iary, malarial infection, which it was maintained he had
contracted in this hospital.

He was readmitted here on March 15, 1914, on a medical certificate
which stated that the patient said he snuffed cocaine prior to
admission to the navy; that the murder he believes he committed was
due, according to his statement, to the refusal of the victim to
permit sexual intercourse. The patient has at present the same fixed
delusion of having committed this murder in 1909. He wants to expiate
his crime to escape those who are continually hounding him. When
irritated he flies into a rage, cries, tries to do himself injury, and
talks incoherently. For no cause, while working in the yard, he struck
a fellow prisoner and pursued him with a shovel. During maniacal
attacks he can be restrained only with much difficulty, smashes
furniture in his cell, and is slovenly in habits. Complains constantly
of numbness and needle-like pains in vertex. As a probable cause,
prison routine was given. It will thus be seen that the same fraud
about the murder, which served at one time to bring him an additional
sentence of a year, was considered at another time one of the symptoms
which justified his return to this hospital. The patient's version of
the reason for his return is as follows: Soon after his transfer to
Portsmouth the guards began to annoy him, calling him crazy guy, hard
guy, etc. He also got into trouble with the sergeant because the
latter cursed him, began to express the same ideas about the murder,
and thought this was the reason they sent him back.

The mental examination and physicians' notes made during his second
admission showed no gross psychotic symptoms. The patient still
maintained that he actually committed this crime in Rochester, and
related it in great detail. He stated that when he was confined in
Portsmouth Prison he became remorseful over this crime and decided to
confess. His conduct during his second sojourn here was exemplary. He
appeared at conference on April 20, 1914, and a diagnosis of
psychopathic character was made. The opinion was expressed that it was
extremely difficult to pick out the truth from the abnormal elements
in the patient's story, and that there were a great many things in the
general emotional reaction of the patient that fitted into the story.
It was believed that the patient had a sort of determination to get
into diff