to occupy herself and made a perfect recovery.

She gave a rather shallow retrospective account about the
last phase: at first she said it was natural for people to
feel happy at times, and that she did not talk more because
the inclination was not there. The only point she added
later was that she held her fingers in the shape of a ring
because she was thinking of her wedding ring.

She was discharged on _October 11_.

The patient was seen again in _September, 1915_. She then
stated that she had been perfectly well until 1912, when
she had a breakdown after childbirth. (A childbirth in 1910
had led to no disorder.) The attack lasted six months. She
slept poorly, lost weight, and felt weak, depressed, "my
strength seemed all gone." In _July, 1915_, following again
a childbirth, she was for about six weeks "despondent, weak
and tired out."

At the interview she made a very natural, frank impression,
and displayed excellent insight.

CASE 13.--_Johanna S._ Age: 47. Admitted to the Psychiatric
Institute January 23, 1904.

_F. H._ It was claimed that there was no insanity in the
family.

_P. H._ The patient was said to have been bright and rather
quick-tempered. She came to the United States from Ireland
at the age of 20, worked as a servant, was well liked, and
retained her position well.

She was married at 24. After a second confinement, at the
age of 26, the patient had her first attack of manic
excitement, from which she recovered in four months. She
had, subsequently, at the ages of 28, 30, 32, 35, 43, and
45, other attacks of the same nature, each one lasting
about four months. No precipitating cause was known for any
of them. Only one of the attacks, the fifth, (none were
well observed) seems to have shown features different from
an elated excitement with irritability. At the end of this
attack she was said to have been "dull" for a month.

Her husband died four years before the present admission,
evidently soon after her sixth attack.

The present attack:

About two months before admission the patient began,
without appreciable cause, to be sleepless, complained of
headaches and appeared downhearted and sad. She sat about.

After a week she would no