t been discussing, in fact it is one of the evidences of the
loss of emotion. We presume that a patient is apathetic when there is no
expression in the face and when he does not respond to external stimuli,
whether these be physical or verbal, by movement or by word.

Bodily inactivity is present in all degrees, and in some forty
consecutive cases was recognizable in every one. In its most extreme
form there is complete flaccidity of all the voluntary muscles, and
relaxation of some sphincters. As a result of the latter we see wetting,
soiling and drooling. Even those reflexes which are only partially under
voluntary control, like those of blinking and swallowing, may be in
abeyance; for instance, saliva may collect in the mouth because it is
not swallowed, and tube-feeding is frequently necessary on account of
the failure of the patient to swallow anything that is put into his
mouth. The eyes may remain open for such long periods of time that the
conjunctiva and sclera may become quite dry and ulcerate. In these
extreme cases there is, of course, no response to verbal commands. What
is more striking, no reaction appears to pin pricks, so that it seems as
if consciousness of pain were lost.

This deep torpor does not usually persist indefinitely. The commonest
evidence of some form of consciousness persisting is probably to be seen
in blinking when the eye is threatened or the sclera or cornea actually
touched. A very large number of patients, when otherwise quite inactive,
showed considerable response in their muscular resistiveness, the
phenomena of which will be discussed shortly. The relaxation of the
sphincters is apt to persist even after control of the rest of the body
is exercised to the point of permitting the patient to stand or walk
about.

The first phase of obvious conscious control is seen in those patients
who will retain a sitting posture in bed or in a chair. The next stage
is reached where the stuporous case can be stood upon his feet but
cannot be induced to walk. The next degree is that of walking only when
pushed or commanded. Finally spontaneous movement is observed in which
the inactivity is evidenced merely by a great slowness.

No correlation can be established between restrictions of speech and
motion other than that present in the extremes. With complete inactivity
there is almost always consistent mutism, and perfect freedom of speech
does not, as a rule, appear until the movements are fre