XII. Instances of remarkable Ahnormities in the Voluntary Muscles. By G. E. Paget, 

 M.D., F.R.C.P., late Fellow of Gonmlle and Caius College. 



[Read March 8, 1858.] 



The rarity of such cases as the following induces me to communicate them to the Society. 



Joseph D., 10 years of age, son of an agricultural labourer at S., a village near Ely, was 

 admitted into Addenbrooke's Hospital, June 3, 1857. In stature and general bulk he was 

 a little below boys of the same age. He was not strikingly deformed, nor was there any want 

 of symmetry between his right and left sides. Yet he appeared ill-shaped and clumsy, and 

 even at first sight his figure was observed to be very peculiar, and his movements still more 

 so. In walking he carried himself in a strangely awkward manner, throwing his shoulders 

 very far back, and advancing his belly like a corpulent man : he walked flat-footed and 

 waddling, the whole side of his body being moved with evident effort at the advance of each 

 leg, the feet being raised higher, and knees more bent than is usual in well-made persons. 

 He could not run : when he attempted it, his movements were only a clumsy and feeble 

 acceleration of his walking gait, with all its awkwardnesses exaggerated. 



He often fell from slight causes, or without any obvious cause ; and when on the ground 

 was unable to rise : he was obliged to lie there until somebody raised him. When replaced 

 on his feet he was very liable to fall again, through a defect in the power of balancing himself 

 in an erect posture. He fell heavily and helplessly in any direction to which his body might 

 happen to incline, forwards, backwards or sideways, and often struck his forehead or occiput 

 against the ground. 



He was unable to get up a low step, such as that at the door of the Hospital, without 

 making use of his hands, and even with their assistance he had much difficulty in accomplishing 

 it. His mode of proceeding was this: — He first laid hold of the right door-stall with both 

 hands: and thus supporting himself, he swung round his left leg outwards and forwards, so as 

 to get that part on the step. He then, with a laborious effort, dragged his right foot after 

 him. 



He was unable to get into bed without the assistance of others. 



To get down a step (though only a few inches in height), he went backwards, as a man 

 goes down a ladder. 



When standing still, his spine, in dorsal as well as lumbar region, was bent with its con- 

 vexity forwards ; his shoulders were drawn far back ; his knees were turned inwards and 

 projected forwards. When seated, his whole spine was uniformly bent with its convexity 

 backwards, as frequently seen in children that are weakly or fatigued. 



On examining him carefully with the view of discovering the immediate cause of his weak- 

 ness and infirmities, I found no defect, disease or deformity of the bones. The defects and 



