Hypnotic treatment has also often been successfully used in cases of organic1 disease. Liebeault and Bernheim, the earliest investigators, and others who have studied the therapeutic value of hypnotic suggestion have demonstrated this. Later on others - such as David, Grossmann, Stembo, Lloyd Tuckey, also Bechterew and, quite recently, his pupil Pewnizki - have likewise emphasized the importance of hypnosis in the treatment of organic disease. Lloyd Tuckey observed the severe pains in a case of tabes dorsalis disappear under treatment by hypnotic suggestion; Stembo subdued pains arising from cicatrices; Pewnizki saw the spontaneous pains decrease in a case of syringomyelia, but those caused by peripheral stimulation increase under the influence of hypnotic suggestion. Bernheim saw an apoplectic paralysis rapidly improved by suggestion. The objection that the diagnosis was mistaken was contradicted by the autopsy when the patient died of disease of the lungs later on. Martin, also, has expressed a decided opinion against limiting hypnotic treatment to functional diseases. He has described, among others, cases in which the vomiting of pregnancy and pains in the hips and thighs arising from the pressure of the gravid uterus were subdued by hypnosis.

He also succeeded by means of hypnosis in making patients retain food and medicines which they otherwise invariably returned.

1 I here include among the organic diseases some that are usually classified as neuroses, because we are as yet unaware of (he nature of the anatomical lesions that produce them; but such anatomical lesions must certainly be assumed to exist, for example, in paralysis agitans, facial cramp, acute chorea, etc. Of course, some organic change is the basis of every neurosis. Still we are justified in making certain distinctions, as between paralysis agitans and hysteria. If we take into consideration the progressive course of the disease and the immutability of its chief symptoms, then the organic lesion in palsy must be of a much more stable character than is the case in hysteria.

A superficial examination of the question might very easily lead to the view that the employment of hypnotic suggestion in the treatment of organic disease is but the result of an uncritical over-estimate of the value of that method, because it is not the organic lesion that is cured by suggestion. Such a conclusion would be altogether erroneous. If we believe that Frankers therapeutic exercises have a beneficial effect on the symptoms of tabes dorsalis, then there is no reason to contest the efficacy of other psycho-therapeutic agencies in the treatment of organic disease. For Frankers method is a mental remedy; it is an attempt to restore voluntary co-ordination of certain movements by making special uses of the sense of sight. So that even if we admit the efficacy of this remedy, we are not bound to assume that the morbid anatomical changes in the spinal cord are done away with by it. Sperling pointed out long ago that the part of the brain injured in apoplexy is not restored by electricity; nevertheless the treatment of apoplexy by electricity is considered a scientific method. In the same way psycho-therapeutic measures are often effective in cases of organic disease, without the organic lesion being thereby cured.

This view does not lead us into the realms of the miraculous; on the contrary, it enables us to understand the mode of action of such remedies, even if the explanations given do differ somewhat. They all depend upon the following fact, established by correct observation: - In many organic diseases, the functional disturbance, which we usually consider the symptom of the organic disease, extends much farther than the direct influence of the organic lesion justifies. In the following considerations, an endeavour will be made to explain this fact from the theoretical point of view; they do not refer exclusively to hypnosis and suggestion, but to psycho-therapeutics in general as well. To prevent any artificial disconnection of subjects that belong together, and at the same time to avoid repetitions I should otherwise have to make in the next chapter, I shall discuss this question with reference to psychotherapeutics in general.

In a whole series of cases, Bernheim has watched the influence of hypnotic suggestion on the symptoms of organic disease, and thinks that in many organic diseases the functional disturbance lasts longer than the organic lesion, and that the functional disturbances are sometimes much more extensive than the organic lesion justifies even during its presence. In both cases it is possible to obtain improvement by means of psycho-therapeutic influence, also when the disease is organic. Let us take a case in which the functional disturbance lasts longer than the organic change. When a muscle has been injured it may happen that the pain lasts after the anatomical results of the injury - for example, extravasation of blood, inflammation - have passed away. We can understand that this after-effect of the cured organic lesion can be done away with by psycho-therapeutics. Bernheim mentions apoplexy, in which the functional disturbance is far more extensive than the lesion. He thinks that the lesion acts on the adjacent parts like "shock," setting up functional disturbance. We can quite understand the benefit derived from mental treatment in this case also.

Indeed, psycho-tberapeusis sometimes satisfies the indicatio morbi, at least in the first case, in which the functional disturbance lasted longer than the organic lesion, and in the second case (apoplexy) it was indicated as symptomatic treatment.

From Charcot's neuro-pathological standpoint, the successes obtained in cases of organic disease require a different explanation. As already mentioned, Charcot's conception of hysteria was totally different to that which originally obtained, especially in Germany. In particular, he held the opinion that hysteria supervenes in many organic diseases, the latter often being the exciting cause of the former. But he thought that in such cases we should make a strict distinction between the symptoms of the organic disease and those of the accompanying hysteria. According to Charcot the local anaesthesia met with in cases of lead-poisoning is often improperly described as a symptom of the intoxication, whereas it is really a symptom of the accompanying hysteria. Similarly, he thought that the tremors observed in mercurial poisoning should in most cases be considered symptomatic of the accompanying hysteria and not a phenomenon of the poisoning. In common with his pupils and many other investigators, Charcot considered hysteria an after-effect of many infectious diseases - typhoid, for example. His pupil, Gilles de la Tourette, states that malaria may bring about a recurrence of hysteria, which then takes an intermittent character.