Six months before admission she began to say she wanted to leave home, but made no move to do so. Then she began to speak of bad odors, made some remarks about the neighbors talking about her—saying she should kill herself; again she said the family would be brought to death, or the mother was falling to pieces, the father looked sick. She also said her head was swelling and was getting thick. Finally she wanted to hire a furnished room and kill herself and asked if 75 cents which she had was enough to do it with.
Two weeks before admission she left home, wandered about all night, was picked up by the Salvation Army, and returned to her home. She said she wanted to die.
At the Observation Pavilion she stated that her mother was falling to pieces and her father sick. She also said she wanted to die.
Under Observation: The patient was at first petulant, saying "I don't want to stay here," turning her face away from the doctor, generally uninterested. Though it could be established that she was quite oriented, often her answers were "I don't know," or she did not answer. But she was also seen crying at times, and she was apt to bite her finger nails. She had to be tube-fed. Gradually these tendencies increased so that she lay in her bed with head covered, saying in a peevish tone, when spoken to, "Oh, let me alone." And for years she was mute, lying with her head covered, tube-fed. When reëxamined in 1914 (ten years later), she was found lying in bed with an empty smile. There was paper stuffed in her ears. When approached, she turned her head away and would not talk.
Case 25.—Catherine W. Age: 42. Admitted to the Psychiatric Institute November 11, 1904.
F. H. The father died at 75, the mother at 44. Two sisters died of tuberculosis. A brother wanted to marry but was opposed by the father; he set fire to the house of the girl and then drowned himself.
P. H. The patient came to this country when 20, and worked for some years as a servant. Then she married after a short acquaintance. The husband, according to his own statement, drank, and there was friction from the first. She left him a few weeks after marriage, and a few months later he went to Ireland; she also went some time later but did not go to see him. Then they lived together again. They had four children, but had had no intercourse for nine years.
Development of Psychosis: Eight years before admission the patient became nervous, slept badly, but got better. It was claimed that for six years she had been quieter and more sullen than before. Three years before admission the patient had to take a place as janitress, since she needed the money. From the first she had trouble with the tenants and accused everybody of
being in league against her. Some six or eight weeks after she had taken the position, she developed what was called typhoid fever, and some time later the daughter came down with the same disease. After the typhoid she was more antagonistic towards her husband, accused him of infidelity, repeatedly locked him out of the house, but continued to do her housework. About six months after this illness she left her home, but returned in a week. She had vague ideas thereafter that the priests were saying things against the family, and she often quarreled with the tenants. For a year she had done no work but sat about. Ten days before admission she stopped eating.
Under Observation: The patient was mute, stolid, gazing straight ahead, sometimes cataleptic. She had to be tube-fed, was usually very resistive to any passive motions; quite often she retained her urine, but she did not hold her saliva. Yet there was some quick responses at least in the beginning. At such times it was found that she was oriented, but nothing could ever be obtained about her feelings, etc., except that she once said, when asked whether she was worried, that she "felt weak," had "nothing to worry about." Occasionally she was seen to cry silently; at times she would breathe faster when questioned, or flush; once she took hold of the doctor's hand when he questioned her, and cried, but made no reply. On another occasion she was affectionate to her son, kissed him, although she paid no attention to her daughter who accompanied the son. Later she said to the nurses, "He is the best son that ever lived." But more and more she became disinterested, totally inaccessible, resistive, had to be tube-fed. In this condition she remained for five and a half years. At the end of that time she died of tubercular pneumonia.