Ideas, in the intervals latent, would become more insistent, and he talked of them in a distracted way with occasional silly laughter and some scattering. At the same time he would show considerable physical unrest: rocking in his chair, nodding his head, sucking with his lips, and making occasional grimaces. A sharp word would, however, bring him to reality and normal behavior and speech, or the same result could be obtained by his own volition. In fact sufficient effort from either without or within could, it was several times demonstrated, postpone the further development of these symptoms for several days. Inevitably, however, control over his psychosis was lost. He became more excited; was assaultive till chastised by his father, after which that symptom no longer appeared; he would give none but irrelevant answers to questions; he masturbated openly. In the next phase he refused to answer questions altogether, sat in a chair by the window, rocking and tapping the floor or wall with his feet; reading a paper in a whisper or tearing it into scraps; spitting on the floor, his clothes or the window pane and then drawing pictures with his finger on the wet glass; intermittently chanting the same air over and over again with words, totally indistinguishable, except for the name "Jesus Christ" apparently interpolated irregularly in the course of the song. All this time he wore a silly smile occasionally breaking into a low chuckling laugh devoid of real emotion. In a short time his clothes and his immediate surroundings were in a state of horrid filth from his saliva and the torn papers. Towards the end of the attack he ceased making any sounds, simply rocked, spat and grinned. He would often pass twenty-four hours without emptying his bladder, though he never wet nor soiled himself. Few psychiatrists would have required more than a casual examination to give a diagnosis of hopeless deterioration, if they saw the patient only in the latter stage of one of these attacks. Yet in from seven to fourteen days after the first onset he would go to bed, sleep well, and in the morning appear perfectly normal and resume his efficient work. And this story had been repeated regularly once a month for four years! When normal his memory was hazy for the external events occurring during his attack, corresponding with his objective lack of contact with his environment, but the recollections of his ideas showed that he had been living in a perfect riot of fancies. The inference from this is inevitable that what we regard as a "Trendless praecox" or a taciturn dement may simply be one who does not choose to talk and not necessarily a vegetative wreck with neither delusions nor hallucinations. [3] For the privilege of using observations made on this patient at the Sheppard and Enoch Pratt Hospital, we wish most heartily to thank the Superintendent, Dr. Edward N. Brush.