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Direction.—Strabism (inward, outward, mono-lateral, bilateral).
Sclerotic Coat.—It may be injected with blood (delinquents), or partly covered over by an abnormal development of the semilunar plica or fold of the palpebral conjunctiva.
Pupillary Foramina.—The two foramina of the pupils ought to be equal in size, circular and with a clearly marked contour. But under various conditions of age and ill health the size as well as the equality of the pupils may vary.
As regards the size of the pupils:
When the pupillary foramina are too small, this constitutes miosis—a condition frequently found in certain serious nervous diseases (locomotor ataxia, paralytic dementia), and in chronic opium poisoning; it is frequent in meningitis. In old persons miosis is a normal condition.
When, on the contrary, the foramina of the pupils are too large, this constitutes mydriasis (poisoning from atropine, intestinal diseases, etc.).
In addition to these, there is anisocoria, when the two foramina are unequal (neurasthenia, chronic alcoholism, first stage of paralytic dementia).
Form of the Pupillary Foramen.—It is not always round, sometimes it is oval (cat's-eye). Frequently the form of the pupil is permanently altered as the result of a surgical operation.
Thus, the contour of the pupil may be broken instead of clear cut; in verifying this phenomenon it is important to inquire whether the subject has suffered from any progressive disease of the iris, such as might produce the same condition.
Anomalies of the Ear.—While in the case of animals the external ear is greatly developed, movable and detached from the cranium, in man it is reduced in size, immovable and attached to the cranium. Two measurements are taken of the ear, the length and the width, and by means of the usual formula we obtain the index of the ear, which for the European race is about 54 per cent. This index has a certain importance because we find that the proportion of width to length steadily increases as we descend through the inferior human races, down to the ape, and the same increase continues if we descend through the different grades of the simian order.
This is to a large extent a result of the fact that, in the descent from man to ape, the lobule of the ear, which is essentially a human form, steadily diminishes, until it finally disappears.
From this it may be concluded that there exist minute zoological differences other than generic between man and animals. As to malformations of the human ear, which may consist of shortness or absence of the lobule (formerly interpreted as a simian inheritance) they are to-day attributed to physiological causes. An abundant circulation produces an ample and fleshy lobe; in oligohæmic constitutions (deficiency of blood) the lobe is delicate, pale and even atrophied. Brachysceles often have a big lobe, and macrosceles, predisposed to phthisis, often have no lobe.
In regard to the external ear we should observe:
1. Symmetry.—The ears should be symmetrical:
a. In respect to their position.
b. In respect to the more or less pronounced divergence of the ears from the cranium.
c. In respect to their form.
a. Position.—We must look for this form of asymmetry by observing the cranium according to the occipital norm. The asymmetry may be caused by one of the ears being placed too high up or too far back in respect to the other, or both asymmetries may occur together.
b. The asymmetry due to divergence is observed from two norms, the facial and the occipital.
c. Asymmetry of form is perceived by observing successively the two external ears according to the lateral norms; their morphological aspect should correspond on the two sides.
2. Anatomy and Malformations of the External Ear.—A preliminary anatomical note is necessary. The external ear consists of various parts, which were first studied and named by Fabricius of Acquapendente:
Instances may be found of malformation of each and all of these various parts of the ear, which may be excessively developed, or almost wanting, or altered in form.
The Helix.—The over-folding of the cartilage may be wanting, leaving the margin of the auricle straight; this form is met with in the Mongolian race, but among us it is a malformation (Morel's ear). It is a more serious malformation if it occurs combined with excessive development of the Darwinian tubercle; in this case the auricle assumes a really animal-like aspect ("canine ear").
The helix may originate within the concha from a root so prolonged that it divides the concha itself into two parts, an upper and a lower.
The helix may be greatly developed and sharply divergent from the cranium—handle-shaped ear; or it may be bent at an angle at the upper outer margin—embryonal ear.
The lobule is, as we have already said, an essentially human formation, and as though man were conscious of this fact and proud of it, it is customary in all races to adorn it with ear-rings, to such an extent that in India and in Cochin-China the lobe is burdened with ornaments of great weight, in consequence of which it has continued to develop until it almost touches the shoulder.
The lobule may be attached to the cheek (sessile lobule).
The antihelix may be so developed as to rise in front of the helix—Wildermuth's ear.
Another important malformation connected with the ear, which is commonly found in idiots, is a prolongation and restriction of the intertragical fossa into a fissure (fissura intertragica). The tragus ought normally to exceed the antitragus in dimensions.
Anomalies of the Nose.—The nose presents very numerous individual varieties, even among normal individuals. In the European race we distinguish the straight nose (Italian), the aquiline, the retroussé (French), the sinuous, etc. But in all these forms one characteristic remains more or less constant: the aperture of the nostrils is long and narrow, or rather its length exceeds its width (the nostrils are thin and mobile, the skeleton of the nose projects above the plane of the face). In the other races of mankind, on the contrary, two other types of nose are distinguished in respect to this characteristic: 1. The aperture of the nostrils is round (the nostrils themselves are fleshy, the base of the nose somewhat flattened)—mesorrhine nose, characteristic of the Mongolian race, and found repeatedly in mongoloid idiots; 2. the aperture of the nostrils is broadened, i.e., the width exceeds the length (the nose is flattened and almost level at the base, and furrowed for the most part with transverse wrinkles, the nostrils are exceedingly fleshy and immobile)—platyrrhine nose, peculiar to the African and Australian races. Corresponding to the external form of the nose there is also a difference in the skeleton in relation to the piriform aperture and the naso-labial duct; the external form of the nose is really dependent upon the skeleton consequently, the above-mentioned nomenclature applies also to the piriform aperture of the cranium (see Skeleton of the face). The flat nose is found as a malformation in idiots, and is usually accompanied by prognathism.
Other important malformations relating to the nose are the development of a tubercle at the tip—trilobate nose, frequent in low types of idiots; and the tip of the note bent sideways (usually toward the left); this form occurs in leptorrhine noses and is considered to be a stigma of criminality (thieves).
Anomalies relating to the Buccal Apparatus.—Malformations occur in relation to the lips, the teeth, the tongue and the palate.
The Lips.—The European type of lips is well known both as regards their proportions and their lines of contour which determine the distinctive form.
Sometimes this graceful modeling is wanting; the contour of the lips is formed of almost horizontal lines, the oral aperture is very wide, and has the appearance, especially when laughing, of being edged by a perfectly uniform, narrow line, thus resembling the mouth of a monkey.
At other times we meet with thick, fleshy lips, slightly pendulous, like those of the black races, especially the Hottentots and Australians; it is a malformation frequent among idiots, and occurs together with prognathism and the flattened nose.
Another notable form is that in which the lips are not only thick and fleshy, but the internal tissues are so abnormally developed that they protrude from the oral orifice in a slight prolapsus; this form of lips is quite characteristic of myxedematous idiots. Finally, we may meet with the so-called hare-lip, or lip divided in the middle, signifying an arrest of embryonal development and frequently accompanied by a cleft palate and a double uvula (see Development of the face).
The Teeth.—There is nothing new to tell of the characteristic forms of the teeth—the incisors, the canines, the premolars, and the molars—nor of their regular placement in a single row corresponding to the curve of the maxilla and the mandible. I shall therefore merely give the two dental formulæ corresponding to the two dentitions of man.
First dentition, or "milk teeth":
2—2 1—1 2—2 = 20 teeth –—– –—– –—– 2—2 2—2 2—2 incisors canines premolarsSecond or final dentition:
2—2 1—1 2—2 3—3 = 32 teeth –—– –—– –—– –—– 2—2 1—1 2—2 3—3 incisors canines premolar molarsIn relation to the teeth there are a great number of anomalies which may occur, in number, in position, in size and form, and these anomalies are so frequent that we may say the smile stigmatizes the degenerate. Frequently it is the most evident stigma of the whole face; so much so that this same smile which adds so much charm to the normal human countenance becomes ugly and repulsive in degenerates.
Anomalies in Number of Teeth.—Sometimes there are more than 32 teeth, owing to the presence of certain supernumerary teeth; these will be found to occur most frequently in the case of the canines, next in that of the incisors, and lastly in that of the premolars.
Fig. 132.—Mongolian eye.
Fig. 133.—Embryonal ear.
Fig. 134.—Decayed teeth.
Fig. 135.—Worn-down teeth.
Fig. 136.—Example of a worn-down tooth.
Fig. 137.—Handle-shaped ears.
Sometimes the number of teeth is less than 32, in which case it is necessary to distinguish two cases of very different significance: First, the last molars ("wisdom teeth") may be wanting; secondly, some of the other teeth may be wanting (incisors, canines, or premolars). The last molar is of no use whatever to man, because it does not enter into the service of mastication, and it is tending to disappear. We may even predict that the day is coming when mankind will no longer have wisdom teeth, and the human dental formula will be as follows:
2—2 1—1 2—2 2—2 = 28 teeth –—– –—– –—– –—– 2—2 1—1 2—2 2—2 incisors canines premolar molarsThe absence of useful teeth, on the contrary, is a grave sign of degeneration, and one which leaves wide spaces between two adjacent teeth (wide diastemata).
The diastema, or space left between adjacent teeth, is of great importance.
There are various causes for this stigma. Besides the one already mentioned, due to congenital absence of a tooth (broad diastema), another recognized cause is an anomalous placing of the teeth (narrow diastema). The significance of this is not always the same: for example, the diastema between two upper incisors indicates a very slight anomaly of embryonal development, and, some people
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