CASE HISTORIES 35 



ents." This was constantly repeated, but I could never discover 

 the hidden meaning. 



The following is a typical conversation: ("What made you 

 sick in the first place?") "It might have been actual sexual 

 intercourse at a distance. It might be action. A married man. 

 Sexual intercourse at a distance. I can't state just the reasons 

 for it. I never had difficulties at a distance. It seemed to be 

 action, that's all. Action is movement. From a distance to my 

 penis. I never had any difficulties. While I was at work elderly 

 men more than young men bothered me. An affliction. If he 

 wasn't married, it wouldn't be action against him." 



When not constantly stimulated by other people he was liable 

 to go off into his fantasies, which were usually unpleasant, and 

 then begin his violent tics and glahba-glah-ing or smacking. He 

 could play casino but went into these tics while waiting his turn 

 to play. He liked to join the other patients in playing catch 

 with a baseball, and was quick and skilful, but lapsed into his 

 mannerisms if the ball were not thrown to him frequently enough. 

 When the others heard him begin to glahba-glah they threw a 

 basket ball at his head, and he would laugh and join the game 

 again. 



A few times he made sexual advances to the nurses. But his 

 great preoccupation was masturbating. Several times a day he 

 would retire into the watercloset and indulge in it in spite of 

 attendants and fellow patients. 



Occupational therapy: He could not learn the simplest weave 

 in basket making and spent fruitless weeks on a stocking cap. 

 He would continually lapse into fantasy and weave blindly. 

 Every day the instructor made him do some simple task such as 

 marking holes on tray bottoms. He could play a game of cards 

 because the other players continually called him out of his 

 fantasy. 



Physical examination: Slender type of skeleton, well nour- 

 ished and muscled. Skin presents slight actiniform lesion. Beard 

 slight, small amount of hair over abdomen. Genital hair normal. 

 Very large genitalia. Extremities cold and cyanotic with derma- 

 tographism present. Heart normal. Extensive reflex excursions. 



Endocrine diagnosis: Submyxedema. 



