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Disorders Of Memory

Many patients suffering from various nervous symptoms insist that they
are losing their memory or that it is becoming notably deficient in
some ways. If they are a little on in years they are sure that their
memory is not as good as it used to be and that they now forget many
things that were formerly remembered without difficulty. Especially
are they likely to assert that the names of people and certain words
will not come to them when they want them, that they often have to
seek for facts and dates that should be quite familiar, that they fail
to remember acquaintances and the like. These symptoms of which they
complain are often sources of considerable worry and serve to
emphasize in them the idea that there is something serious the matter
with their general health, or some pathological condition developing
in their brain. They have heard much of loss of memory as a sign of
degenerative nervous diseases and they are prone to think that their
own special loss of memory, be it real or imaginary, must be a
forerunner, or perhaps even an early symptom, of some important
organic lesion.

This idea of progressive memory disturbance as a preliminary of
nervous breakdown often becomes so firmly fixed as to be of itself a
profound source of anxiety to patients, and an almost unspeakable
dread. So it is important to make them understand what the real nature
of their condition is and what their loss of memory, supposed or real,
is due to. As a matter of fact, what many of these patients need is
not treatment for a diseased memory, but reassurance from what we know
about the psychology of memory, that their troubles are only quite
natural incidents in the life history of their particular memory
faculty. Many a man who is worrying about his supposed loss of memory
or, at least, impairment of it in some way, is not suffering from a
true pathological condition, but is usually the victim only of some
functional disturbance of the nervous system with the neurotic anxiety
and heightened introspection that accompanies such a condition.

Reasons for Memory Difficulties.--Nervous patients particularly
complain that they do not remember what they wish to as easily as they
used to a few years before. They say that it is much more difficult
for them to impress things upon their memories and, in addition, that
it is much easier for them to forget. There are three quite natural
reasons for these phenomena as far as they actually exist, which
should be pointed out to these patients. The first and most important
is that they are incapable of that concentration of mind which they
had in earlier years and which enabled them to give themselves up so
completely to the consideration of a particular subject that it could
not help but be impressed on their minds. They are now so much
occupied with many other things, and, above all, most of these
patients are so preoccupied with themselves that they cannot hope to
have the concentration of mind that was comparatively easy when they
were younger and is now impaired, but which is so necessary for the
enduring remembrance of things. Secondly, their over-anxiety to
remember things sometimes acts as an inhibitory motive in securing
that deep, impression that will enable them to remember details very
well. Thirdly, their supposed impairment of memory is due to a false
judgment with regard to themselves. They are not comparing their power
of memory now with what they used to have, but owing to anxiety about
themselves they have taken to comparing themselves with others and,
after all, the faculty of memory acts very differently for different
people and it is well known that what one man remembers with ease
another recalls with difficulty, or only because of special attention.

Attention and Memory.--The first of these causes for supposed
impairment deserves to be discussed further. It is often said that as
we grow older our memory is not so retentive as it used to be, and
that while we remember the events of boyhood and the things we learned
in the early years of school life, our recollection of recent events
and things learned in later years is much less vivid. This is all very
true, but the reason usually given, that in the meantime our memories
have failed in power is inconclusive. What we learned in early
childhood came to us with the surprise of novelty and for this reason
we paid close attention, it was new and impressed us with its
importance, it was dwelt upon for long periods and often, because
there was little else to think about, has been frequently recalled
since and, of course, is indelibly impressed upon our memories. The
same thing is true with regard to early acquaintances. We got to know
them so well that, of course, we cannot forget them. What we have
learned in later life, however, has come in the midst of many other
things, has not been dwelt on very long, has not been often recalled
and, of course, occupies much less place in the memory than the things
of earlier life. That is not, however, because of any defect in
memory, but because of lack of attention and repetition that means so
much for memory.

Age and Memory.--It is often said that people do not learn so
readily when they get older. This is, of course, a truth of common
experience, but it is not because of dullness of the faculty of
memory, but failure to concentrate the attention sufficiently for
memorizing. I have known old men who could learn things just as well
as any young man and indeed better than most of them. They were men
who had been accustomed all their lives to concentrate attention on
the subject they had in hand and who did not allow the cares and
worries of life to intrude on their studies. Cato learning Greek at
eighty is often quoted as an exceptional example, but I have had some
dear old friends who could learn things quite as readily as younger
men and whose minds were just as bright and clear. Whenever they
devoted as much attention to anything that they wanted to remember as
they did when they were younger men, I am sure that they remembered
quite as well. It is a question of attention and not of any loss of
faculty that makes the difference between the memory of the young and
the old until, of course, senile impairment actually comes.

Solicitude and Memory.--Everyone who has had to depend much on his
memory knows that over-anxiety with regard to the recollection of
anything may seriously inhibit the power to recall it. Public speakers
know that to hesitate is to be lost. If they want a particular name or
word which they know often escapes them, they must with confidence
begin the sentence in which it is to occur, though perhaps wondering
all the time whether the word will be on hand or not for them to use
it. Occasionally it will not come, but as a rule it turns up just in
time. If they allow themselves to be disturbed by the thought that the
word or expression may not come, then they know the hopeless vacant
blank that stares them in the face when they want it. They have to
make a circumlocution in the hope that it may turn up. Some let it go
at that, but many start another sentence in the hope to tempt it to
come and often it will eventually come, but sometimes it persistently
refuses to come. That is not a loss of memory but a failure of neuron
connections. There are some of us who know that certain words will
always do that with us. Archimedes has bothered me for years and his
name will often not come when I want it. Then there are certain words
with regard to which transposition is likely to take place. We
involuntarily and unconsciously substitute one word for another. We
call one man by another's name. We have done it before and we know
that we are likely to do it again. Somehow the connections in memory
exist along these wrong lines and are constantly mismade. The name of
something a man has written comes up instead of his name. This
heterophemia is often noted in men of excellent memory.

Peculiarities of Memory.--Memory is an illusive and elusive function
at best. All of us have had the sensation of having a word, and
particularly a name, on the tip of our tongues. We often know the
first letter and sometimes the first syllable of it. What memory
brings to us, however, may not always be the first syllable of a word
or name, though we are prone to think it must be, and we may go
looking for it in the dictionary of names only to discover after a
time that we are many letters away from its beginning. Very often we
have to give up seeking in sheer inability to get a hint of it and
then of itself it will come a little later. Sometimes it will come
when we no longer want it. As a rule, words that have escaped us once
in this way are prone to do so again. Over and over again the
experience will be that a particular word or group of words
escapes our memory, or at least fails to be at our command, as most
other things are. Those of us who are not much given to introspection
take no notice of these difficulties which are common-place
experiences enough, but the man or the woman who is looking for
symptoms, who is prone to believe for some reason or other that his or
her memory is failing, will take these hints of the more or less
natural fallacy of memory as confirmations, strong as direct proof of
the fact that memory is seriously deteriorating.

Such pauses and lapses of memory are much more likely to occur if we
are nervous and over-anxious about possible loss of memory. I was once
asked to attend for a few hours before the time fixed for his oration
one of the greatest orators of this country, who was about to talk at
a university commencement. What surprised me was that this practiced
speaker, who had often appeared before very large audiences, took a
very light meal in considerable trepidation, immediately after asked
to have certain books brought to him and certain facts looked up for
him, took notes in a hurried, feverish way and generally displayed all
the over-excitement of the schoolboy about to make his first oration.
He was a magnificent occasional speaker, often called upon, yet he
assured me that it was always thus with him and that the reason for it
was that in spite of previous preparation--and the finish of his
orations made it clear that he had devoted much thought to them
beforehand--certain of his facts and names and dates had the habit of
slipping from him in the midst of the development of his theme, unless
he had refreshed his memory with regard to them immediately before,
and that he feared that sometime he would find himself in the midst of
an address with an absolute blank before him and that he would be
compelled to sit down in disgrace. He had never done so and never did
in the many years that he, lived afterwards, though always with this
dread, never trusting his memory as most people do.

Name Memory.--There are certain circumstances in which memory may
fail and yet no significance of a pathological nature can be
attributed to the fact. All of us probably have had the disturbing
experience of undertaking to introduce two friends whom we had known
for many years and yet having to ask at least one of them for his name
before we could make the introduction. It is not that we did not know
the name, but at the moment we were utterly unable to recall it. After
this has happened once or twice it is prone to happen again, because
when we set about introducing people the thought of the previous
unfortunate occurrences of this kind comes to our mind and acts as an
inhibition of memory, making it impossible for us to recall names. Not
infrequently if we are brought to the pass of having to ask one of the
parties for his name we have to ask the other, though it was on the
tip of our tongue a moment before, because in the meantime the
disturbance of mind incident to having to ask has interfered with the
train of recollection. Men have been known to forget their own names
under circumstances of great excitement and such a forgetting is not
pathological, but only a physiological disturbance of function because
of secondary trains of association set to work in the brain which
disturb ordinary recollection. Of course, some people have an
excellent memory for names and never have such experiences, but they
are very rare, though practice in recalling names does much to keep
people from such embarrassing situations. On the other hand,
there are some people especially gifted with name memories. Napoleon
could recall all his soldiers' names.

Fatigue and Memory.--Occasionally it happens quite normally that when
we are very tired certain portions of our memory at least become vague
and indefinite and may even fail to respond to any excitation on our
part. Under these circumstances we seem to be able only with
considerable effort to exert the effort necessary to bring about such
connections of brain cells as will facilitate recollection and
reproduction and we may fail entirely. In a foreign country it is, as
a rule, much more easy to talk the language in the morning when we are
fresh than in the evening when we are tired. Especially is this true
if we are asked to pass from one foreign language to another, which
always requires a special effort. Everyone who has traveled must have
had the experience that on crossing the frontier suddenly to be
addressed in German after he has been talking French for weeks, may
quite nonplus the traveler, even though he knows German as well or
even better than French. This is especially true if much depends on
the answers, if he has been addressed by a railway official or customs
inspector. Apparently there must be a momentary wait until some
shifting operation takes place in the brain before the German memory
can get to work to establish the connections necessary to enable him
to talk German. After a man has been talking to a number of people in
one foreign tongue he is likely to be quite lost for words for a
moment if he has to use another. The effects of fatigue and excitement
and unusualness upon memory then must be remembered in order to be
able to reassure patients who pervert the significance of the

Ribot gives an excellent personal illustration of this peculiarity of
memory in his "Diseases of Memory," which is worth recalling here. He

I descended on the same day two very deep mines In the Hartz
Mountains, remaining some hours underground in each. While in the
second mine, and exhausted both from fatigue and inanition, I felt
the utter impossibility of talking longer with the German inspector
who accompanied me. Every German word and phrase deserted my
recollection; and it was not until I had taken food and wine, and
been some time at rest, that I regained them again.

Sensations and Memory.--Just as soon as people compare their memories
with others, as they do when they worry and begin to grow
introspectively self-conscious, they find noteworthy differences and
because of differences they will be prone to think that their memory
is pathologically defective when it is only different, or, still more,
that because they are not able to remember some things, as others do,
their memory must be failing. It is well known that some people have a
good memory for things seen, others for things heard, and still others
only for things in which they have taken actual part. These are spoken
of as visual, auditory and action memories. Memories for things seen
are divided into special classes. Some people remember forms very
well, while others remember colors. It is evident that our memories
are somehow dependent on the special mode in which sensation affects
us and that our acutest sensations are the sources of our longest and
best memories. Color vision defectives are not affected much by colors
and easily forget them. The tone-deaf have no memory for tunes. Every
sense defect affects the memory. Sense defects are often unconscious.
Their effect on memory may only be noted when introspection
begins to bring out the special sensation and memory qualities of the
individual. Nature, not disease, may be the basis of some memory
troubles thus brought to recognition. All these curious phenomena with
regard to memory need to be recalled whenever there is question of a
supposed deterioration of it, for it is not easy to decide such a

Limits of Normal Forgetfulness.--Curious instances of forgetfulness
may occur in the experience of men with excellent memories, which,
when they happen to persons morbidly inclined to test their every act,
are interpreted to signify something much more serious than they
really mean. Nearly everyone has had more than once the experience of
telling a story to a particular group of people and then forgetting
all about having told it and coming back a few days later to tell it
over again. Occasionally a teacher hears the same lesson a week apart
and yet does not remember that he went over it before, though the
class is almost sure to do so. A man may repeat a lecture that he has
given before to the same audience without realizing it. The story has
been told more than once of a clergyman delivering the same sermon on
two Sundays in succession and, though such lapses are very rare, they
do not necessarily indicate a failing memory, but may only mean a lack
of concentration of attention on the part of the human mind. Prof.
Ribot in his "Diseases of Memory" tells the story of one such case in
which the subject was quite alarmed lest it should indicate that he
was beginning to suffer from some serious memory disturbance due to
brain disease, though there was no ground for his fears:

A dissenting minister, apparently in good health, went through the
entire pulpit service one Sunday morning with perfect
consistency--his choice of hymns and lessons and extempore prayer
being all related to the subject of the sermon. On the Sunday
following he went through the service in precisely the same manner,
selecting the same hymns and lessons, offering the same prayer,
giving out the same text, and preaching the same sermon. On
descending from the pulpit he had not the slightest remembrance of
having gone through precisely the same service on the preceding
Sunday. He was much alarmed and feared an attack of brain disease,
but nothing of the kind supervened.

Attention not Memory.--When patients come with complaints of the loss
of memory, the most important thing is to analyze their symptoms
carefully. This will usually enable us to give patients ample
reassurance. I have known men who were convinced that they were losing
their memories because of their failure to recall important details in
their business affairs in the midst of much hurry and bustle in the
winter time, find that when they were living a simpler life in the
course of travel or life in the country during the summer time under
conditions different from the ordinary, their memory could be
absolutely depended on for trains and travel details and all important
matters to which they were now devoting attention.

Cultivating Looseness of Memory.--Many people complain of loss of
memory in the sense that they do not now remember when things took
place as well as they used to. For instance, I have had men of fifty
tell me that they were sure that their memories were growing weaker
than they used to be because a number of times within a year they had
found that events which they thought had taken place only a year or
two ago really dated four or five or even more years in the
past. Some are considerably disturbed by this. As a matter of fact it
is only another instance of lack of attention. Most of what we read in
newspapers attracts so little of our serious attention that it is no
wonder that we do not recall with exactness when events took place.
Events crowd each other out of memory. Newspaper reading is, indeed,
the best possible cultivation of looseness of memory that we could
have. We do not expect to remember what we read. We would probably
grow distracted if we did. At the end of the day if you ask a man what
he read in the morning paper he will have no idea at all, unless
something especially startling or particularly interesting to him has
turned up. After a week we could no more separate Monday's from
Tuesday's news of the week before than we could recall a random list
of events, having heard it but once. We cultivate looseness of memory
with great assiduity. Let us not be surprised if, to some extent, we

Memories Individual.--People are often much worried over children's
memories and may communicate this worry and anxiety to the children
themselves, making them solicitous. It is probable that our memories
are like our stature. They are what they are. By thinking we cannot
add a cubit to the one nor facility to the other. The training of the
memory is a very small element compared to the natural faculty. It
must not be forgotten, however, that many distinguished men have been
noted for rather bad memories when they were young and yet these
faculties have developed quite enough to enable them to accomplish
good work afterwards. The memory is, after all, a comparatively
unimportant faculty in itself and other intellectual faculties surpass
it in significance. It is the faculty that first develops, however,
and so a child is often thought to be intellectually slow when it has
not so bright a memory as its companions, though a little later its
other faculties may develop so as to put it on a plane above its
fellows. Memories, too, are very individual and may not retain any of
the ordinary subjects, while they may be very attentive for certain
special lines of thought. This form of the faculty is better, for the
encyclopedic memory is usually of little use and, except in high
degrees, encourages superficiality rather than real knowledge.

As a matter of fact, few of our greatest thinkers have had what would
be called brilliant memories and it would almost seem as though the
diversion of mental energy to this faculty rather disturbed the
development of the others. Many a distinguished man has been rather
notorious as a child for bad memory, so that in the early days when
memory was the only faculty called upon at school he was set down as a
dunce. Perhaps the most striking example of this was Sir Isaac Newton,
who was actually called a dunce, and yet the world would welcome a few
other such dunces. Thomas of Aquin, the great medieval writer on
philosophy and theology, who still influences philosophy so much, was
so slow as a young man that he was called by his fellow pupils "the
dumb ox." His great teacher, Albertus Magnus, recognized the depth of
mind that his fellow students could not see and declared that the
bellowings of that "ox" would be heard throughout the world. Sir
Walter Scott was spoken of as a very backward child. This is all the
more surprising to those who know and appreciate the wealth of
information that he put into his Waverley Novels. Goldsmith, than whom
we have no more brilliant writer in English, seemed not only a dunce
as a child, but all his life, so far as outward appearance went,
was a numbsknll. This was due to a lack of readiness rather than any
lack of wit.

Tricks of Memory.--Some tricks of memory may be very disturbing to
those who are over-occupied with themselves and with the possibility
of losing their memory. For their consolation it is well for the
physician who hears their complaints to have at hand some stories that
illustrate certain of these curious tricks of memory. I had been
trying to persuade a literary woman for some time that it was not her
memory that was playing her false, but merely her habit of attention
and lack of concentration of mind on things because she is occupied
with a great many interests, when one day she came to me with what she
thought was absolutely convincing proof that her memory was going. She
had read a passage in a newspaper the day before which she liked very
much, but after reflection it sounded strangely like some of the
things that she had thought along these lines herself. It was a
quotation, but there was no indication to tell whence it came. A
little inquiry, however, showed that the quotation was from an article
of her own written only two years before. Here was definite proof of a
failure of memory. Strange as it may seem, however, this experience is
quite common. I feel sure that there is not a single writer for
periodical literature who has not had similar experiences. Anyone who
writes much editorially, where the articles are unsigned, finds it
rather difficult two or three years later, as a rule, to be absolutely
sure which editorials are his. Occasionally it happens that even by
the time the proof comes back for monthly periodicals, say six weeks
or two months, some at least of what was written may seem quite
unfamiliar. This will be particularly true if phases of the same
subjects have been treated in successive articles and thus repetitions
are caused.

There is plenty of good warrant for such occurrences in the lives of
distinguished writers. Scott once heard a song in a drawing-room that
he did not care for very much and he said rather contemptuously, "Oh!
that's some of Byron's stuff." His attention was called to the fact
that he was the author of the stuff himself. Carlyle confessed to
Froude when Froude went over some of the passages of Carlyle's own
autobiography with him, that he had quite forgotten some of the things
written down there. Manzoni, the distinguished Italian writer, whose
"I Promessi Sposi" has probably been more read throughout Europe than
any novel written during the nineteenth century, except possibly some
of Scott's, tells some stories of his own lapses of memory and, above
all, of having once quoted a sentence of his own to confirm something
that he was saying, though he confessed that he did not know by whom
the quotation had been written.

Memory and Low Grade Intelligence.--There are many people who complain
of their memory and of their inability to recall many things which
others recall without difficulty. They are prone to think that this is
some defect in them and not infrequently, as a consequence of
comparisons, they persuade themselves that their memory was better and
that it has lost some of its qualities. Until they became familiar
with some of the feats of memory possible of performance by others,
they were quite satisfied, but now they find in every instance of
forgetting a new symptom of an increasingly deficient memory. I have
found in these cases, that setting before such people some of the
curiosities of memory, and especially the fact that memory is by no
means necessarily connected with profound intelligence, so that,
indeed, its presence is quite compatible with a low grade of
intelligence or even with what is practically idiocy, will do much to
rob these gloomy forebodings of their terrors with regard to their own
supposed deterioration of intellect. Ribot, in his "Diseases of
Memory" [Footnote 52] has an excellent passage in which he sums up a
number of these peculiarities of memory that are likely to be
especially consolatory to people of ordinary memory who are worrying
about themselves.

[Footnote 52: International Scientific Series,
D. Appleton & Co., New York.]

It has long been observed that in many idiots and imbeciles the
senses are very unequally developed; thus, the hearing may be of
extreme delicacy and precision, while the other senses are blunted.
The arrest of development is not uniform in all respects. It is not
surprising, then, that general weakness of memory should co-exist in
the same subject with evolution and even hypertrophy of a particular
memory. Thus certain idiots, insensible to all other impressions,
have an extraordinary taste for music, and are able to retain an air
which they have once heard. In rare instances there is a memory for
forms and colors, and an aptitude for drawing. Cases of memory of
figures, dates, proper names, and words in general, are more common.
An idiot "could remember the day when every person in the parish had
been buried for thirty-five years, and could repeat with unvarying
accuracy the name and age of the deceased, and the mourners at the
funeral. Out of the line of burials he had not one idea, could not
give an intelligible reply to a single question, nor be trusted even
to feed himself." Certain idiots, unable to make the most elementary
arithmetical calculations, repeat the whole of the multiplication
table without an error. Others recite, word for word, passages that
have been read to them, and cannot learn the letters of the
alphabet. Drobisch reports the following case of which he was an
observer: A boy of fourteen, almost an idiot, experienced great
trouble in learning to read. He had, nevertheless, a marvelous
facility for remembering the order in which words and letters
succeeded one another. When allowed two or three minutes in which to
glance over the page of a book printed in a language which he did
not know, or treating of subjects of which he was ignorant, he
could, in the brief time mentioned, repeat every word from memory
exactly as if the book remained open before him. The existence of
this partial memory is so common that it has been utilized in the
education of idiots and imbeciles. It is worth noting that idiots
attacked by mania or some other acute disease frequently display a
temporary memory. Thus, an idiot in a fit of anger told of a
complicated incident of which he had been a witness long before, and
which at the time seemed to have made no impression upon him.

Training Memory.--In recent years in many departments of therapeutics
training has been found to be of value. This is especially true with
regard to nervous defects. Probably one of the greatest surprises that
nervous specialists have had in the last twenty-five years in the
domain of therapeutics came from the introduction of Frenkel's methods
of retraining the muscles in locomotor ataxia. This idea of retraining
has been found useful in such distinct departments as the use of the
eye muscles, the co-ordination of the muscles of speech, so as to get
rid of stuttering and stammering, and the muscles of the hand for
writing. We are only just beginning to realize that retraining can be
of great value in psychic affections also. Patients may be disciplined
against their dreads and tremulousness due to over-apprehension and
against even certain defective uses of their intellect. Urbantschitsch
of Vienna showed that by training defective hearing it might in many
cases be very much improved. What he accomplished, however, was not
any better use of the external auditory apparatus, but a more
intense attention of mind which enabled the patient to catch and
understand sounds which had hitherto been so vague that their
significance was lost.

In a number of cases of complaint of loss of memory I have
deliberately set patients to retrain their memories and have at least
relieved their apprehensions if I have not always succeeded in
increasing their actual memory power. It has even seemed, however,
that in old people some actual improvement of the memory faculties was
thus brought about. Under the head of Occupation of Mind I have
referred to the exercise of memory in younger people as representing
an excellent form of mental diversion. When the idea first suggested
itself it seemed as though patients would not take to it at all, and
yet I have found that with a little persuasion they become much
interested and find a great deal of pleasure in their gradually
increasing power to recall the great thoughts of great authors in the
literal original words. A reference to that chapter will tell more of
my experience. This made me more confident of the possibilities there
were of making people understand that if they were losing their
memories they could bring them back by proper exercise. In this way
many of the modern evils of lack of attention and of failure of
concentration of mind can be corrected.

My rule now is to tell patients who come complaining of loss of memory
that if there is any real loss of memory it is due to their improper
use of the faculty, or perhaps to their failure to exercise it
sufficiently, for the proper performance of function depends on
adequate exercise. They are then instructed to take certain simple
classical bits of literature and commit them to memory. At the
beginning such short poems with frequently repeated rhymes of the
modern poets as are comparatively easy to learn are set as memory
exercises. Later Goldsmith's "Traveler" and "Deserted Village" are
suggested. Then passages from Shakeaspeare are given. Just as soon as
the patient finds that he can commit to memory as he used to, if he
only gives himself to the task, a change comes over his ideas with
regard to the loss of memory. For many of these people the occupation
of mind is an excellent therapeutic measure. Besides selections can be
made in such a way as to keep before their minds the thoughts they
most need in the shape of memory lessons. It is a discipline of memory
that revives it and also a constant exercise in favorable suggestion.

Gregor in the Monattschrift fuer Psychiatrie und Neurologie, Band
XXI, has detailed some of his experiences with the retraining of the
memory of patients suffering from Korsakoff's Psychosis--alcoholic
neuritis with psychic disturbances, especially of memory. The patient
was required to learn words and then after a certain length of time
was tested to see if he could learn a similar series with fewer
repetitions than at first. The memory increased in capacity with the
exercises and there was evidently a definite gain in the faculty. In
this disease patients have also lost the power to some degree at least
of recognizing objects. After exercises in recognition they are much
more capable in this matter, however, and it is evident that in every
way the memory can be improved. This experience, with a serious form
of disease that gravely impairs the memory, shows how much can be
accomplished in circumstances far more unfavorable than are those
which usually bring patients to the physician complaining of
deficiencies of memory.

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