CASE HISTORIES 93 



because it meant strength both physical and mental. His mind 

 seemed deteriorated and much of his talk was unintelligible. He 

 was quiet and apparently emotionless, sitting all day long in a 

 chair. His expression was dull ; he spoke slowly and seemed to 

 have difficulty in moving his jaw. A sample of his talk is. " I'll 

 say it's glass that wheels itself and begets itself and lets you hear 

 and then collects itself back into line." 



To everyone's surprise his mind cleared after a few weeks and 

 he seemed quite normal. He was interested in everything, was 

 quick to join in any conversation and became facetious and witty 

 in a country smart Alec way. When confronted with what he 

 had said in the previous dull period, he exclaimed that it didn't 

 make any sense. He said also that he no longer had any queer 

 ideas. In three weeks he went into another depression, looked 

 dull and apathetic, heard voices and talked nonsense. Any noise 

 became a speaking voice to him, as the purr of a radiator, or 

 squeaking footsteps, and he would report to me what they said. 

 Sometimes voices shouted indistinctly in his ear. 



In two weeks he was alert again and said, " Those voices 

 come when I feel sick, or bilious, or have indigestion, and leave 

 when I feel good." These alert and dull periods lasting from two 

 or three days to a week or two alternated continually. During 

 the dull periods he could play a slow but good game of checkers 

 and continue slowly his leather pressing occupational work. 

 When dull he sometimes used clang associations, and he always 

 had trouble moving his jaw to speak. He also complained of 

 feeling weak and tired and not being able to remember well. 



Occupational therapy: After hesitating three days he began 

 to work and continued it without interruption. In his depressed 

 periods he did poorer work than in his normal ones. He pre- 

 ferred leather pressing, showed good judgment and artistic feel- 

 ing and improved steadily. He originated some of his designs. 



Physical examination: Large type of skeleton. Powerful 

 muscular development. No deformities. Skin soft and pliable 

 but shows localized hyperaemias or "flushings." Perspires very 

 easily over hairy parts. Face is notably plethoric. Hair, normal 

 distribution over chest and genital region. Genitalia normal. 



