_Development of Psychosis:_ Eight years before admission the patient became nervous, slept badly, but got better. It was claimed that for six years she had been quieter and more sullen than before. Three years before admission the patient had to take a place as janitress, since she needed the money. From the first she had trouble with the tenants and accused everybody of being in league against her. Some six or eight weeks after she had taken the position, she developed what was called typhoid fever, and some time later the daughter came down with the same disease. After the typhoid she was more antagonistic towards her husband, accused him of infidelity, repeatedly locked him out of the house, but continued to do her housework. About six months after this illness she left her home, but returned in a week. She had vague ideas thereafter that the priests were saying things against the family, and she often quarreled with the tenants. For a year she had done no work but sat about. Ten days before admission she stopped eating. _Under Observation:_ The patient was mute, stolid, gazing straight ahead, sometimes cataleptic. She had to be tube-fed, was usually very resistive to any passive motions; quite often she retained her urine, but she did not hold her saliva. Yet there was some quick responses at least in the beginning. At such times it was found that she was oriented, but nothing could ever be obtained about her feelings, etc., except that she once said, when asked whether she was worried, that she “felt weak,” had “nothing to worry about.” Occasionally she was seen to cry silently; at times she would breathe faster when questioned, or flush; once she took hold of the doctor’s hand when he questioned her, and cried, but made no reply. On another occasion she was affectionate to her son, kissed him, although she paid no attention to her daughter who accompanied the son. Later she said to the nurses, “He is the best son that ever lived.” But more and more she became disinterested, totally inaccessible, resistive, had to be tube-fed. In this condition she remained for five and a half years. At the end of that time she died of tubercular pneumonia. CHAPTER XII DIAGNOSIS OF STUPOR