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One should note that Meige and Feindel were, in a way, on the threshold of this theory when they said that tic, like the other psychoneuroses, is due to some congenital anomaly, an arrest or defect in the development of cortical or subcortical association paths unrecognized teratological malformations.
There may be no normal fatigue, there may be no fatigue sensation, there may be no rest feeling on account of perceptions, or on account of associations, or on account of impulses to action; there may be no normal response in the subcortical center, there may be no physical effect in the cortex on account of an existing hyperæmia or on account of an abnormal condition of the cells.
The fatigue sensation, the subcortical sleep center, the contraction of the vessels in the cortex, and finally the rest sensation form together the complete circle. The difficulty which arises in this case lies only in the fact that the cortex gone to sleep annihilates also, of course, the fatigue sensation and the rest sensation.
All impairment of speech is called Aphasia, and it is called Motor Aphasia when the apparatus is damaged on the side of movement. If the fibres coming out from the speech zone be impaired, so that the impulses can not go to the muscles of articulation and breathing, we have Subcortical Motor Aphasia.
To understand sleep, we have to recognize it as one of the fundamental instincts, comparable with the instinct for food or for sexual satisfaction. Every one of such instincts has a circular character. Mental processes, subcortical processes, and physical effects are involved in such a way that each reënforces the others.
This protective physical activity is now evidently itself controlled by a subcortical center, just as secretion and sexual hyperæmia are controlled. This center probably lies in the medulla oblongata. Some theorists, to be sure, are inclined to think that the fatigued brain cells enter directly through their exhaustion into the protective sleep state. But that simplifies the situation too much.
When I awoke her from her drowsy state, she was quite exhausted from the excitement. I repeated that scene with her four times. She assured me that she felt it every time more dramatically. The power of the obsession weakened from the first day. After the fourth time, it had disappeared. The subcortical complex had evidently found its normal channels of discharge.
With this there goes another fact which characterizes this form of aphasia, and which is called Cortical, as opposed to the Subcortical Motor Aphasia described above, that the person may not be able even to think of the words which are appropriate to express his meaning.
And again only the higher layer of the neurons in the population sees its doings recorded in the annals of history; and yet whatever those leaders of action and thought and emotion may achieve is dependent upon and working on the actions of those millions of subcortical population neurons. The historical record has its unity through the interrelation of all parts of historical mankind.
From such simple adjustment of reactions of the spinal cord, we come step by step to the more complex activities of the subcortical brain centers, and finally to those which are evidently only short-cuts of the higher brain processes.
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