• #2-4. Defining the Epicanthus and Two Letters from History


    May, 1860


    Dear Dr. J. Sichel in Paris, 


    My respected colleague, Dr. Sichel! In 1831, I wrote a paper on a relatively obscure facial deformity and named it epicanthus. I added detailed images of this condition as well as a safe treatment method called Rhinoraphe. Following publication of my paper, the awareness of epicanthus as well as its treatments became widely known in Germany. My paper was translated into different languages and now, the rest of Europe and even countries across the Atlantic are recognizing this facial deformity and are treating it. In a matter of just a few years, epicanthus has achieved a sort of 'Tour de Monde.' I have been collecting data from my research and others to perform a more extensive study on epicanthus. And I came across your critical paper on this matter. You have long been my trusted and respected colleague in the field of ophthalmology and your paper helped improve the hypothesis of epicanthus. You were like a great teacher that helped me improve my research. I will include a brief description of these results in my paper. I would like to dedicate this paper to you as an expression of my gratitude to your interest in my first paper on epicanthus and your help in getting the next generation of doctors interested in this topic. As I have greatly admired your work in ophthalmology, I truly hope that the next generation will pay attention to the new findings on this topic.  

    In this paper, I examined the etiology of epicanthus, races affected, its effect on countenance, and treatment. Our individual studies disagree on certain details but also agree on many aspects. I was able to fully or partially corroborate some of your new findings but I must say there were some that I could not agree with. These disagreements point out gaps in our knowledge which should be filled with more in-depth research. Although the history of epicanthus is short, new theories continue to replace old ones and drive toward scientific advancement through the process of doubt and proof and expansion and limitation. In the big picture, efforts to iron out the details will be the impetus that drives this advancement of research. Blind force alone will not complete the job. While humans work tirelessly, science goes through a long and winding road toward advancement.

    This paper mainly deals with congenital epicanthus. The other form of epicanthus, epicanthus acquisitus which involves Metopon epidermis which lies between the eyelid, nasion, and medial canthus, is discussed in Chapter 5. However, epicanthus acquisitus is a deformity and should be distinguished from epicanthus. I have named this condition “epicanthis” and wrote a short paper on its etiology and treatment including a case study. Epicanthis should be differentiated from epicanthus congenitus. So far, this condition was considered in the same category with epicanthus congenitus and this has caused misunderstanding and errors. I hope my paper inspires my colleagues and scientists to be interested in facial deformities such as epicanthus and epiblepharon and to continue research on this topic. Moreover, findings from such research should be compiled into racial research.  

    Pathoanatomical research on epicanthus and epiblepharon, particularly on susceptible skin structure, should be conducted to support initial findings. Moreover, cadaver study should be included to provide more accurate evidence on epicanthus and epiblepharon in various races. I admit that the historical discussion and literature review included to my paper, except for Fr. von Siebold’s study, are only anecdotal and lack the academic rigor in terms of anatomy or physiology. Only Fr. von Siebold examined these concepts from an anthropological perspective based on his travels. On the same note, I hope the scholars participating in the Preussen East Asia expedition take note of this! I am expecting Wilhelm Heine (from Dresden), the most well-known member of the Preussen expedition, will gladly examine the etiology of epicanthus (Epicanthische Bildung) in an ethnological perspective.



    Dr. V. Ammon in Dresden


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    I will discuss this in greater detail later, but Ammon refuted Sichel’s race theory on epicanthus in his paper published in 1860, and held up his initial opinion that epicanthus is a congenital malformation. However, a closer look at his correspondences and paper shows that Ammon was not unwavering in his conclusion but suggested the need for corroboration of the biological racism theory.

    Today, epicanthus is listed in ICD10 by World Health Organization (WHO) under Q10.3 other congenital malformations of eyelid. The first edition of International List of Causes of Death was adopted by International Statistical Institute in 1893. WHO started overseeing ICD6 starting in 1948 and now ICD is used in over 100 countries. Despite such worldwide recognition of epicanthus, it still remains an elusive anatomic, pathologic or racial concept.

    Outside medicine, epicanthal fold is an important issue in biological anthropology. Max Planck Institute for Evolutionary Anthropology’s 2016 publication mentions the following.

    “For both the epicanthic eye fold and for single eyelids, we don’t know the genetic basis for these traits, nor do we even know whether there was indeed positive selection for these traits, so all of this is purely speculative.”

    Currently, the etiology of epicanthus may be best described as inconclusive. 


    -To be continued

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