In Chap. I. directions were given for inducing the hypnotic state. This state varies to a certain extent, according to the method used. As was previously said, the pulse-rate may rise, the face flush, or the reverse may occur, or hypnosis may be induced without causing either effect. One may be hypnotized by simply telling him that he will sleep, and in disease the beneficial effects seem to depend both upon the method of inducing the hypnotic state, and upon the suggestions made during hypnosis.

In the various mental states accompanied by delusions, active suggestion of such a nature as to contradict and correct the delusion is always necessary. When there is a high degree of nervous excitability without delusion, absolute repose should be sought, and can best be obtained by inducing hypnosis simply through the sense of touch, and by commanding the patient to close his eyes. Sometimes simply stroking the hands gently will be sufficient. Stroking the head may he necessary, or placing the tips of the fingers over the eyelids will answer, when other methods fail. Music will often prove of service, and dim light will frequently aid. Total darkness is rarely desirable.

In chronic diseases, where the patient is fretful, and exaggerates minor symptoms, he should, by ordinary verbal suggestions, he taught self-control, and should not be encouraged to rely too much upon hypnosis to relieve him of pain, which it is often best for him to endure for a time.

In a case seen by me a patient, who had been suffering for a long time, desired to be kept in the hypnotic state, practically all the time. While his sufferings were not at all times intense, occasionally the pain was severe. It was impressed upon him, both in and out of the hypnotic state, that his own self-control was essential to a permanent cure, and that the hypnotization must be reserved to relieve the acute pain. Where there is severe pain the attention must be held in every possible way.

In addition to the subject's looking at a bright object, suggestions should be made rapidly and sometimes very sternly. Where there is extreme restlessness and insomnia with those who are acutely ill, with fevers for example, utter repose should be sought, and the sense of touch and hearing are the best avenues through which to induce it. Natural sleep sometimes comes instead of artificial hypnosis. In this natural sleep the patient will not obey suggestion, and it is always preferable to any artificially suggested condition of sleep.

In the application of hypnotism to disease, The personality of the operator counts for a great deal. He should, by every possible way, obtain the volitional obedience from his patient, and the removal of every cause of pain and discomfort should be sought before hypno-tization is attempted.

The question is often asked how long it is safe to leave a patient in this state. No evil consequences are likely to follow the use of hypnotism for the relief of either mental excitement or physical pain. The degree of hypnotism induced should vary according to the suffering of the patient. It should be carried just so far as will afford relief to him, and no useless suggestion should be made to him during the period of hypnosis.

I have elsewhere said that natural sleep frequently follows by transition upon the hypnotic state, or, when the attempt is made to hypnotize the patient, he falls instead into a natural sleep. This is always desirable. It is astonishing to what extent one's consciousness exaggerates even a small amount of pain when it has been endured for a long time. The value of repose of the nervous system as a sedative to other diseased functions of the body, has never yet been fully appreciated. A patient of mine suffering for months from a very painful affliction of the bladder, had obtained no rest either night or day. Morphine disagreed with him to such an extent that its use was discontinued. The drugs which sometimes afford relief in this condition had all been tried, but, owing to the sensitive condition of the stomach, they all, in turn, had to be given up.

The man was a nervous wreck, shrieking and screaming with every recurrence of pain. He was a curse to himself and to his friends. He had been discharged from a number of hospitals, for he was ill-tempered and unmanageable, owing to his sufferings, and neither attendants nor physicians had any patience with him.

I was requested by a friend to see him, and from his manner and mode of speech, at once gathered the idea that his physical sufferings were intensely aggravated, and at the same time exaggerated by both his fear, and, if I may use the word, the hyper-excitability of his whole consciousness. Pain there was, however, and plenty of it. He was not free from it night or day, catching only about two hours' sleep in the twenty-four, and that in snatches. Examining the patient I found that he held all of his muscles rigid, and that he was so afraid of being hurt that an examination of the bladder was practically impossible. Chemical analysis showed blood and pus in the water.

I told the man that if he would relax every muscle of the body his pain would cease, and that he would go to sleep. I told him to think of sleep and for a time to forget, and not allow in his consciousness that he had any pain. At the same time I gave him some sugar-of-milk pellets. I sat by him and held his hands and stroked his head and commanded him to sleep. In a half-hour he was sleeping quietly. This was a natural sleep, not a hypnotic trance. He slept four and one-half hours, and was much refreshed, but again complained of pain, and I insisted upon his remaining perfectly quiet, and explained to him the difficulty he gave both his physicians and attendants, and reassured him that perfect repose, mental and bodily, would greatly lessen his pain. His attendants, who were very capable, caught the idea at once and assisted me in carrying out the plan of treatment. He was taught by a series of exercises, after the Delsarte system, complete muscular relaxation. The degree of mitigation obtained in this way was astonishing beyond measure. The chronic disease which had made his life a curse to him was, in a measure, subdued.

The utterly unmanageable patient became docile, and, while the disease ended fatally, the man was made comfortable without the use of drugs, all of which caused him greater discomfort.