of such obtrusive events as the moving from one ward to
another, tube-feeding, physical examination, the presentation at a staff
meeting, and the like.

_Affect:_ Complete affectlessness is an integral part of the stupor
reaction. Modification of the statement will later be mentioned. The
patient is indifferent so far as his basic condition is concerned, and
it is only by certain stimuli that at times emotional reactions can be
elicitated, some tears at a visit of a relative, an appropriate smile at
a joke or a comical situation when the stupor is not too deep or an
angry reaction called forth by interference.

_Catalepsy:_ Waxy flexibility or merely a tendency to maintain
artificial positions is a frequent but not an essential symptom.

_Physical Condition:_ Not infrequently we find in the beginning or in
the course of the stupor an elevation of temperature to 101 deg., 102
deg. or even 103 deg. In one case we found a marked cyanosis in the
extremities. Case 2 showed marked loss of hair. Gain in weight is never
observed and marked emaciation is the rule. This we may attribute to the
refusal of food.

A perusal of these cases, then, shows that the dominant (and well-nigh
exclusive) symptoms of the stupor are inactivity, apathy, negativism and
disturbance of the intellectual functions. Benign stupor can be defined
as a recoverable psychosis characterized by these four symptoms. The
meaning of such vague physical manifestations as the low fever is not
clear.

FOOTNOTES:

[1] MacCurdy has discussed the psychological phenomenon of a dramatist
depicting a psychosis correctly in "Concerning Hamlet and Orestes."
_Journal of Abnormal Psychology_, Vol. XIII, No. 5.

[2] Many of these states seem to be hysterical rather than
manic-depressive stupors, but so far as the unconsciousness goes, there
is probably as much psychological as symptomatic resemblance between the
two types of reaction.

[3] Kraepelin recognizes, of course, the occurrence of stupor symptoms
or states in the course of manic-depressive psychoses. It is stupor as a
clinical entity, as a separate psychosis, that he regards as one form of
the catatonic, and therefore of the dementia praecox, reaction.

[4] Kirby, George H.: "The Catatonic Syndrome and Its Relation to
Manic-Depressive Insanity." _Jour. of Nervous and Mental Disease_, Vol.
40, No. 11, 1913.

CHAPTER II

THE PARTIAL STUPOR REACTIONS

The cases thus far considered, namely, th