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In April, 1913, Zenia X—, came to consult me. She was incapacitated for any form of continuous work or pleasure. She had erected a complicated series of ceremonials, which compulsive activities occupied her whole waking time and made the living of life unendurable. Far above the average in physical, mental and moral endowments, her life, up to her thirty-fifth year, had been practically futile because of her psychoneurosis. She despaired of ever finding any relief and welcomed the idea of self destruction.
She was the elder of two girls, and had a brother two years older, another two years younger, and her sister was four years younger than herself. The parents were second cousins. There were no ascertainable neuropathic factors on the father's side. A maternal grandmother had asthma, her sister had compulsive ideas and died psychotic in the presenium. The mother died of a cerebral thrombosis (hemorrhage?) at the age of fifty-four. Three children of a maternal uncle died of tuberculosis.
The prominent complaint at the time when first seen was an uncontrollable femoral tic, spreading to the vagina, perineum and anus. This had been present several years. Coupled with this, or independent of it, and even more persistent, were compulsive