The Time of Some Mental Processes in the Retardation and Excitement of Insanity BY SHEPHERD IVORY FRANZ (From the Laboratory of Pathological Physiology of the McLean Hospital, Waverley, Mass.) Reprinted from the AMERICAN JOURNAL OF PSYCHOLOGY January, 1906, Vol. XVII, pp. 38-68. The Time of Some Mental Processes in the Retardation and Excitement of Insanity. THE TIME OF SOME MENTAL PROCESSES IN THE RETARDATION AND EXCITEMENT OF INSANITY. By SHEPHERD IVORY FRANZ. (From the Laboratory of Pathological Physiology of the McLean Hospital, Waverley, Mass.) TABLE OF CONTENTS. Introductory, Clinical histories of subjects, Description of experiments, Experimental results, Conclusions 2 3 12 17 31 Introduction. The present work was undertaken in order to gather material for the solution of the problem : to what part or parts of the nervous system may we refer the increased and the decreased psychomotor activity usually found in depressed- maniacal insanity. The earlier psychiatrists considered as separate disease enti- ties abnormal emotional depressions and exaltations, under the names of melancholia and mania, and the condition in which there is a more or less regular alternation of the exaltation and the depression, called circular insanity. The last state was deemed very peculiar, but until the time of Kraepelin it seemed not to have been closely associated with either of the two other conditions. To Kraepelin is due the credit for having shown that circular insanity, m form) are interrelated Manisch-depressive Irresei main points of the present pelinian school) of the o simple termed up the Krae- eWncholia and Mnatio the older circular insanity; 2 a tendency to recurrence, the ab- sence of mental deterioration, psychomotor excitability or re- 1 This name has been variously translated, the most common being "manic-depressive insanity." See Hoch's article in Wood's Hand- book of the Medical Sciences, Vol. V, "Manic Depressive Insanity," Paton's recent book: Psychiatry, and. de Fursac, Manual of Psychi- atry, Trans, by Rosanoff. This designation is a transliteration of the German, regardless of English meaning and spelling; the word manic is not given in the Century Dictionary and the word depressive means "able or tending to depress." It is not the insanity which is depres- sive but the depression is the "insanity." *0 cit. MENTAL PROCESSES. 3 tardation, emotional exhilaration or depression, and difficulty or (apparent) ease in thinking. These alternative symptoms may be variously combined in individual cases, the most usual, however, being the combinations of (a) exhilaration-|-excita- bility-j-flight of ideas and (b) depression-}-retardation-|-diffi- culty in thinking. In the excited phase of this condition the emotional tone is exalted. There is a feeling of bien aise, of ex- pansiveness, of great ability, and of self-satisfaction. There is more or less motor excitement and a seeming rapidity of asso- ciations, with flight of ideas. The associations are usually superficial and sound associations. The attention is very un- stable. In the depressed phase there is a lowering of emotional tone, and a feeling of malaise, of hopelessness, perhaps of fear, and there may be suicidal tendencies and attempts. There is often a profound motor disturbance in which the reactions using that word in its widest sense are slowed, and an ap- pearance of decrease in associative ability; in other words a retardation. Any of these symptoms, but of course not oppo- sites, may be present to a mild or to a most marked degree. The differences in motor activity of this class of the insane have been studied to some extent * but so far as I am aware there is no published account of work such as is here attempted. At the present writing there is available only an incomplete skeleton of the work necessary for a full understanding of these motor conditions. The present article is, however, complete in itself and is to be considered as part of the general plan. Clinical Histories of the Subjects. Six subjects were chiefly used in the research, two normal, two depressed (retarded), and two exhilarated (excited), as follows: Normal subjects. F., the writer, upon whom the whole series could not be made, was used as one normal subject. The other normal subject was B., a business man, age 49 at the time the experiments were being made, had been a patient at the hospital for about seven years. During the course of the experiments B. was consfileSred 'recovered,' and had been prac- tically so for about a year. He w'as admitted 2 to the hospital Oct. 22, 1897. He had previously indulged quite freely in alcoholic liquors, but for over a year had very little alcohol. For ten months before admission the patient had appeared not ^Especially reaction times : W. Bevan Lewis, Textbook of Mental Diseases, 2d edit., London, 1899, pp. 164, 364 and 365. Richet: Dic- tionnaire de Physiologie, Article Cerveau, Vol. Ill, p. 29. v. Tschisch: Neurol. Centralblatt, 1885, IV, p. 217. G. Leftnann : Psychol. Arbeiten, 1904, IV, 603-668. On fatigue: Hoch,Journ. of Nervous and Mental Diseases, 1904, XXVIII, 620-628. 2 The clinical accounts have been copied from the hospital records. The notes were made chiefly by Drs. A. Hoch, Steele, Roberts and Hamilton. 4 FRANZ : so well, had become absent-minded, depressed, and later more inactive. On entrance he spoke slowly in a monotonous tone, expression immobile, rather blank, yet said he worried about everything. He was not clear as to where he was, and in the afternoon did not remember the physician whom he had seen for a short time on entrance (morning). Later he was oriented as to time, place and persons, did not occupy himself, did not speak spontaneously, but answered calculation questions, even difficult ones, very promptly, but questions regarding his con- dition were answered by "I don't know." There was no memory difficulty. In four months he became a little more spontaneous, and his sentences were a little longer when he talked. In the gymnastic class he was reported to make his movements promptly and well. For four years he remained practically stationary, answering slowly, doing little, but when made to do things, as in the gymnasium class, doing them promptly and well. "It is the fact that with a sufficient ex- ternal stimulus the patient can act promptly while it seems that if he has to supply the stimulus himself there is so little activity that it makes his general condition appear rather the outcome of an apathy than of a retardation." In June, 1903, it was noted that "there has been a slow, gradual gain which from day to day or week to week, or even month to month has been imperceptible, but which on looking back has amounted to a very great transformation. The man shows now in regard to conversation and in regard to occupying himself with every- thing that is possible in the hospital a very decided sponta- neity. He shows, moreover, good judgment in his conversation. He is one of the best billiard, tennis and whist players and is occupied all the time." He did not ask to be allowed to go home, did not think he could attend to his business, but when questioned in regard to his condition the old reply "I don't know" was sometimes given. During the following summer the patient was occupied most of the time playing golf, tennis, etc. There was a gradual improvement, although when any- thing out of the ordinary arose he was inclined to hesitate a little. During the succeeding year there was a gradual recov- ery and at the time of the laboratory experiments he was prac- tically well, although disinclined to take up business. The patient was discharged May 29, 1905. Retarded subjects. Ed., a hotel clerk, age 21, was admitted to the hospital May 8, 1904, greatly depressed and retarded. For some years previous to his attack of melancholia he had been troubled greatly with dyspepsia, and he had always been inclined to worry about his business and other affairs. In March, 1904, the patient could not attend to his work, gave up his position, and was greatly worried about himself. He would MENTAL PROCESSES. 5 say, as an example of his depressive ideas, "I am no good." When taken to drive he feared lest the horse was not strong enough to pull him, etc. At this time the patient was taken to his father's office and performed what little things were asked of him, e.g., writing down orders and answering the telephone, but there was no spontaneity. Gradually he be- came slower in his movements, but in the beginning of May was restless and once made an attempt at suicide by drowning. After this he was even less active, refused food, and was untidy if not closely watched. He expressed the ideas that he was turning to stone, that his throat had been cut, that his feet had been taken off, that he had no tongue, and that his neck was broken. After his entrance to the hospital he remained in bed, lying perfectly quiet, seldom moving any part of his body. Upon repeated requests he did not show his tongue, although it was seen to move slightly in his mouth, which was partly open. There was no reaction to pin pricks. He was tube-fed. When requested he could be made to walk slowly to a chair and to sit down, but all movements made at command were done very slowly and often incompletely. It was impossible to get the patient to answer any questions. On most occasions he had to be moved by the nurses from place to place. On one or two occasions he was heard to say "What have I done?" "Where am I?" About three weeks later the patient obeyed simple commands such as 'Get out of bed,' 'Sit in the chair,' but all his movements were made slowly, and with a consid- erable interval between the command and the beginning of the movement. Common answers to questions, sometimes given quite promptly, were "No," "I don't know." He knew his name and age, and related part of his previous history slowly but well, but he did not know where he was, how he came to the hospital, or how long he had been here. He did not re- member the physician although he had been tube-fed by him for twenty-three days, three times a day. A few days later he could not be made to give the date, place, etc., and answered to all questions "I don't know." At this time he was heard to remark, "I have no eyes, no arms, no legs." Three weeks later he knew the names of the nurses and of many of the patients on the ward, and not infrequently made remarks about the latter. His time was entirely unoccupied, and was spent walking slowly about the hall or in the yard, or sitting or lying about the hall or in his room. On June 2, he ate well three meals and from that time did not have to be tube-fed. Simple questions were now answered readily, but questions the answers to which required the least thought either received no response or "I don't know." July 30, there was considerable improve- ment over his previous condition. Occasionally, especially 6 FRANZ : towards evening, he walked about better, and talked more freely to the nurses and physicians. At times, however, all one could get from him was "I am suffering more than any one else in the world," or "I am all twisted," etc. On general subjects he often answered well but slowly, but so soon as his condition was touched upon, he would not answer. He was at this time perfectly clear regarding his surroundings, oriented as to time and place, and knew the people about him. On August 24th, when the series of experiments were begun, the patient was in the condition just described. He answered slowly and in whispers and it took considerable persuasion and often commanding to get him to start upon the work. A month later, September 26, it was noted that there had been a steady improvement in the patient's condition. He took part in games, and made a fairly natural general impression. He played pool and billiards well. For about three weeks he had not talked so much of being "abused" and of being "the sick- est man in the world," and these ideas had been gradually disappearing. The period of his convalescence seemed to be very short; he seemed to get well by leaps and bounds. The experiments were continued from August 24 until his discharge "recovered" Nov. 9, 1904. Ev. , the other retarded subject, was at the time of the ex- periments 65 years old. He was a business man, admitted to the hospital Oct. 15, 1903. In temperament he was inclined to be optimistic. He was social and entertaining, but rather easily irritated. Previous to his present illness he had had six attacks of depression. All of these had been rather typical, showing depression, a feeling of inadequacy, and some retarda- tion. These attacks came respectively at the following ages: 22, 30, 37, 44, 51, and 58. The later ones lasted about six months, and the course was very similar in all. Each started with a depression, and a gradual quieting and inactivity. Then he took little interest in things about him, was depressed about everything, thinking that his business was 'going to the bad' and that his family would be ruined. At these times there was considerable self-reproach, etc. He always spoke i a low tone and answered slowly. The attacks usually wore off quite gradually, with an improvement in his physical condition and a relief from his insomnia, and he returned to his 'natural opti- mistic self.' During the past five years the patient had been under a mental strain because of business difficulties. The present illness began in December, 1902. He began to be de- pressed and to sleep poorly, but kept at his business until February, 1903, when the firm failed. He was 'completely exhausted' by the failure and remained in bed for a week dur- ing which time his condition was as follows: quiet, felt unable MENTAL PROCESSES. 7 to do things, had considerable self-reproach, took little interest in things about him, complained of feeling exhausted and weak. Then he became restless and agitated and would not eat. He was sent to an insane hospital in a neighboring city, his restlessness disappeared and gave place to a retardation. He remained quiet for the most of the time, sat in one place, and had to be urged to do things. He was mentally clear, and well oriented. On entrance to McLean Hospital, October, 1903, the patient answered questions very slowly five to eight seconds looked quite depressed, obeyed commands slowly, walked quite hesitatingly, protruded the tongue barely beyond the lips. He sat about unoccupied, without any spontaneous talk, almost with no movement. He showed, in fact, a very typical psychomotor retardation. He is senile physically, but not mentally. The condition of the patient remained stable. He was always quiet, saying and doing nothing except an oc- casional mumbled answer in a tone so low as to be scarcely audible. His time was occupied in standing quietly or sitting in one place, occasionally looking around him. He occasion- ally answered questions briefly, slowly, and in a very low tone. When told to go to the dining room he went very slowly, but was able to find his own seat. He ate in a normal manner, using knife, fork and spoon properly, and at the proper times. At night he would not undress himself, and in the morning would not get up until taken out of bed by the nurse. He ate and slept well. During the next few months the patient grad- ually improved in that he took more notice of things about him, moved a little more quickly, and more often. He looked after his wants better, and was a little more independent, e. g., he would go to the dining room when the bell was rung. From that time the condition remained almost stable. He sat about the ward, always unoccupied, very depressed, never talked to any one except to answer questions. He was dis- tinctly retarded except in the matter of eating, which he did as rapidly as any one. He dressed and undressed himself slowly. He was perfectly oriented as to time and place, and knew the people about him. There seemed to be no memory defect and no thinking disorder. The following is a note made August 29, 1905: "Very little change has been noted in the patient's condition. He is always seen sitting dejected and inactive in the sitting room, and if asked to shake hands he extends his right hand very slowly forward. In answering a question he hesitates for some time, and finally whispers out a reply. This observation applies to his conduct on the ward, where his retardation is marked. About two weeks ago he was taken to the laboratary for four days to be put through a number of tests. One of these tests required him to read 8 FRANZ : aloud, which he did quite audibly on the third day. . . . Other tests were responded to in such a manner as to indicate that he not only understood all that was said to him, but that he could do various things calling for a considerable exercise of his power of attention, recognition and discrimination. Once an experiment was explained to him, he co-operated in- telligently, and although with considerable retardation, quite accurately. . . . His memory is good, as is also his ori- entation as to time and place. Depressive ideas remain, as for example, his usual answer to questions concerning his health: "No better I shall never be any better. " (Hamilton.) This patient took part in the experiments reported in this paper from August to December, 1904, and again in August, 1905. He was discharged to go to another hospital Oct. 8, 1905, in the condition that had been characteristic of him for the past year. Excited Subjects. C., age 48, a mechanic, of fair education, with a fourth attack of insanity, was admitted as a patient to the hospital August 2, 1904. The first attack (March 8 to May 21, 1901) was a depression. The patient had been a heavy drinker and six years before entrance, in 1901, he had taken the Keeley cure. After that he did not drink until a short time before his admission. In the previous summer C. was very irritable and inclined to worry over small matters. Then he lost interest in his work. Four months before admis- sion he stopped work, and thought his friends were against him, avoided them, became morose and remained at home. His memory at that time was not good, he slept poorly, but there was no marked depression. When admitted (March, 1901) the patient said that he stopped work because he could not attend to it and "got balled up." He had difficulty in thinking. Multiplications that required much thinking were difficult and almost impossible. He said spontaneously that his memory was poor and objectively it was shown to be so. Things which he knew well, e. g. t when he came to the hos- pital, when he last saw the physican, etc., took him a long time to think out. He worried because he could not do his work. During the succeeding two and one-half months he im- proved rapidly, felt able to take up his work again, and said that his memory was good again. His second attack was an ex- citement (December 4, 1901, to March 18, 1902). After leav- ing the hospital in May he began to work, bought another business, worked hard, and showed good judgment in his affairs. In November he became exhilarated, and talkative, but not unduly expansive in his ideas. He also showed a cer- tain forgetfulness. During his stay at the hospital he was decidedly euphoric and exhilarated. He showed a great deal MENTAL PROCESSES. 9 of over-activity. He talked much, decorated his room, and showed a distinct flight of ideas. Everything was said to be "fine;" the hospital "the finest place in the world," etc. He showed no memory defect at that time, but on the contrary had a good grasp on details of both present and past events. He gradually quieted down and became more normal and was discharged "much improved." For four months the patient worked well, but was a trifle irritable from time to time, and in the summer became quite tired. About three months before his third admission he began to have difficulty in applying him- self to his work, and drank heavily. Afterwards he could not do his work, became seclusive and slept poorly. Readmitted in December, 1902, he was depressed until May, 1903 (third attack). In this attack he was more depressed than he had been in 1901. He said he was 'done for,' would never amount to anything, others did not want him around, etc. In church he felt that the clergyman was talking at him because he talked of vices, and he asked if he should not get up and confess. He was unoccupied, complained of feeling dull in his head, heavy, and s~aid his mind was weak and that he could not remember things. He said very little. Objectively his memory was not found to be particularly poor, he was oriented in regard to the place and time, and he knew the names of those with whom he came in contact. His calculation ability was poor, and he said it was difficult for him. He improved during the five months of his stay and was discharged in May, 1903. Later he became abnormally irritable and excited and returned to the hospital August 2, 1904. During the interval of over a year he drank frequently and- at these times neglected his business. At such times he talked alternately, religiously and profanely. During the six weeks previous to his re-entrance to the hospital he was more talkative, sometimes abusive, and he took no rest and went to meals irregularly. During this period he was arrested twice for acting peculiarly. His man- ner at the hospital was a jolly one, and his talk showed a "flight." He remained exhilarated as evidenced by his gen- eral activity in sports and in his movements and talk. He was apt to become irritable at the slightest provocation. This was his condition during the experiments. In May, 1905, it was noted that he had become a little quieter, but that he made the impression of still being mildly exhilarated. July 29. 1905, the patient was discharged. He had become less exhilarated, but remained active. His conversation was clear and not particu- larly expansive. Throughout the last attack the patient did not seem to realize that his condition was abnormal. The diag- nosis that was made was "Manic-depressive insanity, circular form." For a time, and particularly during the first two at- IO FRANZ : tacks, there was considerable doubt about the diagnosis. At first he was considered a case of "General paralysis." This was due largely to the presence of certain physical signs, e.g., no pupillary reaction to light, but good reaction to accommo- dation. Later the tendo Achillis reflex was noted to be absent, but there were no speech defects, no tremors, no gait disturb- ances, and the other reflexes were found to be normal. In view of the facts that there is no noticeable dementia, and that there is a regular alternation of the depressions and excite- ments, it seems most probable that the man is not a case of paresis. If, however, it happens that he is found to be paretic, the results of the experiments would not be affected, because at the time the tests were made he was undoubtedly in an ex- cited, maniacal condition without dementia. The pupillary disturbance, I think is the result of the man's occupation. He has to look alternately at bright lights and to dark objects, and this would tend to reduce, perhaps abolish, the light reflex. P., was a bright business man, age 48 at the time of his ad- mission to the hospital, May 29, 1904. At this time he was greatly excited and exhilarated, and remained under hospital care until December 5, 1904, when he was discharged on a visit home. A month later he was brought back to the hospital very depressed, after a suicidal attempt. He is now in the hos- pital (November, 1905). The course of his disease is a typical mania-melancholia, the manisch depressive Irresein of Kraepelin. Three years previous to the present attack P. had bought a business on a friend's advice and when he found later that it was much worse than any one could have expected, he became melancholy. This abnormal depression was, however, only ot a short ciuration, a couple of weeks. Four weeks before en- trance to the hospital P again became 'worked up' over his business, but this time the insanity took on the excited form. Much extra work had been thrown upon him in the business in which he was engaged, and, in addition, he was occupied with the affairs of another concern that he was purchasing. He took a trip to New York in connection with the new busi- ness, and there was very erratic. For example, it is said that he bought 500 pocket knives and distributed them among the street gamins. Returning to Massachusetts he wrecked the furnishings in a Pullman coach, was arrested and finally brought here On entrance he was talkative, excitable, med- dled with everything. He seemed to be perfectly clear in re- gard to his surroundings. He was expansive, euphoric, and quite convinced of his own power and excellency. There was, however, no absurdity in his expansiveness or in his general behavior. He showed insight into his condition, realized that he was excited and irritable, but wanted to go to a summer MENTAL PROCESSES. II resort for rest rather than remain in the hospital. There was a marked flight of ideas. He knew the other patients were in- sane, knew the names of the people, and was oriented as to place and time. He remained in that condition for about five weeks. Then he became more excited, would not keep his clothes on, was violent when an attempt was made to restrain him. In this state he talked of religious matters and sang very often. He believed that he saw worlds made, and that he lived in another world, although he appeared to be perfectly clear in regard to his surroundings, and only once did he not recognize people. After a week of this violent excitement, he became calmer although still much exhilarated. His talk was volu- minous and he did not occupy himself beyond writing letters about his business ventures and erotic epistles, all comparable to his talk. About the middle of September the patient showed signs of improvement. He tended to keep to his room more and not to meddle with things, although he was still exhila- rated. He began to have some insight into his condition, ex- plaining it as "brain fever." Later he ceased his continuous talking, although he would chatter so long as any one would ask him an occasional question. He gave up writing letters, and read much with enjoyment. Four or five weeks later he was not so active but remained exhilarated. His talk, how- ever, was more hopeful than his financial affairs warranted. It was in this condition that he first came to the laboratory, and the experiments continued until he was discharged in Decem- ber. In the meantime, he gradually became more natural in actions and talk, and his excitement was noticed only in a great activity in his games and amusements. As has been said, a month later he returned to the hospital depressed and retarded. During the time of the experiments, therefore, B. and F. were normal subjects, Ed. and Ev. were greatly depressed and retarded, and C. and P. were mildly excited and expansive. The four last cases, possibly with the exception of Ev., showed a considerable improvement during the course of the experi- ments both in the laboratory and on the ward. Ev. improved greatly in rapidity in the laboratory, as will be shown later, and he talked more freely and louder, but on the ward there was no appreciable improvement. At no time did any of the subjects show any difficulty in thinking and there was in none of them any appreciable (by tests) memory or attention dis- order. All the subjects seemed willing to take part in the experi- ments; some of them were anxious to show how well they could do. The experiments also gave them a change of scene and I 2 FRANZ : occupation, which was probably an agreeable change to them from the monotony of their ordinary life. The results, there- fore, are as trustworthy, it seems to me, as could be expected with normal people of the same grade of intelligence. The series was continued in some cases for a period of fifteen weeks with intervals, but some of the patients were not used for more than half that time. The results from all the subjects are comparable if we take the results in serial weeks as will be done. The degree of retardation in Ev. and Ed. differed, but so far as the general problem is concerned, this variation is not of great importance. C. and P. at the time of the experiments did not greatly differ in the degree of exhilaration, but if there was a difference, P. was probably the more excitable. Description of Experiments. All the work to be reported in the present paper deals with the time of certain mental proces- ses. A number of other experiments were made on accuracy, memory, judgment, and apprehension, but these will not be published at this time. The object of the time tests was to determine the amount of slowing in the cases of retardation, and any marked increase in ability in the exhilarated patients who were convinced of their own excellency. The following seven kinds of experiments were made : A. The time of rapid tapping. B. The time of the simple reaction to sound. C. The time of choice reactions to sounds. D. The rapidity of reading. E. The time of discriminating and marking out letters. F. The time of adding. G. The time of discriminating and distributing colored cards. In addition to these tests a few other time measurements were made and these fewer and less systematic experiments will be mentioned incidentally in the text. It should be noted that most of the tests were made as simple as was consistent with accuracy, in order that the same kinds of experiments might be performed later on the wards with other patients, who could not conveniently be brought to the laboratory, or who might become unduly excited in a strange situation. With the exception of the reaction time experiments, the tests were of such a character that the patients were tolerably familiar with the materials and methods that were employed. The results have been grouped by weeks, and the average weekly averages are given in the following tables unless other- wise designated. From these averages the average variations were calculated and these are also given in the tables. The number of experiments in one week varied with the character of the test. In such tests as rapid reading, tapping time, etc., MENTAL PROCESSES. 13 usually five determinations were made each week, but in the reaction time experiments from ten to one hundred were made each day. The numbers of experiments of each kind are noted in the appropriate tables. The arbitrary weekly division of the results was made in order to determine the practice effect. A. The method for determining maximum rapidity of tap- ping was as follows : A sheet of paper, 8 x 10 inches, was placed before the subject, a pencil was given to him, and he was instructed (and shown) to tap progressively in lines back and forth on the paper at his maximum speed. The signals for starting and stopping were explained to him, and the ex- perimenter watched the tapping of the subject to see that the beginning and end of the process coincided with the signals. The tapping movement was made by the forearm, although no insistence was made on this point. Most of the subjects re- mained seated at the table for the experiment, but one (C. ) said it was much easier for him to stand up to tap. Thirty seconds was chosen as a convenient time in which the subject had an opportunity of warming up and of attaining his maxi- mum speed, and it seemed not sufficiently long to show any plain evidences of fatigue. In this method there is a possibility of a constant error of plus one tap, but probably not more, and this constant error was probably the same in all the subjects. The number of taps in the thirty seconds was counted, and the time for making one tap was found by dividing the total time by the number of dots on the paper. The differentiation of the parts of the tapping process, i. e., the holding down, the holding up, etc., could not be calculated from the records. Such details were considered unnecessary in this work. Usu- ally only one experiment of this character was made each day. B. The time of simple reaction to sound was determined by means of a Hipp chronoscope. The patient was instructed to hold down the electric key, and to release it so soon as the sound was heard. The stimulus was produced by an electric telegraph sounder, and was a clear, sharp, rather loud sound. Two or three days' practice in reacting to the sound was given to each subject before any time measurements were made. This was done to familiarize the subject with the apparatus and to get rid of any possible fear of electricity, etc., that might have been present at the beginning. None of the pa- tients showed, however, the least sign of fright, and all re- ported that they had none. In each day's series about half a dozen practice reactions were made before the time measure- ments were taken. All the subjects were right-handed, and only the right hand was used in these experiments. The chronoscope was controlled frequently by a fall hammer. In 14 FRANZ : the calculation of the records the weekly averages and the average variations were determined. Experiments on the reaction to light and tactile stimuli are planned to supplement the present ones on sound, and reac- tions with the lips as well as with the hand. For a solution of the general problem, i. e., the localization in the nervous system of the retardation and excitation processes such experi- ments will probably be necessary. C. The sound apparatus used in the experiments on simple reactions was employed in the choice reaction tests to give a loud sound (same intensity as in simple reactions), and for the less intense sound a telegraph key was hit gently. The in- tensity and quality of the low sound differed from the other sound, and the intensity probably also varied in the different experiments. The right hand reacted to the sound for the telegraph sounder, as in the simple reactions, and the left re- acted to the sound from the telegraph key. The reactions with the right hand were used for comparison with the times of the simple reactions. Only these right hand reactions were timed, but the subjects did not know that the left hand reactions were not being taken. This procedure, i. e. , considering only the right hand reactions, was necessary in order to make the results comparable with the results for the simple reactions. D. The time necessary to read aloud one word was found from a rapid reading of a page of printed matter from three hundred sixty to four hundred words in length. The subjects were given the page of printing and instructed to read aloud at a maximum speed to the end of the page. The total time divided by the number of words gave the average time for reading one word. The matter which was read was unfamiliar to all the subjects. The words, however, were neither peculiar nor difficult. The type was lo-point, single leaded. In ex- periments such as these the time will vary greatly with the individual, since education and previous practice play great parts in the ease of reading. The patients who were used, however, did not vary very much in their average of intelli- gence, and possibly not much in their reading practice. It is possible that C. was least intelligent and the least read of all the patients and Ev. the most intelligent and most widely read. These are the impressions the writer got from careful observa- tion of the subjects, but it is extremely difficult, almost impos- sible, as all know, to make any accurate estimate. E. One hundred E's in a number of words with an average total of 850 letters were to be discriminated and crossed out as rapidly as possible. The subjects were not informed how many letters there were to be crossed out, but only to do the work accurately and rapidly. This experiment, but with 100 A's in MENTAL PROCESSES. 15 a total of 500 letters, was used in the tests of the Columbia College students. 1 The time for the total task was taken by a stop watch. The number of omissions was noted. The pro- posed method of calculating the results by lengthening the time proportionately to the number of omitted letters was tried, but was given up. The total time in any one experi- ment is the sum of the time for discriminating the 850 letters, and the time for marking the 100 E's. In the tables both the total time and the number of omissions are given. This test was very unsatisfactory, owing to the two factors of variability, time, and accuracy. With some subjects the accuracy did not greatly vary, and with others the time was fairly constant. F. The time of adding was obtained from a series of twenty problems. Each problem consisted of two five-digit figures, 43678 one placed over the other,