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.

Several of the forms of paralysis have each its significant gait. For
instance, if a patient comes in with a firm, rather precise, calculated
sort of gait, "clumping" each foot upon the floor as if he had struck it
an inch sooner than he had expected, and clamping it there firmly for a
moment before he lifts it again, as though he were walking on ice, with
more knee action than seems necessary, you would have a strong suspicion
that you had to deal with a case of _locomotor ataxia_, in which loss of
sensation in the soles of the feet is one of the earliest symptoms. If
so, your patient, on inquiry, will tell you that he feels as if there
were a blanket or even a board between his soles and the surface on
which he steps. If a quick glance at the pupils shows both smaller or
larger than normal, and on turning his face to the light they fail to
contract, your suspicion is confirmed; while if, on asking him to be
seated and cross h