Charcot also thought he could detect the exciting cause of hysteria in many nervous diseases. The symptoms of organic nervous disease and of hysteria may become associated in many ways, partly because organic nervous disease is an exciting cause of hysteria, and partly because the two sometimes appear simultaneously without there being any causal connection between them. But it is often very difficult to decide in any particular case which symptom should be ascribed to the hysteria and which to the organic disease. Thus according to Charcot hysteria and multiple sclerosis are not infrequently observed together. Now, the intentional tremor observed in both diseases is very much the same; hence it is difficult to decide in the case of a person so afflicted whether the tremor is of hysterical or of organic nature. The way in which we conceive psycho-therapeutics to act in cases of organic disease is in accord with this theory of organic disease combined with hysteria. The patient is relieved of the hysteria, but not of any symptom of the organic disease itself.

We can see that there is a difference between the theoretical views of Charcot and those of Bernheim. But I shall not discuss that question any further, as it would practically only lead to a contention about words. Considering the difficulties in the way of differential diagnosis, and the conflict of opinion as to hysteria, the question, whether a symptom that has been relieved by hypnotic suggestion was referable to the organic disease or to the accompanying hysteria, could hardly be made the basis of a profitable discussion. As far as the practical value of psycho-therapeusis in the treatment of organic disease is concerned, such a discussion would be meaningless.

A few further considerations will serve to show the importance of psycho-therapeutics in organic disease, but I shall not discuss any further the question whether hysteria or something quite different is present, because the exact meaning that should attach to the term "hysteria" is still a matter of dispute. In many organic diseases a functional disturbance may supervene, provided the disturbance caused by the organic disease be augmented by auto-suggestion. Paralysis agitans is a case in point. It often happens that patients suffering from palsy are unable to walk properly, or fall when they attempt to get about. One fall suffices to make the patient feel even more insecure, and thus considerably diminishes his power of locomotion. We can easily understand how these troubles may be lessened by suggestion or other therapeutic measures without the organic disease being done away with. Again, let us take a case of polyarthritis deformans in which the knee-joint is affected as well as others. Motion in the joint is essentially inhibited both by anatomical changes in the joint and by pain. In addition to this there is the fear of the pain, which increases the functional impairment of the joint even when there is no real pain present.

In such a case autosuggestion may make certain movements impossible, thereby rendering the functional derangement persistent even when there is neither a mechanical obstacle nor a sense of pain. This enables us to understand how such patients come to stand up when momentarily excited; an outbreak of fire suffices to make them jump up and run out. But when peacefully seated and undisturbed, the patient cannot voluntarily rise from his chair. That disturbances which are not the direct outcome of the organic lesion should be done away with by psychic remedies is quite comprehensible.

How readily mentally-determined functional pains follow organic lesions is shown by the fact that people who have had a limb amputated often feel exactly the same pains after, as before, the ablation. Attempts have been made to refer this to irritation of the nerve-stumps in the cicatrix. This explanation may apply in some cases, but there is much to be said against it; indeed, it is much more probable that in many cases the original peripheral pain is reproduced centrally. This view is supported by the fact that the patient experiences the same pain, at the same spot, as before the amputation, which can be better explained by central reproduction than by the physical stimulation of the peripheral nerves. Of course the pain experienced by the subject in such a case could be explained by the law of the pheripheral ramification of the nerves; but that would not explain why the patient feels exactly the same pain in exactly the same spot as before the operation. Let us take as an example the case of a person suffering from a painful ulcer on the leg. The patient feels severe pains at a particular spot on the leg; he also feels that the pain is of the particular kind caused by a peripheral affection.

The local affection is then removed by amputation, and yet long after the operation, often years after, the patient experiences a sensation of pain in exactly the same way that he did before. Does irritation of the nerve-stump at the place where the amputation was performed explain this ? Certainly the patient thinks he feels the pain at the same spot as before, and not in his heel or his toes; but that is better explained by central reproduction of the pain than by peripheral stimulation; and this view is quite in accord with many other psychological experiences, for mental processes primarily set up by peripheral stimulation acquire a tendency to be reproduced centrally.

The- efficacy of psycho-therapeutic measures in the treatment of organic disease is further rendered intelligible by the fact that organic troubles are more acutely felt by neurotic subjects than by those whose nervous system is in a healthy state. Maximilian Sternberg cites tooth-ache as an example " of the connection between the sufferings caused by a disease and the irritability of the central nervous system." If a person whose nerves are in a healthy condition forgets his toothache at the dentist's door, it goes to show that toothache in cases of neurosis is particularly dependent on the general state of the subject's health* Sternberg advances caries as an example of this, because it is often connected with hysterical tooth-ache and with tooth-ache as observed during pregnancy. In these cases the general neurosis causes the pain to be felt more acutely than the caries justifies. The neurosis, and not any change in the circulation, is to blame. Consequently all kinds of suggestive remedies - mouth-washes, hypnosis, etc. - are effective in such cases, though of course local treatment should not be neglected.