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 more than before by constant impulsive attempts to hurt herself in every conceivable way--by bumping her head against the wall, putting her head under the hot water faucet, trying to pound the leg of the bedstead on her foot, striking herself, pinching her eyelids, pulling out her hair, trying to pick her radial artery, throwing herself out of bed, knocking her head against the bed rail, etc. This was done in silence but with what appeared a great determination that occasionally showed itself in her face. She also sometimes scowled and frowned. With the difficulty in feeding her and the constant impulsive excitement in which bruises could not always be avoided (once an extensive cellulitis developed in the arm which had to be lanced), the patient got weak, emaciated and exhausted; much of her hair fell out, although some she pulled out. It should be stated that during this entire impulsive state she could not be taken care of in the Institute ward, but was sent to a special ward in the Manhattan State Hospital, where suicidal patients are under constant watch. These impulsive attempts at self-injury lessened only towards the end of the period. Her laughter, which had been such a prominent trait, disappeared almost entirely during this entire phase. With all this, the general resistiveness, as has been stated, remained towards feeding or any other interference. It was only in the beginning associated with laughter as in the previous stage. Although there were, as a rule, no spontaneous remarks and no replies, she on one occasion said spontaneously, probably referring to her unsuccessful attempts to kill herself: “I can’t do it, I have no will.” During the same period she once said: “I don’t want to eat, I don’t want to get well, I want to do penance and die.”