Early American Manual Therapy

Studies in the Osteopathic Sciences
The Physiology of Consciousness: Volume 3
Louisa Burns, M.S., D.O., D.Sc.O.
    The intermediate areas are those placed between the different primary and overflow sensory and motor areas. The primary areas are, for the most part, surrounded by the overflows. Between the overflow areas lie the intermediate areas. These have been called indifferent areas, because of the fact that their removal or injury was found to give rise to no localizing symptoms in the cases first studied, and that the experimental stimulation of these areas in the brains of animals and in the brains of a few human beings suffering surgical injuries produced no bodily movements. They have been called association areas, because other facts of clinical evidence indicated that they were in some way concerned in the association of ideas. They have been called unused areas, because no function was at that time ascribed to them.

    Partly because of the studies of Flechsig and partly because of many clinical reports the view is now accepted that the cortical areas of the left hemisphere altogether, and probably most of the right hemisphere in human beings, are concerned with important functions. The areas are properly “intermediate” areas, since this term conveys no false psychological ideas. It is not known whether the intermediate areas are any more concerned in consciousness than are other areas, or whether they are to be considered as concerned in consciousness at all. They are placed between the sensory and motor overflow areas, and the term “intermediate” conveys no unbased or indefensible ideas concerning psychic relationships.

    The areas intermediate between the overflow of any primary area and the overflow of any other primary area are concerned in the association of the impulses from both overflows.

The Stereognostic Area

    In the precuneus, near the mid line, there is an area called the stereognostic center This occupies the area between the visual overflow and the somesthetic overflow. It will be remembered that the somesthetic overflow includes as part of its functions the retention of memories of simple muscular movements. Thus, the area between the visual and the somesthetic overflows is concerned in the appreciation of ideas resting upon the proper correlation of the primary sensations of sight, touch, and the sensations associated with simple muscular efforts. This is the physiological basis upon which objects are seen as having extension in three directions, as having solidity, of being placed at a distance, and of being real, rather than unreal and evanescent.


    Lesions of the stereognostic area are associated with sensations due to the lack of these coordinations; there is seen only a flat, colored surface, as the primary visual area produces the sensations in consciousness. No ideas of space in three directions are possible under such conditions. Touch gives ideas only of plane surfaces; muscular effort alone gives ideas only of resistance to effort; hearing gives no idea of extension in space, primarily; and the individuals so injured are able to perceive nothing as solid, thus nothing as real. Things absent from immediate environment are not to be thought of as having existence, though memories of past experiences may be normally vivid. Such memories are like the memories of a very vivid dream, whose elements are vividly present as memories, but whose unreality is not to be questioned.

Area for Equilibrium

    At the posterior extremity of the temporal lobe, and extending somewhat into the parietal and the occipital lobes, lies an area with undetermined limits, whose injury results in a lack of conscious equilibrium. The person so injured may not stumble or lose his balance; he may be able to perform rather complex acts with no apparent difficulty, especially if he does not pay any attention to the actions. But he has no sense of proper orientation to his environment; he is afraid of stumbling, and this fear may make him actually fall. But so long as he attends to other things the activity of the lower centers of coordination seem able to govern his movements fairly well. Such a person is apt to lose also the sense of orientation in other directions; he may find himself always with a feeling of being out of place, of being unwelcome, of failing in his efforts to perform his duties satisfactorily, or of having engaged in the wrong vocation. It is probable that an unbalanced functioning of this area may be associated with the peculiar mental make-up of the proverbial “rolling stone.” The constant effort to orient the reactions to the environment in a satisfactory manner results in constant changing of vocation and constant change of environment. Sick people of this type go from one doctor to another and try fad after fad of pseudo-hygiene and diet. The religious life may be affected by such deficiencies; the persons thus affected change their denominational affiliations with the changes of the seasons. The remedy for such conditions, when dependent upon unbalanced development, is educational. Children who display such tendencies should be taught to postpone the expression of unrest until the environmental factors have been thoroughly examined. The manner in which these educational factors may be used is discussed in a later chapter of this book.

Anterior Association Area
    There are three well-marked intermediate areas. These have been called the anterior, middle and posterior association areas.

    The anterior association area occupies those parts of the frontal lobe not occupied with the motor overflow, the writing and speech centers, and the primary motor area. This area presents no marked variations from the typical cortex, except that the line of Bailarger is rather well marked, and the association fibers of Meynert are present in rather large numbers. The sensory impulses from the viscera may be received by this area, though there is much reason to doubt the matter. The motor overflow extends well forward, and probably the activities of the neuron systems of the motor overflow are important factors in the determination of the ideas of personality.

    The anterior intermediate area is concerned in the coodinations of those nerve impulses which are concerned with the relationships of the individual to his environment. Lesions of this area are associated with a lack of the normal reactions of the individual to his fellow man, and to the circumstances of his life. He is apt to be foolishly extravagant, foolishly egotistical, and often his lack of consideration for the rights of others or for the commonest ethical considerations cause him to perform criminal acts.

Abnormal Conditions
    Lack of normal relationship between this area and other intermediate and overflow areas causes the individual to be peculiar, to assume at times a demeanor of extravagant humility, at other the most arrogant self-conceit. The same contradictory characteristics may be found in the same person, or any individual may display only one set of the characteristics. Normally, the activities of the frontal areas control the activities of the lower centers, and they are concerned in the coordination of the impulses initiated by the activities of all parts of the cortex. It is this area whose activity is concerned in deciding the manner in which the individual shall react to any given environmental change. In other parts of the brain the propriety of the proposed action is decided, but in the anterior intermediate area the reaction which the certain person is to make to the certain stimulation is decided, not always in accord with the decisions made by the posterior areas.

    The activity of the neuron systems of this area, as they stimulate the neurons of the motor area to action, causes the phenomenon called volition, or will “power,” in consciousness. Impulses are not sent from the anterior intermediate area because of the “power” of the will, but the sense of will power results from the transmission of these impulses, with the associated activity of the giant cells. The larger the cells stimulated, the greater the sense of power in their activity. Thus, if it is desired to cause a sense of well being in the neurasthenic, it is only necessary to cause him to contract the large muscles, those concerned in extending the spine, throwing up the thorax, extending the arms, breathing deeply, etc.

The Insula

    The middle association area is that of the insula, or the island of Reil. The nature of the processes coordinated in this area is not known. It was formerly supposed that the insula was concerned in speech, but later studies have shown that not the insula, but the fibers under the insula, carrying impulses from the auditory to the motor speech center, were concerned in speech. It now seems probable that the insula is concerned in the association of abstract ideas.

The Posterior Intermediate Area

    The posterior intermediate area occupies part of the parietal lobe, chiefly on the left side of the brain. The common sensory and muscle sense overflow bounds it anteriorly, the auditory speech center bounds it inferiorly, the visual overflow and the visual speech center bound it posteriorly and inferiorly. The stereognotic sense occupies part of the area.

    In this area the impulses are coordinated which are concerned in the appreciation of the factors of the environment, without especial regard to the personality. By means of the activities of these neuron groups the abstract ideas are related; the memories are associated together, and with present experiences; objects are classified, scientific attainments become possible, and all of what are ordinarily called higher intellectual attainments are secured. Nevertheless, it must be recognized that the activity of this area is of value only as it modifies the individual’s reactions, either for the present or for the future. It may be that this modification is only for the sake of giving his wisdom to others who may use it, but it must be remembered that the unification of the race in attainments is one most important function of the nervous system. It is in the activity of the posterior intermediate area that this function is most completely performed. It is here that those coordinations are secured which add to the sum total of the world’s knowledge, which plan future events, which engage in altruistic work, generous deeds, with no thought either of self-seeking or of self-sacrifice. Either sacrifice or selfishness compels the activity of the anterior intermediate area.

The Motor Areas

    The gyrus anterior to the central fissure (of Rolando) is concerned in the discharge of the motor impulses which govern the movements of the skeletal muscles, so far as these are under volitional control. The gyrus posterior to the central fissure is concerned in the sensations associated with the same parts of the body. The body is thus projected upon the cortex of the central areas much as the retina is projected upon the occipital cortex. The map of the cortex displays a projection area which is, very roughly, a map of the body, in which the body is inverted and placed somewhat in the embryonic position.

    The cortical area represents the contralateral half of the body. The movements of the feet and toes are governed from the area upon the medial aspect of the hemispheres. The movements of the legs and thighs occupy the area upon the upper aspect of the hemispheres; a little lower lies the area in which the movements of the lower part of the body itself are controlled, then the areas governing the upper part of the body, the shoulders, arms, hands, fingers, face and neck appear in order. The movements of the head are probably controlled from an area lower than the finger area, though certain facts of clinical and post-mortem evidence seem to indicate the control of the head movements from an area just lateral to that controlling the hands.

    Destruction of the motor area is associated with a loss of the so-called volitional movements, and the muscles controlled by the injured part of this area suffer spastic paralysis.

    Experimental stimulation of different parts of this area causes movements of certain muscles, according to the area stimulated. Experimental ablation of different parts of the motor area in animals causes paralysis of certain muscle groups, and these paralyzed muscles are about the same as those found paralyzed in the man or woman who suffers from lesions of corresponding areas. In this connection the results of experimental stimulation, experimental ablation, clinic evidence and post mortem examinations all agree within fairly well-defined limits.

The Motor Cortex
    The structure of this area is peculiar because of the extremely large pyramidal cells of the internal layer of large pyramids. The line of Bailarger is not well marked in the motor area. This is, no doubt, due to the fact that the cells act more as units in the emissive part of the cortex than in the receptive areas. The coordination processes are performed in the overflow and intermediate areas, and the impulses resulting from the related activities of those cells cause the stimulation, in the motor area, of the cells essential to the performance of some certain action. Probably there is a certain amount of coordination in the motor centers, but this must be much less than is the case in the overflow and intermediate areas. The lack of the line of Bailarger indicates this lack of correlation of motor impulses in this area.
Motor Overflows
    The motor area receives impulses from practically all parts of the cortex. The overflow lies just anterior to the primary motor area. The overflow near the center for any group of muscles may become developed for the performance of especially complex actions of those muscles. The speech center, just anterior to the area for the movements of the tongue, lips, laryngeal muscles, etc., and the writing center, just anterior to the center for the movements of the hands and fingers, illustrate this relationship. Certain facts of clinic evidence seem to indicate the existence of other areas for the performance of movements of considerable complexity. These have not been exactly defined, partly because of the impossibility of animal experimentation in investigating such relationships, and partly because uncomplicated brain lesions associated with the loss of these complex reactions, except in the case of speech and writing, have not been reported.
Nature of Volition
    The stimulation of the motor area by impulses from other cortical areas gives rise to the consciousness of effort and the exertion of effort. The tendency in consciousness is to assume a psychological energy-producing volition. The facts of experimental and clinical evidence indicate that this consciousness of volition is the result and not the cause of the stimulation of the efferent neurons of the motor cortex; in other words, the movement occurs, and this produces the consciousness of volition. The occurrence of the movement, however produced, gives the consciousness of increased energy, and this may serve as a means of increasing what is usually called the will power to a noticeable extent. If the sick and feeble person can be stimulated in any way to move the muscles concerned in volitional efforts, the effect in consciousness is about the same as if he chose to perform the same movements in the same way.
Abnormal Conditions
    The largest pyramidal cells of the motor area are those concerned in the activity of the largest and most powerful muscles. Stoddard makes use of this relationship in describing the pathology of the manias and the melancholias. He infers the existence of some paralyzing agent formed within the neuron by its own abnormal metabolism. This substance affects the larger cells most profoundly, since these have the greater mass, with metabolic processes which vary according to the cube of similar dimensions, while their eliminative powers are limited by their surfaces, which vary according to the squares of their like dimensions. The weakness of the larger muscles, which hold up the head and shoulders, extend the back, etc., gives the picture of the person suffering form melancholia.

    If any poison should be circulating through the blood, however, the smaller pyramids should suffer most profoundly, since their powers of absorption are greater compared to their mass than is the case with the larger cells.

    The remarkable restlessness of the smaller muscles, which move the fingers and toes, in persons suffering from various forms of toxemia, illustrates the effects of the extracellular poisons upon the smaller pyramidal cells of the motor cortex. The stimulation of the smaller pyramidal cells of the cortex is associated in consciousness with the feeling of nervous irritability and inefficiency. This is easily determined by experiment. The stimulation of the large pyramidal cells of the cortex is associated in consciousness with a feeling of efficiency and power. This also is easily verified by experiment. If any one has the feeling of inefficiency and a lack of power in any way, if he will contract the larger muscles of the body, those which hold the spine erect, draw the shoulders back and hold the hips and thighs steady, the effect produced in consciousness is that of increased power. On the other hand, if one permits the shoulders to droop, the spine to fall into increased curves, and the hips to become unsteady, the effect produced in consciousness is that of weakness and inefficiency. Contraction of the smaller muscles which move the fingers and toes, however forcible these may be thrown into action, does not give the consciousness of strength that the contraction of the larger muscles, due to the activity of the larger pyramidal cells, gives. This should be one factor to be considered in outlining exercises which are to be employed by the patient in certain spinal curvatures, etc. The patient who is down-hearted and has too vivid a sense of his inefficiencies should have given him those exercises which include the energetic action of the large muscles, while the person who does not suffer from this sense of weakness may have only the exercises absolutely required for the correction of the structural abnormalities.

Therapeutic Principles
    In dealing with neurasthenics whose symptoms are of a melancholy type, the use of exercises involving the contractions of the large muscles is of value The contraction of these muscles may be made of use in giving whatever corrective movements are needed in certain cases Any movements which the patient is compelled to make under the eye of the physician seem to be especially efficient in modifying the physiological activities. This is, no doubt, because of the increased stimulation due to the presence of someone in authority. The more earnestly the patient endeavors to perform any given action properly, the greater is the stimulus given to the intermediate and overflow areas, and the greater is the educational and therapeutic value of such actions. It is much more important that a patient should try earnestly to perform his exercises properly than it is that he should perform them properly. Thus, the value of having the patient go through the exercises in the presence of the physician or his assistant is evident.
The Motor Overflow
    The extent of the motor overflow is not exactly known. Certain clinic histories seem to place it upon the cortex anterior to the primary motor areas, while other cases show evidence of a locality posterior to the area for the common sensations as being concerned in muscular memories. It is possible that both areas may be concerned in the coordination of the muscular memories. The physiological relationships involved are not modified by the structural dissociation of the overflow, even if it should be found to occupy areas not continuous.
Muscular Memories
    The sensations associated with muscular effort are remembered, as other sensory images are. The memories of muscular effort are of considerable biological significance in the maintenance of individual personality. The memories of muscular movements are probably of rather late phylogenetic development, and are found to possess certain qualities characteristic of the consciousness associated with the activities of developing cortical neurons. In the first place, the muscular memories are poorly differentiated from muscular sensations. The very thought of performing an action in any certain manner gives rise, in consciousness, to the sensation of performing that act. Thus it appears that normal people, awaking from sleep, may think honestly that they have arisen and are preparing to do the day’s work, though, as a matter of fact, they are only dreaming. Again, children not recognizing the differences between muscular memories and muscular sensations, are apt to state long, and complex, and impossible stories of their experiences, as if these had actually occurred. These highly imaginative experiences are actual, so far as the child’s consciousness goes; the muscular memories are simply dissociated through the incomplete action of the cortical neurons, and the elements are recombined with associated impulses from other cortical areas, and the effects in consciousness are thus practically identical with the effects produced in consciousness by actual occurrences. The children who are punished for “lying” are not more bewildered nor more unfairly treated than are those who are ridiculed for their “precocity.” The rational treatment of such children is simply to ignore the sayings to a great extent, and the further development of the overflow areas makes the appreciation of the facts of actual life more vivid in consciousness. Ridicule and punishment fix the whole occurrence more firmly in the memories, and delay the normal development of the neurons concerned in the memories and recognitions of muscular movement and personality.
    The ideas of personality are intimately associated with the memories of muscular activities. The development of the cortical areas associated in consciousness with the muscular memories is associated with the strongest personality ideas. The “weak character” is that of the person in whom the impulses from the primary and overflow and intermediate areas are not associated with motor impulses. Persons of great mental worth, of sound judgments, of high intellectual attainments, and most admirable characteristics otherwise, may yet be inefficient and without much force because of the lack of the development of the cortical areas associated with personality—that is, with the memories of muscular effort.
Educational Principles
    In increasing this developmental process it is necessary only to see that the impulses associated with the activities of the different cortical areas are interpreted into terms of movement as quickly and as energetically as possible. It is not at all desirable that the movements be actually performed in many cases. The vivid appreciation of the character of the movements which should be performed in almost or quite as efficient in development of the neurons of the motor overflow areas as is the actual motor reaction.

    The actual motor reactions are essential, of course, to the securing of motor memories. Sometimes people have not even the motor memories well developed. Those persons are of very weak and inefficient personality. They must be treated as children are, and their developing efficiency must result from increased use of the motor reactions. They must be encouraged to do things quickly, with the appearance of interest, whether they feel interest or not. They must be taught to decide quickly and to do things quickly, and to stand for their decisions. They must be taught to interpret all sensations and intellectual actions into terms of actual or imagined muscular effort, and they must be taught to try to appreciate vividly the feelings associated with earnest, and energetic, and enthusiastic work, and play, and urgent endeavor.

    In trying to secure the development of the stronger personality in those who are deficient in this direction it is not necessary or particularly desirable to arouse any feelings of interest or determination. The essential thing is to see that the impulses concerned in the expression of interest and determination are sent through the cortical areas associated with these psychical factors.

    If any person acts as if he were energetic, and interested, and enthusiastic, and if the physiological requirements of nutrition, pressure, etc., of the cortical neurons are met in a fairly adequate manner, the development of enthusiasm and force of character must be a matter of a comparatively short time. The older the person is, and the more seriously his cortical neurons have been injured by faulty use and disuse, the longer the development of the normal activities requires. This development may occur at any time of life. The person who is young enough to recognize a fault in his own mental make-up is young enough to correct that fault. The neurons concerned in the reactions expressive of any personality are those whose activity confers that personality. If any characteristic is desired, it is only necessary to act as if one possessed that characteristic, in its essential sense. The effort required to appear to others to possess any characteristic confers only the qualities associated with imitation, and hypocrisy, and affectation; but the effort required to place every factor of any desired characteristic plainly and vividly in consciousness, both from its sensory and its motor standpoint, confers the essential features of that characteristic upon the individual in as great a degree as the structure of the neurons and their relationships permit.

    The same laws govern the undesirable characteristics. If any person or any child is so placed as to be impelled to look upon undesirable traits constantly, even if he sees them with horror and disgust, the neurons concerned in the reactions associated with those traits have the lower liminal value, and his character becomes modified in accordance with the same law. This exception is found: if the person so placed constantly interprets the actions he sees with horror into terms of antagonistic activity, then the antagonistic reactions may become the more pronounced. But the vivid appreciation of horror and disgust with no associated motor images of antagonistic nature are of no avail in preventing the undesirable factors of environment from affecting adversely the character of individuals who perceives them. It is said that the persons of weak personality are not able to do good work in the slums, among the wicked, and so on, while persons of strong personality are not so apt to become wicked themselves if they try to engage in missionary work. The essential difference is simply this, that the person of what is ordinarily called weak personality is the one whose motor areas and motor images are associated with the activities of the sensory areas rather than with the activities of the overflow and intermediate areas. The relationships may be very intimate between the primary sensory areas and the motor areas, in which case any person is apt to react according to every change in his environment, “tossed about by every wind of doctrine.” Such a person is apt to be unendurably obstinate, holding with relentless obstinacy the edicts based upon the appreciation of comparatively few environmental factors, or he may vary with the weather vane, or he may display alternate obstinacy and variability in a manner which puts him at the mercy of any person who is shrewd enough to take these characteristics into account, and shuts him out from the common sources of knowledge as found in the fellowships of everyday life. The daily variations of obstinacy and pliability depend in such persons upon the variations in the physiological conditions of the neuron systems concerned in the relationships of the motor areas, the sensory and intermediate areas, and the different ganglionar centers in which the instinctive and emotional reactions are coordinated.

    In dealing with patients who possess this peculiarity of mentality, it is necessary to manage them at first in accordance with that peculiarity. It is often necessary to take advantage of every whimsy in order to secure the obedience to hygienic procedures and the cooperation necessary in making the structural corrections which are essential to recovery. The aim should be to appeal to the logical faculties and the common sense of the patient whenever possible; but if he has no common sense and his logic is one-sided, if he has nothing perceptible but an accumulation of whimsies and habits, then those whimsies must serve as a basis for the development of new habits and a saner mentality. Again, it must be remembered that the development of the neurons concerned in any reaction makes that reaction the more liable to recur under similar conditions. If the patient can be induced to act as a reasonable and obedient being in a few simple matters, he may gradually be taught to care for his body and to cooperate with the physician in a comparatively sensible manner. As the rational physician works to secure better circulation, better structural relations of the different parts of the body, the conditions needful for the maintenance of proper nutritive conditions for every part of the body, as he explains these things in a manner suitable to the understanding of the patient, the educational factors are being met with the greatest wisdom. The very fact that the patient yields even the faint obedience of turning over upon the treating table is a foundation for the educational factor needed in these cases.

The Fetal Position

    The position which the body assumes under the effects of certain physiological and pathological conditions of the cortical neurons is of interest in this connection.
The tendency to assume the fetal position under stress of the depressing emotions is well known. This position is that which places the least tension upon the larger veins of the body, and thus it decreases the rapidity with which the blood reaches the right ventricle of the heart. The amount of blood flowing to the lungs is thus decreased, the rapidity of the heart’s action is lessened, and the arterial pressure is decreased. This is associated with the lack of the normal oxygenation of the blood and thus of the tissues, including those of the nervous system. It is not now evident whether any beneficent reaction can be associated with this series of events, which at first view appear to be rather malevolent, so far as the physiological effects are concerned. The effects produced in consciousness by these physiological occurrences are those associated with inefficient activities of the cortical neurons in general, namely, a feeling of weakness and inefficiency and the persistence of the images associated with depressing and unpleasant circumstances.

    The fetal position must be that associated with the most efficient growth, else it would have become lost in the process of phylogenetic development. The conditions associated with most efficient growth are those most suitable for the repair of injured or diseased tissues. It would seem probable that in some way this position is associated with repair, and that, while the series of events as they occur under depressing emotions seem to be rather malevolent than otherwise, it may be that the ultimate tendency is to the relief of the high tension, the rest of the neuron systems concerned, the elimination of the products of metabolism, and the ultimate recovery from the condition of excessive emotional depression.

    The fetal position is that which is employed among many of the prehistoric races in burial, as well as among many savages of this day. Some of the very earliest remains of the Paleolithic man show this position. The very earliest of the Egyptian remains show the same position. All over the world the evidence is fairly conclusive that the placing of the dead in the fetal position is constant. Among certain races this position is assumed in sickness, and especially when death is imminent.

    The position produces the sense of a lack of tension and of inefficiency. The lowering of blood pressure under the influence of the position is often considerable. Under certain abnormal conditions, as in apoplexy, and when for any reason the lowering of the arterial pressure is indicated, the position is often naturally and involuntarily assumed, and is beneficial. If it is not assumed involuntarily, the body may be placed in a similar position, in order that the arterial pressure may be lessened in that manner unless some other factors of the case interfere with the propriety of the assumption of such positions.

    In certain of the East Indian philosophies the attainment of wisdom and merit is facilitated by the assumption of almost the fetal position. The result of the lessened tension upon the larger veins causes lowered arterial blood pressure. Deficient oxygenation of the blood occurs as the result partly of the decreased amount of blood reaching the lungs and partly as a result of the impeded respiratory movements produced by that position. The lack of the efficiency of the intermediate and motor areas is noticed first, because of the higher development of the neurons of these areas. The ganglionar and lower centers thus remain in unimpeded activity. The consciousness associated with the relaxed muscles, the lowered blood pressure, the inactivity of the whole body in the lack of sufficient oxygen and the lowered blood pressure, together with the lack of activity of the motor and intermediate areas, is that of a dreamy, contented, unemotional, unvolitional, impersonal happiness, or Nirvana. The higher development and the lowered liminal value of the cortical neuron systems of the Occidental brain makes the attainment of this state among normal Americans or Europeans almost impossible.

Development of Strength

    The relationship between the contraction of the larger muscles and the associated activity of the larger pyramidal cells and the conscious phenomena of strength has been discussed. The constant use of the larger muscle groups is associated with the development of the larger pyramids, and with the increased activity of the neuron groups concerned in the feelings of strength and efficiency. Thus, it is evident the person who needs “bolstering up” should be compelled to employ those larger muscles constantly. The larger muscles are those of the shoulder and pelvic girdles and the extensors of the back. The examination of clinic patients of the weak and inefficient type, the “constitutional failure,” the person who knows himself inefficient, and the person who is inefficient but does not know it, all of these are found to show the physical conditions associated with the lack of the activities of these larger muscles. The muscles of the shoulder and pelvic girdles and the external back muscles are found flabby and without the normal tone. Many of these persons have the smaller muscles excessively contracted The emergencies of life and the instructions of others induce them to endeavor to “brace up,” and this results in the increased stimulation of the smaller muscles. The deeper layers of the back, the muscles of the face and the hands, fingers and feet show excessive contractions. The person is apt to suffer from the effects of the stiff spine thus produced, and the various visceral disturbances associated with the stiff spine do not increase his vigor or his sense of strength.

Use of the Extensors

    The extensors are, as a rule, larger than the flexors. The contractions of the extensor muscles are usually associated with a sense of well being and of energy, while the contraction of flexors is associated with the sense of diminished environment and of personal inadequacy. How much these conscious variations depend upon racial history and how much depends upon the physiological activities of the neurons directly we are not able to determine. The movements associated with the extension of the limbs do tend to increase the environment of the individual, and the flexion of the limbs does tend to decrease the environment. It may be that these reactions are merely the effect of racial history.

Education of the Week

    These factors may be employed in the education of children and of neurasthenic and hysterical patients. The use of exercises involving the extensor and abductor muscles may be taught in cases of children who are too self-centered and selfish, and cases of patients, especially the hysterical, who show too great egoism. Such patients and children should be taught to assume those positions associated with slightly increased extension, and especially those positions which are dependent upon the use of the larger muscles. The head well up, the legs strongly placed, the shoulders placed well, the fingers relaxed, the arms and feet slightly apart—in short, the attitude which is commonly recognized as giving the appearance of the broad-minded and generous person is the attitude which should be encouraged and taught to both children and adults who re inefficient, selfish, and of narrow mentality.

Bony Lesions in Etiology

    The bony lesion has its place in modifying personality through the factors just mentioned. The person with an atlas lesion, for example, may be unable to hold his head comfortably without turning or depressing the face, or holding it in some other abnormal position. The very fact that he is placed in the position assumed under the influence of shame or fear causes the neurons concerned in the coordination of those emotions to have the lower liminal value. The impulses associated with his daily life are interpreted as shame or fear in increasing degree. The fact that his face is held in that position causes the people with whom he is associated to attribute to him those qualities, and they are apt to treat him accordingly. If the lesion, or the torticollis, is sufficiently pronounced to cause a position which is apparently an abnormal one, then he himself and the people with whom he is associated recognize the fact that an abnormality of physique and not an expression of character are responsible for the condition, and his mental make-up is less seriously affected.

Adenoids and Personality

    The position assumed by the child suffering from adenoids is of a certain psychical importance. It is not altogether the deficient oxygenation of the blood and the deficient nutrition, the passage of the unwarmed and uncleansed air through the mouth to the lungs, which are responsible for the mental deficiency of these children. In part the position assumed by the mouth-breather, his hanging jaw and opened mouth, his loss of the normal tone of the temporal and masseter muscles, cause something of the same state of consciousness which is caused by actual inefficiency and the lack of decision. These factors are not alone in causing the abnormal mentality, but they are factors which must be considered.

    The positions assumed by the body are efficient in modifying consciousness. They are efficient in modifying the physiological activities, circulatory and nutritive. They are concerned in perpetuating the effects of disease, under certain conditions, and the substitution of normal positions of the body for those abnormal positions which are habitual may be one factor in helping sick people to recovery.

Functions of Motor Areas

    The essential function of these various activities of the primary sensory, overflow and intermediate areas is the control of the reactions which the body makes to its environment. The whole use of incoming sensory impulses, of the complex structure of neuronic activities which are associated with the complex and important phenomena of consciousness, of the coordinations concerned with what are commonly known as reason, science, judgment, art, and all the other complexities of mental life as we daily experience it, all have as their ultimate function the one thing, the modification of the activities, the control of the daily replies which we make to the environmental variations.

Value of Motor Impulses

    This pragmatic view of the cortical activities is the physiological view. Those nerve impulses which are not, and can not be, associated with efferent impulses are useless, and, in the effects which they may produce within the nervous system, may be harmful. The recognition of this fact has been unduly delayed among those who teach both the young and the old. It has a place in the determination of the methods to be employed in the care of those who are sick as well as in the training of the well.

Deeds a Criterion

    Moral, and ethical, and philosophical writings everywhere, among all races and all centuries, wherever civilization has attained a sufficient development for philosophy, and ethics, and morals to be considered, have been, and are being, filled with the importance of doing, the inefficiency of merely thinking or merely hearing, and the great value of deeds as the basis for real merit, real living, real service. It must be understood that the ultimate value of the activity of the entire nervous system lies in the fact of added efficiency of the motor reactions. The various philosophical and ethical systems have this truth in common, and it is sound physiological truth, as well as sound logic, and ethics, and religion.

    The recognition of this truth and its adoption in meeting daily emergencies simplifies the whole matter of living. It makes the line between the valuable and the useless in attainments and thought fairly clear, and it diminishes the necessity for any of those morbid introspection processes which sometimes interfere with the normal activities of hyper-conscientious people. All of the looking into one’s own emotional states, all of the analysis of feelings and weighing of motives, is seen to be useless and wasteful unless the motor reactions may be modified by such introspection.

    So long as unimpeded impulses produce wise and kindly motor reactions, with no consciousness of impending unwise and unkind motor reactions, there is no need to assume anything but a wise and kindly personality. The first condition is that by which we judge the personality of others; both are properly concerned in judgments of ourselves. An unfortunate egoism causes people of a neurasthenic type to consider only the second condition in judging themselves; they refer to their own consciousness for the proof of their own righteousness. Introspection is rarely of value. Consciousness is affected by the activity of the cortical neurons, and these are subject to variations in their physiological conditions, such as rest or fatigue, good blood or bad, lack of oxygen or plenty, normal pressure of the blood or excessively high or low pressure, and a number of other things. Evidently, the knowledge gained by introspection concerning the value of life must be poorly founded. The proof of the value of life comes from a recognition of the value of deeds; the proof of the righteousness of any person’s life is found in the value of his service to his fellow man. His service may be concrete and be felt directly; it may be found in his power to add to the value of the lives of others. Directly or indirectly, it is in deeds that the measure of personal worth must be found.

    Sensory impulses which reach the cortical centers usually affect the overflow and intermediate areas, and the efficient reply to this stimulus follows, either as an actual motion produced through the agency of the primary motor area, or as a variation in the cells of the motor overflow, by means of which the results of the series of nerve impulses affect future reactions. This activity of the cells of the motor overflow, by means of which future reactions are modified, is associated with the consciousness which is called “determination,” or the “making up of one’s mind.” The modification of the cells of the motor overflow is comparable physiologically to the modification of the cells of the sensory overflow, by means of which the phenomena of memory are produced in consciousness. The determination process is a sort of inverted memory, if the expression may be permitted. By means of this physiological action the occurrences merely imagined may affect future reactions in very much the same manner as if the actual circumstances had occurred.
Educational Principles
    In educating children, appeals are often made to the emotions and to the faculties of idealization. These appeals are dangerous when they are associated with no possibility of reaction.

    In early childhood each sensory impulse should be permitted to be associated with some motor reaction. No sensory impulses should be associated with actual repression. Even painful sensation should initiate cries in the small child, as it does, as a matter of course. Too early attempts to educate the child to refrain from crying because of pain are unwise. As soon as it is possible to substitute some other reaction for crying, this may be done with beneficial educational effects. But some motor reaction ought to be permitted, during early childhood, for every sensory impulse which reaches the sensorium. The place of education at this stage of development is in establishing the habit of making a wise reaction, rather than a foolish one. If the child stumbles over a stone and hurts himself, it is not wise to cry or to try to punish the stone, as is the teaching of some mothers; but the wise reaction should be to attempt either the removal of the stone or the turning of the path, or some other action by means of which the probability of repeating the stumble may be avoided, both for himself and for others. Even very young children may be taught to make replies to even painful stimuli in some such manner as this, and the neuron systems concerned in making these altruistic reactions become developed in a way which makes the wise and kindly action habitual probably throughout life.

Development of Self-control

    What is true of the sensory impulses is true of the more complex reactions associated with the emotional and instinctive states. When circumstances cause the reactions characteristic of fear, anger, etc., these reactions ought always be modified, to a certain extent, but never, in children, to be absolutely repressed. The reactions may be temporarily inhibited, and thus the impulses initiated by the activities of the cortical neuron systems may be permitted to modify the reaction, but any attempt at absolute repression is apt to be injurious. Anger may be thus inhibited, the impulses concerned in memories of previous kindnesses on the part of the offending person, of previous pleasures associated with the toy which fails to lend itself to the wishes of the child, or other memories or coordinations may be associated with the activities of the emotional neuron systems, and the ultimate reaction may thus be an expression of kindness or of help, rather than of anger. In fear, the temporary postponements of the reaction may be associated in like manner with various memories, coordinations, or teachings, and the reaction may become indicative of curiosity and interest rather than of unintelligent terror. In those uncontrollable terrors to which neurotic children are sometimes subject, no attempt at education should be made until the nervous system of the child has been brought to a more normal condition through the use of proper hygienic measures and the correction of whatever structural abnormalities may be present. The same thing is true of those furious fits of anger to which some children are subject. The best educational treatment for such children is simply to avoid all irritating circumstances until the nervous system becomes normal and the reflexes become less excessive. Then mild educational methods may be used, with careful avoidance of whatever is known to cause the storms, either of fright or anger, or of any other uncontrollable emotion.

Educational Use of the Motor Overflow

    Teachers in school often endeavor to inculcate high ideals by appeals to the child’s sense of what is true and beautiful, even beyond the child’s capacity of appreciating these things. Such appeals, when they are made in a way which permits either the immediate performance of an appropriate reaction, or when an imagined reaction may be clearly brought into consciousness, by means of the activities of the motor overflow areas, may serve an excellent purpose in modifying the future reactions of the child during life. But such appeals, when not associated with the activities either of the primary motor area or its overflow, or are not expressed vividly in language, are dangerous as a source of abnormal inhibitions later in life.

    Perhaps the average Sunday-school teacher is at fault as often as any one, so far as this matter is concerned. Most Sunday-school teachers seek to teach the children high ideals of life, and they do this by constantly appealing to what are usually called the higher emotions. Ideals of fine living, of self-sacrifice, of great and kindly helpfulness, are placed before the children in an abstract manner, which is not possibly associated with any motor impulses, either directly or indirectly. To lead children, or older people either, for that matter, to higher levels of living, it is necessary that they be induced to actually do or say, or determine to do or say, some real thing. Cortical activities associated with motor reactions are efficient for good if they are wisely determined, for ill if unwisely, but always efficient in the modification of character.

    People who are grown may employ these methods in their own education. It must be remembered that feelings and aspirations which are not interpreted into action, either actual or determined, or into language, which is a form of action, have no real value as educational factors.

Therapeutic Considerations

    In dealing with the sick, use may be made of the same methods. The appeals to the “better” sense, to the higher ideals of usefulness, to the desire for increased strength and ease, are of little value unless they are associated with some concrete action or determination. Through the eye, or the ear, or the sense of touch, or the sensations associated with increasing strength, impulses may be sent into the motor areas, which cause increased activity of the primary motor area, and the consciousness of increasing strength is given, or the impulses may initiate increased activity of the cells of the motor overflow areas, and the consciousness of determination, of choice, of impending strength and recovery is compelled.

    The patient’s consciousness is of “making up his mind to get well,” but it is the activity of the neuron systems concerned in the motor overflow areas, and especially of the larger pyramidal cells of the primary motor area, which cause this consciousness. The variations in the activity of these cortical neuron systems are as completely subject to the control of an efficient physician as are the various centers of the spinal cord. The stimulation of the motor overflow area, or the primary motor area, is as easily done, if one really tries, as is the stimulation of the heart center, or the increase of the peristaltic movements.

    Fig. 13. Diagram of the sensori-motor areas.
        1. Primary motor areas.—1, hip; 2, trunk; 3, shoulder; 4, arm; 5, wrist; 6, fingers; 7, face, 8, lips; 9, larynx.
        2. Primary areas for common sensations. Numbers as in 1.
        3. Motor overflow areas.
        4. Overflow areas for the common sensations.