Case of vigorous contractions of the platysma myoides muscle under great fear¹

John Hearsay² (admitted March 10^th, 1870; aet., 20) an undersized but tolerably well made lad, slightly prognathous, of quiet and very obliging disposition and fair intellectual powers, has been taken on several occasions since admission with an affection of the following kind (lasting for a day or two each time):— He is found, when one is called to see him, sitting in a chair or lying down, not speaking unless addressed, with the lower part of his face, and the front of his neck engaged in a series of spasmodic retractions— The corners of his mouth are drawn at each retraction very much backward, and the skin of the parts mentioned is drawn away from the middle line in front. By palpation the platysma myoides in its whole extent, and also the depressors of the jaw and larynx, and the sternomastoid muscle, may be felt to be contracting at each period of spasm— The mouth is not opened nor is the larynx much depressed. The retractions occur about forty times a minute and the series of them lasts from five minutes to several hours.

When questioned as to his state he answers with some difficulty, a contest seeming to occur between the spasmodic movements and the movements necessary to speech. After a little, questioning him and exacting answers seem to allay the spasm. His replies express an all-absorbing fear for the fate of his immortal soul; he says he fears he has been a dreadful sinner, that there is no more hope for him &c., and occasionally when being questioned he ejaculates “Oh,! Lord (”this word very much prolonged“) have mercy on me” “Oh Lord! take me to thyself this night”, and similar sentences. About the times of these attacks he reads the Bible very much—

The drinking habits of his parents are supposed to be connected with a certain amount of mental weakness which has been from birth; masturbation and unsteady habits are probably causally connected with the present affection which has been going on for two years.

Note— In the case of Joseph Ellis (lately a patient in the West Riding Asylum),³ who was affected with melancholia & most dread-inspiring delusions, there were strongly marked lines on the lower parts of the cheeks and on the lower jaw, concave forwards and upwards, transverse to the direction of the platysma, and seemingly capable of being caused only by its steady (“tonic”) contraction. See also Wakeford’s case.⁴

Case of Melancholia, coincident with advancing blindness— Effect on facial expression.—

Richard Emsley⁵ (Admitted 8^th April 1870; aet 52) a man of moderately strong build but now very shaken, troubled with advancing blindness (to which his insanity is attributed), of very distressed expression of face, is in a state of continual terror and anxiety—except when under the influence of narcotics—believing that he is being, or is about to be torn in pieces by imaginary foes,—among whom the Evil One is prominent.

Facial expression. The notable points are that the wrinkles in the middle part of his forehead (i.e. over the root of the nose) are very well marked and likewise lines running outward from the outer angles of his eyes— The eyelids droop.—⁶ The corners of his mouth are drawn back and slightly elevated.

His expression is rather blank when he is not agitated by grief; the latter is expressed by a sort of half-sob.

Case of melancholia with delusion— Facial expression—

Elizabeth Wakeford⁷ (admitted 14^th December, 1870; aet 46) a tall spare woman, of very quiet, retiring disposition, is affected with deep melancholia, which arose on the death of her husband, and is now much aggravated by the accession of a delusion to the effect that she has been bewitched by a fellow-patient and will never recover.—

Facial expression. The long transverse lines of the forehead are slightly marked, and are visible principally in the middle part— Two perpendicular furrows from the inner ends of the eyebrows, running upwards, are notable, especially (at present) that on the right side. The lines below and on the lower eyelid are well marked. The upper eyelids cover about one fourth of the corneae— The eyebrows run, for half their length, outwards and a very little downwards; for the other half outwards downwards and backwards. There are well marked furrows running downwards and outwards from the outer parts of nostrils and mouth, and there are curving lines on the lower jaw & lower part of the cheek, concave upwards and forwards, transverse to the platysma fibres. The lips are considerably appressed. Corners of mouth slightly depressed. The expression as a whole is one of seriousness and trouble.

Case of simple melancholia;—with the effects on the facial expression.—

Sarah Ann Greenfield⁸ (Admitted March 10^th, 1870; aet. 23) of gentle intelligent disposition, and soft womanly countenance (though with not very regular features) is in a state of melancholia owing to the desertion of her husband— While she is most tractable in every way—takes medicines, employs herself when desired with laundry or needle work, and listens quietly and intelligently to verbal admonitions and encouragements—none of all these seems to move her in the slightest degree from a calm & fixed despair of her being of any more good in this world. She is sinking under an attack of pulmonary consumption.

Facial expression.

In the middle of the forehead there are distinct though narrow transverse lines, the constant (very slight) play of which indicates the activity of the muscle beneath.⁹

Just above the inner end of the eyebrow a slight furrow commences which runs upwards and inwards for a little way ($\frac{1}{4}$inch); this is most marked, as she is being examined, on the left side. The eyebrows run, from their inner ends, outward and a little downward—almost in a straight line— There is well marked drooping of both eyelids so as to conceal nearly half the cornea. There is a shallow but still notable depression running from the inner angle of either eye, downwards and outwards. The downward and outward lines, from the outer part of the nostrils and mouth, are marked sufficiently to aid in giving the sad expression of the face. There is an appearance of tightening and slight drawing down, about the corners of the mouth; and there is considerable appression of the lips.— The cheeks are rather sunk.

The expression is one of disconsolate sadness—imprinted upon the bloom of a full, soft, youthful, almost girlish face— This effect was still more noticeable before the ravages of pulmonary consumption¹⁰ gave a more wasted, and older appearance.—

Answers to “Queries About Expression”; from these and other

cases.—¹¹

5.—¹² Depression not in every case, often slight. The eyebrows are apparently always raised as described.

7.—¹³ In one well marked case the phenomenon was as mentioned— In another the skin above & outside the angle of the mouth was drawn back in a direction between the lines of the buccinators & the elevators of the upper lip.