the patient was totally mute. The exceptions
occurred mostly when her resistance was called forth. Thus
one day when fed she said, "I wish you people would have
more to do," or on another occasion, when she had resisted
being brought into the examining room, she said, "I will
get out of here if I break a leg." But once when the nurse
accidentally tickled her, she said, "Since I am ticklish, I
must be jealous--I should worry." She also answered very
few questions and such responses as she made were chiefly
expressions of resentment. Thus, when one kept urging her,
she finally would say "stop," or after much urging "I am
going to hurt you pretty quick." Sometimes she said "Go
away," or "Let me alone." She was just as silent with the
mother and the priest as with the physicians. On one
occasion she told the nurse that the priest had told her to
talk to the doctors, but that she had nothing to say.
Sometimes she did not even look at the visitors, but turned
away from them, as she did from the physicians, but at one
visit from a priest, though she scarcely said anything, she
held on to him when he was about to depart and would not
let him go. Throughout this period, since scarcely any
answers were given, nothing was known about her
orientation, except when on admission she gave a few
answers. She then thought she was at the Observation
Pavilion, seemed unable to tell even that the physician was
a doctor, but knew the date. When asked how she came to
Ward's Island, she said "By ambulance." The physical
condition presented nothing of note, except for a certain
sluggishness of the skin with marked comedones.

2. By _January_, 1914, the picture changed somewhat and she
then presented the following state for an entire year: The
mutism persisted and indeed became even more absolute, and
she began to wet and soil constantly. This commenced as
what seemed to be an act of spite as a part of her
resistiveness, for the first time she soiled she seemed to
do it deliberately when the nurses insisted that she allow
them to put on a dress. Later this explanation no longer
held. Tube-feeding too was for the most part necessary, the
resistiveness continuing as before. But the inactivity was
broken into much m