242 Dr. PAGET, ON INSTANCES OF REMARKABLE ABNORMITIES 



The maximum girth of the calves: — right 11 in., left 111 in. 



The girth of ankle 6^ inches. 



The length of leg from upper end of tibia to the sole of the foot was 12 inches. 



The enormous development of the calf is the more remarkable as the boy wore the highlows 

 so common among our agricultural labourers, in which thick soles, rigid upper-leathers and 

 tight lacing combine to prevent free movements of the ankle-joint and toes. 



It is probable that there were other defects in his muscular system, which (being more 

 deeply seated) could not be clearly made out by an external examination. The defects that 

 have been particularly described seem inadequate to account for all his failures in locomotion, 

 such as his want of power to lift up his feet so as to ascend a step in the ordinary way, and 

 his inability to get up when lying on the floor. In both these cases the immediate cause 

 seemed to be that he was unable to draw well forward, or flex, his thighs on the trunk. This 

 may have been a consequence of feebleness or absence of the psoas and iliacus muscles, but I 

 could not discern such a want of fulness in the groins as to make me sure that these muscles, 

 or either of them, were absent or very imperfect, like the pectoral muscles. 



If he leaned forward, resting with his hands on a table, he was quite unable to recover 

 the erect posture. This seemed to indicate a deficiency in the extensor muscles of his spine ; 

 but the chief failing must rather have been in his legs; for, in making the eff"ort to recover 

 the upright position, his knees became bent ; — and when this was prevented by firmly sup- 

 porting his legs, he was enabled, though with difficulty and effort, to" regain the erect posture. 

 The muscular masses situated along either side of the spine seemed sufficiently developed, as 

 far as they could be judged of by external appearances, for the mid line, in which the spinous 

 processes lie, was marked by the usual longitudinal depression. 



From his mother's statement it appeared that the defects dated from his earliest infancy, 

 and were probably congenital. Even when a child at the breast he had a tendency to fall 

 backwards : he was also weakly, and could not sit up in her arms like a healthy child. His 

 bowels were relaxed and irritable, so that ingestion of food was quickly followed by an evacua- 

 tion, and this lientery had not ceased until twelve months before his coming to the Hospital. 

 He was unable to walk until 2 years old, and even then had the tendency to fall, under which 

 he has ever since laboured, often falling forwards on his forehead, never saving himself or 

 breaking his fall, but not losing consciousness. 



His calves began to enlarge when he began to walk: before that time they were not of 

 immoderate size. 



He is extraordinarily wilful, obstinate and ill-behaved ; but it is probable that this is merely 

 the consequence of ill-judged indulgence by his parents, through pity for his physical infir- 

 mities. His education has been wholly neglected : — he was not sent to school, because other 

 boys in the village amused themselves by pushing him down, and leaving him on the ground 

 unable to rise. 



While he was in the Hospital his general health was good, pulse 96, bowels regular, 

 appetite hearty. He ate the full diet of an adult patient. He improved a little, but only a 

 little, in strength and power of locomotion. 



A brother, Thomas D., aged 9, was admitted into the Hospital at the same time, labouring 



