PART III

CHAPTER XII

THE THRESHOLD IN ABNORMAL MENTAL LIFE

IN the interrelation of moment aggregates the moment threshold plays an important role, since its oscillations, its height and fall are at the basis of their associations and dissociations. Consciousness, consisting of complex aggregates of moments, passes in the course of degeneration through stages in the inverse order in which it has been built up. The complex aggregates of the higher type become dissolved, dissociated into less complex aggregates of moments of lower types. Constellations become disaggregated into clusters, clusters into communities, communities into systems, systems into groups, and groups may become decomposed into their constituent elements. The process of disaggregation may be slow or rapid, but its course is the same, it is from constellations to groups, from higher to lower types of moments.

            With the process of dissolution going on in a mental aggregate we find modifications and redistributions of thresholds of all those moments with which the dissolving aggregate is directly or indirectly connected. A variation produced in one moment threshold tends to modify all the rest. An aggregate consists of many subordinate aggregates, and with its dissolution many moment thresholds become modified, affecting other thresholds of moments with which the constituents of the given aggregate are interrelated.

            The slow heightening of the thresholds going hand in hand with the process of disaggregation may result in a permanent rise of thresholds or may end in a paradoxical fall of thresholds. The components of the dissolving or already dissolved aggregate fall into the subconscious, the moment thresholds become lowered. While the thresholds of the moments, when stimulated through the components of the dissolving aggregate, become insurmountable, the components of the moments become more easily accessible through the lowering thresholds, if the attempt is made through the subconscious. We are thus met with the paradoxical state in which anesthesias are also hyperaesthesias, and amnesias are at the same time hypermnesias. In fact we may assert that all psychopathic functional disturbances, that is, disturbances in which great rise of moment thresholds with consequent functional dissociation of moment aggregates have taken place, present this seemingly contradictory double aspect of loss and presence, of a hyperasthetic anesthesia and a hypermnesic amnesia. Redistribution with rise and fall of thresholds gives us a clew to the phenomena of functional psychosis.

            The dissolution of a moment aggregate sets the components free, which become through subconscious intercommunication more easily accessible. In other words, the, process of disaggregation, while raising the conscious moment thresholds, reveals by it the low subconscious thresholds, in the same way as distraction of the attention reveals the presence of an exaggerated reflex knee-jerk or as the removal of the cerebrum in a frog reveals the low thresholds of the spinal nervous aggregates. The subconscious is in fact a reflex consciousness, and its activity becomes fully revealed with the removal or dissolution of the upper strata of consciousness. As long as a group, system, community, cluster, forms a part of an aggregate it is more difficult to have it aroused to function than when it is dissociated, isolated from its other constituents. This relation may be formulated in the statement that the rise of threshold is directly proportional to the complexity of the aggregate and inversely proportional to the simplicity of its constitution.

            The simpler an aggregate is the lower are the moment thresholds. This truth is clearly manifested in the case of children. The child is easily aroused to action, slight stimuli divert its attention in different directions, and any idea and image crossing its mind has its motor manifestations. In savages, too, we meet with a similar condition of mind. Mental life is simple, and any passing mood and emotion have immediate motor manifestations. In the mentally defective, such as the imbecile, the cretin, the idiot, the systems that are more or less intact are easily aroused by slight stimuli; in other words, the aggregates have low thresholds. In psychopathic cases and in the insane we meet once more with similar conditions of mental aggregates, the moment thresholds fall and become lower with the process of degeneration.

            The same thing is manifested in the state of belief induced in persons whose mental life is narrow and limited. Belief is the beginning of action. Now in children, savages, and mentally defective, belief is easily induced. This is clearly manifested in the case of suggestibility, which in fact is closely connected with the state of belief. It is notorious how children are extremely suggestible, so are savages, so are mentally defective persons of narrow thought and low education, and also the mentally unbalanced and insane. Anything, no matter how absurd, that falls in with their expectations is greedily accepted and immediately acted upon. Insane delusions in the different forms of melancholia and paranoia seem to present an exception to our statement, but as a matter of fact they, too, fall in line, considering the fact that any suggestion is readily accepted by the insane, if it only goes to strengthen the central delusion. Whatever can be assimilated by the functioning mental aggregate gains easy access, clearly demonstrating the fact that even where the mental disease is of such a nature as to have moment thresholds raised, conditions found in the various forms of melancholias, still the chief organized functioning systems are set into activity by the slightest stimulations showing a low threshold of the dissociated active moments. All other conditions remaining the same, it may be asserted that the simpler in structure a moment becomes the lower falls its threshold. An aggregate in the state of disaggregation will have the thresholds of its constituent moments progressively lowered, the fall being directly proportional to the depth of the disaggregative process.

            The continuous functioning of an aggregate brings about a process of disaggregation, the moment threshold of the given aggregate slowly rising until the reverse process of aggregation sets in, more or less restoring the previous state of the moment threshold. This is partly to be seen in the phenomena of fluctuation of the attention. If the attention is fixed on an object, say on a blot of ink, at first the interest flags, then there is a persistent tendency to look away from the blot, transfer the gaze to something else, and finally the whole blot vanishes from the field of attention and vision. New, persistent, though fluctuating efforts of attention are requisite to keep the object, the image, the idea before the focus of mental vision. The functioning of the particular mental aggregate is slowly bringing about a. process of disaggregation, thereby raising the moment threshold, making further functioning more difficult, and finally having it arrested through the maximum rise of the moment threshold. This rise of threshold through function makes it possible for other aggregates to be aroused in the order of the heights of their thresholds; the lower the threshold the earlier is the aggregate stimulated, the higher the threshold the later is the aggregate set into activity.

            Fluctuations of moment thresholds and formation of combinations of moment aggregates are of special importance in pathological states. Maniacal states of different forms of mental alienation present a similar distribution of thresholds. Maniacal states, wherever they occur, present a disintegration of the total interrelation of aggregates of moments as synthetized in the principal constellation, with a consequent lowering of the disintegrated constituent aggregates. Once such disorganization is induced, any stimulus may call forth an aggregate, which, through its radiating stimulations, may awaken all kinds of combinations and constellations in the aggregates the thresholds of which have been lowered. These aggregates, liberated from the control of the principal constellation, when stimulated, naturally give rise to chaotic, meaningless kaleidoscopic play of moments. The maniac is full of activity, his muscles are in constant play, and when the attack is at its height, he is continually gesticulating, running, dancing, shouting, singing and screaming. Reactions are intensified, reflexes are lively, verbal associations are greatly facilitated.

            Disintegration of moment aggregates, redistribution and fall of thresholds are the cardinal traits that characterize maniacal states, wherever they are found, whether in the general somatic diseases, or in the conditions of mental alienation. Now in all states of such a nature, once a moment is started to activity, it goes on developing by ever forming new phantastic combinations. This process is very much similar in character to the activity of the moments in dream states. The difference between the two being that while the combinations in the dream states are largely due to a rise of moment thresholds, in the maniacal states the different combinations and connection of moments are mainly due to a fall of the moment thresholds.

            Maniacal states, on account of the general fall of moment thresholds, are very much similar to the waking states. In both the waking and maniacal states the same condition of reduction of the moment thresholds is to be found. Maniacal states are waking states with the only difference that they are abnormal, psychopathic waking states. The maniac is too much awake, responding with all his being to every slight and passing stimulus. He is in a state of intoxication, his mind and body are shaky and unstable, as if he were under the influence of strong liquors. The maniac seems to be possessed by powerful, active and malicious demons of the world of spirits.

            The nature of maniacal states gives us also a clew to how to counteract them, and if possible, when the process of degeneration has not advanced far, to bring about a synthesis of the moment aggregates and thus re-establish the controlling synthetic life activity of the disintegrated principal constellation, constituting the personal character of the particular individual as the result of his whole life history and development. To free the maniac from the baneful action of the world of demons, the influence of those harmful spirits must be removed. The patient’s psychic life must be better defended and protected against the, demoniacal possession by surrounding him with higher battlements and stronger fortifications. In other words, mania can be reduced by raising the moment threshold. This rise of the threshold may come on by itself and the maniacal states may even pass into states of melancholy.

            States of melancholy, whether found in general somatic diseases or in conditions known as insanity, are characterized by a redistribution and rise of the thresholds of the moment aggregates. The more or less general rise of the thresholds makes it difficult for the usual combinations of moment aggregates to become formed. Combinations of incongruent moment aggregates, the thresholds of which are relatively lower, are alone in a condition to function: The field of consciousness becomes narrowed, the subconscious thresholds rise higher and higher. The course of mental activity, on account of the rise of the thresholds of the moment aggregates, is limited and confined to a narrow field, in which only those moment aggregates can participate, the thresholds of which are relatively lower than the rest. The ensuing result is the formation of a delusion, which becomes the more pronounced and the more fixed the longer the general conditions of the rise of moment thresholds continue. The mind of the melancholic, especially in the chronic forms, becomes inactive, and turns in one narrow groove delved out by the delusion. The gradual growth of difficulty in effecting combinations of moment aggregates, due to the gradual rise of the moment thresholds, are accompanied by unpleasant moods and painful emotions so highly characteristic of melancholic states. In this respect of mood and emotion melancholic states differ radically and in fact are the very opposite of the maniacal states in which the moment thresholds are lowered and the formation of moment aggregates and their combinations are effected with greater ease, giving rise to agreeable moods and pleasant emotions.

            Melancholic states may be said to be characterized by the cardinal traits of redistribution and rise of moment thresholds, by a narrowed activity concomitant with a painful emotional condition. The moment aggregate aroused by a stimulus will in the melancholic mind grow and develop and arouse to activity moment aggregates, the thresholds of which are low enough to be reached by the radiating stimulations coming from the primarily awakened moment aggregate. On account of the more or less general rise of moment thresholds, the process of synthesis has but a narrow selection. In the course of time, as the process of synthesis is more often repeated, definite and stable combinations of moment aggregates become formed. The longer the general states of the rise of moment thresholds last the more stable do these combinations of moment aggregates become, and finally they become so firmly organized as to form stable compounds; the melancholic states become chronic.

            The rise of moment thresholds in melancholic states can be easily, demonstrated by observation, and especially by experimentation. The mind of the melancholic patient is concentrated on his miserable condition and fixed on his principal delusion. Moments relating to his general state are alone active, while others are awakened with great difficulty. Reaction time is retarded in melancholia, and so is association time. The most simple questions must often be repeated a number of times before they are fully realized. The answers come only after a considerable time, and sometimes they are not forthcoming at all. Especially is this the case when questions relate to subjects lying outside the narrow field of the patient’s delusions.

            This rise of the moment thresholds and consequent narrowing of the field of consciousness is clearly seen stuporous melancholia, but it is still more clearly demonstrated by experiments, even in the mild cases and early stages of melancholia. The method of association is valuable for testing the degree of narrowness of the field of consciousness, the height of the rise of the moment threshold, the strength and extent of the organization of the moment consciousness constituting the principal delusion. If the patient, for instance, is told that when a word is given to him, he should immediately tell a series of words that come into his mind and pronounce them in quick succession as rapidly as possible, it is found, when an interval, of five or ten seconds is allowed for the experiment, that the patient cannot tell more than a word or two, and more often nothing at all, the mind being a perfect blank. The same holds true, if the patient is told that when a word will be pronounced he should tell any phrase that happens accidentally to come into his mind. The result is the same the mind is a blank. The words and phrases given by the patient, when such are given at all, are found to relate to his principal delusion. The moment aggregates are organized round the principal moment, which forms the kernel of the delusion, the whole combination forming a stable compound.

            The great stability of the combination of moment aggregates is a very characteristic and also very important trait of melancholic states. In respect to stability, melancholic states contrast strongly with maniacal states, the psychic combinations of which are extremely unstable and fluctuating.

            Melancholic states have a great similarity to sleeping states. The conditions in both are very much alike. The more or less general rise of the moment thresholds in melancholic states, with only a relative fall of thresholds in a more or less narrowed field of moment aggregates, brings the melancholic states very near to the dream consciousness of sleeping states; in fact, we may say that melancholia is a sleeping state, only it is an abnormal, or psychopathic sleeping state. The melancholic dreams with his eyes open. The dream of melancholia is unchangeable, fixed, oppressive; it is of the nature of a nightmare. The melancholic has on him the relentless grip of a horrible incubus. From the depressing sleeping states the melancholic may awake, he may then have lucid intervals, and with the further removal of “inhibition,” with the fall of thresholds, may even pass into states of excitement, into states of maniacal exaltation.

            This view of melancholic states from the stand-point of moment threshold is not purely theoretical; it is not entirely devoid of practical application. For it suggests a way of how to alleviate the condition of these unfortunates. As our investigations have shown that melancholic states consist in a rise of the moment thresholds, with a consequent formation of extremely limited combinations of moment aggregates, the only way to counteract this state of things is to endeavor by different means, whether by stimulants or by other agencies, to demolish the great heights of those thresholds. To counteract effectively melancholic states and to bring about a dissolution of the stably organized delusional moment compounds, one must direct the battering-ram against the thresholds. In the treatment of melancholia, the psychiatrist must keep before his mind one, and only one, paramount principle: reduce the thresholds.

            The following hospital notes of observations and experiments on a case carried out by Dr. A. Heger, under my direction, may be of interest to the reader:

            “Admitted to Manhattan State Hospital, March 21, 1896; age, 19. Single. Seamstress. Hungary. Reads andwrites. Diag., melancholia acuta.

            “Patient noisy and screaming; does not seem to know what goes on about her. She is morose and sullen.

            “Excitable on admission; troublesome; says, ‘There is something the matter with me, my head aches; I think I am different from other people.” Has ill-defined delusions of persecution; is depressed and melancholy. Is excitable at times and noisy, if interfered with.

            “Patient became despondent about a month ago. She complained of being sick and having no appetite; was very irritable and took a dislike to members of the family.

            “March 30th.—Patient becoming quiet, speaks little; appears confused. One month later speaks only with members of family, and in June speaks to no one.

            “From this time on patient remained in this condi-tion, with but little change from time to time. She was tube-fed the greater part of the time, occasionally spoon-fed, and occasionally up and was helped about the ward; at no time would she make any voluntary movements; she never soiled herself. She was on thyroid treatment for several months and improved during this time. From this time on patient remained in a stuporous and cataleptic condition for two years.

            “January 29, 1898.--Patient lies in stuporous condition. She is cataleptic, tube-fed; eyes are closed, with some tremor of the lids. Various stimuli tried, such as tickling, disagreeable odors, electricity, and pain, but responses were absent or occasionally barely perceptible. Has never been seen to sleep, but lies in the same stuporous manner night and day. She assumes strange positions at times.

            “She was given six ounces of spiritus frumenti in three doses by tube. Half an hour after first dose, patient began to cry and moan; later on, to sing and talk; spoke about her previous life, said her mother was poor and she had had to work very hard, but that Miss O’Donnell, the forewoman in the shop, had been very kind to her; said that two doctors had been in and had given her some brandy. She spoke about her sister not having been to see her for some time; called the nurse by her name, asking her to excuse her for giving so much trouble; that she knew she had her eyes closed, but she could not open them. She asked for a looking-glass, and said she would not know herself. Sang constantly in a drunken manner ‘Nearer, my God, to Thee,’ and on being asked, sang also ‘Rosie O’Grady’ (this song came out while she was in the hospital). Her manner was that of a sane and drunken person. She then became quiet, and when roused would make an effort to sing.

            “January 30th.—In her usual condition, but seems more docile; will move hands on being urged; drinks milk; later eats rice, bread and milk from spoon; will partially open eyes if urged.

            “No special treatment; patient quiet all day.

            “Night nurse stated that patient apparently slept several hours. Patient up and in usual quiet condition when seen at 10 A.M. No drug given; was made to stand and left in order to see if she would seat herself. She swayed considerably, but remained in the same place; was gently directed to a chair, but in trying to sit, missed the chair and fell, her eyes being shut, and received a slight abrasion of the chin. She seemed quite disturbed by this; her pulse rose to 100, and she appeared agitated. She was taken to a room and stimuli, such as snuff, blown in her nostrils, and snow on her neck tried, but without success. Ridicule was tried. She was told that she would be a success in a dime museum as an ossified woman, at which she smiled, and her arms were put in the position of a banjo player and a jig whistled which also amused her.

            “Her abdomen was kneaded over the stomach; this was done suddenly and roused her. She showed signs of distress and attempted to leave the chair, opening her eyes and apparently starting to speak, but quickly regained her quiet, and after this the same process brought no response. So far the results undoubtedly show that if a stimulus, new and unexpected, is tried, a response is almost certain; but if the same thing is repeated, she seems prepared and will take no notice of it.

            “In the afternoon she was taken to the patients’ dance, in the hope that the change and the music might rouse her. She was in the care of a nurse, who was instructed to note her actions carefully and try and interest her in the proceedings. She opened her eyes on reaching the hall, and after apparently taking a look around, closed them and kept them closed; except for this, and for the fact that she opened them slightly at various times on the walk to the hall, she remained in her usual condition. Her physical condition has improved since the experiments, her tongue becoming clean and her breath less foul. In regard to sleeping, the nurse thinks that she was asleep, but is not sure, as she did not snore, but her breathing seemed heavier than normal.

            “One nurse who had charge of her for some time states that she never slept, but lay ‘in a kind of stupor’ all the time.

            “January 31st.—Patient received four ounces of spiritus frumenti. The effect was not very marked. She talked and later read aloud five pages from a book given her, asking about the words she could not make out. She was not as excitable as usual.

            “February 1st.—Received four ounces spiritus frumenti at 10.30 A.M. At 3 P.M. she was dressed (visitors being in the wards till this time), and she walked with some difficulty; would not respond to or notice any questions.

            “February 2d.—Was dressed with the other patients in the morning. No spiritus frumenti. Sat about the ward during day; could not be made to talk, but ate her meals and allowed herself to be led about; walks well.

            “February 3d.—Up and sitting in ward; takes no notice of efforts made to rouse her; patient received six ounces of spiritus frumenti in three doses. A little later opened eyes on being urged and kept them open for about half a minute at a time. She laughed, cried and sang; would speak a little when questioned; was intoxicated and incoherent.

            “She had talked with the nurses and eaten her dinner with a good appetite. Later on she was taken into a separate room off the ward and an effort made to hold her attention as much as possible. She said she felt tired and that her stomach ached and she wanted to go to bed. She was apparently but slightly, if at all, under the effect of the whiskey. She had a tendency to fall back into her stuporous condition, and this was combated. She kept her eyes resolutely closed. She would remain quiet for about a minute and then suddenly make some remark, in nearly every case repeating some phrases overheard by her previously. She would stop in the middle of a sentence suddenly, as if she had lost her train of thought, and cry out in anger and clasp her head and say, ‘Oh, don’t make me talk,’ or, ‘I can’t say anything,’ and begin to scream. When quiet, it is difficult to rouse her or get her to speak, but while speaking, if a question is abruptly put to her, she would answer, and sometimes would carryon a short conversation. Her answers were, as a rule, very sensible, and she would sometimes joke. Her memory is very good, and at times extraordinary. She spoke about her commitment, and said, with a laugh, that a doctor had asked her if she heard voices or saw visions. It was only by the most constant effort that her attention could be held or her interest excited, but during the period of two hours that she was questioned she improved in her attention. She laughed frequently and had fewer outbreaks of screaming and had an appearance of animation. She gradually recovered from the effect of the whiskey without lapsing into stupor, and continued to talk while quite sober. Later on she returned to the ward and ate supper, and asked to be taken into the room, the first time she had made such a request. In the evening she was in her usual stuporous condition.”

            The principal point in this method of work is the lowering of moment thresholds, no matter by what means such lowering is effected. The best way is to use various stimuli at different intervals, so that the patient should not become habituated to them, which may on this account lose their effect. The patient in the intervals should be stimulated to greater activity and exertion.

            When complex moment thresholds become lowered, moments submerged into the subconscious step over the threshold and enter consciousness. Such a fall of the moment threshold is often found under the influence of intoxicating drugs. Slight stimuli of minimal intensity set into active function numerous moment aggregates endlessly varying in their combinations, intensity and vividness. Thus under the influence of opium or of hashish long-forgotten incidents arise with such intensity and vividness that one cannot help recognizing them.

            The rise and fall of moment thresholds stand out clearly and definitely in cases of sensory derangement where hypoaesthesia or hyperaesthesia is present. In the case of hypoaesthesia, the threshold is raised, while in hyperaesthesia the threshold is lowered. In hypoaesthesia, to pass the threshold and reach the psychic minimum the stimulus must either be intensified or a. series of stimulations must become summated before a moment aggregate, with its psychic minimum, is aroused to activity. Thus in a case under my observation and experimentation, a case suffering from tactual anesthesia, with hypoaesthesia of pain, pressure, temperature and kinaesthetic sensations, a stimulus to reach consciousness and be felt had either to be very intense or a series of stimuli had to be given in quick succession. When a series of intense stimuli were given in quick succession and thus became summated, overstepping the raised threshold, the many stimulations were felt as one. If, for instance, a strong prick was given, the patient felt nothing at all, but if the pricks came one after another in quick succession, then the patient declared that pain was felt as if a prick was given. If asked how many pricks, the patient either answered, “I do not know,” or declared them to be “one.”

            The same holds true in the case of the other sensory stimulations or series of quite intense pressure, pain or temperature stimuli, they are felt as one, their multiplicity not being discriminated, their total amount being just sufficient to give rise to one impression. This impression is often so vague that it is often hard, if not impossible, for the patient to localize the stimulated place or point out the direction where a series of pain, pressure or temperature spots have been excited in quick succession, forming a line having a certain direction. The patient, while experiencing the stimulation, is often even unable to tell to which hand the stimulus was applied, whether to the right or to the left hand. The same holds true in the case of the kinaesthetic sensations. When I get hold of the patient’s hand and move it slowly, the hand can be changed in position almost through an angle of 90°, and the patient, when blindfolded, is not in the least aware of the change. The patient thinks that the hand is in the same place and in thesame position. When a series of quick, sharp movements are impressed on the hand, the patient feels the movement, but does not know in which hand to localize the movement, nor is she cognizant of its direction. It is only an intense wrench of the hand, arm or forearm that can raise in the patient a full consciousness of the movement impressed both as to locality and direction. If the intensity of the stimulation is decreased, but the extensity increased, the same result follows; thus when the stimulated area is increased, the patient is able to feel a stimulus of less intensity. This holds true of all sensations with the exception of touch. In other words, the raised moment thresholds can be overstepped either by a higher intensity or a greater extensity of stimulations.

            The following case of aphasia brought to me by Dr. Winter, Instructor in Neurology at the New York Medical College, is of interest from this standpoint.

            Annie Bell, age 30, Irish. Came to my laboratory May 20, 1900. Four years ago, when patient was 26, she had a sudden apoplectic attack while on the street. She was taken home in a state of unconsciousness. Since that time her right side is affected. There is a marked tremor and paresis in the right hand and leg. There is a history of alcoholism; syphilis is denied by patient. Patient has always been well up to the time of the attack; family history is negative.

           Reflexes are exaggerated; pupillary reaction and binocular accommodation are normal. Patient complains of severe headaches. There is a hypoaesthesia of all the forms of sensations on the affected side and also that of kinaesthesia. With her eyes closed, patient is not able to reproduce well with her left hand the different positions produced by slow and very light rotations of the right hand. Dynamometric pressure for left hand is 70; for right hand, 55. The movements of the tongue are normal.

            Patient’s mental life is greatly affected; questions must be repeated before she answers them. There is considerable difficulty in forming the answer, which is often incorrect. Although patient was to school, and before her attack she could write quite well, after the attack, all her school knowledge, and along with it her ability of writing, was completely gone. She could read neither written nor printed letters.

            In the examination of the patient, she gave her name correctly, but when asked how old she was, she first said 40, and then corrected to 30. When asked what year it was, she could not answer. Is it 1900? Patient answered, “I don’t know.” When a paper with the date of 1900 was shown to her, she did not know what it was. When her address was asked, she said, “284 Bleecker Street” (right number 285). When asked, “Is it 275?” she said, “Yes.”

            Q. Do you know the name of the city? A. New York.

            Q. What country do you live in? No answer.

            Q. What is the name of this country? No answer.

            Q. Is it England? A. No.

            Q. Is it Ireland? A. No.

            Q. What is the name of this country? No answer.

            Q. Is it the United States? A. Yes.

            Q. Is it the Northern or Southern part in which you live? A. Northern.

            Q. What is the name of your husband? A. Tom Bell (correct).

            Q. How many children have you? A. Eight—no, two (two is correct); one living and one dead.

            Q. What is your husband’s occupation? A. Driver.

            Q. How much does he make a week? A. Twelve dollars.

            Q. What was your occupation before marriage? A. Laundry.

            Q. How old is your child? A. Eight years.

            The more familiar associations, having a low threshold, could thus be easily awakened.

            Patient is unable to talk in connected sentences and speaks in monosyllables. The following is an example of her speech:

            “My sister, goin' away, three months, in the country, nice time, Sprengt, Sherring Strings. Got a fellow up there. Write to him. Nice. How once upon time. Mother-in-law broke it up. All for drink. And five children. One is dead and other living.

            “An awful headache once in a while, top of me. Tchaking much.” (Patient has great difficulty to pronounce the word “shaking.” Lips twitched. She tried again and again, and failed.) “If I ever get better. Leg too ever get better?” Patient, however, repeats single words well; mispronounces only when she has to repeat a whole phrase.

            Her mother told us that the patient could not name objects correctly, but that she does it quite well now. Different objects were shown to the patient, and she named them correctly, though there was some difficulty noticed in the process of recollection of the names.

            She could recognize pictures, but named them with difficulty. The more familiar pictures took a shorter time. She could identify, however, the represented object when the name was given to her.

            During the experiments of naming objects which required her utmost attention, the tremor in her hands completely ceased.

            The patient was asked whether she could picture to herself a dog or a cat. She answered, “Yes.” When asked if she could picture to herself her husband, she likewise answered affirmatively. It is, however, doubtful whether patient really understood the questions.

            Colors were shown to the patient. She recognized them and sorted them well, with the exception of yellow. She does not know the name of color yellow, but remembers the names of colors. She does not recognize the shades of yellow as yellow even when told.

            With her eyes closed, a lemon was put into her hand, and when asked what it was, she said, “A ball.”

            Q. Is it hard or soft? A. Soft.

            Told to smell and then asked what the object was, patient said it was a lemon. With her eyes closed, she could by sense of touch and pressure and kinaesthesis give the correct name of familiar objects, such as scissors.

            Q. Can you spell cat? A. C A T.

            Patient was not quite sure of the spelling.

            Q. Can you spell pretty? A. I can’t.

            Q. Is it K, L, M? A. I don’t know.

            Patient knows about half of the letters of the alphabet if the letters are named to her; others she cannot identify even when named; they seemed to have been entirely gone from her memory. She can distinguish figures from letters, although she cannot name them and does not know them.

            Patient can count up to twenty, and if aided, up to thirty-five. She also knows that after forty comes fifty, and so on up to one hundred. Beyond one hundred she cannot go. One hundred and one is an unknown, if not an unknowable quantity to her.  She traces letters quite well, although she reproduces them imperfectly a minute after.

            Q. How much is two and three? A. Five.

            Q. Three and one? A. Four.

            Q. Six and one? A. Seven.

            Q. One and six? A. Sixteen.

            Q. Two and six? Patient did not know.

            When, however, vertical strokes are made in groups of five and three, she counts the marks, adds them up correctly, and then she knows how much five and three are in the abstract. This, however, is very slow. Sometimes, after counting the strokes, she still fails to give the correct answer, when the numbers are given in the abstract. The threshold is thus higher for the abstract than for the concrete and the sensory; the threshold can be passed by the help of sensory experience, such as visual, tactual, and so on.

            She was then asked the following questions:

            Q. What is more, six or five? A. Six.

            Q. Eighteen or seventy-five? A. Don’t know.

            Q. Eighteen or twenty? A. Twenty.

            Q. Twenty or seventy-five? A. Don’t know.

            When, however, more complex figures were asked concrete form of dollars, she gave correct answers.

            Q. What is more, 43 dollars or 39 dollars? A. Forty-three dollars.

            Q. Fifteen dollars or 76 dollars? A. Seventy-six dollars.

            Q. Eighteen dollars or dollars? A. Seventy-five dollars.

            With her eyes closed a watch was held close to her ear and she was asked to tell what it was. She said, “Tick, tick, tick.”

            Q. What is it? She could not tell the name.

            Q. Is it a wagon! No reply.

            Q. Is it a watch? A. Yes, yes.

            She was told to open her eyes, and she was asked to tell the time. Patient gave the correct time with each change of the movement of the hands of the watch.

            As patient knew some of the letters, syllables were made of them and she was asked to pronounce them. She could not do it. Thus she knew letter B and letter A, but when asked to read the composite syllable BA, she could not do it. The same was in the case of LO and OF. When shown syllable OF and asked if it would read as “of,” she did not know.

            The following series of figures were given to her in order to test her memory:

            23, 47, 89, 76, 52.

            The series was shown to her and she was told the value of each number. She was then asked what the first one was. She could not tell. After telling 'tier five times, she was asked what the first number was; she still could not tell. Patient is conscious of her defective memory and says, “Right away forget them.” She was then told again and once more asked, “What is the first one?” She then gave the correct answer, twenty-three.

            Q. What is the second? A. Don’t know.

            Q. What is the third? A. Don’t know.

            Q. What is the second? A. Don’t know.

            Q. Is it fifty? A. No.

            Q. Is it sixty? A. No.

            Q. Is it forty? A. Yes—no.

            Q. Is it forty-nine? Is it forty-three? A. Yes.

            Q. What is the first? A. Twenty-seven.

            The interesting point is that she learned readily the individual figures, but she could not learn their combination, just as in reading she learned some of the letters of the alphabet, but she could not learn the syllables, that is, the combination of the sounds even when the individual values of the sounds were known to her.

            To test patient’s memory, and especially her power of representation, the following questions were put to her:

            Q. How many sides has a square? Patient could not answer.

            Q. How many sides has a box? A. Four.

            Q. Has a box a top and a bottom? A. Yes.

            Q. How many sides has a box? A. Four.

            Q. How many sides has a house? A. The front.

            Q. How many more sides has a house? Patient seems puzzled.

            Q. How many legs has a chair? A. Four.

            Q. How many legs has a table? A. Four.

            These questions were put to the patient with her eyes shut.

            Q. How many toes have you? A. Five.

            Q. How many on both feet? A. Ten.

            Q. How many toes and fingers have you? A Twenty

            Q. How much is ten and ten? A. Twenty. (The answer is given very slowly.) She could not have given this correct reply if the question had been put in its pure abstract form.

            Q. How much is five and five and five and five? A. Twenty (very slowly).

            Q. How many legs has a horse? A. Four.

            Horses are quite familiar to the patient since her attack, as patient lives in a large city and in a place where the traffic is very great, and besides, her husband is a driver.         When, however, the less familiar question was puzzled to her: How many legs has a bird? patient was puzzled, then said, “Three.”

            Q. Has a bird got three legs? A. I don't know.

            Instead of the general form the question was put in a more particular form:

            Q. How many legs has a chicken? A. Four.

            Q. Has a chicken four legs? (Patient embarrassed.) A. I don’t know; I don’t understand you.

            Q. How many legs has a cat? (familiar). A. Four.

            Q. How many legs has a chicken? A. Don’t know.

            Q. Has a chicken teeth? A. No.

            Q. What do you use in drinking tea? A. Cup.

            Q. What more? A. Saucer.

            Q. What more? Nothing.

            Q. Don’t you make it sweet? A. Yes; sugar.

            Q. Do you stir it? A. Yes; spoon.

            Q. Is pepper sweet? A. No.

            Q. Is it salty? A. No.

            Q. What is the taste of pepper? A. I don’t know.

            Q. Would it taste hot?   A. Yes.

            Q. Would it taste bitter? A. Yes.

            Q. What is the taste of vinegar? A. Sour.

            Q. What is the color of silver? A. Don’t know; don’t understand.

            Q. Is silver blue? A. No.

            Q. Is it red? A. No.

            Q. What is its Color? A. Don’t know.

            A more familiar color of a very familiar object was then asked:

            Q. What is the color of grass? A. Green.

            Q. What is the color of gold? Patient kept on repeating the word “gold” many times, as if one trying hard to recall but did not succeed.

            Q. Is gold blue? A. No.

            Q. Is it green? A. No.

            Q. Is it yellow? A. Yes; oh, yes!

            In many nervous diseases where the advanced stages are characterized by complete loss of the muscular sense and of kinaesthesis, the early stages present phenomena of rise of threshold. This can be verified in the initiatory stages of tabes. Thus in an interesting case that came under my observation, the patient for about the course of it. No years revealed no other symptoms, except severe attacks of periodic nausea and vomiting, and on an examination revealed no sensori-motor derangements indicative of any lesion as of the active progress of a pathological process. A closer examination, however, by the method of minimal impressions revealed a great rise of the threshold for kinaesthesis in the toes. The case was afterward regarded to be one of tabes. I may add, by the way, that the method of minimal impressions in relation to the rise of thresholds can be used in many forms of nervous diseases from a purely practical diagnostic standpoint, the method being all the more valuable in the initiatory stages of the malady.

            In hypnosis and trance states the moment thresholds are often found reduced. The fall of the thresholds in these subconscious states gives rise to an extreme condition of hyperaesthesia. This hyperaesthesia is by no means of an organic character, but purely of a functional psychopathic nature. In other words, the hypnotic hyperaesthesia is not at all due to a modification within the peripheral sense-organs, but simply and solely to a lowering of the moment thresholds of the more complex and higher constellations of moment aggregates. Stimuli of minimal intensity, which in the waking state cannot overstep the higher thresholds of the higher constellations of moment aggregates, constituting the personal self-consciousness of the individual, are enabled to do so when the trance state is induced and the moment thresholds are lowered. The impressions are subconsciously present, but can only enter consciousness or self-consciousness through the medium of trance states. To this effect I have carried out a series of experiments, varying them in all possible ways, but with the same result,—apparently unperceived stimuli during the waking state are still present subconsciously and become manifested with the induction of subconscious states. The hypnotic subject, when in a very deep trance, is often highly hyperaesthetic, his discrimination becoming very acute. The subject's eye can perceive a difference, when no other eye can see any; his ear can detect the slightest difference in apparently similar sounds; the hand can recognize and identify objects in all their details by the slightest and most superficial touch. This fact of hyperaesthesia in trance can be verified by anyone who has carried on extensive experiments in hypnosis and has had subjects who could be submerged into the deeper subconscious regions. In other words, moment thresholds are lowered in hypnosis, minimal and subminimal stimulations give rise to psychic processes which become assimilated in the moment aggregate.

            Furthermore, experiences received subconsciously come to the surface with the induction of hypnosis and of trance states. The thresholds having become lowered, subconscious experiences are enabled to overstep thorn and become assimilated in the functioning moment aggregate. This holds true not only of subconsciously received experiences, but also of such experiences that have been so deeply submerged into the subconscious as to be beyond the reach of self-consciousness. In the deepest stages of hypnosis, as well as in similar trance states induced by other means, memories are often revived that have fallen altogether out of the grasp of the individual. In short, subconscious moment aggregates manifested in hypnosis and trance states have lower thresholds.