According to the school of Nancy, suggestion is the key to the whole position. By it the patient is hypnotized, and without it he lies like a log, inert in mind and body. By it one centre can be made to act independently of others, and can be thrown into functional activity without the corresponding actions of those ordinarily associated with it. Thus, connections advantageous to the organism can be formed, and unfavourable associations can be modified or broken off.

The state of the subject lying passive and unacted upon by suggestion very closely resembles natural sleep. The breathing becomes slow and regular, the pulse slower and more full, the pupils contract and the eyeballs turn upwards. There is generally relaxation of all the muscles, as in sleep, and the arm, if raised, falls at once, unless retained in its place by suggestion. Ophthalmoscopic examination of the retina shows neither anaemia nor congestion. If a state of profound hypnosis is kept up continuously for several days or weeks, as has sometimes been done, changes are said to occur in the urine. The chief of these has been called ' inverted formula of the phosphates,' the relative proportion between the earthy and alkaline phosphates becoming changed. Dr. A. Voisin kept several patients who were subject to periodic attacks of insanity in the hypnotic state for from fifteen to thirty days, * and he and Dr. Harant carefully collected and examined the urine passed before and during hypnosis.

They found this inversion of proportion the only characteristic difference (vide table, p. 292).

But the amount of urea, fixed residue, and phosphoric acid were all slightly increased, thus justifying him in stating that in such cases the nutritive and eliminative function were better performed in the hypnotic than in the waking state.

Voisin conducted these experiments in consequence of a paper read before the Academie des Sciences by Dr. Gilles de la Tourette, in which that opponent of the Nancy school stated the results of experiments he had made on some hysterical patients and on some subjects in Charcot's stages of hypnosis. He also found the ratio of earthy phosphates to that of the alkaline phosphates inverted from the normal proportion of 1 to 3 to 1 to 2, and sometimes 1 to 1. He, moreover, found the quantity of urea, phosphates, and fixed residue diminished in both hysteria and hypnosis, as well as diminution in the quantity of urine passed, and he therefore concluded that the hypnotic state is a hysterical neurosis, and that it is attended with serious disturbance of nutrition. Here again we see the antagonism between the schools of Paris and Nancy, and in this case it would certainly seem that reason is on the side of the latter, for whereas Gilles de la Tourette's experiment extended only over a few hours, that of Voisin extended, as we have seen, over weeks. The experiments of the former were, as was generally the case in Paris, made upon hysterical subjects who were hypnotized: it was therefore natural that the secretion should partake of the characters of hysterical urine.

Voisin's figures also lose much of their value in consequence of his subjects being in a state of mental disease, so that experiments on healthy persons are wanted to decide this point.

* Revue de l'Hypnotismc, March, 1891.

And this brings me to the vexed point whether hypnosis is pathological, and a neurosis, as was contended by Charcot, or physiological, and even indicative of perfect mental health, as is asserted by Bernheim, Voisin, Forel, Dejerine. and others. I have little doubt myself but that le grande hypnotisme of Charcot, when it occurs spontaneously, is a distinct neurosis of the hysterical type, and that many of the phenomena of advanced hypnosis are only obtainable in subjects of neurotic temperament. But that all people who have been hypnotized, or might be hypnotized, are hysterical or neurotic would be to so classify the great majority of mankind.

Dr. Buzzard says that most brain-workers and men of energy are more or less neurotic, and that the word should not carry the reproach with which it is sometimes associated. Even if most brain-workers are neurotic, one cannot so characterize agricultural labourers, soldiers, or sailors, and we know that among them are often found the best subjects for hypnotic experiments.

A most masterly and judicial exposition of hypnotism is contributed by Professor Tamburini, of Modena, who impartially holds the balance between the theories of Bernheim and those of Charcot. He and Dr. Seppilli experimented on a hystero-epileptic patient, and published their notes on the case in 1882. At that time the important part now assigned to suggestion was not fully recognized, and in dealing with experiments made more than twenty years ago one has to guard against the possible invalidation of the facts brought forward by unintentional suggestion. Tamburini, however, is positive on this point, for he approached the subject in a most sceptical spirit, and under the impression that the patient's unconsciousness was merely simulated. But he obtained all the phenomena described by Charcot at once, without difficulty, and without suggestion being possible. The further experiments of Vizioli, Grocco, and Lombroso in Italy fully confirm his results, and make it impossible to doubt that the stages described by Charcot are real somatic phenomena occurring in certain individuals.

Tamburini, however, traverses Charcot's assertion that such phenomena are characteristic of all cases of le grande hypnotisme, and contends that they are rare accompaniments of hysteria in hypnotized subjects of the hystero-epileptic type. Tamburini considers that these somatic phenomena are not obtainable in their entirety even by means of suggestion in ordinary hypnotized subjects, nor even in the majority of hysterical subjects. Hypnotism merely accentuates and brings into prominence the characteristics of the patient, both physical and psychical, whether they be undeveloped or suppressed. To enforce this theory, he cites cases where Charcot's phenomena have occurred in hystero-epileptic subjects in the waking state, just as in a few rare instances stigmata have been spontaneously produced without hypnotism. Hypnotism, by cutting off the life of relation, greatly facilitates the production of these accompaniments of extreme hysteria. *