I need hardly say that the difference the patient's attitude makes to the sensitive physician's comfort is enormous.

Dr. Constance Long says: ' As a good bedside manner is expected of the doctor and helps towards the recovery of the patient, so a good in-bed manner helps the doctor, and it is the duty of the patient to cultivate it.'

A visit to some of the Paris hospitals will afford justification for the assertion which is sometimes made, that abuses have not been confined solely to non-medical operators, and I am in agreement with a French correspondent who writes: * 'I consider that every hypnotist commits a very grave fault when he provokes posthypnotic phenomena which have no bearing on the treatment of the case. The production of pains or paralyses which do not exist, and of hallucinations, etc., may determine brain troubles, and lead to accidents.' The temptation to experiment is sometimes great, but it should never be yielded to except with the full consent of the subject, and for a definite scientific object. The old experiments have been repeated ad nauseam, and who is now the wiser for seeing a T5-stone operator stand on the outstretched body of a cataleptic subject, or what can be learned from seeing a victim eat tallow candles under the impression they are sweetmeats? When experiments are made, it is important not to repeat them too often, and to be careful always to remove any suggested hallucination before the subject goes out into the world.

The much-quoted case of Krafft-Ebing's illustrates very clearly the dangers of hypnotism when the state is induced constantly and wantonly in a morbid and hysterical subject. While in a hospital at Pesth, before she came into Krafft-Ebing's hands, she was constantly being hypnotized, not only by the physicians, but by all sorts of people, simply for amusement; and in the hypnotic state most absurd and trying hallucinations were generally suggested to her - ' that she was a dog, that she was intoxicated, that there was a snake on her dress,' etc. What wonder that she ran away from an institution where such things were allowed, and that when Krafft-Ebing saw her first, he found her confused, absent, and with her mind full of delusions and misconceptions ! This poor girl was one of a family in which suicide, hysteria, and madness were rampant, and it would be hard to find a surer plan than that adopted of developing all the diseased mental traits latent in her constitution. Professor Krafft-Ebing has embodied in his book the experiments which he continued to make on this subject, but they were conducted with great care, and led to the elucidation of many instructive points.

He says: 'No detrimental effect upon her disease was ever observed as a result of hypnosis when proper precautionary suggestions were made.' This patient was so susceptible to suggestion that stigmata could be evoked, and on one occasion so severe an injury resulted from the suggestion of a severe burn on her arm - the blade of a pair of scissors being held against the skin, and the suggestion made that it was red-hot - that the wound took several weeks to heal. It has been asserted that there is danger of persons who have been hypnotized becoming subject to attacks of spontaneous somnambulism, and of their being reduced to a condition of dangerous over-credulity. I can well believe that if the method adopted is defective, there is some justification for these fears. If, for instance, a person is told that he is to fall into a state of catalepsy on hearing a gong, the result might be embarrassing when the dinner-gong sounded (see note, p. 61).*

* Dr. David, of Sigean (Aude).

Again, suppose a patient has been frequently hypnotized by being made to regard the rotating mirror. Certain advertisements at our railway-stations bear a considerable resemblance to this instrument, and it is possible that a sensitive subject might be involuntarily hypnotized through staring at them. Fortunately, such mishaps need never occur. The method used should be of a nature not likely to be spontaneously reproduced, and the patient should be told that he is not to feel the least inclination to hypnotic sleep except under certain circumstances, and with his own full consent. So powerful is the effect of suggestion that the subject thus protected will certainly be safer against hypnotic wiles than a person who has never been hypnotized. It has often happened that when the patient has been warned against allowing himself to be hypnotized, the very operator who has made the deterrent suggestion has for a time been unable to influence him.

* Men, like the lower animals, are creatures of habit, and association of ideas plays a leading" part in our words and actions. If the association is artificially strengthened by hypnotic suggestion, it may be of overmastering cogency. We all know the story of the circus horse which was borrowed for use as a charger. Everything went well until the end of the review, when ' God save the Queen' was played. At the first bar the animal reared on his hind-legs, at the second sat down on his haunches, and at the third rolled over on his back. He had been trained to these actions, and they were evoked by the accustomed stimulus.

There is another objection urged against hypnotic treatment, namely, that its effects are temporary, and that when a relapse occurs hypnotism will not again prove even palliative. The exact reverse is the truth. A patient who has been once relieved by hypnotic treatment is from that very cause a particularly good subject for future treatment by the same means. In diseases where the influence of hypnotism can only be temporary and palliative, as in locomotor ataxy and cancer, it will be found to relieve the pains more quickly and surely after six months than it did at first.

It is not easy to understand what foundation there is for many statements made about hypnotism. Most of these stories probably date from the time when mesmerism was extensively practised by ignorant and credulous persons, and others are perhaps founded on the experiences of professional magnetizers who have not been careful as to their method nor too scrupulous in their aims. I have on two or three occasions seen the induction of hypnotism for medical purposes actuate an attack in an epileptic subject, and I have also on more than one occasion seen it threaten to develop an access of hysteria in a subject in whom that neurosis was latent. But in nearly all cases it is easy to control any untoward symptoms by calming suggestions, or, if these fail, to awake the patient and discontinue further proceedings for the time. I think there is no doubt but that hypnotism determines the manifestation of latent emotional states - in the same way as chloroform - and this is a reason for insisting on its very careful handling. I have only seen one class of willing patients in whom hypnotism seemed rather to produce an aggravation of the symptoms - cases of what Dr. Whittle calls congestive neurasthenia.

In two cases of the kind which came under my observation, I began by adopting the course recommended by Dr. Whittle, and applied three leeches behind the ears to relieve the urgent congestion. This procedure greatly relieved the head symptoms, and I then induced hypnosis with great facility and considerable advantage. The patient should feel refreshed and invigorated after the operation, and if this result is not observed, but lassitude should prevail in spite of suggestions to the contrary, I think it may be taken as a sign that the treatment is counter-indicated. I have only met with one case of the kind in my own practice, but I have heard of a few others.