f before he
would submit to an operation. He refused to eat, saying that the food
was not fit to eat, and that he would refrain from taking nourishment
until he was given better food. A visit from his wife served to
appease him. When given a Hospital night-gown to wear he threw it
away, saying he could not sleep in coarse clothing, and this had to be
finally substituted by a silk one which his wife brought him. For two
weeks following this he was allowed the freedom of the courtyard,
where he was quiet and well-behaved, except when spoken to by the
physician. At times he would turn with lightning suddenness into a
maniacal state, and his paranoid ideas would come to the front, among
which his fear of being operated upon was always predominant. At this
time he had not completely transferred his paranoid ideas to the
officials here. His clouded consciousness cleared up completely. He
read the newspapers daily, took an active part in his immediate
environment, and except for the periodic outbreaks of rage when
talking to the physician, he showed no outward conduct disorder. He
was taking nourishment regularly after a special diet was ordered for
him. After a sojourn of about a month, the attention of the officials
was called to the fact that the patient was planning an escape by
overpowering the attendants, in which plot his wife, who was at that
time an inmate of a disreputable house, was to assist him by
furnishing him a gun. It was thought advisable to take special
precautions with the man, and consequently his freedom of the
courtyard had to be curtailed, and he was confined to his room. This
was immediately followed by a marked exacerbation of his psychotic
manifestations. He became very unruly, abusive and threatening. His
outbursts of fury assumed the character of an excited epileptic. They
differed, however, from this, in being accompanied by clear
consciousness, and in not being endogenetic in their occurrence, but
distinctive reactive manifestations to definite situations. Every
refusal of a request was followed by one of those outbreaks, during
which he would be profane, abusive, destructive and violent,
threatening to kill the officials who had anything to do with his
safe-keeping, and would elaborate an ill-defined general paranoid
trend towards them. He was simply persecuted by a bunch of unchristian
anarchists who were running this place;