2. For eight days her condition was sometimes one of marked reduction of activity, with preoccupation. She sat in a dejected attitude, and had to be urged to do anything. Sometimes she was very slow in greeting and slow in answering, and said very little. But whenever spoken to she was apt to cry and this might
lead to such distress that the reduction of activity was no longer to be seen. Thus on June 28, when greeted, she began to cry and say, "Oh, what have I done!—Oh, just cut my head off—Oh, please what have I done—I have given my hand." (Tell me the whole story.) Imploringly and with hands clasped: "No, I can't do it—just cut my head off, please, please." (Why can you not tell me?) "Oh, what have I done!" The imploring to cut her head off was then several times repeated, and she could not be made to answer orientation questions. On June 29 she became agitated spontaneously and cried loudly, saying, "Oh, let me go home and die with my father." She was then put to bed, and when seen she could not be made to answer orientation questions. But when asked whether she had seen the physician before, she said, "I saw you yesterday." She could not be made, however, to say how long she had been here, "I think a"—not finishing the sentence. Although she would not answer further, she presently began to say "Oh, cut my head off—oh, where is my papa and mamma?" When told that her people were in Germany and that she could go back to them, she said "I haven't any money to pay it." Then she wanted to know if she was to pay for her board and bed and said she could not do it.
Again, on July 1, although she had been quite preoccupied, inactive and silent, she began to say when greeted, "Oh, please cut my head off." But she then answered some questions, said she had not worked enough. On questioning, she explained it was not that the work had been too much, but that she had been nervous, had tried to work as much as the servant next door, but could do only half as much, "Oh, I ought to have worked."
Repeatedly on other occasions she begged, with distress, to have her head cut off or to be killed. Frequently there were statements of self-blame: she ought to have worked more, was lazy or "I am not worthy"; or she said she had lied and stolen; or again, "I have not paid for these beds and I cannot," or "I am a bad girl."
3. For a month she presented a more marked reduction of activity. She sat about with a dejected look, often gazed in a preoccupied manner, or she stood or walked around slowly. Sometimes she had to be spoon-fed. At other times she ate slowly. Toward the latter part of this period, a distinct tendency to
catalepsy appeared. During this period, too, as a rule (though not always), she would cry when spoken to. A few times she would make some ineffectual motions when questioned, but she scarcely ever spoke.
4. Then followed a period again lasting about one month in which the picture was at times one of still greater inactivity. She would retain uncomfortable positions, allow flies to crawl over her face. She presented resistance in the jaws, did not react to pin pricks. She sometimes sat with eyes closed or, with an immobile face, the eyes stared with little blinking. The catalepsy was more decided. She often would not swallow solid food but swallowed fluid. Again she held her saliva, sometimes drooled. Once she held her urine and had to be catheterized. When spoken to she once smiled at a joke, sometimes there was no response, but as a rule there were tears or flushing of the face. On the physical side, there were marked dermatographia and, for a time, towards the end of the period, profuse sweating. Throughout the stupor proper her temperature was between 99° and 100° as a rule.
5. The period which followed and which lasted about two months was characterized, like the one just described, by marked stupor symptoms, associated, however, with more resistance, while the crying practically disappeared. On the other hand, a number of plainly angry reactions were seen and, towards the end, smiling and laughing. She lay in bed, on her back, staring, allowing the flies to crawl over her face; retained uncomfortable positions without correcting them, and her arms often showed a decided tendency to catalepsy. Sometimes she soiled. She constantly held saliva in her mouth, though she did not often drool. She was totally mute, did not respond in any way except in the manner to be presently indicated. She had to be tube-fed a good part of the time, was quite resistive when an attempt was made to open her mouth. When attended to by the nurse, she was apt to make herself stiff. But as a rule, she was not resistive to passive motions when tested. On a few occasions she had, as was stated, marked angry outbursts. Thus on one occasion when her temperature was taken she angrily pushed the nurse away and then struggled vigorously. On another occasion, when the bed-pan was put under her, she threw it away angrily and struck
the nurse; once she did the same with the feeding tube. She struck a patient, on another occasion, when the latter came to her bed. On two occasions she suddenly threw herself headlong on the floor. Towards the end of the period, when the blood-pressure was taken, she smiled and then laughed out loud. She could be made to smile again later.
6. The last period, before the more definite improvement, lasted about a month. She was inactive and slow, ate slowly (feeding no longer necessary), and was mute. But she did not stare, was no longer resistive, no longer held saliva. She appeared indifferent, but could be made to smile quite readily when spoken to. On one occasion she laughed out loud when a comical toy was shown her, again was amused at a party. In the beginning of the period she was once seen to cry a little when sitting by herself, and at the same time wept a little when spoken to, but this was now isolated. Towards the end of the period she spoke a little, asked for paper and pencil and wrote: "Dear Mother.—I only take up the pencil in order to write you a few lines. We are all cheerful and in good health and hope that you are the same and we congratulate you on your birthday 19th of December that I have not written to you for a long time were in the same ..." (Translated.) This was written very slowly.