we call
absorbed manics or manic stupors. In fact, he uses the last term. The
commonest introductory psychosis, he claims, is depression, but from his
brief case reports it would seem that most of his patients were not
stuporous, in the narrow sense of the term, but severely retarded
depressions. In fact, in perusing his case material comprising "stupors"
in the course of many types of functional insanity, or as a complication
of epilepsy or general paralysis, it is evident that in practice he does
not follow the discriminative definitions of the earlier portion of his
paper. For him, apparently, patients who are markedly inaccessible to
examination from whatever cause are "stuporous." He closes with
excellent remarks on physical and psychic treatment. As to prognosis he
has nothing to say beyond the opinion that most of the cases recover.

If Dagonet be accepted as summarizing the early French work, we can
conclude that their generalizations were on the whole quite sound. These
were: that stupor is an abnormal mental reaction, usually psychogenic
but often the result of exhaustion, that it consists in a paralysis of
emotion, will and intelligence; that the prognosis is usually good; that
mental stimulation may produce recovery. What remained to be done after
this work was the refinement in detail of these generalizations,
particularly in respect to the differentiation of prognostically benign
and malignant types. But other Frenchmen did not take up this work,
apparently, for the brilliant psychopathologists of the next generations
attended to stupor only in so far as it was hysterical.

An Englishman, however, soon took up the task, adding more exactness to
his formulations. Newington[14] published his important paper in 1874.
A nascent stage of stupor, he thinks, is a common reaction to great
exhaustion, "such as hard mental work, prolonged or acute illness,
dissipation, etc." Such conditions, like the grave psychotic forms, he
regarded as due to physical exhaustion of the brain cells, but, since he
thought psychic stress could produce this exhaustion, this "organic"
view did not bias his general formulations. He makes a division into two
stupors: Anergic Stupor and Delusional Stupor. The former may be
primary, being generally caused by a sudden intense shock (Esquirol's
"Acute Dementia"), or secondary (a) to convulsions of any kind, (b) to
mania in women, (c) to any other prolonged nervous exhaustion. The
delusional