arly constant is a low fever, the temperature running
between 99 deg. and 101 deg. Twenty-eight out of thirty-five cases had
this slight elevation with a tendency for it to occur immediately at the
beginning of marked stupor symptoms. Although the evidence does not
positively exclude any possibility of infection, it speaks distinctly
against this view. A possible explanation is that the low fever is a
secondary symptom. The suprarenal glands may function insufficiently as
a consequence of the emotional poverty, since all emotions which have
been experimentally studied seem to stimulate the production of
adrenalin. Without this normal hormone for the activity of the
sympathetic nervous system, there would be a disturbance of skin and
circulatory reactions that would interfere with the normal heat loss.
Suggestive evidence to support this view comes from the frequency with
which the extremities are cyanotic or cold, the skin greasy, sweating
profuse or absent, and so on. Further observations are necessary to
confirm or disprove this hypothesis, but we feel inclined to accept it
tentatively because it is plausible and consistent with the view that
stupor is essentially a psychogenic type of reaction. Another physical
anomaly, which is presumably of endocrine origin, is the suppression of
the menses. This probably results from lowered nutrition. In some cases
it ensues directly on a psychic crisis before any nutritional change can
have taken place. Finally, among the symptoms of possible physical
origin, epileptoid attacks were described in two of our cases. This is
chiefly of interest in that such phenomena are extremely rare in the
benign psychoses.

We believe that the mental symptoms summarized above constitute a
specific psychotic type of reaction capable of appearing in any severity
from mere lethargy and indifference to profound stupor. Since the
prognosis is good, we feel obliged to classify this with the
manic-depressive reactions. Further justification for this grouping is
found in the occurrence of the stupor reaction as a phase in many
manic-depressive psychoses. A patient may swing from mania to stupor as
from mania to depression, and when the partial stupors are recognized as
milder forms of the same process, it seems to be a frequent type of
reaction.

If stupor be a reaction type, its laws must be psychological. According
to the view of modern psychopathology, the essence of insanity is
regression with ind