eful examination of the onset reveals further
atypical features, suggestions or definite evidences of a dementia
praecox reaction before the stupor itself appears. One common occurrence
is a slow deterioration of character and energy that proceeds for months
or years before flagrantly psychotic symptoms appear.

Then when delusions or hallucinations are eventually spoken of by the
patient, an appropriate or adequate reaction is lacking. In a benign
psychosis false ideas do not appear with an equable mood unless the
stupor reaction has already begun.

More important than this, although in benign stupors there may be a
reduction or an insufficient affect, it is never inappropriate. This
pathognomonic symptom of dementia praecox frequently occurs in the onset
to malignant stupors. In fact we often find in reviewing such cases that
a plain dementia praecox reaction has been in evidence, that a diagnosis
has not been made simply because the stupor picture blotted out this
earlier psychosis before an opinion was formed. Frequently these early
symptoms are reported in the anamnesis and not actually observed by the
physician.

Three cases may be cited as examples of dementia praecox onsets. It will
be noted that the ensuing stupors were, like those already quoted,
atypical.

CASE 23.--_Catherine H._ Age: 21. Admitted to the
Psychiatric Institute October 10, 1904.

_F. H._ The mother's brother had two attacks of delirium
tremens. The mother died when the patient was eleven years
old; she is said to have been normal. The father was
living.

_P. H._ The patient was always a nervous child, had very
bad dreams, but she was smart at school up to ten or
eleven, and played with other girls. Then she began to work
less well, got thin, more nervous, complained of headaches.
It was about that time that her mother died. (The reaction
to the death was said not to have been different from that
of her sister.) She was kept at home and was quiet.... "You
could see something was working on her." She began to
menstruate at 14, and it was claimed that she then wakened
up a little. It was further stated that she was always
"stuck up" about her clothes.

At 16 she went to work in a factory, but her sister thought
the work was too much for her, so she was taken home.
Thereafter she lived alone with her father, doing his