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A¡¡remarkable¡¡study¡¡of¡¡the¡¡modification¡¡of¡¡laughter¡¡and¡¡crying¡¡by¡¡disease¡¡is¡¡found¡¡in¡¡that¡¡most¡¡interesting¡¡of¡¡diseasesexophthalmic¡¡goiter¡£¡¡In¡¡this¡¡disease¡¡there¡¡is¡¡a¡¡low¡¡threshold¡¡to¡¡all¡¡stimuli¡£¡¡That¡¡the¡¡very¡¡motor¡¡mechanism¡¡of¡¡which¡¡we¡¡have¡¡been¡¡speaking¡¡is¡¡involved£»¡¡is¡¡shown¡¡by¡¡an¡¡enormous¡¡increase¡¡in¡¡its¡¡activity¡£¡¡There¡¡is¡¡also¡¡an¡¡increase¡¡in¡¡the¡¡size¡¡of¡¡certain¡¡at¡¡least¡¡of¡¡the¡¡activating¡¡glandsthe¡¡thyroid¡¡and¡¡the¡¡adrenals¡¡are¡¡enlarged¡¡and¡¡overactive¡¡and¡¡the¡¡glycogen¡­producing¡¡function¡¡of¡¡the¡¡liver¡¡is¡¡stimulated¡£¡¡The¡¡most¡¡striking¡¡phenomenon¡¡of¡¡this¡¡disease£»¡¡however£»¡¡is¡¡the¡¡remarkable¡¡lowering¡¡of¡¡the¡¡brain¡¡thresholds¡¡to¡¡stimuli¡£¡¡¡¡In¡¡other¡¡words£»¡¡in¡¡Graves'¡¡disease¡¡the¡¡nervous¡¡system¡¡and¡¡the¡¡activating¡¡glands¡¡the¡¡entire¡¡motor¡¡mechanismare¡¡in¡¡an¡¡exalted¡¡state¡¡of¡¡activity¡£

If¡¡this¡¡be¡¡true£»¡¡then¡¡these¡¡patients¡¡should¡¡exhibit¡¡behavior¡¡precisely¡¡contrary¡¡to¡¡that¡¡of¡¡those¡¡suffering¡¡from¡¡acute¡¡infection£»¡¡that¡¡is£»¡¡they¡¡should¡¡be¡¡constantly¡¡clearing¡¡their¡¡systems¡¡of¡¡these¡¡superabundant¡¡energizing¡¡materials¡¡by¡¡crying¡¡or¡¡laughing£»¡¡and¡¡this¡¡is¡¡precisely¡¡what¡¡happensthe¡¡flood¡­gates¡¡of¡¡tears¡¡are¡¡open¡¡much¡¡of¡¡the¡¡time¡¡in¡¡Graves'¡¡diseasea¡¡disease¡¡of¡¡the¡¡emotions¡£

We¡¡have¡¡already¡¡interpreted¡¡pain¡¡as¡¡a¡¡phenomenon¡¡of¡¡motor¡¡activity¡£¡¡When¡¡pain¡¡does¡¡not¡¡lead¡¡to¡¡muscular¡¡activity¡¡it¡¡therefore¡¡frequently¡¡leads¡¡to¡¡crying¡¡or¡¡to¡¡moaning£»¡¡just¡¡as¡¡tickling£»¡¡which¡¡is¡¡equally¡¡an¡¡incentive¡¡to¡¡motor¡¡activity£»¡¡results¡¡in¡¡laughter¡¡if¡¡it¡¡does¡¡not¡¡find¡¡full¡¡expression¡¡in¡¡action¡£

From¡¡the¡¡foregoing¡¡we¡¡infer¡¡that¡¡pain£»¡¡the¡¡intense¡¡motor¡¡response¡¡to¡¡tickling£»¡¡and¡¡emotional¡¡excitation¡¡are¡¡all¡¡primitive¡¡biologic¡¡reactions¡¡for¡¡the¡¡good¡¡of¡¡the¡¡individual£»¡¡and¡¡that¡¡all¡¡have¡¡their¡¡origin¡¡in¡¡the¡¡operation¡¡of¡¡the¡¡great¡¡laws¡¡of¡¡evolution¡£¡¡If¡¡to¡¡this¡¡inference¡¡we¡¡add¡¡the¡¡physiologic¡¡dictum¡¡that¡¡the¡¡nervous¡¡system¡¡always¡¡acts¡¡as¡¡a¡¡whole£»¡¡and¡¡that¡¡it¡¡can¡¡respond¡¡to¡¡but¡¡one¡¡stimulus¡¡at¡¡a¡¡time£»¡¡we¡¡can¡¡easily¡¡understand¡¡that¡¡while¡¡diverse¡¡causes¡¡may¡¡integrate¡¡the¡¡nervous¡¡system¡¡for¡¡a¡¡specific¡¡action£»¡¡if¡¡the¡¡cause¡¡be¡¡suddenly¡¡removed£»¡¡then¡¡the¡¡result¡¡of¡¡the¡¡integration¡¡of¡¡the¡¡nervous¡¡system¡¡may¡¡be£»¡¡not¡¡a¡¡specific¡¡action£»¡¡but¡¡an¡¡undesigned¡¡muscular¡¡action£»¡¡such¡¡as¡¡crying¡¡or¡¡laughter¡£¡¡Hence¡¡it¡¡is¡¡that¡¡laughter¡¡and¡¡crying¡¡may¡¡be¡¡evoked¡¡by¡¡diverse¡¡exciting¡¡causes¡£¡¡¡¡The¡¡intensity¡¡of¡¡the¡¡laughter¡¡or¡¡of¡¡the¡¡crying¡¡depends¡¡upon¡¡the¡¡intensity¡¡of¡¡the¡¡stimulus¡¡and¡¡the¡¡dynamic¡¡state¡¡of¡¡the¡¡individual¡£

The¡¡linking¡¡together¡¡of¡¡these¡¡apparently¡¡widely¡¡separated¡¡phenomena¡¡by¡¡the¡¡simple¡¡law¡¡of¡¡the¡¡discharge¡¡of¡¡energy¡¡by¡¡association¡¡perhaps¡¡explains¡¡the¡¡association¡¡of¡¡an¡¡abnormal¡¡tendency¡¡to¡¡tears¡¡with¡¡an¡¡abnormally¡¡low¡¡threshold¡¡for¡¡pain¡¡£¨Fig¡£¡¡36£©¡£¡¡In¡¡the¡¡neurasthenic£»¡¡tears¡¡and¡¡pain¡¡are¡¡produced¡¡with¡¡abnormal¡¡facility¡£¡¡¡¡Hence¡¡it¡¡is¡¡that£»¡¡if¡¡a¡¡patient¡¡about¡¡to¡¡undergo¡¡a¡¡surgical¡¡operation¡¡is¡¡in¡¡a¡¡state¡¡of¡¡fear¡¡and¡¡dread¡¡before¡¡the¡¡operation£»¡¡the¡¡threshold¡¡to¡¡all¡¡stimuli¡¡is¡¡lowered£»¡¡and¡¡this¡¡lowered¡¡threshold¡¡will¡¡continue¡¡throughout¡¡the¡¡operation£»¡¡even¡¡under¡¡inhalation¡¡anesthesia£»¡¡because¡¡the¡¡stimulus¡¡produced¡¡by¡¡cutting¡¡sensitive¡¡tissue¡¡is¡¡transmitted¡¡to¡¡the¡¡brain¡¡just¡¡as¡¡readily¡¡as¡¡if¡¡the¡¡patient¡¡were¡¡not¡¡anesthetized¡£¡¡¡¡In¡¡like¡¡manner£»¡¡the¡¡brain¡¡may¡¡be¡¡sensitized¡¡by¡¡the¡¡administration¡¡of¡¡large¡¡doses¡¡of¡¡thyroid¡¡extract¡¡prior¡¡to¡¡operation£»¡¡the¡¡threshold¡¡to¡¡injury¡¡in¡¡such¡¡a¡¡case¡¡continuing¡¡to¡¡be¡¡low¡¡to¡¡traumatic¡¡stimuli¡¡even¡¡under¡¡anesthesia¡£¡¡Under¡¡the¡¡sensitizing¡¡influences¡¡of¡¡thyroid¡¡extract¡¡or¡¡of¡¡Graves'¡¡disease¡¡the¡¡effect¡¡of¡¡an¡¡injury£»¡¡of¡¡an¡¡operation£»¡¡or¡¡of¡¡emotional¡¡excitation¡¡is¡¡heightened¡£¡¡¡¡The¡¡extent¡¡to¡¡which¡¡the¡¡threshold¡¡to¡¡pain¡¡or¡¡to¡¡any¡¡other¡¡excitant¡¡is¡¡affected¡¡by¡¡Graves'¡¡disease¡¡is¡¡illustrated¡¡by¡¡the¡¡almost¡¡fatal¡¡reaction¡¡which¡¡I¡¡once¡¡saw¡¡result¡¡from¡¡the¡¡mere¡¡pricking¡¡with¡¡a¡¡hypodermic¡¡needle¡¡of¡¡a¡¡patient¡¡with¡¡this¡¡disease¡£¡¡As¡¡the¡¡result¡¡of¡¡a¡¡visit¡¡from¡¡a¡¡friend£»¡¡the¡¡pulse¡­rate¡¡of¡¡a¡¡victim¡¡of¡¡this¡¡disease¡¡may¡¡increase¡¡twenty¡¡beats¡¡and¡¡his¡¡temperature¡¡rise¡¡markedly¡£¡¡I¡¡have¡¡seen¡¡the¡¡mere¡¡suggestion¡¡of¡¡an¡¡operation¡¡produce¡¡collapse¡£¡¡As¡¡the¡¡brain¡¡is¡¡thus¡¡remarkably¡¡sensitized¡¡in¡¡Graves'¡¡disease£»¡¡we¡¡find¡¡that¡¡in¡¡these¡¡patients¡¡laughter£»¡¡crying£»¡¡emotional¡¡disturbances£»¡¡and¡¡surgical¡¡shock¡¡are¡¡produced¡¡with¡¡remarkable¡¡facility¡£

I¡¡hope¡¡that¡¡even¡¡this¡¡admittedly¡¡crude¡¡and¡¡imperfect¡¡consideration¡¡of¡¡this¡¡subject¡¡will¡¡suggest¡¡the¡¡possibility¡¡of¡¡establishing¡¡a¡¡practical¡¡viewpoint¡¡as¡¡to¡¡the¡¡origin¡¡and¡¡purpose¡¡of¡¡pain£»¡¡of¡¡tickling£»¡¡and¡¡of¡¡such¡¡expressions¡¡of¡¡emotion¡¡as¡¡laughter¡¡and¡¡crying£»¡¡and¡¡that¡¡it¡¡may¡¡help¡¡us¡¡to¡¡understand¡¡their¡¡significance¡¡in¡¡health¡¡and¡¡in¡¡disease¡£



THE¡¡RELATION¡¡BETWEEN¡¡THE¡¡PHYSICAL¡¡STATE¡¡OF¡¡THE¡¡BRAIN¡­CELLS¡¡AND¡¡BRAIN¡¡FUNCTIONSEXPERIMENTAL¡¡AND¡¡CLINICAL£§*£§

£§*£§¡¡Address¡¡before¡¡The¡¡American¡¡Philosophical¡¡Society£»¡¡April¡¡18£»¡¡1913¡£


The¡¡brain¡¡in¡¡all¡¡animals¡¡£¨including¡¡man£©¡¡is¡¡but¡¡the¡¡clearing¡­house¡¡for¡¡reactions¡¡to¡¡environment£»¡¡for¡¡animals¡¡are¡¡essentially¡¡motor¡¡or¡¡neuromotor¡¡mechanisms£»¡¡composed¡¡of¡¡many¡¡parts£»¡¡it¡¡is¡¡true£»¡¡but¡¡integrated¡¡by¡¡the¡¡nervous¡¡system¡£¡¡¡¡Throughout¡¡the¡¡phylogenetic¡¡history¡¡of¡¡the¡¡race¡¡the¡¡stimuli¡¡of¡¡environment¡¡have¡¡driven¡¡this¡¡mechanism£»¡¡whose¡¡seat¡¡of¡¡powerthe¡¡batteryis¡¡the¡¡brain¡£

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In¡¡view¡¡of¡¡the¡¡similarity¡¡of¡¡brain¡­cell¡¡changes¡¡it¡¡is¡¡not¡¡strange¡¡that¡¡in¡¡the¡¡clinic¡¡as¡¡well¡¡as¡¡in¡¡daily¡¡life£»¡¡we¡¡are¡¡confronted¡¡constantly¡¡by¡¡outward¡¡manifestations¡¡which¡¡are¡¡so¡¡nearly¡¡identical¡¡that¡¡the¡¡true¡¡underlying¡¡cause¡¡of¡¡the¡¡condition¡¡in¡¡any¡¡individual¡¡case¡¡is¡¡too¡¡often¡¡overlooked¡¡or¡¡misunderstood¡£¡¡In¡¡our¡¡laboratory¡¡experiments¡¡and¡¡in¡¡our¡¡clinical¡¡observations¡¡we¡¡have¡¡found¡¡that¡¡exhaustion¡¡produced¡¡by¡¡intense¡¡emotion£»¡¡prolonged¡¡physical¡¡exertion£»¡¡insomnia£»¡¡intense¡¡fear£»¡¡certain¡¡toxemias£»¡¡hemorrhage£»¡¡and¡¡the¡¡condition¡¡commonly¡¡denominated¡¡surgical¡¡shock£»¡¡produce¡¡similar¡¡outward¡¡manifestations¡¡and¡¡identical¡¡brain¡­cell¡¡changes¡£

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