s out of thirty-five, in which high fever and leucocytosis appeared
episodically, are hardly enough to justify the view that stupors are the
result of a specific infection. We must remember, too, that no focal
neurological symptoms are ever observed, which makes the possibility of
a central nervous system infection highly unlikely.

An alternative view might be that the slight rise of fever is somehow
the result of stupor, not the cause of it. The editor consulted
Professor Charles R. Stockard, of Cornell Medical College, as to this
possibility. The following argument is the result of his suggestions:

What we call a normal temperature is, of course, the result of a balance
maintained between heat production and heat loss. Either an increase in
the former or a decrease in the latter must produce fever. It is
possible that heat production may be increased in many stupors as a
result of the muscular rigidity. Some cases showed higher temperature
when this was more marked, but this was not sufficiently constant to
justify any conclusions being drawn.

Heat loss occurs preponderantly as a result of radiation from the skin
and by sweating with consequent evaporation of the secretion. These
processes are functions of the skin and surface circulation. Are they
disturbed in our stupors? We find considerable evidence that they are.
Flushing or dermatographia occurred in six cases, cold or blue
extremities in four cases, greasy skin in four, marked sweating in
three, the hair fell out in two cases, while the skin was pathologically
dry in one case, in fact there were few patients who showed normal skin
function. Circulatory anomalies were also observed. The pulse was very
rapid in eleven cases, weak or irregular in two, and slow in one case.
All these symptoms are expressions of imbalance in the involuntary
nervous system, further evidence of which is found in the rapid
respiration of six cases and the shallow breathing of one patient. These
pulse and respiration findings are the more striking in that individuals
in stupor are, by the very nature of their disease, free from emotional
excitement.

This imbalance could result from a poverty of circulating adrenalin
which is necessary for the activation of the sympathetic nerves. A cause
for low suprarenal function is to be found in the apathy of the stupor
case. As Cannon and his associates have so conclusively demonstrated,
any emotion which was open to investigation resulted i