Clinical cases covering the spectrum of upper limb pathology are presented here. In the hand, these include congenital hand deficiencies, Dupuytren’s disease, rheumatoid disease, nerve lesions and tendon transfers. In the elbow, this includes osteoarthritis and in the shoulder, massive cuff tear, scapula winging and painful shoulder arthroplasty. Clinical examination findings for each of the cases are highlighted.

This chapter looks at a spectrum of paediatric clinical cases ranging from generalised conditions such as Ehlers– Danlos syndrome to tibial bowing and foot disorders. Skeletal dysplasia and rotational and other malalignments are also covered. The emphasis of the cases shown is to demonstrate how clinical features can contribute to management.

Eighteenth-century British culture witnessed the ascendance of the ideology of proper human form, a belief system interlinking concepts of the beautiful, the natural, and the good with proper bodily configuration. The relatively new discourses of physics, biology, and aesthetics, and the re-emergence of the ancient pseudo-science of physiognomy, contributed to the formation of this ideology. Many of the period’s literary texts endorsed and/or critiqued social expectations of the beautiful and the natural, as these established the popular assumption that a well-shaped and good-looking body instantiated the proper human form. This assumption in turn associated proper form with high moral standards, the possession of which determined an individual’s social respectability and acceptance. Such physiognomic thinking also equated deformity with depravity. However, authors such as Aphra Behn, Jonathan Swift, and Sarah Scott, each in their own way, exposed the complexities and contradictions inherent in such reasoning. Moreover, the novel – emerging as a genre during this century – assumed an important role by becoming a vehicle by which the culture of sensibility softened and appropriated certain aspects of the ideology of form by recasting defective and deformed characters as objects of pity and charity.

The idea of capacity is central to Godwin’s political theory. In spite of his assurance that equality is unrelated to physical or intellectual ability, Godwin makes individual and social liberty contingent upon the types of contributions one’s capacities allow. His political system inevitably produces exceptions (those who do not or cannot contribute to the general good) for which he needs to devise additional measures. People who lack the right kinds of mental and physical capacities prove to be an intractable difficulty. In his fiction, Godwin centralizes the idea that the mind should work in concert with the body, and sees incapacity in either of these as socially and personally problematic. We see this in his repeated use of automata, dolls, and characters who disengage from their bodies in various ways; and in his fictional use of rejuvenation and cure. Godwin speculates that when reason governs society, illness and incapacity will no longer be present. His attitude towards deformity is quite separate from his views on capacity. Deformity, in Godwin’s fiction, is usually a visual sign of an evil character, and he does not articulate the prodigious phase of disability.

Picturesque theorists disagree vehemently over whether the picturesque deformity that can be appreciated in buildings and landscapes could also be appreciated in people with deformities, be these people real or represented. William Gilpin writes about ruins and people in ways that suggest that they possess the same aesthetic value. Fitness for representation is Gilpin’s criterion for a certain type of aesthetic appreciation, and, using this criterion, he regards picturesque deformity in a positive light. Uvedale Price, however, offers the idea that beauty, the picturesque, and deformity exist on a continuum, making deformity a question of degree. The quality of being striking enables Price to think of people and things as giving aesthetic pleasure in the same way. Drawing on Addison’s aesthetics, Richard Payne Knight makes a distinction between real and represented deformity. Knight argues, like Percy Shelley, that art has a transformative power that makes deformity aesthetically pleasing. The picturesque theorists are concerned with reconciling deformity (as a quality of the picturesque) with the aesthetic pleasure that derives from it.

Many critics struggle with defining the creature in Mary Shelley’s Frankenstein, as the novel offers a combined monstrosity–deformity concept that blurs the distinctions between moral and physical attributes. The critical focus on categorization, however, marginalizes Shelley’s interest in the ethics of looking, and, in particular, her interest in how looking constructs monstrosity/deformity. The novel reveals the failure of transformative vision in the case of monstrosity and deformity, and invites sympathy for the object of such failure by reiterating instances in which the uncanny is familiarized and vision is changed. The creature’s brief encounter with a blind character offers an opportunity for transformative listening, but this goes awry, and reinforces the central tragedy of the novel.