fluence. Sometimes, however rarely, the induration spontaneously decreases. When this occurs the hardened part of the corpus cavernosum remains always softer than is natural, and incapable of full erection.

Similar softness and loss of erectile power sometimes comes without induration in the part just behind the glans, and makes copulation nearly impossible; but in the very rare instances in which I have been told of this the patients had so unsound nervous systems that I have suspected a local nervous rather than a structural error.

In some persons the same part of the corpora cavernosa, for half an inch or more behind the glans, is naturally more than commonly tough; and some of them suspect cancer. But in these as well as in the really morbid hardenings of the part, the diagnosis from cancer is very seldom difficult. The hardening is less intense than that of cancer; it is more tough, elastic, flexible; the textures about it, unless inflamed or scarred, slide over it easily; there is no corresponding disease of the skin or mucous membrane, in or just beneath which, in an immense majority of cases, cancer of the penis begins; and, even after months or years, there is no ulceration or infection of lymphatic glands.

CHAPTER IV

ON SPINES SUSPECTED OF DEFORMITY

AMONG the fears of disease for which one is consulted none is more frequent than that of lateral curvature of the spine. These fears are felt, especially, by mothers among the richer classes; and usually the fear is only for their daughters' spines. It is thought essential to the welfare of a young lady that her spine should be straight, and her form not notably unsymmetrical, and that she should habitually sit upright with her back unsupported. There is no such thought for young gentlemen, and it appears to be, chiefly, a consequence of this difference that in the well-to-do classes lateral curvature of the spine is at least twenty times more frequent in girls than in boys. For mothers seldom look at their sons' spines; and they let them sit with their elbows on the table, loll back in their chairs, and lie flat on their stomachs, and do many more such prudent things as in the daughters would be deemed shame

ful. Thus boys' spines grow straight; the muscles helping to support them are not over-tired, or, when they are, they can be rested in any comfortable posture. But among girls the postures deemed graceful must be maintained till some deformity is discovered or suspected, and then the poor girls must be made miserable by the treatment deemed necessary for its cure.

The folly and the mischief of this contrast are happily becoming known: the good rule of letting girls grow up like boys is becoming more and more widely observed, and a larger proportion of them are well-formed, graceful, and strong.

Still, the unfounded fears of deformity of the spine are far too frequent, and they are maintained, in many instances, by the existence of slight deviations from the supposed pattern-shape which are quite harmless. It seems to be assumed by some that all spines should have curves and other characters exactly similar to those which are seen in artists' models or in anatomical plates. It is much more probable that there are as many varieties of healthy spines as of healthy chins or cheeks, or as many in the human species as in the horse or ox. Round shoulders, straight backs, hollow loins, and other such shapes are as common in members of the same family as are any other family features, and

they are due to the imitation of parents in only the same degree as may be the expressions of similarly formed limbs or faces.

I wish I could describe the variations of shape as accurately as are the forms of spines studied and measured in skeletons or sections by such anatomists as Sir William Turner and Professor Cunningham. But this is not possible; and yet the varieties of form may be well enough observed, even as those of faces or of any single feature may be, though they be not exactly measured.

I find notes of some of these varieties which may supply hints useful to be remembered when examining cases of 'Suspected Spines.' Spines.' They relate to the dorsal and lumbar portions of the spine in which alone the feared lateral curvatures are usually looked for; and they relate to none but young persons.

But, first, the suspicions are often founded on pains in the back which are, by some mothers, regarded as sure forerunners of deformity. When they are complained of, the whole length of the spine should always be examined, for they may be signs of disease in it, though, indeed, they rarely are so. The most common result of the examination is that the spine is found well formed, but tired through having been too much exerted in holding the body upright while sitting or standing. The tired muscles

ache prudently, needing rest and more various activities.

I often quote for such cases, and for many more, an excellent sentence which I learned from Sir Henry Holland: Standing has all the disadvantages of posture without any of the benefits of exercise.' And for spines it may be said that sitting upright has similar disadvantages without the benefits of

rest.

Such aching muscles are, I think, most common in girls whose spines are very flexible; and this flexibility in all directions should always be tested. An apparent excess is harmless, unless it be associated with such muscular weakness that when the spine is extremely bent in one direction it can hardly be lifted up again. A very defective mobility is more suggestive of disease, especially if it be associated with pain at any definite part of the spine, and if the pain be increased in very wide movements or in violent and not guided movements, as in sneezing or laughing. Such pain with restraint of movement may be due to a rheumatic trouble, but it should. always suggest a suspicion that there may be carious disease of the spine and a possibility of angular curvature. If careful examinations of this kind be always made it will be found that only a very small proportion of the aching backs of young or recently