Dr. PAGET, ON INSTANCES OF REMARKABLE ABNORMITIES, &c. 241 



other abnormities were apparent only in the muscular system. The most striking defect was 

 in the muscles by which the arms are united to the trunk, viz. the two pectoral muscles and 

 the latissimus dorsi: Of the pectoralis major a small band could be made out, but so meagre 

 was its volume as not to be perceptible except when his arm was extended laterally. This 

 small band had its origin from the clavicle, and therefore represented only the upper part of 

 the great pectoral muscle ; its lower or sternal and costal portions being wholly absent. The 

 anterior boundary of the axilla was therefore very defective, the fold of skin, containing the 

 small representative of the pectoral muscle, forming a barely visible projection ; and the poste- 

 rior boundary was equally defective, through the smallness of the latissimus dorsi, so that the 

 axilla presented scarcely any cavity or hollow whatever. Of the lesser pectoral muscle not 

 the least trace was discernible. The defects on both right and left sides were the same. 



One strange consequence resulted from the deficiency in the bulk and tone of these muscles. 

 It was not possible, by putting one's hands under his armpits, to raise him from the ground, 

 as is so easily done with children in general. When the attempt was made, his shoulders 

 were lifted up, as if they had scarcely any connexion, or at most only a passive and very loose 

 one, with the thorax : there seemed no resistance, except from the mere weight of the arms. 



Another consequence of the defective condition of the pectoral muscles was, that, when he 

 was desired to draw a deep breath, the upper part of his thorax was not perceptibly elevated, 

 though its lower and lateral parts were largely raised by the effort. 



The serratus magnus was very deficient in bulk, and the trapezius somewhat meagre. So 

 likewise were the muscles of the upper arm, with the exception of the deltoid which was of 

 normal dimensions. 



On the contrary, the muscles of the forearms were larger and firmer than usual in a boy 

 of his age, and in these respects contrasted strongly with those covering the humerus — ^^the 

 biceps, brachialis anticus and triceps — which were both small and flabby. 



The maximum girths of these parts were : 



Right upper arm 6 inches : forearm 7 inches. 

 Left 7 : 6| 



The nates were very large and prominent, and appeared more strikingly so through the 

 bending in of his back. The thighs were somewhat small in their upper part. The knees 

 of ordinary size ; the ankles small and well-formed. The calves on the contrary were so enor- 

 mously large, as to appear strangely unsuitable to the rest of his figure. They appeared 

 larger in proportion than I evel* saw them in any individual. They seemed larger, in pro- 

 portion to the length of his leg, than in the stoutest porter or the Farnese Hercules*. They 

 were so incongruously large as to appear really ludicrous, and they were as firm as the sole of 

 a shoe, presenting in this respect a striking contrast to those muscles which have been mentioned 

 as deficient in bulk, all of which were soft and flaccid. 



The maximum girth of each thigh was 1 1^ inches. 



The girth of each leg between calf and patella was 9 inches. 



* I hare found this to be the fact — the maximum girth of the calf in the Farnese Hercules bearing a proportion to the length 

 of the leg of 10 to 11. 



Vol. X. Part I. 31 



