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Further, Knauer reports that even at the height of post-rheumatic stupor, external stimuli make some impression, in that a thoughtful facial expression appears. In deep stupors, such as occurred in our series, this response is not seen. The same phenomenon of “rousing,” larval in Knauer’s cases, is often well marked in encephalitis lethargica and is, of course, a pathognomonic symptom of delirium.
The edema of the brain, irregular pink mottlings of white substance, and an exudative lesion of one focus in the pia mater of the right side suggested an encephalitis more marked on the right side. Microscopically a few small vessels showed plugs of polynuclear leucocytes. The nerve cells were affected by various acute changes.
I took what was taught me scholasticism, syllogistic rules, theology, and Hebrew in earnest; I was an apt student; I am not to be numbered with the lost for that. Such were these two years of inward labour, which I cannot compare to anything better than a violent attack of encephalitis, during which all my other functions of life were suspended.
As will be discussed in a later chapter on the literature, reactions resembling benign stupors occur as a result of toxins, particularly following acute rheumatism. Recently the medical profession has been called on to treat many cases of encephalitis lethargica where similar symptoms are observed.
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