intellectual young man of about sixteen, and he came in on a single crutch, with the left or affected limb swinging limp and wholly useless, and when I laid him on his back, and took hold of the leg to examine it, I found it utterly resistless to every motion. The muscles were wasted, soft, and without tonicity, and, there being a large outward bending in the middle of the bone with lapping of more than two inches, it would roll about, when touched, like a crooked stick on the floor, and it was almost impossible to keep it still long enough to make a diagram. The attenuation of the soft parts was so great that the bone was easily examined, and no line of union or the slightest evidence of callus being felt at the seat of the alleged second fracture, and being assured that one of the remarkable things in the case was that there had never been any callus, I concluded that the bone had not been fractured at the last injury. There was no doubt that an unfractured bone had been hastily put in splints, and for a year, and up to that time, three eminent men had been devising and using various splints for securing apposition of a fracture which did not exist. That it did not exist is proved by the fact that three days after his arrival he was walking on that leg.
The explanation of this case is exceedingly simple: he thought he had refractured his femur at the second accident. This impression caused him instinctively and quite unconsciously to withhold muscular action in that limb—that is, he did what he ought to have done if the limb had been fractured. It was the completeness of the control over the muscles, the utter restraint of all muscular action, causing the totally relaxed and powerless condition, which was mistaken for a broken bone. Of course, the trouble was purely mental. But it was not a condition of mind of which he was in the slightest degree conscious. He was not aware of the fact that he was restraining the muscles from acting during this long time; so effectually restraining them that all spontaneity was destroyed by a direct and positive effort of the will. He held his limb in a mental vise of such force and persistency that its nutrition was interfered with, and it was wasted to the last degree. And yet he did not know it. There was no shamming. His condition was a great distress to him. He was also at an age when male persons are the least liable to morbid sentiments. At any rate, I could find none in his case. A mere explanation of his condition was not sufficient to enable him to relax his mental hold on the limb. The mental impression subordinated his will and the ordinary desire. His treatment consisted in providing situations which would assist him to let go of his leg. I caused him to take certain violent exercises with his upper extremities. The intention was to make them so violent that his whole attention would be required for the upper, and there would be none left for the lower extremity. The plan succeeded. Within three days he gave up restraining the limb—let go of it; in fact, spontaneity was restored, and he began to walk; began involuntarily, and
