CASE HISTORIES 97 



were his most prominent traits ; he wanted what he wanted when 

 he wanted it, and nothing but superior force would make him 

 desist. He seemed to have no conception of adjusting his wishes 

 to those of others. 



One physical examination had to be given up because he was 

 so excitable and afraid, and in the second attempt he showed 

 much fear of the rubber hammer used to test reflexes, and re- 

 acted exaggeratedly. 



Occupational therapy: He took hold of the work with alac- 

 rity and quickly learned to do all branches of it well. His wil- 

 f ulness made him impatient of instruction and he went on accord- 

 ing to his own ideas. In his elated periods he worked rapidly and 

 even grabbed other patients' work away from them in order to 

 " help " them. In his depressions he did no work at all. In the 

 occasional intermediate periods he worked steadily and quietly. 



Physical examination: Slender type of skeleton, but well 

 muscled. Skin normal. Small amount of hair on chest but 

 normal in genital region. Genitalia normal. Heart rapid. Pupils 

 dilated. Reflexes were active. Psychomotor activity pronounced. 



Endocrine diagnosis: Hypoadrenia. 



Glandular therapy: He was fed suprarenal gland. At first 

 he showed a marked improvement. Instead of having a depres- 

 sion every day or so, he would remain elated for several days at a 

 time. When the depressions recurred they lasted barely a half 

 day and were not so deep but what he could work throughout 

 them. The attendant said that during them his skin was cold 

 and clammy, and immediately after them his face was pigmented 

 brownish, and then the color gradually faded to normal. 



By the end of six weeks the good effects of glandular feeding 

 had begun to wear off. The depressions grew somewhat more 

 frequent and deeper, and he began once more to refuse food. 



Four months later: He seemed much the same. The de- 

 pressions and elations now lasted about a fortnight each. When 

 depressed he often became ugly and attacked other patients 

 viciously, trying to choke them. He had to be confined in an 

 undesirable ward. 



Mental diagnosis: Schizophrenia with projection and fea- 

 tures of circular insanity. The projection of his bad impulses 



