Just as people can be made ill by constantly telling them how poorly they look, so a cure may be prevented by making the patient believe that it is impossible or by putting him in constant dread of the remedy - hypnotic suggestion, for example.

It is often said that hypnosis may be used, but only as a sort of last hope. I consider that not only an unjust view of the importance of hypnosis but impracticable as well. Considering the large number of remedies and methods at our disposal, some patients would have to attain the age of Methuselah before hypnotic treatment would be permissible on such principles. It is the duty of every one who believes that hypnosis is harmless when properly applied, to use it where it is indicated. It often happens that the longer a disease has lasted the more difficult it is to cure, and some diseases become incurable because they were not rightly treated at first. We might hesitate to make long preparatory experiments with people difficult to hypnotize (Grasset). But where one or two experiments demonstrate that a sufficiently deep hypnosis can easily be induced, it would be a mistake to postpone hypnotic treatment until a hundred other methods, all disagreeable to the patient, had been tried in vain.

I have hitherto discussed the use of hypnotic suggestion to remove morbid symptoms, but, as I have already said, the importance of hypnosis to medical practice is not limited merely to that. For instance, I briefly mentioned prolonged hypnosis and touched on the prophylactic use of hypnosis where morbid states have a tendency to recur at times. I also mentioned seasickness, and I may add that hypnotic suggestion has been recommended as a prophylactic in cases of attacks of migraine. It has also been specially proposed that the increased power of memory exhibited by hypnotics should be utilized for therapeutic purposes. This has occasionally happened in close connection with suggestion. Naef used it to remove a temporary total, and partially retrograde form of amnesia. The patient, who had lived in Australia at the time his memory was beginning to fail, was methodically treated in hypnosis with the suggestion that he would at once regain his memory for details of all kinds, and would retain it on waking. The possibility of increasing the power of memory in hypnosis has been used by others - Brodmann, for example - for the purpose of ascertaining the pathogenesis of certain disturbances.

Various authors also state that in cases of organic lesion it is possible to carry out movements in hypnosis which cannot be executed in the waking state. Stembo thinks this must be ascribed to a heightening of memory; he believes that the memory-images of movements that have fallen into disuse are lost in the waking condition. Consequently the movements cannot be carried out even when the lesion is repaired. In hypnosis, however, there is a heightening of memory by which the mechanism of movement is again recollected and so set in action. On the other hand, a few doctors - Vogt and Stadelmann, for example - have employed suggested amnesia . for therapeutic purposes.

Special mention must here be made of two authors, Breuer and Freud, who have put forward the possibility of heightening the memory in hypnosis as a recommendation for a special form of treatment which they term the cathartic method. They started from the hypothesis that hysterical symptoms are often caused by an arrested emotion. The process which produced the hysterical symptoms must be made quite clear so that the emotion which it arrested may be released. For this purpose the patient should be made to give as detailed an account of that process as possible, and should also be made to express the emotion in words. Both investigators assert that they have Gumpertz has also called attention to hypnosis as an aid to diagnosis. He distinguishes two ways in which hypnosis may be employed for this purpose. In the first place, the result obtained by suggestion is of importance, as in the cases already mentioned. Gumpertz thinks that in a case in which the diagnosis between paralysis agitans and a traumatic hysterical affection was not clear, he was justified in excluding paralysis agitans, because suggestion acted beneficially on the tremors.

He also thinks he was right in describing a case of paralysis of the obliquus enternus as hysterical paresis, because of the beneficial influence of suggestion on the double vision. The third case was that of an elderly maiden lady suffering from contractures of the muscles of the hands and feet; a single hypnotic sitting sufficed to remove the contractures, and it was shown both by the anamnesis and the influence of hypnotic suggestion that a subsequent attack of aphasia might well be put down to hysteria. Secondly, Gumpertz considers that, besides the results produced by suggestion, the course of a hypnosis may be used for diagnostic purposes, because deep somnambulism with hallucinations makes one suspect hysteria, just as a brief period of spontaneous oblivion after waking does. Hirschlaff also, who holds that somnambulic hypnosis occurs in some forms of chronic intoxication of the nervous system, especially alcoholism and morphinism, thinks we may use hypnosis as an aid to diagnosis on this assumption.

I do not deny that hypnosis can be used as an aid to diagnosis, but I hold the opinion that this should only be done with the greatest reserve. First of all, as far as the opinion of Gumpertz and Hirschlaff, who use deep hypnotiz-ability in the diagnosis of hysteria, is concerned, I think we must be very cautious in this connection. I must here refer the reader to what I said on p. 303 et seg., concerning the meaning that attaches to "hysteria." But we must in general be very careful about using hypnosis for diagnostic purposes. Take the case of a person suffering from severe pain in which the diagnosis lies between a tumour and a hysterical pain. It is easy to assume that a differential diagnosis can be made because suggestion removes functional, but not organic pain; But from the practical point of view there are many difficulties in this respect. I do not lay any weight on the fact that there is very often a combination of functional and organic pain; but what follows is well worth considering. There are functional pains that cannot be removed by suggestion; therefore the persistence of pain might be no proof that the disease is organic. In addition to this the pain caused by organic disease can, as we have seen, be removed by suggestion, at least for a time.