The pain exists in both cases, and is not imaginary. If in the latter case the patient were to refer it to an external stimulus he would be wrong. But the doctor must take the pain the patient says he feels to be real. To combat and' remove such pains is just as much the duty of a doctor as the healing of a wound. A doctor may be able to detect and explain the functional nature of a pain, and even trace it to its mental origin, but he should never say that it is imaginary. It may possibly not be invariably, easy for him to avoid mistakes; for there are patients who think their disease is not understood when a doctor assures them of its purely functional nature. A doctor must not only take into consideration the education a patient has received, he must also think of the degree of intelligence possessed by the latter. He must remember that a patient's power of thinking logically is influenced by disease in so far as the patient's own conclusions as to his disease are concerned. There are well-educated people, people who as a rule think logically, and who are yet unable to understand that a functional complaint is just as much a disease as an organic one, and may even bring about more serious consequences than the former.

Experience and tact are the best aids a doctor has for getting over such difficulties.

As years go on I am more and more convinced that uprightness, truth and candour afford the best help a doctor can give his patient, and that the reserve that used to be displayed is only too often inimical to the patient's interests. Even when we tell a patient truthfully that we cannot cure his disease, the truth is often of use. Kant tells of himself that his flat and narrow chest, which gave but little play to his heart and lungs, predisposed him to hypochrondriasis. He suffered from cardiac oppression, but the conviction that the cause of the oppression could not be removed soon made him cease to dwell upon it. "The oppression is still there, for it is caused by the build of my body, but I have mastered its influence on my thoughts and actions by distracting my attention from it, as though it had nothing to do with me." A man suffering from hemiplegia following an apoplectic fit, with no sign of improvement as time goes on, will often be greatly benefited by a doctor who teaches him to take no notice of the paralysis, provided, of course, that the chance of curing him is very small or nil.

Such a method of treatment will be more advantageous to the patient than sending him from one expensive doctor to another or from this to that institution and finally landing him in the hands of a quack. When the chance of obtaining a cure is small, the question of expense is generally important. It is better for a doctor himself to inform a patient that he is suffering from tabes doralis than to let him be brutally told the truth by some one else. It is just in cases of tabes that a truthful explanation lessens the patient's dread of his disease. Recent statistical investigations have shown that the average duration of life is not affected by locomotor ataxy. There are cases in which the name of the disease terrifies the patient, and yet good may be done by explaining its nature; as, for instance, when a doctor explains that diabetes is an inclusive term and does not mean a definite disease, and that there are forms of diabetes which are in nowise dangerous.

It will be seen from the foregoing that I rate explanation and instruction very highly. But this must not be overrated as a curative factor, as some have done - for instance, Dubois. People forget that suggestion plays a great part in all explanations, and cannot be altogether excluded. The patient who trusts the doctor from whom he receives instruction and explanation is subject to the influence of that doctor's suggestion. Much that Dubois and others put down to instruction is really due to suggestion. But apart from this, there are cases in which suggestion is more effective than instruction. Many forms of auto-suggestion belong to this category. A patient who suffers from diarrhoea after taking black coffee may be relieved of this inconvenience by explaining that it is the result of auto-suggestion. In other cases counter-suggestion proves much more effective. Explanation will always improve the condition of a person suffering from imperative ideas. The patient clearly recognizes the foolishness of the idea, but is unable to resist it. When it is possible to induce deep hypnosis in such cases good results can be more readily obtained than by instruction. It sometimes happens that explanation given at a wrong time is absolutely dangerous.

I can recall the cases of patients who were weaned from the drug habit by sham injections - indifferent solutions that they imagined contained morphia. But when such patients are told the truth, they invariably return to their old habit. Experience, at least, shows this.

Of course, many patients feel flattered when they are told that they will not be treated by suggestion but that their own intelligence, powers of thought and will, will be brought into play. Suggestive treatment usually appears easier to the patient, but his vanity is flattered by the explanatory method. Nevertheless I think there are many cases in which it is carrying suggestion too far to tell a patient that he is being cured by instruction, whereas in reality the improvement in his condition is mainly due to suggestion. Unintentional suggestive therapeutics may consist in the suggestion to a patient that he is being cured by instruction and his own will. People who in the present day discard suggestion as a therapeutic method go too far. In the same way that Rosenbach formerly did, Grasset has recently held up suggestive-therapeutics as psycho-thirapie infirieure in contradistinction to psycho-thirapie supirieure as generally accepted. Nevertheless, catchwords should be avoided, and it should never be forgotten that what is supposed to have been brought about by psycho-thirapie supMeure is often the result of veiled suggestion, the patient being convinced that his own will and intelligence have restored him to health.