MOTOR RETARDATION AS A MANIC-DEPRESSIVE 
 
 SYMPTOM. 
 
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MOTOR R1 
 
 By FREDERIC LYMAN WELLS, Ph. D., 
 
 Assistant in Pathological Psychology in the McLean Hospital, 
 Waver ley, Mass. 
 
 Reprinted from 
 
 AMERICAN JOURNAL OF INSANITY 
 Vol. LXVI, No. 1, July, 1909 
 
4 
 
 
 
 
Volume LXVI 
 
 JULY, 1909 
 
 No. 
 
 AMERICAN 
 
 JOURNAL OF INSANITY 
 
 MOTOR RETARDATION AS A MANIC-DEPRESSIVE 
 
 SYMPTOM. 
 
 By FREDERIC LYMAN WELLS, Ph. D, 
 
 Assistant in Pathological Psychology in the McLean Hospital, 
 Waver ley, Mass. 
 
 CONTENTS. 
 
 PAGE 
 
 1. The Experimental Criterion of Retardation i 
 
 2. Clinical Histories and Experimental Results 13 
 
 3. General Conclusions 46 
 
 I. The Experimental Criterion of Retardation. 
 
 Our reaction to a given situation is determined by the lines of 
 least resistance in the nervous pathways at that moment and to 
 that stimulus. This “ set of the nervous system is determined 
 essentially by the various impulses that have traversed it before, 
 and by immediate conditions of nutrition. These factors give a 
 series of lines of least resistance to an indefinite number of situa- 
 tions, and the reaction to any of these situations will be along the 
 line of least resistance which the past history of the individual 
 has determined for it. The factors which go to determine these 
 lines of least resistance are normally and naturally selected in 
 such a way as shall be most beneficial to their possessor. It is 
 apparent how largely the teleological character of our behavior 
 depends upon the maintenance of the fine balance in the nervous 
 pathways in favor of the most advantageous series of responses. 
 One can also readily figure the profound disorder of behavior 
 inevitably resulting from any disturbances of this neural bal- 
 ance,” be these disturbances themselves the ultimate products of 
 intoxication, or of faulty habits of action and thought. 
 
 I 
 
2 MOTOR RETAEiDATION [July 
 
 In a fundamental retardation we have an agency or number 
 of agencies, presumably of toxic origin, which tend to increase 
 the difficulty with which certain nervous impulses, consequently 
 certain psychic functions, can proceed. The actual study of 
 cases shows us that the symptom of retardation may involve 
 the various mental functions largely independently of one another. 
 When its manifestations occur mainly in the higher, associative 
 processes of the mind, we speak of it as a ‘‘ difficulty in thinking ” 
 or “ thinking disorder ’’ ; we may also see its phenomena confined 
 with some definiteness to the motor side; and as has been else- 
 where suggested, those manic-depressive states which show an 
 emotional condition of apparent apathy in contradistinction to 
 depression are the manifestation of this same symptom in the 
 afifective sphere. In like manner we may find these phenomena 
 even more restricted within the categories mentioned. 
 
 It is obvious, however, that in merely speaking of a “ greater 
 difficulty ” of the nervous processes, we do not tell the whole 
 story of the effect of this difficulty upon the resulting movements, 
 which are, of course, our ultimate criteria of the symptom. The 
 response may be merely delayed, without seeming to be otherwise 
 affected. More often, however, there is coupled with this delay 
 a certain weakening of its force and effectiveness. On the other 
 hand, the response may be long delayed and then come with 
 explosive force, as though the patient had been gradually accumu- 
 lating sufficient energy to burst through the retardation. Occa- 
 sionally the response fails entirely, apparently from not being 
 strong enough to break through ; this is apt to be the case with 
 indifferent situations. Under great stresses, however, a marked 
 retardation may be entirely swept away, indicating a considerable 
 reserve strength of the voluntary impulse, just as our muscles 
 seldom if ever put forth under voluntary stimulation the effort 
 of which they are physiologically capable. 
 
 Clinically, we judge of a patient’s retardation through the gen- 
 eral character of his behavior, by the quickness with which he 
 seems to think or speak or move. Experimentally, we make use 
 of the innumerable tests put forward as measures of mental time. 
 So long as we deal only with the presence or absence of retarda- 
 tion in general, the precise mental function that we sdect to 
 measure is probably of secondary importance to the accuracy of 
 
FREDERIC LYMAN WELLS 
 
 3 
 
 5L 
 
 \aJ4G 
 
 
 
 1909] 
 
 the experimental method itself. Most such experiments, however, 
 would afford very little information about the character of the 
 retardation, whether concerned with the lower, motor, or higher, 
 associative processes. A purely intellectual retardation we cannot 
 measure directly by any psychological methods at present known, 
 for we always require some form of motor response in addition 
 to the intellectual or associative process. We may first turn 
 attention therefore to the functions which are more primarily 
 motor, attempting to make our measure of retardation, so far as 
 possible, independent of the higher mental processes. 
 
 To experimentally isolate mental retardation from motor re- 
 tardation is no easy task. Almost every experiment in the time 
 relations of voluntary movement involves a conscious process of 
 greater or less complexity, followed by a motor response. While 
 this is not absolutely true (as in simple reaction time in late prac- 
 tice) it is essentially so in the situations with which we have to 
 deal clinically. For rough and ready purposes, some idea can be 
 gained from the comparative degrees of retardation in responses 
 involving different degrees of purely mental effort. Thus if a 
 subject could calculate but slowly, and yet could respond quickly 
 to commands, the indication would be that the retardation was 
 mainly in the nature of a thinking disorder. On the other hand, 
 the more the simple and complex responses were equal in slow- 
 ness, the greater the likelihood of a retardation principally in the 
 lower, motor centres. The presence of a certain amount of 
 ordinary motor activity does not prove the absence of a motor 
 retardation. The essential point here would be whether the 
 reactive movements are quick or slow, and this does not appear 
 in the ordinary observation of a patient’s behavior. The phe- 
 nomena which seem to be associated with motor retardation in 
 these experiments have appeared most strikingly in cases in 
 which little if any retardation would have been evident to ordinary 
 clinical examination. 
 
 But, as has been said, the time of reaction in most psycho- 
 logical experiments is an unsatisfactory measure, since there is 
 not sufficient differentiation between the mental and motor aspects 
 of the symptom. Even such a measure as simple reaction to sound 
 is, at all ordinary stages of practice, seriously vitiated by this 
 difficulty in interpretation. Obviously, the simpler and more in- 
 
 
4 
 
 MOTOR RETARDATION 
 
 [July 
 
 dependent of the higher centres we make our experimental proc- 
 ess, the more exclusively it becomes concerned with the purely 
 motor factors, and a measure of time relations in the motor sphere. 
 
 Of those reactions to external situations which are so automatic 
 as to be largely independent of control of the higher centres, the 
 eye movements are the most important. Theoretically, I should 
 consider the ocular pursuit reaction (Diefendorf and Dodge) as 
 altogether the best criterion of retardation by the method of 
 reaction to external stimulus. The present criterion of retarda- 
 tion possesses a good quality in that it is not immediately depend- 
 ent on reaction to external stimulus, as well as certain minor 
 technical advantages. 
 
 The psychological process involved in the successive movements 
 of the tapping test is not clearly made out. It is, however, the 
 verdict of introspection that the successive taps at maximum rate 
 are not each the product of a separate conscious innervation. Nor 
 can we conceive of the process as one of successive simple re- 
 actions to the various kinsesthetic sensations that the movements 
 of the test present. The normal initial rate of tapping (about 7 
 per second) cannot be executed without 14 co-ordinated move- 
 ments per second, and in reality the process is much more com- 
 plex. Only the simplest reflexes have such a rate as this ; no 
 movement in which a voluntary process shares. A series of taps 
 at the maximum rate is therefore a product of but few volitional 
 processes, which merely give a ‘‘ set ” to which the organism 
 responds by a continued series of reflex responses. 
 
 What then determines the rate at which these reflex responses 
 take place? It is limited by the refractory phase of the neurone- 
 paths, but, save in late practice, it is much slower than this ; it is 
 a matter mainly of efficiency in co-ordination. Beyond this we 
 must judge purely empirically, by noting the external conditions 
 which affect it. In normal individuals it does not seem to be 
 especially influenced by conditions which are open to introspection. 
 On the other hand, any previous activities tending to produce 
 the Erregung” of Kraepelin, seem to increase the rate. If car- 
 ried to the point of physical fatigue, the rate is decreased ; but it 
 does not seem that what is ordinarily called “ intellectual fatigue ” 
 has any marked effect. If the tapping be continued, there results 
 the decrease in efficiency ordinarily described as fatigue. This 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 5 
 
 can hardly be dependent on muscular factors, since it normally 
 is a matter of about 14 per cent within 180 taps, and the isolated 
 muscle would hardly fatigue to rapidly succeeding stimuli in this 
 way. Nor has it any but a very indirect relation to the sensa- 
 tions of fatigue, which are presumably of muscular origin. The 
 process can only be described as a decreased efficiency of co- 
 ordination (possibly also to a proportionate lengthening of the 
 period of the refractory phase). Both the absolute rate and the 
 fatigue phenomena of the tapping test seem thus to be determined 
 by obscure conditions of neural tone. 
 
 Once the general volition to tap as rapidly as possible is ob- 
 tained, the minute features of the process go on in relative inde- 
 pendence of conscious influence; it is not therefore a function 
 that we should expect to see especially influenced in the presence 
 of a pure thinking disorder. This might affect the time taken 
 to respond to the signal to begin to tap ; but once the tapping is 
 begun, its rate is rather a matter of raised or lowered Willen's- 
 spannung, using this term in a wholly objective sense. 
 
 The efficiency of this purely motor responsiveness of the or- 
 ganism, the maximum rate of repeated voluntary movements 
 measures in a relatively unequivocal way. For the rest, it is an 
 ordinary work-curve, such as may be obtained in any continuous 
 psychological experiment, being subject to and reflecting all the 
 influences which affect the curve of work. Fatigue, and the 
 reflex inhibitions resulting from sensations of fatigue, tend to 
 produce a decrease in efficiency. Factors having a favorable in- 
 fluence are the so-called “ warming up ” processes, as well as any 
 more or less external influences that may spur the organism to 
 greater effort. The work-curve that we finally obtain is the com- 
 plex of all such influences, and their separate analysis is impossible 
 save on a purely empirical basis. We are not concerned, however, 
 with the measurement of such abstractions as absolute fatigue, 
 warming up, or impulse effects, but with the immediate question 
 of how the individual responds to any experimental conditions 
 demanding the continual exercise of a certain voluntary effort. 
 In every individual and in every measure the factors that determine 
 the course of the Arheitskurve have a certain way of balancing 
 each other, and the way in which this balance varies in different 
 
6 
 
 MOTOR RETARDATION 
 
 [July 
 
 individuals and under different conditions is the essence ot the 
 problem with which we are attempting- to deal. 
 
 In a previous report, attention was called to certain anomalies 
 in the work-curve especially associated with the retardation of 
 manic-depressive depression.^ In the present study certain of the 
 more important of these cases, together with certain additional ma- 
 terial, will be more fully presented from the standpoint of clinical 
 analysis, and the correlation of the experimental results with the 
 clinical pictures. Certain points in differential symptomatology 
 also appear. 
 
 While the method and general experimental conditions are the 
 same as those described in a previous contribution,^ a brief review 
 of them may not be out of place here. The subject begins at a 
 given signal and taps at the maximum rate until a record of 30 
 seconds is obtained, when he receives a signal to stop. Then 
 follows a 2-minute and 30-second pause, after which a second 
 series is executed, then another 2-minute and 30-second pause, 
 and so on until five series of 30 seconds, each with an intervening 
 pause of 2 minutes and 30 seconds, have been obtained. A sim- 
 ilar record of five 30-second series is then made with the other 
 hand. When more than one experiment is made, the hands 
 alternate in precedence from experiment to experiment, except 
 as otherwise specified. In this form the experiment requires 
 about half an hour to make, the greater part of which time is 
 occupied in the pauses. This time can, of course, be much short- 
 ened by having the hands alternate from series to series, with 
 a very much shorter pause, say 30 seconds, intervening between 
 the different hands. For the first five or six daily experiments 
 (50 or 60 series) the writer does not believe that this shorter 
 form would, in normal subjects, yield different results from the 
 form with the 2-minute and 30-second pause. In the present 
 subjects, however, many of the points which appear of essential 
 significance would have been much obscured by such a routine, 
 so that this apparently uneconomical form of experiment seems 
 to have more than justified itself. 
 
 The experiment is evaluated by counting the number of times 
 
 ^ Studies in Retardation, Am. J. Psych., XX, 1909, pp. 38-59. 
 
 * Am. J. Psych., XIX, 1908, pp. 437-439- 
 
1909] 
 
 FREX>ERIC LYMAN WELLS 
 
 7 
 
 the key is struck and the circuit closed during each of the six 
 5-second intervals in each 30 seconds’ tapping. The precise 
 method of dealing with the data may be illustrated by quoting 
 in full the figures of a single record (five series) with the right 
 hand of a normal individual at the beginning of practice. 
 
 TYPE RECORD. 
 
 I I I ®l 
 
 I I J ^ . 
 
 
 Ist interval 0' 
 
 2d interval 6" 
 
 3d interval 10" 
 
 4th Interval 15' 
 
 6th interval 20' 
 
 6th interval 26' 
 
 Total numbe 
 
 taps in eaol 
 
 series. 
 
 ist Series 
 
 .35 
 
 34 
 
 32 
 
 33 
 
 32 
 
 32 
 
 198 
 
 2d Series 
 
 .36 
 
 33 
 
 33 
 
 33 
 
 31 
 
 31 
 
 197 
 
 3d Series 
 
 .36 
 
 34 
 
 34 
 
 32 
 
 32 
 
 33 
 
 201 
 
 4th Series 
 
 .36 
 
 34 
 
 34 
 
 33 
 
 34 
 
 33 
 
 204 
 
 5th Series 
 
 .38 
 
 38 
 
 36 
 
 35 
 
 34 
 
 34 
 
 215 
 
 Average of intervals. 
 
 .36.2 
 
 34-6 
 
 33-8 
 
 33-2 
 
 32.6 
 
 32.6 
 
 203.0 
 
 Each of the 30 two-place integers gives the number of taps 
 executed in an interval of 5 seconds. Reading the top line 
 from left to right, we obtain a gradual decrease in the size of 
 the figures, indicating a slowing up in the tapping rate. The 
 rig:ht hand figure of three digits, 198, gives the sum of the figures 
 for the six intervals, i. e., the number of taps for the whole 30 
 seconds. Each successive line may be read in the same way. 
 Considering the two-place integers in column, we obtain in the 
 six figures of two digits and a decimal on the bottom line (36.2, 
 34.6, 33.8, 33.2, 32.6, 32.6) the average number of taps executed 
 during the first 5 seconds, the second 5 seconds, etc. Naturally, 
 a regular decrease is noted. The figure in heavy-faced type, 
 203.0, gives the sum of these six interval figures, i. e., the average 
 number of taps executed each time during the five 30-second 
 series. This figure is taken as indicating the “ total efficiency ” 
 of the function in that record, subject, of course, to the variability 
 of the single series it represents. Six successive 5-second intervals 
 form a series, five 30-second series a record, and the two records 
 of right and left hands constitute the single standard experiment. 
 
8 
 
 MOTOR RETARDATION 
 
 [July 
 
 An index of fatigue (f) for each record is obtained by dividing 
 the average of the last five intervals by the average for the first 
 interval. The average for first interval is 36.2, and the average 
 
 for the remaining five is 33.6 ; the therefore, equals 33 ;^^ or .93. 
 
 36.2 
 
 A high f indicates immunity to fatigue loss, a low f indicates 
 susceptibility to it. If the f is above i.oo it indicates that the 
 favorable influences on the work-curve so outweigh those of 
 fatigue that the performance of the five later intervals averaged 
 actually better than the first interval. In normal individuals 
 
 jVo. oj fd-ps IT] 5^ 
 
 5 ‘' /o" / 5 ' 20^ 25 " 
 
 Fig. I. 
 
 this practically never occurs ; the normal f tends to fluctuate 
 between .85 and .95. 
 
 There are, of course, many other features in the experiment, 
 but in the present paper we shall be mainly concerned with this 
 /, and with the character of the work-curve, of which it is an 
 index. The fatigue-curve is plotted by joining together the points 
 representing the average of five performances during each 5- 
 second interval ; thus the curve in the above-quoted record would 
 run as shown in Fig. i. 
 
 This gives, in each complete experiment, a curve for the right 
 and a curve for the left hand. With normal subjects two experi- 
 
FREDERIC LYMAN WELLS 
 
 9 
 
 1909] 
 
 ments are described, the work with the right hand preceding in 
 the first experiment, and that with the left hand preceding in 
 the second experiment. In speaking further of these records, 
 
 X 
 
 - 10" is" ZO* 0.5" do" 
 
 Fig. 2. 
 
 Ri and Li will be used to designate those of the right and left 
 hands in the first experiment; R2 and L2 the right and left 
 hands in the second experiment. Where a greater number of 
 
lO 
 
 MOTOR RETARDATION 
 
 [July 
 
 experiments are performed, the hands alternate in precedence 
 from experiment to experiment. As it makes some difference 
 which hand comes first, it is necessary to distinguish these ex- 
 periments in the curves. The experiments in which the right 
 hand precedes are sketched in a continuous line, those in which 
 the left hand precedes are sketched in a broken line. The upper 
 continuous and dotted lines naturally refer to the right hand, 
 the lower to the left hand, except as otherwise specially indicated. 
 According to this scheme of presentation, the course of the 
 fatigue phenomena was found in lo normal men to be as shown 
 in Fig. 2.* 
 
 That is, the curves follow the usual form, the decrease in the 
 rapidity of tapping being more rapid in the earlier intervals, and 
 then slower. The f, or ratio of the last five intervals to the first, 
 approximates .90 in each case, being a little higher in the right 
 than in the left. We see that the hands are somewhat closer 
 together in the second experiment than in the first, that is, the 
 right hand is relatively better in the first experiments and the 
 left hand better in the second. Each hand thus tends normally 
 to be relatively better when it precedes than when it follows in 
 the experiment. This relationship is markedly disturbed in some 
 pathological cases, sometimes so much so that whichever hand 
 precedes, it is always better (or worse) than the following hand. 
 
 In a typically retarded case of manic-depressive depression 
 the curves shown in Fig. 3 were obtained. 
 
 These curves will serve to illustrate most of the peculiarities 
 found in the records of the cases to be subsequently presented. 
 Besides the lowered rate of tapping, the most striking abnormality 
 is in the shape of the curve. This always drops very much less 
 than the normal, and in the case oi Ri it even rises considerably. 
 The interpretation of these delayed, or even negative fatigue 
 phenomena, seems to be that assigned independently by Hoch, 
 Specht, and Hutt, the progressive overcoming of the retarda- 
 tion. This we see most markedly in Ri, where the curve is 
 
 •''The results with a commensurate group of women were similar so far 
 as the present comparisons are concerned. Cf. Am. J. Ps., XX, 1909, pp. 
 
 353-363. 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 II 
 
 almost the reverse of the normal. The first interval should 
 normally be the best; here it is the worst. Whenever the per- 
 formance of the first interval is surpassed by the performance 
 
 29 
 
 E-8 
 
 27 
 
 of a later interval, this will be known as reversal. Besides its 
 conspicuous appearance in Ri, reversal is seen less markedly in 
 Li and in R2, where the second interval surpasses the first. The 
 
12 
 
 MOTOR RETARDATION 
 
 [July 
 
 fs of all these curves are naturally very much above the normal, 
 being as follows : 
 
 
 Rl 
 
 R2 
 
 LI 
 
 L2 
 
 Normal average 
 
 90 
 
 .91 
 
 .88 
 
 .90 
 
 Typical depressed case 
 
 1.08 
 
 .99 
 
 •99 
 
 .96 
 
 It is also very striking how much faster the second experiment 
 is than the first. Such a difiference is, so far as I know, never 
 observed in normal cases. The practice effect in two such ex- 
 periments is negligible. There is thus indicated very much less 
 retardation in the second experiment than the first, and this is 
 confirmed by the fact that the curves of the second experiment 
 (dotted lines) are much closer to the normal shape than those 
 of the first. The right hand shows much less of the abnormal 
 “ reversal,^’ the left none at all. We see, however, that the dotted 
 lines are very much farther apart than the continuous ones. This 
 here indicates the following hand to be the more favored, and is 
 the contrary to what we find normally. It is as though the work 
 done with the first hand helped to overcome the resistances to 
 be encountered by the second hand. To this rather characteristic 
 favoring of the following hand has been applied the name of 
 transference. The lowered absolute rate and the abnormal pres- 
 ence of reversal and transference are the essential phenomena of 
 retardation as given in the present results. 
 
 The principal source of error in these observations is imposed 
 by limitations in material that are scarcely avoidable in the groups 
 investigated. Whenever we wish to make a comparison between 
 a normal and a pathological group, it is desirable that the groups 
 be as similar as possible, save in the characters to be investigated ; 
 otherwise it is possible that other characters than those investi- 
 gated are responsible for the peculiarities noted. The greatest 
 difficulty is that of age. This objection applies with about equal 
 force in the analogous experiments of Hutt and of Specht, and 
 in those of the writer. Thus Specht’s traumatic cases form a 
 fairly homogeneous group, and so do his normal cases, but their 
 averages are many years apart, the normal individuals being for 
 the most part in the twenties, the traumatic cases well along in 
 middle life. So here, the normal group would average about the 
 same as that of Specht, the depressions probably somewhat older, 
 and much more variable. Of how much this factor has influenced 
 
1909] 
 
 FREDERIC LYMAN WELE^ 
 
 13 
 
 the results, we can judge only indirectly. The phenomena do not 
 seem dependent upon age within the normal or depressed groups, 
 seeming in the latter, at least, much more dependent upon changes 
 in the condition than upon age, nor are they sufficiently evident 
 in equally old cases of other psychoses. The manic group, for- 
 tunately, is sufficiently homogeneous with the normal to be ca- 
 pable of direct comparison. 
 
 We may now proceed to study the results of the method in a 
 number of special cases. Of cases I, II, III, IV, V, and VIII 
 mention has been made in a previous study, American Journal 
 of Psychology, Vol. XX, pp. 38-59. In this previous study they 
 are respectively cases XII, IV, VIII, X, XI, and III. 
 
 2. Clinical Histories and Experimental Results. 
 
 Case I. On account of existing uncertainties as to the relation- 
 ship of certain depressive states to psychasthenic conditions and 
 to hysteria the following case, which can now with considerable 
 certainty be assigned to the manic-depressive group, is perhaps 
 of special interest. The patient is a man of 61, with some hered- 
 ity, described as having always been a very nervous man. A 
 six months’ mental breakdown occurred at 38 and another at 40. 
 Since then there have been no marked upsets until the present 
 time, though he has been continually apprehensive and hypo- 
 chondriacal. He would often get slightly depressed, but never 
 sufficiently so to give up his work. Regarding these {Abortivcm- 
 fdllef) he has said that it was “ hard to concentrate his mind,” 
 “ became very blue,” “ did not want to do anything,” “ all these 
 attacks begin with a sense of ennui of work.” The patient is a 
 man of exceptional intellect and refinement. Physically, he has 
 always been fairly healthy, though he mentions having had dizzy 
 spells since childhood, and he has taken mercury and arsenic 
 for an enlarged liver. 
 
 The beginning of the fixed ideas which color the present attack 
 is referred subjectively to an episode about 18 months before ad- 
 mission when the patient, reading of a case of mercurial poison- 
 ing who had injured his family, began to fear a similar impulse. 
 This fear became so strong that on one occasion he appealed to 
 the police to restrain him, and during the latter part of this 
 
14 
 
 MOTOR RETARDATION 
 
 [July 
 
 period he remained away from his family, though wanting very 
 much to be with them. During this time he underwent some 
 hypnotic and psychoanalytic treatment with negative results, and 
 there are recorded three ineffectual attempts at suicide. With 
 this subject the regular experiment was performed four times; 
 on August 19 and 27, and December 23, 1907, and February 24, 
 1908. 
 
 The first two experiments were performed within about a month 
 after the patient’s admission. In the first experiment the ^subject 
 
 ^7 
 
 / 
 
 L/ 
 
 seemed to co-operate willingly, although expressing many de- 
 pressive ideas, especially toward the close of the experiment, when 
 he talked more. This experiment was made in the afternoon, 
 while the experiment of a week later was made in the morning, 
 and at this time he was more depressed. The curves in these 
 experiments are as shown in Fig. 4. 
 
 These records, especially those in the second experiment, are 
 as marked illustrations of intraserial warming up and reversal 
 as the writer has observed. The first interval is always the 
 worst, while in only one of the records is the final interval sur- 
 passed by an earlier one. For the period used, therefore, the 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 15 
 
 fatigue-curves are almost the reverse of the normal. The trans- 
 ference ’’ phenomenon is, however, altogether absent; if any- 
 thing, it is the preceding hand which is more favored. 
 
 During the time up to the next experiment the patient was 
 clinically noted to improve somewhat, and he began to occupy 
 
 SeriesI ^3 45^/2.34 S 
 
 Fig. S- 
 
 himself with various intellectual pursuits that interested hirn. 
 A physician’s note of his condition of January i, 1908, reads in 
 part : “ The patient eats and sleeps well and takes a moderate 
 amount of exercise, though a great deal of his time is spent in 
 his room where he reads and writes. He is always cheerful 
 and agreeable. He was granted parole of the grounds on Octo- 
 ber 23. Since then he has taken several trips to Cambridge with 
 
i6 
 
 MOTOR RETARDATION 
 
 [July 
 
 his friends. These he invariably enjoys.” A nurse’s note made 
 the day before the third experiment speaks of him as ‘‘ doing 
 well, seems more cheerful.” We have apparently to do, therefore, 
 with some progressive improvement in the patient’s condition 
 which may be compared with the difference in response to the 
 test. 
 
 The curves in the third experiment, December 23, 1907, are 
 as shown in Fig. 5. 
 
 The most striking feature of these curves is that the curves 
 of the two hands are of a totally opposite type. The right hand, 
 which precedes, shows a typically reversed curve, while the left 
 hand, which follows, shows a curve much more approximating 
 the normal, with reversal only in the second interval. It is to 
 be noted also that while the left hand was inferior to the right 
 in both previous experiments, it is now markedly superior to it. 
 These phenomena indicate a considerable progressive change in 
 the fatigability of the two hands throughout the experiment. The 
 character of this change is best shown in the curve of the f itself, 
 given below the rate curves for the two hands. It will be ob- 
 served that regardless of the hand used, the f shows a progressive 
 decrease throughout the two records. That is, the further the 
 “ resistances ” of the depression are overcome by the work in 
 hand, the more do the characteristics of the retarded work-curve 
 disappear, and the more does the work-curve approach a normal 
 character, with fs below i.oo. In the first two experiments the 
 patient responded to these warming-up influences only within a 
 single series, thus affording in both hands fairly typical reversed 
 curves ; but now, after a certain interval marked clinically by 
 improvement in condition, the warming-up influence extends not 
 only from series to series, but progressively throughout the rec- 
 ords. An examination of the individual fatigue-curves shows 
 how the earlier ones are typically reversed, and how this condi- 
 tion gradually changes over into the normal. The first curve 
 of the experiment, made with the right hand, runs 25 — 27 — 27 — 
 28 — 29 — 29, f 1. 12, a typically reversed curve; the last curve of 
 the experiment, made with the left hand, runs 30 — 28 — 28 — 27 — 
 26 — 26, f .90, a typical normal curve. The apparent superiority 
 of the left hand to the right is presumably a real “ transference ” 
 phenomenon. 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 17 
 
 The points' indicated in this experiment appear still more strik- 
 ingly in the experiment made February 23, 1908. When the 
 
 5criej5| 2.3 4«S"i2.34 5" 
 
 Fig. 6. 
 
 patient was sent for he was asleep, and had to be awakened to 
 come to the laboratory. On arriving there, although, as usual, 
 
 2 
 
i8 
 
 MOTOR RETARDATION 
 
 [July 
 
 entirely clear, he showed a depression and apprehensive manner 
 not much out of keeping with his condition when first observed. 
 This wore off during the experiment, at the conclusion of which 
 he was quite smiling and talkative. The curves are as shown in 
 
 Fig. 6. 
 
 We observe here a marked increase in absolute rate, which could 
 hardly be associated with other than a changed condition of 
 the patient. It is beyond the limits of both probable error and 
 practice improvement. There is to a lesser degree the same 
 difference between the preceding right and the following left 
 hands as appeared in the third experiment. The right hand has 
 reversal in the second interval, and shows very little fatigue ; 
 the left hand has no reversal, and even fatigues a little more 
 than the normal. There is thus shown the same change in the 
 conditions of fatigability, of which the curve of the fs again 
 affords the best index. As in the previous case, this curve shows 
 a progressive tendency to fall, though the fall is now confined 
 to the first half of the experiment, while in the third experiment 
 it persisted through the whole of it. Although this does not 
 appear in the curves quoted, it should also be mentioned that 
 the absolute rate of the five successive series now progressively 
 increases in both hands, in the preceding right hand more than 
 in the following left hand, whereas in the previous experiment 
 this was evident only in the following left hand. The indications 
 are that the patient is now much more susceptible to these warm- 
 ing-up influences, since they occur sooner in the experiment, and 
 cover a wider range of improvement. The first right hand 
 series is the slowest in all four experiments, with 133 taps, show- 
 ing a curve with but slight reversal, which, however, persists 
 throughout, 21 — 22 — 23 — 22 — 23 — 22, f 1.07. It is interesting 
 to compare this with the second series, which in spite of its high 
 f, 1. 21, shows much less reversal. It runs 26 — 30 — 34 — 33 — 30 — 
 30 ; i. e., a low initial rate, quickly warming up to the maximum, 
 and then fatiguing normally. After this the fs drop below i.oo, 
 though the individual curves do not assume a normal character 
 until the last right hand series is reached, running 36 — 34 — 32 — 
 32 — 31 — 31, f .89. The curves of the left hand are all per- 
 fectly normal, as the averages indicate, except that at the con- 
 clusion of the experiment there seems to have been a marked 
 
FREDERIC LYMAN WELLS 
 
 19 
 
 1909] 
 
 Schlussantrieb. Superficially then, we had in this experiment a 
 condition of depression apparently associated with the subject’s 
 just having been aroused from sleep, which, under the keying-up 
 influence of the experiment (often very noticeable, even in nor- 
 mal individuals) gradually “ swings over ” into a condition in 
 which the mood, at least, is rather hypomanic. The final series 
 of this experiment are also not dissimilar from those obtained 
 from manic cases. 
 
 The most reasonable interpretation of this case would seem 
 to be that it is a manic-depressive condition which, owing to 
 factors in the patient’s make-up, is dominated by impulsive ideas. 
 The depression is not secondary to the fixed ideas, but it is the 
 fixed ideas which are secondary to the depression. This is further 
 evidenced by the fact that the content of the patient’s depressive 
 ideas has recently changed somewhat and become more typical 
 of what is ordinarily seen. The striking evidence of a motor 
 retardation which these experiments afford throws an interesting 
 sidelight on the fundamental character of the depressive symptoms. 
 
 Case II. Market gardener, 65, some heredity. As a boy he 
 was quiet and retiring, of a rather “ artistic ” temperament, 
 learned well at school. Leaving school at 18 on account of 
 illness, he went into business, his occupation being neither 
 eventful nor exacting. The first attack occurred at 42, without 
 cause, showing depression and inadequacy. It was mild and 
 did not interrupt his work. During the next 16 years there were 
 some half dozen similar attacks, which seemed to be followed 
 by hypomanic states. Then attacks of three or four months 
 began to occur every winter, characterized by depression, inade- 
 quacy, tendency to worry, and restlessness. These were also 
 followed by slight exhilarations. The patient was admitted 
 in the attack previous to the present, which was the sixteenth. 
 At this time involution symptoms began to appear in exaggerated 
 apprehensiveness and a restlessness occasionally “ breaking 
 through ” the retardation. He was discharged very much im- 
 proved after some six weeks, and got along fairly well at home 
 for about a year, when he again became depressed, with delu- 
 sions, suspiciousness and restlessness, and was readmitted two 
 months later. He was entirely clear about his surroundings, but 
 showed much inadequacy and self-accusation. 
 
20 
 
 MOTOR RETARDATION 
 
 [July 
 
 The regular experiment was performed twice. In interpreting 
 the records it must be borne in mind that the subject does better 
 
 32,1 
 
 
 N. 
 
 
 
 .1 
 
 ✓ 
 
 Fig. 7. 
 
 with the left hand than with the right. The upper continuous 
 and dotted lines are thus those of the left hand. The curves are 
 as above. 
 
1909] FREDERIC LYMAN WELLS 21 
 
 The most striking point in these records is the difference be- 
 tween the first and the second experiments. The first experiment 
 shows little abnormal in the shape of its curves, and its absolute 
 rate is far beyond the limits of probable error above that of the 
 second, which also shows marked evidence of intraserial warming 
 up. As there could hardly have been such changes in superficial 
 co-operativeness, the most natural indication is a change in the 
 patient's condition. No such change can be traced in the clinical 
 notes made independently of the experiments, though it was 
 noted by the writer that the depression did seem somewhat deeper 
 at the time of the second experiment. It would seem, then, that 
 whatever the change in the patient’s condition may have been, 
 it was not one which was likely to be apparent to ordinary obser- 
 vation. The clinical notes speak of the patient’s condition as 
 fluctuating a good deal from day to day, but give no indication 
 that this was one of his poorer days. 
 
 Very shortly after these experiments the patient left the hos- 
 pital on a visit, and appeared very well for the first few days 
 at home. Then delusional ideas began to return, coupled with 
 restlessness and apprehension, which resulted in his return to 
 the hospital some three and one-half months subsequently. Eight 
 months later, a little over a year after the first two experiments, 
 a third experiment was performed, whose results were very 
 characteristic. The depression was deeper than at either of the 
 two previous experiments. On being questioned a little when he 
 came to the laboratory, his answers were very long in coming, 
 but when they did arrive they were quick, sharp, and decisive. 
 He was constantly fidgeting about, and showed very strikingly 
 that the retardation was specifically one of the time of the outward 
 reaction to the impulse, and not a matter of the absence or abso- 
 lute feebleness of the impulses themselves. He denied feeling 
 blue, but said he felt “ bad.” During the course of the experi- 
 ment his general motor activity increased, and it was noted that 
 he answered questions more promptly, and began a series of 
 tapping sooner after the signal was given. Toward the end of 
 the experiment he also spoke spontaneously. It was evident to 
 ordinary observation that there was markedly less retardation at 
 the end of the experiment than at the beginning. The curves are 
 as below. 
 
L 
 
 *7 
 
 >4 
 
 IS 
 
 Saries 12.345’ I Z 3 4 5 
 
 Fig. a 
 
FREDERIC LYMAN WELLS 
 
 23 
 
 1909] 
 
 The simple curves for the right and left hands show little of 
 significance. There is a tendency to reversal, which, however, 
 is not maintained after the second interval. The undistinctive 
 character of these curves, however, is due wholly to the fact 
 that the progressive overcoming of the retardation already noted 
 clinically, produces so great a variation in the individual series 
 that in simply taking the average for the intervals the progressive 
 changes are masked. The number of taps in each of the five indi- 
 vidual series with the right and left hands is as follows: 
 
 Number of Taps in 30 Seconds. 
 
 Right hand 93 62 82 8l 99 
 
 Left hand 123 96 102 125 157 
 
 The characteristic in both hands is a relatively high rate in 
 the first series, which drops to a minimum in the second, and 
 then increases to the end. In each hand a low initial performance 
 seems to be broken through by special influences at the beginning, 
 after which the retardation again asserts itself, only to be over- 
 come by the activities of the test. If we compare the relationship 
 of the right and left hands in this experiment to their relationship 
 in the other two experiments, there is evident a marked trans- 
 ference phenomenon, i. e., undue favoring of the following hand. 
 The left hand here averages half as fast again as the right, while 
 in the previous experiments it was only slightly more rapid. The 
 series in this experiment show a wider variation in rate than 
 occurs in any other experiment the writei; has made. 
 
 This variation is related in a rather significant way to the 
 fatigue phenomena which the successive series show. The course 
 of the fs through the successive series is plotted in the same way 
 as for Case I. The fs begin low but at once mount very high, 
 showing a great amount of reversal and then a gradual tendency 
 to decrease to the end. Thus at the beginning of the experiment, 
 at the period of greatest retardation, there was within the indi- 
 vidual series no response to the warming-up influences at all, the 
 first series running 19 — 16 — 14 — 15 — 15 — 14, f .79. Later, when 
 the retardation is more overcome, we do find this response to 
 intraserial warming up, obtaining such series as the fifth, with 
 the right hand, running 14 — 15 — 18 — 18 — 18 — 16, f 1.22. 
 Finally, the retardation is so far overcome that the best efforts 
 
24 
 
 MOTOR RETARDATION 
 
 [July 
 
 are put forth immediately with no delay in warming’ up, e. g.^ 
 with the fifth series in the left hand running 27 — 27 — 27 — 26 — 
 25 — 25, f .96, with no actual reversal at all. 
 
 These records illustrate especially a point in which the writer 
 has quoted certain interpretations of Hutt." The most profound 
 conditions of retardation may present no response at all to the 
 warming-up influences of the activities of the test, and a gradual 
 overcoming of retardation is first seen in the ability to respond 
 to these warming-up influences (as shown in the reversed curves), 
 while, finally, the retardation being still further overcome, the 
 fatigue-curve again more approximates the normal in form. 
 
 Case III. Retired manufacturer, 71, some heredity. An in- 
 dustrious and hard-working man all his life, of best habits, re- 
 tiring from business a few years ago, after he had made a 
 moderate fortune. Although always having given a certain 
 amount of his time to church work, at about this period he began 
 to show excessive interest in religious activities that indicates 
 the possibility of a hypomanic condition. Then matters went 
 along about normally for a year, when three or four months 
 before admission he was noticed to be sleepy, apt to lie down, 
 slow to understand, lacking the power to start things. He also 
 began to worry about financial matters, but no real mental cause 
 of this or any other nature is known. For a brief period before 
 admission he spoke openly of suicide. At the time of the experi- 
 ments he was perfectly clear and oriented, and formed a striking 
 example of those cases who, with a first attack at the involution 
 period, yet show none of the characteristic involution symptoms, 
 but form a typical picture of manic-depressive depression. 
 
 With this subject the regular experiment was performed 10 
 times, first on July 6, 1908, three days after admission; again 
 on July 15, and daily for the eight days following. The averages 
 of the six intervals are given in the curves subjoined, the experi- 
 ments in which the right hand precedes being sketched in a con- 
 tinuous line, those in which the left hand precedes being sketched 
 in a dotted line (Fig. 9). 
 
 ■The absolute rate is somewhat below the normal, and there 
 
 *Hutt: Rechenversuche bei Manisch-Depressive, Ps. Arb., V. 3 (1908), 
 PP- 338-370. Wells : Studies in Retardation, Am, J. Ps., XX, pp. 49-50. 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 25 
 
 is considerably less fatigue loss than the normal, as is usually 
 the case. On the other hand, except for those with the right 
 hand preceding, the curves show no real reversal, but each indi- 
 vidual curve runs along about on a level with no marked fluctua- 
 tion. The subject co-operated with active willingness, and seemed 
 always anxious to do his best ; so that although there is no actual 
 reversal, the curves probably present a real over-balancing of 
 fatigue loss in the constant maintenance of a low but maximum 
 rate. 
 
 The transference phenomena, which are the most striking ex- 
 perimental features of retardation in this case, are superficially 
 
 
 Fig. 9. 
 
 shown in the above quoted curves, the dotted lines being farther 
 apart than the continuous ones, showing here that the following 
 hand is the more favored. They are presented in greater detail 
 in the accompanying curves (Fig. 10). 
 
 Bearing now in mind that on the odd days the right hand 
 precedes the left, while on the even days the left hand precedes 
 the right, the more favorable position of the following hand is 
 evident. This is very seldom seen in normal individuals, except 
 in a late stage of practice. In the curve for the index of right- 
 handedness the index is invariably low {i. e., the left hand rela- 
 tively poorer) Vv^hen the left hand precedes, and high when It 
 follows; on the fifth day the right and left hands were exactly 
 equal. With the sole exception of the last day, the index rises 
 
26 
 
 MOTOR RETARDATION 
 
 [July 
 
 on the odd, and falls on the even days. This result corresponds 
 closely to that obtained by Hoch in a similar case with the ergo- 
 graph {Psychol. Bull., I, 255). With respect to f the left hand is 
 
 Fig. 10. 
 
 subject to a certain constant influence that may be in the nature 
 of practice effect, but the alternation of the right hand fs is 
 perfectly clear cut. They are high on the even days when the 
 right hand follows, and low on the odd days when it precedes. 
 Such warming-up effect, then, as is transferred from the pre- 
 
FREDERIC LYMAN WELLS 
 
 27 
 
 1909] 
 
 ceding left to the following right hand, shows itself in a greater 
 immunity to fatigue in the right hand ; when it has not this 
 warming-up influence behind it, it is distinctly more susceptible 
 to fatigue losses. 
 
 In the curves of the total efficiency from day to day, one can 
 trace the same relationship of the right and left hands that the 
 index of right-handedness shows with more fidelity; but it is 
 necessarily obscured by the intercurrent changes in the patient’s 
 condition. The writer made a brief daily note of the patient’s 
 apparent condition (before evaluating the experiment, of course), 
 the main points of which are as follows: 
 
 1. July 9. Patient clear, did not seem much depressed, but 
 expressed spontaneously a feeling of apprehensiveness as dis- 
 tinguished from depression. 
 
 2. July 15. Did not seem to take as much interest as pre- 
 viously. Seemed rather more depressed. Spoke spontaneously 
 twice. 
 
 3. July 16. Mentioned spontaneously feeling a little more 
 
 cheerful, as he had been doing some things in which he was in- 
 terested. Made an adjustment in the apparatus of his own 
 accord. Walked about the laboratory afterwards, examining 
 apparatus. j 
 
 4. July 17. Said he felt worse than day before, and, in general, 
 seemed more depressed. 
 
 5. July 20. Subject about the same. Cannot lie down to 
 
 rest on account of the depressive ideas that come on him at such 
 times. ' 
 
 6. July 21. Subject felt a little better than usual, according 
 to his own statement. Did not talk so much. 
 
 7. July 22. Talked a good deal more freely. Subjective con- 
 dition better than previously. Spoke of a certain series (wrongly) 
 as the best yet. 
 
 8. July 23. Felt worse than day before, did not talk so much. 
 
 9. July 24. Subject mentioned feeling “alert” in contrast to 
 usual “ numbness ” ; more alert to-day than at any previous time. 
 Thought was doing better. Talked depressively, but a good deal. 
 
 10. July 25. Not nearly so “ alert ” as day before. About as 
 usual. 
 
28 
 
 MOTOR RETARDATION 
 
 [July 
 
 The nurse’s notes, covering this period, contain nothing con- 
 tradictory to the above observations. It should be mentioned that 
 these memoranda are derived mainly from immediate observation 
 of the subject, only secondarily from the subject’s introspective 
 account of his condition. It is rare, indeed, that a depressed 
 patient will admit feeling better until recovery is far advanced ; 
 they often struggle against such an admission, long after im- 
 provement is clinically evident. 
 
 As we should expect, there is indicated a tendency for the gross 
 rate to be higher on good days, and lower on poor ones. The two 
 extremes of condition, the second and ninth days, are marked 
 by, respectively, the worst and the best performances in the test. 
 For the other days there is nothing special to note, except that 
 on the seventh and tenth days the apparent chcmge in condition 
 was sufficient to affect both hands in the same direction ; the 
 curves usually run in opposite directions owing to the trans- 
 ference of “ warming up.” 
 
 While the series made on a single day vary less, the day-to- 
 day variability in this subject is a good deal more than the normal,, 
 and there may also be noted the absence of practice effect. It 
 seems to be a frequent observation with pathological subjects that 
 susceptibility to practice (Uehiingsfdhigkeit) is decreased, but 
 this is probably secondary to inferior co-operation, the normal 
 practice improvement demanding a degree of doing one’s best 
 that is probably never attained in this class of subjects, even under 
 the conditions of greatest apparent willingness. 
 
 The following figures give the averages and m. v.’s of the 
 quantities expressed in the foregoing curves, classified according 
 to the preceding hand: 
 
 Index of right- 
 handedness. 
 
 /(rt. hd.) 
 
 Gross rate 
 rt. hd. 
 
 Gross rate 
 1ft. hd. 
 
 Av. m. V. 
 
 Av. 
 
 m. V. 
 
 Av. 
 
 m. V. 
 
 Av. m. V. 
 
 Right hand preceding .960 .018 
 
 .966, .001 
 
 1595 
 
 2.9 
 
 153.3 
 
 2.0 
 
 Left hand preceding.. .925 .022 
 
 .989 
 
 .006 
 
 159-9 
 
 1.8 
 
 148.2 
 
 2.4 
 
 The differences in favor of the following hand are small, but 
 save in one case well beyond the limits of probable error. 
 
 Case IV. Machinist, 59, heredity unknown, grammar-school 
 education. The case is one of rapidly recurring and rather short 
 depressions recurring at intervals of about two years, since their 
 
FREDERIC LYMAN WELLS 
 
 29 
 
 1909] 
 
 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 
 
 L 
 
 Fig. II. 
 
 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, co- 
 operating willingly all the while, though seeming to brighten up 
 
30 
 
 MOTOR RETARDATION 
 
 [July 
 
 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 fs are considerably greater than the normal. On the 
 other hand there is much greater fatigue loss in the second ex- 
 periment (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 experi- 
 ment 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 consid- 
 erable 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. 
 
FREDERIC LYMAN WELLS 
 
 31 
 
 1909] 
 
 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 
 
 35 
 
 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 fa- 
 tigue. He mentioned feeling worse at night. Some improvement 
 was noted during the next month, after which his condition re- 
 mained 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- 
 
32 
 
 MOTOR RETARDATION 
 
 [July 
 
 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 typic- 
 ally 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, be- 
 sides 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 Hemmungswirk- 
 ungen, which the course of the experiment tends to overcome. 
 He writes : “ Die Hemmung . . . . ist hier im Beginn der 
 Arbeit grosser als im weiteren Verlauf ; sie schwindet nicht, aber 
 in ihrer Wirkung auf den Gang der Arbeitsleistung wird sie 
 durch die arbeitsfordernden Einflusse der Uebung und moglicher- 
 weise auch der Anregung abgeschwacht.” 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 repre- 
 sents 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 Ermudungsmessungen, Arch. f. d. Ges. Psych., 
 Ill, 1904, pp. 316-318. 
 
FREDERIC LYMAN WELLS 
 
 33 
 
 1909] 
 
 other hand, there were no anaesthesias or paraesthesias, 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 de- 
 pressions 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-de- 
 pressive basis, but with a more or less accidental traumatic color- 
 ing. 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 
 
 3 
 
34 
 
 MOTOR RETARDATION 
 
 [July 
 
 this interpretation. He did not speak spontaneously, and from 
 the time of the experiments until he was next seen he was 
 reported not to have spoken at all. At this time he came into 
 the room slowly, looking not so much depressed. Asked if he 
 had ever seen the speaker before he replied, “ Yes.” How long 
 ago was it?” “ About two weeks — no, longer; it must have been 
 five or six weeks ago.” (Approximately correct.) Asked what 
 he did at this time he said, “ Tapping,” also making the motion 
 with his hand. He then lapsed into his former inaccessibility, 
 sitting immobile, with head hung down, and nothing further 
 could be gotten from him. 
 
 Clinical notes of the patient’s condition at and about this time 
 are as follows : “ The patient has a dull facial expression. He 
 sits about in a dull, apathetic manner. The saliva drools from 
 his mouth, and he remains in fixed attitudes for long periods of 
 time, is very resistive, and does not dress or undress himself, 
 and at times shows considerable negativism. Occasionally there 
 are times during which he is active, and during these spells he 
 does undress himself and tears his clothing.” This covers the 
 patient’s condition during September, October, and November, 
 1908. During December he is reported to have shown consid- 
 erable improvement. “ There is at present considerable retarda- 
 tion of both psychical and physical activities, but he is able to 
 answer questions fairly well. Memory and orientation seem to 
 be quite good. He has taken on considerable flesh of late, and 
 is gradually becoming more active and doing some light work 
 about the ward.” Three months later : “ The patient continues 
 to show a slight, gradual improvement. At present he takes con- 
 siderable interest in his surroundings, reads the newspapers, has 
 parole, and does considerable work about the ward. Some 
 retardation exists in his mental and physical condition.” And 
 again, a month later, “ The patient is showing gradual improve- 
 ment, is at present doing some work about the grounds, but is 
 rather slow in all his movements, and does not show a normal 
 amount of interest in his surroundings. There is some retardation 
 of both mental and physical activities.” 
 
 Since this time the patient has been at home, where he was seen a 
 few days before the present writing, but the data obtained still leave diag- 
 nosis doubtful. 
 
FREDERIC LYMAN WELLS 
 
 35 
 
 1909] 
 
 So that, as between manic-depressive depression and dementia 
 prsecox, we have a previous history that speaks strongly for 
 dementia prsecox, a picture at the time of the experiments that 
 showed traits both of a manic-depressive and of a prsecox nature, 
 and a course that is much more characteristic of a manic-de- 
 pressive condition, but by no means excludes dementia prsecox. 
 
 .V 
 
 24 
 
 I 
 
 The overshadowing characteristic of his condition at the times 
 when he was observed was the slowness and inefficiency of his 
 responses, and the essential point is whether this slowness and 
 inefficiency represented an extreme lack of affective reaction, or 
 if it was the product of a specific retardation of the motor func- 
 tions. Regarding this question the curves shown in Fig. 13 give 
 some rather significant testimony. 
 
36 
 
 MOTOR RETARDATION 
 
 [July 
 
 These curves stand considerably closer to what has been ob- 
 served in manic-depressive than in praecox conditions. The gross 
 rates are below the normal, the fs are high, and there are distinct 
 phenomena of reversal, these being in each case more prominent 
 in the following hand, i. e,, the left in the first, the right in the 
 second experiment. It may also be noted that in the first ex- 
 periment the preceding right hand is much poorer than the left. 
 In the second experiment the following right hand is much better 
 than the left ; indeed, the transference phenomenon is in this case 
 more striking than in any other subject observed, save in the 
 third experiment with Case II. The abnormalities in these rec- 
 ords are distinctly those associated with manic-depressive 
 depression rather than with dementia praecox ; indeed, it is quite 
 doubtful whether dementia praecox cases show any consistent 
 abnormality in the tapping test. In the presence of a specific 
 motor retardation the case has certainly run a very different course 
 from the usual dementia praecox cases, in whatever diagnostic 
 group the case may fundamentally belong. 
 
 Case VII. This case and the following are depressed states 
 showing clinically considerable retardation, but with factors in 
 the history indicating the possibility of one of the protean forms 
 of general paralysis. The patient was a man of 41, veterinary 
 surgeon, no heredity. As a boy, he showed unusual mental 
 ability, and he has always been a hard worker, physically strong, 
 with no serious illnesses except for a history of syphilis. There 
 is also a history of some nervous breakdown three years before 
 admission, from which it is not certain that there was complete 
 recovery, but which did not interrupt his work. The symptoms 
 definitely related to the present illness began about a month before 
 admission. He seemed to be losing interest in his work, would 
 often be very irritable, and quickly get over it again. Appetite 
 and weight were falling off. There were no known fainting at- 
 tacks nor seizures. Physical examination was negative, though 
 lumbar puncture showed a marked excess of small lymphocytes. 
 The experiments were performed about four months after admis- 
 sion, and the patient remained under observation for about 10 
 months after this, when he was transferred, his condition remain- 
 ing practically stable up to the present. During observation he 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 37 
 
 was fairly clear, his memory was good. No great emotional 
 depression was evident on the surface; the one prominent and 
 fundamental symptom seemed to be a marked and typical retarda- 
 tion. The curves are as below. 
 
 The curves are remarkably inconstant in form. The second 
 experiment shows much less fatigue than the first, and the left 
 hand much less than the right. One of the records shows con- 
 siderable reversal, but the individual series are very irregular, 
 and the statistical correspondences with the certain manic-depres- 
 
38 
 
 MOTOR RETARDATION 
 
 [July 
 
 sive records are quite likely to be a product of chance. There 
 are a good many failures of innervation, as long periods of pres- 
 sure and release, and these seem to be more marked in the earlier 
 portions of the series. The performance is distinctly a patholog- 
 ical one, but it is more similar to what has been seen in coarse 
 neurological conditions, and it seems to give little evidence of the 
 clinically apparent retardation. 
 
 Case VIII. A man of 42, merchant, bad heredity. Was bright 
 and active as a boy, of good habits and learned well. He went 
 to school until 18, since when he has been in business. He has 
 applied himself very closely to his work, hardly ever taking a 
 vacation, was not thought of as a nervous man, and has shown 
 good business ability. 
 
 The present attack, which is the first, seems to date back to 
 some self-accusatory ideas which the patient developed regarding 
 the fatal illness of a relative to whom he was much attached. He 
 began to sleep poorly, and about five months later went to an 
 institution, where he was mostly unoccupied, at times resisting 
 the efforts of the nurses to get him out of doors, though he was 
 not violent nor suicidal. His sleep improved. When transferred 
 to the McLean Hospital he was rather depressed, unoccupied, 
 showed no interest, not speaking spontaneously, but answering 
 questions, and was oriented. He remained under observation a 
 little over a year, during which time his mental condition re- 
 mained about the same, perhaps showing a slight improvement, 
 and again a relapse shortly before his removal, since when his 
 condition has been practically stable. The present tests were made 
 a little over two months after admission, the curves being as 
 shown in Fig. 15. 
 
 No pathological element appears in these records. The gross 
 rate is somewhat above the normal average, but not abnormally 
 so, and the same is true of the susceptibility to fatigue. There are 
 certain characteristics in the experiments that usually appear in 
 normal individuals only after some practice, though no history 
 of such practice was obtained. Although the second experiment 
 is slightly inferior to the first (as is usually the case with normal 
 individuals), the clinical notes indicate a slight improvement in 
 the patient’s condition during the week between the experiments. 
 Whatever may be the correct diagnosis in these two cases, the 
 
FREDERIC LYMAN WELLS 
 
 39 
 
 1909] 
 
 results strongly indicate that there is a type of retardation in 
 which the motor work-curve is not affected in the same way as 
 in the more characteristic retardation of manic-depressive de- 
 pression. 
 
 \ 
 
 
 Fig. is. 
 
 Case IX. It is, of course, a clinical commonplace that retarda- 
 tion is not a necessary accompaniment of emotional depression ; 
 various conditions are seen in which the depression is accompanied 
 by considerable activity, as in the mixed states of manic-depressive 
 insanity or in involution melancholia. From this point of view the 
 
40 
 
 MOTOR RETARDATION 
 
 [July 
 
 records of three agitated depressions may be presented for com- 
 parative purposes. The first of these is a man of 58, bookkeeper, 
 no heredity. He learned well at school, and after a short period 
 as a bank clerk became a bookkeeper, holding a single position for 
 the 30 years preceding his illness. It seems that a year or two 
 previous to this attack his ability had been falling off, but the 
 acute symptoms began when he was summarily discharged from 
 the position, possibly because of his loss of efficiency. Before 
 admission to the McLean Hospital he had been 18 months in 
 another institution, and the present experiments were made just 
 one year after admission. Nearly a year has elapsed since this 
 time, during which the patient's condition has not changed ma- 
 terially. He presents uniformly a typical involution picture, show- 
 ing anxiety, agitation, “ moral pain ” but not self-accusation, 
 suicidal tendencies, and a good deal of motor activity and rest- 
 lessness. 
 
 The usual experiment was made 10 times. Co-operation was 
 exceptionally good, the patient often seeming to go at the test 
 as a temporary substitution that might distract him for the 
 moment from his depressive ideas. During the pauses he would 
 often grow impatient to begin again. Ten experiments were 
 made, on successive days, the right hand preceding on the odd 
 days, the left hand on the even days. The curves, calculated in 
 the same manner as for Case III, p. 24, are as shown in Fig. 16. 
 
 The gross rate is somewhat, not markedly, below normal, while 
 the / is just normal. There is no evidence whatever of a motor 
 retardation in the shape of the fatigue-curves. If the records 
 are examined with reference to a transference effect from one 
 hand to another, it will be seen that each hand is relatively better 
 when it precedes than when it follows. This is seen in normal 
 subjects, but the phenomenon in this case is much more marked ; 
 it is the precise opposite of the transference that is seen in manic- 
 depressive retardation. Its character is illustrated in the curves 
 shown in Fig. 17, which are plotted in the same manner as those 
 for Case III. 
 
 The curves of total efficiency and for the index of right-hand- 
 edness run in precisely opposite directions to the corresponding 
 curves in Case III, who, it will be remembered, was a case 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 41 
 
 showing a first attack, at the involution period, of a typically 
 manic-depressive character. In the present case the curve of the 
 right hand rises on the odd days, when it precedes, and falls on 
 the even days, when it follows ; while the curve of the left hand 
 falls on the odd days, when it follows, and rises on the even days, 
 when it precedes. The index of right-handedness shows again 
 
 3Z 
 
 Z 
 
 \ 
 
 a precisely opposite alternation from that of Case III, but the 
 fatigue phenomena show nothing of significance. 
 
 It will be remembered that in Case III it was possible to trace 
 a certain correspondence between the total efficiency curve and 
 the fluctuations in the patient’s condition. In the present case there 
 were fluctuations in the patient’s behavior even more marked than 
 those noted in Case III, but they have left absolutely no trace 
 on the results. These fluctuations consisted in a cyclic exacerba- 
 tion and subsidence of the agitated symptoms on alternate days. 
 
42 
 
 MOTOR RETARDATION 
 
 [July 
 
 Q. Ag Q. O. J^g Af OL Aj Q. 
 
 iSo 
 
 m 
 
 Day I 
 
 S fc T » 9 I* 
 
 Fig. 17. 
 
 "> 
 
 
 4 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 43 
 
 This may be illustrated by the brief daily notes of the patient’s 
 attitude, running substantially as follows: 
 
 October 12, 1908. The subject entirely co-operative. Agitated 
 and depressed but quite clear, and talks a little on general sub- 
 jects, asking for example about the possibility of the Bulgarian 
 tangle resulting in a European war. 
 
 October 13. Much more active and apprehensive and less clear 
 than yesterday. Talked unceasingly, begging to be released. 
 Complained that his breathing was painful and that his bowels 
 were paralyzed. Was impatient to begin every fresh series. 
 
 October 14. Not so agitated as yesterday nor so calm as the 
 day before. Did not ask to be released. Asked questions and 
 made remarks spontaneously on various subjects, these giving 
 rather the idea of an attempt to get away from the background 
 of the depression. 
 
 October 15. Very much agitated, with continual motor activity. 
 Begged to be allowed to go home, offering the experimenter 
 $10,000 to recommend his discharge. 
 
 October 16. Very quiet, more so than at any time during the 
 experiments, hardly spoke at all, except to himself. 
 
 October 17. Agitated, a good deal of motor activity, and ap- 
 parently more “ moral pain ” than at previous interviews. 
 
 As it was reported that this alternation of quiet and agitated 
 days was a regular occurrence with the patient, no experiment 
 was made on October 18 in order that the same precedence of 
 the hands in the experiments should not be confined to depressed 
 or agitated days. 
 
 October 19. Very much agitated, more active than at any 
 previous time. Paced the floor continually, offered the experi- 
 menter $1000 an hour to let him go home for 48 hours. Also 
 tried to induce the nurse to aid in his escape. 
 
 October 20. Quiet, did not get up out of chair. Not nearly 
 so agitated, and showed more ability to rise above the depression. 
 
 October 21. After the second series paced the floor contin- 
 ually, twice tried to get into a drawer where sharp instruments 
 were kept, and made requests similar to those above noted about 
 going home. 
 
 October 22. Patient quiet. Condition substantially similar to 
 October 20. 
 
44 
 
 MOTOR RETARDATION 
 
 [July 
 
 The tapping test is ordinarily quite responsive to such changes 
 in condition as are reflected in the behavior here, and its failure 
 to be aflPected by them in this case is surprising. It may be men- 
 tioned that while the patient actually does considerably better with 
 his left hand, he said that it was easier for him to perform with 
 his right, and he also said he thought he did better with it. 
 Though the difference is slight, the preferred hand shows in the 
 
 long run the greater immunity to fatigue, as we are accustomed 
 to find. 
 
 Case X. A man aged 78, retired merchant, some heredity, 
 early history negative. He was successful in business, from 
 which he retired at 63 on account of “ nervous prostration.” For 
 about five years before admission he was somewhat eccentric and 
 inclined to be ugly toward his family, but about a month before 
 admission his attitude changed and he became very affectionate. 
 This lasted -for about three weeks, when one night he performed 
 a number of eccentric actions, finally culminating in a feeble 
 
I909I FREDERIC LYMAN WELLS 45 
 
 attempt to kill his wife. When it was suggested that he should 
 come to the hospital he was at first willing, but later became 
 irritated and uncontrollable, and escaped from the house to a 
 pond where he made a weak attempt to drown himself. Here 
 he presents a picture of irritability, a few feeble persecutory 
 delusions, and a tendency to malingering, but with alertness and 
 no marked memory defect. Two experiments were performed 
 about six weeks after admission, the results being as shown in 
 Fig. 18. 
 
 The gross rates are distinctly above the normal and there is 
 neither reversal nor favoring of the following hand. The right 
 hand fatigues very little, but there is partial disability in the right 
 arm, due to its once having been broken, so that what we have 
 here may be analogous to the latter part of the fatigue-curve, the 
 higher initial rate that we should have had being lost. The left 
 hand begins at about the same level as the right and fatigues 
 normally. These records thus show no evidence of a motor 
 retardation. 
 
 Case XL A printer, aged 47, bad heredity ; has used a great 
 deal of alcohol. The present attack is the seventh. Between the 
 previous attacks he has cleared up sufficiently to work, but his 
 intemperate habits doubtless help to throw him into the successive 
 depressions. The present condition is characterized by consid- 
 erable emotional depression with delusions. He is always on the 
 move, though his movements are not especially rapid or efficient. 
 He does not speak, but keeps up a low moaning to himself. How- 
 ever, he understood what was wanted in the experiments with 
 surprisingly little difficulty, and co-operated exceptionally well, 
 seeming, like Case IX, to go at the test as a sort of ‘‘ substitution.” 
 In the ward he wore mitts to keep him from tearing his clothing, 
 which were necessarily removed for the experiments, and the 
 entire time of the pauses he would spend picking at himself unless 
 restrained. Two experiments were performed, the second two 
 days after the first, the fatigue-curves being as shown in Fig. 19. 
 
 Only one of these curves, that of the right hand in the first 
 experiment, shows an abnormal immunity to fatigue, nor is there 
 sufficient evidence of transference to afford any certain criteria 
 of motor retardation in these records. 
 
46 
 
 MOTOR RETARDATION 
 
 [July 
 
 The method then fails to demonstrate in these three cases the 
 usual phenomena of retardation, in spite of the fact that the last 
 considered case should probably be assigned to the manic-depres- 
 sive group in any but the narrowest acceptation of the term. 
 
 T. 
 
 \ 
 
 \ 
 
 \ 
 
 \ 
 
 3 3 ^ \ 
 
 Fig. 19. 
 
 3. General Conclusions. 
 
 In order to compare the average performance in the tapping 
 test of normal and depressed individuals, as well as the perform- 
 ance in diagnostic groups in whose symptomatology retardation 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 47 
 
 does not play a fundamental part, the accompanying figure is 
 presented. This gives the average fatigue-curve in 10 normal 
 subjects, seven manic subjects, six cases of dementia prsecox, five 
 of general paralysis, and, finally, that of the 10 manic-depressive 
 cases presented in a previous study. While the individual cases, 
 of course, vary considerably about these averages, it is doubtful 
 
 /o" IS" 2.0" zs" 3o‘ 
 
 Fig. 20. 
 
 if the significance of the results warrants their more detailed 
 presentation in this connection. The principal point in this figure 
 concerns the relation of the manic performance to the depressed. 
 
 The results of the manic cases indicate a maximum rate dis- 
 tinctly above the normal. In the cases which showed a real 
 manic excitement the maximum rate was considerably higher, but 
 the average is brought down by two cases who showed a rather 
 
48 
 
 MOTOR RETARDATION 
 
 [July 
 
 easy-going euphoria, and co-operated with more willingness than 
 zeal. The curve remains somewhat above the performance of 
 normal subjects until half way through the work period, when it 
 drops somewhat below it. Compared with the normal cases, 
 the manic thus show a higher initial rate and a greater suscepti- 
 bility to fatigue. In the isolated cases in which it was possible 
 to observe the behavior of the test with respect to changes in 
 condition, it seemed also that the more manic states had the higher 
 initial rate with the greater susceptibility to fatigue. 
 
 The average curve of the depressed states, on the other hand, 
 shows a very slow initial rate with a slight reversal in the first 
 interval, which then fatigues very gradually through the rest of 
 the work period. The work-curves of the manic and depressed 
 states are thus found to be both in amount and character on 
 opposite sides of the normal. 
 
 Franz, using two normal, two depressed, and two manic sub- 
 jects in various psychological tests, did not find any consistent 
 superiority of the manic performance over the normal ; indeed, 
 the manic subjects were apt to be rather inferior to the normal, 
 though not so much so as the depressions. Hutt, however, using 
 the fatigue-curve of the addition test again found the manic 
 performance to be somewhat superior to the normal. On the 
 other hand, while there is in the tapping test observed an increased 
 susceptibility to fatigue, Hutt found that manic cases would grad- 
 ually increase in rapidity in the same manner as the depressions. 
 There are features in the manic state according to which either 
 of these results can be interpreted. Hutt classes the increased 
 manic efficiency with the increased excitability under stimulation 
 clinically noted in these cases ; the abnormally rapid loss in effi- 
 ciency found in the present experiments corresponds rather to the 
 suspended inhibition of manic cases, leading to the putting forth 
 of greater initial effort, and consequently the more rapid wearing 
 out of the organism. The explanation of the difference probably 
 rests in the character of the experimental task, and the different 
 levels of neural activity which are involved. Objective motor 
 fatigue is generally admitted, while the nature or even the exist- 
 ence of intellectual fatigue is still somewhat in dispute. 
 
 Working with the eye movements over a wide range of cases. 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 49 
 
 Diefendorf and Dodge' found the angular velocity in manic cases 
 distinctly superior to the normal. On the other hand, the simple 
 reaction time, as well as the pursuit reaction, was found to be 
 slightly shorter in the normal than in the manic cases. It may 
 be noted, however, that in these two functions the greater dis- 
 tractibility and inferior attention of the manic cases would operate 
 more to their disadvantage. This perhaps explains why, though 
 the manic states are worse, the “ hypomanic are better than the 
 normal in these two functions ; the distractibility would be less 
 here and the attention better. They are, however, not quite so 
 quick in simple reaction. 
 
 It is the prevalent clinical opinion that the greater superficial 
 activity in the manic state is to be interpreted not as the greater 
 efficiency of the nervous impulse but as the removal of the 
 inhibitions it ordinarily has to overcome. This fact does not 
 itself justify the secondary interpretation sometimes made that 
 psychic capacity is fundamentally decreased in the manic state 
 just as truly as in the depressed. Every clinician of experience 
 is familiar with cases who make much better superficial impres- 
 sions, and who in some instances may be actually regarded as 
 more efficient members of society when they are hypomanic than 
 when they are normal. The potentiality of the more efficient re- 
 actions is there, but they are normally restrained by inhibitions 
 which the hypomanic condition removes. Thus the taciturn indi- 
 vidual who becomes an excellent conversationalist after a few 
 glasses of wine may have the same ideas when normal as when 
 elevated, but in the normal state their expression is inhibited 
 by something that he would probably describe as the thought that 
 the ideas were too trivial to express. 
 
 If the essence of the manic state is the removal of inhibitions, 
 it follows as a corollary that maximum efforts must be higher in 
 the manic state than in the normal state. Maximum efforts may 
 not be so easy to obtain, owing to distractibility, nor may the re- 
 actions be so well adjusted to the environment, owing to clouded 
 judgment. But the inferiority that manic cases are very apt to 
 show in psychological tests demanding special co-oj>erative effort 
 is probably mainly secondary to the first of these factors. If as 
 
 ’ Brain, Vol. XXXI, Part CXXIII, 1908, pp. 451-489. 
 
 4 
 
50 
 
 MOTOR RETARDATION 
 
 [July 
 
 good ‘‘ attention ” or concentration could be obtained as with 
 the normal state, the maximum performance should be better. 
 
 It must probably be regarded as a limitation of the German 
 terminology that it uses the word Hemmung to describe both 
 retardation and inhibition. Hoch has indicated this difficulty very 
 clearly® in his studies of retardation, especially in his employment 
 of the term resistances instead of inhibitions to describe the proc- 
 ess. That psychomotor retardation is the product of excessive 
 inhibition is more than doubtful. Inhibition is opposition, and 
 excessive inhibition is nothing more nor less than a blocking 
 negativism, which is not part of the recognized symptomatology 
 of manic-depressive insanity. This is a difficulty that must be 
 overcome if the strict continuity of the manic and depressed states 
 is to be maintained together with the theory of decreased inhibi- 
 tion in the manic states. We must recognize two factors that may 
 lessen the freedom of a mental or motor reaction — opposition and 
 obstruction. Excess of the former is negativism, excess of the 
 latter is retardation. The crucial question then becomes: Is the 
 manic state a removal of inhibitions or a removal of obstructions ? 
 Removal of inhibitions describes the manic state as we know it 
 very well, but excessive inhibitions describes something very dif- 
 ferent from the retarded state. On the other hand, excess of ob- 
 structions describes the retarded state very well, while its relation 
 to the manic state is the same as that of the theory of loss of 
 inhibition. Both viewpoints are compelled to conceive of some 
 process which acts independently upon the primary or the inhibi- 
 tory impulses, for if they were equally affected the end-effects 
 would remain essentially unchanged. The point is perhaps a minor 
 one, but for the sake of clearness it might be well to examine the 
 objective criteria of obstruction, or resistances, as distinguished 
 from inhibitions, with reference to the more precise analysis of 
 the manic state. 
 
 Such phenomena of retardation as appear in the dementia 
 praecox cases observed are objectively differentiated from the 
 depressive ones in that they appear more episodically, almost 
 fortuitously, as it were, affecting one hand and not the other, 
 or only individual series with a single hand, as distinguished from 
 
 ■Hoch: On Certain Studies with the Ergograph. Journ. Nerv. and 
 Ment Diseases, XXVIII, 1901, p. 626. 
 
1909] 
 
 FREDERIC LYMAN WELLS 
 
 51 
 
 the manic-depressive retardation whose manifestations are more 
 consistent throughout. However, while there have not been ob- 
 served outside the depressed states instances of the phenomena 
 of retardation which did not seem to have objectively a different 
 origin from those regularly observed within the depressed states, 
 yet the possibility must be granted that the retardation measured 
 in these experiments may be a symptom of many mental diseases, 
 possibly in much the same way as a rise in temperature is a 
 frequent accompaniment of bodily disorders. We do not discard 
 the clinical thermometer because it will not immediately dis- 
 tinguish between the fever of a typhoid and the fever of a pneu- 
 monia ; nor need the measurement of retardation lose its clinical 
 significance because it will not serve the purposes of penny-in- 
 the-slot diagnosis. 
 
 To briefly recapitulate. The measurement of such elementary 
 functions as are given in the ocular reaction times, the ocular 
 pursuit movements, or the tapping test and the like, affords the 
 most unequivocal criterion of motor retardation that it is at present 
 practicable to obtain. The criteria of motor retardation as illus- 
 trated by the tapping test are (a) a lowered absolute rate, (b) a 
 rise in the work-curve where it should normally fall (reversal), 
 (c) a relative gain over the normal in the efficiency of the work 
 that comes later in the experiments (transference). Case I, su- 
 perficially characterized mainly by fixed ideas, illustrated marked 
 phenomena of retardation under the conditions of the experiment, 
 indicating the existence of a more fundamental psychic disturb- 
 ance to which the fixed ideas are secondary. Later, this case 
 showed extreme instability of the phenomena of retardation, 
 which markedly decreased through the experiments, a progressive 
 change which the mood tended to parallel. Case II illustrated a 
 pronounced motor retardation, probably without much thinking 
 disorder. Here there were also to be noted characteristic fluctua- 
 tions as the experimental work progressed. Case HI was mainly 
 significant in showing that the phenomena of retardation might 
 appear characteristically in a first attack at the involution period, 
 in giving an especially clear-cut illustration of transference phe- 
 nomena and further reflecting episodic changes in condition. 
 
 Case IV illustrates the effect of an objectively given condition 
 of retardation in accentuating the phenomena of transference and 
 
52 
 
 MOTOR RETARDATION 
 
 [July 
 
 lowered absolute rate. Case V illustrated certain phenomena in 
 retardation in a depression of immediate traumatic antecedents, 
 and with other clinical characters of the traumatic psychosis. 
 In Case VI the characteristic phenomena of manic-depressive 
 retardation appeared in a case showing otherwise many dementia 
 praecox traits, but whose subsequent course was more favorable 
 than is usually to be anticipated in this condition. In Cases VII 
 and VIII a considerable clinical retardation failed to reveal itself 
 in any characteristic way experimentally ; in each of these cases the 
 possibility of a general paralysis had been considered. Case IX 
 is a classical involution depression whose deviations from the 
 normal are in the opposite direction from those of the manic- 
 depressive depressions. No retardation is shown and, save for 
 the lowering of the gross rate, the performance resembles that 
 of the manic cases more than that of the typical manic-depressive 
 depressions. The performance is also practically unaffected by 
 considerable fluctuations in the superficial condition. Cases X 
 and XI are presented in this same connection, as agitated de- 
 pressions not showing retardation ; and affording, with the three 
 previous cases, experimental indication that emotional depression 
 involves retardation no more necessarily than retardation involves 
 emotional depression. Each is seen fundamentally and inde- 
 pendent of the other, though either may be secondary to the other. 
 
 The cases of dementia praecox and general paralysis show 
 little or nothing of significance, but the manic cases tend to 
 show an increased initial rate and a heightened susceptibility to 
 fatigue, the exact reverse of what is shown by the retarded cases. 
 When the psychological measure can be made sufficiently inde- 
 pendent of special factors in co-operation it is probable that the 
 optimum performance of manic states is quite superior to the 
 normal as well as the depressed. Insufficient light exists on this 
 question, however, a satisfactory treatment of which is possible 
 only in the study of a group of circular cases through various 
 'periods of depression and excitement. Since the essentially re- 
 tarded state is almost certainly an over-obstruction, not an over- 
 inhibition, of the reaction, the manic state may also perhaps be 
 better interpreted as the loss of normal and teleological obstruc- 
 tion to the primary impulses rather than to the loss of an inhibitory 
 faculty usually exercised by the opposite impulses.