THE PHYSIOGNOMY OF PAIN ILeonardo da Vinci, in his celebrated treatise on painting, in speaking of the difference between laughing and weeping, says: 'In eyes, mouth, and cheeks there is no difference between one who laughs and one who weeps. They are distinguished from each other only by the position of the eyebrows, which contract during weeping, while in one who laughs they are drawn upwards. He who weeps raises the eyebrows at the inner corners, draws them together, wrinkling the skin above them, and turns the corners of the mouth down, while one who laughs draws the corners of the mouth upwards, and has an open, uncontracted brow.’ With these words da Vinci shows the characteristic expression of the face in laughter and in tears; but the physiologist is not content with what satisfies the artist, he seeks the cause and origin of the phenomena, analyses the reason of the difference and similarity in the expression of laughing and weeping, joy and pain. The impetus which Herbert Spencer and Charles Darwin gave to the study of human nature was so powerful, the progress made so rapid, and the new horizon so vast, that numerous philosophical and scientific books at once became obsolete; and when we now turn over their leaves, we seem to feel the breath of decay, as though we were groping amid the ruins and dust of edifices that have crumbled for centuries. The study of nature was much easier for the spiritualists and philosophers of the old school than for us, because with little trouble they found reasons which satisfied them, and in their faith they had a strong bulwark that sheltered them from the uncertainty and doubt which follow us everywhere as we grope deeper and deeper, trying to find out the causes of things. Duchenne de Boulogne, in his well-known book on the mechanism of human physiology, printed in 1862, still maintains that the facial muscles were created for the expression of the soul. 'Le crÉateur n’a donc pas eu À se prÉoccuper ici des besoins de la mÉcanique; il a pu, selon sa sagesse, ou—que l’on me pardonne cette maniÈre de parler—par une divine fantaisie, mettre en action tel ou tel muscle, un seul ou plusieurs muscles À la fois, lorsqu’il a voulu que les signes caractÉristiques des passions, mÊme les plus fugaces, fussent Écrits passagÈrement sur la face de l’homme. Ce langage de la physionomie une fois crÉÉ, il lui a suffi, pour le rendre universel et immuable, de donner À tout Être humain la facultÉ instinctive d’ex 'Il Était certainement possible de doubler le nombre des signes expressifs de la physionomie; il fallait, pour cela, que chaque sentiment ne mÎt en jeu qu’un seul cÔtÉ de la face. Mais on sent combien un tel langage eÛt ÉtÉ disgracieux.’ According to Duchenne de Boulogne all passions have a special muscle at their service, which enters into activity in order to express the feelings of the mind; benevolence, joy, laughter, sadness, attention, reflection, lasciviousness, irony, contempt, fright, cruelty, pain, weeping, appear on the human countenance each through the medium of a muscle possessing the privilege of representing a particular emotion. Duchenne de Boulogne certainly went rather far with his theory of localisations. He treated the face as Gall did the skull and brain. Classifications of mental faculties are too artificial, being derived from an abstraction based on facts and phenomena neither distinct nor definable. Gall wished to localise, so to speak, the metaphysical and theological faculties of the mind in the different parts of the brain, and invented the phrenology which made him famous. But in none of his writings is there any penetration to the real origin of facts. He let his imagination and, IIDarwin reduced the principles on which the expression of the emotions depends to the following three:
According to Darwin the expression of pain depends essentially on the first and third of these principles. He assumes, indeed, that in all animals, in the series of innumerable generations, intense pain has produced the most violent and diverse movements in order to escape its cause. As the muscles of the thorax and of the vocal organs are those most habitually used, they were called more particularly into action, and animals began to make sounds, to howl and to screech. Darwin believed that vocal sounds were useful to animals, particularly to the young and to those living in community, because in case of danger the cries serve to call the parents or to warn the other animals. These opinions of Charles Darwin open up a wide field for discussion, The movements of the facial muscles depend, according to Darwin, on the constitution of the nervous system. We must remark, however, that Darwin took this idea from Herbert Spencer, who, a few years before Darwin published his book, had written a chapter in his 'Principles of Psychology’ entitled 'The Language of the Emotions.’ Darwin recognised the priority of Herbert Spencer, and I think it advisable to quote a passage from his book, 'The Expression of the Emotions,’ so that the reader may become acquainted with one of the most important pages published on the subject of which we are treating: 'As Mr. Herbert Spencer remarks’ (says Darwin on p. 71), 'it may be received as an “unquestionable truth that, at any moment, the existing quantity of liberated nerve-force, which in an inscrutable way produces in us the state we call feeling, must expend itself in some direction—must generate an equivalent manifestation of force somewhere”; so that, when the cerebro-spinal system is highly excited and nerve-force is liberated in excess, it may be expended in intense sensations, active thought, violent movements, or increased activity of the glands. Mr. Spencer further maintains that an “overflow of nerve-force, undirected by any motive, will manifestly take the most habitual routes; and, if these do not suffice, will next overflow The simplicity of this theory is seductive, but it suffices to subject it to a superficial examination in order to see that it does not quite correspond to the facts. If we find out which are the most habitual routes of nerve-force, and write them down in order one after the other, and then compare them with the movements expressing the passions, we shall see that there is not a perfect correspondence. It was perhaps for this reason that Herbert Spencer afterwards introduced the idea of the nervous lines of least resistance, in order to explain the greater facility with which certain muscles contract, compared to others. 'The molecular motion’ (says Spencer) 'disengaged in any nerve-centre by any stimulus, tends ever to flow along lines of least resistance throughout the nervous system.’ The solution of the problem was thus removed to the domain of experimental physiology. The question now is, whether in reality the muscles most commonly in use are those which have nerves offering less resistance, or whether the nervous excitement hidden in the centres is sufficiently strong to allow the resistance made by the nerves to its passage towards the muscles to be disregarded. Spencer and Darwin gave no proof of their statements, so that it devolves upon us physiologists to discover experimentally whether the intuition of these great philosophers is correct. Darwin was, as usual, very cautious, and in Chapter III., in which he treats of the general principles of expression, after having mentioned the above theory, says: 'Our present subject is very obscure, but, from its importance, must be discussed at some little length; and it is always advisable to perceive clearly our ignorance.’ IIII made a few experiments in order to see whether in reality, as Spencer assumes, there exists a difference of conductibility amongst the various nervous filaments which move the muscles of the face, and which, as we know, are united into one bundle called the facial nerve. I irritated this nerve at its point of departure from the skull, and near the ear, where it is most easily isolated. There is no need to describe the process of irritating the nerves by electric currents. Galvani began in the last century to produce contractions of the muscles by means of electric currents originated by the contact of two metals; and we all know that the contractions of the legs of some skinned frogs, observed by Galvani in Bologna while he was hanging them on the iron railings in his garden, were the beginning of one of the greatest conquests of science, and one of the dis The apparatus made use of to irritate the nerves is an invention of Professor Du Bois-Reymond. Many who are not physicians will yet know the apparatus, which is often used in the cure of diseases by electricity; its greatest advantage consists in the facility with which the intensity of the electrical stimulus may be increased or diminished. After having produced such a profound sleep in a dog by means of chloral that he was insensible, I tried to irritate the nerve which moves the muscles of the face by a very weak electric current. At first the current was so weak that no effect was visible, but as it was increased, a slight contraction of the cutaneous muscle of the neck appeared, and a little movement at the corner of the mouth. It might perhaps be of use to explain here how, in the muscles situated under the skin of the neck, other facial muscles originate, amongst others the so-called risorial muscle; but in order not to interrupt the relation of this experiment, I shall reserve these remarks till the beginning of the next section. The intensity of the electric current when the slight movement of the mouth appeared was equal to 400 units. If the current is increased, the movement of the lips becomes more apparent, and when the electric irritation of the facialis reaches the intensity of 700, a contraction of the orbicular muscle of the eyelids I obtained the same results with the animal soon after death. These experiments show that Herbert Spencer’s hypothesis is correct; but we shall presently see that the matter is exceedingly complicated, and that we must take into account other factors no less important in the expression of the face. IVThe muscles of the face have certainly not the office, as Duchenne de Boulogne thought, of expressing the passions of the soul. To speak frankly and without sentimentality, pedantry, or conventionality, we must recognise that the most important feature of the face is the mouth, and that the mouth is a funnel of flesh attached to the alimentary canal. Sometimes it only serves to seize the prey and receive the food before sending it to the stomach, as is the case in fishes, One of the most curious things discovered by anatomists is, that many muscles of the face, of great importance in the expression of the emotions, were originally, that is, in the inferior animals, muscles serving a very different purpose. I shall develop this fact briefly, so that the reader may see how difficulties continually increase the nearer science approaches to the origin of things. We all know that the hedgehog rolls itself up on the approach of danger, its body having the appearance of a ball covered with bristles. This movement is executed by means of a muscle under the skin which covers nearly the whole body, and which contracts in a similar manner to a bag drawn together by a string. Many other animals are similarly furnished with a fine muscular layer which covers the body. In the mole, for instance, this muscular system is well developed. Amongst domestic animals we may mention the dog, the cat, and the horse, in which, although these layers of cutaneous muscles are less compact, they are still sufficiently developed to be noticeable when they enter into action. We have all remarked the rapid twitching of the In all higher animals the traces of organs exist, which remind us of our kinship with the lower animals. Sometimes these organs retrograde from want of use, at other times they remain in existence but fulfil a very different office, and one always much less useful than the original one. Thus the cutaneous muscles still exist under the skin in many parts of the human body, as an inheritance and a sign transmitted to us by generations of animals that have preceded us on the earth. But the contractions of these muscles are no longer of any actual use. When the nerve-force in emotion spreads from the centre towards the periphery, these muscles, from their position in the skin, produce effects which are more easily seen than in other parts of the body, but which serve no effectual purpose in the struggle for existence and in the preservation of life. In the dog and cat, for instance, the contraction of these muscles in strong emotions causes the erection of the hair on the back, and gives the animal the characteristic expression of attack or defence, of fear or pain. In man, on the other hand, a forcible contraction of the cutaneous muscles of the neck which extend under the From Ehlers’ observations on the facial muscles of the gorilla and chimpanzee, we learn that these animals have the same muscles of the face as we have. Ehlers maintains that the statement made by certain authors is not true, namely, that the single fasciculi in the muscular system of the face of these animals are less thick and compact than in man. Only the wrinklings of the brow are less developed, and the muscles round the eye are finer, while those distributed to the nostrils and lips are more highly developed. It is not true that laughing and weeping are exclusively human. One need only observe attentively the face of a sensitive and faithful dog in order to see the first traces of expressions betraying an altered state of the nervous system. In joyful emotion, as, for instance, when he meets his master, the lips are lifted in such a manner as to uncover the teeth, the head inclines in a caressing attitude, the rhythm of the respiration is modified, and the eyes glisten. Notwithstanding the difference of anatomical structure and the wide dissimilarity of parts, we can yet trace in the dog the rudiments of those involuntary muscular movements which attain Darwin wrote many interesting pages about the way in which monkeys laugh. Humboldt observed the eyes of a monkey fill with tears when it was overcome by fear, and Brehm relates that seals weep with pain, and that young elephants when ill-treated shed tears as abundantly as man. VTheir reasons why changes in the psychical state are reflected are numerous with such facility by the muscles of the face. Besides that of proximity to the nerve-centres propounded by Spencer and Darwin, there is the anatomical fact that the facial muscles have, for the most part, no antagonists. We know that in the hand, for instance, a slight contraction of the muscles which serve to open the hand and extend the fingers, is opposed by the action of the flexors which bend and contract the fingers. In the face the majority of the muscles can act freely, hence a slight nervous shock produces effects far more intense than in the other muscles of the body, in which the slight contraction of muscles acting in a contrary sense must always be overcome. The muscles of the face are also more delicate, and have less volume than those of other parts of the body. Another anatomical fact of the greatest importance, brought into prominence by Meynart, is to be found in the origin of the facial nerve within the brain. All other nerves have a very intricate course, and are connected with other cells, and other nerve-filaments, which constitute the cerebral convolutions; the facial nerve only receives commands directly from the central parts of the brain and transmits them by the shortest route to the periphery. If I may allow myself to make use of a comparison, I should say that the facial nerve is like a telegraph wire, which transmits the messages directly to their destination, while with the other nerves the messages are sent successively from one station to another, consequently they pass less rapidly from the brain to their destination in the muscles. The investigation of that part of the brain whence are issued the commands causing the contraction of the muscles, the accurate, microscopic examination of the cells which, by their activity in the deep parts of the brain, produce the expression of the physiognomy, is a new and important study. An American anatomist, Mr. Edward Spitzka, There is a lower nucleus, the cells of which preside over the respiratory movements and the expression of the emotions, and an upper nucleus directing the orbicular muscle of the eye. While the latter presents very few variations when studied in different animals of the zoological series, the lower nucleus of the facial nerve, on the other hand, varies considerably, according to the development of the other muscles of the face. In reptiles, for instance, the nucleus of the facial nerve which goes to the eye is well developed, while the lower nucleus is in a retrograde condition. In birds, which, like reptiles, have no muscles giving expression to the face, this mass of cells forming the lower nucleus is entirely lacking. In the elephant, on the other hand, the lower nucleus is well developed, because the nose is a complex organ requiring a special group of nerve-cells and nerves in order to act. Spitzka’s anatomical researches having shown that the lower nucleus of the facial nerve reaches its maximum development in the monkey and in man, we must regard it as very probable that the nerve-cells which we see at this point in the brain, at the lower origin of the facial nerve, are really those which produce the expression of the physiognomy. As I write this, I have before me a very thin section of the brain, showing the nucleus of the facial nerve as it appears in man. It is a gray spot, as large as the head of a small pin, slightly spindle-shaped, and having a volume of about two cubic millimetres. If we look at it under the microscope we see nothing but an accumulation of cells, about the five-hundredths of a millimetre in diameter, and with delicate branches intertwining with each other. In vain the eye tries to find a path through this intricate network of filaments and cells; imagination loses itself as in a labyrinth, and we remain humbled and almost frightened at the thought that we are contemplating the corpse of the noblest part of the brain. The activity of these cells has roused the most powerful emotions of our life: our knowledge of men, our sympathy, indifference, suspicion were provoked by the movements which they gave to the faces of those we have known; friendship, affection, and the most holy joys of life brightened our countenance with a smile which came from these cells; they, again, diffused the shadow of sadness, pain, and tears—and all this drew life from a part of the brain so minute that by a mere touch we could unconsciously crush it. VIThe greatest difficulties in the study of the alterations which the human face undergoes in suffering are essentially two in number. The first is the rapidity and the perpetual restlessness of muscular movements, For this reason I made use of instantaneous photographs in studying the expression of the face. The first experiments were made on a few friends and on myself. Pain was produced by introducing the fingers between five pieces of wood, which were then pressed firmly together. This pressure may become unbearable, but the expression of the face is less characteristic than we are accustomed to see in suffering people. In oppression and fear there is not generally that effort of will which subdues the reflex movements in voluntary pain. Tears, agitation, spasms, terror, faintness, which appear in the terrible reality of nature, can only be studied in actual sufferers. I had therefore to leave my laboratory and continue my investigations in the hospitals. I owe thanks to my colleagues in Turin who assisted me during these researches, and allowed me to place my In this way I have made an album of pain. It is a saddening and terrible book, from which I take only two pages, reproduced in Plates I. and II. Their reality is represented in it with such vividness that one shudders on opening it. No artist’s fancy has ever been able to imagine or express what photography faithfully reproduces. In acute stages of suffering the human face inspires fear in one contemplating it; it is not alone the profound commiseration which we feel for the anguish of a sentient being which moves us, nor the humiliation which the sight of human misery awakes in us, but also the selfish thought that this palpitating flesh might be our flesh, that our soul, shaken with pain, would also forget its tranquillity, and our tortured nerves wring from us the same cries and the same tears. The pictures which I reproduce were taken in the Mauriziano hospital in Turin, and represent a boy, eighteen years of age, who had received a wound on his elbow which had healed badly, rendering the joint I shall not attempt to describe these pictures, because I feel sure that no words of mine could express the transformation which the human face undergoes in pain. Even had I the talent and the pen of a great artist or a great writer, I should yet refrain, for I know that every description is useless, pale, and vague when confronted with reality. Instantaneous photographs are the best means of showing how even the greatest painters and sculptors have fallen far short of reality, in their representations of the spasms and sufferings which disfigure and distort the human face. VIIThe expression of pain alters according to age; it is different in the child, the youth, the adult, and the old. Energy of will or weakness of character also exercise a profound influence upon it. I have been present at surgical operations, and have performed them, on persons who refused to be chloroformed, and have noticed how great was the difference of conduct. An old officer, who bore the operation of lithotomy without anÆsthetics, only clenched his hands But none, whatever be the strength of will, succeed in suppressing completely the expression of pain when intense. Only very energetic persons succeed in preserving immovable the muscles of the face, while they discharge the activity of the nervous system into other muscles by tetanic contractions. We may say that every malady has its peculiar expression of pain. Often, by merely looking at the patient and hearing him moan, the physician can tell which are the affected organs. This study is very much complicated because of the rare occurrence of simple sensations of pain. Our states of mind are so variable and so complex, that the expression of the face is, as it were, the result of numerous factors. To be convinced we need only think of the touching sight of a woman about to become a mother. Notwithstanding the pangs that torture her, in spite of the indescribable agony of the most intense pains to which human nature is condemned, she yet finds a smile which expresses the hope of surviving, and the joy of motherhood shines in the Italian literature can boast of two very valuable books on the physiology of pain. The first was written by Professor Filippo Lussana in 1860, and dedicated to Dr. Paolo Mantegazza, 'who was writing his celebrated “Physiology of Pleasure” when the joyous spring of his twenty-second year smiled upon the author.’ Twenty years later, in 1880, Paolo Mantegazza also published a valuable book on the 'Physiology of Pain.’ The merits of this book are great, and it is perhaps one of his greatest achievements in the field of physiology, but science has since made such rapid progress, that it would be well if a third volume were added to the group, developing the anatomical and physiological part, illustrating by instantaneous photographs the most characteristic movements and expressions of pain, and subjecting to a severe criticism the most celebrated pictures and statues of the various schools. I cherish the wish that Paolo Mantegazza, who was my master, and one of the greatest popularisers of science, may find time to complete and rejuvenate his work, for who else would find courage to take a place at his side, and to glean where he has reaped? VIIIThe art of the future, comprising all visible nature within its limits, will find a great and terrible potency of effect in the expression of pain. The difficulties, I believe that, with the advance of a scientific criticism nurtured on an accurate knowledge of physiology, and intimately acquainted with the functions of the muscles, we shall one day recognise that the Greeks of the epoch of Phidias and Praxiteles were unequal to the effectual reproduction of violent passions. Winckelmann said that Greek art was always tranquil and majestic, like the depths of the sea, which remain immovably calm, however the tempest may ruffle the surface. But I fear there is some exaggeration in the statement that beauty was the only law of Greek art, and that the Greeks shunned the expression of pain because the sight of suffering excites disgust in the spectator. Sophocles and Homer believed in an art of wider limits; they made their heroes weep, and shriek, and groan; all human weaknesses are faithfully represented by them, descending even to the grotesque and ridiculous. At the epoch of Phidias monuments vividly expressing the internal passions of the soul are rare. It was only later, in the time of Praxiteles and Scopas, that subjects and compositions of greater effect were attempted. The most ancient monument of pain, Some great artist—perhaps Praxiteles or Scopas—wished to adorn the temple of Apollo with this terrible picture of revenge taken upon man by an offended deity. It is Niobe, the daughter of Tantalus, who, proud of her children, dared to compare herself to the mother of Apollo, and now sees them killed one after another, shot by the revengeful arrows of Apollo and Artemis. No subject could be more tragic. The first time I entered the 'Galleria degli Uffizi’ in Florence, I remember halting, almost afraid, at the door leading to the hall of the Niobean group, thinking of the heart-rending scene I was about to see, and of the emotion which I should feel while contemplating one of the most celebrated productions of Greek art. I confess that it did not produce the effect which I had imagined, and that a careful examination of the statues forming the group resulted in a great disappointment. Only the mother filled me with emotion, so perfect It was in the schools of Asia Minor, after the time of Alexander, in Pergamos and Rhodes, that antique art, before it became extinct, developed its greatest splendour, showing an irresistible tendency to the The discoveries which have been made of late years in the excavations in the Acropolis of Pergamos have restored to the admiration of centuries treasures which mark an epoch in the history of plastic art, and throw a vivid light on the last phase with which Greek art completed its evolution. Works so moving as those of the sculptors of Pergamos had never been produced before. Art devoted itself entirely to the embodiment and representation of physical pain in its innumerable manifestations, as though the observation and experience of suffering, the study of the pathetic, having accumulated for centuries in the mind of artists and people, burst Brizio, in his 'Studies of the Laocoon,’ speaking of the school of Pergamos, says: 'After an exhaustive examination of the statues in the museums of Naples, Venice, Rome, and St. Germain-en-Laye, not only the intention of the artists becomes evident, but also the pleasure they took in representing with the greatest perspicuity the death of combatants with all the torture and agony preceding it. In none of the monuments A further step in the representation of physical pain is marked by the sculpture of the 'War of the Titans’ around the altar of Jove. When we throw a comprehensive glance on these scenes of the battle between gods and giants, we are struck by a new and horrible phenomenon—namely, the part which the animals, tearing the human bodies to pieces, take in it. Anyone contemplating in the Museum of Berlin the figures in haut-relief which formerly adorned the plinth of the altar at Pergamos, 135 metres in length, feels that this is perhaps the most imposing work which sculpture has ever produced. Art was in full possession of its most potent means, and more advanced science had contributed its part. It was by a most minute study of details, by an exact knowledge of the movements of the muscles, and long practice in |