CASE HISTORIES 3! 



replies were only excuses to hide the real cause of his pleasure. 



General observations: He was untidy and tore his clothes. 

 He would not wear suspenders and had to hold up his trousers 

 with one hand when walking. He never spoke unless spoken to, 

 and would if possible move away without answering. He whistled 

 a good deal, learning the latest airs from the graphophone, and 

 he liked to look at pictures, but never read. 



The attendant noticed that when out walking he would 

 respond to greetings from a distance but as soon as a person 

 approached him he became uncomfortable, looked in another di- 

 rection and tried to get away. 



Occupational therapy: He turned his back on the instructor 

 and paid no attention to her efforts to interest him. 



Physical examination: Skeleton out of proportion with small 

 pelvis and heavy upper extremities. Skin dry and covered with 

 scabs. Hair dry and scaly and very fragile. Beard scanty. 

 Genital hair normal. Genitalia normal. Heart slow. Circula- 

 tion sluggish. Extremities cold and cyanotic. Patellar reflexes 

 exaggerated. Gait shambling. 



Endocrine diagnosis: Submyxedema. 



Glandular therapy: The thyroid test caused him to become 

 considerably more extroverted. He answered more readily when 

 spoken to, didn't try to get away as much as formerly, noticed 

 other patients, put on a bizarre skull cap belonging to the at- 

 tendant and joined heartily in the resultant laughter, complained 

 of pains and aches while formerly he never mentioned how he 

 felt, and even consented after some urging to try basket-weaving. 

 He also became tidier with his clothes. 



Later a combination of thyroid and suprarenal was given him. 

 The improvement was maintained. 



Four months later: He seemed to have returned to his condi- 

 tion previous to glandular stimulation. 



Mental diagnosis: Schizophrenia, with projection in the be- 

 ginning at least. The meager records of his disease tally in the 

 main points with the usual schizophrenia. He never got his libido 

 over to the opposite sex, and he had a sense of unworthiness and 

 sin due, no doubt, to perverse cravings. Perhaps at first he had 

 insight, for he claimed he was to blame for it all. After three 



