enough to be taken home. Though she continued to
work for over two weeks, she worried over many trivial
matters and talked much about this. She also said that
everything looked queer at her home and complained of
having difficulty in concentrating her mind. Finally she
became elated and talkative. Nothing is known of any
special ideas.

At the _Observation Pavilion_ she appeared to be typically
manic.

Then she was sent to an institution where she remained for
six weeks. The report from there stated that she was for
ten days "elated, excited, talkative, with flight of
ideas." Then her condition suddenly changed to a marked
reduction of activity, in which she neither spoke
spontaneously nor answered questions. She "appeared to
sleep," but was said to have talked to her people. When
interfered with, she was resistive and sometimes let
herself fall out of bed. On the other hand, she
occasionally wandered about at night. It should be added
that during the stupor an alveolar abscess developed which
discharged pus. It was washed out and healed.

Then she was sent to the Manhattan State Hospital and
admitted to the service of the Psychiatric Institute.

_Under Observation:_ 1. On the first day she lay in bed
with cyanotic extremities, weak pulse, grunting, moaning
and not responding in any way when examined. After this the
moaning and grunting ceased and she was essentially
indifferent, and for the most part kept her eyes closed.
Often she wet and soiled herself. She was resistive to any
care or examination. She would not eat, as a rule, but
again gulped down milk offered her. For a considerable time
she had to be tube-fed. During the early part of this
stupor she once took a paper from the doctor, examined it,
and then gave it back without saying anything, or again she
peered around silently, or asked to go home, or again, on a
few occasions, answered a question or two or spoke some
unintelligible words. Orientation could not be established.

2. After a few weeks she became more rigid, a condition
which continued for six months. She let saliva collect in
her mouth, and drooled. She had to be tube-fed. She lay
very rigid, with very pronounced general tension, with her
lips puc