of
post-rheumatic stupor, external stimuli make some impression, in that a
thoughtful facial expression appears. In deep stupors, such as occurred
in our series, this response is not seen. The same phenomenon of
"rousing," larval in Knauer's cases, is often well marked in
encephalitis lethargica and is, of course, a pathognomonic symptom of
delirium. We might therefore think that these conditions are mixtures of
two organic tendencies, namely, delirium and coma. It is not impossible
that resemblances to benign stupor are due to functional elements
appearing in the reduced physical state as additions to the organic
symptoms. The prominence of pain might be taken as a likely cause for an
instinctive reaction of withdrawal, which would account for the
emotional palsy of these conditions on psychogenic grounds. [This
argument can be better understood when the chapter on Psychological
Explanation of Stupor has been read.] We therefore feel justified in
holding that the resemblance of the symptoms of certain plainly organic
reactions to those of benign stupor do not necessitate a splitting of
these stupors from the manic-depressive group.

When we consider certain bodily manifestations of these typical stupors,
however, fresh difficulties are encountered. Unlike depressions,
elations and anxieties, certain physical symptoms appear with frequency,
even regularity. This would seem to indicate the presence of physical
disease. Inasmuch as the most constant of them is fever, the natural
conclusion would be that we are dealing with an infection which
produces a mental state called stupor. If we were not faced with an
obvious relationship to manic-depressive insanity, where such symptoms
are usually accidental and intercurrent, we would accept this
explanation, but this quandary necessitates further analysis.

Let us first consider the fever. In 35 cases, on whom data of
temperature could be found from the records extant, 28 showed fever
usually running between 99 deg. and 100 deg., often up to 101 deg. or
slightly over this point. When these cases were analyzed, however, it
was found that 27 were typical and 8 atypical, showing pictures
resembling those described in the last chapter. Of the latter only one
had a rise of temperature, while of the typical group only one was
afebrile. Therefore, since out of 27 typical cases 26 had the typical
slight fever, we must conclude it to be a highly specific symptom. Of
these 28 cases the