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A matter of summation. There is an interval of hours or days between the instigation and the outbreak of the symptoms. One has a sort of feeling that an obstacle is being overcome and that a process then goes forward.
A matter of summation. Even without an instigation one has an impression that there must be an accumulating stimulus which is present in the smallest quantity at the beginning of the interval and in the largest quantity towards its end.
A matter of summation, in which susceptibility to aetiological factors lies in the height of the level of the stimulus already present.
[This MS. is undated. It does not form part of the rest of the collection of ‘Fliess Papers’, but was in the possession of Dr. Robert Fliess in New York. It appears to be a document, apparently referred to as having been recently written, in a portion, not published here, of Letter 22 above. This is dated March 4, 1895.—Both Freud and Fliess were sufferers from migraine. (See Jones, 1953, 339, and The Psycho-pathology of Everyday Life (1901b), Standard Ed., 6, 21.]
A matter with a complicated aetiology. Perhaps on the pattern of a chain-aetiology, where a proximate cause can be produced by a number of factors1 directly and indirectly, or on the pattern of a summation-aetiology, where, alongside of a specific cause, stock causes can act as quantitative substitutes.2
A matter on the model of menstrual migraine and belonging to the sexual group. Evidence:
Rarest in healthy males.
Restricted to the sexual time of life: childhood and old age almost excluded.
If it is produced by summation, sexual stimulus too is something produced by summation.