a** Dr. PAGET, ON INSTANCES OF REMARKABLE ABNORMITIES 



shoulder may tend to augment the size and tone of those of the forearm by throwing upon 

 them an unusual share of labour. A greater exertion of the muscles of the forearm is made 

 to compensate for the defective strength and activity of the upper arm ; and the former are 

 therefore augmented by the operation of the well-known law of the nutrition of muscles. 



Similar remarks would apply to the thigh and leg. The want of vigour in the thighs 

 would probably lead in a variety of ways to increased exertion in the muscles of the calves, 

 and therefore to an augmentation in their bulk, but I think the most potent cause of the 

 enormous development of the calves was the boy's peculiar carriage. 



In walking, his shoulders were drawn very far back, and the whole trunk leaned backwards. 

 This would have the effect of throwing the centre of gravity further back than is usual, so 

 that a vertical line through it would fall nearer to the heel, and further from the toes, than is 

 consistent with easy walking. As progression is mainly effected by the muscles of the calf — 

 raising the heel so as to throw forward the centre of gravity, which turns round the ball of 

 the foot, or toes, as a fulcrum — the effort required must be greater, if the body be so carried 

 that a vertical through its centre of gravity falls too far back. Increased labour would thus be 

 thrown on these muscles, and their bulk would in course of time be proportionally augmented. 



The throwing back of the shoulders seems a natural consequence of the defect in the 

 pectoral muscles, causing them to yield to the greater tonic power of their antagonists : and 

 in fact the scapulae were drawn very closely together, their posterior costae being remarkably 

 approximated. The leaning backwards of the trunk may have been due partly to this drawing 

 back of the shoulders, and partly to the feebleness of the psoas and iliac muscles, which 

 revealed itself in another way through the feebleness of his efforts to flex his thighs upon the 

 trunk. 



If these explanations be correct, the deficiency in .the pectoral muscles (or in the pectoral, 

 psoas and iliac muscles), occasioning the peculiar carriage of the shoulders and trunk, must be 

 regarded as the primary cause of the enormous enlargement of the gastrocnemius and soleus. 



The boys were removed from the Hospital on Sept. 6th : their mother being disappointed 

 at the small improvement in their condition. I have recently heard (after an interval of five 

 months) that the younger boy remains in the same state, but that the elder is certainly feebler 

 than he was when he quitted the Hospital. 



I am not aware that any precisely parallel case is on record ; but I am able to cite a few 

 which present a portion of the same features. Mr Quain mentions having observed, in the 

 dissection of a body, that the lower half of the costal portion of the larger pectoral muscle was 

 wanting, so that the smaller pectoral lay exposed to a considerable extent after the integuments 

 had been removed ^■■. 



A more remarkable case is published by Mr Alfred Poland, in the 6th volume of Guy's 

 Hospital Reports. The defect was discovered in dissecting the body of a man, of whom no 

 history could be obtained, except his being a convict, and that it had been remarked that he 

 could never draw his left arm across his chest : when asked to give his left hand, in order that 

 his pulse might be felt by anyone standing on his right side, he invariably turned round to do 



* Anatomy of the Arteries of the Human Body, bj Richard Quain, 1844, page 233. 



