f dementia praecox. At the beginning, however, the
condition was superficially similar to that of a benign stupor, it being
only on careful observation that other symptoms were noted.

CASE 21.--_Rose S._ Age: 23. Admitted to the Psychiatric
Institute April 5, 1905.

_F. H._ The mother was living, the father dead. Otherwise
no pertinent information was secured.

_P. H._ The patient was said always to have been somewhat
seclusive, mingling little with other people; this tendency
was so strong that she would leave the room when visitors
came. She always slept a great deal. It was stated that she
was able to do heavy housework quite well, but never
learned cooking.

At 16 she hired out as a servant for a year and a half, and
then did laundry work. When 18 she had an illegitimate
child by a co-worker.

_History of Psychosis:_ About a year before admission the
patient's sister was burned to death. When the patient
heard of this she said that something had come up in her
throat. Henceforth she often complained of a lump in her
throat, and often bit her nails. Two months before
admission she suddenly left the laundry, again spoke of the
lump in her throat, and claimed to have seen the dead
sister. Two weeks later when the family had an anniversary
mass for the sister the patient appeared sad, but the
following day laughed, said she had seen her "sister
beckoning her to come." She also thought she saw her
picture "and Heaven was behind it." She also talked of
"dead relatives and friends." A reaction of levity in
connection with a sister's death is highly suggestive of a
malignant psychosis.

Two weeks before admission her mother found her in a
stupor, immovable, with her eyes closed. In 24 hours she
woke up, began to sing "Rest for the Weary," prayed, then
was stuporous again for six hours. When she came out of
this, she said she was "going to die," God had told her so
and talked of her own funeral arrangements. She again went
into a stupor, in which she was sent to the Observation
Pavilion.

At the _Observation Pavilion_ she was described as happy,
laughing, singing, saying she felt happy, but adding, "I
like to be sad too, I am going to Heaven Easter Sunday."
She claimed that