a^s r«- S-***» *«a** VJlti* "ir?/ ^ - • • • - .^."»M. jS^Sm "■••■.■—■.■"." ■ -• ■-- ■- t. M ■ *• • >^ -CORNELL UNIVERSITY LIBRARY GIFT OF PHILOSOPHICAL REVIEW Cornell University Library RC 494. W54 1897 Hypnotism and its application to practic 3 1924 012 163 964 Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31 92401 21 63964 HYPNOTISM AND ITS APPLICATION TO PRACTICAL MEDICINE OTTO GEORG WETTERSTRAND, M.D. Member of the Society of Swedish Physicians at Stockholm ; Corresponding Member of the Society for Psychical Research, London ; Corresponding Member of the German Society for Psychical Research, Munich ; Honorary Member of the American Society for the Study and Cure of Inebriety Authorized Translation (from the GERMAN EDITION) EY HENRIK G. PETERSEN, M.D. Member of the Societe d' Hypnologie et de Psychologic, Paris, etc. TOGETHER WITH MEDICAL LETTERS ON HYPNO-SUGGESTION, ETC. By Henrik G. Petersen, M.D. G. P. PUTNAM'S SONS new YORK LONDON 27 West Twenty-third Street 24 Bedford Street, Strand SC^e J^nichnboclur ^rtss 1897 T 1?^ /I- 10 if 20 Copyright, 1897 BY G. P. PUTNAM'S SONS Entered at Stationers' Hall, London is- X ^-L a^ t n 1 U 'i o p fi . r ..^ [_ /j> 7 i e u) ICbe ffsnicliecbacbec iprees, flew !!2orft TO THE HIGHLY ESTEEMED DR. LIEBEAULT IN NANCY in profound admiration dedicated by The Author \\ CONTENTS. Author's Preface to English Edition PAGE vii Author's Preface to German Edition ix Translator's Preface xi Bibliography .... . xiii Introduction .... I I.- —Insomnia and Other Disturbances of S LEEP . 7 II. —Habitual Headache 12 III. — Neuralgias . 17 IV.- —Paralyses of Organic Nature . 26 V.- — Locomotor Ataxia .... 28 VI. — Epilepsy and Epileptiform Convulsion s . . 28 VII.- —Chorea ... . . • 31 VIII.- —Spasmodic Movements • 35 IX. —Stuttering .... . . . 36 X.- —General Nervous Debility (Neurasthe nia) . . 41 XI. — Light Psychoses • 45 XII.- —Hysteria ... . . ■ 51 XIII.- —Amblyopia and Nervous Deafness . 54 XIV.- — Chronic Alcoholism. Delirium Tremi ENS POTA- torum 56 XV.- —Morphinism, Chloralism, and Nicotinisi VI . 61 XVI.- — AnjEmic Conditions. Chlorosis 66 XVII.- —Rheumatic Diseases 70 XVIII.- —Hemorrhages . 73 XIX.- —Consumption (Phthisis Pulmonalis) 75 XX.- —Asthma. Nervous Cough 80 XXI.- —Heart Diseases 82 XXII.- —Local Congestions .... 88 XXIII.- —Diseases of the Stomach. Diarrhcea 90 XXIV.- — Bright's Disease • 94 vi Contents. PAGE XXV. — Incontinentia Urin^e . .... 96 XXVI. — Neuralgia of the Neck of the Bladder . 99 XXVII. — Children's Diseases . . . . loi XXVIII. — Menstrual Disturbances 106 XXIX. — External Diseases . . . . 107 XXX. — The Use of Suggestive Therapeutics in Opera- tions and on Some Other Occasions . . . 109 XXXI.^The Use of Suggestive Therapeutics in Obstet- rics . . . . .112 XXXII. — Conclusion . 114 MEDICAL LETTERS ON HYPNO-SUGGESTION, ETC. Preface .... 121 Practical Teachings of the Use of Psychology in Medi- cine. Notes from Clinical Studies with Bernheim, Forel, von Krafft-Ebing, etc. . . . . -125 Suggestive Treatment in Reform Work. Moral Idiots AND Others . . 153 Post-Hypnotic Responsibility 158 Music not Sermons in Insane Hospitals .... 162 AUTHOR'S PREFACE TO THE ENGLISH EDITION. THE following work, which, thanks to Dr. Petersen of Boston, now appears in English, consists of unpretentious notes by a physician who, under the pressure of a fatiguing and en- grossing practice, has not been able to develop his rich material into a more complete form. However, I am well aware that this attempt of mine has aided greatly in making known and in prov- ing Li^beault's method in Germany and in German-speaking countries. I am also indebted to it for the pleasure of seeing a great many German physicians in my Stockholm clinic, the majority of whom now employ in their native places the treatment with which their visit to me made them familiar. I can say the same also of Russian physicians. It is my sincere wish that the English edition may likewise help to make generally known a method which, in- augurated by so meritorious a man as Dr. Li^beault, and proved and recognized by such men as Professor Bernheim, Professor Forel, etc., is now making its way throughout the civilized world. Therefore, I cannot adequately express my gratitude to my colleague for his willingness to translate this work, which now appears in four languages. It has not been my intention to write a manual, or text-book, but simply to allude to the value of a therapeutic agent and a method which so strikingly illustrate the truth of the words: r esprit gouverne, le corps obe'it. Otto G. Wetterstrand. Stockholm, November 9, 1896. AUTHOR'S PREFACE TO THE GERMAN EDITION. THE following work first appeared in the Swedish language in the " Hygiene," a periodical of the Swedish Medical Society. The German edition, which I here offer the pub- lic, appears, however, in an enlarged form, as I have added the experience of the last two years. In the publication of this work, I cherish the hope that it will aid in creating recognition for a method of treatment which worthily follows the other processes of healing in practical medicine. May my German colleagues, into whose hands, perhaps, this little work may fall, not without testing reject a method which, through the investigations of Li^beault, Bernheim, Forel and others, has found a constantly increasing recognition among those physicians who are not blinded by prejudice. Otto G. Wetterstrand. Stockholm, October, 1890. TRANSLATOR'S PREFACE. DR. WETTERSTRAND'S work has appeared in both Swe- dish and German, and a Russian translation, by Dr. N. Dal, was published in Moscow, in 1893. The English-speaking medical profession to whom it is now presented, will undoubtedly recognize the value of Dr. Wetter- strand's work as fully as their European colleagues have done. More practical than theoretical, it offers the results of conscien- tious and able observation in what is today an important branch of medical science. We ought not, however, to forget that theories must necessarily be experimented with, before their intrinsic value in relation to facts can be ascertained. Nevertheless, it is also true that from facts have often been evolved theories, and this reversed position may, perhaps, be looked upon as the more fortunate one. Such is preeminently the case in regard to hypno-suggestion, which is far stronger in its facts than in its theories, and, there- fore, although still subject to investigation, it receives the increas- ing support of studious physicians. Today the modern physician must study psychological causes and effects. The nature of his life's work makes this imperative. He must adopt that which observation and experience prove to be the best under existing circumstances, and never meet such aid with any prejudiced questioning into its origin. He who professes the healing art is, first of all, 2. physician, and from that standpoint alone, and as such, his duty is principally toward the sufferer who confides in him. By clinging subser- viently to his own methods, utterly neglectful of anything better, he gives countenance to an error. He must be broad-minded enough to approach any theory, but, at the same time, also, be conscientious enough to choose that one which is not only right but practical, — regardless of his system, but not of his duty. To fight windmills is not expected of him, neither should he flit whimsically from one idea to another, nor stagger under the burden of his own or another's obstinacy. xii Translator s Preface. By taking position in the ranks of advancing progress, his part becomes that of an educator. Intelligent and lucid dissemination of psychological medicine is needed, we must confess, in this country, where more than elsewhere, perhaps, such knowledge has long been riotous or apathetic, presented either by enthusi- astic ignorance or by a too confident conservatism. We need now to make our laboratory and text-book psychology a living factor in daily life and a practical aid to the sufferer. The way to obtain this result is through the physician's private and clinical work here as abroad. The public will then under- stand that our progress is truly their benefit and renounce their often absurd ideas upon the subject. Our own medical literature will then be able to offer us a work like that of Bernheim, or this of Wetterstrand. • With the latter I can but express the sincere wish that the medical profession at large may judge of this therapeutic agent by personal experience, and I do not doubt that their conclusion will be as satisfactory as has been my own during a period of about five years. Henrik G. Petersen. 85 Newbury St., Boston, January, 1897. BIBLIOGRAPHY. Archives de Neurologie, 1881-82. Charcot (Jean-Martin). " De I'hyperexcitabilite neuro-musculaire." Azam (C.-M.-Etienne-Eugene). Hypnolisme, double conscience et alUrations de la personalite. Paris, 1887. Balfour (George William). Clinical Lectures on Diseases of the Heart. London, 1882. Beale (Lionel Smith). On Slight Ailments : their Nature and Treatment. London, 1880. Beard (Geo. M.) and Rockwell (A. D.). A Practical Treatise on Nervous Exhaustion. London, i8go. Beaunis (Henri-Etienne). Le somnambulisme provoqu^. Paris, 1887. Berillon (Edgar). See Revue de V hypnotisme . Vols. ii. , iv. . See Premier congrh international de V hypnotisme . Paris, 1889. Berlin, klin. Wochenschrift, 1883 (?). Koths. Nos. 24 to 27. Bernheim (Hippolyte). De la suggestion et de ses applications a la the'rapeutique. Paris, 1880. Binet (Alfred) and Fete (Charles). Le magnMsme animal. Paris, 1887. Bizzozero (G.) and Firlcet (Ch.). Manuel de microscopic clinique, etc. Paris and Bruxelles, 1S85. Borsieri de Kanifeld (Giovanni Battista). 1725-1785. Institutiones medicince pract. Venetiis, 1817, vol. ii. Braid (James). Neurypnology ; or. The Rationale of Nervous Sleep, Considered in Relation with Animal Magnetism. London, 1843. Brain, a fournal of Neurology. London, July, 1888. Bristovve (John Syer). Bremaud (P.). See Bulletin de la sociHi hysterique, 1884, No. I. Bristowe (John Syer). See Brain, July, 188S. Broadbent (Wm. H.) The Pulse. London, 1890. Brown-Sequard (Charles-Edouard). Recherches exp^rimentales et cliniques sur Vinhibition et la dynamoge'nie. Applica- tion des connaissances fournies par ces recherches aux phinomenes principaux de V hypnotisme et du transfer t. Paris, 1882. Bruce (J. Mitchell). Materia Medica and Therapeutics. London, 1886. xiv Bibliography. Bulletin de la sociifU hyste'rique, 1884, No. I. Bremaud (P.). " Des differentes phases de I'hypnotisme et en particulier de I'etat de fascination." Charcot (Jean-Martin). See Archives tie Neurologic , 1881-82. Charpignon (J.). Physiologie, midecine et m^taphysique du magnMsme. Paris, 1848. Clinique mMicale. Paris, 1868, vols, i., ii., iii. Trousseau (Armand). 1801-67. Colombat (Marc) dit Colombat-de-L'Is^re. 1797-1851. Traitd de tous les vices de la parole et en particulier du begaiement. Paris. 1843. Correspondenz-Blatt fiir Schweizer Aerzte, year xiii., Nos. 11 and 12. Basel, 1888. Ringier (G.). Corval (H. von). See Therapeutische Monatshefte. Coste (Marie Leon). Vinconscient. £tude sur I'hypnotisme. Paris, 1889. Day (William Henry). Headaches : their Nature, Causes, and Treatment. London, 1878. Delboeuf (J.). De forigine des effets curatifs de I'hypnotisme. Paris, 1887. Dieffenbach (J. F.). 1795-1847. See Rohlfs (G. H.). Geschichte der deutschen Medicin. Leipzig, 1885, vol. iv. Dieulafoy (Georges). Manuel de la pathologic interne. Paris, 1884. Dowse (Thomas Stretch). Lectures on Massage and Electricity in the Treatment of Disease. Bristol and London, 1889. Durand de Gros (Philips). Cours thSorique et pratique de braidisme ou hypnotisme nerveux. Paris, i860. Faria, Abbe. De la cause du sommeil lucide. Paris, 1819. Fontan (J.) et Segard (Ch.). Elements de mMecine suggestive. Paris, 1887. Forel (Auguste). Der Hypnotismus, seine Bedeutung und seine Handhabung. Stuttgart, 1889. See Miinchener med. Wochenschrift, 1889, No. 38. Gazette hebdomadaire de mMecine, 1887, No. 48. Magitot (E.). Harless (Emil). 1820-62. Lehrbuch der plastischen Anatomic, etc. Stuttgart, 1856, vol. i. Herrero (Abdon Sanchez). ^e.s Premier congrh international de I'hypnotisme. Paris, 1889. Hirt (Ludwig). Pathologic und Therapie der Nervenh-ankheitcn. Wien-Leipzig, 1890. Holmes (Timothy). A System of Surgery. London, 1870, vol. iv. Jong (A. de). See Premier congrcs international de l' hypnotisme. Paris, 1889. Bibliography. xv Kerr (Norman). Inebriety : its Etiology, Pathology, Treatment, and Jurisprudence. London, 1889. Korona. See Verhandl. des kaukas. Aerzte-Vereines, 13 Dec, 1887. Koths. See Berlin, klin. Wochenschrift, 1883 (?), Nos. 24-27. Krafft-Ebing (R. von). Psychopathia sexzmlis. Stuttgart, i88g. Kussmaul (Adolf). Die Storungen der Sprache. Leipzig, 1877. Ladame (Paul). See Revue de V hypnotisme. Lancet, The, 1882. vol. ii. Liebeault (A.). Du sommeil ei des /tats analogues. Paris, 1866. Le sommeil provoqui. Paris, 1889. See Revue de V hypnotisme, vols, i., ii. Lymau (Henry M.). Insomnia and Other Disorders of Sleep. Chicago, 1885. Macfarlane (Alexander William). Insomnia and its Therapeutics. London, 1890. Magitot (E.). See Gazette hebdomadaire de me'decine, 1887, No. 48. Marce (Louis-Victor). 1828-64. See MSmoires de I'Acad/mie de MMecine. Paris, i860, tome xxiv. M/moires de ! Acad/mie de MMecine. Marce (Louis- Victor). 1828-64. " De I'etat mental dans la choree.'' Paris, i860, tome xxiv. Mendel (E.). Sammlung gemeinverstdndlicher wissenschaftlicher Vortrdge. Heft 93. Hamburg, 1890. ■ Mesnet (Ernest). See Revue de V hypnotisvie . Moll (Albert). Der Hypnotismus. Berlin, 1889. Moreau de Tours (Paul). La folic chez les enf ants. Paris, 1888. Morin. Valcoolisme. Etude m/dico-sociale . Paris, 1889. Milnchener med. Wochenschrift, 1889. Forel (Auguste). Murrell (William). See Practitioner, The. Oliver (George). On Bedside Urine Testing. 3d ed. London, 1885. Padioleau (Aristide). De la m.e'decine morale dans le traitement des maladies nerveuses. Paris, 1864, Pichon (Georges). Les maladies de I esprit, ddire alcoolique et toxique, etc. Paris, 1888. Le morphinisme. Etudes chimiques, etc. Paris, 1890. xvi Bibliography. Piorry (Pierre-Adolphe). 1794-1879. La m^/, — emphasizing strongly the word " feel " — , whenever there is a call for urination, and then wake up. I have in that way obtained a better and quicker result than when only forbidding the patient to urinate while asleep. XXVI. — NEURALGIA OF THE NECK OF THE BLADDER. Many times I have been consulted in regard to a condition, which has presented the following symptoms. The patient, — generally of the female sex, — suffers for some days, weeks, or months, or even longer from an incessant desire to urinate. She may have to urinate even fifteen times a day, according to this pressing need, each time voiding very little, ac- companied with much burning and pain. If the urine be ex- amined, we find it normal, containing neither mucus, blood nor albumen. As already said, it is women chiefly who suffer in this manner, but sometimes men do also, and with the same symptoms. They then complain of "a burning sensation along the urethra, and of sensitiveness on pressure in the region of the prostate. One does not find, upon careful examination, what such symptoms might indicate, and generally, not the slightest change can be de- tected in those suffering from this trouble. Sir Henry Thompson " calls this condition " perverted sensibility of the neck of the blad- der, or neuralgia," and thinks it may be referred to a disease of the liver or the kidneys, the presence of hemorrhoids etc., but he ' " Traitement par suggestion hypnotique de I'incontinence d'urine chez les adul- tes et les enfants," Revue de V hypnotisme , vol. i., p. 71, etc. ^Holmes. A System of Surgery. London, 1870, vol. iv., p. go8. 1 oo Hypnotism. himself confesses that many cases are inexplicable. Before I knew of hypnotic suggestion, I used to treat such cases with cam- phor and opium, or after Sidney Ringer's ' method, with tinct. cantharid. in small doses. The efificiency of this remedy is, how- ever, thrown into the shade by suggestion, which, sometimes in one treatment, dispels the painful symptoms, as will be related in the following case. io8. Anna P. fifty-four years old ; married. The patient, who had been cured by hypnotism of chronic rheumatism of many years' stand- ing, complained for eight days of pain and a burning sensation when urinating ; finally, they became so severe that she was obliged to con- sult me. This was on the 14th of May, 1887. Only a few drops passed at a time, accompanied by violent pains. At the same time she experienced an incessant desire to urinate. The urine was clear and had no bad odor. She was hypnotized ; deep somnambulism resulted. I suggested that upon waking she should urinate without the least pain. This she then did to her great surprise. The quantity was one hun- dred and twenty-five c.c. and such a quantity she had not voided during the whole time that the trouble had lasted. This treatment was entirely sufficient and she was normal ever afterward, as she told me late in the summer. In the next case the pains returned after four days, but dis- appeared again after a repeated suggestion and have never re- turned. 109. Christina N. thirty-three years old ; single. Suffered for four days from pains and burning when urinating. She felt a need of urinating fifteen or twenty times a day, but could void only a few drops each time. She was otherwise healthy and with not the least sign of any bladder disease. She was hypnotized and, upon waking, could fill a teacup full of urine without any painful sensations. She was free from pain for four days and then it returned. After having been hypnotized once more she was well. I have observed this trouble also in young persons, in a boy of eight a-hd a girl of sixteen, who were both cured by a few hyp- notic treatments. Finally, I remark that the hypnotic suggestion can be em- ployed with much benefit in all disturbances of the urinary organs, dependent upon diseases of the nervous centers, as in locomotor ataxia, etc. ' P. 429. Children s Diseases. loi XXVII. — children's diseases. Pediatric practice can make u.se of hypnotic suggestion in num- berless, one migiit even say unlimited, cases. I have tried it with success in a great number of diseases already mentioned, among the cases of which there have been, now and then, those of chil- dren. Here I will dwell upon what is of most interest in diseases of children, to which I have not before particularly referred. I will mention some cases of tuberculous meningitis, where hyp- notic suggestion has relieved the most violent headaches. The following will serve as an illustration. no. Fanny B. seven years old. She was a delicate, weak girl. Commenced to complain of headaches on the 15th of May, 1887, and these grew more and more violent. I was asked to see her on the 21st of May. I found her quietly reposing in bed, the eyes half closed, sighing now and then, and at times groaning and crying pitifully. She often put her hands to her forehead and pressed it. The eyes were wandering and the pupils dilated, the right more than the left one. The intellect was undisturbed, and answers to my questions were clear and precise. The pulse was one hundred and eighteen per minute, uneven but not dicrotic. Very high fever ; profuse sweat over the whole body ; ab- domen retracted and hard ; constipation, but no vomiting. Chest organs healthy. From these symptoms and the girl's general appear- ance, my diagnosis was tuberculous meningitis. In such a case I could think only of relieving the severe headache, and as I know of no better remedy than hypnotism, I made use of it the more willingly as the child had not slept for several nights. I hypnotized her with the greatest difficulty, and it was very inter- esting to notice how her groaning and sighing ceased by degrees, and sleep overpowered her. I suggested that she should sleep two hours. Calling the next day I found that she had slept but half an hour, and after that awoke. The pains had returned although they were not so severe as before. I hypnotized her a second time, and the effect of my suggestions was thenceforth better and more lasting. Seeing her then so calm, it would have been difficult to imagil^ the wild scenes which had preceded the hypnosis. In this case, as in so many others which I have observed, the suggestion produced a real euthan- asia. The girl died finally on the 29th of May with hardly a pain, quiet and calm. I often employ hypno-suggestion to relieve, as in fever and other disea.ses, the symptomatic pains in the head and the general 1 02 Hypnotism. malaise of which children frequently complain. The following is an example. 111. Anna P. ten years old. Developed measles on the 19th of May. The eruption had appeared on the previous day. Had slight cough and moderate fever, but complained particularly of severe pains in the head and the back. She was hypnotized and her happy face on awaking told that the pain had disappeared. Neither head- nor back- ache returned, and the measles had a normal course. I now come to a case of peliosis rheumatica, the cure of which created the greatest astonishment not only in the mother, but in those patients then present, who saw the child before and after hypnosis. 112. Cornelia L. six years old. She was brought to me from the country on the 23d of August, 1887. The mother carried the child upstairs. She could limp across the floor only with the greatest diffi- culty. Had been complaining for several days of pains in both feet, which were covered with red spots ; there was no swelling of the joints, which, however, were sensitive on pressure. Otherwise, the child was well and had no fever.^ She was hypnotized ; result probably som- nambulism which is very difficult to diagnosticate in children. She could run about in the room after the sleep and went downstairs alone without feeling the least pain in her feet. The mother told me on the nth of October that the child had been cured instantaneously by the first and only hypnosis. In children we often observe a certain group of symptoms (which do not indicate any decided organic trouble), such as, for instance, a feeling of general lassitude, depression, lack of appe- tite, bad humor and sometimes, also, sensitiveness and pain in the pit of the stomach. All such symptoms disappear, as by magic, by one or more hypno-suggestions. To prove this I will cite two cases. 113. Ebba L. twelve years old. Pale and small for her age ; com- plained for several weeks of backache and besides of being tired and weak. She did not care for anything, would not study, but instead, would lie on the lounge the whole day. Hypersesthesia, restless sleep, poor appetite. No decided disease could be discovered. I hypno- tized her for the first time on the 4th of May, 1887, and she was per- fectly well by the 8th of May, after the third treatment. Children s Diseases. 103 The next case had more pronounced psychic symptoms, and here ajso was the suggestion effective. 114. Martin Robert K. nine years old. The boy was sad and restless for three months ; he had no desire to learn as before, would not go to school, but, as the mother told me, had grown very lazy and dull. Complained of pains in the feet, no appetite and had a sickly appearance. Was hypnotized on the 2d of June ; somnambulism resulted ; quite changed after the third treatment, the 6th of June, had become happy and gay, a condition with which the mother was highly pleased. The little patient, whose case now follows, underwent a great change, and it merits our attention for more than one reason. 115. Anna B. six years old. Was for more than a year very low- spirited ; never a moment away from her mother's side ; had no appe- tite, and her strength was much diminished. Sleep was disturbed ; she would wake up suddenly with a terrible shriek, and then sleep again heavily. I could not get a word out of the child, when she and her mother came to see me on the lothof March, 1889. The child hid her face in the mother's dress and shouted : " Go away, go away ! " " She is like that," the mother said, " the whole day and gives me not a moment's peace ; if I leave her, she begins to shriek loudly and calls me to her." The girl looked pale and feeble ; it was, however, im- possible to make a thorough examination. She had been given iron and other tonic remedies, but she always spit out the medicine. How then to treat the child under such circumstances ? If I only looked at her, she would begin to weep and sob ; to produce hypnosis in the usual raajiner was thus out of the question. At last I told the girl to sit on her mother's lap, and I pretended not to see her at all. I said to the mother several times, that the child would soon sleep. I waited two hours, and during the whole time did not pay any apparent attention to the child. Finally, she slept, and I then entered into rapport with her. I suggested that she should grow calm, not hang on constantly to the mother's skirt, sleep well in the night, and have no fear, either of me or of anybody else. The girl woke up half an hour later, looked about her in a surprised manner, told me her name, gave me her hand, and behaved, in every respect, like a dif- ferent child. On the following day the mother told me that the child had slept well, and expressed a wish to visit me again. I walked about the room alone with the child, and gave her an apple which was accepted with thanks. The child was perfectly normal and well after four more treatments. 1 04 Hypnotism. It is an every-day occurrence for children to refuse to take medicine when it does not taste nice. Hypnotism is excellent to make the child willing. One can give either the medicine during the sleep, or say to it in the sleep that it is to take the medicine voluntarily, that the medicine will not taste bad, but good. I have tried this many times and have been successful whenever the children were hypnotizable, i. e., had reached the age of about three years. Castor oil is generally what children resist taking most energetically, but nothing is easier than to persuade them by means of hypnotic suggestion to accept it, even when they know that they will feel squeamish afterward. The next case is an example of this. 116. Stig a. seven years old Developed measles on the nth of May, 1887, and was constipated for a few days. I prescribed castor oil. The mother remarked that her child had never been able to take it without vomiting. I gave him the oil during sleep, with the sugges- tion that hereafter he could take castor oil easily and without vomit- ing. I further told him that it would take effect in two hours. There was no vomiting, and the boy said afterward that he could take it very well, and that it tasted like water. The effect manifested itself at the time suggested. I have often given adults as well as children, when hypnotized, water instead of castor oil, with the suggestion that its effect would be felt at a certain moment, and the result has always been the same as when taking the castor oil itself. In the next case, the suggestion was carried out post-hyp- notic after a single hypnosis. 117. Ferdinand A. seven years old. The child has suffered since the 30th of April, 1887, from albuminuria, the result of recent scarlet fever. He could not be persuaded to take the prescribed milk. This was possible after one hypnotic suggestion, and now, the 3d of May, he drinks four or five glasses daily with great relish. 118. Anna E. three years old. Diarrhoea for several days. Would not take the prescribed oil emulsion, but was extremely violent when the mother brought the medicine, clenched the teeth, and, when, finally, some was forced into her mouth, she immediately spit it out again. The mother gave her a teaspoonful of medicine the moment after she came out of the hypnotic sleep, and she took it with great pleasure saying that it tasted good. Children s Diseases. 105 Hypnotic suggestion has not only a beneficial effect in reliev- ing psychical sufferings among children, but it is also powerful in eradicating certain bad instincts and moral defects. For instance, lying, lazy and indolent children can be made industrious, atten- tive and obedient ; this fact is illustrated in the next case. 119. Oscar D. fourteen years old. The boy was healthy and strong ; was educated in a religious, and in every respect an excellent family in the country. He was industrious in general, but it was noticed, finally, that for about six months, he had commenced to tell lies, to be lazy, to find his lessons tedious and to neglect them. He came to me for the first time on the 14th of October, 1889, when I spoke to him about his changed behavior. He was willing to be treated by me, and came fifteen times. The mother wrote me three weeks later : "What a pleasure to see once more his former self ; he is now an industrious, truth-loving and well-behaved boy." Those antagonistic to the use of suggestive therapeutics for moral purposes will probably assert that I thereby interfered with the individual's free will. Such is, however, not the case. I only developed the good qualities in the boy, and convinced him that he was on a dangerous path which he must abandon. What was bad in him was checked, while the good, which is present in every human being, was brought out more decidedly. I have cured many boys and girls who were confirmed mas- turbators. One of these was so great a victim of this vice that he could not be left alone a single moment. He is now entirely changed, has become obedient, attentive, happy and amiable and it is a genuine pleasure to see this boy's open and candid face. His physical condition has undergone a complete change. Previously, he was always shivering, felt tired, was pale and his features indicated his vice ; he is now just the opposite, strong, rosy-cheeked, and full of life and health. I have never seen any unpleasant effect of hypnotism in chil- dren. They quickly comprehend its beneficial effect, and I can say from personal experience, that they attach themselves with evident pleasure to the hypnotizer. Therefore, let no physician entertain the prejudice that hypnotism has an injurious effect upon children, but this method of cure may be made use of also ■where bad habits and moral defects are to be fought and eradi- acted. Those physicians who are particularly interested in this io6 Hypnotism. side of the question, I will refer to Dr. B^rillon's ' very important treatise on the subject. XXVIII. — MENSTRUAL DISTURBANCES. It is to-day an unquestioned fact that menstruation belongs to those processes of the organism which may be influenced by suggestion. When no exact anatomical cause can be discovered in the pelvic organs, their menstrual activity can easily be con- trolled, both when there is an absence of menstruation as the result of anaemia, and when it is too profuse or too frequent and painful. Li^beault" has cited such cases as being successfully cured, and Bernheim," Fontan, S^gard,' and Voisin ' have also shown that suggestive therapeutics can influence menstruation. I have, personally, had occasion to observe this phenomenon in various cases, and I have often succeeded in calling forth the menstruation at a certain time, or in checking it, if too profuse or painful. Delayed menstruation returned at the suggested time in the following case. 1 20. Alma J. seventeen years old. A pale, slender girl, suffering from the ordinary symptoms of chlorosis. Dyspeptic sensations ; the pit of the stomach very sensitive on pressure ; no appetite, depressed and downhearted. Had never menstruated. She called for the first time on the 14th of September, 1887. I hypnotized her, as she had derived no benefit from iron, previously taken. She received the suggestion that the menses should appear at 6 a.m. on the 20th of Sep- tember, and continue for three days without giving her the least pain. She remembered perfectly well what I had said upon awaking. She came on the 22d of September, and told me that the menses had ap- peared exactly as I had suggested. The same condition resulted on the i8th of October and the 19th of November, and the girl was very well after six treatments. I have not seen her since the 22d of No- vember, but I have every reason to believe that she has remained normal. ' " De la suggestion et de ses applications a la pedagogic." Revue de I'hypnotisme, vol. ii., p. i6g, etc. Further : Premier congrh international de V hypnptimie. Paris, 1889, p. 157, etc. ^ P. 462, etc. 3 P. 557, etc. •• P. 296, etc. ' Revue de I' hypnotisme , vol. ii., p. 221, etc. External Diseases. 107 Many cases of profuse and too frequent menstruation with ' ^ much pain have been regulated by hypnotic suggestion, and the pains relieved. The next case is an illustration. 121. Anna L. sixteen years old. Weak and tired since the autumn of 1886 ; menstruation too profuse, lasted usually eight days, appeared irregularly, sometimes every fortnight or three weeks. She came to see me on the loth of January, was pale, tired, and weak, and had frequent headache. She had been hypnotized in the spring, and proved an excellent somnambulist. I therefore suggested during the sleep that the menses should appear at 6 a.m. on the i6th of January, last for three days and be absolutely painless. She remem- bered all I had said to her. Exactly at the suggested hour, on the 22d of January, her menses commenced, lasted the three days, were painless, and there was no headache. I asked her to come again, and then suggested the 13th of February as the date for the next menstrua- tion. This succeeded, and also later suggestions that menstruation should occur regularly every four weeks. She is now, on the 4th of March, perfectly well, with no trace of lassitude, weakness, or head- aches. I saw her last on the 15th of March, 1890, and she had been well ever since. It seems as if many people would not need so deep a hyp- nosis to influence the menstrual functions. A girl of twenty-five, who had almost the same symptoms as the above mentioned Anna L., after sleep only in the second degree, menstruated according to my suggestions at fixed times. The result may be obtained by a single treatment when the patient is a somnambul- ist. Where the sleep is light I advise, however, endeavoring to obtain a deeper one by repeated hypnoses, which generally in- crease the suggestibility. One does not always succeed even with somnambulists, but for this I am unable to give any reason. It is, at any rate, advisable to make use of this harmless and simple treatment before having recourse to other remedies. There is, all things considered, no " infalHble " method, and hyp- notic suggestion does not claim any such infallibihty, but, I can cite several cases of delayed menses, where iron has had no effect whatever, while hypno-suggestions, after a few treatments, have induced a normal function. XXIX. — EXTERNAL DISEASES. Concerning these diseases also, I have been able to observe facts which prove that hypnotic suggestion can here find a useful 1 08 • Hypnotism. field in cases like contusions, contractions, traumatic synovitis, etc., where painful sensations prevail. One of the most important elements of disease disappears when suggestion removes pain, and restores the disturbed function in a very short time, or even immediately. This assertion I will illustrate by an example.' 122. Otto Emil F. sixteen years old. The patient received a contusion of the right knee, on the 22d of May, 1887, while attaching a pair of horses to a car. Immediately afterward he felt pains in the knee-joint, could hardly walk home, and noticed, in the evening, that the joint had swollen. He came to me the next day ; mounted the stairs with difficulty and was obliged to limp when walking. On examination I found the joint swollen, but according to the patient's account, it was no worse than on the previous day. It was sensitive on pressure, and from time to time he would feel cutting pains in the joint. He was hypnotized ; somnambulism resulted. When he awoke it was possible to press the joint on all sides without causing any pain or sensitiveness, and he was able to walk up and down the room with- out limping. I told him to call again the next day ; all swelling had then disappeared. After a very careful comparison I could not find any difference between the two knee-joints. The next case closely resembles the last one, except that the effusion was a month old when the patient consulted me. 123. Carl F. sixteen years old ; schoolboy. Complained for about a month of pains in the right knee and walked with difficulty; the joint was somewhat swollen during this time. The trouble had arisen, he said, from a blow on the knee. He limped into my office on the 13th of October, 1887. The leg was in a semi-flexed posi- tion and he could neither bend nor extend it. The joint was swollen considerably, with strong fluctuation. Two places above the patella were sensitive on pressure. I hypnotized him, and on awaking he was able to walk without limping ; all sensitiveness and pain had dis- appeared, and the joint could be bent and extended without any incon- venience. On the 14th of October he said that, on the previous day, he had walked a good deal with the greatest ease ; the effusion had almost disappeared, but was still visible. On the 20th of October I happened to meet the patient, had an opportunity to examine the knee, and found the swelling entirely gone. ' Fontan and Segard, who have made their observations in a large military hospital in Toulon, mention in their work some cases of external diseases where hypno-suggest- ion produced a beneficial result. As my own experience in this direction is not large, I will, therefore, recommend their work. The Use of Suggestive Therapeutics. 109 I have employed hypnotic suggestion also in some cases of pes valgus, where the foot was sensitive, painful and swollen. The result was good, as the following case will prove. 124. Nanny D. seventeen years old. Had suffered from pes valgus since her childhood. The patient, who works in a paper-box manufactory, was obliged to stand the whole day. She complained of pains in the left foot, which, sometimes, would be swollen in the even- ing. At times she was forced to lie down, as she could not stand. I saw her first on the 29th of September, 1887. She limped, and on ex- amining the foot, I found that the parts surrounding the external meta- tarsal bones were swollen and sensitive on pressure. She had great pain in stepping. I hypnotized her ; somnambulism resulted. After hypnosis she could step with the foot and walk without any pain. She returned on the 2d of October at my request, and I found no swelling. By this I do not mean to say that suggestion can cure pes valgus. I only relieved the inflammation which so often accom- panies this trouble. The suggestion did what any other remedy would have done, but in a much shorter time. XXX. — ^THE USE OF SUGGESTIVE THERAPEUTICS IN OPERATIONS AND ON SOME OTHER OCCASIONS. It is evident to all that hypnotism can not replace chloroform in operations, but this does not prevent, however, its being used on many occasions where anaesthesia is desirable. Hypnosis should always be tried first, because, even if the effect is slight, a smaller amount of chloroform becomes necessary, and the fre- quently occurring stage of excitement is entirely avoided as well as the vomiting which follows. Therefore, in cases where I have to use chloroform, I first try to hypnotize the patient. If he is susceptible to it, I need only to let him inhale a few grams of chloroform, and anaesthesia follows in a very short time. Last summer I had an opportunity of demonstrating this phenomenon to a colleague who was operating upon a phthisical woman for a large submuscular abdominal abscess. A short time ago another colleague made use of the blunt hooks in parturition after the woman had first been hypnotized and chloroform then admin- istered. She was again first hypnotized and then was given chloroform in order to remove the placenta. There were used both times in all about ten grams of chloroform. 1 1 o Hypnotism. Whenever somnambulism is induced, operations can be per- formed without pain, and the patient on awaking has no remem- brance of what occurred. I have often made use of the anaesthesia accompanying somnambulism, but never in very difficult or par- ticularly painful operations. I have removed a tonsil without the patient's being aware of it. 125. Hilda S. nineteen years old. She suffered from an often returning throat inflammation, mostly on the right side. I proposed re- moving the right tonsil which was considerably enlarged, and, thereby, permanently to check the trouble. The left tonsil was also somewhat enlarged which made swallowing difficult. On the 20th of May, 1887, she came to have this done, and was hypnotized. She was in somnambulism almost immediately. I told her to rise from the arm- chair and to sit down where I indicated, to bend the head backward and open the mouth. She obeyed in all ; and nobody even held her head while I removed the tonsil with a bistoury. I told her to rise and gargle the throat, and then permitted her to return to the arm- chair, waking her a few moments afterward. She was very much surprised when she was told that the operation had already taken place, and believed it only after seeing the tonsil which I had removed and the blood-colored water ; even then she remembered nothing about it. The next case was that of a large rectal abscess. The patient still vividly remembered the pains occasioned by a former incision and, therefore, was quite willing to be hypnotized. 126. Anna A. twenty-eight years old ; married. Had felt rectal pains for about a week, and a large abscess was discovered on the 8th of November, 1887, on the left side of the anus. She was hypnotized on the 9th of November, and received the express suggestion not to feel the operation. I purposely made the incision very slowly ; she remained perfectly quiet and, as those present could prove, did not move a muscle. I woke her up when the wound had been bandaged ; she said that she had had only the slightest perception of my having touched her, but had felt no pain, only as if lame and unable to move. Once I tried to incise a paronychia, when the hypnosis was in- sufficiently deep, and I had made a mistake in regard to its degree. The patient woke up and felt great pains. Of course it is necessary to proceed carefully in using hypnosis in important operations. The patient ought to be hypnotized The Use of Suggestive Therapeutics. 1 1 1 several times before the operation, so that the physician may be convinced of his susceptibility, and teach him to sleep deeply. It must always be done in a quiet, gentle and confident manner. A failure is very natural if the patient is hypnotized for the first time immediately before the operation, as he cannot then be sufficiently passive to induce the necessary degree of sleep." Another method can be employed to produce anaesthesia as the following case illustrates. 127. Anna L. sixteen years old. Suffered from toothache for several days and the left cheek became gradually more and more in- flamed. When she came to me on the 24th of May, 1887, I noticed a hard and sensitive sweUing outside of the first left molar tooth of the upper jaw ; her violent toothache had originated in this carious tooth. I hypnotized her and told her during the sleep, that the pains would disappear ; that she would better return at five p.m. the following day and would experience no pain while I made an incision in the swelling. The toothache disappeared immediately and did not return. I made the incision the next day and she felt nothing. It was as if I cut into dead tissue, a proof of the wonderful power of suggestion." I know hundreds of people in whom I can produce anaesthesia in any part of the body by a word, i. e., by suggestion. It is evident how great an advantage this has for physicians and surgeons. If we wish to examine the larynx, for instance, the examination will be greatly facilitated by hypnotizing the patient, and it is not necessary that the hypnosis should be particularly deep. We suggest absolute anaesthesia, wake him up, quietly introduce the laryngoscope, and let it remain there as long as necessary without the least inconvenience to our patient. I have often shown my colleagues how I could tickle such a patient's throat with a feather, when anaesthesia had been produced by hypnotic suggestion. For some time I used hypnotic treatment in the case of a lady who suffered from brachial neuralgia. The result was unsatisfac- tory and I then tried electricity. She could not, however, stand this, but as soon as I had produced hypnotic anaesthesia, there was not the least difficulty or inconvenience. In this connection I will call attention to the fact that there is no easier method for ' See further, Azain. Hypnotisme, etc. Paris, 1887, p. 30, etc. * See further. Santelli, De V ane'sthisie chirurgicale far V kypnotisme et suggestion. Montpellier, 1887. 1 1 2 Hypnotism. those who wish to study the position of Ziemssen's points than during somnambulism, or after suggestive anaesthesia has previ- ously been produced in the subject. Before I had learned the effect of suggestion in certain kinds of constipation, I treated a girl seven years old who had suffered several years from an obstinate form of this trouble. The method employed was abdominal massage. As the girl was unable to re- lax the abdominal muscles, I had almost decided to give up the treatment, as the massage had no effect on account of the ex- tremely tense muscles. 1 therefore hypnotized her, and the result was surprising. I could now make an impression upon the large intestine and the sigmoid flexure, as the hypnosis had relaxed the abdomen. She was cured in eight treatments. Finally, I will also call attention to the observations made by Delboeuf ' of Lifege, which go to prove that wounds received by a person in the hypnotic state, i. e., during anaesthesia, heal much more quickly than those which have been received when subject to pain. XXXI. — THE USE OF SUGGESTIVE THERAPEUTICS IN OBSTETRICS. 128. Regina a. twenty-five years old ; married. She consulted me on the 30th of August, 1887, on account of daily, violent headaches of long standing. They were most pronounced at the vertex, forehead and eyes, and were often so severe that she had to keep her bed. She was then pregnant, in the ninth month, as she believed, and, she assured me, was otherwise in good health. She had already borne four living children. The woman was well built, looked healthy, had red cheeks, a good appetite, and, except for the above mentioned headaches, no diseased condition could be discovered. Believing that a hypnotic suggestion would probably free her from the headaches, I proposed it. She was hypnotized ; light somnolence resulted with suggested catalepsy, inability to open the eyes, etc. She had been conscious of all that happened, had heard my voice, the cars in the street, and the ticking of the clock on my desk. I gave her very em- phatic suggestions in regard to the disappearance of her pains. They had disappeared upon awaking and have not returned. What was more interesting than merely a rapid cure, like many that I had so often witnessed, was the opportunity which here presented itself for demonstrating by the near confinement the power of hypnot- ism. I therefore asked her to visit me a few times per week for the ' De Vorigine des effeis curatifs de I' kypnotisme. Paris, 1887, p. 23, etc. The Use of Suggestive Therapeutics in Obstetrics. 1 1 3 purpose of being hypnotized. This case is further of great interest, as it proves that a person can learn, by repeated suggestions, to sleep deeper and deeper and that, consequently, sleep is but a phenomenon of suggestion. She was a somnambulist after the fourth treatment, and on awaking knew nothing of what had occurred during her sleep, but a still more remarkable fact is that it was impossible to recall to her memory what had happened during hypnosis. It is well known that after sleep a firm exhortation on the part of the hypnotizer can recall to the patient's memory what has occurred. In this case, it was impossible. The amnesia was complete in spite of all efforts. So peculiar a circumstance was clearly due to the fact that the patient's memory generally, and also her power to think, had been blunted by the violent headaches. She could not, for instance, re- member what she had done five minutes previously, and she often forgot what she was going to do. A change took place, however, after six or eight treatments, and she acted quite differently. I could then bring back, at once, her memory in regard to the somnambulistic stadium, and its faculty gradually increased as the headaches disap- peared, until it finally became entirely normal. Later, she became perfectly anaesthetic so that she could suffer a needle to be thrust into her flesh without causing her to make the least movement, and still better, could receive a very strong electric current without wincing. Her former confinements had always lasted ten or twelve hours, and the after pains had been severe. I gave her the suggestion that during this parturition she should sleep and feel no pains, that it should pass off more quickly, and be fjee from all after pains. The patient had made a miscalculation as to time of delivery, and I was called to her as late as the 19th of October at 2.45 p.m. A col- league, who had seen her previously in a state of hypnosis, and had then examined her without her knowing the fact, had already preceded my arrival. She was then walking up and down the room having oc- casional, light pains. The midwife said that the liquor amnii had escaped at midnight. I ordered the patient to lie down and I then hypnotized her. She closed her eyes, and was asleep immediately. She heard nobody but me, became anaesthetic in a few moments, and unable to say where I touched her on the body with a penknife, though sometimes I pressed very hard. She was now examined and the os admitted about three fingers. The pains grew stronger about 3.15 p.m. What is remarkable at this point was that she acted as .if awake, and said that the labor pains troubled her very much, and got up twice to walk up and down the room. Her eyes were closed all the time. The pains came now about every five minutes, and were very strong. The last stage of the 8 114 Hypnotism. parturient process passed very quickly. She became absolutely silent when the child's h?ad was born at 4.30 p.m., and looked like one asleep. She did not hear the child cry, and did not feel the removal of the placenta. After this she was awakened, could not remember anything about her delivery, and asserted that she had not felt or heard the least thing from the moment when she went to sleep. While on former occasions her after pains had been quite severe, this time they were not felt. She was able to get up seven days later, and felt well. She bore another child on the 8th of April, 1889, and this birth dif- fered from the previous one in this respect, that she was in deep som- nambulism, and showed not the least sign of pain during the whole process, which lasted only two hours, from four to six a.m. She had no remembrance of it upon awaking. I have witnessed a third case of this kind in somnambulism, (a woman thirty-one years old,) which, in every respect, resembled the one in 1889. The first was very similar to the one described by Dr. Mesnet." What I have already said in regard to the use of hypnosis in operations, applies equally to parturition. One should remember to commence in time, and the cases cited, according to my opinion, can serve as an example of the advantage which hypno- tism is able to give. It would be interesting to investigate in what way, and how far, chloroform can be used after hypnosis has already been induced. Any other use of hypnotism in regard to parturition is beyond my experience, but Li^beault " has demon- strated that it can be used advantageously also, under other circumstances. XXXII. — CONCLUSION. If asked which diseases are most adapted to treatment by suggestive therapeutics, the answer is, — functional nervous dis- eases. The method has won its greatest triumphs in this direc- tion. It would hardly occur to any physician to treat pneumonia, typhus, cerebral tumors, etc., in this way, but certain symptoms may, nevertheless, arise in connection with these diseases, as in- dicated by Hirt" and also in this work, that would yield more or less to suggestive treatment. ' " Un accouchement dans le somnambulisme provoque." Revue de I' hypnotisme , vol. ii. , p. 33, etc. ' " Emploi de la suggestion hypnotique en obstetrique." Revue de I' hypnotisme , vol. ii., p. 328, etc. ' Pathologie itnd Therapie der Nervenkrankheiten. Wien und Leipzig, l8go, p. 472. Conclusion. 115 Functional nervous diseases represent a majority of cases occurring in daily practice and, as before said, suggestive thera- peutics finds here a gratifying field for usefulness. The methods hitherto employed in such diseases, such, for instance, as are mentioned in the latest work' now before me, offer no particular results, and suggestive therapeutics would therefore be all the more welcome. It would further serve in a number of peculiar psychic conditions, which, with de Jong, we may call functional psychic neuroses. In all diseases where the will has been en- feebled,' and where it is important to strengthen it, the psychic treatment possesses great advantages. Finally, I may also call attention to its effect when necessary to reform character, a fact, which is proved by Lidbeault, Bernheim, Forel, etc., as well as myself. The question whether such cures are permanent can be answered only by those who have a real insight into this subject, an experience which can be arrived at only by using this method for many years. It is, consequently, absolutely unjust and de- cidedly frivolous to dismiss this question with the categoric assertion that its curative results are but apparent and temporary. Li^beault, who has employed hypnotism for more than thirty years, and *Bernheim, whose experience covers a period of seven years,^ have assured us that the cures are, in many instances, per- manent. Moreover, van Renterghem and van Eeden of Amster- dam are inclined to compare, in regard to permanency, in certain cases, the results of suggestive therapeutics with those of surgical- treatment.* Forel ' shows in his reply to Ziemssen's attack that the result of hypnotic treatment can really be of permanent dura- tion. I have myself used this treatment for nearly three years' and a half, and have had among my patients several, both in Stockholm and in the provinces, whose cases were discharged three years ago and have since then remained cured. It is true that relapses sometimes occur, but does not this happen also even in other successful methods of cure? If relapses ' Robson Roose. Nerve Prostration and Other Functional Disorders of Daily Life. London, 1888. ^ Ribot. Les maladies de la volonte. Paris, 1887, p. Ill, etc. ' This was written in 1890. ^ Pp. 16, 17. ' Miinchener med. Wochenschrift. 1889, No. 38. ' Written in i8go. 1 1 6 Hypnotism. occur, they are to be attributed rather to the character of the disease than to the method itself. Why do we sometimes see relapses in cases of drunkards? Simply, because they are con- stantly exposed to great temptations. I have known drunkards, concerning whose cure one felt quite positive and who, neverthe- less, in all probability have again fallen victims to the habit. I know others also who for no price, would recommence their former life with its sorrows, misery and poverty, and to whom the treatment has proved a blessing. The opposition with which, remarkably enough, suggestive therapeutics still meets, here and there, is based partly upon ignorance regarding the manner of employing the method, partly because suggestion is confounded with imagination. But does anyone really believe that blisters can be produced, the beating of the heart influenced, headaches, nervous pains and rheuma- tism permanently cured, or menstruation either induced or checked by imagination? If again we are asked whether hypnotic treatment by a com- petent physician involves any danger to the patient's life or health, the answer must be in the negative.. However, injury can result from radically wrong methods of procedure. Such is the judgment of experience in all countries. I have induced hypnosis about sixty thousand times, and I have never seen or heard that anybody suffered any bad effect afterward. The only unpleasant circumstance which I have observed, was that sleep would come involuntarily to the patient. I have seen this phenomenon twice in somnambulists, but a single suggestion sufficed to prevent any further repetition of that condition. The advantage, on the contrary, consists in this, that many, through hypnotism, learn to exercise such control over their own sleep and thoughts that they usually are able to sleep as long as they wish and whenever they wish, and hundreds, as I have seen repeatedly, have been, by the mere thought, freed from various troubles which previously had afflicted them at all times.' I conclude this work with these words, which I base upon my own experience, and that of other physicians, that the hypnotic treatment is in many cases of great and important value, and often the only means that can secure the desired result — recovery of health. The method is based on a thorough psychic treatment, and its often observed effects are just so many proofs that our ' Liebeault, p. 479, etc. Conclusion. 117 thoughts possess a great power over our bodies, when the will, in a certain degree, is limited and inactive. It is difficult for the medical profession of today to acknowledge this ; as Bernheim says, they believe themselves able to explain all the secrets of life by mechanical, physical and chemical laws, without taking into consideration that the mind also has something to do with the human organism, and that — he continues — there exists a psycho-therapy as surely as a psycho-biology. Of this I am also convinced, but I do not, therefore, see a panacea in hypno-suggestion, to the exclusion of all other means and methods, although its field of usefulness is great and exten- sive, nor do I, in the least wish to assert that its use is always successful. Suggestive therapeutics, as established by Li^beault, will make its way as surely as gymnastics, electro-therapeutics, hydro-therapeutics and massage. Who thinks now, for instance, upon what the learned Riolan had to say against Harvey's dis- covery of the circulation of the blood, and what matters, today, the antagonism of the Paris Faculty toward his ingenious dis- covery?' The history of science contains many pages of obsti- nate antagonism, but also of final victories, and I will remind the antagonists of hypnotism of the words with which Dumont- pallier finished his welcome speech to the First Hypnotic Con- gress : — " Let us advance and not care for the indifference and scepticism of those who will neither learn, see, nor hear ! " ' Raynaud. Les m/decins au temps de Molihre. Paris, 1863, p. 163, etc. HYPNO-SUGGESTION, ETC. MEDICAL LETTERS HENRIK G. PETERSEN, M.D., MEMBER OF THE SOClfexfi d'hVPNOLOGIK ET DE PSYCHOLOGIE, PARIS, ETC. PREFACE. THESE pages on hypno-suggestion as a therapeutic agent, were written by request, and at irregular intervals, after my return from a two years' clinical study of nervous and men- tal diseases, principally under Professor Bernheim in Nancy and Professor von Krafft-Ebing in Vienna, to whom I here reiterate my grateful appreciation of the advantages thus afforded. The purpose was to give a succinct idea of the present status of practical psychic therapeutics, as based on the observation of clinical facts. If, with no other claim, I have succeeded in this, I trust that these pages may also, in their present form, still fur- ther serve that purpose, and, therefore, I dedicate them to all who are earnestly interested in the application of psychic processes to physical and mental disease. The Author. CONTENTS. PAGE Practical Teachings of the Use of Psychology in Medi- cine. Notes from Clinical Studies with Bernheim, FoREL, von Krafft-Ebing, etc. . ... 125 Suggestive Treatment in Reform Work. Moral Idiots AND Others ..... ... 153 Post-Hypnotic Responsibility . . . 158 Music not Sermons in Insane Hospitals .... 162 123 PRACTICAL TEACHINGS OF THE USE OF PSYCHOLOGY IN MEDICINE. NOTES FROM CLINICAL STUDIES WITH BERNHEIM, FOREL, VON KRAFFT- EBING, ETC. I. AN early train in July 1891, brought me from Strasburg to Nancy. There was a strange comfort in leaving, as an indescribable feeling of uneasiness had grown stronger during my short stay. Impartial in my views, and a perfect stranger, nothing but politeness and kindness had been extended to me. The new Strasburg had elicited my admiration, with its fine private and public buildings — a magnificent university, for instance, an eloquent interpretation of the German love and re- spect for scientific pursuits. The pride manifested in showing me all this was legitimate, and no exultation struck a discordant note. Still, one labored under the irrepressible feeling that to bridle utterance, whether of criticism or of praise, would be just as much an act of kindness as of prudence. It was intolerable. A silence of unspoken thoughts made the city mournful and chilly. To watch the characteristic, ill-concealed language of those faces, eyes, gait, and then to think of the terrible effect when the spell eventually breaks ! This prison air unnerved me. Just as silent and masked hes the steel girdle around. The rippling surface of the surrounding land looks like a half-forgotten burial-ground, but its undulating lines are the war-god's hieroglyphs. There, in these hidden casemates, are buried at present the weighty argu- ments of— a future day. And over it all, green waving grass, birds and a fleecy sky. Speeding on, there were banners and music from the frontier to Nancy. What a contrast between the 14th of July here and there ! On several occasions I had partaken of French enthusiasm on that day, but had never before been equally touched by its 125 126 Medical Letters. pathos and meaning. The gay coloring of the crowd thronging the streets on the passing of the troops, and filling the great square to witness their review, was a pleasant welcome to the city which for so many years I had longed to visit. Stanislas Place, surrounded with its magnificently wrought iron gates, opened into the P^pinifere, a park of great rural beauty and rich in shade trees and tastefully arranged flower-beds. Thousands filled it. The military band played, and later in the evening, when numberless lanterns splashed streaks of color upon the ani- mated promenaders, it made one think of the preparation for a carnival. The next day had sobered this exuberance, and Nancy was again the quiet, easy-going provincial town, claiming no ambitious position otherwise than that accruing from peaceful thrift among its citizens. This was not, however, what attracted me to the place. Nancy had attracted the physician, not the sightseer or inquirer into its patriotic or its industrial status. It reckoned among its citizens men of keen observation, men whose fearless and successful researches had given their names to the scientific world by proclaiming a new departure, apparently in direct oppo- sition to former theories and experience. Li^beault and Bernheim are known to the medical world as advocates of psychological therapeutics based upon rational and honest investigation of psychic possibilities. The result of their experiments is known as " hypno-suggestion." They have gathered around them those who have been willing to try the new, not in contempt of the old, but incited by a spirit of progress that believes in evolutionary phases of existing things. Accordingly there is a constant intel- lectual growth which necessarily must supersede the old. There- fore the modern world differs in this from generations of the past, that it nurses fewer theories at the expense and refutation of facts. In making Nancy a medical Mecca, the modern physician comes there, not to sit at the feet of any exponent of abstract philosophy, but to observe readily demonstrable facts, to test them, and then discuss the theory which endeavors to furnish an explanation. This purpose animated me when I called upon Professor Bernheim that day. Rather below middle size and slightly bent at the shoulders, he carries a well-formed head of especially fine frontal develop- ment, closely cut hair more gray than white, a moustache and goatee. His eyes have a friendly smile which encourages, and Teachings of the Use of Psychology in Medicine. 127 makes a well-modulated voice more sympathetic. He has few, almost no gestures, and the whole impression is one of quiet and modest assurance. He is enthusiastic, but a good hstener. Ac- customed to contradiction, his discussion is never tainted with bitterness or with obstinacy. He manifests more than polite in- terest in your views ; but, without appearing over-anxious to change them if opposed to his own, he does not tire of justifying the position he has taken. With these impressions I left his cosey office in Carrifere Place, and the congenial professor's "^ demain, Docteur, nous verrons bien des choses!" opened to me for a long time I'hopital civil, whose clinical chief he is, for the nervous section, and where his remarkable experimental studies of hypnotic conditions have ad- vanced practical medicine, not at the expense of innocent lives scientifically tortured, but by judiciously utilizing that subtle power inherent in every human being, which eludes the scalpel, the microscope and all direct material research. About a hundred patients, male and female, received Professor Bernheim's morning visit in airy wards with large windows, where the monotony of white was broken by restful green plants and the patients' pet flowers, many in bloom. From bed to bed we went, and after the individual case was examined, Bernheim would ad- dress the sufferer in a gentle, firm voice in no way different from his ordinary conversational rhythm. He told them to sleep either at once or before he left the ward, suggested the alleviation or the disappearance of their pains, made them take imaginary tonics, at times touched the seat of pain, and assured them that when their slumber had ceased — he fixing its duration as well as the right time for it — they then would feel comfortable and in a hap- pier mood. The ease, one could say elegance, with which the hypnosis was induced, formed a striking feature in itself and differed essentially from what I had previously observed in the clinics in Berlin and Vienna. Professor von Krafft-Ebing, for instance, would look steadily at the patient, even hold his hands or make movements like passes from the vertex down over the eyes, while he verbally and in a rather monotonous but pleasant voice impressed him with what he expected to be the result in regard to either physi- cal or mental sensations. At Nancy the whole change occurred with astonishing rapidity, and often so suddenly that the inter- vening degrees would escape the observer. 128 Medical Letters. For instance, a patient listens to the record of the last twenty- four hours of his case, and to the Professor's remarks ; he is then told that certain painful conditions are going to change during the sleep he now enters upon. He seems perfectly conscious, and you would consider his marked attention to what is told him very natural, and if you ventured to address him think httle of his not heeding you. His real condition, if you are aware of it, offers now, however, the opportunity for studying the curious phenom- enon of a gradual fading away of his individual self, the primary ego, with increasing absorption of its substitute, the alter ego. He may one minute hear, but not. see or feel, and the next again be completely oblivious to any other extraneous influence except the one upon which his intellectual faculties are riveted, while the sensory impressions are being annihilated. In the time the physi- cal surroundings are undergoing these changes, his intellectual forces being concentrated, and their energy directed toward the result to be obtained, the subject is really brought to utilize his own powers by obeying the will which dictates. It is suggestion in the waking state, dispensing with hypnotic sleep. You can test the actuality of the suggested impressions and, if possible, compare them with the previous ones. The arm which a moment before was paretic, and the force of which the dynamometer reg- istered but a feeble pressure, has received increased strength. At will, you make the various parts of his body anaesthetic or hypersesthetic. One case,. that of ulcer of the stomach, which I had the advan- tage of observing for a week, was finally discharged cured from the hospital, and that after many efforts had proved failures in other places. Excruciating internal pains are assuaged by an imaginary lotion, by the direct command not to suffer, and the despondent mood is made calm and hopeful. Both the mental and physical effects thus obtained are the result of the physician's suggestion, and while he uses the hypnotic condition in many cases for the sake of creating a passive state, and thus increasing the subject's suggestibility, it can be dispensed with. The idea, therefore, that to receive a suggestion, which is to be carried out even to an act, necessitates a previous deep unconsciousness, is erroneous in many respects. The patient has entered into the receptive state by what is explained as inhibition of the cerebral cortex, and a potent psychical influence has taken possession of him by directing both the mental and the physical functions. Teachings of the Use of Psychology in Medicine. 1 29 Professor Bernheim does not reject the idea of thought-trans- ference, but says that with him the experiment. has never suc- ceeded. Some of his French colleagues and others, however, have proved this possibility, but its apparently exceptional occur- rence has deprived it at present, perhaps, of practical usefulness for therapeutical purposes. It would be beyond the present intention to enter upon a speculative discussion of the question, almost offensively delicate, as to whether we possess an independent will or not. Much evi- dence corroborates to strengthen a negative view, because in every case where the individual will finds expression we are more or less ignorant of the causes which have made us act. To sustain the contrary would be more flattering than substantial, and although we may delight in ascertaining that the waves of molecular vibra- tion in our brain produce consciousness, we are still forced to ac- knowledge our unconsciousness as to the vibratory cause itself. Any controversy in regard to this and also to telepathic possibili- ties is therefore of no mean interest and may ere long by con- tinued earnest investigation approach a solution. For that purpose we need first of all to divest the subject of its apparent mystery. W. Crookes thinks that we have happily outgrown the preposter- ous notion that research in any department of science is a mere waste of time. This may be true, but many ideas strange to our own perceptions are continually dwarfed by an opposition which often has no better argument than a leer or affected superiority. Of late we are informed that Professor Nicolas Tesla has been able to illuminate a room without connecting his lamp with the light source in any ordinary way. The experiment recalls a de- monstration, several years ago, by Professor A. E. Dolbear, at the Massachusetts Institute of Technology, in explanation of his tele- phone. Here conversation was carried on at both ends, although the conducting elements to all appearances were interrupted. Something similar has been observed quite lately between two telephone stations in California. The mystery of all this may find its natural and logical explanation in the very fortunate fact of the right conditions being established for ethereal vibration. Have we a more plausible r£ason in presuming cerebral vibration to be any greater mystery?) To us there seems to be a logical sequence and similarity between wireless electric light and speech and wordless suggestion. We necessarily reason from transient effects in trying to seize permanent causes, and even if these 130 Medical Letters. effects should present apparent mysteries, to conclude that the whole is an absurdity, would not be justifiable. It may, as Her- bert Spencer says, be truth perpetually that accumulated facts lying in disorder begin to assume some shape if an hypothesis is thrown among them, but how often does it not act as an extin- guisher instead of as a spark? The following experience can be vouched for : The day trains between Boston and New York are at certain points of the route less crowded. Such trains offer good opportunities for telepathic experiments. The proper selection of subjects will in many in- stances be the outcome of failures and successful reflection upon their possible causes. Let us suppose, for instance, a person sit- ting several seats in front of you, on your side of the car, near the window, and with his back turned. He reads his paper after having settled comfortably down in his seat. There are fair chances for successful experimenting with anybne thus engaged. The man does not seem to be absorbed exactly, but he reads on doggedly. It is now your turn to substitute some other subject for the prosy article, without necessarily attempting to create poetical visions. Doing so, you will notice that the man becomes fidgety, moves in his seat, drops his paper, turns several times uneasily, and finally, as with a fixed purpose, wheels right around and gazes at you in a far from accidental manner. He who has ever seen a hypnotized person when awakening, or when in the post-hypnotic state, will find in this individual's facial expression the same blank, puzzled look of astonishment as if he were un- successfully wrestling with an explanation that eluded his mental grasp. You could have told him that it was your work, and that through your will, more powerful at the moment than his self- chosen entertainment, a molecular action had been started in his brain, its vibrations responding to those from your own. Once this pendulum-swing between yourself and your subject, condi- tions permitting, you may carry the experiment farther. Your mutual positions in the car were guarded here against self-decep- tion as they involved the greatest physical inconvenience possible to him in his change of position at the moment he obeyed the given impulse. This example leads us to the conclusion that our intellectual faculties can be most easily controlled when the mind is passive, or, as the saying goes, thinking of " nothing." This may happen suddenly as if stormed and captured, or again, by slow degrees as Teachings of the Use of Psychology in Medicine. 1 3 1 if by a regular siege. The busy mind, on the other hand, resists your thought just as it would your speech. It is a question whether a mind seriously occupied with a potent idea is more or less proof against foreign thought-influence than one revolving kaleidoscopic images of stocks and bonds, fairs, Paderewsky, bar- gain sales, etc. In this last condition a person is a hard subject. Such apparent immunity from mental access would almost recom- mend a state popularly known as "giddiness," presuming individ- ual possession without well-defined ideation. It must, however, be conceded that this places him in line with certain alienated individuals upon whom suggestive experiments succeed only after the sacrifice of much time and patience. A person of good com- mon-sense and not imaginative, but concentrated and accustomed to discipline, proves an excellent and surprisingly easy subject. Statistics show men to be about one per cent less susceptible than women, and this not, as Charcot asserts, among neurotic and hysterical patients alone. This the Nancy clinic demonstrates daily. As a physiological fact, the importance of which is evident, we notice a more marked susceptibility in childhood and youth and a diminution thereof in advanced age. Suggestion as pro- jected will is powerful enough to break down intervening obstacles whenever encountered, but it is no magic sesame ^nA manifests its power only when judiciously and patiently directed. Unconscious mental suggestion and sensitiveness to its promptings have been well demonstrated in the case of a Bishop or a Cumberland. While an absolute follower of the Salpdtrifere school would on Charcot's authority refer it to fibrillary contractions and vascular modifications caused by emotional impulse, the Nancy school goes a step farther, and while agreeing to a physical condition from psychic causes, it unites this psychic cause with psychic effect, the third link in the chain of sequences. In passing through the wards of the Nancy Hospital we natu- rally perceive that the atmosphere of expectancy greatly aids in producing the impressions suggested. This Bernheim of course admits and rejoices in the fact. The therapeutic results lose no value thereby either as a scientific demonstration or as a blessing to the inmates. One might just as well say that a patient recov- ering rapidly under the treatment of a physician in whom he places impHcit confidence, ought to have submitted his case to some other of his colleagues toward whom he feels utterly in- different, although he recognizes his skill. In fact, the first step 132 Medical Letters. toward hypnosis is thus begun, and the subsequent increase of suggestibility introduced. The patient himself aids by auto- suggestion. From a medical point of view, the novel and curi- ous sight of a whole ward faUing asleep according to order was less striking than the awaking, and the conviction through tangi- ble proofs of both physical and mental improvement in most cases. It must be remembered that these are patients in the City Hospital, and subject to the ordinary regulated routine of every clinic, with every opportunity to follow up their conditions hourly and daily. Consequently here were to be seen both recent and old cases, and the development of the symptoms could not be said to be the effect of imaginary mirage or complacent belief. After one such experience no one will make a boast of his dul- ness or his prejudice. If an inflammation can be produced by suggestion, is it not just as natural that it could be reduced by the same means? If a person can be talked into the belief that he looks badly and feels poorly, you can also talk him out of it. The mental medicine, its existence and its effects, grief or joy, can be demonstrated by the pathological changes it produces when the patient's assertion leaves you sceptical. What the American public knows as mind cure and "mental science " every honest and observing physician acknowledges tO' be fundamentally true, though he strongly opposes their fallacies ; this, for instance, that diseases are but products of thought. Adults may be hypochondriacal regarding their bodily status,, and physicians often have to dispel diseases resting upon morbid notions, but children cannot therefore with any shadow of logic be said to have thought themselves into a diseased condition. If treated as a question of heredity, however, the subject may find defenders. The modern physician finds it worth his while tO' give these ideas a thoughtful consideration and does not reckon it a sacrilege to infuse an orthodox mummy with heterodox life. He admits even a layman's ability to produce similar results, but he does not admit his promiscuous endeavors, although he be, as in some instances, a well-trained philosophical mind inspired with noble intentions. There must be as thorough a comprehension as possible of bodily as well as mental functions, normal as well as abnormal, no fanatical enthusiasm and exclusiveness blinding^ the senses to differentiating shades and the aid most needed. Thus we will not be called upon to witness the appalling tragedy Teachings of the Use of Psychology in Medicine. 133 of thought-battles and prayer-conclaves to assuage and save both children and adults under extreme conditions dependent upon medical or surgical skill alone. In these sentences is therefore also expressed our belief that mind-power and hypno-suggestion are not the all-replacing thera- peutical agents, but take their places as powerful adjuvants which enlarge our field of usefulness, and, although at the present time hardly more than empirical, they have already adjusted many of the grosser medical errors to a finer and more scientific stand- ard. Their presence, their action, and their results remind the world of thought of the too often forgotten fact that the human body is not the essential man, and that if considered as an un- known quantity, all hypothetical deductions of a purely material science will be misleading. II. The great argument to stay both study and practice of hypno- tism is the confused idea of its danger. The idea is confused because even at this moment the majority of the medical pro- fession are ignorant of its principles. In the days of Mesmer, etc., the then demonstrated phenomena were most learnedly dubbed fraud, and it remains a curiosity of science that Benjamin Franklin, who had himself experienced the ridicule of his country- men and the English Academy for his attempts to identify light- ning and electricity, should have been one of the committee of savants who, in 1784, in Paris, examined the claims of Mesmer- ism and condemned it as absolute quackery. The various phases of its development down to the present give evidence of the fact that while serenely ignoring and condemning even tangible proofs, these investigators, blinded by their materialistic zeal, overlooked entirely the presence and importance of that greatest of all magnets — the human will. So, also, when the famous Perkins' metallic tractors were found to be equal to wooden ones, the efTect of the former ones was not reduced to an absurdum, nor was any benefit derived from the so-called exposure. Its permanent cause, suggestion or auto-suggestion, found no intel- ligent advocate, and the opportunity was lost in a mass of triumphant self-conceit. Under such circumstances the lack of information and prac- tical study on the part of physicians incapacitates them for judg- ing of its danger or usefulness. Professor Bernheim and also 134 Medical Letters. Professor Forel go even so far as to refuse anyone the right to judge of hypnotism who has not succeeded with at least eighty per cent of those experimented upon. There must first be per- sonal observation and then personal experience. Summing up the result, we would frankly admit the presence of a danger, but such a one as is always co-existent with imperfect knowledge. A surgical instrument is a terrible weapon in a child's hand, and poisonous drugs are usually so when administered by an ignorant or careless person. Abuse does not abolish use. This exag- gerated idea of hypnotic danger has been the cause of a con- venient laziness on the part of the medical profession at large, and has delayed its intelligent comprehension by the public. It is not enough to criticise and condemn public demonstrations by those whose education would not warrant a lucid explanation. Such criticism reverts, however, when the dignity aroused re- mains crystallized, and we permit ourselves to be guided by a priori conclusions. It must be confessed that just this position has retarded our insight into hypno-suggestive causes and effects, and given valuable material into hands from which only our own progressive ability and the public's appreciation may finally wrest it. Schiller has given us the yet recognizable features of the stu- dent who works only with a need to making his bread, as follows : " Every extension of his bread-science makes him uneasy, because it gives him fresh work or makes what he' has learned useless; every important innovation frightens him because it shatters the old-school form, which he took such pains to master, and he is in danger of losing a whole life's work. Who have written more about reformers than the mass of these bread-students? Who impede the progress of useful revolution in the domain of knowledge more than these? Every light that genius kindles, it does not matter in what branch of science, makes their poverty visible. They fight with bitterness, malice and despair, because they fight for their own existence while defending the school sys- tem. Therefore, no enemy is more implacable, no colleague more jealous, no calumniator more wilUng, than the bread-student. Every new discovery within his world of activity, is a loss to him, but a delight and a gain to the philosophic mind. It filled, per- haps, a gap which had deformed the perfection of his thoughts, as it placed the last stone wanting in his ideal structure, which it completed. But even should it all go to pieces, and a new line Teachings of the Use of Psychology in Medicine. 135 of thought, a new phenomenon, a new undiscovered law of nature destroy his whole scientific edifice, he would, nevertheless, love truth better than his system, and he feels happy to change the old and imperfect form for one new and beautiful." The species thus described by the German poet is not extinct. For the sake of parallelism, this instance is given : When James Esdaile, a prominent surgeon in H. B. M. Indian Service, regis- tered painless operations under what then, in 1840, was called mesmeric influence, the Royal Medical and Chirurgical Society of London retorted by this classical utterance: "Pain is a wise provision of nature, and patients ought to suffer pain while the surgeon is operating ; they are all the better for it, and recover better." The ergo was, of course, an absolute condemnation of Dr. Esdaile's methods. An echo of this was heard in 1890, at the meeting of the British Medical Association, discussing hypnotism in therapeutics. Dr. Norman Kerr, although acknowledging the hypnotic phe- nomena as facts, called it " false therapeutics" to annul pain by hypnotism, because pain is a message from a diseased part. We need not dwell upon the absurdity and narrowness of the utterance. Even if true that hypnotism exchanges one morbid condition for another, would it not be desirable to welcome the one that gives the least pain ? The more the idea of hypnotism is freed from coarse errors, the sooner will it become a real benefit. Unscien- tific precursors have induced the error of presuming a mental weakness or faulty equilibrium of nervous force in hypnotic sub- jects. This is contradicted by facts. Some again say that hyp- nosis can be produced by any means causing fatigue of the senses, just as certain phenomena in the hypnotic state can be made apparent by mechanical irritation. This also is incorrect as a parallel. Hypnosis never occurs without suggestion or auto- suggestion ; it is not pathological, but physiological, not in its origin somatic, but psychic. Neurotrophic changes might then also be said to result from the application of a postage-stamp to a person's back, while its vesicatory effect is due to the will- control of motor and sensory centers. Fatigue is a factor, not the entity. When sleep occurs, then first commences the active influence. Suggestion not only prepares but dominates after hypnosis has produced passiveness and receptiveness. Seeing as we do no marked difference between this state and ordinary sleep, we can- 136 Medical Letters. not admit that a nervous debilitated condition is caused, result- ing in a dynamic modification of the brain. The sleep induced is not abnormal, as it does not create new functions, and the phenomena observed we obtain during both states. There is con- centration in both these cases, and the activity of our intellectual faculties is evident either as a dream or as a direct suggestion. It is this cerebral activity during repose that is utilized, and if for the best purpose, one is hardly justified in saying that contact with an organ continually vibrating under external impressions is at any time hurtful as a strain upon conscious cerebration. Such contact may and does prove corrective and strengthening. Forel claims that a sound brain is under such circumstances giving the most satisfactory results, as capable of a more clearly defined state of expectancy. A subject awake is able to correct and also to repel an impression or suggestion, while his passive observation in hypnosis seizes upon the projected thought to the obliteration of all others. The insane as well as the inebriate are difficult subjects for hypnotism or suggestion, chiefly on account of their erratic thoughts, as already alluded to. Nevertheless, here also has suggestion proved successful. Of course, if their brain substance has degenerated, no power on earth can replace anatomically de- stroyed parts, but the morbid development may be impeded by limitation of the area already involved. Certain physiological facts must guide our efforts. So we know that nervous exhaus- tion, mere physical fatigue alone, does not produce either sleep or hypnosis. Great mental excitement can counteract sleep, although extreme bodily weakness exists ; but, at the same time, increased physical weariness can also completely conquer psychic effects. Consent and co-operation are required to hypnotize a person, but for suggestion a peculiar susceptibility is needed. As the hypnotic state prepares for that of suggestibility, the involuntary subjection of individual thought becomes difficult in the waking state, and more particularly so when the subject is not aware of any such purpose. Time and patience are indispen- sable, and timid people may rest assured that, only in exceptional cases, a sudden snapping of fingers and an imperative command to sleep, or the insidious infiltration of a stranger's thoughts and will, can have immediate effect. It depends just as much upon the subject as upon the experimenter, and the wonderman, the platform hypnotizer, has gone Therefore it is mostly after re- Teachings of the Use of Psychology in Medicine. 137 peated suggestions that the hypnotic and suggestive state can be reached. This fact was clearly demonstrated when new patients arrived, and many of these did not yield quickly to our efforts. Professor Bernheim failed as well as his assistants, and he acknow- ledges that this is a daily occurrence in his private practice. There is, of course, a way of doing which only repeated experimenting can teach, but all means finally produce the same result. The individuality exercises its influence, whether the more potent concentration or its very quality, most likely both, and this gives, in many instances, the explanation why our patients reap greater and quicker benefit from one physician than from another. In fact it is but the phenomenon of daily life with the examples it offers through the senses. What are emotions but suggestions entering the brain to produce results on our physical or mental conditions? We may therefore see that it is not a necessity, sine qua non, to produce a profound sleep as the initiatory step to suggestive therapeutics. The antidote for a too easy suggestibility is suggestion itself. Bernheim and colleagues using the hypnotic state therapeutically, would invariably suggest before waking the subject that no one should be able to hypnotize him or her except the physician whom they voluntarily wished should relieve their sufferings. Thus the impressibility of a natural disposition, or that provoked by repeated hypnosis, may be limited to its proper sphere of use- fulness. Considering the agent as therapeutical and not as a novel mode of entertainment for drawing-room or platform, the danger is lessened. A safeguard to both physician and patient, more- over, is the presence of a third person, without which no such treatment should be entered upon. Clinical experience has not yet proved' any disastrous after-effect as the unavoidable result of hypnosis, and a patient's mental independence has no more been transformed into stupefied docility than it would be as the result of any other anaesthetic, provided no post-hypnotic condi- tion remained to fetter his will. It is, then, a physician's duty to superintend this. A gradual waking after having suggested that it should be a pleasant one restores completely a self-conscious equilibrium, and leaves but in few cases a confused sensation, more or less transient, according to individual constitution. Some investigators have thought to correct or rather to pro- mote hypnosis by the administration of narcotics from the very fact that this condition is often obtained with great loss of time 138 Medical Letters. when the method of suggestion alone is employed. We think this gives rise to many physiological obstacles, and an increase of experimenting fraught with real danger. The safe proportion of the animal and the psychic life, their mutual limitations and capacity for independent control, are not at present cognizant to scientific knowledge, and would be apt to pass beyond the aim we desire to reach. If, nevertheless, narcotics have been advocated and even successfully employed where hypnosis otherwise could not be obtained, we must recall that there are numerous cases where, in such dilemma, the mere preparations to anaesthetize have produced its somnolent effect under well-directed suggestion and consequent auto-suggestion. Moreover, aside from its doubt- ful advisability, we must not forget the subject's own individual predisposition, which it is decidedly erroneous to confound with the degree of hypnosis. Suggestibility is one thing and hypnotic susceptibility is an- other, and they are not dependent upon each other although they correspond. We have observed persons easily hypnotized, but at the same time manifesting difficulty either in seizing the idea sug- gested or in acting upon it, from a marked check of the motor or sensory sphere. It is, further, not verified by increasing clinical observations that hysterical subjects are particularly good hyp- notic subjects. Nervous affections are predisposing causes, no doubt, but the great number of, in every respect, healthy persons, born of healthy parents, in whom all the hypnotic degrees can be provoked, contradicts the views of Charcot, while strengthening those of Bernheim. On various occasions we have witnessed even a singular resistance on the part of hysterical and neurotic indi- viduals claimed to be such very easy subjects. Of no little im- portance is it in this connection to know that hypnotism does not create hysterical after-conditions in otherwise healthy people. The attempts which occasionally have been made to emphasize such a possibility are at best based upon a confused definition of hysteria. The employment of hypno-suggestion has at this moment entered private as well as official practice, and its beneficial results have established the conviction that medical science, with the adjuvants it now possesses, cannot afford to discard its ser- vices. No European clinic of any importance is bare of illustra- tions to prove its right to therapeutical consideration, and linger- ing prejudice is but an asthmatic argument in the race of weighty Teachings of the Use of Psychology in Medicine. 139 facts. It is through such channels and in the hands of the Old World's most eminent teachers that ample time and opportunity to investigate will do more than discussion ex cathedra and the monopoly of knowledge. We have spoken of its dangers and we know that Legislatures endeavor to limit them by definite laws. But its use for the social good is also agitated today, and at a re- cent debate in the Austrian Reichsrath, a member reproached the Minister of Education for the university's lukewarm interest in the question, designating such indifference as a "crime," whereby suffering humanity is deprived of valuable aid. This accusation is made publicly in a country where it is already taught and prac- tised by the most eminent chairs. Several hundred cases observed during a period of two years give me as; a physician a similar right to employ this remedy. Diseases within and outside of hospitals have been relieved and cured by hypno-suggestive therapeutics. They have not been limited to neurotic persons and light cases, but on the contrary in very many instances have been applied to those considered hopeless. I^either would it be right to say that cases benefited through this agent suffer relapses and therefore gain but a tem- porary good. We have observed the bane of bad habits eradi- cated by it, leaving an invincible disgust for falsehood, tobacco, alcohol, opium, morphia, etc. Its application may, however, like all other remedial agents, come too late and be merely able to sustain a sinking system. Where nature's resources are not yet all exhausted, and where manhood lingers, its use is certainly not in vain. Such observations are at the disposal of any sceptical but intelligent mind, if facts are required in place of theory. The medical profession in America has retarded its advance in this direction. Its interest, indeed, ought not to remain limited to club talk or discussion in iron-hooped societies with exclusive studies and purposes. As a liberal science its researches ought to be independent of any watchword placing it in subser- vience as tyrannical as French fashions and English fads. For those who are timid, there is at the present time sufficient author- ity to shield any attempt to carry hypno-suggestive therapeutics into legitimate private practice, and our clinics and hospitals should be called upon to instruct in a branch of the healing art — certainly not any more empirical than other honorable and plaus- ible efforts to widen its field. American contribution to this science has hitherto come al- 140 Medical Letters. most exclusively from non-medical circles, the papers being often well written and clearly defined, and on many occasions the writer has been singularly impressed by noticing that the Old World's scientists adopt and adapt transatlantic notions in this direction, although not sanctioning them in the original form or acknow- ledging their primary authority. American medical literature relating to the subject is scarce, and is not quoted abroad as weighty enough to enrich European experience. Still, the American mind is creative, although its blunt crudeness may lack speculative polish ; it is observant, and astonishingly intuitive so that often its right choice resembles the result of tact and study, its obstacle to independent thinking, and that in spite of a " go- as-you-like " principle, is, nevertheless, its timid reliance upon foreign criticism in matters where it is taught yet that it is inferior, which certainly is true, and mainly on account of this acceptance of a subordinate position. When this idea of deference ceases to impede our progress we may hope to gain respect for our own observations, deductions and conclusions, and not be obliged to sanction them as imported second-hand articles. III. At the Second International Congress of experimental psycho- logy, held in London in 1892 from the first to the fourth of August, the tendency of its communications and discussions was to decrease the number of theories extant and to throw light on accumulated matter by additional facts and more concise terms. In Europe, where, so far, the clinical study of psychological ac- tion has broken through the hitherto wellnigh unassailable strong- hold of medical conservatism, the subject claims today not only better qualified advocates within the profession proper, but also a more rational and less prejudiced insight among the intellectual class. This fortunate position is largely due to the absence of any ponderous playing at secrecy and oracular misgivings when- ever the problem refuses to fit any scientific strait-jacket. Be- sides, although there are leaders, there are also independent co-workers suffering on the whole but little from the general apathy and conservative spirit. Among the communications which attracted most attention at the congress was one by Dr. F. van Eeden of Amsterdam. Holland, who, with his colleague. Dr. van Renterghem of the same city, has made extensive studies at his private clinic. The Teachings of the Use of Psychology in Medicine. 141 lessons taught by these experiences he presented in a paper on The Prhtciples of Psycho-Therapeutics, and even a fragmentary acquaintance with his remarks will presumably prove useful and interesting reading both to physicians and laymen. He regrets first that the words hypnotism and hypnosis were ever made use of in connection with suggestive therapeutics, as they have given rise to prejudice, confusion and misunderstand- ing on the part of those who might have been benefited them- selves through benefiting others. The hypnotism of today, or rather that which was brought into existence by the name and authority of so eminent a man as Charcot and then caricatured by stage exhibitions, had as its natural sequence strong opposi- tion and the birth of a more refined and truer view — suggestive or psycho-therapeutics. The fact, however, that it followed in the wake of the Salpetrifere hypnotism, has been detrimental to its ready and rational acceptance, and the show-business, accord- ing to Dr. van Eeden, has injured it still more even in the eyes of physicians. Concurring as we do in this view, we can but gratefully remember that indifference was thereby stimulated into activity, and that Charcot's demonstrations and hypotheses, through a searching opposition, showed themselves to rest upon too material a basis, and by their abnormal character to divert the observer from any deeper cognizance of the underlying psychic possibilities in man. While, therefore, at first, physicians, on being taught that this was going to serve as a therapeutic agent, could see but an odd novelty fit for the working of charlatans, it has helped finally to attract, both directly and indirectly, a number of serious investi- gators. If the profession had given heed to the patient work of Li^beault's modest clinic at Nancy at least ten years earlier than the hypnotic movement at Salpetriere, suggestive therapeutics would have found their way unobstructed by prejudice just as massage, hydro-therapeutics, and electro-therapeutics have done. Today, the mere idea of patients at Li^beault's and Bernheim's clinics having run the risk of danger is more ridiculous than ever, as no unbiased student and practitioner of psycho-therapeutics doubts that the sick can be cured— we say not indiscriminately— by their inherent vis medicatrix, guided by proper suggestion and favored at times by an induced somnolent state. This is the reason why the practitioner from the very beginning must keep apart the two notions— hypnotism and psycho-therapeutics. 142 Medical Letters. The question as to whether hypnosis, may be considered a normal or abnormal sleep is still an open forum, as we, today, are not even able to define its ordinary aspects. Still we may, with- out risking our position, admit the hypnosis to be a possibly abnormal state by its anaesthesia and obedience to external im- pressions without waking. We may require both conditions ; as when we wish to perform a surgical or dental operation, to correct stammering speech, subdue writer's cramp, or give movement to paretic or paralytic limbs, etc. Nevertheless, the obedience to external promptings does not make sleep abnormal any more than the act of a sleeping conciirge who opens the door when the bell rings, the automatic march of a soldier in the field, and the mother attending to the comforts of the child at her side. From a therapeutic point of view, it would be out of the ques- tion, and even freighted with danger, to make our patients, when asleep, needlessly speak, write, walk, or open their eyes. Then we would produce a pathological condition creating nocturnal somnambulism, for instance. Public exhibitions having phenom- ena only as their aim, have nothing in common with the purpose of the physician to relieve and cure instead of to astonish and gain the applause of a crowd at the expense of persons who more wil- lingly than wisely submit to such experiments. For therapeutic purposes we do not need this abnormal condition wherein a per- son presents another self impelled by foreign will. Medical sug- gestive effort can but gain by this very independence of all fictitious existence and rise to a position of unsuspected utility. The hypnotism of Salpetrifere has been the greatest enemy of psycho-therapeutics by frightening both sick and well, and in this fact is to be found the only valid excuse for doctors making such remarks to patients as follows : " Do as you like, but never allow anyone to hypnotize you 1 " Or, whenever a patient has been successfully treated by psycho-therapeutics : " Well, well, the cure, as you call it, is only apparent, as you will find out at your cost later ! " Or this : " Be careful, it is not so innocent a thing as it looks ! " A patient retorted : " You do not believe, however, that it would kill me ? " " No," answered the physician, " you may not fear that exactly, but what is far worse will happen to you ! " Others inform their patients that they would have been cured anyhow, and that this particular treatment had nothing to do with the result. Now, if these remarks were made in the course of general practice, surgical or gynaecological, they would Teachings of the Use of Psychology in Medicine. 143 have been put down as disloyal to the profession, and, perhaps, not deemed worthy of any reply. But whether due to ignorance or malignity, such remarks are of far more significance to the practice of psycho-therapeutics. The danger would be similar to that of using a. surgeon's instruments, without his knowledge, in performing an autopsy or any operation on a dead body, because speaking thus, with the authority of a physician, his words are suggestions which may profoundly and forever injure a nervous or impressionable person, and distrust once created, all suggestive treatment may afterward prove a failure. Forel has said that the hypnotic sleep stimulates the suggesti- bility, because it produces irregular mental action (ataxy of the mind), and that this ataxy, when suggestions are often repeated, may present itself also during the waking state. Nobody would deny this, and we are consequently facing abnormal conditions under which our curative efforts would suffer needlessly. It must be remembered that although such results may be checked by energetic contra-suggestions, it is, nevertheless, true that psychic ataxy is one of the principal symptoms of hysteria. Strictly speaking, therapeutic suggestions would make no person hysteri- cal, but it does not thereby follow that by repeating too often merely experimental suggestions one might not awaken latent hysteria. The physician's insight and the necessity of the case would consequently only suggest what was in harmony with the normal functions of the organism. Therefore it is a fundamental principle to stimulate as little as possible. Personal experience teaches us the radical difference which exists between treating the ordinary class of patients in dispen- saries and hospitals, and treating those of superior intellect in private practice. Whoever has studied suggestive therapeutics at the Nancy Hospital is struck by the facility with which the inmates obey the various suggestions and often repay those efforts with prompt curative results. Under such circumstances, the authority displayed and believed in does away with many words and explanations. The more decided the tone, the more brilliant the effect. If an energetic suggestion fails, then the aim fails also. Otherwise the failure is when the patients are independent, educated, and sceptical ; the authoritative tone irritates them and may even appear ridiculous. They will not be subject to any command, and, above all, they will not accept without under- standing. An impression is rarely made before the operator has 144 Medical Letters. succeeded in giving them a somewhat clear idea of the whole thing. The future of psycho-therapeutics is threatened by these obstacles, and by the apparently illogical fact 'that a therapeutic method has been elected which is suitable for one class only and not for all alike. If it were to remain so, the very class among which the greatest number of psychic and nervous diseases pre- vail the most would reap no benefit. Fortunately we are not limited to one method, that of absolute authority on the part of the physician and blind obedience on the part of the patient. Whenever we meet with obstinate opposition from a well-educated and well-balanced individual, it is neither because of his being afraid nor because he reflects another's contrary opinion ; but simply because he does not comprehend the thing in itself, and therefore lacks confidence in what seems to him arbitrary and enforced. We sympathize with such a state of mind ; at the same time it becomes our duty to dispel it by generalizing the prin- ciples which guide our theories of therapeutic suggestions. Then we will find no difficulty in applying them with as much beneficial result here as in the case of children and persons who are less positive and less educated. Theoretically considered we must to a certain extent abandon the authority system and preserve the independence of the individual instead of being instrumental in its enfeeblement. Clinical facts speak in favor of such a proceeding inasmuch as the most satisfactory results have been obtained where the patient either knew nothing, or all that at present can be known upon the subject. It ought not to be difficult in either case to gain the patient's ear and interest, especially as the aim in both instances is above any endeavor to control and is decidedly in the direction of benefit and aid. While with one class it is simply affirmed that everything will happen as suggested, and that by following instructions all morbid symptoms will disappear, the intelligent and educated patients must be spoken to as the operator would himself wish to be addressed. The ideo-plastic idea, the sugges- tive theory, must be explained and how it is possible to dominate and cure pathological conditions by ideas and volition. They must be told that no restraint is put upon them, that they are merely shown the way and that their present conditions will change, not by any preponderance of another's will, but as the result of a proper effort to aid by using their own will. They are Teachings of the Use of Psychology in Medicine. 145 helped to develop the ideo-plastic faculty, whereby is meant the power that ideas possess to influence physical conditions, as, for instance, the production of cholera symptoms by fright, or that of bleeding marks on hands and feet from profound and con- tinued contemplation of or meditation upon the crucified Saviour's wounds. They are guided by word and thought with- out restraint, authority, and command. This seems easy and yet we find just here no slight obstacle. Truly intelligent patients are rare, and the majority possess but half-culture. What is lacking in intelligence and culture is made up in pretension, and unable to understand they are at the same time unwilling to submit to the knowledge of the physician. His task is doubled by being obliged to instruct as well as cure ; his tact is required in managing their susceptibilities and ideas of mental independence while exercising his intellectual experience in their behalf. With a good and firm will to surmount these obstacles, much can be achieved, but the assistance of proper direction, exercise, and time is also needed. IV. The centralization of psychic functions is another principle, the tendency of which must be evident, at least to every psycho- logist. The equilibrium and order of all collaborating forces are indispensable to maintain the energy and resisting force of the entire organism. The conscious will of the patient must be appealed to. We are justified in saying that whenever a chronic disease is cured under such circumstances it offers the least chances of relapse. It can even be presented as a principle that, in every disease, we have to reckon with this psychic factor just as much as with nourishing diet, cleanliness, and pure air. If such an idea of psychic centralization should be opposed merely on the ground of a belief that only a few cases yield to its influence, the suggest- ive theory of Bernheim gives both a denial and an explanation. Suggestion, or rather suggestibility, is composed of two ele- ments : ability to receive an impulse from without, and the ideo- plastic faculty. As these are absolutely independent of each other, we must distinguish between them. There are patients who are very impressionable, and who accept a suggested idea with absolute confidence; the influence, however, of the idea upon their physiological functions is feeble. They do not realize 1 46 Medical Letters. the suggestions, and their morbid symptoms yield with great dif- ficulty, as their ideo-plastic conception is small. Others, on the contrary, accept suggestions slowly, are incredulous and even resist them. Nevertheless, we find that the physiological and pathological processes are easily modified by the psychic influence, sometimes by auto-suggestions. Here, then, the suggestibility is undeveloped and small, being surpassed by the ideo-plastic fac- ulty. Forming, as it does, the very basis of psycho-therapeutics, we have no doubt as to its future, believing that the limits for its action will rapidly reach beyond the present ones, although even these furnish us with illustrations of severe organic diseases yield- ing to the beneficial influence. The observations of Li^beault, Bernheim, B^rillon, Lloyd- Tuckey, Kongolensy, Wetterstrand, etc., as well as our own expe- rience, have offered numerous proofs. Take, for instance, the improvement of the general bodily functions in pulmonary phthi- sis as an illustration. The exaggerations which so much marred Professor Koch's first experiments were due to ignorance of the power of suggestion on the part of the great bacteriologist. If he had understood how to separate the suggestive element as an active co-operating factor in his injections, the benefit effected in the beginning would not have been attributed to the lymph, and the final failure would not have been so discouraging. However, although recognizing the existence and power of the ideo-plastic faculty, it is rational to submit it to a conscious volition whenever it can be done in accordance with the physician's discrimination. Above all, the methods in each particular case should be varied with proper guidance and moderation, not because the suggesti- bility is thereby increased, but because the ideo-plastic faculty is thus developed and placed under the influence of a will that knows and directs its tendencies. What we look for is, therefore, a slight receptivity for outside impulses and as great a centraliz- ation of psychic functions and the ideo-plastic capacity as possible. It is rare to find this combination, but it can be attained by train- ing and education. Experience has taught many, myself included, that the psychic effect for curative purposes was stronger where patients either did not sleep at all or merely submitted to a somnolent sensation that left the senses conscious of what took place and also a clear recol- lection afterward. So in most cases, a somnolent state, or merely a passive condition, enhances the energy of the psychic force. Teachings of the Use of Psychology in Medicine. 147 The attempt may be made to produce a profound sleep in cases of melancholy, anguish, and restlessness and insomnia, but even in such cases the effort is to develop the inherent faculty, command- ing sleep whenever the patient desires to rest. It is an important point in the treatment of all neuroses and psycho-neuroses to regulate rest, and it is equally surprising to observe the remark- able results of a persistent and patient impulse. An intelligent patient is finally persuaded to suggest to himself before going to sleep that the effort of his conscious will shall act during the period of repose. Many of us have experienced how easily and correctly we wake up at a time which necessity has suggested to us before retiring. Of course the efficacy of this power may be lost when the patient is left to his own resources for too long a time. The process is so subtle and complicated that numerous causes are apt to interfere with it, such as a mistaken notion, mental depression, defiance, or a foreign influence. The physi- cian's suggestion is then needed in order to avoid a complete relapse. Would anyone raise an objection to this ? Are they not patients and he the physician ? Or is any therapeutical method known, the results of which exclude all possibility of a relapse ? , There is no objection so weak and void of sense as that which accuses psycho-therapeutics of not making absolute and durable cures. Medical practice in general proves our position because no pretended cure of chronic disease by chemical agents is an absolute cure — and for this reason, that nothing gives the as- surance of the patient's power of resistance having been increased. On the contrary, it has rather been enfeebled and spoiled by the use of drugs. Some object that all this is nothing particularly new, and that psychic agents have never been discredited. No ! the idea itself is not new, and was honored fifty years ago more than of late, as is evident from the works of Ruseland, Johannis Muller, and von Feuchtersleben. What today is new, however, is the method and the firm conviction. Thus, both in the way of science and of application, the idea is new. It has become scien- tific in its method, which, applied, resulted in a conviction based upon results. Most physicians probably applaud the idea as a beautiful one, but entertain little faith in its practical value. Why ? Simply because they ignore recent psychological research and its discoveries, and the more that they are not, as a rule, pre- pared for it by previous training. Now this imperfect insight 1 48 Medical Letters. into the domain of psychology, side by side with their greater familiarity with physiology and chemistry, has resulted in the fact that the medical practice of today relies principally on mechanical, chemical, and electrical agents, and dares not confide in the power of psychic functions. As these functions, nevertheless, play a great role in the human organism, medicine as a science alien to this knowledge will never know human nature thoroughly and never be able to give genuine relief and comfort to its ills, but will remain, as at present, incom- plete, provisory, and inexact. From this it does not follow that medicine is too materialistic. The natural sciences must neces- sarily be materialistic, as they embody the knowledge of external phenomena as matter or force, and are observed through the senses. Only that materialism which exaggerates the superiority of these sciences can be said to be the negation of thought itself, much as if we would pretend that paper and ink were of greater importance than the ideas they serve to convey. When Virchow discovered that the body is a combination of infinite collaborating cells, he called our attention to an effect, but their inherent vital- ity, being confounded with chemical and physical qualities, escaped recognition just as it did the scalpel. The psychic functions, the vibrating vital cause, remained hidden as before. To bring these functions to light, to establish their presence and their action in every individual life, is the mission of the psychology today. The work is in a fair way of advance upon an enlarging basis of solid, scientific facts. It is characteristic, to say the least, that Dr. van Eeden can in this way voice the sentiments and the experience of a large num- ber of physicians all the world over to whom psychology means more than a curious plaything. We perceive that every day brings us farther from a conservatism that either had no method at all, or, when one was offered, made a wry face and indulged in what was then considered a superior kind of sneer. The subject finds an eager ear now among competent thinkers and practi- tioners, and has passed beyond the discussion as to whether such facts are reliable. We know they are, and also that they are within the reach of anyone who brings intelligent and patient in- quiry to bear upon psychic life. The material is as abundant as the field is extensive. Research of this kind demands many workers and necessarily creates many branches. Our own part, as physicians, is not to engage in speculative philosophy only, but to Teachings of the Use of Psychology in Medicine. 1 49 apply within practical limits whatever our experience has added to the means of combating disease. Were we only to accumulate facts and come to a standstill be- fore puzzling theories, we would be no better than the miser hoard- ing riches useless to himself and others. Once sure of possessing reliable and undeniable facts, theories must take care of them- selves and will in due time naturally evolve sound teachings. We have, in the meantime, no right to closet ourselves with our ex- perience, simply because we have not succeeded in elaborating the subtle laws which govern them. The mystery may never be un- ravelled, and may remain as problematical as the source of life it- self. Human existence is too short to permit us to lose any opportunity to better the work we are engaged in. We naturally seek the cause of every effect, and it is plausible that we should endeavor to discover it, but no one will gainsay that we may all the same turn effects to practical account before we fully master the theories of them. That is just the position of suggestive therapeutics today, not yet an exact science, but decidedly scien- tific in its methods and success. Just as little as we who practise this branch of modern medicine do so to the exclusion of the ordi- nary methods, just aslittle do we refute the utility of drugs. We use them because we are convinced by experience of their value, but we are often forced to recognize their failure and are anxious to find a better substitute for them. We are equally convinced that the psychic agent removes physical as well as mental obsta- cles in many instances where the medicines which we relied on were disappointing. There is a particular interest in the emphasis with regard to strengthening the patient's conscious will instead of constantly substituting for it a foreign one. This has ordinarily been a point of crude misunderstanding with many. Psychic no more than general therapeutics need go to the necessity of forced feeding. An exhausted system is taught to take its nourishment, whether mental or physical, by what might be called infused volition which permits his own to play both a receptive and an elective part in the process. There may be many reasons why the individual fails to assimilate at once, but the resistance is rarely of long duration. The fact also that unconscious sleep is unnecessary in the ma- jority of cases may surprise those whose ideas of suggestive thera- peutics are based upon public exhibitions of hypnotic phenom- ena. Just as in ordinary practice patients are only occasionally 150 Medical L e iters. submitted to the influence of ether, so also here we may dispense with making the body and the will negative to the extent of un- consciousness. The logic and simplicity of these proceedings ought to commend themselves instead of repelling sympathy. The instinctive impulse which causes desire we will find more potent than the will. A patient's desire to get well has reached the stage of practical incentive when it induces him to confide in a physician, but although his desire has been embodied in a strong motive, his active self-consciousness stops there, and the volitional process lacks firmness as well as ability to become active at the proper moment. Therefore his will may remain feeble at the same time that his desire is strong. Under such circumstances he brings to his physician the very elements which, if intelligently understood and applied, cause an equalization of the psychic functions, thereby establishing the equilibrium of nervous force. If, on the contrary, a comprehension of what is meant by psycho-therapeutics is one-sided and superficial, and one should indiscriminately attempt to produce the unconscious condition, in most instances the result would be that one would be found battling against a weakened desire and an obstinate, even hostile^ will. It would, then, surely be fair to surmise that the non-suc- cess was due more to our limited resources than to any original difficulty. Such cases are somewhat frequent, and we suspect that the method has done much to render both the physician and his patient weary and discouraged at the same time, as it may have brought the efficacy of the curatiye agent itself into tempo- rary discredit. Most morbid mental and physical conditions may serve as examples, but among what is termed bad habits, that of morphinism forms a singular exception. Excluding advanced cases, we refer to those who stealthily indulge and furnish them- selves plenty of good arguments for so doing. Here the desire as well as the will to stop the practice is blunted. Such a man is irresolute because he knows that the poison is a necessary stimulant. As a rule, he is of a high-strung nature, with aspirations which are continually in conflict with commonplace surroundings.. Of good social position, his intellectual work is often of a high order, and must be attended to even when the organism cries for rest. The difficulty consists in awaking the unfortunate's desire,, and then his will, to get rid of the habit. How soon a suggest- ive treatment will be able to remove these obstacles depends Teachings of the Use of Psychology in Medicine. 1 5 1 upon circumstances ; but it does not become necessary to isolate the patients in ordinary cases. There is one point toward which observers have not always sufficiently directed their attention although it is closely con- nected with psychic functions and, undoubtedly, has often enough presented itself to most investigators to elicit its recognition. We refer to thought-conveyance as a force in suggestive therapeu- tics. The audible word is used, and must as a rule serve in all cases in the beginning, but even that, as we know, is inefficacious until a receptive although perfectly conscious condition is estab- lished. The impressive state thus created will then admit of seizing the unspoken suggestion, which naturally imprints itself so much more strongly if it is in harmony with the ideas desired to be conveyed to a patient. Of course, this depends upon the individual's degree of suggestibility and the physician's aptitude for mental centralization. But this fact seems to have been generally overlooked or, at least, its practical value has hitherto been somewhat underrated. An illustration of this may be taken from my last day at Nancy Hospital, about five years ago. Following Professor Bernheim on his morning visit through the wards, we were as usual spending some time experimenting upon his great subject, Henriette, so well known to visiting physicians. Leaving her at the first bed in the hypnotic state, we proceeded toward the other end of the ward. During all this time the woman would continuously answer the professor's questions to the other inmates. The logical connection between question and reply was not once interrupted. As the distance became greater, and her words consequently became confused, I felt anxious to ascertain whether the correctness still existed. Placing myself as far from Bernheim as possible without losing the sense of his words, I became convinced that she was able to understand him although the distance was almost double. When near her I was able to hear his voice, which was low, but not to distinguish a single word. Calling the attention of a visiting Russian colleague to this circumstance, I asked him to stand mid- way between us and to repeat the professor's questions to me in German. The result proved beyond a doubt that she caught easily and clearly the sense of his words. Walking home with Bernheim, I mentioned my experiment to him, and in giving my opinion of the phenomenon, I think I called it telepathy. Strangely enough, he would not accept this and assured me that 152 Medical Letters. he had never succeeded in obtaining the desired effect by thought- suggestion alone. Nevertheless, he recognized the fact as related and explained it as due to induced hypersensitive audition, indis- putably present in this woman's case, but the question which I then tried to settle was whether the phenomenon did not depend more upon the coming into play of a psychic function than upon an extraordinarily acute sense of hearing. Having repeated this experience in daily practice, my es- teemed teacher's explanation has proved itself only half the truth, because thoughts have actually been answered. Either a patient when in a somnolent state would suddenly ask, " What did you say, doctor?" or, where the comprehension was more distinct, "Yes, I will try," etc. How concentrated the mind would be upon the suggested ideas may be inferred from the fact that external noises, such as passing cars, the ringing of the door- bell, or knocks at the office door, often for long intervals were not perceived by the patients. Thought seems therefore to be a no less potent factor because speech does not convey it, if the ability of projecting and receiving it exists. It can be but a question of time when in this country also, universities, hospitals, clinics, and extended private practice shall give physicians and the public the same facilities and benefits as older seats of learning now do in Europe in regard to suggestive therapeutics. In the first place, tolerance as to ideas is the only way to reach a correct and fruitful understanding of the principles underlying psychic life and functions. Next, psychology cannot be classed among positive sciences, and efforts to do this have retarded results if not obscured the way to them. For the easy- going majority, that waits until pushed forward and has to be assured that such studies are perfectly " respectable," and need neither to be abhorred completely nor approached after the fashion of Nicodemus, no further excuse exists for retaining its present ridiculous attitude, and those who have already been benefited may yet find moral courage to bear testimony to their profitable heresy. The first step to inaugurate this mental progress should belong to the medical profession, which, no doubt, procrastinates only to instruct the better. SUGGESTIVE TREATMENT IN REFORM WORK. MORAL IDIOTS AND OTHERS. IN 1884, Auguste Voisin, physician at Salpetriere, Paris, first attempted to use hypnotic suggestion in mental diseases. The case was that of an insane woman who was maniacal, had hallucinations of hearing, was absolutely incoherent, and filthy in words and acts. Her accesses of fury were calmed by plunging her into hypnotic sleep only to reassert themselves with unbounded violence upon awakening. Then moralizing suggestions were made during the sleep and with a surprising result. The woman became rational, obedient, laborious, and both in thought and behavior a moral example to her surroundings. It proved to be a radical cure and she was given a position as nurse in one of the Paris hospitals, where she has fulfilled her duties to the complete satisfaction of her superiors. Since then, many well authenti- cated cases of a similar nature are reported, which have clearly demonstrated that insane persons can not only be hypnotized but also cured by the process. Psychological insight and prud- ence on the part of the physician, together with great expendi- ture of time and patience, are required. Taking these facts into consideration, have we not here a powerful moralizing agent that ought to gain admission also to our reformatories and penitenti- aries? The problems of our social work are surely beset with great difficulties, and the present means have not always proved sufficiently effective. The rational way of looking upon hypnotic suggestion is that it differs only in degree of intensity from that usually employed by school and reform. In substance they are alike. Our criminal population is an outgrowth of misspent childlife, the early stages of which educational influence is called upon to develop and to suppress through moral, intellectual and physical means. Its broadened theories embrace every child-character individually. It is both a science and an art, endeavoring to adjust opposing elements and blend bodily health with mental and moral strength. Leibnitz said that he who masters edu- 153 1 54 Medical Letters. cation masters the world. The truth of this we become cogniz- ant of through our failures. The complex study of heredity- alone is to the educator more a source of despair than encourag- ment. The inherited tendency may be of a surprising vehem- ence, and the latent germ invisible, and yet, nourished by many generations, bursts forth with seemingly unconquerable strength. We do not share the opinions of criminal anthropology, espe- cially the Italian school, that declares itself helpless to grapple with the heredity fatality. Such conditions of helplessness open up a future of habitual crime. Criminality thus becomes a diseased state, an incurable neurosis, which has the dangerous excuse of incurability. Thereby we are brought face to face with a large number of criminals, who are victims of degeneration and con- taminated will, irremediable by any means hitherto adopted and employed. Through all our honest endeavors and discouraging failures we still cling to the hopeful doubt that perhaps heredity, or acquired perversity, may be strong only in proportion to the inadequate means of opposing the bad influence. Industrial schools have proved their superiority over dis- ciplinary and reformatory schools, because here the morally smit- ten children are ofTered the earliest opportunity to counteract the predominance of inherited vice by preventing rather than correct- ing evil. Nevertheless, the noblest efforts are constantly baffled, but will not allow themselves to be weakened. Searching for new means, the scientific study of psychological possibilities has finally enabled a plausible idea to become a demonstrable fact. Hyp- notic suggestion, which has unlocked many and varied sources of benefit to sufferers, today takes rank as a most valuable auxiliary to educational reform. A few examples may substantiate its claims to attention and sober consideration. A boy, aged sixteen, was sent to Dr. Voisin. His character had grown more and more unbearable, especially from his seventh year. He had been returned several times from various institu- tions as incorrigible and on account of being a bad example to others. He was spoken of as cruel and malicious, a liar and a thief, and had recently robbed his mother under peculiar circum- stances to satisfy his base desires. The third attempt to hypno- tize him was successful, and the result of the given suggestions was that he discontinued to steal. A treatment was given every three days, and after five weeks he appeared completely changed, having no desire to do evil, and was obedient and kind to his Suggestive Treatment in Reform Work. 155 mother. Later investigation found the boy's moral character good and no relapse had occurred long after all suggestive treat- ment had ceased." Dr. De Jong of The Hague, Holland, whose experience is very- extended, reports, from both his hypnotic clinic and his private practice, numerous and durable changes of many vices in depraved children. Dr. Wetterstrand of Stockholm, where he has a large clinic for hypnotic suggestion as therapeutic treatment, brings the same testimony, according to which early vice has been checked and eradicated without injury to other faculties. Dr. Lidbeault of Nancy gives many examples of children, who, in spite of the greatest care and effort on the part of parents and teachers, were behind in intellectual and moral development, but finally improved by hypnotic suggestion. The most remarkable is probably the case of a young idiot who never had been able to read or reckon, and who, after the lapse of two months, learned the alphabet and the rudiments of arithmetic. Similar results he has, obtained in cases of vicious, impulsive, obstinate and lazy children. These cases, embracing intellectual and moral idiots, alike, are facts of rare merit and most serious importance, commanding the attention of all those who have at heart the welfare of future generations. It is, no doubt, unnecessary to remark that the hyp- notic suggestion does not regard normal children, as those belong to the care of educational teachers. Only when, for some reason, no, impression can be made upon the individual in the waking^ state, the sleep suggestion is justified as possessing greater effect. The hypnotic suggestion is, therefore, to be used only when all other means have failed ; we know that, even then, its field would be large. Hypnotic suggestion creates nothing. It revives or deadens the spark for good or evil, latent in every human breast. It rushes to the rescue of the better self, and forces into the back- ground all lower instincts which ordinarily enfeeble and obstruct a healthy moral growth. As before said, its intensity is greater, its penetration deeper, than other means afford. The method is a natural one, and we have been subject to its influence before our birth through maternal impressions ; so also in our early child- Hfe, which imitates before conscious volition grasps the intellectual purpose. As Professor Bernheim has feelingly said, the mother is the most beautiful illustration of suggestive power. 1 5 6 Medical Letters. The student of the world's progress knows that what is rightly understood by hypnotic suggestion has today passed out of the domain of fancy and charlatanry. The theoretical opinions of those who merely believe this or that without practical knowledge has no value in the eyes of science. It is thus known that the individual will under hypnosis suffers no more harm than the body from an anaesthetic while the surgeon operates. The ob- stacle, which would prevent the best result, is but temporarily removed. If improperly applied, hypnosis may prove injurious, but it is so with all things in educational matters as well as in medicine. He who administers ether need not be a surgeon, and yet we would not select for that ofifice a man that was igno- rant of surgical principles. It may be an apparently easy thing to produce the condition necessary to suggestion, but an inex- perienced, not to say a malicious, person is not therefore a desirable or admissible practitioner. He might, perhaps, without any mishap, produce anaesthesia, but how would he operate? There is no more improvisation in hypnotic experiments from the medical point of view than in any other serious and respon- sible occupation. Even if he may be a physician, he is not able to perform an operation of any importance as well as a surgeon who, through practice, has acquired the needed skill. This ap- plies to hypnotism and hypnotic suggestion in the same degree, and it is one of the principal reasons why so few physicians un- derstand it, and do not succeed when they superficially make a trial. One might term it a more refined and higher degree of brain surgery, a kind of mental orthopaedics. As a valuable branch of modern medicine, it demands the knowledge that study and practice give, and not the mere smattering of worn phrases " glibly explaining (?) curious parlor experiments without a psj^cho- logical basis. The views of modern research upon this subject have been more fully set forth in my former articles upon thera- peutical suggestion, and need not be further alluded to here. Moralists admit that psychology forms a necessary and im- portant auxihary to their science. The physician who recognizes that fact can save much private and public misery by rendering an early assistance, and at a moment, perhaps, when a life's future is in the balance. As the true educator must be a psychologist, so the physician ought to be one. Modern medi- cine has entered upon a new era, and no longer is material re- search extolled at the expense of that more subtle one which Suggestive Treatment in Reform Work. 157 studies man's inner being. The use of a psychological factor does not interfere with the freedom of will, as Kant's moral prin- ciples are not violated by imposing upon either child or adult ideas not already existing as germs. Calling forth the best in human nature by rescuing it from the encroachment of its in- herent subliminal baseness is, indeed, to respect individual will. By strengthening man's better nature, he becomes a better judge of good and evil. It is, therefore, but pleading for the outcasts from our social world when an appeal is made that this new agent might co-operate to solve a problem of so much importance. It is more than a plausible idea. Years of laborious research have proved its practical value. Men foremost in scientific pursuits have testified to the legiti- macy of its claims. When the public has learned of this, when idiosyncrasies are set aside and systems become dependent upon their beneficial soundness alone, there will be a demand for the application of this agent to many of those plagues which now but seldom receive alleviation. The public must look with consterna- tion at the rapid increase of its insane population, at the multiply- ing of criminal progeny, and shudder at statistics which, for Massachusetts alone, for instance, give one suicide for every 225 individuals, and one death from brain disease in every ten persons. Cognizant of such facts increasing rather than decreasing, ani- mated by humane aspirations to stem the tide, knowing of a potent but hitherto untried remedy to cope with the misery ex- tant, the public will not refuse its sanction to try the salutary agency of hypno-suggestion, and thereby be able to judge of its merits as a social safeguard. The decision as to its intrinsic value cannot be reached through rhetorical efforts, but through sober and impartial application, testing the claims advanced, as now is done in regard to sanitary methods, vaccination and quarantine. POST-HYPNOTIC RESPONSIBILITY.' THE jurisprudence of Kansas has in these days given the country a solemn demonstration of applied psychology by sentencing to death not the murderer by fact, but the instigator of his crime. Hypnotic influence is said to have been exercised, and on the strength of this the murderer was declared irresponsible. His tempter went about it in a cunning though crude way, but none the less effective. He attacked a vulnerable point, love of name and home, pretending that the wife had been villified. This prepared the mind. His verbal suggestions after- ward did the rest, and the indignation and anger ripened into crime. Here we have to deal with a state of somnambulism. Those who observe and study these phenomena know that it is not the sleep that characterizes somnambulism, as it also has a waking state. The person must necessarily be suggestible. In certain ' This article was written ill January, 1895, at. the request of the Editor of the Boston Evening Transcrift, who desired expert opinion in regard to the decision of the Lower Tribunal in Kansas, declaring innocent a murderer, who had acted under the influence of hypno-suggestion, and sentencing to death the instigator to the crime. The Superior Court sustained the verdict in April, 1895. The facts in the case are that on May 5, 1894, at Winfield, Kansas, Thomas Mc- Donald shot Thomas Patten fatally, but pleaded in extenuation that he was at the time hypnotically influenced by Andrew Gray, who was found guilty of murder in the first degree. Although this case is one of the most extraordinary in American legal annals, it has had, however, its predecessors in the law courts of continental Europe. It is no new principle in law that the man who promotes and procures a murder to be done by another, is as much a murderer as he who actually took the life of the victim, but it is a higher and more difficult degree of legal justice to recognize and exonerate from guilt his instrument, than to condemn both, even with varied severity. At the present time, we do not possess any work on Legal Medicine treating profoundly and scientifically this point in law. The continuous advance of psychological study will undoubtedly soon make such a work a necessity, as the older ideas of testing relations between cause and effect are in- adequate to establish responsibility. Foremost among European works on this subject, we may refer to De la suggestion et du somnambulisme dans leur rapports avec la jurisprudence et la medecine Ugale. Jules Liegeois, Professor in the Faculty of Law, at Nancy, France. Paris, 1889. Author. 158 Post-HypHotic Responsibility. 159 individuals this condition presents itself with great facility, almost spontaneously. There is consciousness, but another than the one exhibited in daily life, one in which the reasoning faculties are lessened or absent, while the imagination, spurred and nourished by suggestions, even auto-suggestions, takes command. It is, in fact, another being whose moral resistance has been diminished by natural or provoked somnambulism, and thus impelled to acts of which the normal life was innocent, absolutely or in a high degree. This double personality we all carry with us. We may be known as Dr. Jekyll, but we might, under adverse circumstances, intro- duce ourselves as Mr. Hyde. Let us remember that the hypnotic suggestion never creates but merely develops the germ always present though imperfect. We know that this state can be in- duced by comparatively insignificant circumstances, can change back and forth under impressions received from external scenes, under the guidance of a well directed and firmly concentrated will, verbally or mentally. Here, the original impression of received injury was made more vivid and forcible by a growing need of energetic self-pro- tection, and the fatal purpose was further fostered and fixed in the mind by various correlative facts, for instance, the shooting practice. The initial deficiency of motive force had been over- come. Just as his personal interest had served to rivet the atten- tion, so it was strengthened by repetition and finally brought to a climax in a resolution to commit the act. It is in this resolution we find embedded the whole process of volition, as at this point there is not only a motive but a desire to act. There is also antici- pation of a result which has been prepared, and therefore from that moment the purpose cannot miscarry or end in a failure. The other self has emerged. The sub-region that existed as primitive material appears as a distinctly conscious existence. The hitherto unknown personality has been moulded for the crime and the murderer lies in ambush. The question now arises, " Can a morally sound person, either in the waking or sleeping hypnotic state, be induced to commit crime by suggestion of another party? " The Kansas jury has admitted that criminal suggestion is possible, and the schools of Nancy and Salpetrifere both support this view. The Supreme Court will now have to decide whether a criminal suggestion can affect an honest person. Five years ago the answer to these questions would have been 1 60 Medical Letters. negative, but today the weight of evidence makes it affirmative. In the cause celibre of the associates in murder, Eyraud and Gabrielle Bompard, at Paris, the latter was said to have become accessory to crime through Eyraud's hypnotic influence. In pro- nouncing sentence of equal responsibility before the law, the presiding judge declared that an honest subject resists a dishonest suggestion. If he obeys, it is not because his will is subjugated, but because he consents. Crimes can only result from experi- mental cases in clinics and hospitals and after long manipulation. If the individual yields to the crime suggestion, he becomes cata- leptic in the moment he attempts to commit the act. This high judge further said that in pronouncing sentence he remained indifferent to all scientific and philosophic consideration and was guided only by his desire to defend society in general. Were he to accept the plea of irresponsibility for an act accom- plished under the irresistible influence of a suggestion, it would be to plunge said society into anarchism of unpunished crimes. This dictum must have been inspired by the psychological experts opposed to the opinion of the Nancy school, and Charcot's name has been mentioned in this connection. It looked as if the Sal- p^triere school had scored a victory, but it soon became apparent that our judge had prepared for it a signal defeat. In fact, from that day its prestige suffered, and many who had previously sided with Charcot turned to Bernheim and his school, which to day numbers the majority of earnest and enlightened observers. The study now received a new impulse, and the problem that confronts us today is in regard to the degree of resistance which an individual can attain under criminal suggestion. It seems today sufficiently demonstrated by both schools alike, that an honest person can be influenced to commit crime. There may be hesitation and remorse, but the act is mo.st assuredly done. If often subjected to the same influence, the resistance diminishes, although even then he must finally obey the irresisti- ble force. Often this delay may be caused by doubt on the part of the one who makes the suggestion, or because he involuntarily or carelessly has given a counter-suggestion. A long interval between suggestion and execution may seem to efface, but cases have proved its vividness and thoroughness even to minute details after a year had elapsed. It is an error to generalize this resist- ance, as it varies according to the nature of the suggestion and the state of the somnambulist. Auguste Voisin. doctor at the Post-Hypnotic Responsibility. i6i Salp^triere, demonstrated a few years ago the above-mentioned judge's pompous conclusion a profound error. Before three learned judges hidden behind a screen, he hypnotized an innocent young fellow and suggested to him to murder a patient in the ward, with the result that he buried his knife in the sawdust of a manikin. He then walked quickly away, without becoming cataleptic, as was expected by the legal luminaries. Three days later he came to the doctor, full of grief because he thought he had committed a murder. The majority of observers agree that in certain individuals there exists complete automatism, whereby consciousness is totally suspended and the impulse to act an irresistible one. A very few still hold that the abolishment of moral liberty is but fictitiaus, that the subject discusses the value and the gravity of the suggested act, that he is compos sui in spite of appearances, that he can control himself if he wishes, and is, therefore, re- sponsible. To this can be answered that if a subject could be made to do only what was agreeable to him, such a fact would refute the existence of psychological automatism which is char- acteristic of the hypnotic state. Later, Charcot had also to admit that although an honest person may resist suggested crime, he finally commits it. Professor Pitres of Bordeaux holds that the physician who is asked to give his advice as to the degree of responsibility of a criminal by suggestion, ought always to insist upon his legal irresponsibility. MUSIC NOT SERMONS IN INSANE HOSPITALS. A RETROSPECTIVE glance upon the former conditions of the insane calls forth a warm appreciation of modern efforts to ameliorate the physical, as well as the mental, state of this unfortunate class. The time of dungeons and chains, filth and brutality, hand in hand with ignorant ideas as to the proper means of combating the disease, has given way to airy and scrupulously clean dwellings, a never ceasing endeavor to reflect the kindness and brightness of better fated lives, and thus to comfort and rekindle fading intellects. Our civilization pays in this manner its debt to victims of its own creation, to all those whom the ava- lanche of aspirations, both surfeited and starved, have maimed or crushed. Every day inaugurates some methods of' reaching the wants of this class, and it is characteristic of our time that they are preventive as well as restorative. We may also say that sen- timentality — the disappointing outcome of a former brutality — has collapsed with the failure of exclusively moral treatment car- ried to an extreme. The spirit of sentiment is left, embodied in a practical and broad form, which permits both restrictions and enlargements bearing upon general principles rather than idiosyn- crasies. The medical superintendence, therefore, has by its side a select body of citizens presumed to be sensitive to rational reform, and expected to consider only the intrinsic value of any means which might serve mutually to facilitate a humane work. It may have occurred also to others, who either have been occasional visitors to insane hospitals, or directly connected with them through active work, that the strictly religious feature of these institutions is of a decidedly non-committal character. It is a part of the programme hitherto undiscussed and undisturbed in its relations to place and circumstances. A question which might arise in regard to its existence is whether religious services may be considered useful or merely ornamental. We admit that whatever is done by a community for its mem- bers should give them the greatest satisfaction and leave in the homes of the afflicted ones a feeling of confidence concerning the l62 ] Music noi Sermons in Insane Hospitals. 1 63 discharge of public duty. It is, however, quite another thing if that same community, out of deference to traditional usage and in obeyance to its conservative spirit, would retard whatever might be more in keeping with modern views and practical phil- anthropy. In our opinion this would be the point to argue and the question to decide with respect to the present preaching to insane congregations. It must be borne in mind that insane hospitals are neither reformatories nor prisons, where we may hope that the ethics expounded will germinate and influence a later social life outside of those precincts. We might just as well hold to the former belief in exorcising evil spirits by spiritual therapeutics. In appealing to a rational consideration of this decidedly useless expenditure of energy and sentiment, we mean no irreverence to any creed. The minister may be a welcome visitor as long as these asylums continue to be also refuges for inebriates who are yet susceptible to spiritual advice and comfort. We mean dis- tinctly their insane population, as being unfit for his reformatory or comforting work. Any minister who has performed this duty must certainly, at the sight of his queer and unbalanced congre- gation, have experienced a feeling of despair at a task which can- not differ from that of the Danaides and their delusive hope of final success. He would, perhaps, also confess to a peculiar per- plexity with respect to his individual fitness for delivering a ser- mon to those who are justly considered alike unable to profit by a scholarly ora simple address. With scarcely an exception, any- one who has been a listener on such occasions, would sympathize with him in his embarrassing dilemma, whatever the insane them- selves may think of his effort in their behalf. Now the undertak- ing of furnishing religion to those who under such circumstances could not possibly derive any benefit therefrom, must be con- sidered a somewhat misdirected public duty, which beconfies even more objectionable when, from a spirit of impartiality, this pur- pose necessitates an array of creed and sect, in some hospitals represented by four or more ministers of as many denominations. If the insane inmates, therefore, do not profit by such a system, and there is still some advantage in it, then either the ministers or the institutions are the beneficiaries. Should its maintenance give us satisfaction on chiefly aesthetic grounds ? Impossible. It would at best either be bigotry or sham to make believe that this would enhance the value of these 1 64 Medical Letters. institutions, and that without it they would fall into discredit. We doubt if anyone would have the courage openly to advance an idea so preposterous and fanatical. As a mere ornament, a religious service would under such circumstances be but a grin- ning caricature, and one might equally well intimate that going to church for the purpose of seeing and being seen was a laudable religious instinct. These institutions, being dedicated to the alleviation of human misery, are in themselves religious monuments in the highest sense, and are pervaded with a genuine religious spirit when they carry out that noble aim tenderly and honestly. They need not give any extra assurance thereof and emphasize that truth by a quasi-7es.\}a.&\\c label, and the sooner such an understanding is reached, the better for the community at large, and for those whose dut}' it is to attend to its interests. We fondly believe that any ecclesiastical body will support our view. The question as to whether this useless custom might not also be injurious seems unavoidable, and yet it need not be gone into at present. Were a census to be taken of the unbiased opinions of the medical superintendents in the United States and in Europe, our exchanges with several well-known alienists render us confident of the fact that their replies would not be equivocal. By the modern treatment of insanity all exciting influences are carefully avoided, and on that ground no chance of recovery is neglected, always bearing in mind that a very prominent factor in the production of insanity is the absence of proper mental disci- pline and lack of control over the passions and emotions. Con- sequently there does not exist any coercion as to their presence at the religious services in insane hospitals, but in general those who are considered safe are admitted. Medical prudence, therefore, lessens considerably the risk of any ernotional shock to their irra- tional brains. However, it cannot be overlooked that the risk exists, and would therefore necessarily be ever ready to take effect from even the slightest cause. Of all agents able to soothe and comfort a nervously strained and vaguely conscious mind, musical harmony stands assuredly foremost. The power of its influence has been recognized as far back as the human record of fact and fancy. In the" Egyptian temples the cure of nervous disorders depended largely upon it ; an Orpheus subjugated the ferocious animal creation. David dis- pelled by his playing the gloom and frenzy of an insane Saul, and Music not Sermons in Insane Hospitals. 165 so on. We are all conversant with the fact, but we have hardly utilized it to its full extent. A step in this direction we witnessed some years ago in a London hospital, and, if we are not mistaken, a minister inaugurated it. The idea was to try the effect of music upon the sick. In a general sense it may be said that the music furnished by these Cecilia concerts was a wonderful comfort to the sufferers, whether it manifested itself by a listless or an eager attention. The experience proved, however, that for its success- ful application the music had to be individualized by adapting a different kind to each class. Already, from the outset, all stereo- tj-ped sentimentality was discarded, and it was clearh' understood that there should not be a monopoly of sacred music merely be- cause the audience was composed of invalids. It was simply carrying out an intelligent humane thought bent upon deriving the best results by the most practical means, and a study in which all could join with an honest endeavor to solve the problem. This disposition not to impose upon the feelings of their charity- guest by giving him a hymn when his condition required a sprightly melody by Strauss and vice versa, seems to be the only laudable way of dispensing a good thing and of preventing its being spoiled by settling into ruts." There is nothing very different to be said with regard to an insane audience. The fundamental fact exists in this case also, and by making an intelligent study of individual needs, no com- plicated classification would become necessary to bring the beau- tiful treasures of music to souls that words cannot reach. The musical sense of insane persons is rarely impaired as an impres- sional factor, but, on the contrary, is often a very marked feature. A well-known psychiater. Dr. Wildermuth-Statten, has recently observed a number of idiots with the result that out of 150 such children and adults only eleven per cent seemed to lack com- pletely all musical aptitude, while a third manifested it in an un- mistakable degree. Even where there was complete idiocy, among thirty he found an absence of all reaction indicating pleasure or ' The Medical Magazine, England, has lately given some details in regard to more recent results obtained by the society known as " Guild of St. Cecilia," endeavoring through music to relieve or cure diseases in private or hospital practice. In one hospital 50 per cent gained sleep ; in another the temperature of seven out of ten fever patients was lowered and became almost normal whenever suitable music was performed. The experiment seems, so far, to have proved satisfactorily that music exercises a considerable influence upon the nervous system, the digestion and the circulation. Author. 1 66 Medical Letters. annoyance in only five, and yet he is led to believe that these received sound-impressions. All the others expressed the musical influence by sympathy or antipathy, according to the choice of subject. Surely this investigation encourages rather than limits our field of activity in behalf of sufferers, be they sane or insane. There is no doubt a great deal done at present in every insane hospital toward the entertainment of its inmates in musical as well as in other directions, and in some instances the appropriations are not stinted for that purpose ; but still we hold that a great deal more can be offered, beginning by removing what is but the legacy of routine thought or misunderstood kindness. It need not swell the expenses to any alarming extent either. Why should not, for instance, the attendants, male and female, form a singing society ? It would be a pleasant distraction from their dreary task, and by providing for their patients a source of enjoyment, they would at the same time fit themselves better for the mo- notony of their duties. This seems at any rate one way of ap- proaching the problem, both agreeably and practically. Also, in a city where so much music is given to the inhabitants, there would be nothing Utopian in wishing it extended to lessen pain and to illuminate, were it but for a few moments, minds which are clouded and ill at ease. The medical profession would wel- come such delicate aid, and assist the effort with heart and soul. This future "music mission" would, with the already existing " flower mission," present a graceful pair, whose proudest adorn- ment would be the thanks of thousands. Stanbarb fiDebical ipubUcations. BERNHEIM. Suggestive Therapeutics. A Treatise on the Nature and Uses of Hypnotism. By H. Blrnheim, M.D., Professor in the Faculty of Medicine at Nancy. Translated from the second and revised French edition, by Chrisiian A. Herter, M.D,, of New York. 8°, cloth $3 50 " Nowhere else will the reader find so complete an account of the manipulation of hypnotic suggestions used to cure diseases ; and the preferences of the author do not lead him to lengths which are not fully to be accounted for by his natural enthusiasm and the seductive nature of his %\i\y\^a.."— -Medical and Surgical Reporter. The book is both thoughtful and practical, and claims thorough reading and earnest con- sideration. It contains truths without seme grasp of which no physician is fit for his charge." —N. E, Medical Gazette. CUTLER. Manual of Diflierential Medical Diagnosis. By Condict W. Cutler, M.S., M.D. I6^ cloth . . . . . $i 25 " This manual has decided merit, and will commend itself to every one engaged in the study of medicine. . . . The author displays rare skill and judgment in contrasting disease. His differentiation is clear, but not too sharply drawn, and displays extensive labor and research as well as practical knowledge." — N. Y. Medical Joiirnal. DAWBARN. An Aid to Materia Medica. By Robt. H. Dawbarn, M.D. Revised and adapted to the U. S. Pharmacopoeia of 1890, by WooLSEY Hopkins, M.D. 16°, cloth $1 25 " Such a work as this is especially important to students because examiners require much that the practitioner soon lays aside. ... We are sure that no intelligent practitioner can afford to neglect to place this little book upon his working-table and always keep it there." — A fnerican Lancet. " This book will be found extremely interesting.'' — yournal A ni. Med. Ass^ n. HERSCHELL. Indigestion. An Introduction to the Study of the Diseases of the Stomach. By George Herschell, M.D., London. Second edition, revised and enlarged, 12°, cloth . . . . . $2 00 HERTER. The Diagnosis of Diseases of the Nervous System. A Manual for Students and Practitioners. By Christian A. Herter, M. D., Physician to the Class of Nervous Diseases, Presbyterian Hos- pital Dispensary, New York City. Illustrated, 12°, cloth . . $3 00 " We do not hesitate in saying that it is one of the best books we have seen. It shows that it is the product of a well-ordered mind." — Medical Journal. KRAFFT-EBING. An Experimental Study in the Domain of Hyp- notism. By R. VON Krafft-Ebing, Professor of Psychiatry and Nervous Disease in the University of Graz, Austria. Translated by Chas. G. Chaddock, M.D., A.ssistant Physician, Northern Michigan Asylum. 8°, cloth . . . .... |l 25 " This little monograph by one of the greatest alienists in Germany has already become classical ; and amid the mass of rubbish written on hypnotism, it stands as one of the few exhaustive scientific studies. It is with pleasure, therefore, that we greet the work in a form accessible to the English reader."— .Soi/<;» Medical and Surgical yournal. LETCHWORTH. The Insane in Foreign Countries. Notes of an Examination of European Methods of Caring for the Insane. By Hon. W'M. P. LETCHWORTH, President of the New York Board of Charities. 8°, with many illustrations ... .... $3 00 *' Every person interested in the welfare of the insane poor, and the provision made for their protection and support in different countries, will find this a most interesting and valuable volume ; and equally so whether such person be a physician or not."— yournal of the A meri- can Medical Association. MEDICAL REGISTER (The), of New York, New Jersey, and Connecticut. Published Annually under the supervision of the New York Medico-Historical Society. Edited by John Shrady, M.D. 12°, cloth . ■ $2 50 MORRIS. How We Treat Wounds To-Day. A Treatise on the Sub- ject of Antiseptic Surgery which can be understood by beginners. By Robert T. Morris., M.D. 16°, cloth . . . . $1 00 Lectures on Appendicitis, and Notes on other Subjects. By Robert T. 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