it may be well to summarize briefly the
diagnostic problems in connection with benign stupor.

In the first place one naturally considers the differentiation from
conditions of organic stupor or coma. Since psychotic stupors never
develop without some signs of mental abnormality, the history is usually
a sufficient basis for final judgment. In case no anamnesis is
obtainable the functional nature of the trouble may be recognized by the
absence of those physical signs which characterize the organic stupors.
One sees no violent changes in respiration, pulse or blood-pressure,
such as are present in the intoxication comas of diabetes or nephritis.
There is no characteristic odor to the breath, and the urine is
relatively normal. The unconsciousness of trauma or apoplexy is
accompanied by focal neurological signs. Even in aerial concussion (so
frequently seen in the war) where no one part of the brain is
demonstrably affected more than another, there are neurological
evidences of what one might call "physiological" unconsciousness. The
eyes roll independently, the pupils fail to react to light. On the other
hand, there are definite symptoms characteristic of the functional
state. Mental activity is evidenced by a muscular resistiveness or
retention of urine. Even in states of complete relaxation the eyes move
in unison, the pupils react to light, and almost universally the corneal
reflex is present. The patient appears in a deep sleep rather than
actually unconscious.

The post-epileptic sleep may resemble a stupor strongly. But this
condition is temporary and the situation and appearance of the patient
betrays the fact that he has just had a convulsion. Rarely, protracted
stuporous states occur in epilepsy which closely resemble the conditions
described in this book. In fact it is probable the true stupors may
occur in epilepsy just as in dementia praecox or manic-depressive
insanity.

There is usually little difficulty in the discrimination of hysterical
stupor. Occasionally it shows, superficially, a similarity to the
manic-depressive type. Fundamentally, there is a wide divergence between
the two processes, in that in the hysterical form a dissociation of
consciousness takes place, the patient living in a reminiscent,
imaginary or artificially suggested environment, while in a true stupor
there is a withdrawal of interest as a whole and a consequent diffuse
reduction of all mental processes. This difference is sooner