essure" as a
stimulus and cites a case of rapid improvement after a change of scene.

Since 1874 very little advance has been made by British psychiatrists,
as seen by a perusal of Clouston's[15] summary in 1904. He regards sex
exhaustion as a highly frequent cause, although Dagonet had shown 32
years before that sex abuse does not produce a true stupor. He thinks
stupor usually follows depression or mania and says that "the
'Confusional Insanity' of German and American authors is just a lesser
degree of stupor." Omitting his stupors in general paralysis and
epilepsy he makes three clinical divisions: _melancholic or conscious
stupor_, which is not a product of delusions, although delusions of
death or great wickedness may be present, impulsiveness and fits may be
observed; _anergic or unconscious stupor_, which corresponds roughly to
our deep, benign stupor; and _secondary stupor_ after acute mental
disease, which resembles our partial stupor. He warns against a rash
diagnosis of dementia in this last group. His views on the importance of
mental causation and the relation to manic-depressive insanity may be
gathered from these sentences: "The condition of the mental portion of
the convolutions in stupor is probably analogous to the stupidity of a
nervous child when terrified or bullied." "Stupor is frequently one of
the stages of alternating insanity following the exalted condition. It
is more apt to occur in those where the exalted period is acutely
maniacal. The stupor is usually melancholic in form." Since he claims
that the anergic is a "very curable form of mental disease," while only
50% of the melancholic cases recover, it seems clear that this division
is not prognostically final. The "melancholic" is evidently Newington's
"delusional" without his more accurate discrimination of symptoms.

From the standpoint of accurate description the opinion may be ventured
that there is a gap in the literature from the early French writers and
Newington up to the paper by Kirby, which has been discussed in the
first chapter. This gap is filled by literature of the German schools
and their adherents in other countries. German psychiatry has been
concerned mainly with classification or the elaborate examination of
certain symptoms. Inevitably such a program militates against detached
objective clinical description. It is hard to record symptoms that
interfere with classification. German psychiatry has tended to make the
insa