4. This apathy cleared up too, so that by the middle of March she was bright, active and smiled freely. With the nurses she was rather talkative and pleased, though this was not marked. Towards the physician only was she natural and free. She then gave the retrospective account of the onset detailed above. When questioned about her condition she claimed not to remember the Observation Pavilion, although recalling vaguely going there in a carriage. She was almost completely amnesic for a consider
able part of her stay in the Institute. She claimed it was only in November or December that she began to know where she was (five months after admission). In harmony with this is the fact that she did not recall the tube- and spoon-feeding which had to be resorted to for about four months of this period. No ideas or visions were remembered. As to her mutism she said, "I don't think I could speak," "I made no effort," again "I did not care to speak." She claimed that she remembered being pricked with a pin but that she did not feel it. She remembered yelling when taken to the tub (towards end of the marked stupor) and claimed she thought she was to be drowned.
When she went home (March 24, 1908) she got into a more elated condition. She was talkative, conversed with strangers on the street, said to her mother that she was now sixteen years old and wanted "a fellow." When the mother would not allow her to go out, she said it would be better if they both would jump out of the window and kill themselves. She then was sent back to the hospital. In the first part of this period after her return, she was somewhat elated and overtalkative, though she did not present a flight of ideas, and was well behaved. She soon got well, however, and was discharged, four months after her readmission, fully recovered.
After that, it is claimed, she was perfectly well and worked successfully most of the time with the exception of a short period in the spring of 1909, when she was slightly elated.
In 1910 she had a subsequent attack, during which she was treated at another hospital. From the description this again seems to have been a typical stupor (immobility, mutism, tendency to catalepsy, rigidity). According to the account of the onset sent by that hospital (it was obtained from the mother), this attack began some months before admission, with complaints of being out of sorts, not being able to concentrate and fearing that another attack would come on. Finally the stupor was said to have been immediately preceded by a seizure in which the whole body jerked. She made again an excellent recovery.
The patient was seen about two years after this attack, and described the development of the psychosis as follows: She claimed she began to feel "queer," "nervous," "depressed," got sleepless. Then (this was given spontaneously) she suddenly
thought she was dying and that her father's picture was talking to her and calling her. "Then I lost my speech." As after the first attack, she claimed not to have any recollection of what went on during a considerable part of the stupor but recalled that she began to talk after her brother visited her. It is not clear how she was during the period immediately following the stupor.
She made a very natural impression and came willingly to the hospital in response to a letter and was quite open about giving information.
Case 2.—Caroline DeS. Age: 21. Admitted to the Psychiatric Institute June 10, 1909.
F. H. The father died of apoplexy when patient was nine. The mother had diabetes. A paternal uncle was queer, visionary.