Reprinted from The Chicago Medical Recorder, September, 1894 
Spasmodic Laughter and Weeping. 
A LECTURE DELIVERED AT THE BY PROFESSOR 
EDOUARD BRISSAUD... 
TRANSLATED FROM THE REVUE SCIENTIFIQUE FOR THE CHICAGO MEDICAL RECORDER, 
WITH THE PERMISSION OF THE AUTHOR, 
HUGH T. PATRICK, M. D., CHICAGO. 
Gentlemen :—I am going to study with you to-day spas- 
modic laughter and weeping, particularly the varieties which are 
observed in hemiplegia of cerebral origin. Those of you who fol- 
low this service had the opportunity of seeing a few days ago an 
old lady, a hemiplegic, transferred to the hospital wards for some 
slight indisposition, gastric trouble, I believe. This woman had 
been admitted to the infirmary for a paralysis of the right side, 
preventing her from earning her living. Here she had been very 
well until this last attack, moving about with tolerable facility 
despite her infirmity. When she entered the hospital ward we 
noticed an exaggeration of her contractures, which ordinarily were 
not very pronounced, and as soon as we began to question her she 
began to weep most copiously and was shaken with sobs. She 
was seemingly plunged in the deepest despair and this without 
apparent provocation. The moment she was addressed with ten- 
derness, or was even looked at she burst into tears. At present, 
she seems consoled ; at least she does not weep any more, and has 
returned to the infirmar}' in her former condition, except that she 
retains from this transitory ailment a propensity to laugh without 
adequate cause. Her hemiplegia persists but is not more pro- 
nounced than before. Episodes of this nature are of common 2 
occurrence in the history of hemiplegics and they are observed at 
the Saltpetriere especially in winter, in the course of any indiffer- 
ent illness or indisposition. We see all at once an exaggeration of 
the reflexes, the paralysis increases with a tendency to contracture 
and sometimes a singular laughing and crying is added which is 
nothing but an exaggeration of the spasmodic condition. 
This laughing and crying although not constant in hemiplegia 
is very frequent and this spasmodic condition, which is evidenced 
by an increase of sensitiveness and of reflex phenomena nearly 
related to it. is encountered also in other diseases. We have here 
the necessary and sufficient elements for an attempt at central 
localization whatever may be the cerbro-spinal affection with 
which we have to deal. 
It is of this question that I have decided to talk to you and 
my wish to do so is increased by the fact that I have recently seen 
the report by Bechterew of a case of uncontrollable laughter.1 I 
had already studied this subject with some care and had presented 
my results to the Congress of Limoges. Ido not enter into the 
question of priority and would not have mentioned these details 
had I not seen that work earlier than mine had been published by 
Bechterew in Virchow’s Archives. 2 Far from claiming priority for 
my communication I am happy to concede it to Prof. Bechterew 
and regret that I did not know of his interesting paper at the time 
of the Congress of Limoges. I would add that my conclusions 
while differing slightly from those of the professor of Kasan, agree 
with them in the main and I am glad to be in accord with him on 
this point. The case of Bechterew is as follows: A young man 
affected with cerebral hemiplegia of the left side, of syphilitic 
origin, was heavy and somnolent. He had a marked tendency to 
weep and looking at him sufficed to cause a burst of tears. Besides 
he was taken with spells of unconquerable laughter, veritable 
spasms occurring several times during the day. They did not 
seem to be an ordinary reflex action ; tickling, for instance, did not 
provoke them, and they always occurred from psychic influence; a 
spontaneous influence, autochtonous as Bechterew calls it, often so 
fugitive that the patient could not remember the cause of his 
laughter and found it out of place. The attacks lasted half an 
hour, an hour, two hours, with but short intermissions. Specific 
treatment was employed, the hemiplegia improved and at the same 
time the attacks of spasmodic laughter disappeared. The conclu- 
sions drawn from this observation, the autopsy is wanting, are that 
the location of the lesion corresponded to the centers for expres- 3 
sion in the anterior part of the thalamus. Here in fact we find the 
system of nuclei where converge on the one hand the fibers which 
transmit cortical stimulation and on the other those which con- 
duct reflex excitation. Is the cerebral lesion the direct cause of 
the tendency to irresistible laughter or is it the indirect cause by 
preventing the action of the inhibitory centers? Prof. Bechterew 
adopts this latter hypothesis because to provoke the laughter a 
psychic influence was necessary, however trivial. 
But whatever our conclusions may be, for the moment we will 
simply bear in mind the fact of this uncontrollable laughter, and 
the fact is not rare. We see in hemiplegics sometimes spasmodic 
laughter, sometimes weeping, occurring in spells, occasioned b}' 
the awakening of an image stored away probably in the frontal 
lobes. The phenomenon is familiar; it is known that these patients 
are the subjects of a peculiar sensibility, but it has not been 
specially studied as an entity and with regard to the interesting 
question of localization. 
We know nothing of the mental state of our fellow creatures 
except b}' means of the expressions which they furnish us. Left 
by ourselves would we even have emotions? The question is still 
sub judice and the judges will ever be divided. But it seems that 
these manifestations of the two extremes, sadness and joy, are to 
be the point of departure for this physiological research. If from 
the analysis of certain simple facts we can draw some conclusions 
as to the variations of the emotional function, perhaps we shall 
succeed in finding one of the unknown quantities in the great prob- 
lem of the psychic life. 
To return to our patients ; I must at once guard you against 
one source of error. The hemiplegics in question do not belong 
to those cases of senile dementia in whom small foci of softening 
occur day by day, and in whom the intelligence decreases pari 
passu. They do not represent that type of “whimpering senility” 
of which Diderot stood in such horror. Our patients possess all 
their faculties although at first view deprived of them. If we 
question them closely we see that the memorjq the association of 
ideas, in a word the understanding is intact or very nearly so. 
Senile dementia, a misnomer since it may occur at all ages from 
organic cerebral disease, has also its silly laugh and inexhaustible 
tears, so well described by M. Magnan, but that is not the object 
of our consideration at present. 
We shall see that many hemiplegics suffer cruelly from this 
disposition to excessive laughing and weeping and that they recog- 4 
nize how ridiculous are these tempestuous manifestations. A mild 
pleasantry quite incongruous with such bursts of gaiety, induces an 
explosion of mirth which it seems will never end. Some of these 
subjects in spite of their interest in intellectual pursuits cannot, 
for example, go to the theater for fear of rendering their vicinity 
insupportable by their boisterous laughter and tears. 
A hemiplegic in the full possession of his faculties recently 
confided to me how painful for him was this hyper-sensitiveness, 
and related the following : A lady mentioned to him that her 
little dog had just died. “Indeed,” said he, “Oh, that is too bad.’’ 
Was it this expression of condolence which by a sort of sugges- 
tion awakened a train of sad ideas? At any rate all the machin- 
ery of expression was set in motion ; the simple sadness of the 
face induced tears, the tears, sobs, and worse still, this unfortun- 
ate man was no longer master of his sphincters. I could cite 
many analogous cases in which laughter took the place of tears. 
Thus in a general way the laughter or the weeping in these 
cases is indeed the manifestation of an emotion, sad or gay, but 
more demonstrative than it should be. It is a voluntary expres- 
sion but excessive, as manifested by the spasmodic phenomena. 
Before studying these morbid manifestations I wish to say a 
word about the corresponding physiological processes: But we 
must acknowledge that the ultimate mechanism of laughing and 
crying is but poorly understood. Laughter, especially, cannot be 
experimentally studied “for laughter is peculiar to man.” Weep- 
ing is also said to be one of our exclusive peculiarities. The 
assertion may be contested for if there are no animals that laugh, 
there are some that weep, and under such conditions that they 
would seem to thus express an emotion. A whole class of mam- 
malians, particularly ruminants secrete tears in abundance. 
In man laughter and weeping are accompanied respectively by a 
special facial expression. But have not animals an analogous 
faculty? Some anthropoids have most significant facial expres- 
sions, not only the grimace which amuses us, but true expressive 
movements which merit closer study, much more so indeed than 
the problematical language of these animals. 
But to return to the laughter and weeping of man. They 
enter into the category of muscular, that is motor, manifestations 
which are the necessary consequence of every emotion. This does 
not pass beyond the limits of simple physiology and pathology. 
There is nothing rash in saying, as I have just done, that a “move- 
ment of the soul” cannot be represented except by a muscular 5 
action or its equivalent, secretion for instance, and is necessarily 
thus represented. Gratiolet3 in a work, already old, on physiog- 
nomy and the movements of expression affirmed that every emotion 
manifested itself by an act. 
I will give you a fresh example of this truth. A medica 
student whom I know intimately and who for the past six years 
has been affected with a syphilitic hemiplegia tells me that he has 
given up reading novels; the misfortunes of the heroine produce a 
torrent of tears and he is in a transport of joy over the happy pas- 
sages. However, he does not read aloud but only with the eyes 
and it is simply the emotion which he feels that brings into play 
his muscular apparatus. In his case it is a spasm which occurs 
instead of the imperceptible vibration which we ail feel. Thus, as 
Fer£ has demonstrated, in pleasure and pain, joy and sadness, 
there is a “necessity of reaction.”4 In subjects in a condition of 
spasm the least contraction tends to become general. You know 
besides, as the experiments of Charcot and P. Richer have shown, 
that a contraction provoked in certain muscles of the face may 
induce a whole series of appropriate attitudes; and this brings us 
to our subject, for the acts of laughing and weeping have a pri- 
mary facial localization and then tend to become general. It would 
seem that in describing laughter one might repeat the lecture of 
that master of philosophy, M. Jourdain; you will see that in con- 
struing these vulgar facts we may find information of the greatest 
interest. 
The first facial manifestation, at the labial commissure, con- 
sists in a slight contraction of a tegumentary muscle, the zygoma- 
ticus. The debut is always here, that is, in the region supplied by 
the filaments of the inferior facial; at first only a smile confined to 
the “corners of the mouth,” then spreading, gaining the throat 
region and the phenomenon, at first limited to the face, attains the 
upper glottis and then the lower which dilates for the passage of 
the air expelled by the diaphragm. When this latter muscle comes 
into play it is evident that the excitation, starting from the nucleus 
of the facial has reached that of the phrenic nerve passing by way 
of the nuclei of the pneumogastric and spinal accessory. This is 
the moment of the full hearty laugh. Finally are produced mani- 
festations still more boisterous and generalized. The motor column 
of the cord itself is attacked and the entire body participates in the 
spasm. We “hold the sides” and are “doubled up.” This is the 
Homeric laugh of the Olympic gods at the sight of halting Vulcan 
trying to fill the place of Ganymede. 6 
If now we pass in review the phenomena characteristic of 
weeping we shall see them succeed each other in an order quite 
analogous. This time the debut is a depression of the mouth by 
the chin muscles, the depressor labii inferioris and triagularis 
menti which by their contraction produce in the sub-buccal region 
the significant undulations which, especially in children, precede 
the torrent of tears. The excitation is propagated to the muscles 
of the glottis, the diaphragm and finally the sobs burst shaking 
convulsively the entire body the same as the laugh. 
I have reserved the tears themselves for the last. But the 
flux of tears also depends upon the motor nerve. It occurs with a 
suddenness and abundance that can be occasioned only a vaso- 
secretory nerve, such as is the chorda tympani for the salivary 
function. The lachrymal secretion occurs under conditions exactly 
analogous to those of the salivary secretion in the memorable ex- 
periments of Claude Bernard and Vulpian. We know that the 
chorda corresponds closely to a motor nerve in origin, re- 
lations, distribution and function. . It is a filament of the facial as 
is the branch of the ophthalmic which supplies the great lachry- 
mal gland. Likewise blushing is essentially a phenomenon of vaso- 
dilatations and not the result of passive congestion such as is seen 
in the beginning of asphyxia. Thus all these effects depend upon 
the same gray motor column. Let us attempt then to locate the 
centers which preside over their production. I present to you a 
section representing the optic thalamus with the posterior segment 
of the internal capsule; below, the posterior commissure and the 
tubercula quadrigemina in the middle, the aqueduct of Sylvius sur- 
rounded by its gray matter. I spoke to you in my last lecture of 
the nuclei of the motor oculi communis distributed one above 
the other in this region; they form part of the same gra}' 
column that we find lower down, constituting first the origin of 
the facial, then that of the pneumogastric, the glosso-pharyngeal 
and further down the spinal accessory; farther still the origin of the 
phrenic which we shall see comes into play to shake the thorax in 
violent laughter or sobbing. With these few anatomical facts we 
may at once examine the process of laughing from the simple 
smile, a slight facial contraction, to the burst of laughter which 
convulses like a clonic spasm, a process always following the same 
track, always descending for the short diagonal of the rhomboidal 
floor of the fourth ventricle down to the gray matter of the cervi- 
cal cord. And the stimulus of these bulbo-spinal nuceli is not ar- 
rested here since we may have a generalized spasm, a veritable convulsion, the “crazy laugh ” the “epileptic laugh.” Finally I 
would add that the action of the gray motor column brought into 
play in laughter and weeping always begins at the level of the nu- 
cleus of the fifth pair, never higher. Above this the motor column 
corresponds to the intrinsic and extrinsic eye muscles and saving in 
exceptional cases the gray nuclei of the aqueduct do not partici- 
pate in the action of the ganglionic masses in the expression of 
emotion. Nor does the nucleus of the patheticus take any part in 
this excitation. The fourth pair is misnamed for it has never 
added one whit to the pathos of any face. 
Before inquiring as to the communications which serve to con- 
nect the cortical centers with the bulbar nuclei, let us endeavor to 
see the relation of these nuclei to expression itself. Investigators 
have sought for a long time to determine the location of the de- 
cussation of the motor tracts coming to these nuclei of expression. 
As the movements of facial expression are bilateral, at least in 
frank laughing and weeping, we must admit that the decussation, 
complete or incomplete, is perfectly symmetrical. The anatomi- 
cal details are but little known and are still being studied, but 
recent experiments by Muratow have shown that the decusation of 
the motor tract for the face, superior and inferior, excluding the 
eye muscles, takes place just below the corpora quadrigemina, that 
is, just below the region which is never interested in these reflex 
phenomena of laughter and weeping. 
It remains for us to inquire if the facial has different branches 
for laughter and for tears. No ; in all probability the same nerve 
fibers and the same nuclei serve for these two opposite expres- 
sions, but, varying with the case, they create different motor com- 
binations. We may say in a general way that the expression of 
laughter is due rather to the action of the levators and weeping 
to that of the depressors. And if we consider the muscular ac- 
tions of laughing and of weeping as a whole we might make a 
somewhat similar statement of the other muscles engaged, the 
nuclei of the pneumogastric and spinal accessory supply muscles 
of inspiration and expiration. It is the first which are employed 
in the act of sobbing, and the second in laughing ; for whether it 
be bursts of laughter, or a passion of weeping, it is the respira- 
tory muscles which are in action. In short, although the nuclei of 
the motor column always stimulate their corresponding muscles our 
emotions arenot expressed by means of such and such anucleus taken 
as a whole. It would seem that they choose certain cells of each 
group. But if we are moved by more complex emotions, several 8 
of these groups of cells may be discharged together, and if an emo- 
tion is extremely intense the neighboring groups cannot remain 
intact and the muscles of the face which serve for a frank laugh or 
cry combine their action so as to produce a complex result ; we 
“laugh till we cry,” we “weep for joy.” Let me add that as great 
emotional agitation, so also do certain pathological conditions 
give rise to a double expression of sadness and joy. Thus the 
bulbar phenomenon is not always simple; the activity of the nuclei 
is not always uniformly localized. The reason lies in the fact that 
the medulla oblongata does not act as a purely reflex center but 
obeys commands from above, from the cerebral cortex. A direct 
bulbar stimulus has no effect but a reflex contraction without any 
manifestation of expression, as experiments have decisively shown. 
These orders which produce psycho reflex acts are transmitted, 
without doubt, by the optic thalamus. The connections of the 
thalamus witfe the bulbar nuclei are so arranged that for every ex- 
pression, simple or complex, there exists a center of command. 
From this center are sent out the impulses to the bulbar nuclei, 
these impulses being discharged by a psychic stimulus. 
Suppose for a moment a lesion exclusively irritative and con- 
fined to the medulla. You would see nothing but a spasm, a grim- 
ace resembling at once the act of laughing and of crying. All 
these groups of cells would act at the same time because the thala- 
mus does not intervene to make a choice. Do we find such phe- 
nomena in neuropathology? Without a doubt, and I have already 
shown you the fact on another occasion apropos of a case of 
amyotrophic lateral sclerosis. You remember the characteristic 
meaningless laugh and weeping of Charcot’s disease. It is due to 
the irritation of all the bulbar nuclei for facial expression. It is 
neither frank laughter nor tears, but a mixture of both. 
While the complex phenomena of laughter and weeping are 
the consequence of an action of the cerebral cortex, we must not 
conclude that they are always of exclusively cortical origin. 
Laughter and weeping are often of a purely reflex nature ; that is 
to say that they occur under circumstances in which the cerebral 
hemispheres are entirely neutral. Tickling, for instance, provokes 
the most frank laugh, a laugh nevertheless over which the cere- 
br*um exercises no control whatever. There are still other kinds 
of activity of this system of bulbar nuclei which are, like laughter 
and weeping, sometimes psychic in nature, sometimes reflex. 
Yawning is one of these acts, with an established mechanism in 
which participate the muscles supplied by the seventh, tenth, 9 
eleventh and twelfth cranial nerves, and a whole series of cervical 
nerves. Sometimes it is reflex, sometimes psychic; one yawns 
from ennui, and one yawns from want of sleep. Spasmodic 
yawning is also observed sufficiently often in hemiplegia. Nor is 
it simply a symptom added to the ordinary spasmodic phenomena 
of epilepsy, (Fere),5 or hysteria, (Charcot,6 Gille de la Tourette, 
Guinon et Huet).1 It seems indeed to depend upon an organic 
lesion but I will not insist upon this point for the present. I con- 
fine myself to the mention of it as a symptom ; as a complex 
systematic act, the frequency and intensity of which are exaggerated 
as are the laughter and weeping of hemiplegia mentioned in the 
beginning of the lecture, and which may be produced by a 
mechanism purely reflex or psycho-reflex. 
To return to the laughter. It is about demonstrated that its 
center of coordination is in the thalamus. It is here, too, that the 
stimulus of tickling is reflected; but the laugh thus provoked has 
no relation to the pathological laugh we are studying. 
I present you here a patient whom you have already seen. 
She is a hemiplegic, but her hemiplegia is not of cortical origin; it 
is due to a lesion of the basal ganglia which has produced the 
facies called “pseudo-bulbar.” You observe that her hemiplegia 
is left-sided, and her gait decidedly spastic. Question her, and 
she replies with the greatest difficulty, moving the tongue with 
effort and drooling saliva. This pseudo-bulbar paralysis is the 
result of a lesion which has cut, above the motor decussation, the 
fibers which pass from one hemisphere to the other to produce 
the bilateral movements of the face. The result has been a 
bilateral facial palsy. This paralysis, however, is not complete ; 
the patient can articulate, but it is exceedingly difficult to under- 
stand her. You know enough of the history for us to study 
together this peculiar group of bulbar symptoms that she presents 
in such a marked degree. The neighbors of this woman in the 
ward are hysterical cases who, by the way, are far from being as 
sensible as she is. The other day, during our visit, one of them 
presented a typical picture of hysterical delirium. She assumed 
the most fantastic attitudes, with gestures pompous and comical ; 
she made solemn salutations and bowed as if at mass with imper- 
turbable solemnity. Our patient, although habituated to such 
scenes, could not help laughing, and having begun, you remember 
what followed. The explosion of her apparent gaity filled the 
ward with ringing laughter, and she became, in spite of her efforts, 
much noiser than the hysterical subject. 10 
This variet}' of laughter is absolutely identical with that of the 
patient whom I just presented; the hemiplegia which is the cause 
of this hilarity is so by reason of a lesion of the basal ganglia; 
the connection of the thalamus with the cortex is respected. The 
result of the cortical stimulus is a laugh yesterday it was 
tears ; she was discouraged and indulged in a fit of uncontrolla- 
ble weeping. 
The other patient before is also a hemiplegic whose face, 
as you see, is impassive. He can still walk but with 
very short steps. However it is not his hemiplegia to which I 
would call your attention. Notice the physiognomy, in which we 
do not see evidence of a single emotion; an immovable mask. The 
eye muscles are normal but deglutition is difficult and speech 
almost impossible ; the intellect is intact and he comprehends 
fectly his attacks. He is a laugher and a most pronounced one. 
Simply the word “laugh” spoken to him causes a burst of merri- 
ment that he is unable to control; he laughs till he chokes. He is 
menaced at all times with these attacks, is never sure of himself, 
and avoids everything which might induce them, for once begun he 
is bound to submit to his irrational laugh until it is exhausted. It 
is like an epileptic fit fated to pass through the cycle of convulsive 
manifestations and which nothing can arrest once the aura has ap- 
peared. 
Finally I show you a young woman presenting the complete 
symptom complex of the hemiplegic form of multiple sclerosis. 
The spasmodic condition dates back three or four years. In con- 
trast to what you have just seen in the preceding patients, she has 
no immobility of the face; on the contrary she talks with a grimace, 
puckering and drawing her lips in an affected manner. Her bulbar 
nuclei are not paralyzed but she is subject to the same attacks. 
The first time that we saw her she filled the ward with laughter 
that nothing could stop. 
Thus we see a burst of spasmodic laughter in subjects whose 
faces are impassive, and we find the same phenomenon in this 
woman whose face, on the contrary, is in perpetual motion. Can 
a lesion explain these apparent contradictions? I will endeavor 
to demonstrate that it may. But first I wish to say a word about 
the anatomical arrangement of the lower levels of the cerebral 
hemispheres. 
The figure represents a horizontal section of the left hemi- 
sphere. You recognize the island of Reil, the subcortical white 
matter, the claustrum, external capsule, lenticular nucleus and cau- 11 
date nucleus which is nothing but the continuation of the putamen; 
posteriorly we find the cauda of this nucleus and internally the 
optic thalamus and ventricle. We know perfectly the course of the 
pyramidal tract in the internal capsule, the motor tracts for the in- 
ferior and superior extremities and for the face excepting the fibers 
for the orbicularis. 
All these known divisions belong to the posterior limb of the 
capsule; in front is a terra incognita, the anterior limb which to- 
ward the peduncle becomes the “innominate tract” still called 
the “psychic tract.” This tract does not always degenerate after 
cortical lesions. It is distinctly connected with the frontal lobes 
and is at first constituted in part by the fibers of the anterior thala- 
mic region which rejoin it after having been distributed in the 
thalamus and which form the anterior root of this ganglion. Lat- 
erally from this tract, separated by a bundle of capsular libers is 
seen Arnold’s tract which extends to the vicinit}? of the corpora 
quadrigemina. We do not know which of these two tracts it is 
that conducts the stimulus from the frontal cortex to the centers 
of coordination in the optic thalamus, but we may be sure that 
the inferior fibers of one of them must fill this role. For in cases of 
complete destruction of the anterior limb of the capsule, see what 
we observe; whatever effort the patient may make he cannot suc- 
ceed in stimulating the center of expression for the opposite side; 
one hemisphere only is active and he laughs on one side only. 
On the contrary let us suppose a lesion involving the knee of the 
internal capsule, the voluntary motor tract for the face, the genicu- 
late tract. The psycho-reflex movements will then be possible 
and the patient will retain the power of facial expression. The 
symptoms will be those of psuedo-bulbar paralysis from a unilateral 
cerebral lesion. 
Finally if the two geniculate tracts are involved, either by a 
double symmetrical lesion or by a single one at their point of 
decussation, the subject will be unable to execute a single voluntary 
movement of the face. Nevertheless he will have a tract conduct- 
ing the stimulus of psychic impressions to the internal capsule and 
as far as the center for the coordination of facial expression; thus 
he will still be able to excite his bulbar nuclei, but fheir action will 
be deranged because they have, so to speak, lost their head; it is 
impossible for the'patient to master his hilarity by voluntary inhi- 
bition and the “bulbar laugh” without limit and without control is 
the result. 
Such is the lesion which I infer in the hemiplegics of whom I 12 
just spoke, a lesion purely irritative when located in contact with 
fibers of the anterior limb of the internal capsule and paralyzing 
when it cuts the posterior limb. You see then why our patients 
have immobility of the face and why, also, when stimulated, exces- 
sive laughter or tears result. Ordinarily, indeed, they can be quiet 
for it is rare that the voluntary motor tract is totally destroyed but 
the veriest trifle sets them off and the laugh terminates in an ex- 
plosion such as you have just witnessed with hiccough, laryngeal 
constriction, salivation, even vomiting, becoming a truly convulsive 
attack when the process extends to all the muscles. 
Prof. Bechterew assumes a lesion of the thalamus in his case. 
I admit that I can scarcely imagine such a location; that is, a 
destructive lesion of the center of distribution of movements. If, in 
a hemiphegic, there were a lesion at the level of these centers, a 
lesion not destructive, but simply irritating, I admit that it might 
produce these irritative troubles of the movements of expression; 
but how at the same time explain the hemiplegia of Bechterew’s 
case? It is absolutely necessary that there be a lesion of the 
internal capsule. It appears to me then much more reasonable to 
suppose a lesion of the capsule destroying the voluntary motor 
tract and in contact with the fibers for expression without destroy- 
ing them. If, in cerebral affections, spasmodic laughter or weep- 
ing may depend upon this lesion, let me add that it may be seated 
high up or low down. The lower down it is toward the medulla 
the less we will find differentiated the expressions of joy, pain, 
hate, terror, etc., corresponding to the infinitely delicate play of the 
centers for the tegumentary muscles of the features. And this is 
explained by the well-known disposition of the various “systems of 
projection,” the fibers converging more and more as we descend. 
If then we have a lesion located at the point of convergence we 
must admit that all the emotions will be expressed by a single play 
of feature. This is the case in the striking facies of pseudo-bulbar 
paralysis. 
The localization which we have just studied produces in addi- 
tion to the paralysis spasmodic troubles such as are caused by any 
irritative affection, as amyotrophic lateral sclerosis. For example 
you remember in the last patient presented we found the signs of 
multiple sclerosis of the hemiplegic form. There is besides a 
whole category of patients in whom we find this bulbar type, viz., 
idiots, who also have attacks of laughter. From chronic lesions of 
the capsule, of the ganglia of gra)? matter or of the cortex they real- 
ize the pathogenic conditions of an unstable physiognomy. Simple 13 
atrophy, porencephalus, chronic diffuse encephalitis, etc., may be 
the cause of the phenomena. In these patients as in the preceding 
the lesion affects that part of the capsule which is frequently called 
the “ psychic tract,” the projection of Arnold’s tract, or the 
anterior root of the thalamus. Here I must say mea culpa. At 
the time when I was studying with Prof. Charcot, the degenerations 
of the pes pedunculi our attention was directed to this bundle to 
which, as yet, no name had been given. I scarcely knew how to 
designate it and called it the “ psychic tract. ” The name has been 
adopted in several classical works, but I am the first to recognize 
the fact that it is not entirely satisfactory. It certainly is the most 
direct path of communication between the frontal cortex and the 
gray matter of the base and medulla. If it takes no essential part 
in the elaboration of mental acts it at least a role in the 
external manifestation of these acts; a connecting link between 
certain centers where thought is born and others less noble that 
automatically present its reflections, it is the indispensable balance 
wheel of the movements which, rightly or wrongly, have been called 
the psycho-reflexes. For this and this only it seems in a measure 
to merit the title. 
2 Die Bedeutung der Sehhiigel auf Grund von experimentalen und 
pathologischen Daten. Virchow’s Arch., 1887, vol. 110, p. 102. 
1 Soc. of Neurol, and Psych, of Kasan, April 24, 1898. 
3De la physionomie et des mouvements d’expression, Paris, 1869. 
4Sensations et mouvements, Paris, 1887. 
sNouvelle Iconographie de la Salpetriere, 1888, t I. p 163. 
'6Legons du Mardi, 1888-89 et Clinique des maladies du systime nerveux t I. 
p. 429. 
7Nouvelle Iconographie de la Salpetriere, 1891, No. 3.