BODILY DEFORMITIES IN GIRLHOOD. 323 



family doctor and the sang-froid of the general practitioner who 

 meets the difficulties hy the administration of a few doses of steel and 

 quinine and rest in the recumbent position ? 



No deformity of a child's body gives rise to so much alarm to par- 

 ents, or is the subject of greater diversity of treatment among medi- 

 cal men, as lateral curvature of the spine, and this is due, I believe, 

 to an imperfect acquaintance with its origin. Specialists are accus- 

 tomed to treat lateral curvature, knock-knee, and flat-foot as distinct 

 deformities, while in truth they are all links in the chain of one de- 

 formity. Lateral curvature may arise in different ways, but in all 

 cases it is due to the loss of the lateral balance of the body in the up- 

 right position, and is the result of an effort of nature to maintain the 

 center of gravity of the body and support the head and shoulders in 

 the position which requires the least expenditure of muscular effort. 

 The paralysis, wasting or loss of a limb, or the shortening of one of the 

 legs by disease of joint, rickets, knock-knee, or flat-foot in growing 

 children, will produce lateral curvature, and these are its chief if not 

 its only causes. It is not a deformity arising from general debility, 

 and I do not think it can be produced, as is often asserted, by an 

 awkward sitting position, as in writing and other school occupations. 

 The curvature of the spine which results from these causes is antero- 

 posterior, or what is commonly called round-shoulder (non-carious). 

 The tendency of debility, whether local or general, is to bring the 

 body into the prone or recumbent position, and not to tilt it on one 

 side. 



Setting aside the cases of lateral curvature in children who have 

 been affected with rickets, disease of joints, paralysis or loss of a limb 

 in early life, and which affect both sexes and all ages equally, what 

 may be called the idiopathic or acquired deformity is rarely found in 

 children of either sex under the age of nine or ten years, and very 

 rarely in boys above that age. It is, indeed, almost peculiar to girls 

 verging on puberty, and is as often found in strong and healthy as in 

 weak and delicately built girls, and most commonly in those who are 

 too fat and heavy for their stature and age. It is a deformity wdiich 

 is less common among the laboring classes than among the rich and 

 well-to-do, and is largely associated with a life of indolence and 

 luxury. 



A careful examination of the subject has satisfied me that this ac- 

 quired lateral curvature in girls is due to the change in the position of 

 the lower limbs, resulting from the development of the pelvis from 

 the infantile to the female type a year or two before the accession of 

 puberty. Any one who will examine the figures of young children 

 below this age will find little differences between the two sexes. The 

 legs of young girls are set on the body like those of boys, and, within 

 the limits of their training and dress, they can run as well and as 

 gracefully as boys ; but as puberty approaches, and the pelvis alters 



