There are two classes of cases one meets in neurological practice, cases which at times are exceedingly difficult to deal with and cause both the family and the physician endless trouble; I refer to pavor nocturnis (night terrors) and certain cases of hysteria. For the benefit of the laity, I shall give a brief picture of both conditions.

Pavor nocturnis is characterized by the following symptoms: a child of nervous temperament or weak constitution, when in bed for the night, starts on his journey from the waking condition to the state known as sleep; the journey wherein the objective consciousness becomes gradually obtunded and effaced in oblivion, while that ever watchful sentry, the subjective ego, assumes entire control. Somewhere in this journey, more likely at the latter part or even after sleep is reached, the child starts up in bed with a cry, and is found sitting bolt upright, eyes staring wide open and every evidence of a visual hallucination, of the most painful and terrifying kind. He may jump from the bed and run through the house in wild fright, at times carrying on an inco-ordinate, one-sided conversation. Any attempt to awaken or calm the sufferer is usually wasted. After a while, there is spontaneous awakening, when it is discovered that the child has no recollection of what has taken place- These attacks vary as to severity and number.

It will be noticed that I have specified the child as "of nervous temperament or weak constitution." I might say that I have seen pavor nocturnis in boys who have led an out door life and have had all external signs of robust health; but these are rather exceptional.

The other class of cases I referred to above was of hysteria, and 1 shall now qualify that by limiting it to certain cases produced by fright.

Very frequently a patient will present herself suffering from a multitude of hysterical symptoms, globus hystericus, palpitation, flushes of heat, insomnia, frightful dreams, which are often of one particular dream picture, areas of paraesthesia, tenderness over mammary and ovarian region, tenderness of scalp, hallucinations of sight and hearing, reversal of color field, diplopia, which proves frequently to be monocular, internal strabismus, macropsia, and a host of others, too many for tabulation.

The patient gives a history of fright or mental shock of some kind. It may have been in the form of a practical joke in the dark, or possibly a ghost story by an indiscreet nurse. The patient may or may not ascribe her condition to this cause. She may look upon the fright, now well in retrospection, as a very insignificant thing, and at times, as you can see from the case below, the history of fright will be absolutely forgotten objectively.

Now these two classes (pavor nocturnis and hysteria) seem to me to be disorders of the subjective mind. There is never an effect without a cause, and I consider the cause in these cases to be frequently purely physical.

What agents are at our disposal in an attempt to cure these cases? We can change the mode of life of the patient. Send him from the city to the country and put him on the rest treatment. We can alter an injudicious diet and correct faulty personal hygiene. We can look for some visceral or other reflex disturbance; gastritis, g stro-enteritis, torpid liver and the like. We can examine the urine and find, as is frequently done,, large excesses of indican and even, at times, uric acid in aggressive amounts, which latter will tempt us to flush out our patient with quantities of water between meals. As to drugs, nux vomica, the bromides, iodides, and salicylates, all come in for their share of favor. Some practitioners get excellent effects from thyroid extract, or colossal doses of blue mass. You see, from the above, that it will be some time before the physician in charge wakes up to the uncomfortable discovery that he has tried all indicated remedies and failed to produce a cure.

Very frequently he will so benefit his patient by a careful system of therapeutics, massage, electricity, etc., that there may be an absolute cessation of all symptoms. But look out for the cases that in spite of all the above measures, and more too, yet come to your office with sickening regularity and tell you, day after day, that they are no better; if anything, a trifle worse. Their name is legion. Now hypnotism, properly used, will often produce the most happy results in these cases, and is of use from a diagnostic as well as a curative standpoint.

Sometimes through hypnotism, you can discover the psychical cause, and in other cases you can not. The first case I cite is purely hypothetical and composite, and illustrates the discovery of cause of symptoms, and cure through hypnotism. The second is from my own practice, and is an instance where the psychical cause was not apparent but where cure was effected through hypnotic influence.

Case I. Woman, 33 years of age. Unmarried. Menstrual history negative. No specific trouble. Usual diseases of childhood. Housekeeper. Never used alcohol to excess. No bad habits. Presents herself at clinic with following history: every night on retiring she has vague feelings of fright and impending disaster. After being in bed a half hour or so, and having become quite drowsy, she fancies she sees at the foot of her bed a man in black with a knife. He walks around to the side of her bed and makes ready to strike, at about which time she recovers enough strength to scream and throw herself out of bed, away from her spectre. This only happens once a night. It began about three months ago, at first being once or twice a week, but of late having taken place every night. She has lost twenty pounds. Her knee jerks are excessive. Her heart is rapid and irregular. Digestion poor. Constipated. Cries a great deal, and says she will take her life if relief is not forthcoming.

Now, what, is particulary interesting, and what I want you to note is that the closest questioning fails to elicit any cause, - history of fright or bad dreams. For a time she was put on drugs for the purpose of producing sedative and tonic effect. But she got no better.

Two weeks after coming to clinic, she was hypnotized, and passed easily into deep somnambulism, in which she gave a story much at variance with the one she had given in objective consciousness. She said, under hypnosis, that five or six months ago while going out to the woodshed, she unexpectedly came upon a tramp loitering about. She was greatly startled but regained her equanimity again, and thought no more of it. Several nights after this occurrence, she had dreamed that a man in black had come into her room for the purpose of murdering her. (This dream, as such, you will see from what has gone before, was never perceived by the objective consciousness.) This dream she said was repeated quite frequently. When awakened the patient does not remember anything she has said, and upon questioning gives the same history she did in the first place.

Her subjective dream was repeated until so strong an impression was produced that an hallucination occurred. The patient, after being deeply hypnotized, was told that she had mistaken the thing in the man's hand. It was not a dagger, but a roll of dark-colored paper. This suggestion was enforced most strongly and, after awakening, the patient told to return in two days. At the next experiment she was told that he really had no intention of killing her, but on the other hand was rather amicably disposed toward her.

At the next experiment she was told that what she had supposed to be a man was in reality a dark shadow and not a man at all, and that it would cause her no alarm. During the several sittings following, it was strongly suggested that this shadow was disappearing, and, at length, that it had entirely disappeared and would not return. Further she was told she would not be disturbed by dreams but would get her full amount of sleep, peacefully.

This woman was cured. For safety she was hypnotized once a month for a number of months in order to renew the suggestion.

Case II. "Woman. Age 40. Single. Nervous temperament. Usual diseases of childhood. No venereal history acquired or hereditary. Menstrual history negative. Great trouble and worry nursing sick sister. This followed by condition of neurasthenia with persistent insomnia. Great loss of weight.

Periodically she gets an idea that she has touched some object (a book, table, etc.) which has been touched by someone's hand which has held the Holy Sacrament. She will then be thrown into a state of mental agony, and begins washing her hands over and over again, for hours at a time, weeping the while.

I hypnotized her for two weeks, before attempting to assail her religious delusions. She was very easily hypnotized, and I took this means of making he* sleep from nine or ten o'clock at night until breakfast time next morning, when, I told her, the nurse would awaken her. Her improvement was wonderful. A few experiments directed against the hand-washing trouble were sufficient to totally eradicate that suggestion.

Now, what is necessary to success in giving suggestions during hypnosis? Tact. Tactfulness is the rock on which most unsuccessful operators split. If, in dealing with Case I, you had said the first time you had hypnotized her, "There is no man at all in your room, no dagger, no black cloak,"etc.,etc.,in all probability she would have fought against so radical a change, with all her power. The rule, that it is easier to produce an illusion than an hallucination, in a way applies here. That is to say, it is easier to change the nature of what already exists in the mind than to eradicate it altogether. I do not say that it is always impossible to produce at the first trial so radical a change, because anyone who has done much work in hypnotism has many instances to the contrary. But I do say there are many cases of failure because of too much haste, and had the inexperienced operator built his foundation of suggestion slowly, gradually, and with tact, he would have had success to take the place of failure.

In dealing with children, who are subject to night terrors, it is well to put them into the somnambulistic state, where there is perfect amnesia, and question them quietly and with confidence. Do not jump at a conclusion too soon. If the child says at first, that he has experienced no fright or ghost story, do not form the conviction that the cause is not to be found by that means. Rather take the child back tactfully, get him to tell about the companions he has had in the past, and what their methods of keeping him amused have been. Do not necessarily think that this has all to be accomplished at one sitting. It is a great mistake to tire a subject, particularly is this so where a child is concerned.

Also remember that the novelist's idea of the perfect veracity in hypnotism under all conditions, is absolutely fallacious. Experience has proved that a subject may become the most adroit liar when hypnotized, and throw all manner of obstacles, in the shape of misstatements, in the operator's way. This is par-ticularlv true when the subject gets the idea that he is thrown on his own resources for self-preservation.

The attributes of a successful operator are, a good forcible use of the English language (providing the subject speaks English), a voice capable of modulation, as well as clearly enunciated monotone, a belief in his own ability, and lastly, an abundance of tact> without which last, no one will rise to any degree of success.