These points have to be taken into consideration when discussing the connection between hysteria and hypnosis. I have already (p. 49) spoken of the supposed connection between hysteria and hypnotizability, denying its existence, and I based my negation on the clinical meaning of hysteria. But some cautious German investigators - e.g., Hirschlaff, Hellpach, Gumpertz, Vogt - have recently attempted to establish a close connection between hysteria and hypnosis, or at least a certain psychological relationship. This would be quite right from Mobius's point of view, according to which both states are equally influenced by ideas. But it is quite different if we accept the climical conception of hysteria, for that does not admit a close connection between hysteria and hypnotism, or, more particularly, the connection between hypnotizability and hysteria which used to be sometimes assumed.

But it is necessary to insist upon the various meanings given to the term hysteria if we are to ascribe a definite position to hypnotic and suggestive therapeutics, or, indeed, to the whole of mental therapeutics. If we accept polysymptomatic hysteria with the varying pathological picture it presents then a remedy that allays the morbid phenomena in such cases is often considered of minor importance because the term hysteria, used in this sense, is too easily associated with the ideas of exaggeration and simulation, and because, moreover, such hysterical symptoms are themselves liable to undergo variation. Let us now take the second clinical meaning of hysteria, and examine the case of a person suffering from a severe pain in a muscle - the biceps, for example - but without any other symptom of hysteria, then if the patient is freed by suggestion from the pain the people who want to make out that hypnotic treatment is only beneficial in cases of hysteria at once exclaim, "You see that was only another case of hysteria." They carefully suppress the fact that the patient was not hysterical in the first meaning of the word. This is the way in which the word "hysterical" is juggled with to prove that only hysteria can be influenced by hypnosis.

Such methods can only tend to obscure the whole question; and it is easy to see bow much more likely this is to occur, if at one time the clinical meaning and at another Mobius's definition of hysteria is made the basis of the discussion.

How easily a confusion of these meanings may lead to misunderstanding, is exemplified by a letter which Charcot once addressed to Guttmann, in which he asserted that only hysteria can be treated by hypnosis. But, as Nonne remarked, Charcot understood much more by "hysteria" than German physicians did in those days. In contradiction to two German authors, Oppenheim and Thomsen, Charcot distinctly declared that the variability of the symptoms is not the chief characteristic of hysteria. Hence, according to Charcot, the indications for hypnotic treatment are not so limited as those authors assumed from their antiquated German notion of hysteria. We shall see later on that Charcot understood much more by hysteria in other respects; he was satisfied that hysteria was a concomitant of many organic diseases in which its presence was denied by other authors.

The most suitable maladies for hypnotic treatment are the neuroses - i.e., nervous complaints in which no anatomical cause is demonstrable. But, as pointed out, there must be no confusion with hysteria or neurasthenia. The nomenclature is certainly somewhat arbitrary. Whether an occasional headache is described as hysterical, or nervous, or even functional, often depends more on the individuality of the physician than on the nature of the pain, and in the same way a patient suffering from imperative ideas may be described either as a neurasthenic or a psychopathic subject. Dubois, for example, arbitrarily classified neurasthenia, hysteria, hystero-neurasthenia, mild forms of hypochondria and melancholia, and, finally, certain severe disturbances of mental equilibrium which border on insanity, under the heading psycho-neurosis or neurosismus. Considering the arbitrary way in which all such designations are used, I shall not place too much value on a scientific terminology; but to avoid any misunderstanding, I must maintain that cases of polysymptomatic hysteria are not invariably suitable for hypnotic treatment, especially when the symptoms vary very rapidly.

This is obviously caused by the auto-suggestibility of the patient, which in such cases counteracts the effect of the external suggestion. We can often remove such a hysterical symptom as pain in the head or the leg by suggestion, but another symptom readily takes its place as the result of auto-suggestion. On the other hand, it not infrequently happens, as Kraepelin has pointed out, that cases which come under the monosymptomatic conception of hysteria are often suitable for hypnotic treatment; this we shall see from the following summarization of the indications for such treatment. I will now proceed to enumerate the most important states in which hypnotic treatment has to be considered.

All kinds of pains that have no anatomical cause - e.g., headaches, stomach-aches, ovarian pain. Rheumatic pains, even with effusion in the joint, according to Block; but it is possible to confuse with hysterical effusion. Many forms of neuralgia, also, are influenced beneficially by hypnotic treatment; Forel observed good results in a case of neuralgia of traumatic origin.

All kinds of other sensations of nervous origin, as, for example, pruritus cutaneous nervosus, paraesthesiae; nervous ringing in the ear.

Nervous ocular disturbances (Forel, Mollerup, Chiltoff).

Various kinds of local spasms - e.g., blepharospasm (Forel Ritzmann); vaginismus (Barbaud). All kinds of tics (Meige and Feindel, Wetterstrand, Renterghem, Feron, Vlavianos). Paramyoclonus (Scholz). Neglected cases of chorea (Dumont-pallier, Leroux); hemichorea (Farez).