208 , PHYSICAL EXPRESSION. 



John Clark came under my observation May, 

 1878 ; he was then twelve years of age. The 

 complaint made was that his hands twitched, his face 

 worked much, and that at times he was quite silly. 



He was a well-grown lad, of good complexion ; 

 his features presented a constrained appearence, 

 and there was much movement of the face. The 

 right hand twitched, but not violently. As he 

 stood up there was some irregular muscular twitch- 

 ing all over the body. He spoke well, and was not 

 himself conscious of the twitching of the face. 



The movements of the face were very striking, 

 and were carefully observed. They were principally 

 confined to the parts about the eyes, nostrils, and 

 mouth. 



In July, when he was an in-patient at the East 

 London Children's Hospital, I took the following 

 description : 



Face : complexion somewhat anaemic, mucous 

 membranes a little pale, not markedly so. There 

 is considerable movement of the muscles of the 

 face ; he frequently closes his eyes, next draws up 

 the angle of the mouth on the same side, then 

 contracts his eyebrows (corrugators), next he ele- 

 vates them. He appears quite unaware that he is 

 making grimaces. The inner portions of the 

 occi pi to-fron tales (grief muscles) frequently contract 

 in excess of other portions of these muscles ; no 

 movements of the hair or scalp se*-n. 



The orbicularis oculi is frequently contracted, as 

 indicated by the furrows around the eye, and the 

 movements of the lower lid, while at the same time 



