Francis Warner

“ We must study man in all aspects of the case, and when we see in the face, limbs, or body indications of his brain or mental condition, we should analyze and describe—first, the position of features and parts as we see them, then the muscles which produce those positions or movements, knowing that the muscular condition which has produced the movements or positions is the result of the state of the corresponding nerve-centers. It has been said that a man's face is an index of his mind, and this is true ”

“ I have been accustomed to regard the nerve-muscular condition of "nervous cases," when seeking definite signs by which to describe them, in the light of the principle that movements depend upon nerve-muscular stimuli originating in nerve-centers. Examples may easily be given, showing how we commonly judge of the state of the nervous system by muscular conditions. Note the stooping attitude and spiritless gait of a tired man as compared with that of the same individual when rested and refreshed. ”

“ A healthy child, when it runs in its play or to meet a friend, commonly holds out its arms, the hands assuming the "energetic position"; and this, as the result of observation, is, I think, characteristic of a healthy, nerve-muscular condition; healthful children in pictures by the best masters are often thus represented. When a child is in a state of convulsion it is well known that usually the hand is closed, with the thumb turned in upon the palm, the fingers being flexed around it. ”

“ It is, of course, in the free or disengaged hand that we must look for examples illustrating the condition of the brain which governs it. If the muscles be employed in some definite act, such as holding an object, or in an act of manipulation, such as sewing, then the movements are directed to accomplish the aim attempted, and are not simply indicative of the condition of the brain, as may be the case with the free hand when unconsciously expressing the mental condition by gesticulation. ”

“ The movements of the head—aside from those due to movements of the cervical spine—may be classified as those of flexion and extension; the bending forward and backward of the head; of rotation, in which the head remains erect; and of inclination or the depression of one or the other side. Flexion and extension of the head are of frequent necessity and physiological import; rotation is frequently necessary to move the eyes toward an object looked at, or to direct the ear toward a source of sound. ”

“ The educated and refined singer trains and refines his whole mind, i. e., his brain, and is well aware that his "whole soul," as he may express it, comes out in the action of the muscles concerned in producing his song and musical notes. In the infant the condition of the nervous system is best recorded in terms of nerve-muscular phenomena. It laughs, and is playful; reflex action is well marked when a finger is placed in the child's mouth. The eyes are moved and directed toward any object looked at ”

“ Doubtless there is much expression in a torso; in many cases a weakly condition is indicated by a stooping attitude, with a lolling over to one side. It is difficult to indicate in precise terms the positions and movements of the spine, and perhaps this is one reason why so little is known about the action of the muscles of the back. With regard to the lower extremities, the gait and manner in walking may be characteristic of brain or cord disease. ”

“ The knowledge that we already possess of the nerve centers is from observation of the condition of the muscles. In a given case, by comparing the state of the muscles during life as they may be affected with paralysis or spasm with the brain-lesion found after death, and by collecting and comparing many cases, it has been found that destructive or irritative lesions of certain parts of the brain cause paralysis or spasm of a certain set of muscles corresponding. ”

“ Inclination is, I think, often of other significance: it sometimes indicates weakness, it is more frequently seen in young girls and weakly persons than in strong men. Inclination, with rotation to the same side, with slight flexion, is a position of the head very commonly seen in choreic girls, and then often accompanies an awkward, ill-balanced position of the spine. Inclination of the head, with rotation to the opposite side, and slight extension, is indicated by Sir Charles Bell in his figure in "Adoration." ”

“ Asymmetry is, however, seen in facial palsy, in sneering, and occasionally in the one-sided grimaces of very nervous people. Certain commonly marked lines in the face—horizontal and vertical lines in the frontal zone, the naso-labial grooves, the lines of the upper and lower lips, and the positions of the angles of the mouth—exist as the result of the puckerings produced by muscular action. ”

“ The life of the eyes is given, not by the eyeball, which is almost wholly lacking in expression, but by the conditions of the eyelids and of the muscles that move them, and in some degree by the muscles which move the eyeballs. The action of the muscles about the angles of the mouth is affected by a very moderate amount of brain disturbance. ”

“ Expression may be indicated by the position of the head, which is seen firmly upright in defiance, drooping in shame; is commonly held on one side in nervous women and girls convalescent from chorea, the first example cited of an asymmetrical gesture. The artist's brush or pencil, the sculptor's modeling-tool and chisel, the pianist's and violinist's finger-touch, indicate the training and actual condition of the working of his brain. ”

“ The energetic or powerful hand is the reverse of this, and is probably seen in life only under certain conditions of the mind, producing what we call "mental states," or states giving energy and the feeling of strength. ”

“ COARSE or extensive paralyses, such as involve one or both sides of the body, and other profound disturbances of the muscular system, have received much attention from clinical and pathological observers, and by the accumulation of their joint observations much knowledge has been gained as to the symptoms that result from lesions of the brain. ”

“ This should encourage us to observe in all cases the conditions of the muscles, knowing that the movements correspond to certain states of the moto-centers, and looking upon such nerve-conditions as indications or expressions of the states of those centers. All expression of feeling is effected by muscular action, whether it be by words, by facial movement or gesture, movements effected by voluntary muscles ”

“ It is a matter of very common experience that children and adult patients "hold themselves awkwardly"; stoop, or otherwise give the spine and trunk an ill-balanced position, due to want of nerve-muscular energy, and characteristic of the condition of exhaustion and weakness. ”

“ Again, intellectual people usually move the eyes in their orbits in looking at any object; the low and vulgar often move the head in the direction required. The movements of the face, like the other forms of expression by muscular action, are generally symmetrical. ”

“ In cases where the muscular expression has been marked, some painful condition and some source of anxiety or mental distress has almost invariably been found. A person suffering from headache, or who "looks as if he had a headache," presents an appearance of depression, heaviness, fullness about the eyes, especially about the under eyelid ”

“ When a very nervous child, or one convalescent from chorea, holds out its hands in front on a level with the shoulder, and with its fingers spread out, we commonly see the nervous hand. As the palms are turned down, the wrist droops slightly. The metacarpo-phalangeal joints are moderately extended, the first and second internodes being either flexed or kept straight. The thumb is simply extended backward, and somewhat abducted from the fingers; and a twitching of the fingers is frequently observed. ”

“ Among the facial muscles, intellectuality appears to be most commonly expressed in the frontal and middle zones, and by the action of the corrugator and orbicularis-oculi muscles. It has been possible among out-patients to accept the facial appearance as a physical sign of mental as well as of physical and organic suffering. ”

“ One eye may move upward or outward, while the other remains quiet, or moves in a different direction or at a different pace, thus causing a temporary and varying strabismus. Usually these movements are confined to the horizontal plane; less commonly the eyes assume a different level, one being in the horizontal plane while the other is turned downward. In these cases the coordination of the movements is restored with returning consciousness. ”

“ When we assent, affirme, yield, grant, vote, confirme, confesse, admit, allow, or approve of a thing, etc., we are wont to nod or bend our head forward, the naturall reason of which motion in these, seems an approving, which is made by the Imagination, seeing, or hearing, somewhat done or said which accordeth very well, and this power remaineth in the Braine or forehead part of the head where in the cell and Seat of the Imaginations lieth. "When any of these things give it contentment, suddenly it moveth the same, and after it all the muscles of the body." ”

“ The associated movements of the eyes may be completely lost in deep anæsthesia from chloroform, in coma from alcoholism, or in the profound sleep of infants. If, in an adult deeply under the influence of chloroform, the eyelids be gently raised, the pupils will be seen minutely contracted, often to a pin-point, the eyes having at the same time lost the parallelism of their axes. ”