IN THE VOLUNTARY MUSCLES. 245 



so. The whole of the sternal and costal portions of the left pectoralis major muscle were 

 deficient ; but its clavicular origin quite normal. The pectoralis minor was wholly absent ; 

 not a vestige of it to be seen. The serratus magnus muscle was also for the most part defi- 

 cient, its two superior digitations only being present. The thoracic vessels were present, but 

 very small, supplying the intercostal spaces. The anterior and middle thoracic nerves from 

 the axillary plexus were not found ; but the posterior, or respiratory of Sir Charles Bell, was 

 present, and distributed to that portion of the serratus magnus muscle which existed. In the 

 left hand the middle phalanges were absent in all the fingers ; except in the middle finger, 

 where a ring of bone, a quarter of an inch in length, supplied its place. The web between the 

 four fingers extended to the first phalangean articulation ; so that only one phalanx remained 

 free on the distal extremity of each finger. In this case it will be observed the defects were 

 not strictly limited to the muscular system. 



I am indebted to my brother, Mr James Paget, for the particulars of another case, about 

 which he was consulted not long ago. The muscular defects resemble those of Mr Poland's 

 subject. My brother's patient is 15 years old, son of healthy and well-formed parents. He is 

 tall, lean, slim, but strong-limbed and in all respects well-formed everywhere, except on the 

 right side of his chest. Here, without any defect of the skeleton, there is a complete absence 

 of the sternal part of the pectoralis major, of the whole pectoralis minor, and of the serratus 

 magnus. No deformity attends the defect, except that the right side of the chest looks thin, 

 bare and very lean ; and the inferior angle of the scapula projects backwards. All the other 

 muscles connected with the chest and with the scapula are well-developed, the deltoid remark- 

 ably so. The movements of the right arm are as strong and free as those of the left, with one 

 exception — that, namely, of drawing the arm across the front of the chest, as in folding the 

 arms or in clasping. This movement is comparatively weak : but the strength of the deltoid 

 seems enough to compensate for all the other movements usually performed by the muscles 

 that are here wanting. The integuments and all the other structures in the seat of the defect 

 appear quite healthy. The defect was congenital. 



It will be observed that in the last three cases the muscular defect occurred on one side 

 only : in my own cases the defect occurred symmetrically on both sides. 



All the cases which I have thus related illustrate the very interesting and suggestive fact, 

 that varieties in muscles are most frequent in parts of which the office is different in different 

 animals — as in the pectoral muscles, which serve for climbing, burrowing, flying, or swimming*. 



My brother has suggested to me that these cases have additional importance in the fact 

 that they probably exemplify the simple and primary defect of muscles, and herein concur 

 with many recently ascertained facts in shewing that muscles are much more often primarily 

 affected with disease and defect than has hitherto been supposed. He thinks that it has been 

 too common to regard all affections of muscles as secondary to those of their nerves. This is 

 a subject of much interest and importance, and any evidence bearing upon it must be valued 

 accordingly ; but the evidence can be only of the probable kind in cases in which we have -no 

 means of ascertaining with certainty whether the nerves are, or are not, defective. 



• M'Whinnie On the Varieties in the Muscular System of the Human £o(2y.— Medical Gazette, Jan. 30, 1846. 



