the end of the period, while quite stiff, she kept grunting and screaming "murder." The soiling continued. She never spoke.
Physical condition during the stupor: At first she had a coated tongue, foul breath and a fetid diarrhea. The latter was treated with high colonic flushing and mild diet. Urine normal—gynecologically normal. General neurological and physical examination not possible. At the same time she had for two weeks a temperature which often reached 100° or a little above, a weak, irregular but not rapid pulse, a leucocytosis of 17,500 and 80% hemoglobin. When she began to refuse food and before she was tube-fed regularly, she twice had syncopal attacks and lost considerable flesh which was gradually regained under tube-feeding. After the diarrhea she was habitually constipated. Cyanosis of the extremities seemed to have been present only at first.
3. Six months after admission she began to make very free facial movements—winking, raising the eyebrows—and soon developed an excitement with marked elation. She had to be kept in the continuous bath, talked continuously, whistled, sang, was markedly erotic towards the physician, careless in exposing herself and often obscene in her talk. Most of her productions were determined by the environment. She was therefore quite distractible, very alert; sometimes she was meddlesome, again irritable, irascible. The following illustrates her productions: "Send for my husband, S.—He had one sister as big as that. She likes candy.... My father is underneath and my mother is on top because she is fat and he is skinny.... Wait till the sun shines, Nellie—we will be happy, Nellie—don't you sigh, sweetheart, you and I—wait till the sun shines by and by.... Come in (as noise is heard)—I bet that is my husband—my name is Regina K. (mother's name)—my mother's name is the same—I got a little sister named Regina—she is my husband." When she heard the word pain, she said, "Who says paint, Pauline used paint, I used paint," etc.