8 CASE HISTORIES 



type distribution, very extensive over chest and abdomen. Gen- 

 italia normal. Extremities cold and cyanotic. All superficial 

 and deep reflexes markedly hyperactive, but movements are slow 

 and deliberate, though with no suggestion of catatonia. Heart 

 rather rapid. 



Endocrine diagnosis: Submyxedema. 



Glandular therapy: While he was fed desiccated thyroid 

 gland, nurses and attendants thought he seemed more alert and 

 energetic. He talked sensibly with the occupational therapist 

 and even joked with her. For two weeks he stopped his spitting, 

 then began again. He went outdoors on his own initiative and 

 lay on a bench. When asked why he had never done so before, 

 he said that this was the first weather warm enough to make it 

 pleasant (April 30). He stopped whispering with me and teas- 

 ingly complimented my personal appearance. 



Four months later: He was still pouting out his lips and 

 spending hours in spitting. When the male nurse tried to prevent 

 the spitting he became very excited. He had shown distaste for 

 food at times and talked of his mouth being dirty. He still 

 kept by himself, smiling over his fantasies and doing no work. 



Mental diagnosis: Simple schizophrenia without projection. 

 He found the inner world of fantasy so far preferable to the 

 outer world of reality that he spent most of his time in thought. 

 Just what his most intimate fantasies were could only be sur- 

 mised. He would not divulge them. It was clear that some 

 of them were heterosexual. I suspected others were homosexual 

 for several reasons; his fear of the topic of homosexuality, his 

 interest in my physical appearance, and his statement that women 

 didn't like him but men did. He showed no signs of conflict or 

 struggle against improper wishes and he projected none of these 

 onto his environment. 



The only painful symptom of his psychosis was the mouth 

 and throat obsession. There was much affect connected with it. 

 It looked like a fellatio fantasy, a symbolic cleansing of the mouth 

 and throat, such as Lady Macbeth's rubbing of her hands to 

 cleanse them of the king's blood. The constantly pouted lips 

 indicating oral eroticism supported this theory. 



