THE PHYSICAL EXAMINATION 17 



hanging head, because the presence of adenoids 

 with flat chest and round shoulders generally 

 means physical weakness and lack of stamina. 



These faults bring on other faults. When the 

 head and shoulders hang forward, and difficult 

 breathing causes under-development of the lungs, 

 then the upper part of the breast-bone is de- 

 pressed. The ribs are deflected downward to 

 an abnormal degree. Thus the chest is made 

 flat, especially in the upper part, causing more or 

 less of a restriction of the lungs, and sometimes 

 even of the heart. A matter for serious consid- 

 eration is the fact that tuberculosis generally 

 begins in this restricted area 



Naturally such a condition in the chest would 

 tend to crowd downward the abdominal organs, 

 causing the abdomen to protrude, and sometimes 

 bringing on disturbances of the crowded organs. 

 It is thus easy to see that the hanging head, 

 round shoulders, flat chest, and protruding abdo- 

 men are likely to go together, and that when they 

 do it is an indication of a condition that may be, 

 or may become, quite serious. A child showing 

 such a combination of characteristics, or even one 

 of them, should be sent to a physician for expert 

 examination. 



When a child has one shoulder higher than the 

 other, the cause is sometimes found to be a spinal 

 curvature, which may be very slight, but not less 



