k of
the psychosis at a time when we believe emotions to be absent or greatly
reduced in their intensity. The recent work of Papanicolaou and
Stockard[9] offers a simple explanation for this phenomenon. They have
shown that in the guinea pig the oestrous cycle can be delayed by
starvation, while in weaker animals a period may be suppressed
completely. When one considers that even with the greatest care the
nutrition of tube-fed patients is bound to be poor, it would be only
natural to suppose that this malnutrition would cause such a disturbance
in the oestrous cycle and was evidenced objectively by a failure to
menstruate. Even in patients who are not tube-fed, under-nutrition is
to be expected and, as a matter of fact, is usually observed. The work
of Pawlow and Cannon has shown how essential psychic stimulus is for
gastric digestion. Any condition of apathy would therefore tend to
retard digestion and indirectly affect nutrition.

Finally, under the heading of Physical Manifestations of Stupor, we must
consider epileptoid attacks, of which there was a history in two of our
cases, both of which have already been described in the first chapter of
this book. Anna G. (Case 1), in her second attack, was treated at
another hospital, and from the account which they sent it appears that
the stupor was immediately preceded by a seizure in which the whole body
jerked. This is, of course, rather thin evidence of the existence of a
definite convulsion, but in the case of Mary F. (Case 3) we have a
fuller description. During the two days when the stupor was incubating,
she had repeated seizures of the following nature. She sometimes said
that prior to the attacks it became dark before her eyes and that her
face felt funny or that she had a pain in the stomach which worked
toward her right shoulder. The attack would begin when sitting in a
chair, with the closing of her eyes, clenching her fists and pounding
the side of the chair. She would then get stiff and slide on to the
floor, where she would thrash her arms and legs about and move her head
to and fro. The warning of the pain working from the stomach to the
right shoulder is highly suggestive of an epileptic aura, although the
other symptoms mentioned so far could have been considered hysterical or
poorly described epileptic phenomena. The rest of the description
indicates an epileptic seizure more strongly. She frothed at the mouth
and once wet herself during an attack. They