patient is said to have worried about it, but was otherwise quite natural until seven days before admission. Then, at the engagement dinner of the brother, the psychosis broke out. She refused to sit down to the table, and then suddenly began to sing and dance, cry and laugh and talk in a disconnected manner. Among other things, she said "I hate her," "I love you, papa" (father is dead), "Don't kill me." She struck her brother. She was in a few days taken to the Observation Pavilion.

The patient stated after recovery that what worried her was that the brother would marry a Protestant and that he would leave home (favorite brother).

At the Observation Pavilion she was excited, shouted, screamed, laughed, called out "Don't kill me," again "Brother, brother," "You are my brother" (to doctor).

Under Observation: 1. On admission, and for two weeks, the patient presented a marked excitement, during most of which she was treated in the continuous bath. She tossed about, threw the sheets off, beat her breasts and abdomen, put her fingers into her mouth, bit the back of her hands, waved her arms about,

sometimes with peculiar gyration, etc., at the same time shouting, singing, again praying, laughing or crying, sometimes fighting the nurses and resisting them. She also talked quite a little as a rule, but there were periods when, although excited, she would not talk or answer questions. She was very little influenced in her talk by the environment. When on one occasion asked if she had any trouble, she said: "No—I don't want, somebody else gave me a book—all right I love myself, Uncle Mike too—all right too—all right I am in Bellevue—I love everybody except the Jews all right, all right—give me water, give me milk, give me seltzer—white horse uncle—Holy Father, he is killing me, I want my mother," or "Wait a minute, say, that's a lie—oh no, Holy water—no I didn't wash the water away—oh, she forgets, I am sick—mother why don't you come—look at the baby, they knocked my head against the wall—wait a minute, isn't that terrible?—I was married—I was so—I forgot—April fool—I kiss you seven kisses and one more—I love papa and mamma, I like others too—I am papa's angel child—yes I confess I love him, but I don't want to die myself." On another occasion, when asked where she was, she said: "I am at the ball—I am going to Heaven—don't shoot me" (affectless). (Why are you afraid?) "Because you see—high water (in the tub)—white horse." (What about the water?) "My name is Caroline—if you love me, father, tickle me under my feet," or, rolling her eyes up, "Oh, isn't that awful, that ring, that diamond, that is the key to Heaven."

2. For about ten days she was somewhat different. She became quieter and at first lay muttering unintelligibly, saying some things about being killed, but speaking little, often restlessly tossing about and tremulous. She had to be tube-fed. On one day (July 1) she smiled more and talked more, said to the physician "You have been arrested for me—you arrested the first man that I ever—New York State—let me see that book" (note pad). Then she went on: "Oh, I am all apart—diamonds—they didn't know—must I keep them clean?—what is your name?—that is another thing I would like to know." But when asked what house she was in she said: "This is the same Ward's Island" and then added, "How long have I been here?—there is my picture up there (register), who is that? (listening) it's Ida

..." She began to sing softly. Then again she whined. "O mamma, mamma!" When asked how long she had been here, she said: "Since Decoration Day, when my father went in my sister's house, nobody could catch up with me—somebody blackened her eyes." When asked whether she was sick, she said "No, insane."

Although, as was stated, she said at one time, "This is the same Ward's Island," usually questions regarding orientation were not answered, as she gave few relevant replies, but she repeatedly said spontaneously that she was in "Hoboken or Bellevue," and called the nurse by the name of a former teacher. A few days after this state had developed she had a fever. Once this rose to 104°. The fever lasted two weeks, coming down gradually. It was associated with a leucocytosis of 15,000 on June 29 (no differential count) and with coated tongue. No Widal (two examinations). No diazo (July 1).

3. Then while the temperature still lasted she developed a stupor which persisted for about a year. During this time her temperature rose to 100° without ascertainable cause. She lay for the most part motionless, changing her position but rarely; her expression was stolid; she retained and drooled saliva, wet and soiled herself. She never answered any questions; showed no interest whatever. At times she was quite stiff and very resistive but never cataleptic. Her extremities were cold and cyanotic. She had to be tube-fed throughout. During this time she lost much hair.

After some months she occasionally gazed about furtively, or later watched everything when unaware of being observed; at this time she also smiled occasionally at amusing things, or perhaps said "yes" or "no" to questions, but usually was stolid when interrogated.

Then about nine months after admission, while in the condition just described, she developed a lobar pneumonia. During it she remained the same. But during convalescence she began to speak and eat.

4. A period followed lasting six months during which she was up and about, but sat or stood around a good deal. On the other hand, she helped the nurses a little when urged. Her face was often stolid, again she looked about. At times (even

nearly to the end) she drooled and soiled. She said little. At no time was she resistive. On other occasions she smiled or laughed, not always on provocation, or she showed little playful tendencies, such as throwing a pillow about the room, tearing leaves from the plants, taking the doctor's arm and walking down the hall, asking him to kiss her. At such times she often looked quite bright, keen, alert and amused. Towards the end she would give at times playful answers, such as "I came to-day," or "This is the Hall of Fame." This tapered off, so that by December, 1910, she was perfectly well.

Retrospectively, the patient claimed not to remember the upset at the dinner, or what happened afterward, although recalling the trip to the Observation Pavilion. She denied any memory of the journey to the hospital, but could tell what ward she came to. How well the condition after that was recalled, was not inquired into, except that she could or would not explain further the utterances during the first period. For the stupor period it is stated that she remembered many external facts, but it is not clear in which period they occurred.

Catamnestic Note. May, 1913: She has worked efficiently, and is said to have been perfectly well.