Next after the face and the hand would come the carriage and gait. When
a man is seriously sick he is sick all over. Every muscle in his body
has lost its tone, and those concerned with the maintenance of the erect
position, being last developed, suffer first and heaviest. The bowed
back, the droop of the shoulders, the hanging jaw, and the shuffling
gait, tell the story of chronic, wasting disease more graphically than
words. We have a ludicrously inverted idea of cause and effect in our
minds about "a good carriage." We imagine that a ramrod-like stiffening
of the backbone, with the head erect, shoulders thrown back and chest
protruded, is a cause of health, instead of simply being an effect, or
one of the incidental symptoms thereof. And we often proceed to drill
our unfortunate patients into this really cramped and irrational
attitude, under the impression that by making them look better we shall
cause them actually to become so. The head-erect, chest-out,
fingers-down-the-seam-of-your trousers position of the drillmaster is
little better than a pose intended chiefly for ornament, and has to be
abandoned the moment that any attempt at movement or action is begun.
So complete is this unconscious muscular relaxation, that it is
noticeable not only in the standing and sitting position, but also when
lying down. When a patient is exceedingly ill, and in the last state of
enfeeblement, he cannot even lie straight in bed, but collapses into a
curled-up heap in the middle of the bed, the head even dropping from the
pillow and falling on the chest. Between this _debacle_ and the slight
droop of shoulders and jaw indicative of beginning trouble there are a
thousand shades of expression significant instantly to the experienced
eye.
Though more limited in their application, yet most significant when
found, are the alterations of the gait itself. Even a maker of proverbs
can tell at a glance that "the legs of the lame are not equal." From the
limp, coupled with the direction in which the toe or foot is turned, the
tilt of the hips, the part of the foot that strikes first, the presence
or absence of pain-lines on the face, a snap diagnosis can often be made
as to whether the trouble is paralysis, hip-joint disease, knee or ankle
mischief, or flatfoot, as your patient limps across the room. Even where
both limbs are affected and there is no distinct limp, the form of
shuffle is often significant.
Public-domain text, read in full here on John Shaqi.
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