commencement at 37 years of age. The attack in which the present experiments were made is much the longest of them, having lasted with one slight remission for nearly two years; the patient was well on the road to recovery at the time of making

the experiment, and has since recovered and gone into another depression. There have been no excitements.

Two experiments were performed on succeeding days. On the first day the patient made a fairly normal appearance, cooperating willingly all the while, though seeming to brighten up

somewhat during the experiment. This experiment took place at 3.30 p. m. The following one was arranged for 10 a. m., and it was arranged that the patient should be left quiet up to this time, with the not unexpected result that the patient's mood was considerably less cheerful at this experiment. The records also reflect a characteristic change in the motor sphere, being as shown in Fig. II.

As in Case III, there are no clear-cut phenomena of reversal, though the f's are considerably greater than the normal. On the other hand there is much greater fatigue loss in the second experiment (dotted lines) than in the first; that is, the individual series show the greater susceptibility to fatigue at the time when retardation is objectively the most prominent, just as did the earlier series of the third experiment with Case II. The most abnormal feature of the records is again, however, found in the transference phenomena. In the first experiment, performed in the afternoon, the right hand record averages somewhat below normal; but the left hand, which follows the right, is much above normal for the left hand, and even considerably surpasses the performance of the preceding right hand. In the second experiment the left hand, which now precedes, has the poorest record of all, but the right, now in the favored position, is much better than the left, though it does not reach its average of the previous day. We thus have an immunity to fatigue and a transference effect above the normal, with a drop in gross rate and increased susceptibility to fatigue associated with an objectively given poorer condition."

CASE V. Market salesman, 55, a slight heredity. As a boy, bright and active, learned well at school, which he left at 15 to work in a store. He was quite successful in business, though when about 45 he had a financial setback that gave him considerable anxiety, which, however, he threw off well. During the last few years he has also worried somewhat over dulness in the market.

The present trouble has its origin in a railroad accident, which

Cases IV, VI, and XI were patients in the Boston Insane Hospital. For access to these cases and for their histories grateful acknowledgement is made to the officers of this institution.

made him a cripple and necessitated two surgical operations. The shock of the accident and the main operation he bore well, and kept in good spirits until the second, a relatively minor operation, when he became progressively very much depressed, growing nervous and irritable, easily disturbed at the slightest noise. Then hypochondriacal delusions began to develop, and there was an attempt at suicide, after which he became more depressed, and

was removed to an institution. On admission to the McLean Hospital, 17 months after the onset of the psychosis, the patient was restless, irritable, hypochondriacal, complaining of great fatigue. He mentioned feeling worse at night. Some improvement was noted during the next month, after which his condition remained about stationary. Two experiments were performed about 15 months after the patient's admission, the curves running as shown in Fig. 12.

It is interesting to note that in spite of the fact that this pa

tient complained greatly of the exhaustion induced by physical effort, he actually showed a little better performance than the normal, and this precisely because of an almost absolute immunity to fatigue losses. The right hand shows a considerable amount of reversal, the curve of the second experiment being more typically reversed than that of the first, though the f is equal in each record. The left hand also shows more tendency to reversal in the second experiment than in the first. There is no transference phenomenon, nor is there any objective change in the patient to which might be referred the fact that the second experiment, besides showing more overcoming of retardation, averages from five to six taps better than the first, and is also much more

constant.

The records in this case correspond quite closely with those obtained in the sixth subject of Specht (Vp. M.). This subject, an entirely typical traumatic case, differentiates himself markedly from Specht's other subjects in showing a progressive increase in the efficiency of performance exactly comparable to that noted in the case above. Specht also attributes this to Hemmungswirkungen, which the course of the experiment tends to overcome. He writes: "Die Hemmung. . . ist hier im Beginn der Arbeit grösser als im weiteren Verlauf; sie schwindet nicht, aber in ihrer Wirkung auf den Gang der Arbeitsleistung wird sie durch die arbeitsfördernden Einflüsse der Uebung und möglicherweise auch der Anregung abgeschwächt." The present result would seem to point to this interpretation in the case of Specht's subject, M., as the correct one; at any rate, this subject represents a totally different fatigue condition from his remaining five subjects, and one which corresponds much more closely to that observed in manic-depressive depressions with the tapping test here, and with the addition test itself by Hutt. However, the clinical data given by Specht mention nothing in favor of a manic-depressive condition for this case. In the present subject the diagnosis was more doubtful. There was a far from positive history as regards previous attacks, and this, coupled with the obvious origin of the symptoms, together with irritability and complaint of exhaustion, pointed to a traumatic neurosis. On the

Specht: Ueber klinische Ermüdungsmessungen, Arch. f. d. Ges. Psych., III, 1904, pp. 316-318.

other hand, there were no anesthesias or paræsthesias, and the presence of a thinking disorder and inadequacy pointed at first in the direction of manic-depressive. The further history of the case, which has failed to improve, indicates that clinically it satisfies better the present conception of a traumatic neurosis. There are, then, two possible interpretations of these two cases: If the normal situation in traumatic neurosis is exceedingly great fatigability, as Specht has found it, and the manic-depressive depressions are apt to exhibit reversed curves, as Hutt and the writer have found, the indications for these two subjects are rather in favor of a psychosis upon a fundamentally manic-depressive basis, but with a more or less accidental traumatic coloring. There is the alternative possibility that traumatic cases may occasionally show the same phenomena of retardation as the manic-depressive, without its having any further influence on the clinical picture.

CASE VI. From a differential standpoint, this is perhaps the most interesting of the cases presented. The patient is a man aged 20, no occupation, slight heredity. As a child he seemed to be perfectly normal, but did not get along well during the latter part of his school life, being unable to keep up with his classes, and has of late been growing "nervous." For the past three or four years he has had an enormous appetite. About six months before admission he became very restless, moved about quickly, would tip over furniture, and so on, and kept constantly on the move, though he sometimes assumed strange positions. About three weeks before admission he said that he saw his father, who had been dead for six months, and for two weeks previous he destroyed his clothing and was very careless in his habits. He was noted to talk to himself.

When first seen by the writer his appearance was downcast and melancholy. He would hardly answer questions at all, and then only very slowly and briefly. He said that he felt blue. When asked if he felt better any particular time of the day he said that he felt better in the afternoon. The immediate picture was one of depression rather than one of apathy, suggesting the more frequent condition in youthful manic-depressive cases, in which the retardation tends to outweigh the affective depression, and his conduct during the experiments was in conformity with