for that length of time on crutches. The foot and ankle were very thin, cold, and clammy, and even very gentle manipulation caused considerable pain. I could not make out, from all the history which I could gather from the lady herself, with the help of her sister, who accompanied her, that the so-called injury had been at all serious, and I concluded that what had been supposed a serious injury to the ankle had simply been a circumstance which had established a condition of apprehension in regard to that locality.
A careful examination satisfied me that the lameness was in the mind, referring to the foot and ankle, but without any sufficient injury of the parts referred to to cause lameness. It was therefore the mind rather than the foot and ankle which ought to be treated, and it was the mind which I did treat, with success. There was no excessive fear here, as there is in many cases, but simply pain on using the foot. Of course there was the misapprehension with regard to the nature of the case, and correcting this misapprehension was one important element in treatment. But such correction only put her en rapport with her treatment, but did not alter the fact that it did hurt to bear weight on the foot. In such cases it is important to give some time for the emotions to adjust themselves to what the intelligence accepts on the subject. In the mean time something was given her to do, some uses of the foot which would fall far short of attaining the point of pressure or motion which her experience had shown would or might be painful; that is, she was required to never approach the point where she had been accustomed to expect to be hurt. Thus the element of expectancy was gradually lessened, and finally eliminated entirely, so that in a few weeks she could walk as well as ever. This was twelve years ago. She has never had a relapse, and is perfectly well to-day. This is one of the classes of cases out of which the so-called "bone-setters" make so much capital.
The foot, ankle, knee, and hip joints are all frequently referred to when there is no organic affection at the point indicated by the mental impression, and I might go on almost indefinitely relating instances, if time permitted. But it may be sufficient to indicate the frequency of disturbed psycho-biological relations to say that I estimate that not less than one half of all cases applying to me for relief from joint affections belong to the class under discussion.
Before leaving this aspect of the subject I think I ought to mention the case of a little girl living in Williamsburgh, who, when she was about three years old, saw a very lame child in the street one day, a patient of mine, and when she returned home her family were surprised to find her lame. The patient the child saw was affected by paralysis, but, curiously enough, the child's lameness simulated disease of the hip-joint. Paralysis could not be well imitated. I was consulted some two years after the first appearance of the lameness, and her attending physician, the late Dr. Brady, of Williamsburgh, gave me the history of