The baby was born three weeks before admission. The patient seemed much worried immediately after the childbirth, fretted about not having enough milk, was quite concerned about her husband and did not want him to leave her side. The brother stated that about this time the patient heard that the husband was out of work. She worried about this and told her sister so. She also began to say that her head was getting queer. On the fifth day after childbirth, a change came over the patient. She cried and said she was going to die. She also spoke of poison in the food and accused the husband of unfaithfulness. The next day she became silent, "did not seem to want to have anything to do with anybody," lay in bed, had a tendency to pull the covers over her head and scarcely ever spoke. But during this period she continued to look after the baby faithfully. Sometimes she clung to her husband, saying she was afraid he was going to die.
After recovery the patient said that while she was at home she thought she saw bodies lying about.
At the Observation Pavilion she was quiet and apathetic, indifferent to environment and could not be induced to speak. She soiled, refused food, and was resistive when anything was done to her.
Under Observation: 1. On admission the patient was fairly well nourished but looked rather anemic and weak. The temperature was normal, the pulse a little irregular but of normal frequency, the tongue coated. She lay inactive but looked about, and the facial expression sometimes changed as she did this. Any interference met with intense resistance. There was no catalepsy. In contradistinction to this inactivity and resistance, natural, free motions were observed at times, as, for example, when she arranged her pillows. She did not speak and could not be made to answer.
For the rest of the first week she made no attempt to speak, except once when she seemed to attempt to return a "good morn
ing," or on another occasion, when the nurse tried to feed her, she said, in quite a natural tone, "I can feed myself." The resistance to interference remained in a variable degree, and was at times quite strong. It was largely passive, though not infrequently associated with a scowl, or she moved away when approached. She sometimes looked dull and stared, again she looked determined, "disdainful," or scowled; or she looked about watching others, sometimes only out of the corners of her eyes. She had to be spoon-fed at times, again she ate naturally when the food was brought. Repeatedly, when taken out of bed, though she resisted at first, she dressed with natural free motions. She always retracted promptly from pin pricks.
Towards the end of the week she even complied at times with a request to do some work, but on the same day she would remain passive, with a look of disdain, or resist intensely when interfered with, e.g., when an attempt was made to make her sit down. She never soiled and never showed any catalepsy.
2. Then the condition changed, inasmuch as the marked resistance ceased entirely, and the mutism gave way first to slow and low answers, and later to much freer speech, though the inactivity improved only gradually. Thus at the examination on February 19, though she was quite inactive, she answered some questions, albeit in whispers and briefly. This was the case when questioned about the year, month and date, which she gave correctly, but she merely shook her head when asked how long she had been here, why she was here, what was the matter with her. Once she smiled appropriately. Later she became freer in speech, with a more natural tone, although her answers continued to be short. Not infrequently, when asked to calculate or to write, she would not coöperate, saying "This has nothing to do with my getting well," or (later) "What has that got to do with my going home?" or she would simply say she did not want to. Improvement in her listlessness and inactivity was more gradual.
The prevailing affective state was indefinite. She denied repeatedly that she was depressed, though later she admitted once being downhearted, yet it seems that even then her mood was not so much one of sadness as of a slight resentment. On one occasion, however, she showed some tears when asked about the baby. She repeatedly expressed the wish to go home, but not in a plead
ing, rather in a resentful, way, saying she would never be better here, that the questions which were asked had nothing to do with her going home, that she would be all right if she went home. She never admitted that she had ever been sick enough to be taken to a hospital, though she quite appreciated that there had been something the matter with her head at home and in the hospital. She stated, in answer to questions, that she had a peculiar feeling in the head which she could not explain, that she could not remember so well as formerly. Once she said, "I hear so much around here that my head gets so full."