I shall never forget the remark of my greatest and most revered teacher,
when he called me into his consultation-room to show me a case of
typical locomotor ataxia, gave me a brief but significant history, put
the patient through his paces, and asked for a diagnosis. I hesitated,
blundered through a number of further unnecessary questions, and finally
stumbled upon it. After the patient had left the room, I, feeling rather
proud of myself, expected his commendation, but I didn't get it. "My
boy," he said, "you are not up to the mark yet. You should be able to
recognize a disease like that just as you know the face of an
acquaintance on the street." A positive and full-blown diagnosis of this
sort can, of course, only be made in two or three cases out of ten. But
the method is both logical and scientific, and will give information of
priceless value in ninety-nine cases out of a hundred.
Probably the first, if not the most important, character that catches
the physician's eye when it first falls upon a patient is his
expression. This, of course, is a complex of a number of different
markings, but chiefly determined by certain lines and alterations of
position of the skin of the face, which give to it, as we frequently
hear it expressed, an air of cheerfulness or depression, comfort or
discomfort, hope or despair. These lines, whether temporary or
permanent, are made by the contractions of certain muscles passing from
one part of the skin to another or from the underlying bones to the
skin. These are known in our anatomical textbooks by the natural but
absurd name of "muscles of expression."
Their play, it is true, does make up about two-thirds of the wonderful
shifting of relations, which makes the human countenance the most
expressive thing in the world; but their original business is something
totally different. Primarily considered, they are solely for the purpose
of opening or closing, contracting or expanding, the different orifices
which, as we have seen, appear upon the surface of the face. This
naturally throws them into three great groups: those about and
controlling the orifice of the alimentary canal, the mouth; those
surrounding the joint openings of the air-tube and organ of smell, and
those surrounding the eyes.
Public-domain text, read in full here on John Shaqi.
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