her sad nor happy nor anxious.
This contrast is revealed not only by the patients' utterances but by
their expressions. The stuporous face is empty, that of the other lined
with melancholy. The intellectual defect, too, is different. In retarded
depression the patient is morbidly aware of difficulty and slowness, but
on urging often performs tests surprisingly well. In the stupor,
however, one is faced with an unquestionable defect, a sheer
intellectual incapacity.

In Chapter VIII the differential diagnosis between perplexity and stupor
has already been touched upon. Here again the affect is a point of
contrast. The patient has not too little emotion but too much. The
feeling of intangible, puzzling ideas and of an insecure environment
causes the subject distress, of which complaint is made and which can be
witnessed in the furrowed brow and constrained expression. There is
also, as we have seen, a rich ideational content in these cases, if one
can get at it. The mind is not a blank, as in the stupor, or concerned
only with delusions of death.

Finally, there are the absorbed manic states. These are the most
difficult, inasmuch as the patient is often so withdrawn and so
introverted that at any given interview there may be no objective
evidence of mood or ideas. Here the development of the psychosis is
often an aid to diagnosis. The patient passes through phases of
hypomania to great exultation, the flight becomes less intelligible,
with this the activity diminishes until finally expression in any form
disappears. If this sequence has not been observed, continued
observation tells the tale. The patient still has his ideas and may be
seen smiling contentedly over them (not vacuously as does the
schizophrenic) or he may break into some prank or begin to sing. Any
protracted familiarity with the case leads to a conviction that the
patient's mind is not a blank, but that his attention is merely directed
exclusively inward. Then, too, when his ideas are discovered, it is
found that they are not exclusively occupied with the topic of death.

CHAPTER XIII

TREATMENT OF STUPOR

In dealing with cases of benign stupor the first duty of physician and
nurse is naturally the physical hygiene of the patient. More is needed
to be done in the bodily care of these persons than for most of the
inmates of our hospitals for the insane. It is perhaps no exaggeration
to claim that a deeply stuporous patient needs as much atten