We are all familiar with the classic experiment of pretending to bleed a condemned criminal to death and actually causing his death, though no blood was really shed. This experiment shows the remarkable power of suggestion in producing illness. I have seen a number of cases near death from imaginary disease; but have not seen any actually die. Hysteria is a common disease in which imagination plays so large a part, that it might almost be considered as imaginary; but there is a real basis, usually, for the symptoms in some functional disorder and sometimes in organic disease, such as gastro-intestinal catarrh. Indeed, so frequently do we find atonic-dyspepsia and gastro-intestinal catarrh associated with neurasthenia and hysteria, that many have been inclined to regard the latter diseases as symptoms of the former, and more especially so from the fact that treatment which improves the digestive tract always results in coincident improvement of the nervous phenomena.

On the other hand, however, purely suggestive treatment, by benefiting the nervous element, often results in improved digestion. The best results are to be obtained by using both methods. Medicines and diet not only act directly upon the alimentary tract, but aid in suggesting cure, and give faith in assurances of improvement and recovery, by relieving disagreeable symptoms. That fright, grief, and worry are capable of stopping the flow of gastric juice, and thereby causing aggravated forms of indigestion and malnutrition, is a well known fact, and one susceptible of easy physiological explanation. That imagination is capable of producing an enlarged and tender knee joint, with most of the physical signs of inflammation, as has been proved by Dr. Weir Mitchell, is not easily explained, but is none the less a fact.

It, therefore, becomes a difficult matter to draw a sharp line between imaginary diseases and functional diseases, or even between imaginary diseases and organic lesions. There are many ills, however, such as mechanical and chemical injuries, and germ diseases, in which imagination cannot bear a causative relation. But, even here, suggestion may aid recovery, by preserving a healthy nutrition. It has no effect upon the micro-organ- isms causing the disease; nor can it hold a broken bone in place. But it may so aid nutrition that the body cells will produce more and better antitoxin, and more and better plastic material for uniting a bone held in place by suitable splints. Suggestion cannot remove a needle from the flesh, but I have seen it completely relieve the pain, when the patient was made to believe it had been removed.

In general terms it may be said that suggestion is a valuable factor in the treatment of disease, but that it should seldom be employed to the exclusion of other remedies and never to the exclusion of other remedies that are clearly indicated. Even in imaginary diseases the best results are attained, at times, only by the combined use of hygienic, dietetic and medicinal treatment, with careful and persistent suggestion. It should, therefore, only be used by competent physicians,* as morphia or other powerful drugs are used. It takes a well educated physician to decide whether a disease is imaginary, or due to some dangerous anatomical lesion. A man with appendicitis may have his pain relieved by morphia or by suggestion. For pain is greatly aggravated by the belief that it is dangerous, and if the patient can be persuaded that there is nothing serious the matter, he will bear it with amazing fortitude and cheerfulness. Indeed, if his belief is absolute, it will practically abolish pain. But neither morphia nor suggestion are good treatment for appendicitis, until the offending member has been removed, for neither will prevent perforation of the bowel, peritonitis and death.

After the real danger has been removed either or both may be judiciously used to facilitate recovery.

In order to use suggestion to advantage it is of prime importance to have the confidence of the patient, as its effectiveness will be in direct ratio to the degree of belief he places in the statements of the operator. There are several ways of gaining this confidence, but only one legitimate way. The method of the quack has ever been by the display of novel and striking machinery or ceremony, coupled with loud assurance of power, and numerous testimonials. Many persons are impressed by such methods, when they will not admit it even to themselves, and while outwardly scoffing. The legitimate method of the true physician is to have the real power of knowledge and use it with scientific accuracy. This is the slow and laborious way; but even the successful quack, who has left it, under the temptation for quicker returns, often wishes himself back in the legitimate track, knowing that his career will be short. The day of bluffing in medicine is fast approaching its end. The man of real ability and honesty will gain a reputation for these qualities sooner than he thinks, and this reputation, once established, will go far toward giving him the confidence of his patients. If he will then display to them a kindly and sympathetic interest, the thing is done.