Thanks CD for copy of Origin.
Encloses extensive, but incomplete, notes on expression among the insane, dealing specifically with blushing and the actions of the platysma and grief muscles.
<third of a page excised> The second case was that of E. <B>. P. aet. 18. Single … from Leeds a girl of hysterical tendencies, who had suffered from Epilepsy from the period of puberty, when she was terribly frightened by a fight which took place in her presence, & whose mind had become gradually enfeebled & unhinged, so that she had lost much of her acquired knowledge, & had attempted suicide & violence against her relatives. The change to the Asylum seemed to interrupt her mental lethargy. When examined she was tolerably intelligent & answered questions correctly, the whole of her face being of a dull purplish red hue. On uncovering her chest it was thought at first that she was suffering from Scarlet fever, as over the breasts & sternum there was a purplish red appearance similar to that on the face, the true character of which was only recognised when it suddently vanished in the course of a few minutes & as suddenly again presented itself in a few minutes more. The blushing seemed to depend upon internal conditions or emotions, as there was nothing in external circumstances to account for its evanesence & reappearance. This girl improved greatly under treatment & was ultimately discharged.
In several other cases, all epileptics, I have noticed, scattered blotches of blushing & red mottling over the chest & breasts, & in all of these cases I have also noticed the cerebral maculæ of Trousseau. In all of them when gentle markings were made with a pencil or the finger nail, on the thorax or abdomen, the portion of skin touched, in less than half a minute, became suffused with a bright red colour, which spread to some distance on each side & persisted for several minutes perhaps ten or fifteen. This condition which undoubtedly indicates a deep modification of the vascularity of the skin, is produced in severe cases by the slightest touch so that the pressure of a finger may produce a diffused blush. Trousseau has recorded cases in which blushing occurred under such circumstances on the thighs as well as the abdomen & chest.
Sir Charles Bell says that blushing extends on to the breasts.
A lady friend tells me that when ashamed or agitated she blushes on her face neck, wrists & hands.— the exposed portions of the skin.
I have sometimes thought that I could trace, in the progressive development of blushing over the cheeks neck &c, the propagation of an influence, inhibitory or otherwise to the three cervical ganglia of the sympathetic system the relative diffusion of the blush depending upon the number of these involved. The number of my observations do not however justify me in calling this anything but a speculation.
I possess a large mass of details as to blushing in morbid conditions, after injury & galvanization of the sympathetic &c. which can be forwarded, if desired.
The Platysma Myoides
I have had an opportunity lately of watching the action of the Platysma Myoides in the case of a patient— T. B. a labourer from Sheffield, labouring under General Paralysis. Whenever this man attempted to speak the whole of the muscles of his face were thrown into a state of violent agitation. The eyebrows were twitched upwards with amazing rapidity, the eyelids were quickly approximated & separated the nostrils & cheeks trembled, the lips shook, & the whole of the skin of the neck from the lower jaw to the clavicle, (as far back as a line drawn from the ear to the outter fourth of the clavicle,) was twitched, & thrown into folds mostly transverse but a few near the mesial line, & the external margin of the Platysma, longitudinal. It is impossible to describe in words the singular effects produced by these contortions of the countenance, which invariably followed any effort at articulation, mastication or the protrusion of the tongue. The skin of the neck, trembled, & quivered strongly & this quivering could be felt going on between the fingers, when the skin was lifted up from the subjacent muscles & structures of the neck. The transverse folds were short, few exceeding an inch & a half in length but numerous while the longitudinal furrows were longer. So violent at times was the action in the skin of the neck, that I am satisfied that there must have been hypertrophy of the of the fibres of the platysma myoides. At times the outline of the Platysma could be traced by the agitation of the skin This man has since died of organic disease of the brain. I find that one of my assistants, knowing nothing of my researches, has entered in the case book.— ``When he opens his mouth the platysma myoides is thrown into a state of violent spasm''.
In several old emaciated men, I have remarked slight twitching or trembling of the skin of the neck, when the chest is exposed, & a perceptible drawing up of the skin over the clavicle, (from the chest to the neck) when the mouth is opened & the tongue put out. This seems to me to be effected by the outter fibres of the platysma, attached to the skin over the pectoralis major which are directly continuous with those attached to the angle of the mouth & lower lip, & which must be stretched by the movement referred to.
I have been quite unable to connect the action of the platysma with any emotional condition. In the old ematiated men alluded to above the general mental state when the muscle twitched was impatience & annoyance at my interference, & observations.
I have recorded persistent contraction of this muscle, in three cases during the past winter—all cases of hypochondriacal melancholia, the most selfish, and to the uncultivated mind therefore the most intense form of grief.
R. S. aet. 51. widow. Tadcaster. fancied that she had passed all her viscera by stool, & that her chest & belly were entirely empty. She was in constant mental agony.—worst in the morning—beat her semi-closed hands rhythmically together for hours. & wore an expression of great distress The corrugators of the eyebrows were permanently contracted, the eyes widely opened, the upper eyelid, having an angular bend about its middle from which its margin was straight to the inner angle of the eye, & having above it a rounded fullness. This condition continued for months but R. S. has now recovered; & her face has resumed its natural expression the margin of the upper lid is now rounded & the fullness has disappeared
J. S. aet 61 from Huddersfield believes that her head is burnt & that there is not a drop of blood in her body. She has an agonized expression. There is marked elevation of the outter third of the left eyebrow, the skin of the forehead over it being gathered into a multitude of minute wrinkles; the corresponding part of the right eyebrow depressed & overhanging. The corrugatores superciliorum, powerfully contracted The eyeballs much exposed, the upper eyelids having an aprupt angular arch rather to the inside of their central points; a rounded kite-shaped fullness over the upper lid: angles of the mouth pulled down; constant restless movements, rubbing & wringing of the hands, with twisting of the body from side to side, the neck being held rigid as if apprehensions were entertained as to any movement of the head.
I have not had time to read over or correct what I have written | J. C. B. | West Riding Asylum | Wakefield. | 15th. March 70