BOOK XXV.

ON GROWTH IN ITS RELATIONS WITH THE DISEASES OF CHILDREN.

The growth of man is the result of the same impulse as that which has given him existence. It is a phenomenon which is necessarily accomplished, and which an unknown force sustains and directs towards a determinate end.

Engendered by sexual intercourse, this force suddenly takes possession of the cell which constitutes the human germ, and will only quit it on the day of its entire development in humanity. It exists before its effect like all the forces of nature, and it varies according to race, seasons, air, and locality. Matter servilely obeys it, as long as no other force happens to disturb it. Then, lessened or neutralized in its action, the development of man suffers from it, that which should be on the right side is observed on the left, white becomes changed to black, that which should be straight is transverse, separated parts coalesce, and those which should be united, on the contrary, remain separate. From the least apparent deformity, to the most complete disturbances of development and of growth, all is possible when the force which directs them happens to be obstructed in its impulse.

After nine months intra-uterine operation, this force is outwardly transmitted with the infant; it continues its work, in the air and light, in the midst of new and varied agents, having from this time forward for an auxillary, the power of a new alimentation, until then unknown.

At this period, the body is finished as regards its outline and its totality, vices of conformation are no longer to be dreaded, growth should henceforth be effected in length and in breadth, and that according to laws as yet little known, but which it would be an important matter to discover.

M. de Buffon is the first who has prepared the way, and he has left a magnificent testimony of it in his account of the growth of a well proportioned young man. Quetelet has followed the example of

our great naturalist, and by numerous calculations, judiciously made, in his work of pure statistic, has nearly elucidated the law of physiologic growth from birth to puberty. Physicians might have seized upon these facts in order to investigate them, or to elucidate pathology, but with the exception of some rare works, amongst which I may cite those of Duchamp and Richard (of Nancy), science has remained silent on this point.

The growth of man, although very variable and impeded by numerous influences, such as temperature, locality, regimen, mode of life, disease, fever, &c., is, notwithstanding, accomplished in a tolerably regular manner, as I am about to demonstrate from tables borrowed from Quetelet.* I shall afterwards investigate the influence of diseases on the growth, and, vice versa, the influence of growth on the development of diseases.

Thus 1st. On growth in the physiological state.

diseases.

2nd. On the influence of diseases on growth.

3rd. On the influence of growth on the development of

1st. ON GROWTH IN THE PHYSIOLOGICAL STATE.

Quetelet made his observations and published his statistical tables in Belgium. It is useless to say, however, that we should not rigorously conclude from the results at Brussels, the existence of similar results at Paris, or in every other place. Hæc scripsi sub sole romano, exclaimed Baglivi, in addressing his readers; he was right, and here, in less decided terms, we say the same thing, in order that we should not draw too absolute conclusions from researches which may only be approximative, if they are verified amongst us.

Fifty male children were measured at the time of birth; they may be arranged in the following manner:†

The same difference exists in the succeeding ages, as may be observed in the following table, made by MM. Delemer, Feigniaux, Guiette, and Van Essch:*

At the sixteenth or seventeenth year, the growth of the girls is then relatively nearly as much advanced as that of young men at eighteen or nineteen years; and it is also observed that from five to fifteen years the growth is fifty-two millimeters for them, whilst it is fifty-six millimeters for the boys.

M. Quetelet has founded the law of growth of the inhabitants of Brussels from his calculations.

1st. The most rapid growth takes place immediately after birth; the child in the space of a year increases about 7.8 inches.

2nd. The growth of the child diminishes in proportion as his age increases nearly towards the age of four or five years, a period at which he attains the maximum of probable existence; thus, during the second year following birth, the growth is only half what it was the first, and during the third year, about one third only.

3rd. After the fourth or fifth year, the growth in height becomes nearly regular until towards the sixteenth year, that is to say, towards the age of puberty, and the annual growth is about 2.18 inches.

4th. After the age of puberty, the height still continues to increase, but very slightly; thus, from the sixteenth to the seventeenth year it

* I have abstained from reducing these fractional parts of the French meter into English measures: the French meter is equal to 3.28 feet English.

increases 1.56 inches; in the two following years it increases only .97 inch.

5th. The complete growth of man does not appear to be yet completed at the twenty-fifth year.

It is by thus studying growth in the inhabitants of cities and of the rural districts that he has observed the height of the citizen exceed that of the peasant. On this head Quetelet confirms the results of Villermé, expressed in these words:

The stature of men becomes more lofty and their growth is attained more quickly, cæteris paribus, in proportion as the country is rich and easy circumstances general; as the habitation, clothing, and especially the nourishment are better, and the troubles, fatigues, privations, experienced in infancy and youth are less. In other terms, misery-that is, the circumstances which accompany it-produces stunted stature and retards the period of the complete development of the body.

Growth usually terminates at the nineteenth or twentieth year; it is sometimes prolonged to the twenty-fifth year.

It is modified by locality as well as by climate. The development of the stature terminates more quickly in very hot and in very cold countries than in the more temperate climes; in low countries than on high mountains where the climate is more rigorous. It is also said that the mode of life has a further influence on growth, and that individuals have acquired a considerable development in height after having changed their mode of life and made use of different food.

Other researches on the particular growth of different parts of the body have been undertaken by Joerg, Tenon,+ Wenzel, and Richard (of Nancy). They have elucidated results sufficiently curious to merit a place in this chapter.

LENGTH OF THE CHEST FROM THE STERNUM TO THE PIT OF THE STOMACH.

* Mémoire sur la taille de l'homme en France. Annales d'hygiene; Paris, 1829; t. i, p. 351. Annales d'hygiene, 1833; t. x, p. 27.

These interesting figures give an approximative idea of the development of the head, trunk, and limbs during the first years of existence. For want of every other document they will serve as the appropriate measure to guide the practitioner in his appreciation of the partial modifications of growth caused by different diseases.

2ND. OF THE INFLUENCE OF DISEASES ON GROWTH.

Some diseases, small in number, arrest the development of the stature; others, on the contrary, increase it in a very remarkable manner. Care must be taken not to assume the modifications of the stature about to be described for arrest of growth.

The arrest or the diminution of the height is either apparent or real. Thus, in the curvature occasioned by great fatigue a temporary diminution of the stature is constantly observed, which is the result of the fatigue, and which disappears after rest. A young man may in this manner lose from .39 inch to 1.56 inch in height. Conscripts often make use of this ruse to escape enlistment; they walk and run about without resting, the evening before and the morning on which they are to be measured, and those whose height approaches the lower limits fixed by the law, having lost .39 or .78 inch, are declared unfit for service. Buffon has related the most extraordinary case of this kind. It was observed by Gueneau de Montbelliard on his son, the same whose growth Buffon has reported in his table. This young man, five feet nine inches in height, after having passed the evening at a ball, lost eighteen full lines of his height, and was only five feet seven inches six small