Summarizing now the results of our experiments, it appears that hypnosis was most readily obtained in cases of hysterical insanity, and in a few cases of epileptic insanity, but in other forms of mental alienation, despite our proceeding in accord with all the experimental rules, hypnosis, excepting in one case of anxious melancholy, was impossible. As regards therapeutic suggestion, made during the hypnosis, we are unable to report any actual results, excepting the case of hysterical ischuria described by Funajoli, though in some cases the hypnosis reached the degree of somnambulism, in which, according to Bern-heim and others, the greatest susceptibility of the sleeper was observed. If, therefore, we may judge collectively of the result of our researches and of those made by the observers cited by us, we must conclude that a suggestive hypnotic therapeusis cannot be established, in the form of any general rule, as a means of cure in mental diseases. It seemed to be effective almost exclusively in cases in which the psychopathic phenomena were connected with a hysterical neurosis, or in dipsomania.

In these special conditions of the psyche, it seems that hypnosis is obtained with sufficient facility, and the suggestion succeeds in modifying the characters, bridling the impulses and bad habits, reviving the affections and sentiments, and removing morbid ideas. On the other hand, in the acute and chronic forms of paranoia, in states of mental weakening with delirious ideas, in grave forms of melancholia and mania, it is very rarely, if ever, that hypnosis can be obtained, or that suggestion alone succeeds in effecting the disappearance or the amelioration of those morbid phenomena which are the consequence of an abnormal organization, or of profound alterations in the cerebral mass.

'The results of therapeutic suggestion in mental diseases being thus examined, it seems to us that we may assume the following principal conclusions:

'I. Therapeutic hypnotic suggestion cannot be instituted as a general means of cure in the treatment of mental diseases, owing to the difficulty of hypnotizing the insane.

'2. Hypnosis succeeds most readily in the hysterical and epileptic.

'3. The most certain results of hypnotic therapeutic suggestion have, up to the present time, been obtained in the psychoses depending on hysteria and dipsomania.

'4. Hypnotic suggestion may be employed when the insane submit to it of their own accord, and derive benefit from it. The physician should use it with great caution, and take account of the hurtful effects which, in certain cases, may be produced.

'5. Therapeutic suggestion made in the waking state is the most reliable and effective means of cure in mental diseases, and to it almost solely are due the beneficial effects of the asylum, which represents a real suggestive surrounding.

'6. In cases of melancholia without delirium, cases of fixed ideas, cases of alcoholism, and in slight forms of stupor, suggestion methodically repeated in the waking state, in order to combat the morbid phenomena, may prove effectual.

'7. In the chronic forms of paranoia suggestion has never given favourable results.'*

It will be seen from this summary that the Commission advises the systematic employment of suggestion without hypnotism in some forms of mental disease. They were led to this conclusion by finding that a considerable number of the subjects whom they tried in vain to hypnotize were amenable to, and responded to, simple suggestion repeated regularly over considerable periods of time. In this way they succeeded in removing fixed ideas, folic de doute, and incipient melancholia in several cases. They also cured by this means a drunkard, whose allowance of alcohol was about ten bottles of wine a day; at least he reduced his allowance to one bottle a day. They found simple suggestion proved effectual in several cases of stupor of the first degree, by removing the state of arrest which paralyzes the will and the ideational faculties.

* ' Therapeusis of Mental Diseases,' by Dr. G. Seppilli, translated from the 'Archivio Italiano,' in American Journal of Insanity, 1891.

Dr. Percy Smith and Dr. A. T. Myers made trial of hypnotism in a series of cases of insanity at Bethlehem, and the conclusions they came to are very similar to those arrived at by the Italian investigators.*

Forel found he could hypnotize even more than 10 per cent. (Voisin's proportion) of the insane who were confined in the public asylum of which he was superintendent, but he expresses great disappointment with the result (op. cit.). Even when he obtained advanced somnambulism, so that the patient proved anaesthetic, and susceptible to negative hallucinations, he often failed to remove a fixed delusion.

For instance, Madame A------ fancied herself Madame B------. She was very susceptible to hypnotism, and Dr. Forel assured her in the somnambulic state that she was Madame A------, and not B------. She only shook her head, and even in this state refused to part with her delusion. Forel, however, obtained good results in mental troubles of emotional and hysterical origin, and altogether is a strong disciple of the school of Nancy.

Dr. Forel showed me a curious condition of partial or complete analgesia which he is able to induce by simple suggestion in subjects whom he has frequently hypnotized. I saw him go up to strong, able-bodied German-Swiss attendants at his asylum, take them by the arm or hand, and tell them they had lost sensation in their right hand, left eye, or some other part; one could then prick the conjunctiva, or pinch the hand, without causing the least sign of pain or discomfort, though the subject would be apparently in full possession of all her faculties. It is common enough for dentists and surgeons to assure their patients that this or that procedure will not hurt, but the affirmation does not, as a rule, make much impression. Forel's assertion, however, did really paralyze the sensory nerve fibres, or inhibit the functioning of their cortical centre. I have been able in a few cases to copy this experiment, and notably in one case - a somnambulic gentleman of thirty-five of good bodily and mental health. Friction of a localized area of skin will produce anaesthesia in a few seconds, and he will then be quite unconscious of any irritation applied to it. On the other hand, a suggestion of hyperaesthesia will be followed by increased sensibility to impressions.

This gentleman, though such a susceptible subject, is now quite insusceptible to the hypnotic suggestions of any save his two medical men, and his individuality has been strengthened by hypnotic treatment. (For anaesthesia induced by suggestion without hypnotism, see p. 81.) Forel made practical use of hypnotism in a peculiar way. The institution was undermanned, and he found the attendants whom he had to employ to look after suicidal patients at night required to be off duty during the day, and so reduced his staff. He hit upon the plan of hypnotizing these attendants, and telling them they might sleep, but that any attempt on the part of the patient to get out of bed would wake them. He found his plan quite successful: the attendants got a fair allowance of sleep at night, and were able to work during the day.

* ' On the Treatment of Insanity by Hypnotism,' Journal of Mental Science, 1890.