CASE HISTORIES 59 



ercise tired him very much and he seldom went on walks, prefer- 

 ring to remain in the ward and work on raffia baskets. The ward 

 attendant made an assistant of him; he helped serve meals and 

 look after and govern the retarded and deteriorated patients. 



He dated his mental recovery from the onset of the goiter 

 and said he didn't tire as easily and felt in better health than 

 before the goiter appeared. His memory for events during the 

 psychosis was not as good as for events of his life previous to 

 it. He took an intelligent interest in everything and was of 

 assistance to me in reporting the behavior of other patients. 



Occupational therapy: No urging was necessary to get him 

 to begin work; he was only too glad to find something to do 

 and kept at it incessantly. After learning how to weave a raffia 

 basket he was satisfied to make one after another in the same 

 pattern, and his weaving was always slack and loose. He hated 

 to try a new pattern and did so only under compulsion. The 

 same old way was easiest, and he had no desire to change it. 

 His baskets sold readily and brought him in quite a little pocket 

 money. 



Physical examination: Medium type of skeleton. Skin nor- 

 mal in color. Pubic hair normal, but hair absent from rest of 

 body with exception of slight beard. Genitalia well developed. 

 Perspires easily and profusely with skin always damp and 

 clammy. Superficial reflexes hyperactive. Deep reflexes nor- 

 mal. Pulse 96, full and bounding. Thyroid region is bilaterally 

 greatly enlarged with prominent superficial veins and bruits 

 which may be heard by stethoscope on both sides from the bases 

 of the ears to the clavicles. There is a striking exophthalmos 

 with several of the eye signs of exophthalmic goiter in evidence. 



Endocrine diagnosis: Compensatory hyperthyroidism. 



Glandular therapy: A successful thyroidectomy was per- 

 formed, about half of the goiter being removed. 



Four months later: He had entirely recovered from the 

 operation and felt stronger and better. The annoying pulsation 

 in his neck was gone, and he no longer woke up at night out of 

 breath. His mind was as clear as before the operation. 



Mental diagnosis: Schizophrenia with projection. The incest, 

 bestiality and homosexuality in this case were out in the open. 



