Influence of Constant Use of 
High-heeled French Shoes upon 
the Female Form, etc. 
BY 
S. C. BUSEY, M.45. 
WASHINGTON, D. C. 
REPRINT FROM VOLUME VII. 
(Smiecalogital IKraiijiacttonji 
1883 THE INFLUENCE OF THE CONSTANT USE OF 
HIGH-HEELED FRENCFI SHOES UPON THE 
HEALTH AND FORM OF THE FEMALE, AND 
UPON THE RELATION OF THE PELVIC OR- 
GANS. 
BY SAMUEL C. BUSEY, M. D., 
Washington, D. C. 
The foot and its coverings is not a new subject. Far 
more attention has been given, however, to the style and 
display of the covering than to the comfort and physical well- 
being of the foot. The " Athenaeum " attributes to Pliny 
the statement that shoes were invented by Boethum, but 
intimates that sandals in some form have been in use since 
the original pair discovered the difference between " the 
flower-carpeted paradise and the hot sands and sharp 
stones of that dreary plain." The ancient Egyptians made 
them of leather, and for the priests of palm leaves and 
papyrus. The Hebrews made them for soldiers of iron and 
brass, but for others of linen and wood ; and the lovers 
displayed their gallantry by engraving the likenesses of the 
adored ones upon the soles of their foot-dress, " so that the 
pathways of the lovers became the picture-galleries of the 
loved." The calcei, with uppers and soles of leather, were 
worn by those who walked much. The solece, which were 
variously ornamented, were for use in the house. The red 
or purple shoe was first worn by the kings of Alba, and last 
by the old Roman dandies. Then followed the sharp-toed 
shoe and half-boots of old Germans ; the high-heeled, long 
buskins, and the shoe with leather soles of the Roman 
women, which enabled the wearer to move about at home 
without any other foot-covering. The old bark shoe was 
probably the progenitor of the French sabots, which were 
1 2 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
in common use and very fashionable throughout Europe 
during the ninth and tenth centuries. During the reign of 
William Rufus, a famous beau, surnamed the Horned, in- 
troduced the long-pointed toes, twisted like a ram's horn ; 
and during the time of Richard II. the toes were lengthened 
so as to be fastened to the knees by chains of silver and 
gold. For three centuries the church and public officers 
inveighed against this fashion, but not until 1463 was it 
prohibited by an act of Parliament. Afterwards fashion 
and taste expressed their extravagance in increasing the 
width of the toe of the shoe, which Queen Mary was com- 
pelled to restrict to six inches; and then followed the 
elegant buff-colored shoes, with enormous and lavishly em- 
bellished tops. The heel at first was a device to make 
short men look tall, and, like the other parts, has under- 
gone many changes to suit the whims of fashion and taste. 
The French high heel worn by women is not only very 
high, but also narrow, and inclines from behind forward, so 
that its inferior extremity (Onimus), instead of being under 
the calcanean tuberosity, is directly under the plantar arch; 
so that increased height, with diminution of the size of the 
foot, is secured. This style was introduced during the 
Regency. Under Louis XIV. the heel was high 
cular, but not oblique. During the reign of Louis XVI. 
this objectionable style began to disappear, but has been 
again revived and is perhaps more general now than at 
any previous time. During all these periods the feet were 
the objects of the most conspicuous vanity, fantastic con- 
ceit, and costly decoration. At some of the barbaric courts 
the soles of the shoes worn by men were made of plates of 
silver or gold, and the brilliant material of those worn by 
the ladies was half covered with precious stones. Even as 
late as the time of George III. a young married couple was 
presented at court wearing shoes with buckles worth two 
hundred thousand pounds. Popular patterns have, at dif- 
ferent times, been designated by the names of prominent 
persons, or for a special class of the nobility, but only in a 
single instance known to the writer has a prince or em- SAMUEL C. EUSEY. 
3 
peror derived his name from the style and material of the 
shoe, and that one the brutal Caligula.1 In the seventeenth 
century the patterns were greatly modified, and made more 
simple and less ostentatious, but with little regard to the 
physical well-being of the foot. Towards the close of this 
century Camper published his work on the best form of 
shoe, in which he discussed the question from the stand- 
points of anatomical construction, utility, and comfort. 
Every intelligent observer must have recognized the 
potent and pervading influence of prevailing fashions and 
common customs upon the human mind and body. Few, 
if any, can alienate themselves from the insidious and ever- 
changing agencies of association, example, and observation. 
Habit is not less potential in producing modification of 
form than in effecting alteration of single parts and dis- 
turbance of the functions of special organs. Everywhere, 
among all civilized nations, in all countries and climates, in 
every sphere of life and grade of society, in all trades, oc- 
cupations, and professions, individuality is characterized by 
diversity of form, inequality of mind, gradations of caste, 
and variations in temperament, disposition, and constitution. 
If it were not so, human life would be simply the monoto- 
nous change from birth to death. 
The causes that have produced these inequalities and 
dissimilarities in the descendants of a common parentage 
are as numerous and multiform as the distinctive differences 
of individuality. Nevertheless, we recognize types that dis- 
tinguish races, nations, communities, and families. These 
types refer to modifications of form, and to the mental and 
personal qualities that characterize peoples, not individuals, 
and are the results of a complex and constantly changing 
combination of influences in long-continued, persistent, and 
habitual operation. 
The variations in form of the types of the different races 
and families are far less marked than their social, mental, 
and personal qualities. It is not possible, at this time, to 
1 The historic details have been collated and condensed from Cam- 
per, Dowie, Onimus, and the American Cyclopedia. 4 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
trace the gradual, imperceptible, and progressive evolution 
of these types of form, or to determine the combination of 
influences, or even the most constant or potential factor 
of any group or succession of circumstances, which have 
established the forms now accepted as the standard of race 
and family development. 
The deviations from these types of species and families 
that distinguish individuality are even more numerous, 
diversiform, and variable than the differences of types of 
form; and their causes are equally diversified and com- 
posite, but very frequently can be ascertained with an ap- 
proach to accuracy. 
The evolution of the typical and individual forms of the 
female sex have, undoubtedly, been influenced, and in a 
measure determined, by the same general order and suc- 
cession of events and circumstances of life; but the ana- 
tomical differences and peculiar physiological functions 
have so marked the general contour of form that conceal- 
ment of sex is almost impossible, however skillful the effort 
to escape detection. These characteristics are not so ap- 
parent during the earlier years of life, and it is not improb- 
able that if the physical, mental, and moral training were 
alike in both sexes subsequent and mature development 
would exhibit, in the general outlines of form, fewer and far 
less obvious dissimilarities. 
Age, pregnancy, and maternity are manifest and admitted 
agencies in the causation of deviations of the female form. 
Stature and the habits of posture and carriage are perhaps 
equally potential. The development, tone, and exercise of 
muscles ; sparseness, redundance, and distribution of adipose 
tissue ; laxness or tension of articulations ; the mobility of 
joints, and degree and extent of the normal curves, are also 
factors, operating either singly or conjointly, sometimes as 
primary, and at other times as correlative and compensative, 
agencies. Asymmetry, either connate or acquired, is the 
most common of physical defects. Lateral asymmetry is 
the ordinary result of over-use or disuse of corresponding 
parts. Disproportion between the trunk and lower extremi- SAMUEL C. BUSEY. 
5 
ties is more frequently a natural defect of embryonic and 
pre-natal development, and is a characteristic of some spe- 
cies and of many families. 
From the foregoing considerations it must appear that 
the study of the natural history of the evolution of the 
types, variations, and individualities of form would involve 
an extensive research in ethnology; the determination, 
grouping, and sequence of causes; and an examination of 
the mechanism of the human frame and its adaptation to 
the exigencies, mutations, and successions of life. Into 
such an inquiry I do not propose to enter. 
The study of the influence of a single factor, such as I 
have indicated, is embarrassed by all the conditions of life 
to which I have referred. Hence the dogmatic assertion of 
any general law, applicable alike to the different types and 
diversities of form, is unattainable. Experimentation is im- 
practicable, except under circumstances that would admit 
of the comparative management of two identical forms, 
under like conditions and development, from early life to 
maturity, and even to advanced life : the one being subjected 
to the artificial props beneath the plantar surface, and the 
other left to bear her weight upon the unprotected soles of 
the feet. Of the first, numerous illustrations in process of 
continuous development are supplied in every town and 
village in the country. To secure the latter would prove 
a difficult task in this esthetic age. I must therefore be 
content with a cursory and general presentation of the 
subject, and the conclusions reached through the processes 
of observation and inductive reasoning. 
Paget has supplied the following description of a perfect 
female foot: " Great breadth and fullness of instep, a well- 
marked great toe, a long second toe, projecting a little be- 
yond the great toe, and a very small, or in some cases 
almost suppressed, little toe." The foot is divided into the 
tarsus, metatarsus, and toes ; and the sole is so formed that 
we rest upon the heel, the articulation of the instep with 
the toes, and, externally, upon the tuberosity of the fifth 
metatarsal bone. The bones of the foot form a double 6 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
arch, the inner span extending from the heel to the distal 
end of the first metatarsal bone, and the outer span from 
the heel to the fifth metatarso-phalangeal articulation. The 
elongation of this arch is of a twofold character: first, by 
flattening under the weight of the body, and consequent re- 
cession of the toes and heels, and lengthening of the foot 
forwards and backwards ; the second, at the articulations 
of the instep and toes, when the toes are turned upward, 
and is due to the hinge-like nature of these joints. When 
the toes are stationary upon the ground, elevation of the 
heel will produce elongation backwards. This backward 
elongation is to a considerable extent compensated by the 
tension of the muscles of the sole upon the heel bone, and 
the consequent elevation of the height of the arch. This 
double-spanned arch also possesses lateral expansion. 
The feet and legs constitute a complex arrangement of 
levers with movable fulcrums, hinge-like and socket joints, 
surrounded by elastic and elongating structures of very 
variable strength and tensile mobility, so that every devia- 
tion of the base of support is so quickly compensated that 
equipoise is maintained. In walking, the heel touches the 
ground first, and supports (Onimus) the whole weight of 
the body for a moment. A little later the point of the 
foot touches, and assists in preserving the equilibrium by 
increasing the base. During the second movement of 
walking the heel is raised (see Figs. 2 and 3), and the weight 
of the body is shifted more and more to the centre of the 
foot and to the toes, the latter spreading and pushing the 
body forward. This last is the movement which displays 
to the greatest advantage the suppleness and elasticity of 
the articulations of the foot, and the adaptation of the arch 
to receive the weight of the body and to transfer it to its 
distal pier, while the body is being moved forward by the 
same act. It is the execution of this movement which 
gives to the gait of women that elegance and those grace- 
ful undulations which are so attractive. Comparative ob- 
servations show that high and narrow heeled shoes not 
only displace the supporting base and upper part of the SAMUEL C. BUSEY. 
7 
foot, but so modify the movement that there is no longer 
succession of contact and pressure. Practically both piers 
of the double-spanned arch strike at the same time, and 
from the moment of contact the weight of the body is upon 
the distal pier (Fig. 3) and toes. Hence, walking, instead 
of being undulating, is stiff and hobbling, and the body 
advances by jerks. 
(From Camper.) 
The bones of the instep are capable of but very little 
movement. When standing, the heel bone (NM Z, Fig. i), 
the joint at K, and the great toe, A C, touch the support 
upon the line A B. When the feet are shod according to 
the present fashion, the line A B is made to assume the 
concave form shown in Fig. 3 by B V T u. The instep 8 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
is made more convex and rounded, which is specially es- 
teemed by a certain class as a peculiar beauty, and the foot 
is actually shortened (see A B, Figs, i and 2). In those 
long accustomed to such shoes it is more than probable 
(Camper) that the heel bone receives the astragalus (77, 
Fig. 1) upon the eminence ML, and the astragalus (77, 
Fig. 3) is bent downwards. This is most apt to occur in 
young persons, while the neck of that bone remains carti- 
laginous. The constant elevation of the heel places the 
body of the pedestrian in the same position as when stand- 
ing upon an inclined plane, which is not only a weak atti- 
tude to sustain weight, but very fatiguing to the muscles 
thus called into action, and compels the lifting of the knee 
higher. It imposes also a greater expenditure of force, 
because a new start is made on stilts from a comparative 
state of rest at every step. Again, the heel is so shaped 
and located (Dowie) that it forces up the key-stone of the 
arch, and weakens the whole structure. If the arch needs 
support the span of the support ought not to be less than 
that of the arch, yet the mechanical construction of the shoe 
heel and shank not only ignores this principle, but may in- 
jure an arch needing strength. The alteration of the nor- 
mal line of the sole of the foot, caused by the rigid fixation 
of the arch in this strained position, produces atrophy of 
the muscles of the heel, instep, and ankle, because of the 
comparative disuse; weakens the lateral and longitudinal 
arches ; increases the curve of the sole, giving rise to a 
rocking motion and jolting gait, retarding progression and 
consuming muscular force; bends the toes upward, thus 
injuring the muscles of the sole by too continuous exten- 
sion, and those above by excessive contraction ; injures 
the fleshy part of the great toe by too great and constant 
pressure; cramps the toes ; diminishes the elasticity of the 
foot; prevents elongation of the arch, and the ready adap- 
tation of the system of levers to the variations of stature ; 
calls into action strained muscles, and imposes upon them 
unaccustomed movements; and so disturbs the natural 
bearings of all the parts as to interfere with the general 
health. SAMUEL C. BUSEY. 
9 
A comparison of the normal or perfect female foot and 
the malformed foot represented in Figs. 2 and 3 ought to 
convince the most enthusiastic devotee of the evil effects 
of the French high-heeled shoe. A further examination of 
the diagrams will show that the toes may also be greatly 
distorted. The continuous pressure upon the joints of the 
instep and toes and the tension of the muscles and tendons 
of the sole of the foot produced by the misplaced heel dis- 
torts the toes, as shown by the lines D f e in Fig. 2, and 
a P c in Fig. 3, so that the tread of the foot, represented in 
length by the line A B, is shortened by the distance A e 
in Fig. 2, and W c in Fig. 3. 
The astragalus receives at R (Fig 3) the weight of the 
body, which is transmitted along the lines R B and R A. 
If the hollow of the foot should be made to touch the 
ground, the line A B would be lengthened by the distance 
from A to X. The conditions of superincumbent weight, 
which would thus flatten the arch and increase the length 
of the foot, might exaggerate the deformity shown in Fig. 
3 in a foot geared in this style of shoe. The diagrams show, 
furthermore, that the measurements taken in the air, as is 
usual, of feet thus distorted, are necessarily too short, and 
the feet will be cruelly pinched in the erect position be- 
tween the lines N B and A O (Fig. 2) by shoes made by 
such measures. 
The casual observation of awkwardness and unsteadiness 
of carriage of the wearers of high-heeled shoes, and the 
occasional occurrence of injuries to the feet and ankles at- 
tributed to their use, had long ago impressed me with the 
belief that the inexorable precept of fashion had lengthened 
the shoe heel far beyond the conveniences of easy and 
graceful locomotion, and that results would follow their 
continued use other, and perhaps graver, than the callosi- 
ties, bunions, in-growing nails, sprained ankles, and painful 
calves which so frequently torment the votaries of this rep- 
rehensible practice. But not until I had seen, under advan- 
tageous circumstances, not long ago, at a fashionable sum- 
mer resort, the most advanced style of full toilet foot gear, 10 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
did I appreciate the probable extent of its influence upon 
the growing form of the female. It had become the custom 
for the lads and misses of all ages from five years to early 
puberty to assemble, during the evenings, in the parlor, 
and engage in the dance. This company comprised many 
different sizes and forms, which exhibited the grades and 
phases of childhood development in great variety. The 
feet and ankles of the larger number of girls were geared in 
shoes with heels so high and slender as to fasten them in 
the position as if always walking down-hill, the toes being 
pushed more and more forward. The rigid fixation of the 
feet in this unnatural position diminishes their size, les- 
sens the spring and elongation of the double and elastic 
arch of the instep, and confines the muscles, tendons, liga- 
ments, and bones in strained relations, impeding, if not 
arresting, the processes of formation, waste, and repair. It 
disturbs the articulation of the diversely shaped surfaces 
of the many small bones comprising the instep, destroys the 
easy, free, and elastic mobility of the tarsal and metatarsal 
joints, and transforms the tarsus, metatarsus, and phalanges 
into a rigid body not unlike a shoemaker's last. The ex- 
cessive elevation of the heel displaces the centre of gravity, 
which should coincide with the centre of movement, and 
transfers the weight of the body, for the most part, from 
the heel to the metatarso-phalangeal articulations, - joints 
arranged with shallow sockets to facilitate movement in 
every direction, and to expedite progressive motion, but not 
to bear the burden of the body-weight. 
The movement, attitude, and poise of those whose feet 
were thus tackled with fashion's latest and choicest pattern 
of high-heeled shoes were in marked contrast with those of 
the less ostentatiously dressed, who retained the free and 
natural play of their muscles and joints, and the capacity 
and elasticity of motion and posture which restore the body 
to its balance from any slip or vacillation without apparent 
effort. The movements of the former were stilted, uneasy, 
restrained, and executed with caution, under mental strain 
and with unnecessary expenditure of force. As I sat, even- SAMUEL C. BUSEY. 
11 
ing after evening, in that gay salooi), a silent and unknown 
spectator, I could see the gradual effacement of the merry 
dimples and glow of health from their cheeks, the deepen- 
ing lines denoting wear of body and tire of nerve, and the 
pallor of distress creeping over their youthful faces, as they 
limped or staggered to places of rest. 
The physical well-being of the feet is a necessary and 
important part of the general sanitation of health. Pedes- 
trian exercise is the great promoter and conservator of 
functional activity and constitutional vigor. To enjoy it, 
and to realize the benefit to the fullest extent, the feet must 
be healthy and the foot-tackle free and easy. Sore, con- 
tracted, and crippled feet, strained and stiffened joints, 
altered and displaced articulating surfaces, restrained mo- 
bility, and alteration of the line of gravitation (any one or 
all of which results may find their cause in too early and 
too constant use of high-heeled shoes) impede and augment 
the fatigue of locomotion, and make walking exercise pain- 
ful. Per contra, they conduce to the acquirement of un- 
gainly habits of carriage ; to disproportion of the component 
parts of the body; and to a sedentary life, with its manifold 
disturbances of the animal economy. Yet how many mat- 
rons throughout the land will entail upon the mothers of 
coming generations some one or more of these injuries, with 
the long train of consequent sufferings, rather than abandon 
the fashion of a shoe ! 
The injuries are not, however, confined to the feet, their 
joints and component structures. During the same series 
of observations I had the unusual opportunity of studying 
the influence of heel-elevation upon the general outlines of 
the body; for the exuberance of fancy in toilet was not 
limited to esthetic decorations of the calves and feet, nor 
were the devotees of extreme styles narrowed to the ages 
of growing and immature girls. I could outline the com- 
parative increase of the ankle, knee, and ilio-femoral flex- 
ures, and the exaggeration of the curves of the spinal 
column. These alterations of the natural angles and curves 
give the fore and aft outline of the general contour an in- 12 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
and-out or zigzag course. The degree of the angles and 
radii of the curves vary according to stature, form, and size. 
The law of adjustment seeks compensation for the primary 
deflection by exaggeration of the nearest flexure in the 
opposite direction. The elevation of the heels displaces 
forward the base of the line of gravitation, and transfers 
greater weight to the distal extremity of the plantar arch. 
The equilibrium of the body can only be maintained by in- 
crease of the natural bendings and curves along the line of 
the bony framework. These angles and curves are usually 
so concealed or obliterated by the necessary coverings and 
decorations of the figure that the effect upon the attitude 
and pose of person is not necessarily either displeasing 
or unattractive. The opportunities for embellishment are 
rather increased than diminished. Art and nature may 
become co-laborers in the display of artistic costumes and 
in the arrangement and deception of adornments, if taste 
and delicacy are not outraged. The exaggeration of the 
dorso-lumbar curve 1 gives fullness to the buttocks, rotun- 
dity and plumpness to the abdomen, elongates the chest, 
and increases the prominence of the bosom ; to which in 
some are added, by the compensating change in the posi- 
tion of the head, elevation of the face, and rounding and 
filling out of the neck and throat, with effacement of the 
depressions and irregular outlines, - the whole imparting to 
the general carriage an air of haughtiness and command, 
which happily is often modified and softened by the innate 
womanly virtues which find expression in the language of 
the face and tongue. But I am seeking to present the sub- 
ject in its physical, and not in its decorative, aspect. 
The uterus occupies nearly a central position in the pel- 
vis, is " delicately and unstably poised," and is supported 
"on every side by the soft and elastic structures which 
everywhere surround it as closely as if it were enveloped in 
a fluid." Its longitudinal axis is coincident with or parallel 
1 This " peculiar bending of the back in the lumbar region " Onimus 
calls " Pensellure, from its resemblance to the appearance of a horse's 
back which has been accustomed to the wearing of a saddle." SAMUEL C. BUSEY. 
13 
to the axis of the plane of the pelvic brim, forming, with 
the vagina anteriorly, and upon itself at the junction of its 
cervix and body, very obtuse angles. So that the line of 
gravitation, which, because of its position and attachments, 
is through its longitudinal axis, would, according to nat- 
ural laws, be vertical through its centre of gravity. Its 
centre of gravity, being supposed (Duncan) to be the cen- 
tre of its mass, must be above, and the vertical line of 
gravity must be anterior to, the cervical attachments. The 
A B Horizon. 
A B I Angle of inclination of pelvis to horizon, equal to 6o°. 
BIC Angle of inclination of pelvis to spinal column, equal to 1500. 
C I y Angle of inclination of sacrum to spinal column, equal to 1300. 
E F Axis of pelvic inlet. 
N Lowest point of mid-plane of ischium. 
Planes of the Pelvis, with Horizon. 
C D Vertical line. 
L M Mid-plane in the middle line. 
plane of the brim inclines (see diagram No. 4) at an an- 
gle of 60°, and the longitudinal axis of the womb, vertical 
to this plane, inclines at an angle of 30°. This relation, 
though not mathematically accurate as thus expressed, is the 
generally accepted rule of normal anatomical relation in the 
erect position of the body, except so far as it may be dis- 
(From Playfair.) 14 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
turbed by the exigent oscillations, within a limited arc, of a 
body so delicately poised amidst contiguous organs subject 
to such fluctuating conditions as the female pelvic viscera. 
Then, so long as the coincidence or parallelism of these 
axes is maintained, so long will the uterus approach the 
horizontal line, in direct proportion with approximation of 
the plane of the brim to the vertical line; consequently, as 
the inclination of the plane of the brim increases or dimin- 
ishes, so, reversely, will the uterus, through its long axis, 
approach or recede from the vertical line. 
The weight of the trunk is balanced upon the ilio-femoral 
articulations, and " the centre of gravity of the parts above 
is (Duncan) nearly vertically over these articulations." The 
line of gravitation and the axis of the body,1 though not 
universally believed to be coincident lines, are, with suffi- 
cient accuracy, represented by a vertical line bisecting a 
horizontal line passing through the centre of the ilio-femoral 
articulatioris. The centre of gravity and line of gravitation 
vary with every backward and forward movement of the 
trunk upon these joints; and the inclination of the womb 
follows the variations in the inclination of the pelvis, ac- 
cording to the law as previously stated. In an elastic and 
flexible body, like the human form, with its numerous 
deviations from a straight line, nature re-adjusts disturb- 
ances of equipoise by compensating alterations of the bend- 
ings and flexures. 
The question now arises, How are these relations of the 
natural conformation influenced by the excessive and con- 
stant elevation of the heels by the use of high-heeled shoes ? 
1 In the diagram of Hodge (Diseases Peculiar to Women, pp. 
317 and 328), the axis of the body is represented by a line touching the 
anterior surface of the third lumbar vertebral articulation, and passing 
through the body of the ossa pubis. In his System of Obstetrics, 
p. 30, Hodge says, " The axis of the body, when in the erect position, 
may be represented by the line of gravity. This line of gravity, or ver- 
tical line extending from the top of the head to the ground, passes 
through the lumbar vertebrae, the base of the sacrum, and cavity of 
the pelvis a little anterior to the tubers of the ischia, bisecting a line 
drawn through one acetabulum to the other." SAMUEL C. BUSEY. 
15 
The primary deflection of the line of gravitation takes place 
at its base. The ilio-femoral articulations being the pivot 
upon which the body is balanced, and the fulcrum of its 
support, and the long arm of the lever being all that part of 
the stature above these ball-and-socket, and most movable 
of the limb-joints, readjustment of equipoise is necessarily 
most easily and quickly restored by increased flexion at the 
hip, with displacement backwards of the pelvis, which 
sooner or later will find its compensation in exaggeration 
of the dorso-lumbar curve. The law of compensation which 
determines other and permanent alterations of form is well 
defined, though subject to many variations dependent upon 
size, height, general conformation, and habit of carriage. 
This law may be briefly stated as follows : Every primary 
curvature is compensated1 by a second and generally equal 
curve in the opposite direction, usually occupying the part 
of the column immediately adjoining the first, and may fol- 
low the column in extended sequence of two, three, and 
even four deviations. The compensation in lordosis is ob- 
tained by increased inclination of the pelvis. The ordinary 
anterior curvature in the loins involves a corresponding 
displacement of the pelvis backwards, and more especially 
when the lumbar curve is itself compensatory and conse- 
quent upon too great inclination of the pelvis. The latter 
is most frequently the primary deviation. Pelvic inclina- 
tion and dorso-lumbar curvature bear a direct and posi- 
tive relation to each other, the excess in either being com- 
pensated by a corresponding excess in the other, so that 
cause and effect react upon each other, producing increased 
backward displacement of the pelvis and greater spinal 
curvature. In curvature of the lumbar region forwards, 
and " in excessive inclination of the pelvis, with which the 
lumbar curve coexists and to which it is due," the chest 
is increased in length; and while the breadth of its lower 
part is strikingly greater than natural, it is very pointed 
above, and flattened from before backwards. Of course 
the ordinary movements of expansion and contraction of 
1 A summary of the conclusions of Rokitansky. 16 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
the chest are disturbed, the diaphragm is depressed, the 
abdominal organs are displaced downwards, and the ver- 
tical pressure of the superincumbent viscera upon the pel- 
vic organs is increased. This pressure does not impinge 
upon the top of the fundus of the uterus in situ naturali, 
but upon its posterior surface. The tendency, therefore, of 
(Hodge, Duncan) all pressure from above, the accumulated 
weight of the organs, aided by the contractions of abdomi- 
nal muscles, is to press the fundus downward towards the 
pubis, and to carry the cervix towards the hollow of the 
sacrum. When the organs are healthy and in a natural 
position the forward proclivity of the fundus is prevented 
by the presence of the bladder and small intestines in front, 
and the ascent of the cervix is resisted by the mass of in- 
testines in Douglas's cul-de-sac. " The bladder (Aveling), 
when filled, is a heavy organ. In the erect posture, when 
the pelvis is normally inclined, it rests upon the pubes ; 
but when the pelvis is tilted back, the whole weight of the 
urine gravitates directly into the pelvic cavity, and presses 
upon the anterior wall of the vagina. Should this be 
weakened by disease or child-bearing, it gradually descends 
and allows the bladder to fall back, describing in its progress 
an arc of a circle around the pelvic bones, to which it is 
anteriorly attached." Thus in cases of excessive pelvic in- 
clination the viscus, which is directly instrumental in the 
redression of the womb and in the preservation of its mo- 
bility, becomes a potential factor in establishing a mal- 
position, and complicates the uterine displacement with 
frequent, difficult, and painful micturition. Cystitis, as the 
necessary result of incomplete evacuation, may also add 
its chain of suffering, unsatisfactory cure, and frequent re- 
lapses. The rectum is an important organ, and it is not 
improbable that the disturbance of its postural relation with 
the sigmoid flexure by excessive inclination of the pelvis 
may promote the establishment of the habit of constipation, 
which is so common among females, and so often the cause 
of no less intractable, but even more painful, affections. 
The uterus is so delicately poised in situ naturali that SAMUEL C. BUSEY. 
17 
it is probably never at rest during the life-time of a woman. 
The varying conditions of vesical repletion and collapse, 
of rectal emptiness and distention, and the movements 
of respiration keep it constantly moving up and down 
a plane acutely inclined to the line of gravitation, and to 
and fro on its transverse axis. This mobility and incessant 
movement constitute the necessary and most essential 
method of uterine hygiene. It is this local exercise that 
promotes healthy circulation, expedites the processes of 
change and repair, prevents congestion, maintains normal 
nutrition, and preserves functional activity. 
The vascular, postural, and nutritive disturbances grow- 
ing out of deflections of the skeleton, which I have at- 
tempted to show may find their starting point in too great 
and habitual elevation of the heel, are not necessarily 
confined to the bladder, uterus, and rectum. All the tis- 
sues and organs, the vagina, ovaries, Fallopian tubes, liga- 
ments, and fasciae, may become involved. Hyperemic con- 
ditions, distortions, and displacements, either singly or 
collectively, may follow in an extended sequence of local 
and general disorders, but menstrual disturbances and 
vaginal discharges are probably more common. 
To enumerate these affections would extend this paper 
beyond a reasonable limit. I might show that diminished 
mobility of the uterus and excessive inclination of the pel- 
vis, with other and consecutive alterations of form, enter 
also into the causation of posterior deviations and descent. 
The moment the fundus, in posterior oscillation, passes in 
the arc of rotation beyond the point of greatest tension of 
the round ligaments, that moment their action carries the 
fundus down the arc of rotation towards Douglas's cul-de- 
sac. This movement would be aided by vesical repletion, 
deflection of the line of gravitation and of the vertical press- 
ure of the superincumbent viscera, transference of the in- 
testines from the anterior to the posterior surface of the 
womb, and by relaxation of the abdominal walls. 
The equipoise of the body upon the ilio-femoral articu- 
lations must be preserved, and Duncan has called attention 
2 18 
INFLUENCE OF HIGH-HEELED FRENCH SHOES. 
to the fact that, while "the small and especially short- 
bodied women " seek the readjustment of the centre of 
gravity by moving backwards the head and shoulders, "the 
tall and long-bodied " seek it by moving forward the sup- 
ports, which is accomplished " by diminishing the angle 
which the pelvis forms with the horizon." This change in 
the pelvis is analogous to that taking place in old age, when 
the forward stoop is counterbalanced by it. The same dis- 
tinguished authority points out the fact that when adjust- 
ment is effected by backward inclination of the head and 
shoulders the hips become prominent, indicating " a prob- 
able considerable obliquity of the pelvis." In the other 
class the hips are flattened, indicating lessened obliquity 
and elevation of the pelvis. These mal-relations of the 
pelvic and corporal axes are consequent upon pregnancy, 
and may also follow acquired habits of carriage and posture, 
such as I have suggested ensue from the constant and 
habitual elevation of the heel. 
I might also trace the obstacles which excessive inclina- 
tion of the uterus and consequent backward displacement 
of the os and cervix present to the transmission, tubulation, 
and lodgment of the sperm cell, impeding the processes of 
insemination and fecundation, and producing sterility. I 
need not pause to consider the obstructions to parturition 
which excessive pelvic inclination may offer, or to trace 
them back to the gearing of the feet in earlier life. They 
are sufficiently obvious to every obstetrician. 
Onimus says the local and functional troubles are fre- 
quently mistaken for strange manifestations of hysteria, 
varying according to the temperament and predisposition, 
and very often concealing the true nature and origin of 
chronic invalidism. In Paris young girls often complain 
of violent pains in the muscles of the leg, which extend 
along the external region of the calf to the thigh. A 
sharp pain from the sole of the foot to the external malleo- 
lus is the most frequent initial symptom. The articulations 
of the knees are many times equally painful, simulating the 
condition one feels after descending from a high mountain. SAMUEL C. BUSEY. 
19 
which has occupied several hours. But the long peroneal 
muscle is the one most often affected, because it is most 
fatigued by the irritation transmitted by its tendon from its 
insertion at the great toe along the plantar arch. The con- 
stant tension of certain muscles to maintain the equilibrium, 
rendered necessary by the height of the heel, produces 
painful cramps and a sensation of constriction, even when 
not walking, and young girls are compelled so seek relief 
from the lancinating pains by rest in bed. It is easy to 
comprehend how the general health may be influenced by 
such functional and local disturbances, and when such con- 
ditions exist in women, where the nervous systems are 
always waiting for an opportunity to become troublesome, 
we may look for serious pathological consequences. 
In the foregoing presentation of the subject I have en- 
deavored to confine the discussion to the physical aspect of 
the question, and to trace out the relation of cause and 
effect which may subsist between the prevailing fashions of 
foot gear and many of the maladies which come under the 
observation of the gynecologist. 
Note. - The illustrations exhibiting the alterations in the outlines of 
stature have been omitted, because the artist neglected to take the pho- 
tographs of the nude figures, with and without the shoes, in corre- 
sponding positions. The differences were sufficiently marked to show 
the changes in the form of the female, caused by the use of high-heeled 
shoes. An effort will be made to supply such illustrations at a subse- 
quent meeting.