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GEOWING CHILDREN 
 
 AWKWAED WALKING 
 
GROWING CHILDREN 
 
 AND 
 
 AWKWARD WALKING 
 
 THOMAS WILLIAM NUNN, P.E.O.S.Bng. 
 
 ooirsTJLTiira suBQEoi? to the Middlesex hospitaii, medical asbooiate 
 OP king's college, lowdoit, etc., etc. 
 
 LONDON 
 KEGAN PAUL, TEENCH, TEUBNEE & CO., Ltd. 
 
 PATBUNOSTER HOUSE, CHAEING CROSS ROAD 
 1894 
 
INSCRIBED 
 
 TO 
 
 ISAAC DOBEBE CHEPMBLL, M.D., 
 
 BEOOK STREET, HANOVER SQUARE. 
 
CONTENTS. 
 
 PllEPACE ANB iNIBODtfCTIOX 
 
 PART I. 
 
 GUOWTH 
 
 PAGE 
 
 ix — xi 
 
 PART II. 
 
 Walkik& 
 
 36 
 
 PART III. 
 
 AwKWAiii) Walkins and Special Deebcts 
 
 48 
 
 PART IV. 
 Correction and Phevention 
 Gymnastics .... 
 Massage and Galvanism . 
 
 Feeding 
 
 Clothing .... 
 ookclusion 
 
 81 
 
 92 
 101 
 104 
 
PREFACE AND mTRODUOTION. 
 
 AwKWAED walking may be something more than 
 an ungainliness ; ungainly gait may constitute an 
 important symptom, requiring careful analysis; 
 for the lower limbs have a complex relationship 
 with other parts. 
 
 The various organs of the body are so inter- 
 dependent, that defect at one point may in- 
 juriously react at a distance, and thus a slight 
 imperfection of growth or of function may be the 
 unsuspected cause of widely mischievous con- 
 sequences. Abnormalities occurring after birth, 
 acquired distortions, have a strong tendency to go 
 from bad to worse, and on this account taken 
 alone, any deviation, however slight, from the 
 normal should not be disregarded, as that which 
 at the outset might have been a small affair, in 
 later years may become gradually and invidiously 
 
PEEFACE AND INTRODUCTION. 
 
 the cause of a disabling lameness. Sucli imper- 
 fections are too often little heeded, their import 
 being not understood. 
 
 Some knowledge of the structure and functions 
 of the human body is especially valuable to those 
 on whom has devolved the duty of watching the 
 growth, of the child, as it makes possible the 
 recognition of early abnormalities, and puts the 
 guardian on the alert as to the liability to trouble 
 in the offing. 
 
 Popular lectures and ambulance classes have, 
 it may be hoped, been useful in the direction of 
 spreading instruction in these subjects ; to the 
 same end I have endeavoured to describe, in as 
 simple a manner as I could, some elementary 
 anatomical facts. 
 
 To those readers who will face a moderate 
 amount of technicalities,! wouldmention, for study, 
 Huxley's "Elementary Lessons in Physiology," 
 Humphry's "Human Foot and Human Hand," 
 Hensman's " Outlines," as giving accurate, clear, 
 and artistic representations of the bones separately, 
 and of the skeleton in relation to internal organs. 
 
 Bourgery's splendid volumes, "Anatomie 
 Elementaire " and " Traite Complet de I'Anatomie 
 de I'Homme," with plates by Jacob, to be found in 
 
PEEPACE AND INTRODUCTION. XI 
 
 the library of tlie Britisli Museum (Press marks 
 respectively, Tab. 1800a and Catalogue desk M), 
 afford, as far as it is possible for drawings to do 
 so, demonstration of the collective organs of 
 locomotion. 
 
 In the Natural History Department of the 
 British Museum at South Kensington, is arranged 
 by the Director, Sir W. H. Flower, a most instruc- 
 tive series of specimens illustrating the bony 
 anatomy of man, and opportunity is given of 
 comparing his skeleton with that of other verte- 
 brate animals, or animals that have arrived at the 
 dignity of a backbone. 
 
 The " Gruide " to the Galleries of Mammalia, 
 in which these specimens are to be found, will 
 materially aid and enlighten the student. 
 
GEOWING CHILDEEN 
 
 AKD 
 
 AWKWAKD WALKING. 
 
 PART I. 
 
 GEOWTH. 
 
 The progressive changes that take place during 
 the development of the helpless new-born infant 
 into the mature, strong, vigorous being, are at 
 some stages gradual, at others rapid ; some 
 developmental processes are completed in twenty- 
 four months, others occupy a period of as many 
 years. 
 
 The different parts of the body do not grow 
 on exactly parallel lines, even under perfectly 
 normal circumstances. Thus, immediately after 
 birth,' the height of the head is less than a fourth 
 of the whole body, and the legs are longer than 
 the arms, the upper arm being longer than the 
 
 ' Vide Huxley's " Anatomy of Vertebra ted Animals." 
 
 B 
 
2 GROWING CHILDEEN AND AWKWARD WALKING. 
 
 fore arm, and tte thigh than the leg. At full 
 growth the height is between three and four 
 times the height of the new born child, and the 
 arms are increased in length in a similar degree, 
 but the head is only twice as large, while the 
 legs are five times as long as those of the child. 
 The female head at full growth is larger in pro- 
 portion to the stature, but the chest is shorter 
 and the abdomen longer than in the male, and 
 the shoulders are narrower, the hips broader, 
 and the thigh bone more oblique. 
 
 Mr. Eoberts ' says : " It has been already ob- 
 served that the lower extremities develop more 
 rapidly and in greater relative proportions than 
 other parts of the body. Thus, from birth to 
 maturity, ^while the head and neck double their 
 height, and the trunk increases to three times its 
 original proportions, the lower extremities in the 
 adult are five times the length they were in the 
 new born infant. The upper extremities grow 
 less rapidly, the arms of the adult man being 
 only four times the length they were at birth. 
 Measuring from the fork to the sole of the foot, 
 the lower limbs double their length before the 
 
 1 "Anthropometry," by Charles Eoberts, F.K.C.8., 
 &c., &c. 
 
GROWTH. 
 
 third year ; at twelve years they are four times, 
 and at twenty-five years five times their original 
 length. The thigh, the leg, and the foot do not 
 increase in the same proportions, . . . The thigh 
 grows more than the leg, and the leg than the 
 foot." 
 
 The increase in stature and the special ex- 
 pansion of the frame follow no invariable and 
 rigid prescript, but are infltienoed by factors of 
 diversity* 
 
 The regular and orderly growth of the body is 
 liable, from obscure causes, to interruption and 
 disturbance from the very earliest date of its 
 existence. The two side halves of the body are 
 seldom symmetrically developed ; as, for instance, 
 the two sides of the face. The development of 
 each of a pair of limbs is frequently unequal. 
 In the case of the upper limbs it is a matter 
 of common observation — in fact, it could hardly 
 escape notice — that one hand is often larger 
 than its fellow, and so this irregularity is looked 
 upon almost as regular. Inequality of growth of 
 the lower limbs, especially in length, although it 
 is less apparent or conspicuous, is by no means rare 
 and can be easily detected. On the equality in 
 length of the lower limbs much depends, for the 
 B 2 
 
4 GROWING CHILDREN AIJD AWKWARD WALKING. 
 
 balance of the rest of the body is interfered with 
 by inequality. 
 
 The organization of the human frame is such 
 that it gives the power of steady movement by 
 means of the lower limbs, and of maintaining an 
 erect and firm attitude upon the feet, and this 
 power constitutes a special endowment. Man is 
 distinguished from other animals in that he en- 
 joys a monopoly of walking and standing by the 
 use solely of the lower limbs. The assistance 
 of the upper limbs in locomotion, unless under 
 emergencies such as, for example, in climbing or 
 in swimming, is not needed. 
 
 But as man is also distinguished by a larger 
 brain and wider capacities, there is imperiously 
 demanded the unimpeded and disembarrassed 
 service of the upper limbs. And in respect of this 
 point Sir Eiohard Owen thus described the charac- 
 teristics of man : " With the predominant think- 
 ing organ has been given an instrument to do its 
 bidding, to wit, a hand, liberated from all share 
 in station and locomotion." ' 
 
 " Man's skeleton," says Dr. Albert Gunther, ^ 
 
 1 Inlroduction to Carter's " Zoology.'' 
 ^ " Guide to the Galleries of Mammalia," Zoological 
 Department of the British Museum. 
 
GKOWTH. 
 
 " differs from the Mammalian type, mainly in 
 relation to the upright position of the body, and 
 the total withdrawal of the anterior" (upper) 
 "limbs from the function of progression, and their 
 modification into grasping and tactile organs ; at 
 the same time the hind " (lower) " limbs are de- 
 veloped sufBciently to be capable, by themselves, 
 of supporting and moving the whole weight of 
 the body." 
 
 This capacity for movement of the body from 
 place to place — locomotion — and for posture in 
 the specially human attitude— station — by the 
 lower limbs depends on the integrity of many 
 and diversified organs : the nervous system, 
 which conditions and underlies every function of 
 the body ; the muscles, the bones and their con- 
 necting links, fibre and gristle (cartilage), the 
 joints, the state of the adjusted tenements for 
 the great nerve centres afforded by the skull and 
 spine ; and on all these being kept in perfect going 
 order by the constant activity of the apparatus 
 for nutrition, and for the circulation of the 
 blood. 
 
 The lower limb is, at command, at once either 
 a rigid column or a series of moveable parts or 
 segments acting as levers. 
 
6 GROWING CHILDEEN AND AWKWARD WALKING. 
 
 Station, or the erect posture, necessitates the 
 combined and simultaneous contraction of groups 
 of muscles, which, acting in opposite directions, 
 hold firm the joints, as the shrouds steady the 
 mast of a ship ; for the body cannot be simply 
 balanced on the legs, there must be continuous mus- 
 cular force to hold the body upright. Locomotion, 
 on the other hand, requires the alternating action 
 of these groups of muscles, and by virtue of the 
 joints, the bones of the thigh, leg, and of the foot 
 taken together, are converted into so many levers. 
 But these bones differ much in character ; some 
 are long bones, some short bones. The bones of 
 the skeleton generally, have been classified by 
 the anatomist as long, short, flat, or tabular, and 
 of a rqixed character. Long bones are described 
 as having a shaft which is either cylindrical or 
 prismatic, and as being equipped with expanded 
 ends, which enter into the construction of the 
 joints, and as having certain projections which 
 give favourable points ' for muscles to be 
 attached to, or to take hold. Bones of 
 the short class have no shaft, but consist of 
 masses of bony substance ; they have smooth 
 surfaces where they come in contact with other 
 bones at joints, and they have rough grooves, 
 
GROWTH. 
 
 and rougli surfaces also, to which are affixed 
 the fibrous material which binds them to other 
 bones independently of joints, or where muscles 
 are attached. Bones have a membrane covering 
 them, which is intimately and closely adherent ; 
 this membrane has an essential share in the 
 nutrition of bones. 
 
 The expanded and moulded ends of the long 
 bones, as well as the smooth facets of the short 
 bones, are encrusted with gristle or cartilage. 
 This is in the form of a thin layer of a grey 
 elastic, glistening material, of about the consis- 
 tence of the kernel of a filbert ; it has somewhat 
 the appearance of mother-of-pearl. Cartilage, as 
 this material is called, forms elsewhere a very 
 essential constituent of the framework of the 
 body, and when intermingled with fibre it enters 
 into the mechanism of some of the joints, a com- 
 bination of fibre and cartilage giving elasticity 
 with tenacity. Cartilage is further a tissue of 
 great dignity, for in the early stages of develop- 
 ment it afi'ords the matrix for the production of 
 bone. 
 
 The cartilage covered ends of the long bones are 
 either convex or more or less concave, and form 
 the joints by the convexity of one bone being 
 
8 GROWING OHILDEEN AND AWKWAED WALKING. 
 
 received within the concavity of another; the 
 bones are thus held in their places ; in some 
 joints the concavity is deepened by a rim of fibro- 
 cartilage. The adaptation is secured by liga- 
 ments made up of a fibrous tissue, which has the 
 appearance of white floss silk. The ligaments 
 are seen as flat bands, or as bundles or cords, or 
 as expanded into a broad sheet ; some are on each 
 side of a joint, some within the joint, some very 
 strong ligaments are found in the foot and 
 elsewhere between bones, and ligaments not only 
 hold the bones in apposition, but limit the 
 movement of a joint. The ligamentous fibres are 
 intimately connected with bone, and with the 
 enveloping membrane of the bone, just spoken of, 
 which shares in the nutrition and development of 
 bone tissue. This kind of tissue is also found in 
 a membranous form around some of the joints, 
 and encloses them, but in such situations, being 
 lax, confers but little strength; however, it 
 sustains a delicate membrane (the synovial 
 membrane), yielding or secreting a viscid fluid 
 (synovial fluid), a lubricant for the surfaces of the 
 ends of the bones. This is indispensable for the 
 prevention of friction. A very simple experiment 
 will illustrate how friction is prevented by a 
 
GKOWTH. 9 
 
 lubricant. Eub the hands together vigorously 
 for a few seconds — heat is at once felt ; repeat the 
 rubbing after having greased, or better, soaped 
 the hands — no heat -will be generated, at any rate 
 not until muscular action has caused more blood 
 to be sent to the hands. One may say en 
 passant that rubbing the hands to warm them 
 is a very interesting physiological experiment ; 
 there are at least three points to be noticed in 
 it : 1st, the friction mechanically produces heat ; 
 2nd, this heat stimulates the nerves; 3rd, the 
 nerves react on the blood vessels (these are called 
 vaso-motor nerves), and cause a fuller supply 
 of blood to be given to the part. Further, let 
 it be observed, if the fingers be blanched 
 and benumbed by cold, it will take long to 
 bring about warmth, as the sensitiveness of the 
 nerves is annulled, and the nerves can say 
 nothing to the blood vessels commanding them 
 to supply blood in greater abundance, and thus 
 there is no help from the blood to add to the 
 warmth. 
 
 In the development and growth of the skeleton 
 cartilage plays a supreme rdle. The bones begin, 
 devoid of mineral matter, as cartilaginous models 
 of what is to be. Bone, at first soft, of a flexible 
 
10 GEOWING CHILDREN AND AWKWAUD WALKING. 
 
 and plastic character, in due course, by having 
 appropriated from the blood a large percentage 
 of mineral material, becomes firm, solid, and 
 elastic, as a billiard ball is elastic. 
 
 The conversion is effected by the deposit of 
 mineral material (chiefly made up of lime com- 
 pounds) in the soft cartilaginous rudiment of the 
 bone. This process commences at certain points 
 called centres of ossification, and spreads from 
 thence. In the long run this deposit of mineral 
 matter entirely alters the relative proportions of 
 the mineral and animal matter from what obtained 
 in the early months or years. The mineral 
 matter in the adult bone is to the animal matter 
 as two to one, but this proportion varies in some 
 degree according to age, etc. 
 
 Albeit hard bone is not formed by the cartilage 
 being simply driven out of the field by the 
 mineral constituent, the metamorphosis is of a 
 complex nature ; it is as a usurpation modified by 
 a subsequent constitutional government. 
 
 Different bones have not the same number of 
 centres of ossification ; and the moulded ends of 
 the long bones, called the articular extremities, 
 the ends entering into the formation of the joints, 
 have in some instances more than one — the lower 
 
GROWTH. 11 
 
 end of the arm bone, for example ; and have, as it 
 
 were, an independent existence, if one may so 
 
 describe the organization which has a most 
 
 important share in determining the growth and 
 
 shape of the bone. The increase in the length of 
 
 a bone takes place by the special activity of a 
 
 stratum of cartilage which intervenes at the 
 
 junction of the shaft or columnar part of the 
 
 bone with the broadened moulded articular end. 
 
 The special activity of this layer of cartilage is 
 
 of the greatest moment ; it is a critical process, 
 
 building up bone as bees build up additional 
 
 honeycomb. 
 
 One has, therefore, to regard the expanded 
 
 ends of long bones during growth as, to a 
 
 certain degree, separate from the long cylindrical 
 
 or the prismatic shaft, as portions federated 
 
 only, so to speak, for the early epochs of life, 
 
 but ultimately becoming, when maturity has been 
 
 reached, firmly welded to the shaft.^ The 
 
 ' The complete solidification of the hones of the lower 
 limh, that is, the complete union of the portions that 
 enter into the formation of the joints and of some of the 
 outgrowths or projections for the attachment of muscles, 
 occupies an era extending from the seventeenth to the 
 twenty-fourth year ; the solidification of the thigh bone 
 appears to precede that of the bones of the leg. This is 
 a matter to be well borne in mind. 
 
12 GROWING CHILDEEN AND AWKWARD WALKING. 
 
 immense importance of the integrity of this inter- 
 vening layer of productive cartilage is shown by 
 the fact that when any disturbance of its own 
 nutrition occurs, such as might arise from 
 inflammation or from mechanical injury, mischief 
 of a permanent character follows — the bone 
 becomes deformed or misshapen; for, suppose 
 that the cylindrical part of a bone shall lengthen, 
 or grow less on one side than the other, it is 
 obvious that a morbid curve must declare itself, 
 and thus spoil the bone as a perfect instrument 
 for leverage. In a parallel manner, if the separate 
 bones that form the spine do not grow sym- 
 metrically, the spine, instead of being straight as 
 an arrow in the fore and aft plane, acquires a 
 lateral curve. Professor Sir G. M. Humphry' has 
 illustrated this point in a paper on the thigh 
 bone, and he has at the same time, by his 
 extended observations, shown that some generally 
 accepted statements regarding the details of the 
 anatomy of this bone have been allowed to pass 
 current, without challenge, by writers who 
 committed themselves to statements without 
 verifying the accuracy of the data upon which 
 those statements were founded. 
 ' " Journal of Anatomy and Physiology,'' April, 1889. 
 
GROWTH. 13 
 
 The stability of bone is maintained by the 
 continuous clearing away of old bony matter and 
 a corresponding replacing supply of new material. 
 It has been found by feeding a growing animal 
 intermittently with a food that is capable of 
 staining bone red, that alternate strata of red 
 stained and unstained bone have been formed. 
 This circumstance permits the hope that a 
 remedy for the results of antecedent faulty and 
 defective nutrition may be discovered in thera- 
 peutic measures. 
 
 We have, then, as the basis of the limb, bone, 
 and its immediate and nutrient covering mem- 
 brane, cartilage, permanent and transitional, liga- 
 ment, and lubricating membrane, the membrane 
 that secretes the synovial iluid. The bones of 
 the lower limb differ in character in a remarkable 
 degree, thus the thigh bone is a long bone with a 
 cylindrical shaft, and the two bones of the leg 
 are long bones more or less prismatic. The knee- 
 cap (the patella) is obviously a short bone, as are 
 the bones of the hinder part of the foot, while 
 the bones of the front part belong to the class of 
 long bones : they are three-sided, and have 
 rounded heads ; they act as outriggers to the toes. 
 The bones in question are those which have a 
 
14 GROWING CHILDEEN AND AWKWAKD WALKING. 
 
 position in the foot between tte short, strong, 
 massive bones of the instep and the toes, and are 
 of the same nature as those bones of the hand 
 lying between the wrist and the fingers. The 
 bones of the toes belong to the shafted class. 
 
 The bones present, for the attachment of muscles, 
 surfaces, and ridges, projections more or lesspointed 
 or otherwise shapen, all of which have a bearing 
 on the direction of the muscular force acting on 
 the bones as levers, and have relation to the joints. 
 
 The joints of the lower limb present certain 
 marked features, especially in respect of their 
 strength. The hip joint is a ball and socket joint, 
 with a strong cord-like ligament directly connecting 
 the semi-spherical ' head of the thigh bone to the 
 centre of the socket, and it is to be noted that 
 the smooth surface of the semi-spherical head of 
 the thigh bone fits so accurately to the hollow of 
 the socket, that atmospheric pressure helps to 
 keep the bones together, just as the plate for 
 artificial teeth is held against the palate by 
 suction, as it is called. The atmospheric pressure, 
 in a minor degree, shares elsewhere in main- 
 taining the bones of a joint in proper position. 
 
 The knee joint presents an enormous amount 
 of surface, and has been described as comprising 
 
asowTH. 15 
 
 ttree joints in one. It has.within it two crescent- 
 shaped fibro-cartilages, and has the striking 
 peculiarity of being completed by a short bone — 
 the knee-cap or patella : ' it is a hinge joint. 
 
 The ankle is also a hinge joint ; and it has the 
 protection on each side of prolongations respec- 
 tively of the two bones of the leg. 
 
 The joints between the bones of the heel and in- 
 step for the most part consist of facets in apposition, 
 while again the joints of the toes are hinge joints. 
 
 The movements permitted by the joints 
 vary much in degree. The ball and socket 
 joint of the hip allows of movement in every 
 direction. The hinge joint of the knee is almost 
 restricted to backward movements, that imply 
 movements to restore the straight line of the 
 limb, or, forward movement after the backward, 
 (extension after flexion) ; lateral movements are 
 possible only in the position of extreme flexion. 
 The ankle joint allows of more latitude in the ex- 
 tended position of the foot — that is, when the toes 
 are pointed downwards and are not on the ground. 
 The bones of the instep are so tied together as 
 to allow only a very limited movement upon each 
 
 ' There are small bones at the under aspect of the 
 great toe joints of an analogous character. 
 
I 6 GROWING CHILDEEN AND AWKWAED WALKING. 
 
 other ; at the same time, small as such movements 
 are between individual bones, the sum of the move- 
 ments is an indispensable amount in the working 
 of the mechanism of the foot, as it allows the 
 impact of the weight of the body to be diffused 
 or spread, and to be thus supportable. The 
 joints of the toes provide a hinge movement and 
 lateral movements to a small extent. 
 
 The long bones of the limb and the combined 
 short bone of the foot constitute so many 
 levers acted on in locomotion by the alternating 
 force of the various groups of muscles. A 
 lever is a rigid bar, oi!' rod, by which a given 
 power is so transmitted as either to confer 
 rapidity of movement of a thing to be moved at 
 the expense of force, or, by a loss of rapidity of 
 movement, to gain force. 
 
 A lever requires for its completion a 
 fulcrum or pivot, on which the lever, the rod 
 or bar, can move. Different kinds of levers are 
 described ; they differ as regards the relative 
 position of the thing to be moved, the fulcrum, 
 and the power ; the same mechanical arrange- 
 ment may be, under varying circumstances, two 
 kinds of levers. For instance, the common 
 hand-barrow used at railway stations for lug- 
 
GROWTH. 17 
 
 gage ; the porter lifts a heavy package by thrust- 
 ing the iron shovel end of the barrow under it ; 
 the fulcrum is the axle of the barrow, and lies 
 thus between the weight to be moved and the 
 power — namely, the man at the end of the long 
 handles of the barrow ; thus the weight is on 
 one side of the fulcrum and the power on the 
 other ; directly the porter has lifted the package, 
 and the handles of the barrow have been brought 
 from the nearly vertical position in which they 
 were at the beginning of the task to a more or 
 less horizontal one, the package or weight will 
 lie on the same side of the fulcrum as the power ; 
 instead, then, of the fulcrum being between the 
 power and weight, the weight is between the 
 power and the fulcrum. Then, again, the power 
 may be between the fulcrum and the weight ; at 
 the elbow the muscles of the front of the upper 
 arm are fixed into the bones of the fore arm, just 
 below the elbow joint, which is the fulcrum ; the 
 muscles are the power, and the hand is the 
 weight to be moved ; a small shortening of these 
 arm muscles produces a great movement of the 
 hand, but it is to be recollected, however, at a 
 large expenditure of muscular energy. The 
 leverage here is like that of an old-fashioned 
 
18 GROWING CHILDEEN AND AWKWAED "WALKING. 
 
 door-latch fixed at one end on a pivot, the op- 
 posite end being heavy to catch into a notch on the 
 door-post, while there is a knob projecting, between 
 the catch and the pivot, by which the heavy end 
 is lifted from the notch. Here is an example of 
 a lever precisely on the principle of that provided 
 by the fore arm, as just stated : the pivot or ful- 
 crum is the elbow joint, the heavy end is the 
 hand and what it may hold, and the lifting power 
 are the muscles in front of the upper arm, the name 
 of one of which is familiar, the biceps . This muscle 
 and an associated muscle take hold of, or are 
 attached, or fixed, to the bones of the fore arm 
 near the joint — an arrangement that endows the 
 arm with great rapidity of action. 
 
 The joints have no automatic power of move- 
 ment, but are moved by muscles: Pictures of 
 walking skeletons are evolved only from the 
 imagination of the unphysiological artist. 
 
 The endowment of a muscle is its capacity or 
 property of exchanging its length for breadth : it 
 shortens, and becomes in consequence broader or 
 thicker ; therefore, if fixed at one end to a point 
 that, for the time, cannot move, and at the other 
 end to a point that can move, it draws the 
 movable point towards the fixed point. 
 
GKOWTH. 19 
 
 To say that a muscle contracts is only to half 
 state the case, for when a muscle contracts in one 
 direction it expands in another; its length 
 diminishes, but its breadth increases ; its actual 
 bulk remains the same. 
 
 A muscle, speaking generally, as an organ of 
 movement, is completed by its tendon. A tendon 
 is as much characterized by its inextensibility as 
 a muscle is by the opposite property: the 
 muscle is very freely supplied with blood vessels 
 and nerves ; the tendon is sparsely so supplied. 
 
 The tendon, or sinew, carries the power of the 
 muscle as the tiller ropes carry the power of the 
 man that steers; it is somewhat, but slightly, 
 elastic, and in many situations it transmits the 
 force as a cord would over a pulley, altering the 
 direction of the force. 
 
 The tendon, while it represents all the power 
 of the muscle, occupies far less space; for in- 
 stance, at the wrist, where the tendons belonging 
 to the muscles of the fore arm are aggregated, the 
 circumference will be found little more than half 
 of the measurement of the largest circumference 
 of the muscular part just below the elbow. The 
 tendons, too, serve to concentrate the force of the 
 muscles on points of the bone which the muscle 
 c 2 
 
20 GEOWING CHILDEEN AND AWKWAED WALKING. 
 
 has to move. In structure, tendon and ligaments 
 — the fibrous cords which hold the bones in appo- 
 sition—are of very much the same material. Be- 
 tween the fibre of muscle and the fibre of tendon 
 there is a great contrast ; the former is red, the 
 latter brilliant, shining white ; the one instinct 
 with movement, the other passive. 
 
 The tendons run in sheaths, also lubricated by 
 the viscid transparent synovial fluid. These 
 sheaths are at some points strengthened by 
 transverse bands of fibre, which keep the tendons 
 in their places and determine the direction of the 
 force of the muscles. 
 
 Absolutely unimpeded liberty of movement of 
 the tendons is essential for the full play of the 
 muscles, and this the synovial fluid lubricating 
 the tendons insures. The rapidity of such move- 
 ments may be imagined when the fingers can 
 perform over 1000 movements in a minute ; as, 
 for example, rendering a passage of music on the 
 pianoforte. 
 
 Chevalier Ganz was so good as to make an 
 experiment for me to show how many notes could 
 be struck in the minute; the result went to 
 prove that he could, without very great effort, 
 strike 252 in fifteen seconds, or 1008 per minute. 
 
GROWTH. 21 
 
 This by no means measured the whole of the 
 muscular movements, as each finger would 
 require to be lifted and then brought down on 
 the key of the piano, and shifted laterally as 
 well. It may be added that the rapidity with 
 which the sound of one note succeeded another 
 was so great that the sonorous effect produced 
 resembled the moan of an approaching cyclone. 
 
 "While muscles end in the tendons, and some 
 muscles start from tendons or tendinous tissue, 
 certain muscles begin, springing as it were, from 
 an extensive surface of bone or of membrane. 
 Some of the conditions of the attachment of the 
 muscles confer protection against injury from 
 sudden strain : a sudden strain will fracture, 
 where a steadily and gradually applied force 
 would do no harm. In the fishing rod, the deli- 
 cately tapering, highly elastic rod prevents the 
 jerk of a heavy fish snapping the line, the strain 
 on the line being made gentle by the whole 
 length of the rod sharing in it. 
 
 We see this protection against sudden strain 
 in the investment of the limbs by a fibrous mem- 
 brane which dips in between the muscles and 
 becomes fixed to the bone; and to this invest- 
 ing structure some of the muscles of the limbs 
 
22 GROWING CHILDBEN AND AWKWAED WALKING. 
 
 are partly attached or connected. For example, 
 the great muscle of the buttock is not only firmly 
 fixed to the upper part of the shaft of the thigh 
 bone towards its hinder surface, but is fixed as 
 well to fibrous investment of the thigh, and thus 
 lays hold of the outer side of the knee and upper 
 end of the bones of the leg ; in this way the 
 power of the muscle, which is one that largely 
 helps to sustain the body on its legs in the erect 
 position, is spread over an extended area, and 
 the strain is divided between a limited surface of 
 the thigh bone and broad expanse of a very 
 strong, tough sheet of fibrous membrane having 
 manifold points of attachment to bone. It may 
 be mentioned in illustration that the tendon of 
 the biceps alluded to at page 18 as concentrated 
 in its attachment to one of the bones of the 
 fore arm, gives a fan-shaped offshoot to a 
 membrane which envelopes the muscles of the 
 arm. 
 
 The other investing tissues of the limb, the 
 skin and the immediately subjacent fibrous 
 membrane, are flexible and elastic ; the necessity 
 for this elasticity is prominently shown at the 
 knee joint. In bending the knee backwards to 
 an acute angle with the thigh, the distance of 
 
GEOWTH. 
 
 the top of tlie leg bone from the lower end of 
 the front of the thigh bone is increased by about 
 two or two and a half inches ; so, if the skin 
 were incapable of stretching, it would split or 
 crack were that movement carried out. 
 
 At some parts an abundance of fatty tissue is 
 essential ; as, for instance, between the bone "of the 
 heel and the skin of the heel, where it forms a 
 cushion, and softens the concussion when the heel 
 comes sharply to the ground. 
 
 Another situation where there is more or less 
 fat is at the back of the knee joint. The purpose 
 is not so obvious as at the heel. The fat probably 
 serves to protect the great vessels and nerves 
 lying in that region. 
 
 Now, some especial reference to the anatomy of 
 the skull and spine, and their contents, brain and 
 spinal cord, and their functions, is necessary. 
 
 THE BEAIN AND SPINAL COBD. THE SKULL 
 AND THE SPINE. 
 
 The nervous system consists of two batches of 
 nerves and nerve centres; immeasurably the largest 
 and most potential one is made up of the brain and 
 spinal cord, and is contained within the skull 
 (the cranium) and the backbone (the vertebral 
 
24 GROWING CHILDEEN AND AWKWABD WALKING. 
 
 column). The smaller one, called the sym- 
 pathetic system, lies outside these bony envelopes, 
 and in its functions and structure differs more 
 or less from the brain and spinal cord. In fact, 
 the precise duties of the " sympathetic " are not 
 known ; the intermingling of fibres from the 
 greater nerve centres makes the difficulty in 
 arriving at the independent share the sympa- 
 thetic nerves have in the general innervation of 
 the body. 
 
 Both of these great centres first named are 
 continuous the one with the other, and consist of 
 nerve force producing centres and nerve force and 
 impression conducting fibres, and from them 
 proceed other fibres, called nerves, to every part of 
 the body. One might in a rough way compare 
 these elements respectively to the cells of a 
 galvanic battery and the wires that conduct the 
 galvanic current. Although the spinal cord is the 
 channel by which the brain is mainly in touch 
 with the body and limbs, it is more than a mere 
 conductor, in virtue of its nerve force producing 
 capacity, as just stated. The brain and spinal 
 cord are also impression receiving centres ; nerves 
 passing from the outside to these centres conduct 
 impressions. When you grasp a friend's hand, 
 
GBOWTH. 25 
 
 you do so by the nerve force at your will, the 
 nerve force of the brain being transmitted to the 
 muscles which close the hand by nerves passing 
 through the spinal cord ; when you are conscious 
 of feeling the responsive pressure of the friend's 
 hand, the brain has recognized the impression and 
 has converted it into a sensation. But the receiv- 
 ing centres can take cognizance of an impression 
 without ordinary sensation being produced, and 
 can straightway cause to be evolved a corre- 
 sponding activity at a distance, an echo-like nerve 
 phenomenon of an impression in which conscious- 
 ness does not necessarily participate : such an echo 
 is called a reflex nervous action. One may liken 
 the reflex nervous action (which is not, however, 
 quite a simple echo) to the movements that take 
 place when, say, two children, A and B, are 
 playing at ball. Suppose A to throw a white ball 
 to B, and after catching it B throws back a ball 
 which is red ; thus something that A does causes 
 B to do very much the same, but the ball is of a 
 different colour ; so an impression on the nerves 
 (called nerves of sensation) of the surface is 
 carried to a nerve centre, brain or spinal cord, 
 by the nerve centre in response to the impres- 
 sion, a mandate is sent forth, and a reflex mus- 
 cular action takes place. 
 
26 GEOWING CHUDEEN AND AWKWARD WALKING. 
 
 Keflex processes have high duties to perform. 
 They are the night and day guardians of the 
 system, ever active, and they maintain and keep 
 active the vital functions under opposite condi- 
 tions, as of sleep and wakefulness. There are 
 some actions allied to reflex actions called auto- 
 matic. Breathing is a reflex action ; holding the 
 head up under ordinary circumstances, for example, 
 is an automatic action. Thus, when a person 
 falls asleep sitting in a chair, the head drops 
 forward, heing no longer automatically sustained 
 by the muscles at the back of the neck ; but 
 breathing continues without interruption. 
 
 The nerve tissue, pure and simple, the medium 
 of these phenomena, whether it be nerve-force 
 producing or the nerve force conducting element, 
 is of the utmost delicacy, subtle structure, and 
 fragile consistence. The great mass of nerve sub- 
 stance within the skull, the brain, has for its 
 protection, thus so essential, intervening layers 
 of strong fibrous membrane which support the 
 several lobes or divisions of the brain, and it has as 
 well a general envelope of the same sort of tissue. 
 The spinal cord within the spinal canal is pro- 
 vided with a fibrous sheath, and the nerve trunks 
 emanating from the cord are fortified by admix- 
 
GROWTH. 27 
 
 ture with fibre identical with the envelopes of 
 the brain and spinal cord. There are other pro- 
 tective structures, those for the brain differing 
 somewhat from those of the spinal cord, such 
 differences being in harmony with the rigid solidity 
 of the skull and the flexibility of the spine. 
 
 There is this important distinction between the 
 skull, the bone case for the brain, and the spine, 
 the bone case for the spinal cord ; namely, the 
 skull, we may for our present purpose say, is 
 built of tabular or " flat " bones immovably 
 dovetailed together ; on the other hand, the spine, 
 or vertebral column, is built of separate bones of the 
 mixed character, all of which have some movement 
 upon one another ; and it is this mobility of the 
 separate vertebrae which confers the flexibility to 
 the vertebral column, and which we have here 
 to take into account ; leaving aside the construc- 
 tion of the skull, and its relation to ideal or 
 typical vertebrae. There are twenty-four vertebrae 
 to make up the moveable vertebral column : with 
 the exception of the first or topmost bone, which 
 is next the skull and is so placed on the vertebra 
 immediately beneath it, that wide movements of 
 the skull upon the spine are possible, all the 
 other bones (vertebrae) have parts more or less 
 
28 GKOWING CHILDEEN AND AWKWARD WALKING. 
 
 resembling each other. These bones, tied and 
 linked together, but in such a manner as to per- 
 mit movement, constitute the vertebral column, 
 the back bone, solid in front and hollow behind ; 
 for each bone (vertebra) is made up of a segment 
 of a pillar or cylinder and a segment of a tube.' 
 Interposed between the separate vertebrae are 
 cushions of a highly elastic substance, which, 
 while they constitute a connecting medium, form 
 the elastic element of the spine, and, assisted by 
 other more fibrous structures, bind one bone to the 
 next. The spine, therefore, presents alternately a 
 bone and a pad of elastic fibro-cartilage, and has 
 besides a peculiar elastic ligamentous tissue, which ■ 
 fills the interval between the segments of the tubular 
 part of each vertebra and adds to its complete- 
 ness. Thus we have both a solid flexible column 
 and a tube, and this double nature of the spine 
 must not be lost sight of. The vertebrae, being 
 bones of the class intermediate between long 
 bones and short bones, present from the exterior 
 aspect of the tubular portions projections, some of 
 which reach directly backwards and are very 
 evident, making a familiar feature in the lower 
 
 ' The second vertebra has a pivot upoa which the 
 first vertebra turns. 
 
GEOWTH. 29 
 
 part of the neck and upper part of the back just 
 above the shoulder blades ; others have a lateral 
 direction, but, instead of being prominent, are 
 concealed by overlying muscles ; these afford 
 short handles, like the outside spokes of the 
 steering wheel of a ship, for muscles which assist 
 in moving the column, and they otherwise share 
 in the structure of the frame ; one of their pur- 
 poses is to help to steady the ribs. 
 
 The spine, limiting the name to the two dozen 
 separate vertebrae, is perched upon a solid mass 
 of bone (the sacrum) placed between the two 
 haunch bones. The shape of this mass is that 
 of a much flattened cone, and is distinctly 
 and characteristically curved; the base of the 
 cone is uppermost ; in an early stage of develop- 
 ment it existed as five and sometimes six pieces 
 resembling vertebrae. There are some extremely 
 strong short ligamentous cords and a layer of 
 iibro-cartilage holding the haunch bones to it. 
 The sacrum has at its lower extremity a few 
 small bones of not much importance, which form a 
 rudimentary tail. 
 
 On each side of the tubular division of the spinal 
 column are a series of openings, formed by the , 
 juxtaposition of notches in two contiguous vertebrae. 
 
30 GEOWING CHILDEEN AST) AWKWARD WALKING. 
 
 in that part of the vertebra that has its share in 
 the formation of the tube. These apertures are 
 for the exit of the nerves springing from the spinal 
 cord and for their associated blood vessels. There 
 are corresponding apertures in the sacrum, but 
 such are found in front and at the back, instead 
 of at each side. 
 
 For the support and movement of the spine is a 
 complicated series of muscles. The principal mass 
 of these is fixed below to the haunch bones and 
 sacrum, and extends itself upwards to the ribs 
 and to projections of the back bone ; an infinite 
 number of smaller muscles lie between one verte- 
 bra and another, and aid the chief muscles, which 
 are those of the loins, in the multifarious move- 
 ments of the spine. 
 
 The spine, or vertebral column, at birth is 
 nearly straight, at maturity has an inclination, 
 or curve, forwards in the neck, backwards between 
 the shoulder blades and as low as the waist, and 
 then again forwards in the loins. Inclination to 
 the right or left, described by some anatomists as 
 normal, does not exist except as an abnormality de- 
 pendent either on a fault primarily of the spine 
 or on disparity of the lower limbs ; this was shown 
 by Mr. William Adams. 
 
GROWTH. 31 
 
 The advent and manifestation of the fore and 
 
 aft curves belong to a phase of development and 
 
 are analogous to the eruption of the second set of 
 
 teeth. I would lay especial stress on the view 
 
 that the nature of these curves is essentially 
 
 developmental. Further, the forward curve of the 
 
 spine in the loins permits of the chest being held 
 
 in the most advantageous position; if the lower 
 
 border of the chest falls downwards, the upper 
 
 ribs have not full play, the cavity of the chest is 
 
 inefficiently expanded, particularly at its upper 
 
 part. It is a vital question whether, under such 
 
 circumstances, the deposit there of tubercle may 
 
 not be favoured. The normal curve backward in 
 
 the region of the chest affords more space for the 
 
 accommodation of the lungs and heart. When the 
 
 spine or this region is unduly vertical, shown by 
 
 there being a hollow between the shoulders, the 
 
 ribs are seen to be too convex in front, and the 
 
 heart is crowded against the ribs. 
 
 Professor Sir W. Turner' has described and 
 discussed the question of certain racial differ- 
 ences in the skeleton — the shape of the skull, the 
 relative lengths of the fore arm and upper arm, 
 
 1 " Journal of Anat. and Phyg.'' vol. xxi., On varia- 
 bility in hnman structures, etc. 
 
32 QEOWINa CHILDREN AND AWKWARD WALKING. 
 
 the shape of the haunch bones and the curves 
 of the spine and sacrum (the cone- shaped repre- 
 sentative of agglomerated vertebrae interposed 
 between the haunch bones), and many other 
 skeletal peculiarities. 
 
 The lesser degree of curve in the loin region of 
 the spine in some races of men of the lower type 
 is remarkable, and appears to be dependent on 
 the shape of the vertebrae and also of the 
 elastic pads between the vertebrae (called inter- 
 vertebral discs). Sir W. Turner says, "Now, 
 should the habits of any race or races be such as 
 to occasion a greater weight or pressure to be 
 transmitted through the spine to the pelvis " (the 
 haunch bones combined with the sacrum) " than 
 in other races, a modification in these regions 
 would arise, which would be perpetuated from 
 generation to generation." 
 
 There is a very important fact regarding the 
 relative growth of the spinal column and that of 
 the spinal cord therein contained. In very early 
 life the spinal cord occupies the entire length of 
 the spinal canal, or tubular part of the vertebral 
 or spinal column — that is to say, the cord and the 
 canal are of equal length at first ; later on, the 
 spinal cord is only two-thirds as long as the canal, 
 
GROWTH. 33 
 
 the growth of the spine has outstripped the 
 growth of the cord ; the result is that below the 
 waist the spinal canal contains no actual cord, 
 but the nerves only, in which the spinal cord 
 terminates. 
 
 There are some differences between the spine 
 of the male and female. The female spine is 
 not so strong, and has more flexibility, such being 
 permitted by the greater length of the segment of 
 the body between the lower edge of the chest 
 and the upper edge of the haunch bones. This 
 mobility of the spine in the female, combined with 
 its less solid construction, renders the girl's spine 
 more liable to some want of order in the normal 
 curves, and also to a tendency to lateral (abnor- 
 mal) curvature, under certain conditions especially 
 in the loins, the region of the waist. 
 
 But nevertheless there is a countervailing 
 advantage in the pliancy of the waist, as a greater 
 extent of reach for the hand is bestowed by it. The 
 much-vexed question of the waist has not been 
 generally argued in all its bearings, and it demands 
 some remarks. Sir Eichard Owen, in the words 
 quoted at page 4, has described the relation of the 
 hand to the body, and the call for its special endow- 
 ment and independence. In the female, the pliancy 
 
34 GROWING CHILDEEN AND AWKWAED WALKING. 
 
 of the waist makes up for the shortness of the collar 
 bone. We see, in woman, the collar bone is not 
 only more delicate, but is shorter than in the male. 
 As regards the skeleton, the collar bone holds the 
 shoulder blade ; in turn the shoulder blade holds 
 the arm with the hand ; so the length of the collar 
 bone, leaving the length of the arm bones out of 
 the estimate, expresses the distance the hand can 
 reach ; or, the longer the collar bone, the greater 
 the reaching power. The flexibility of the loins 
 or waist compensates the woman for the shortness 
 of the collar bone, and thus in some measure the 
 disadvantage at which she is placed, as regards the 
 inherent capacity of reach, is neutralized by her 
 being more easily able to bend the body to either 
 side. In this way Nature, holding or sparing with 
 the one hand, gives with the other. 
 
 Sir Gr. M. Humphry' said of the foot that 
 its formation is "found to have a correspou'- 
 dence with the formation of the head, and 
 may, like it, be, to a certain extent, taken to 
 be an index of intellectual as well as physical 
 capacity. The relation between intellectual 
 power and physical conformation of man . . . 
 which is maintained throughout the frame, is a 
 1 " The Human Foot and the Human Hand." 
 
GEOWTH, 35 
 
 subject of extreme interest, and is one wticli has 
 not attracted the attention of anatomists and 
 ethnologists so much as it deserves." To a cer- 
 tain extent, therefore, the conformation of the 
 waist has a claim to be regarded as a part of the 
 same subject, and the observations of Sir W. 
 Turner regarding Uie racial peculiarities of the 
 spine also, help to elucidate this point. 
 
 There are two or three stock wood engravings, 
 which have been used over and over again to 
 illustrate disquisitions on the waist, and on the 
 iniquity of the corset, intended to show how the 
 compression of the ribs, by tight lacing, causes 
 the figure to vary in shape from the torso of the 
 Venus de Medicis, the work said to be inspired 
 by Praxiteles. At the risk of being thought, by 
 some, heretical, I venture to doubt the anatomical 
 accuracy of the celebrated marble. But concern- 
 ing regulation-fine- art criticism and aesthetics I 
 have nothing in this place to say, being limited to 
 matters of fact. 
 
 D 2 
 
PART II. 
 
 WALKING. 
 
 Walking. — Locomotion on the feet is effected, 
 as already stated, by the successive and alternating 
 activity of the different groups of muscles. This 
 alternating muscular energy is in striking con- 
 trast with the continuous and combined action of 
 all the groups in standing still, station. — In 
 walking, joint movements take place at the 
 hip, the knee, the ankle, and the toes. The 
 thigh has to be lifted towards the trunk 
 through the hip joint, the leg to be lifted towards 
 the back of the thigh through the knee, the 
 foot moved upwards and downwards through the 
 ankle. In the two first instances, the bending of 
 the limb has to be followed by straightening or 
 flexion, by extension. The different groups of 
 muscles, by their relation to the bones, the levers, 
 can exert force in opposite directions : some bend 
 the joints, others straighten them, while move- 
 
"WALKING. 37 
 
 ments of less simple character can be produced by 
 combined action. 
 
 The muscles of the lower limbs may be con- 
 sidered for the time being of two classes — the 
 lifting and propelling, and the sustaining and 
 manoeuvring. In the act of walking, when the 
 foot moves the body, the lifting and propelling 
 muscles take the chief part; when the body 
 moves the foot, the sustaining and manoeuvring 
 come into play, to poise and adjust the foot. 
 
 The movements of the foot in walking are to 
 be divided into those on the ground and those 
 off the ground. In ordinary walking, the foot on 
 the ground has a rolling motion from the heel to 
 the tips of the toes, especially to the tip of the 
 great toe. The foot comes to the ground first at the 
 heel, and it is then gradually laid flat ; the heel is 
 afterwards lifted, and the rolling action commences. 
 
 Sir Wm. Flower thus describes the movement 
 after the foot is on the ground : " The heel is 
 first lifted from the ground, and the weight of the 
 body gradually transferred through the middle 
 to the anterior end of the foot, and the final push 
 or impulse given with the great toe." ' Pettigrew 
 says : " The heel first reaches the ground and first 
 ' " Fashion in Deformity." 
 
38 GROWING CHILDEEN AND AWKWARD WALKING. 
 
 leaves the ground ; when the heel is elevated the 
 weight of the body falls more and more on the 
 centre of the foot and toes, the latter spreading 
 out to seize the ground. The spreading action of 
 the toes is seen to perfection in children." ' 
 
 The movement of the foot off the ground — 
 that is, while the body moves the foot — is a rock- 
 ing one, on the ankle joint ; the front of the foot 
 is raised, whilst the foot is slung forward by the 
 leg and is carried clear of the ground ; the foot is 
 then gently dropped, so that it may be laid flat ; 
 there is also a very slight outward turn, and by 
 it contact with the opposite ankle is avoided ; the 
 outward turn, it is to be remembered, comes 
 from the hip joint. To follow with the eye the 
 movements of the leg and foot is very difficult ; 
 a series of instantaneous photographs would be 
 required to show them. 
 
 This description of walking applies only to 
 walking in a direct line forwards, and on level 
 ground ; a modification of the movements occurs, 
 for example, in climbing a flight of stairs or 
 a steep path. We may here note that any 
 other movements than such as carry the foot in 
 the desired direction involve a waste of muscular 
 ' " Animal Locomotion." 
 
WALKINa. 39 
 
 energy and the planting of the foot in a more or 
 less disadvantageous position for the next step. 
 It is often observable that each foot, during the 
 swinging forward, performs movements that are all 
 waste. The feet also may be seen not to move the 
 one like the other ; one foot may move fairly well, 
 the other shifting about in useless gyrations. 
 
 Professional pedestrians find that to obtain the 
 greatest pace the one foot must be placed in a 
 line directly in front of the other, and it is said 
 that soldiers trained to march with the foot 
 turned outwards do not make successful com- 
 petitive pedestrians. Mr. Ellis, of Gloucester, 
 maintains, in his work on the human foot, that the 
 toes should first touch the ground. Now, as the 
 toes leave the ground last, it would follow that 
 in progression, according to Mr. Ellis's view, the 
 toes would be twice called on. 
 
 In stepping backwards, doubtless, the toe first 
 touches the ground ; but, in stepping forwards, 
 the heel commences the rolling action of the foot. 
 
 There is a just perceptible rise and fall of the 
 body in walking. The limbs during each step 
 form an angle with each other, and consequently 
 the body must slightly descend.' [The absence 
 
 ' How this happens may be easily illustrated. Take 
 
40 GROWING CHILDREN AND AWKWARD WALKING- 
 
 of this rise and fall in progression is striking if 
 one observes a cycle-rider ; his legs are seen in 
 vigorous movement, but the head glides for- 
 wards without any oscillation, imparting to the 
 rider an almost uncanny aspect.] 
 
 The trunk and upper part of the body also is 
 swayed forwards and from side to side by a com- 
 bination of muscular action, in which nearly all 
 the muscles of the body take part ; by this 
 swaying the weight of the body is canted over to 
 the leg just planted on the ground, and the 
 lifting by the agency of the foot is thereby 
 materially assisted. 
 
 Walking — locomotion — forwards may, however, 
 be replaced by locomotion in other directions ; for 
 instance, backwards or sideways, and on inter- 
 mediate lines. The arrangement of the groups 
 of muscles provides for such indispensable 
 modifications of locomotion. 
 
 For all these multifarious movements there 
 
 two volames of the same size ; place them a few inches 
 apart on their edges, so that the backs of the books are 
 uppermost. A ruler laid acr oss the backs will be level. 
 Now half open one volume. The ruler will be no longer 
 level, but will be inclined on the side of the opened 
 volume, since the back of it will have descended, in 
 consequence of the side covers being at an angle, instead 
 of being parallel with each other. 
 
"WALKING. 41 
 
 are muscles reaching from the front of the 
 spine, and from the front and back of the haunch 
 bones, to the thigh bone at many points, and as 
 well, but less extensively, to the two bones of 
 the leg at their upper extremities ; and there 
 are besides muscles reaching from the thigh bone 
 to the same parts of the leg bones. From the front 
 and outer side of the leg pass muscles allotted to 
 the instep and toes; from the back of quite 
 the lower end of the thigh bone, and from the 
 back of the leg bones together, muscles destined 
 for the heel ; from the leg bones muscles for 
 the under aspect of the instep, great toe, and 
 the four outer toes ; and, lastly, a multitude 
 of smaller muscles, on, under, and between the 
 bones of the foot, which help to regulate the 
 movements generally of the toes. 
 
 Some of the muscles are simple, and others are 
 compound or double, while the muscular fibres 
 making up the muscles run parallel, or they run 
 at an angle with the tendon to which they are 
 fixed. 
 
 The great muscle of the calf of the leg is a 
 compound muscle : two muscular masses difier- 
 ently attached — one part above, to the lower end 
 of the thigh bone ; the other part to the two 
 
42 GROWING CHILDEEN AND AWKWAED "WALKING. 
 
 bones of the leg, ending in the strong tendon 
 (the Achilles tendon) which is below, fixed to 
 the heel. An example of a simple muscle is 
 the muscle going from the front of the leg to the 
 great toe. 
 
 The functional result of the action of the 
 groups of muscles depends in a great measure on 
 the position of the limb with regard to the trunk ; 
 a propelling muscle may be, under certain 
 conditions, a manoeuvring muscle. To give a 
 somewhat analogous instance in the upper 
 extremity of interchangeable functional result : 
 if the shoulder blade be held firmly by the 
 muscles at the back, some of the muscles of the 
 front are able to lift the ribs, and thus .expand 
 the chest. On the other hand, the muscles of the 
 back remaining passive, those that would other- 
 wise lift the rib draw the shoulder forwards. 
 
 It may be well to repeat and emphasize that the 
 great variety of movements of which the lower 
 limb is capable are made possible by special 
 construction of the hip joint, a ball and socket 
 joint, which permits of the limb being carried in 
 every direction, and by the mechanical advantages 
 conferred by the " neck," as it is called, of the 
 thigh bone. 
 
WALKING. 43 
 
 The knee joint, although so large a joint, can 
 only move as a hinge, unless it be extremely bent 
 (flexed). Almost the same may be said of the 
 ankle joint, for when the foot is bent upwards 
 the joint becomes locked and no lateral move- 
 ment can be made ; if, however, the foot be ex- 
 tended fully — i.e., be held so that the toes point 
 towards the ground — some considerable degree of 
 lateral movement is practicable. Beyond the 
 ankle joint are the joints of the instep bones, 
 allowing only a slight gliding. The joints where 
 the toes are attached to the long bones of the 
 foot, although hinge joints, have a certain 
 amount of lateral play. 
 
 The joint of the great toe has a wider mobility, 
 and is otherwise distinguished by having two 
 small rounded masses of bone on its under sur- 
 face, which enter into the formation of the joint 
 somewhat in the same manner as the knee-cap 
 enters into the construction of the knee joint. 
 Diminutive representatives, however, of such small 
 bones sometimes exist at corresponding joints of 
 the other toes. 
 
 A few simple experiments will better show the 
 action of the muscles of the lower limb than a 
 written description. 
 
44 GROWING CHILDREN AND AWKWARD WALKING. 
 
 1. Stand with tlie feet close together, then 
 stand on tiptoe ; in this latter movement, the 
 muscles of the calf will he felt to lift the body 
 vertically, the foot acting as a lever, the fulcrum 
 being at the toes, the power at the heel, and the 
 weight between the two; then, on placing one 
 foot in advance, provided the calf muscles of the 
 leg of the opposite side contract, a change in the 
 direction of the force takes place, and the body is 
 forced forward instead of being lifted ; the vertical 
 motion is exchanged for a more or less horizontal 
 one. 
 
 2. Stand with the feet again close together, 
 then turn one foot outwards. The motion will 
 be perceived to come from the hip joint ; the 
 leg may be moved backwards and forwards from 
 the knee without help from the hip muscles, but 
 cannot be turned outwards. 
 
 3. Walk forwards on the heels only, keeping 
 the knee straight ; the muscles of the thigh will 
 be felt to do all the work of progression ; then in- 
 stantly walk in the ordinary manner, and the lift- 
 ing action of the calf muscles will be made very 
 manifest. 
 
 4. Commence to ascend a flight of stairs. The 
 first movement is a bending of the knee and lift- 
 
WALKING. 45 
 
 ing of the one foot by the muscles of the thigh, 
 so as to place it on the step. The next move- 
 ment is a leverage by the other foot to lift the 
 body, which is simultaneously swayed forward by 
 the muscles of the trunk. Contrast this with en- 
 deavouring to ascend without the leverage of the 
 foot — that is, by starting the second foot from the 
 heel — and observe the extra strain on the muscles 
 of the thigh required. 
 
 5. Scrutinize the action of the muscles in 
 descending a flight of stairs. The. sustaining 
 power of the muscles of the thigh and the 
 manoeuvring of the foot by the muscles of the leg 
 will be very observable. 
 
 6. Stand sidewise at the back of a chair, hold 
 on by the top rail, then raise the foot from the 
 ground; it will be perceived that the thigh 
 is lifted towards the trunk and the knee is bent 
 (flexed). Endeavour to lift the foot from the 
 ground, keeping the hip joint and knee rigidly 
 fixed ; it will be found that in order to lift the foot 
 the whole body must be bent over to the opposite 
 side ; in this way the haunch bone carrying 
 the limb is tilted over, and the other haunch 
 bone rolls on the top of the thigh bone at the 
 hip joint. 
 
46 GROWING CHILDREN AND AWKWARD WALKING. 
 
 In some cases, where the hip joint is quite fixed 
 hy old inflammation, the vertebrae of the loins 
 become remarkably mobile, and a kind of sub- 
 stitute for the lost mobility of the hip joint 
 is afforded by that acquired between the 
 vertebrse of the region named. I have seen this 
 where the subject of the disability in the hip 
 had to earn his living at the lathe ; he stood on 
 the sound leg and worked the treadle of the lathe 
 with the damaged limb by the acquired mobility 
 of the loins. 
 
 7. In rising from the sitting position with the 
 legs stretched out, observe that, first, the knees 
 are bent, the feet being thereby drawn back ; 
 the body is then swayed forwards, so that the 
 weight lies over and above the knees ; at the 
 same time the knees are straightened — thus the 
 body rises. The straightening of the knees raises 
 the body. In walking, the straightening of the 
 knee, instead of lifting the body, propels it for- 
 wards, the vertical movement, as in experiment 1, 
 being replaced by a horizontal one, the direction 
 of the muscular force or energy being changed. 
 
 The propelling force of the muscles that 
 straighten the knee is remarkably displayed in 
 cycle-riding. The whole forward movement is 
 
WALKING. 47 
 
 the result of this change in the state of the limb 
 from flexion to extension. The flexed (bent) limb 
 is seen to extend itself (straighten), and then im- 
 mediately to be again flexed, and so on. The 
 straightening plays the most important part, as 
 the flexion is partly carried out by the movement 
 of the crank actuated by the extending leg on the 
 other side of the wheel. 
 
PAET III. 
 
 AWKWAED WALKma AND SPECIAL DEFECTS. 
 
 The movement of the foot in walking is a 
 harmony, but one very liable to be converted into 
 a discord. Injuries in early childhood, unobserved 
 or unrecognized, from falls or sprains, frequently 
 lie at the root of ungainly walking. We must, 
 however, look more in detail for what it is that 
 hinders the muscles from moving the foot in the 
 manner most conducive to obtaining the best result. 
 Is the fault in the muscles themselves ? Are they 
 insufficiently stimulated by the nerves, under- 
 nourished by the blood vessels, or are they placed 
 at a disadvantage by reason of an abnormality in 
 the shape of the bones, and in the conformation, 
 and internal economy of the joints ? Is there 
 some disturbed condition of the nervous system 
 by reflex irritation or actual disease ? The reply 
 to these questions varies with the ease. For 
 
AWKWABD WALKING AND SPECIAL DEFECTS. 49 
 
 mobility of the joints, from the hip downwards, 
 must he absolutely unimpeded. A cause of want 
 of mobility at the hip may arise in the ligaments 
 of the joint, in the very numerous muscles that 
 surround it, or in the neck of the thigh bone — that 
 part between the shaft of the bone and the socket 
 of the haunch bone, and which is at an angle 
 with the shaft — or in the synovial membrane 
 within the joint. The hip joint is so hidden 
 by jnuscle that to estimate the nature of the 
 impediment is made difficult. Any want of 
 mobility at the hip reacts at the knee and ankle 
 joints. 
 
 Sir George Murray Humphry has also shown 
 (1888) that the widening of the hips, such as takes 
 place in girls at puberty, of itself modifies the 
 shape of the extreme upper end of the thigh bone 
 (the neck just mentioned) ; and that this, with 
 the characteristic shortness of the thigh bone, has 
 an influence on the bearings of the whole limb. 
 
 The upper and outer part of the shaft of the 
 thigh bone, which to the touch seems so imme- 
 diately beneath the skin, is in reality separated 
 from the skin by a dense and strong layer of 
 fibrous tissue, extending from the edge of the 
 haunch bone down the outer side of the thigh as low 
 
50 GBOWING CHILDEEN AND AWKWARD WALKING. 
 
 as the knee. Eeference to this fibrous structure 
 has been made at page 22. Against the inner or 
 deep surface of this layer, under healthy condi- 
 tions, the bone moves with ease and freedom, for 
 there is interposed a double layer of that fine 
 smooth moist (synovial) membrane for preventing 
 ' friction. Should there be a want of perfect ease in 
 the movement of the bone against this membrane, 
 such as may be caused by rheumatic disturbance, 
 freedom of the motion of the limb must suffer. 
 
 A very remarkable defect (at the hip) in walk- 
 ing has been especially described and explained 
 by Dr. Buzzard in his book on " Simulation of 
 Hysteria by Organic Disease of the Nervous 
 System " (1891). Dr. Buzzard has arrived at the 
 conclusion that the compound muscle fixed to the 
 spine and inner aspect of the haunch bone on the 
 one hand, and on the other to the upper part of 
 the thigh bone, being thus the main instrument 
 for lifting the thigh towards the trunk, may be so 
 weakened by disturbance of its nerve supply, 
 originating in the spinal cord itself, that the 
 movements of the limb evince imperfection, so 
 that walking in the ordinary way upstairs, for 
 example, becomes difficult, if not impossible. 
 Some most instructive instances are given by 
 
AWKWARD WALKING AND SPECIAL DEFECTS. 51 
 
 Dr. Buzzard of this disability ; one of them 
 completely illustrates my contention that awk- 
 ward walking indicates mischief demanding atten- 
 tion and interrogation, and is curiously a propos 
 as regards the significance of ungainly walking. 
 A girl at fifteen years of age had a peculiar gait, 
 which at seventeen years had become stiff and 
 stilted ; at twenty years, a very definite inability 
 to lift the knee, as in going upstairs, existed — 
 that is, the thigh could not be brought upwards 
 towards the trunk, and the hip joint could not be 
 usefully moved in that one direction ; the muscles 
 that had the chief share in the duty of so lifting 
 the limb were almost powerless, while the other 
 muscles of the limb to all appearance were well 
 nourished and normal, so that the girl could walk 
 and dance. The sequel to this state of affairs 
 happily has been that, although some peculiarity of 
 gait remains, full muscular power has beenrestored. 
 There is a very frequent defect in the move- 
 ment of the Hmb and foot, shown by the child's 
 foot being brought into collision with the ankle 
 or heel of the opposite side ; this may happen 
 from the foot of the defective side being too much 
 inverted, or too much everted ; in the one case 
 the toe, in the other the heel, comes in contact 
 
 E a 
 
.52 GROWING CHILDEEN AND AWKWAED WALKING. 
 
 with the ankle. The foot may be so extremely 
 everted that the heel of the offending foot knocks 
 against the heel of the sound one. The cause of 
 this state of affairs is either at the hip joint or in 
 the muscles of the leg, which rock the foot in the 
 forward movement of taking the step, the nerve 
 control of the muscles being disarranged, either 
 directly by nerve disturbance or by reflex irritation. 
 
 There is a parallel condition to be met with in 
 horses, where the hoof of one side bruises or cuts 
 the leg of the opposite one ; it is technically called 
 cutting, or bruising. 
 
 [I made some inquiries respecting this of Mr. 
 ■Sheather, Fellow of the Eoyal College of Vete- 
 rinary Surgeons. He was so kind as to give me 
 the information desired. Mr. Sheather divides the 
 defect as, 1st, occurring in young horses ; and, 2nd, 
 in those over four years old. In the former class 
 the causes are, he says, malformation, too rapid 
 growth, long journeys in droves leading to a tired 
 ;condition, and a general want of muscular tone ; in 
 the latter, the same want of tone, the exacting 
 a pace or labour beyond what the animal is fit for, 
 want of nervous energy, and the capacity for call- 
 ing into action the various muscles at the right 
 moments. Mr. Sheather adds the remarkable ob- 
 
•AWKWAED WALKING AND SPECIAL DEFECTS. 53 
 
 servation that this is never seen except as a 
 consequence of febrile diseases or of straining the 
 spine. Cutting is said to be rarely permanent. 
 Sometimes the trouble with certain horses comes 
 on in the spring and autumn only, and then but 
 for a few weeks.] 
 
 The knee joint, as is often too obvious, is liable 
 to some deflection from the line best suited to 
 transmit the weight of the body to the foot. The 
 state called knock-knee requires particular notice. 
 A minor degree of this deformity may arise from 
 the hip joint, the obliquity of the thigh tending 
 to push the lower end of the thigh bone inwardly, 
 and thus to put not only the ligaments of the 
 knee, but the muscles, at a disadvantage. But in 
 the more marked degree the bones of the knee 
 are at fault, both the lower end of the thigh 
 bone and upper end of the larger of the leg 
 bones (the smaller bone of the leg does not share 
 in the joint) participating. Sir George M. 
 Humphry brought the subject of knock-knee, 
 and some other deformities of the knee joint, 
 before the profession in 1889, and he showed how 
 uneven growth of the bones at the bone-produc- 
 tive layer of cartilage (see page 11) gave rise to 
 the departure from natural form ; this special 
 
54 GEOWING CHILDEEN AND AWKWARD WALKING. 
 
 communication followed several others pub- 
 lished by Sir Gr. M. Humphry, at various ante- 
 cedent dates, having reference to the cardinal 
 importance of the bone-producing stratum of car- 
 tilage, that stratum between the shaft of the bone 
 and the moulded end immediately forming the 
 joint. ^ 
 
 It is probable that children of quite early years, 
 by some apparently trifling accident or strain, 
 have injury done to this very important stratum of 
 bone-producing cartilage. Children in tumbling 
 about run the risk of such injury [nurses, in 
 snatching at the falling or stumbling child by the 
 arm, often thus cause mischief in the elbow joint], 
 
 Mr. Albert Keeves has given a fuU account of 
 this disordered growth ("Bodily Deformities," 
 1885), and he confirms the statement that the 
 
 ' Professor Charcot first detected the relation, of 
 certain changes in the nervous system to the disordered 
 state of the nutrition of the bones and joints, as well 
 also as of the muscular tissue. Dr. Buzzard holds the 
 view that there is a centre of nerve force presiding over 
 the nutrition of the bony skeleton and the joints, and 
 he has, following up the investigations of Charcot, ela- 
 borated this in his " Lectures on Diseases of the Nervous 
 System," and has logically concatenated the pheno- 
 mena attendant on the form of disorganization of bones 
 and joints found in association with nerve dieeasea. 
 
A WKWAED WALKING AND SPECIAL DEFECTS. 55 
 
 larger leg bone, as well as tlie tliigh bone, is in 
 some cases to blame, and narrates bow tbe pre- 
 judicial condition arises in tbe growtb of tbe bone 
 or bones. 
 
 Tbe opposite condition of knock-knee is seen in 
 bow-leg. In botb knock-knee and bow-leg tbe 
 weigbt of tbe body is transmitted to tbe ankle 
 joint in an unfavourable manner, wbicb interferes 
 witb tbe natural movement of tbe foot. Tbe leg 
 bone, at its lower end, in knock-knee, is tbrust 
 outwards ; in bow-leg it is tbrust inwards ; so tbat 
 in botb tbe side ligaments wbicb bold tbe leg 
 bones to tbe foot are strained. 
 
 In knock- knee, tbe foot during walking is most 
 commonly turned excessively outwards, and tbe 
 rolling action of tbe foot, instead of being towards 
 tbe great toe, terminates at tbe middle of tbe 
 inner edge of tbe foot ; in bow-leg, tbe tendency is 
 to turn tbe toes inwards, and tbe rolling action 
 takes place toward tbe outer edge of tbe foot and 
 to tbe little toe. 
 
 At tbe ankle joint, tbe instep, and tbe joints 
 of tbe foot, we most often find palpable and 
 cbaracteristic examples of defect, and to describe 
 tbem it will be necessary to make reference to 
 tbe structure of tbe ankle and foot. It must be 
 
56 GROWING CHILDEEN AND AWKWARD WALKING. 
 
 borne in mind that, during certain movements 
 in walking, the whole weight of the body has to 
 be sustained by one foot. 
 
 Suppose the weight of the body to be eight 
 stone, that is 112 lbs., or even half that weight, 
 the strain on the ankle joint is no triiling matter.' 
 
 The bones of the leg at the ankle ride on the 
 topmost of the seven short bones of the foot. 
 This topmost foot bone has a two-fold support ; it 
 rests behind on the largest of these seven bones, 
 the heel bone, and is bound to it by very strong 
 ligamentous fibres ; in front, it has a projecting 
 rounded head, which is supported by a short, 
 horizontal, partly elastic bridge of ligament. 
 The ankle bones, as the prominent ends of the 
 large and small bones of the leg are commonly 
 called, are held by ligaments to this topmost bone 
 of the foot, and to the heel bone, variously attached. 
 
 Many and multiform ligaments connect di- 
 
 ^ Ab an example of weights noted of some children, 
 taken at haphazard. Girl, aet. 9, 4 st. 5 lbs. (61 lbs.) ; 
 girl, aet. 15, 8 st. 5 lbs. (117 lbs.) ; girl, aet. 10, 3 st. 12 
 lbs. (54 lbs.) ; boy, aet. 12, 5 st. 10 lbs. (80 lbs.) ; girl, 
 aet. 51, 3 St. (42 lbs.) ; girl, aet. 12, 6 st. 7 lbs. (77 lbs.). 
 These weights include the clothing, as, of course, from 
 the present point of view, the weight of the clothing has 
 as much to be reckoned with as the weight of the 
 body. 
 
AWKWAED WALKING AND SPECIAL DEFECTS. 57 
 
 rectly all the bones of the foot, and there 
 is, besides, a strong fan-shaped fibrous struc- 
 ture which extends from the under part of 
 the heel to the front of the foot, on its way 
 splitting up and being variously associated 
 with the muscles and with those bones of the 
 foot from which the toes spring, so that it forms 
 a tie-beam to the arch of the instep, the front of 
 the foot being thus linked with the heel. A mass 
 of muscle occupies the hollow of the arch lying 
 between this fan-shaped fibrous layer and the 
 bones, and, passing forwards from the back of 
 the sole of the foot, helps to strengthen the 
 instep in walking and standing, in locomotion 
 and station ; another example of the distribution 
 of strain in the mechanism of the body. 
 
 Moreover, the normal shape of the foot, with 
 its arches, lateral and longitudinal, is in a most 
 essential degree maintained by a balance of 
 muscular action, the action of the muscles of 
 the leg, especially of those which are hidden by 
 the calf muscles, and also by those muscles 
 originating from the outer side of the leg. 
 
 A flattening of the instep — flat-foot — has been 
 ascribed to simple weakness of the ligaments. 
 Doubtless in some cases the ligaments, from the 
 
58 GROWING CHILDREN AND AWKWARD WALKING. 
 
 beginning, are deficient in strength, but the 
 ligaments under any circumstances are inadequate 
 to preserve the arch of the foot. 
 
 The preservation of the arch of the foot is 
 essentially dependent on the action of certain 
 muscles, as just stated, hut it is interfered 
 with by a defect in the compound muscles 
 of the calf of the leg fixed into the heel bone, 
 for, when this is not of due length, a full bending 
 forward of the leg upon the foot is not permitted, 
 and the effort towards that movement causes the 
 foot to get, so to speak, a list to leeward ; thus 
 an injurious strain is put upon the ligaments, 
 and upon one ligament in particular, that 
 horizontal bridge ligament that supports the 
 front of the topmost bone of the instep, on which 
 the leg bones ride. This result of contracted or 
 short calf muscles is constantly seen in children, 
 the subjects of a form of paralysis, to which 
 quite young children are peculiarly liable. 
 
 Dr. J. Symington, Lecturer on Anatomy, of 
 Edinburgh, has most minutely described the 
 change in the foot resulting from acquired flat- 
 foot. He adverts to the rarity of specimens in 
 the different museums. I take this as showing 
 how little serious attention has been given to 
 
AWKWABD WALKING AND SPECIAL DEFECTS. 59 
 
 the subject. Dr. Symington agrees with Mr. 
 Golding Bird that the hinder half, measuring 
 from the centre of the arch of the foot, is longer 
 naturally, and is made longer still by falling of 
 the instep.' 
 
 It may be here mentioned that, with the leg 
 straight, the foot should be able to be bent 
 towards the leg, so that the foot forms with the 
 leg a more or less acute angle. In most cases of 
 flat-foot, or falling of the instep, it will be found 
 that the foot can be so bent barely beyond a 
 right angle, as the shortness of the calf muscles 
 prevents the descent of the heel, which obviously 
 must take place before the front of the foot can 
 be lifted towards the leg. 
 
 Beyond the instep, abnormalities of the toes are 
 the source of many troubles. The displacement 
 of the great toe, with enlargement of the joint, 
 commonly known as bunion, and a crumpling 
 up of the smaller toes, are often the cause of 
 lameness and of suffering. These distortions 
 develop during the active stages of growth, and 
 it is worthy of remark that the crumpling of the 
 toes begins earlier than does bunion, and that there 
 is a difference in the liability of the sexes. The 
 • "Journal of Anat. and Phys.," 1884. 
 
60 GEO WING CHILDREN AND AWKWARD WALKING. 
 
 cause of these distortions is not so simple as is 
 usually supposed. 
 
 Surgical writers seem to find it impossible to 
 get away from the very old belief that bunion 
 and the crumpling of the toes are caused by short 
 shoes, and they cling to that plausible but trans- 
 parent fallacy; for example, one recent author 
 lately (1891) wrote that bunion "must be 
 regarded as a simple malposition caused by the 
 use of boots of the wrong shape." ' The same 
 tale is told in most, if not in all, surgical 
 treatises. 
 
 Now, in the first place, one may see extreme 
 condition of bunion in people who have never 
 worn shoes, or, at any rate, do not habitually 
 wear them ; and, in the second place, a pressure 
 competent to dislocate the toes would be 
 insupportable. The shoe theory offers no ex- 
 planation of the hereditary nature of a consider- 
 able number of cases, nor of the fact that the 
 displacement of the toe in bunion goes on 
 increasing as age advances, although there may 
 be plenty of room, and to spare, in the shoe. 
 
 ' And a like suggestion haa been made as regards 
 retracted toes by a writer in " Pathological Society's 
 Transactions," vol. xxxvii., 1886. 
 
AWKWAED WALKING AND SPECIAL DEFECTS. 61 
 
 I contend that the displacement begins in a 
 nervous and muscular fault, which continues 
 and increases the mischief. Mr. Adams says : ' 
 " It is certainly not traceable to the child 
 wearing short boots. I have frequently seen it 
 where the greatest care has been taken that the 
 boots worn by the child should be of full length." 
 Although I thus traverse the statement that 
 badly made shoes cause distortion by simple dis- 
 locative pressure, it seems to me probable that 
 great harm may be brought about through bad 
 shoes, by means of injury to the nerves of the foot, 
 thus causing disturbance of the nerve supply ^ to 
 the muscles especially belonging to the foot, of 
 the same nature as any more obvious mechanical 
 violence to the trunk of a nerve in the leg, an 
 instance of which I give at page 70. 
 
 ' Contraction of the second toe, &c., p. 124, 1892. 
 
 '' " Scrivener's cramp " is due to some disordered con- 
 dition of the nerve supply to the muscles of the hand 
 and arm. The same trouble occurs from the same cause 
 in violin players. In the Dresden Gallery is the celebrated 
 picture of the Beading Magdalen, by Battoni, familiar to 
 many by the engravings. The woman who served as 
 model to the painter had, in a marked degree, displace- 
 ment of the great toe ; it is doubtful whether she ever 
 wore tight shoes. This illustration of lateral displace^ 
 ment of the great toe is rot the only one that may be 
 culled by a study of the old mastei-s. 
 
62 GROWING CHILDEEN AND AWKWAED WALKING. 
 
 I endeavoured ' some time since to show that 
 the real cause of the displacement lay in the con- 
 dition of the muscles, induced by disturbance in 
 the nerve supply; and to indicate how, in 
 numerous instances, the spinal nerves were dis- 
 arranged, and that the crumpling of the toes was 
 of the same nature as the condition of the fingers 
 in " la main en griffe " — ^that is when, in conse- 
 quence of injury to the nerve supplying or ani- 
 mating the muscles of the hand, the fingers can- 
 not be fully extended and assume a claw-like 
 appearance, as was pointed out by M. Duchene 
 de Boulogne, by whom my attention was first 
 drawn to the question. 
 
 I must here interpolate an example of here- 
 ditary distortion of one toe, as relevant subject 
 of the argument. 
 
 A lady had retraction (crumpling up) of the 
 second toe, for which she had consulted me ; her 
 son, at the age of twelve years, also came under 
 my observation on account of weakness of the 
 ankles and shortness of the calf muscles, which 
 prevented his taking part in the game of football, 
 almost obligatory at the public school to which 
 it was proposed he should be sent ; at that time 
 
 1 " Trans, of the Clinical Society of London," vol. xi. 
 
AWKWARD WALKING AND SPECIAL DEFECTS. 63 
 
 there was no retraction of any one of the toes, 
 but later on, when he was almost fully grown, I 
 found he had a retracted toe corresponding to 
 that of his mother. 
 
 The retraction of the lesser toes, so that they 
 are drawn upwards at the middle joint, instead of 
 lying out at full length, involves further mis- 
 chief, those joints where the toes are attached 
 to the bones of the foot being thrust downwards, 
 and bunion in the sole of the foot is the 
 result, as the whole weight of the body is thrown 
 on to the tissues of the sole at these points. 
 Where this condition of retraction exists, the 
 movement of the forward rolling of the foot (see 
 page 37) ends at the ball of the foot, in place 
 of at the tips of the toes, and a jerky, saltatory, 
 affected style is given to the step. In this way, 
 only three-quarters of the foot is utilized. 
 
 This faulty, incomplete rolling of the foot is 
 betrayed on inspection of the sole of the shoe, 
 which shows itself to be unduly worn in the 
 centre part ; this condition of the sole is almost 
 invariably found to be the indication of retracted 
 toes in the wearer of the shoe. 
 
 But to the spine itself and to the spinal cord we 
 have to look for the explanation of failure of 
 
64 GROWING CHILDEEN AND AWKWARD WALKING. 
 
 muscular energy, and of the want of orderly 
 muscular energy. 
 
 The late Dr. Little said,' " A slight degree of 
 flat-foot '' (falling of the instep, failure of the arch 
 of the foot) " is common in girls,'' especially of the 
 upper and middle classes." It is well known that 
 some degree of lateral curvature is very common in 
 the sex and in the classes specified ~bj Dr. Little. 
 
 Sir Benjamin Brodie and others mention that 
 falling of the instep is very often coincident with 
 lateral curvature of the spine, but no stress has 
 been laid by them upon the possibility of a 
 defective or disturbed state of the nervous 
 supply of the muscles being a factor in the 
 production of the distortion. 
 
 There is, however, a question bearing on the 
 relation of the lower limbs to the spine, namely, 
 the frequent inequality in the length of the lower 
 limbs. This inequality, as a cause of deviation 
 of the spine, has not often been fully recognized ; 
 
 ' " Holmes' System of Surgery. 
 
 ' In the female tlie aimiial rate of growth after the 
 age of fourteen is feebler ; her growth terminates about 
 two years before that of the male ; while at the age of 
 thirteen girls are a little taller than boys, at the period 
 of full development women are nearly four inches shorter 
 than men. 
 
AWKWAED WALKING AND SPECIAL DEFECTS. 65 
 
 I must nevertheless state that Mr. Noble Smith 
 has fairly dealt with this subject. It is true 
 that writers on spinal curvature have mentioned 
 imparity of the lower limbs as a cause of cur- 
 vature, but from the drawings to illustrate their 
 text it is clear that they were contemplating a 
 much greater inequality than that one here re- 
 ferred to, which is of remarkable frequency. 
 
 A certain number of measurements of dry bones 
 have been made, and, as far as the measuremehts 
 of dry bones carries us, it would appear that in 
 only ten per cent, of the skeletons measured were 
 the bones of the lower limbs of opposite sides 
 found to be of equal length ; these measurements, 
 which included the bones of many different races, 
 were published by Dr. Garson in 1879. 
 
 Dr. Morton,' of Philadelphia, measured five 
 
 hundred boys between the ages of eight and 
 
 eighteen years ; in less than half did he find the 
 
 legs of equal length. In a large majority of the 
 
 boys whose limbs were not equal, the difference 
 
 was from ^th to fths of an inch, the right 
 
 limb being the longer in over two-thirds of the 
 
 number (Dr. Garson's measurements of seventy 
 
 ' Dr. Thomas G. Morton on " Inequality in Length 
 of the Lower Limbs." 
 
66 GEOWING CHILDEEN AUD AWKWARD WALKING. 
 
 skeletons show the left limb to be the longer^. 
 Dr. Morton, in 1888, wrote on this subject, and 
 directed his attention to inequality in the length 
 of the lower limbs as a cause of curvature of the 
 spine. In the same year I published a paper ' in 
 which I described what I believed to be the con- 
 sequences of the inequality in the length of the 
 lower limbs, one of these consequences being that 
 in the erect position, in order to bring the head in 
 the direct line with the centre of gravity, some 
 degree of lateral curvature of the spinal column 
 must arise, and elevation of the shoulder on the 
 side of the short leg. ' It is impossible that the 
 
 ' " On certain Disregarded Defects of Development 
 chiefly in relation to the Curves (normal) of the Spine, 
 1888. 
 
 ^ The eSeot of the inequality may be illnstrated by the 
 following simple experiment : — 
 
 Enle two parallel horizontal lines six inches distant 
 from one another on a sheet of paper, say eight inches 
 long by six inches wide. 
 
 Take a second smaller piece of paper, six inches long 
 by three inches broad, and cut off from each side a strip 
 one inch wide by five inches long ; this will leave the 
 paper T shaped. When placed on the first piece of paper 
 so that the uppermost edge of the T shall coincide with 
 the top line, the lower edge of the foot of the T will 
 coincide with the bottom of the two ruled lines. Now 
 cut a wedge-shaped or triangular piece, having a base 
 of ^-inoh from the foot of the T ; this makes the vertical 
 part of the T shorter on one side than the other. 
 
 Place the T, mutilated thus, between the two parallel 
 
AWKWAED WALKING AND SPECIAL DErECTS. 67 
 
 act of walking can be perfectly true with the 
 legs of unequal length. 
 
 Dr. Morton says : " Although an inequality in 
 the length of the lower limbs may never cause 
 symptoms, and thus fail to be recognized by the 
 individual, yet occasionally it happens that this 
 defect becomes an important factor in the pro- 
 duction of disease." 
 
 It is immaterial from the present point of view 
 whether the right or left limb be the longer as re- 
 gards the production of a lateral curve. The bend- 
 ing of the spine to one side or to the other, so long 
 as the body is in the erect posture, necessitates an 
 undue effort of the muscles of the loin and back, on 
 
 lines already drawn, so that the edge of the foot shall 
 coincide with the bottom line. The cross-bar of the T 
 will not be found to coincide with the upper of the 
 parallel lines, but will be " on the slant.'' 
 
 Correct this " slant " by making it horizontal, adjust- 
 ing it with the fingers. Two things will become ap- 
 parent ; the upper edge of the T will not coincide with 
 the first of the ruled lines, but will be below it, and the 
 side of the perpendicular part of theT which corresponds 
 to the point of the wedge, the apex of the triangle (cut 
 off), will bulge up. 
 
 The short side of the T ^iH represent the short leg ; the 
 bulging of the longer side will represent the curve of the 
 spine, which is instinctively made by the subject of the 
 inequality to correct the disturbance of the centre of 
 gravity, and the inconvenience, to say the least of it, of 
 having the two eyes at different levels. 
 
 F 2 
 
68 GBOWING CHILDREN AND AWKWARD WALKING. 
 
 the side of tte longer limb to adapt tlie centre of 
 gravity, an inordinate one-sided tax on muscular 
 energy wMch. may react on tte internal organs.' 
 
 This form of lateral curvature of the spine, 
 which may almost be described as intermittent, 
 as it belongs to the erect posture, vanishing on 
 sitting down, appears to me to disarrange the 
 perfect function of the spinal cord, and entails 
 serious mischief. 
 
 Sir James Paget writes -.^ " Of the cases in which 
 deformity of the spine is feared, on account of 
 some more abiding unusual shape, some are 
 associated with inequality in the length of the 
 lower limbs. , . . Exact equality in the length 
 of the limbs is rare, but if the inequality be not 
 more than a quarter of an inch, it will hardly be 
 observable at the spine. A greater inequality 
 may so lift up the pelvis " (haunch bone) " above 
 the longer limb that the flank must appear sunken 
 
 ' Dr. Morton, on the authority of Mr. Hubbell, of 
 Philadelphia, gives an illustration of the ultimate result 
 of an apparently insignificant fault in mechanical con- 
 struction : " The variation of but one-tenth of an inch 
 in the perfect circularity in the tires of the driving-wheel 
 of a locomotive has been known to squander energy 
 enough, measured in the oat of extra consumption of 
 coal, in a few years to buy a new locomotive." 
 
 ' "Studies of Old Case Books," 1891. 
 
AWKWAED WALKING AND SPECIAL DEFECTS. 69 
 
 in, and tte Inmbar" (loin) "part of the spine 
 must be habitually, however slightly, curved." 
 
 For my own part, I venture to assert that the 
 lateral curvation, owing to an inequality in the 
 length of the lower limbs which is constantly 
 overlooked, indirectly induces various kinds of 
 ill-health, and, short of that, pains in the back 
 and aching spine, incapacity for ordinary avoca- 
 tions, and quickly brought on fatigue. 
 
 Interference with the due supply of nerve 
 influence is one of the chief causes of ungainli- 
 ness of gait. There are many ways in which the 
 muscles may be deprived of the necessary nutri- 
 tional nervous stimulus. Damage to the brain dis- 
 franchises the nerve fibres proceeding from the 
 disorganized part to the spinal cord, and the 
 muscles suffer. There may be faults in the 
 development of the spinal cord itself, incident to 
 the change in the relative lengths of the spinal 
 cord and the spinal canal in which it lies, during 
 the period of the rapid growth of the body, or the 
 cord may be the seat of some diseased changes.' 
 There may be a condition of the nerve trunks ob- 
 
 ' Charcot "described tlie changes in the spinal cord 
 causing wasting of muscle. '' Pathog. Soc. Trans.," vol. 
 
70 GROWING CHILDEEN AND AWKWAED WALKING, 
 
 structing the nerve current, a condition brought 
 about by direct injury, or by inflammatory disease, 
 mischief originating in extrinsic or intrinsic 
 influences ; that is to say, by something acting from 
 the outside, or by a constitutional or internal dis- 
 turbance, such as a severe fever. The following 
 is an example of interruption of the nerve current 
 by external injury to a nerve trunk. A young 
 woman, aged twenty-one, at the time of my first 
 seeing her, had received, seven years previously, 
 a blow at the back of the knee joint, which 
 bruised one of the large nerves of that region, 
 the nerve belonging to the muscles of the outer 
 side of the leg, the tendons of which are fixed to 
 the foot. A good deal of pain down the nerve 
 followed the injury, and remained a long while, 
 as I gathered from the girl's report of herself. 
 The result was that the muscles became im- 
 poverished and weak from the want of due nervous 
 stimulus, and the foot acquired a tendency to 
 turn sole inwards ; further, the toes crumpled up, 
 and there was a constantly recurring spraining of 
 the ankle ; the young woman was thus incapaci- 
 tated ; but, after persevering massage, the weakened 
 muscles recovered, and she was able to walk firmly, 
 and to earn her living as a domestic servant. 
 
AWKWARD WALKING AND SPECIAL DEFECTS. 71 
 
 In illustration of the effects of internal mis- 
 cMef, I would mention the ease of a man who, 
 when young, had an attack of small-pox ; an 
 arrest of development of the upper limbs followed 
 it, so that while he had the body of a fully 
 grown man, his arms looked like those of a boy. 
 The Lancet, August 27th, 1887, contained an 
 article on the result of another eruptive fever, to 
 wit, measles. The article is a long one, and 
 gives a careful resume of the opinions of several 
 physicians, but refers especially to the researches 
 of Pitres and Vaillard, and of Dr. Thomas Barlow 
 who found evidence of distinct hsemorrhagic mis- 
 chief in the spinal cord (bleeding amongst the 
 fibres) in a case of measles. The writer of the 
 Lancet's article goes on to say : "Although the 
 occurrence of such marked lesion in the cord is 
 unusual, still we must admit the possibility of 
 a slighter vascular disturbance of the cord as a 
 more general concomitant of severe measles." A 
 constitutional condition of the system (gouty) will 
 interfere with sometimes one nerve, sometimes 
 another. A common example of nerve trouble is 
 sciatica, causing wasting of muscle ; less observ- 
 able is the gouty failure of the nerve animating 
 the greater bulk of the muscles of the hand, 
 
72 GBOWING CHILDEEN AND AWKWABD WALKING. 
 
 making the hand appear somewhat withered, by 
 a hollow forming between the bone that sup- 
 ports the thumb and the corresponding bone 
 of the next finger, this space being occupied 
 under healthy conditions by a bulging mass of 
 . muscle. 
 
 Another example of nerve deterioration, 
 not the result of mechanical injury. The 
 patient, a young lady, ten years before coming 
 under my observation, had an undefined illness, 
 followed by pain in the left loin. She was 
 then seventeen years of age, and fully grown 
 as regards height. When seen by me, walking 
 had become painful from severe bunion and 
 crumpling of the toes ; the left leg was consider- 
 ably wasted, a condition that had been hitherto 
 overlooked ; the foot could not be fully lifted, the 
 shortness of the calf muscles preventing, and the 
 thigh could not be drawn up with the same ease as 
 that of the opposite side, as there was want of 
 mobility of the muscles connected with the hip 
 joint. It is probable that there had occurred, at 
 the time of the illness, some inflammation, either 
 of the trunks of the nerves or of their envelopes, 
 of a rheumatic character, and had treatment at an 
 early date been resorted to, the lameness might 
 have been obviated. 
 
. AWKWAED WALKING AND SPECIAL DEFECTS. 73 
 
 I have already alluded to the possibility of 
 lateral curvature of the spine being a cause of 
 interruption to nerve stimulus. Lateral cur- 
 vature is an abnormality; but the natural 
 curves of the spine may, nevertheless, by exag- 
 geration or by deficiency, likewise prove pre- 
 judicial. A young lady, about sixteen years 
 of age, was brought to me by her parent, on 
 account of a liability to twist the ankle, without 
 sprain, as there followed no discoloration such 
 as is seen ordinarily in rupture or tearing of a 
 ligament when there is a real sprain. I found an 
 excess of the forward curve in the loins, so much 
 as to render her apparent height less by two inches, 
 or thereabout, than her real height. This ex- 
 cessive curve interfered with the nutrition of the 
 muscles which should sustain the foot in its 
 proper position as regards the leg bones ; conse- 
 quently slight inequalities of the ground caused 
 the foot to turn over in walking. 
 
 The fore and aft curves spoken of at page 30 
 (not especially human, they having their repre- 
 sentatives in animals that go on all fours) confer 
 an elasticity and extensibility on the spine. These 
 curves constitute one of those provisions in the 
 animal frame against sudden strain or tax on the 
 strength of a part, and afford protection to the 
 
74 GKOWING CHILDEEN AND AWKWAED WALKING. 
 
 brain and spinal cord against jar in abrupt move- 
 ments. There are otber examples of such pro- 
 vision against shock in the blood vessels as well 
 as in the muscular system. 
 
 As these curves should be developed at maturity, 
 it follows that a lack of curve is an imperfection, 
 and an excess a deformity. Defective develop- 
 ment may thus be positive or negative — may con- 
 sist in the persistence of a normal but provisional 
 condition, or the non-growth of what ought to grow. 
 Some results of defective development are direct 
 and mechanical, some reflex and nutritional. 
 
 A structure so exquisitely delicate and sensitive 
 as the spinal cord, suited to rest in the canal of 
 the backbone, having certain natural undulations, 
 must have its function interfered with when these 
 undulations are abnormal in a degree, especially 
 if complicated with a morbid curve to one side or 
 the other, a lateral curve, whether arising from 
 some irregularity in the growth of the separate 
 vertebrae, or from a tilting over of the haunch 
 bone by reason of an imparity of the lower limbs. 
 As an example of the result of deficiency of 
 curve, I add this case. A young man applied to 
 me on account of lameness in his feet, which 
 caused him to suffer much pain, as his occupation 
 
AWKWAED WALKING AND SPECIAL DEFECTS. 75 
 
 necessitated a standing posture the greater part 
 of the day. I found that the toes were much 
 crumpled up, that he had bunions, and that the 
 spine in the region from the waist to the neck 
 was unduly vertical ; the normal fore and aft 
 backward curve had not been developed. I have 
 so often seen this undue straightness of the 
 upper part of the spine co-existing with the distor- 
 tion of the feet, as above specified, that I cannot 
 but look upon them other than as cause and effect. 
 
 It has occurred to me to question whether 
 what are commonly called " growing pains " are 
 not brought about by the commencement of the 
 development of the normal curves of the spine. 
 
 Among the causes of awkward walking from 
 reflex disturbance of the nervous system, dental 
 irritation may be suspected to be one. The 
 jaws in childhood, only developed so far as 
 to accommodate twenty teeth, afterwards have 
 to expand and give room for thirty-two. The 
 disturbances liable to attend the appearance of 
 the first set of teeth and the eventual expansion 
 of the jaw are many of them of a reflex character. 
 
 In 1877 I contributed a short paper to a 
 medical society in corroboration of the views of 
 the late Mr. Samuel Cartwright, who held the 
 
76 GROWING CHILDREN AND AWKWARD WALKING. 
 
 opinion that certain nervous affections depended 
 on the physiological state of the system induced 
 hy dentition, and I gave instances where disease 
 of the eye had arisen from dental irritation. 
 Papers by others have since been published 
 giving illustrations of the significance of dental 
 irritation in disorders where such irritation had 
 not been previously looked for as a cause. 
 
 St. Vitus's dance — chorea — is a disorder attack- 
 ing children most frequently just before puberty, 
 and has been ascribed to a rheumatic state which 
 has affected the heart. Arguing from the figures 
 afforded by Dr. West,' namely, that out of 422 
 cases 363 occurred between the fifth and twelfth 
 years of age ; as this period coincides with the 
 cutting of the second or permanent set of teeth, 
 excepting the wisdom teeth, the suspicion is justi- 
 fiable that dental irritation has some share in dis- 
 turbing the functions of the spinal cord, of which 
 disturbance chorea is a symptom or sign, and which 
 will generally subside when the " second molar " 
 teeth are cut. Dr. Landon Gray, of New York,^ 
 writes : " The rdle of articular rheumatism in the 
 causation of chorea has been much over-estimated, 
 
 ' " Diseases of Childhood," 5th Edition. 
 
 ^ " Treatise on Nervous Diseases," etc., p. 409. 
 
AWKWAED WALKING AND SPECIAL DEFECTS. 77 
 
 and the idea that chorea was a rheumatic disease 
 is entirely untenable." As another example of 
 loss of muscular equilibrium which corresponds 
 in point of time with the cutting of the first 
 tooth of the permanent set, about the fifth or 
 sixth year, is the squint that so often makes itself 
 evident at that date, notwithstanding squint is 
 sometimes to he observed at birth. The explana- 
 tion that has been given by oculists of the squint 
 becoming manifest at the fifth year is that certain 
 defects of vision begin to take effect, in con- 
 sequence of the child commencing at that age 
 more closely to employ the eyes. 
 
 With regard to the lower limb muscles, the dis- 
 turbance of the nervous system by dental irritation 
 is illustrated by a case that came under my notice 
 some years since (January, 1886), The young 
 lady, in her ninth year, was observed by her friends 
 to be unable to stand unless the feet were widely 
 separated ; when the feet were brought close to- 
 gether, she would fall forwards ; the calf muscles 
 of both legs were somewhat contracted. I ima- 
 gine, that the falling forward was due to an 
 instinctive forward bending of the body to pre- 
 vent falling backwards ; she had a squint of the 
 left eye, her teeth were irregular. Mr. Pillin, of 
 
78 GEOWING CHILDREN AND AWKWAED WALKING. 
 
 George Street, Hanover Square, treated the dental 
 defects, and diligent massage was employed to tte 
 muscles ; by the following October the squint 
 had disappeared, and also the inability to stand 
 with the feet together, the body weight having in- 
 creased in the ten months eight and a half pounds. 
 
 A further example of awkward walking. A girl 
 in her eleventh year, well grown — that is, she 
 weighs 5 stones 2 lbs. = 72 lbs. — walks without 
 putting the left heel to the ground in the ordinary 
 step ; she can stand with both feet fairly placed. 
 There is only about a fourth of an inch difference 
 in the circumference of the legs, the left being the 
 smaller ; there is no shortness of the calf muscles. 
 In bringing the left foot forward in walking 
 she does not quite clear the right ankle ; this is 
 shown by the boot over the right ankle being cut 
 through, while the boot over the left ankle is un- 
 touched. Those teeth that are due at the tenth 
 year show no signs, and those due at the ninth 
 year are not all fully "cut." Dental irritation 
 of reflex nature may here be the primary cause 
 of the symptoms, as no condition of the muscles 
 of the limb sufficient to account for the phenome- 
 non is to be found. 
 
 In another direction, I have observed reflex 
 
AWKWAED WALKING AND SPECIAL DEFECTS. 79 
 
 disturbance concomitant with, the cutting of the 
 teeth ; for example, ophthalmia of different kinds 
 in early life ; and, later on, when the wisdom teeth 
 are making their way through the gums ; in 
 young women, the constitutional health under 
 such circumstances is often deranged, the com- 
 plexion alters, the hair falls, and sometimes dis- 
 tressing pains across the head and in the eyes 
 prevail when any kind of work that calls for 
 ocular strain is attempted, so that reading or 
 writing, for exalmple, becomes impracticable. 
 
 Marked peculiarities in walking should draw 
 attention to the state of the jaws as regards 
 dentition. 
 
 It has to be stated that the hypothesis of 
 dental irritation being a cause of nerve mischief 
 does not find favour with some specialists ; one 
 physician (specialist) denies that there is proof 
 of any relation between dental irritation and that 
 serious nerve affection called infantile paralysis. 
 
 Mr. D. Corbett, of Dublin,' has recorded a case 
 of dental irritation reacting on the lower limbs 
 as well as on the eye. 
 
 1 " British Journal of Dental Science," vol. xxiv., 
 p. 823 : " Evidence of reflex action in relation to con- 
 stitutional disturbance during second dentition," 
 
80 GEOWING CHILDREN AND AWKWAKD "WALKING. 
 
 A young lady at seventeen had suffered no ill- 
 ness until her fifteenth year, when weakness of 
 the lower extremities showed itself, accompanied 
 by occasional impairment of vision. The weak- 
 ness of the limbs increased, until the power of 
 walking about unassisted was lost ; every kind of 
 treatment had failed to do good. Mr. Corbett, 
 by almost a chance, had the opportunity of 
 examining her mouth; he found evidence of 
 severe pressure from the wisdom teeth against 
 the next teeth (" the second molars "), so much 
 as to produce displacement outward of these 
 teeth. Mr. Corbett removed them, and within a 
 week improvement was marked, and in three 
 months the nervous disturbance, with the excep- 
 tion of the eye trouble, had vanished. 
 
 But going the other way round, both Mr. 
 Brudenell Carter ' and Mr. Bickerton (of Liver- 
 pool) ' have given cases where ocular strain from 
 defect in the eye produced symptoms like those of 
 brain disease. 
 
 ' " Transactions of the Clinical Society," 1874. 
 2 Liverpool Medical Association, 1886. 
 
PAET IV. 
 
 COBRECTION AND PEETENTION. 
 
 The restoration of lost power, and the overcoming 
 the resistance of contraction of single muscles or 
 of groups of muscles, are the primary aim in the 
 correction of defects in walking, whatever may- 
 have been in the first instance the cause of the 
 loss of power or of the contraction. Feeding, 
 clothing, and exercise are the general means of 
 keeping up a good standard of health. Gym- 
 nasties, massage, and galvanism are the special 
 and direct agents for correcting derangement. 
 To meet exigencies, gymnastics must be system- 
 atized and modified. 
 
 Under the ordinary circumstances of good 
 health, exercises should be directed to the equal 
 development of all the muscular parts of the body, 
 and be kept well within the compass of the vital 
 capacity of the individual. Exercises in excess 
 cause an undue strain to be put on the heart and 
 lungs ; but exercises duly regulated give in- 
 crease of strength, suppleness, and better carriage, 
 and, by equalizing the distribution of the mus- 
 
82 GKOWING CHILDREN AND AWKWARD WALKING. 
 
 cular and nerve force, also promote a uniform 
 healthy condition of all the functions of the body. 
 
 Special gymnastic exercise and treatment can he 
 applied to single muscles if debilitated with ana- 
 logous effect. It has first to be determined what 
 muscles are at fault, and it must be remembered 
 that, although the cause of such muscles being 
 unequal to their task may be no longer operative, 
 there may have accrued prejudicial conditions, 
 for, whenever a muscle has been_ thrown out of 
 work, it immediately tends to shorten or shrink : 
 this is a very important fact, and is much over- 
 looked. 
 
 Ling's system, known as the Swedish system 
 of gymnastics, is from this point of view the best. 
 The exercise of separate muscles, or of sub- 
 divisions of groups of muscles, is a leading feature 
 in the application of the system. The causing 
 separate enfeebled niuscles to work independently 
 is like calling on a deficient member of a chorus 
 or orchestra to attend extra rehearsals. 
 
 General gymnastic exercises of a simple cha- 
 racter should form a part of the daily education 
 of every growing child, as a matter of hygiene. 
 
 There are several general gymnastic exercises 
 that may be carried out at home, when resort to 
 
COBRECTION AND PREVENTION. 83 
 
 a gymnasium is not practicable, it being premised 
 that no exercise should be continued to fatigue. 
 
 1. Breathing Exercise. — (a) Let the arms be 
 fully extended at right angles to the trunk, the 
 shoulder blades being drawn well back ; then let 
 deep full inspiration be slowly made, (b) Let 
 the thus inspired air be forced out by the muscles 
 of the abdomen assisting the ordinary chest 
 muscles of expiration. The rebound of the elas- 
 ticity of the ribs and their cartilages will be very 
 observable when these have finished contracting. 
 
 2. Spine Exercise. — (a) Eaise the arms ver- 
 tically above the head, keeping the lower limbs 
 straight ; then bend gradually forward, until 
 the 'fingers can touch the front of the foot, {b) 
 Eesuming the upright position, bend the spine as 
 much as possible in the opposite direction. In 
 these two exercises the abdominal and back 
 muscles are strongly, but steadily, called into play, 
 (c) Bend the spine, i.e. the trunk, alternately to 
 the right and to the left. 
 
 3. Limb Exercise. — (a) Standing by the side of 
 an ordinary chair, slowly raise one foot so as to 
 place it on the seat of the chair, (b) Carrying 
 a light weight on the head, walk slowly upstairs, 
 one step at a time, (c) "Walk slowly upstairs, 
 
 G 2 
 
84 GROWING CHILDREN AND AWKWARD WALKING. 
 
 two steps at a time, (c?) Walk slowly downstairs, 
 one step at a time. 
 
 4. (a) Standing half the length of the foot 
 from the wall, bend the knees forward so that they 
 shall touch the wall ; (&) repeat this bending to 
 the wall with one leg only, stretching the other as 
 far as possible backwards, with the knee straight. 
 
 5. With the" feet together, stand on tip-toe. 
 
 6. With the feet together, raise the front of 
 the feet so that the weight of the body shall rest 
 on the heels. 
 
 7. Where a staircase with a handrail on each 
 side is available, ascend the stairs with the help 
 of the arms, the hands taking hold of the rails. 
 
 On no account should a child be allowed to 
 jump down from two or three stairs, or from any 
 height ; irreparable injury to the bone-developing 
 cartilage may result. No educational exercise is 
 involved in such exploits. 
 
 In the attempts to correct deviations of the spine, 
 or to rectify some of the secondary weaknesses, 
 especially when such are due to an inequality in 
 the length of the lower limbs, the great advantage 
 of systematic gymnastics based upon anatomical 
 And physiological facts is that the weaker muscles, 
 those most needing help, get bestowed upon them 
 
COKEECTION AND PEETENTION. 85 
 
 the greatest share of the treatment ; whereas, if 
 a knowledge of these facts be wanting, the indi- 
 vidual, the subject of the lameness, in endeavour- 
 ing to correct the faults, would most probably 
 make the efforts in the wrong direction. There- 
 fore, where systematic exercises are not obtain- 
 able, simple uncomplicated symmetrical exercises 
 only are safe. 
 
 Mr. John Holm, my friend and former pupil, 
 one of the earliest surgical exponents of Ling's 
 system (the Swedish) in this country, has been 
 so kind as to compile a list of such exercises 
 as can be put in force at home. Mr. Holm's 
 directions go further and teach more techni- 
 cally than the very elementary suggestions I 
 have given. It may not be out of place to say 
 that the aim of Ling's system, the working and 
 effects of which I have watched during many 
 years, is not confined simply to guiding har- 
 monious bodily development in the strong and 
 healthy, but extends itself, by being delicately 
 modified and graduated, to the restoration of the 
 enfeebled; while its completeness enables the 
 exercises to be localized so as to encourage the 
 return of strength and function to those parts 
 betraying weakness and failure. 
 
86 GEOWING CHILDREN AND AWKWAKD WALKING 
 
 Mr. Holm's suggestions and instructions are as 
 follows : — 
 
 1. Tte child should stand close to, and facing 
 a wall or door, his feet being at an angle of 45°, 
 the toes touching the wall. The hands should 
 be firmly placed on the hips, the thumbs being 
 behind and the wrists bent well down. The 
 knees should be kept perfectly straight, the head 
 maintained in the upright position with the chin 
 well down, the whole body facing equally for- 
 ward. The abdomen should be kept in close 
 contact with the wall. The above positions 
 being maintained throughout the "movement," 
 the body should be then bent slowly backwards 
 as far as possible without losing balance, return- 
 ing to the original position. 
 
 The movement should be repeated from three 
 to six times. 
 
 2. The child should stand on the edge of a 
 firm table, the feet being separated to the width 
 of the shoulders and turned outwards to an angle 
 of 45°- The arms should be then raised, the 
 elbows being kept straight, to a vertical position 
 in line with the ears, and parallel to each other. 
 The trunk should be then bent, carrying the head 
 and arms equally and slowly forwards and down- 
 
GYMNASTICS. 87 
 
 wards ; slightly bending the knees, the edge of 
 the table should be grasped with the fingers. 
 The knees should be then slowly stretched 
 until a strong tension be felt behind them, and 
 extending along the ppine. Kepeat three to nine 
 times. 
 
 3. The child lies face downwards on a table, 
 the hands being fixed on the hips ; each leg 
 should be then alternately raised, keeping it per- 
 fectly straight, and taking care not to turn (twist) 
 it during the movement. Eepeat from three to 
 six times. 
 
 4. A. The child lies on his back on a table, 
 being especially careful that the shoulders, hips, 
 knees, and feet face equally upwards, the arms 
 being stretched upwards in front, the elbows, 
 wrists, and fingers being perfectly straight, the 
 palms facing and the arms parallel to each other ; 
 both arms should be then slowly lowered in the 
 vertical plane until they reach the horizontal 
 position, making at the same time an effort to 
 draw the shoulder blades together. Eepeat six 
 times. 
 
 4. B. Starting from the latter position, the child 
 should draw the elbows slowly to the sides, at 
 the same time bending the elbows until the 
 
88 GROWING CHILDREN AND AWKWARD WALKING. 
 
 fingers touch the shoulders ; with great concen- 
 tration, but without violence. Simultaneously 
 the shoulder blades should be drawn together. 
 Repeat three to six times. 
 
 5. The child should either sit on the front por- 
 tion of a chair or stand with the feet placed as in 
 No. 2. The hands being firmly fixed on the hips, 
 then, slowly and steadily, the trunk should be 
 turned as far as it will go without bending, first 
 to the left, then to the right, being careful that 
 the elbows maintain their relative position, 
 following the movement of the body. Eepeat 
 four to six times. 
 
 6. The child, standing, is to advance one foot 
 twelve inches forward, then, raising both arms 
 to the horizontal position, the palms facing the 
 floor, should slowly rotate the arms, describing 
 a circle with the fingers. Having performed the 
 rotation from four to nine times, his deep respira- 
 tions should be commenced when the arms are in 
 the most forward and downward position, " cir- 
 cling " them gradually upwards and backwards as 
 the inspiration is made ; backwards, downwards, 
 and forwards as the expiration is made. Four 
 to six respirations. The feet should then be 
 changed, and the movement repeated as before. 
 
GYMNASTICS. 
 
 The inspirations should be made slowly, deeply, 
 and steadily, all spasmodic effort being avoided, 
 but the respiration in each case being pushed to 
 the extreme. 
 
 7. The child should lie face downwards on the 
 floor or on a table in a perfectly straight position, 
 with the hand fixed on hips. The feet must be 
 held firmly down by another person. The child 
 then raises the body slowly upwards, at the same 
 time throwing the chest well out and drawing 
 the shoulder blades — but not the elbows — well 
 back, so that they approximate to each other. 
 Then the trunk is to be slowly lowered to the 
 starting position. Eepeat two to six times. 
 
 8. The child should lie flat on the back with 
 the feet firmly fixed, as in the last movement, 
 with hands on hips. Then the body should be 
 slowly raised, the knees being kept straight and 
 brought forwards as far as possible ; both arms 
 should be then stretched forwards until the toes 
 can be grasped ; the body should now be 
 brought to the vertical position ; the hands having 
 been replaced on hips, the body should be slowly 
 lowered to the horizontal position. Eepeat two 
 to six times. 
 
 N.B. — When accuracy in performing the move- 
 
90 GEOWING CHILDREN AND AWKWARD WALKING. 
 
 ment is attained, its action can be increased by 
 performing it (a) witb the hands on the top of 
 the head, the fingers being interlaced, and (b) 
 the arms being stretched parallel to each other at 
 the side of the head, level with the ears. 
 
 9. The child should stand perfectly erect, with 
 feet closed and the arms stretched perpendicularly 
 on each side of the body. The body should be then 
 slowly bent as far as it will go alternately to 
 the right and to the left, taking great care not to 
 permit of any " twist " occurring in the spine. The 
 chest should be kept well expanded, and the 
 hands should slide along the outer surface of the 
 thighs. 
 
 10. The child should stand perfectly erect, with 
 the heels and back in contact with a door or wall. 
 The hands should be fixed upon the hips, and 
 deep and prolonged inspirations and expirations 
 made, as in " No. 6." 
 
 Of massage and galvanism, it may be sufiBcient 
 to say that these have somewhat similar ultimate 
 results in promoting the nutrition of the muscular 
 fibres. Massage is the simpler agent, and perhaps 
 in some cases the more effective. Galvanism dis- 
 tinctly requires skilled application, and may, unless 
 skill be employed, do more harm than good ; never- 
 
MASSAGE AND GALVANISM. 91 
 
 theless, intelligent and persevering galvanization 
 will sometimes give satisfactory results, even 
 when administered only by a trustworthy nurse, 
 who has been once instructed what is required to 
 be done in the case. Massage must be firm and 
 pointed, so as to be directly expended on the 
 weakened muscles. 
 
FEEDING. 
 
 The method of feeding children is a subject of 
 paramount importance, the growth and solidi- 
 fication of the bones being dependent thereon. 
 The change from soft cartilage to hard bone 
 requires special food. That disorder of the 
 skeleton called rickets, due to a want of equili- 
 brium in the proportions of the earthy and 
 animal constituents of bone, in most cases 
 arises from the child being starved of some of the 
 essential elements of food. "Where a child is 
 kept at the breast for too long a period, or, as 
 too often happens, when the mother's milk is 
 poor in quality, or where a wet nurse has a 
 second child to feed, or where her constitutional 
 condition is such as to unfit her for her duties, by 
 causing her milk to be scanty and abnormal in the 
 way of not containing the full amount of indis- 
 pensable materials, the nursKng's bones remain 
 
FEEDING. 93 
 
 soft and the ends of the long bones become dis- 
 torted. 
 
 A parallel defective quality of the food later 
 on has the same injurious consequences, and 
 tends to produce such deformities as bow-leg and 
 knock-knee, rickety deformities.' 
 
 A mother's milk may even contain something 
 directly deleterious. As an instance, a woman 
 brought her infant to me, covered with an eruption 
 of pustules. The eruption appeared almost im- 
 mediately on putting the child to the breast after 
 she had undergone intense mental excitement, 
 due to some domestic annoyance ; the milk, altered 
 by the nerve storm, had poisoned the child. 
 Similar cases have been recorded by more than 
 one writer. 
 
 Dr. Clement Dukes writes : " " With the ex- 
 ception of the first year of infancy — which is so 
 largely a woman's question, and which is so 
 
 ' To give an illustration from the mineral kingdom, 
 that of the noxious effect, in the opposite direction, of the 
 presence of a minute quantity of one substance in 
 damaging the valuable characteristic of an almost com- 
 paratively unlimited quantity of another substance : in 
 the manufacture of iron, if there be phosphorus in the 
 ■ coal used for smelting the ore, the metal manufactured 
 is found to be dangerously brittle. 
 
 ^ "Essentials of School Dieb." 
 
94 GROWING CHILDREN AND AWKWARD WALKING. 
 
 grievously neglected — the food furnished during 
 the period of youth is the most important of all ; 
 but it is too often little regarded, to the serious 
 detriment of the young." 
 
 It is a physiological mistake to compel children 
 to eat food for which they evince a repugnance. 
 There is a great difference between pampering a 
 child's appetite and giving food that is liked, 
 provided it be wholesome. 
 
 A child has more chance of being underfed 
 than overfed ; perhaps not as regards quantity, 
 but quality. Thus, to give a food not in a form 
 favourable to digestion, or that does not include 
 all the necessary elements for building up the 
 frame, is spoiling the growth. A common example 
 of an improper form of food are those polyhedrons 
 of potato which children are so often allowed to 
 swallow. But, overfeeding is practically starving, 
 as digestion, the cardinal point of the conversion 
 of food into living structure, is hindered or preven- 
 ted by putting too great a load into the stomach. 
 Dr. Cheadle, ' dealing with the nursery epoch 
 of feeding, and Dr. Clement Dukes ' with the 
 
 ' " Diseases which. Arise from Faults of Feeding in 
 Early Life." 
 2 " Essentials of School Diet." 
 
FEEDING. 95 
 
 school and playground epoch, have elaborated 
 the study of this question. 
 
 To ensure digestion the growing child must have 
 enough food, and of the right sort. It must be 
 borne in mind that for the perfection of digestion 
 a free admixture of saliva with the food is 
 essential, and, for this, there must be an- abundant 
 supply of that secretion. 
 
 The salivary secretion, while subsidiary to the 
 gastric juice, has nevertheless some special 
 qualities. The quantity of the daily requirement 
 of saliva is much larger than would be imagined ; 
 that the daily demand is from one to two pints 
 would scarcely be guessed. 
 
 The salivary glands, which afford the supply, 
 are numerous. The cavity of the mouth is set 
 round with these glands, either in the form of con- 
 siderable masses or of small bodies about the size 
 of a split pea. The larger ones pour their product 
 into the mouth at the middle of the cheek and 
 under the tongue by distinct conduits ; the small 
 glands line the inside of the lips, and open at 
 many points upon the smooth mucous membrane, 
 beneath which they lie concealed. 
 
 The full functional activity of these glands 
 depends upon the stimulation of the nerves of 
 
96 GROWING CHILDKEN AND AWKWABD WALKING. 
 
 the mouth, and is the counterpart of the vari- 
 able activity of the tear (or lachrymal) gland. 
 This gland, as we all painfully have learnt, may 
 be acted on directly and indirectly; thus, the 
 tears will ilow — will be secreted — in excess of 
 what the tear ducts can carry off, and will roll 
 down the cheeks, from mental emotion, or from 
 irritating vapours, or other like external impres- 
 sions: at a visit to a peasant's cabin on the 
 moorside, one's eyes may moisten at the sight 
 of some abiding domestic misery, or — from the 
 pungency of the reek of the peat fire. Under 
 ordinary conditions, the tear gland secretes only 
 enough to keep moist the membrane immediately 
 covering the exposed part of the eyeball, and, 
 under the same conditions, the salivary glands 
 secrete sufficient only to keep moist the inside 
 of the cheeks and tongue, otherwise the result 
 would be very inconvenient. Mental emotion 
 will parch the mouth from suspension of the 
 function of the salivary glands; on the other 
 hand, these glands will pour out secretion on the 
 anticipation simply of agreeable flavours. 
 
 The salivary glands are able to start from a 
 state of almost quiescence to one of. intense 
 activity; this marvellous change in functional 
 condition depending on direct impressions made 
 
FEEDING. 97 
 
 on the nerves of the tongue, palate, and throat, 
 aided by the sense of smell. 
 
 It would be too much to attempt a description 
 of these nerves, beyond saying that they constitute 
 a network of great extent and complex structure, 
 having intimate connections with other nerves ; 
 and that the gustatory, or special nerve of taste, 
 is the dominant one of this network, and has 
 allies which take part in conveying impressions to 
 the saliva-secreting apparatus. Not only is saliva 
 necessary for perfect digestion, but for rendering 
 deglutition, or the act of swallowing, possible. 
 
 Food may be, in itself, of such a nature as to 
 supply the stimulus ; but food insipid, or even of 
 monotonous flavour, makes necessary a condiment 
 to keep the salivary glands active. 
 
 Led by instinct, Man has discovered substances 
 called condiments, which are capable of gratifying 
 a craving, the nature of which he is ignorant ; 
 but the purpose of such desire in relation to 
 digestion lies in the fact that it brings about a 
 rush of saliva. Dr. Burney Yeo says in his 
 notice of Sir Wm. Eoberts's book on Food : " Man 
 is a very complex feeder ; he has departed, in the 
 course of his civilization, very widely from the 
 monotonous uniformity of diet observed in animals 
 
 H 
 
98 GROWING CHILDREN AND AWKWARD WALKING. 
 
 in the wild state. Not only does lie differ from 
 other animals in cooking his food, but he adds 
 to his food a greater or less number of condiments 
 for the purpose of increasing its flavour and attrac- 
 tiveness." ' The universal condiment is salt, the 
 condiment ^ar excellence. Bread and salt is a 
 menu of great antiquity and of wide reputation : 
 bread without the salt would stick in the throat ; 
 salt without the bread would not be acceptable.^ 
 
 Salt has the advantage of giving something that 
 the blood requires, and stands in this respect as 
 a condiment unique ; but certain other substances, 
 pungent to the taste, which do not form an 
 integral or essential part of food, take rank as 
 condiments ; some, by their odour appealing to 
 the olfactory nerve, help to accentuate the power 
 of palate nerves ; even warmth may be classed as 
 a palate stimulant. Alcohol is, in some measure, 
 a condiment of the odoriferous order. The ques- 
 tion whether growing children require anything 
 in the shape of alcohol can be safely answered 
 by the direct negative, always assuming that the 
 child is healthy. Dr. Dukes writes in his valuable 
 
 ' Nineteenth Century Magazine, February, 1886. 
 ^ Boasting meat and toasting bread is the burning of 
 a part to make the remainder more highly flavoured. 
 
FEEDING. 
 
 book : ' " Very strongly indeed do I hold ttat no 
 alcohol should be given to the young, in any form 
 or at any time, except as a remedy for sickness. 
 
 In forming an opinion, speaking generally, of 
 the value of alcohol as an article of diet, or of its 
 permissibility as an article of diet for grown-up 
 people, its property as a condiment must be taken 
 into account, and deserves to be carefully estimated, 
 notwithstanding that it is a two-edged weapon. 
 
 " Man, like other animals, is so much the crea- 
 ture of his food ; his physical perfection, his in- 
 tellectual activity are so dependent on the food 
 he receives and the uses he is able to make of it 
 in the processes of digestion and assimilation, 
 that all the details of feeding must be of the 
 greatest interest. The diet that gives the best 
 feeding is a varied one. During active growth 
 the child requires an amount of food much greater 
 in proportion to its size than the adult does for 
 merely sustaining health, to ensure ultimately full 
 development; this estimate is, of course, irrespec- 
 tive of work and labour done, every movement 
 involving a waste or cost of tissue. The variety 
 of the food must not only supply all the elements 
 required for building up the body, but afford 
 • Op. cit., p. 99. ' 
 
 H 2 
 
100 GROWING CHILDREN AND AWKWARD WALKING. 
 
 provision to meet the demands of the warmth- 
 producing processes of the organism. The bones 
 require lime, and, with the muscular and nervous 
 systems, flesh-meat or vegetable equivalent. 
 Fatty, starchy, and other substances having an 
 analogous chemical composition, yield heat, or 
 rather act as fuel." 
 
 To again quote Dr. Dukes : " I am not prepared 
 to say that plenty of food during youth will add a 
 cubit to the ultimate stature, though respecting it 
 there can be little doubt ; but it is absolutely cer- 
 tain that a deficiency of food during this period 
 of life will take a cubit off the stature ; " and he 
 cites in support of his statement the investigations 
 of Mr. C. Eoberts,' showing the different height 
 and weight and increase between the ages of 10 
 and 30 years in artisan class town population 
 and the better fed and cared-for classes, a com- 
 parison which proves much in favour of the last 
 named. For example, taking the three ages 12, 
 14, 16 years, the comparative weights are found, 
 52-99 against 56-97, 57-76 against 61-11, 62-93 
 against 66-40 respectively. To put it in another 
 form, taking the ages of 12, 14, and 16 years, the 
 heights collectively were as 173-68 to 184-48. 
 ^ Anthropometry, op. cit., p. 2. 
 
CLOTHING. 
 
 The clothing must be flexible and unirritating. 
 Irritation of tbe skin by any part of tbe clothing 
 is liable to originate reflex movements which 
 may grow into a habit. The weight, whatever 
 may be the amount of it, with boys, may be safely 
 put on the shoulders ; no belts round the waist 
 should be allowed. With girls, no more than a very 
 small share should be placed on the shoulders, 
 for this reason : there is a difference in the 
 length of the collar bone in the male and female, 
 as already mentioned ; in the male, weight put 
 on the extremity of the collar bone rather helps 
 than hinders respiration ; on the contrary, with 
 the female, weight on the shoulder tends to com- 
 press the upper ribs and impede the inspiratory 
 effort. The length and shape of the collar bone 
 alters the brunt of strain. It is to be borne in 
 
102 GEOWIKG CHILDEEN AND AWKWAED WALKING. 
 
 mind that these remarks do not apply to children 
 of very tender years. 
 
 But the most important part of the dress, in 
 respect of walking, is the shoe or boot. For the 
 safety of the foot, it is necessary that the heel of 
 the wearer should be permitted to remain per- 
 fectly steady in the back of the shoe. "When 
 this condition is not observed, the broader part of 
 the foot at every step slides or is driven into the 
 narrower part of the shoe, and friction is the con- 
 sequence. The steady maintaining of the foot 
 in its proper position in the ordinary shoe de- 
 pends on the accurate " fit " of the instep ; 
 defective adaptation of this part of the shoe 
 very frequently causes the wearer to what is 
 called " step over," the fact being that it is the 
 shoe that " steps " under, i.e. to one side. The 
 hinder part of the foot is so much more massive 
 than the front part, that the position of the 
 heel and instep regulates or determines the posi- 
 tion of the rest of the foot. 
 
 It may at first sight appear that any addition 
 to the sole of the boot at the back part, in the 
 shape of a heel, would help to thrust the foot 
 forwards, by placing the sole of the boot on an 
 inclined plane ; but an explanation of the use of a 
 
CLOTHING. 103 
 
 heel to a shoe may be that a lift or inclination 
 of the heel of the wearer in a slight degree is 
 given, and affords a start in the act of throwing 
 the weight of the body on to the foot in advance, 
 in preparation for taking a fresh step, helping the 
 leverage by the foot : otherwise a heel of any 
 height would be disadvantageous. This explana- 
 tion, if valid, applies only to walking on the 
 level, as in ascending an incline the heel does not 
 touch the ground. 
 
 In measuring the foot for its covering, the 
 fashion shoemakers have of tracing an outline of 
 the foot on paper placed beneath it, furnishes that 
 which only serves to mislead them. The outline 
 of the foot gives no indication of the direction of 
 the force of the tread. It thus happens that the 
 hinder half of the shoe is built with a direction 
 outwards, and the outer side of the foot is thus 
 forced against the outer side of the shoe, and the 
 inner side of the heel of the wearer against the 
 inner side of the back of the shoe, instead of the 
 foot being held in the proper Kne, namely, from 
 the centre of the heel to the centre of the great 
 toe. Treading over is, therefore, more often the 
 shoemaker's fault than the wearer's ; of course, 
 assuming that the foot is not in any way deformed 
 or distorted. 
 
CONCLUSION. 
 
 At various dates during the past several years 
 I have laid before one or other of the medical 
 societies details of cases which bear upon the 
 immediate subject of this essay. Long continued 
 observation has confirmed me in the opinions I 
 have expressed as to the causes of awkward 
 walking. 
 
 It is well worth while to study the causes of un- 
 gainly gait, since a temporary functional irregu- 
 larity may be prevented from growing into a 
 highly disadvantageous habit. Further, as Mr. 
 Francis Galton has insisted, one of the most 
 important duties of man at the present stage of 
 his development is to regulate the progress of the 
 evolution of his race ; therefore the study of, and 
 inquiry into defective action of the lower limbs 
 may be considered a part of tbe fringe of the 
 great problem of the improvement of the physique 
 
CONCLUSION. 105 
 
 of the people : we have to search for the conditions 
 that help to induce degenerate peculiarities of 
 gait. 
 
 Dr. Hambleton said :^ " Great demonstrations 
 are constantly taking place before our eyes of the 
 relationship between condition and types in those 
 trades and occupations that are carried on around 
 us," and he contends that " the type of man after 
 birth is solely produced by the condition to which 
 he is subject." 
 
 Early vigilance is required in the supervision 
 of the growth of children, almost from the 
 moment the child's first attempts to walk are 
 being made. A rickety deformity of the bones is 
 easily to be detected, and should at once be 
 earnestly treated. My conviction is that the 
 defect of development due to rickets has a very 
 large share in the physical deterioration of the 
 urban, especially metropolitan, population. But 
 that misshapen limbs and feet are to be observed 
 with extreme frequency, and not only in the least- 
 well-off classes, due to malnutrition, must be ob- 
 vious to anyone having the simplest knowledge of 
 anatomical facts. We may safely assume that no 
 
 ' Paper read at a meeting of the British Association 
 for the Advancement of Science, 1887. 
 
106 CONCLUSION. 
 
 one would question the wisdom of Mr. Francis 
 Galton's view of our duties in respect of promoting 
 the just development of the race. In order to dis- 
 charge those duties, there must be special as well 
 as general knowledge. 
 
 The study of anatomy will give the special 
 knowledge, and at the same time will enlarge the 
 perception of wonders of entrancing interest. 
 
 It would be well if some of those who crowd the 
 picture galleries would spend part of their leisure 
 time in the galleries of natural history, in study- 
 ing the works of nature, works which, in place of 
 criticism, can only evoke an infinitely reverent 
 appreciation. 
 
 THE END. 
 
 eiLBEKT AWD RIVIIfGTON, LD., ST. JOHN'S HOUSB, OIiEBKBlTWELL, E.O 
 
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