n an increase of
adrenalin output. As our emotions are constantly operating during the
day--and often enough during sleep as well in connection with dreams--we
must presume that emotional stimulus is a normal excitant for the
production of adrenalin. It is therefore inconceivable that the blood
could receive its normal supply of adrenalin with an apathy of the
degree seen in stupor unless some purely hypothetically substitutive
excitant were found.

We may therefore tentatively assume that the fever which marks the onset
and frequently the course of these benign stupors is the result of a
failure of the heat loss function, this being due to an imbalance in the
involuntary nervous system that is occasioned, in turn, by insufficient
circulating adrenalin, and the final cause for the poor suprarenal
function is to be traced to the most consistent symptom of the stupor,
namely, apathy. This hypothesis is welcome, not only because it would
account adequately for the fever, but it also tends to accentuate the
relationship with other forms of manic-depressive insanity, all of which
are marked fundamentally by a pathological emotion. Naturally enough,
one turns to the records again to see if the blood-pressure of these
patients was low, as would be expected with a poor adrenalin supply.
Unfortunately record was made of the blood-pressure in only two cases,
in both of which the reading was 110 m.m. Two such isolated observations
mean, of course, nothing whatever. It is possible that the drooling
which so many stupor cases show is not merely the result of the failure
of the swallowing reflex, but represents as well a compensation for
anhydrosis by excessive salivary secretion.

Another symptom suggestive of involuntary nervous system or endocrine
disorder is the highly frequent suppression of the menstrual function.
At times this may occur as a sequel to mental shock, as it did in the
case of Celia H. (Case 19), who was menstruating when, frightened by the
suicidal attempt of her brother, the flow ceased abruptly. That purely
psychic factors can produce marked changes in such functions has been
demonstrated by Forel and other hypnotists time and again; presumably
the effect is produced by way of alteration in the endocrine or
involuntary nervous system influence. In such cases, however, we can
trace the menstrual suppression directly to an emotional cause. On the
other hand, most women in stupor fail to menstruate during the bul