Answers to CD’s queries on expression; observations on the facial expressions of the insane.
Sussex Lunatic Asylum | Haywards Heath,
13th May, 1870
Case of vigorous contractions of the platysma myoides muscle under great fearf1
John Hearsayf2 (admitted March 10th, 1870; aet., 20) an undersizedbut tolerably well made lad, slightly prognathous, of quiet andvery obliging disposition and fair intellectual powers, has beentaken on several occasions since admission with an affection ofthe following kind (lasting for a day or two each time):— Heis found, when one is called to see him, sitting in a chair orlying down, not speaking unless addressed, with the lower part ofhis face, and the front of his neck engaged in a series ofspasmodic retractions— The corners of his mouth are drawn ateach retraction very much backward, and the skin of the partsmentioned is drawn away from the middle line in front. Bypalpation the platysma myoides in its whole extent, and alsothe depressors of the jaw and larynx, and the sternomastoidmuscle, may be felt to be contracting at each period ofspasm— The mouth is not opened nor is the larynx muchdepressed. The retractions occur about forty times a minute andthe series of them lasts from five minutes to several hours.
When questioned as to his state he answers with somedifficulty, a contest seeming to occur between the spasmodicmovements and the movements necessary to speech. After alittle, questioning him and exacting answers seem to allay thespasm. His replies express an all-absorbing fear for the fate ofhis immortal soul; he says he fears he has been a dreadfulsinner, that there is no more hope for him &c., and occasionallywhen being questioned he ejaculates “Oh,! Lord (”this word verymuch prolonged“) have mercy on me” “Oh Lord! take me to thyselfthis night”, and similar sentences. About the times of theseattacks he reads the Bible very much—
The drinking habits of his parents are supposed to be connectedwith a certain amount of mental weakness which has been frombirth; masturbation and unsteady habits are probably causallyconnected with the present affection which has been going on fortwo years.
Note— In the case of Joseph Ellis (lately a patient in the WestRiding Asylum),f3 who was affected with melancholia & mostdread-inspiring delusions, there were strongly marked lines on thelower parts of the cheeks and on the lower jaw, concave forwardsand upwards, transverse to the direction of the platysma, andseemingly capable of being caused only by its steady (“tonic”)contraction. See also Wakeford’s case.f4
Case of Melancholia, coincident with advancing blindness— Effect on facial expression.—
Richard Emsleyf5 (Admitted 8th April 1870; aet 52) a man ofmoderately strong build but now very shaken, troubled withadvancing blindness (to which his insanity is attributed), ofvery distressed expression of face, is in a state of continualterror and anxiety—except when under the influence ofnarcotics—believing that he is being, or is about to be tornin pieces by imaginary foes,—among whom the Evil One isprominent.
Facial expression. The notable points are that the wrinkles inthe middle part of his forehead (i.e. over the root of thenose) are very well marked and likewise lines running outwardfrom the outer angles of his eyes— The eyelids droop.—f6 Thecorners of his mouth are drawn back and slightly elevated.
His expression is rather blank when he is not agitated bygrief; the latter is expressed by a sort of half-sob.
Case of melancholia with delusion— Facial expression—
Elizabeth Wakefordf7 (admitted 14th December, 1870; aet 46) atall spare woman, of very quiet, retiring disposition, isaffected with deep melancholia, which arose on the death of herhusband, and is now much aggravated by the accession of adelusion to the effect that she has been bewitched by afellow-patient and will never recover.—
Facial expression. The long transverse lines of the foreheadare slightly marked, and are visible principally in the middlepart— Two perpendicular furrows from the inner ends of theeyebrows, running upwards, are notable, especially (at present)that on the right side. The lines below and on the lower eyelidare well marked. The upper eyelids cover about one fourth of thecorneae— The eyebrows run, for half their length, outwards anda very little downwards; for the other half outwards downwardsand backwards. There are well marked furrows running downwardsand outwards from the outer parts of nostrils and mouth, andthere are curving lines on the lower jaw & lower part of thecheek, concave upwards and forwards, transverse to the platysmafibres. The lips are considerably appressed. Corners of mouthslightly depressed. The expression as a whole is one ofseriousness and trouble.
Case of simple melancholia;—with the effects on the facial expression.—
Sarah Ann Greenfieldf8 (Admitted March 10th, 1870; aet. 23) ofgentle intelligent disposition, and soft womanly countenance(though with not very regular features) is in a state ofmelancholia owing to the desertion of her husband— While she ismost tractable in every way—takes medicines, employs herselfwhen desired with laundry or needle work, and listens quietly andintelligently to verbal admonitions and encouragements—noneof all these seems to move her in the slightest degree from acalm & fixed despair of her being of any more good in this world.She is sinking under an attack of pulmonary consumption.
In the middle of the forehead there are distinct though narrowtransverse lines, the constant (very slight) play of whichindicates the activity of the muscle beneath.f9
Just above the inner end of the eyebrow a slight furrowcommences which runs upwards and inwards for a little way(14inch); this is most marked, as she is being examined, on theleft side. The eyebrows run, from their inner ends, outward and alittle downward—almost in a straight line— There is wellmarked drooping of both eyelids so as to conceal nearly half thecornea. There is a shallow but still notable depression runningfrom the inner angle of either eye, downwards and outwards. Thedownward and outward lines, from the outer part of the nostrilsand mouth, are marked sufficiently to aid in giving the sadexpression of the face. There is an appearance of tightening andslight drawing down, about the corners of the mouth; and there isconsiderable appression of the lips.— The cheeks are rathersunk.
The expression is one of disconsolate sadness—imprinted uponthe bloom of a full, soft, youthful, almost girlish face— Thiseffect was still more noticeable before the ravages of pulmonaryconsumptionf10 gave a more wasted, and older appearance.—
Answers to “Queries About Expression”; from these and other
5.—f12 Depression not in every case, often slight. The eyebrowsare apparently always raised as described.
7.—f13 In one well marked case the phenomenon was asmentioned— In another the skin above & outside the angle ofthe mouth was drawn back in a direction between the lines of thebuccinators & the elevators of the upper lip.