Seeing that a degree of analgesia sufficient to render the prick of a needle or some otherwise painful operation painless may be induced by suggestion, it follows that the beneficial influence of suggestion does not exclude the organic nature of a pain. At any rate, when a pain disappears for a considerable length of time through the influence of suggestion we may assume that very probably the disease is not of an organic nature; but it is only to this limited extent that we can consider hypnosis an aid to diagnosis. All that I have here said in respect to pain applies equally to other organic and functional symptoms - e.g., paralyses. I must here refer the reader to Bernheim's remarks on the influence of suggestion on organic diseases, and may add that I quite agree with Gorodickze, who long ago protested against any exaggeration of the diagnostic importance of hypnosis.

I now come to the use of hypnotism in surgery. Hypnotizing for the painless performance of operations is not new; one inventive genius even imagines that God took the rib from Adam while he was in a hypnotic sleep, since he would certainly have waked had it been a natural one. In the days of animal magnetism surgical operations were often performed in the magnetic sleep; for instance, by Recamier in 1821. Such operations were also performed in several of the Paris hospitals under the direction of the Baron du Potet. Cloquet used it in 1829. He related his experiences to the French Academy of Medicine, but Lisfranc, the celebrated surgeon, put him down for an impostor or a dupe. Oudet was no better received in 1837, when he told the Academy of the extraction of teeth in the magnetic sleep. In 1840 Esdaile performed a number of operations during mesmerically induced sleep in the Mesmeric Hospital at Calcutta. The wounds are said to have healed very quickly. Hellwald, also, has recently drawn attention to the quick healing of the wounds of the Arab pilgrims, which are made in the hypnotic state.

In 1852, Vogler, although very sceptical as to animal magnetism, made Esdaile's results known in Germany. Elliotson at the same time was using mesmerism in surgery, in London. Braid, who was much struck by Esdaile's results, also used hypnosis in surgery. At that time the opinion was expressed - it has some adherents even now - that mesmeric passes induce analgesia better than Braid's method. Azam brought Braid's method of analgesia to Paris, as we saw on p. 16; from thence it passed to Germany, but found little support. Nussbaum, who had studied animal magnetism in Paris, thought that Germans were not suitable subjects either for magnetism or Braid's methods. None of his attempts to substitute hypnosis for chloroform met with success. Preyer says that military doctors and others appear often to have used empirical hypnotizing methods to induce analgesia for small operations, such as tooth-drawing. Bon will observed that after a succession of deep respirations a brief anaesthesia appeared; this was confirmed by Hewson. Possibly this is an auto-hypnotic condition, or an auto-suggestive anaesthesia. Recently Forel, Voigt, Tillaux, le Fort, Grossmann, Bourdon, Howard, Wood, Toll, Schmeltz and Starck have used hypnotic analgesia in surgical practice.

In 1890 Haab used hypnosis in the operation for cataract; extraction of the lens was preceded by iridectomy; on both occasions the patient was hypnotized and anaesthesia produced by suggestion, and he smoked an imaginary pipe as the iris was cut through. Lauphear, Aldrich, and others have even used hypnosis for amputations, and Hulst for gastrotomy.

Some years ago I once hypnotized a patient in order to open a boil painlessly. I did not succeed in inducing analgesia, but the patient was almost unable to move, so that I could perform the little operation with ease.

Analgesia has also been induced by post-hypnotic suggestion and an operation performed without difficulty in the waking state (Boursier).

It has been specially for the purpose of extracting teeth that hypnotic suggestion has been so frequently used (Bramwell, Andrieu, Hivert, Klemich, Sandberg, Moiroud). Glogau has even recommended its general use in dentistry. On the question of its practical importance the same remarks would apply as in the case of the use of hypnosis in general surgery.

Besides this, I cannot approve of dentists who have neither general medical training nor experience being allowed to hypnotize their patients. There are cases in which hypnosis is contra-indicated, but that is a point that can only be decided by a properly trained medical man. Just as a doctor is not in a position to treat every kind of dental trouble, so, too, a dentist is not fitted by his training to determine when hypnosis is contra-indicated or to carry out the process of hypnotizing in a technically correct manner. We may take it as quite certain that the ill-effects said to be brought about by hypnosis are really due to incompetence. When a dentist, Beisswenger, tells us that a highly intellectual and talented young man whom he had frequently hypnotized subsequently developed an aversion to work, showed symptoms of persecutory mania, and formed a determination to murder him (Beisswenger), then we may declare straightway that either the patient was a psychopathic individual, or that Beiss-wanger, in spite of his asseverations to the contrary, did not go to work in a proper way. In any case we can only advise Beisswenger very strongly never again to undertake a method of treatment that he does not understand.

Dentists in the present day complain often enough about quackery; they should strenuously oppose those of their colleges who meddle with matters with which they have as little right to deal as a quack has with dentistry.

The value of hypnosis in obstetrics is about the same as in surgery. Lafontaine and Fillassier, among the mesmerists, have magnetized women during labour. As Freyer reports, Jorg certainly thought birth impossible in the magnetic sleep without a quick awakening. Lie beau It has also used his method of hypnotizing in obstetrics. A series of such cases has lately been published (Pritzl, Mesnet, Secheyron, Auvard, Thomas, Varnier, Voigt, de Jong, Schrenck-Notzing, Tatzel, Grandchamps, Luys, Cajal, le Menant des Chesnais). A case in which Delbceuf and Fraipont hypnotized a woman in labour belongs here. The results were not unfavourable. The pains were regular and strong, and could often be made almost insensible by suggestion. Khovrine used post-hypnotic suggestion to prevent attacks of hystero-epilepsy in the case of a woman in labour. Directly the pains started, an attack threatened but was prevented in the manner mentioned. Indeed, towards the termination of the labour the patient lost consciousness at each pain, but only for a few moments, and just before the birth terminated pain was again experienced.

The value of hypnosis for producing analgesia must not be exaggerated. Sometimes analgesia cannot be induced at all, and sometimes it is only possible to obtain complete analgesia after repeated trials. The excitement before the operation increases the difficulty. The cases in which hypnosis can be used to make a severe surgical operation painless are very rare; the care with which every such case is registered by the daily press shows this. Besides, we have at present many means of inducing analgesia that are much surer in their action than hypnosis. In addition to ether, chloroform, and the like, there is Schleich's method of local anaesthesia; further, the modern method of spinal anaesthesia by injection. When by chance a person who is to undergo operation is found to be very susceptible, there is no reason why hypnotism should not be used. Hack Tuke and Forel think that hypnosis should be used instead of chloroform in all cases where that anaesthetic would be particularly dangerous. Forel believes, besides, that analgesia, sufficient for operative purposes, is more easily induced than I suppose.

I certainly think it possible that a clever hypnotist may obtain better results in this direction than I have been able to do.