This is, of course, quite a different thing to 'absent treatment' as understood by Christian scientists and mind healers. 1 recently received a letter from a gentleman of Colorado Springs, U.S.A., suffering from tabes dorsalis, asking me to treat him mentally, and requesting to know my fee, and if I guaranteed a cure. The public still needs a good deal of educating in medical matters ! of fact the treatment is often most successful in them (vide p. 232 et seq.).

I have twice been called in to see what hypnotism could do to procure euthanasia. In one case the medical man in attendance was afraid to give narcotics on account of the state of the heart, and in the other the patient begged that nothing should be given to her to make her unconscious. Hypnotism soothed their last hours to a remarkable extent, and afforded the greatest comfort to the relatives. It should certainly be thought of in cases where the patient's last hours are embittered by excessive irritability and restlessness, and there are reasons against giving drugs.

Dr. Woods (loc. cit.) relates his experience, and gives most gratifying testimony as to his success in over 200 cases which he had treated by suggestion. These comprise many very bad cases of chronic alcoholism, mental disease - chiefly melancholia with delusions - headache, neuralgia, lumbago, gout, dyspepsia, epilepsy, chorea, and writer's cramp. His results correspond with those obtained by other observers. Dr. Woods states that he is often successful in curing his patients by-suggestion alone without hypnosis.

Such detailed experience as that of Dr. Woods is most convincing and valuable. It is corroborated by medical men all over the world. For instance, Dr. Creed, of Sydney, New South Wales, who uses hypnotism extensively in his practice, says, when a good hypnotic subject has a bone fractured, hypnotism will not set the limb or directly repair the injury, but it may assist recovery by preventing pain and muscular spasm, and giving sleep and appetite. In a case of pleurisy he so completely removed the pain by suggestion that only the most careful physical examination and the continuance of an abnormally high temperature convinced him that it was actual and acute pleurisy.

He relates success in many very bad cases of chronic alcoholism and the morphia habit. He considers it specific in insomnia, and most efficacious in asthma and in heart symptoms, even when dependent on organic disease. He has seen it helpful in relieving the severity of epilepsy, and curative in several severe cases of chorea.

He has used it in several cases of gastric ulcer, and speaks with enthusiasm of the results he has obtained. He finds, he says, the stomach can, if pain be prevented, digest a fair quantity of nourishing food without difficulty; and the cessation of the state of semi-starvation in which the patient has lived soon brings about such an improvement in nutrition that the ulcers heal. He finds it very successful in curing vomiting, and in preventing seasickness. He says: 'For obstinate vomiting I believe that in suggestion we possess a remedy which will prove effective when all ordinary ones have been tried and failed.' He also advocated hypnotism as the best remedy for megrim, incontinence of urine, and many forms of neuralgia; and affirms that no good hypnotic subject need suffer from sea-sickness.

Van Renterghem gets more cases of neurasthenia than of any other disease in his clinique at Amsterdam, and reports having treated 118 cases during the four years from 1893 to 1897. Of these, eighty-six were men and thirty-two women. He states that thirty-one were cured and sixty-one were much benefited by hypnotic treatment - a very good showing in such an intractable disease. Neurasthenia, Savill and other authorities teach, depends upon so many causes that it does not do to treat every patient alike. Tolle causam is as important an axiom here as in any class of case. If the condition depend on central nervous causes, such as mental shock, overwork, excessive venery, or if it follows debilitating disease, like typhoid fever or influenza, I believe hypnotism is the best treatment, and that it alone will cure the patient cito et jucunde. If the neurasthenia is the result of mal-assimilation and fermentation of food, suggestion will help to promote eupepsia; and whatever the cause, it will, if the patient is hypnotizable, relieve the mental gloom which weighs him down, and thus hasten his recovery. Neurasthenic patients are apt to be difficult.

Being self-centred and of low vitality, it is not easy to gain their attention; and they are, as we all know, inclined to be sceptical, hopeless and averse to giving treatment a fair trial. They constitute a large proportion of those patients who enter the physician's consulting-room with the announcement that he is the thirtieth or fortieth doctor they have consulted, and that no one can do them any good. I need hardly say that each failure has acted as a strong counter-suggestion to cure, and that the last state of such people is likely to be worse than the first. Success in the treatment of these cases depends a great deal on the doctor being able to inspire confidence and to employ suggestion, whether with or without hypnotism.

Neurasthenia is a very interesting study. A few years ago it was hardly recognized as a pathological entity, and Sir W. Gowers dismissed it in a few paragraphs in the first edition (1888) of his great work on Nervous Diseases. Now there is a mass of literature on the subject, and half our patients seem to be neurasthenic, more or less. Its successful treatment by hypnotism well illustrates the power of suggestion in diseases of nutrition and function. As Dr. Savill and other writers show, a leading feature of neurasthenia is disturbance of digestion, with excessive fermentation of food and dilatation of the stomach and colon: a vicious circle is thus set up of auto-intoxication and nervous atony. Most authorities think the primary fault lies in the brain, and there is no doubt about this being the case in neurasthenia following injury or mental shock. * The indications for treatment are restoration of sleep, which is nearly always impaired, and of tone to the digestive organs. This may be done in many cases by careful dieting and the use of electricity; but if the central nervous system is at fault, the disease is best attacked through it, and here hypnotism proves a most valuable ally. It makes an appeal to the head office direct, instead of addressing the departments in detail.

The sympathetic nervous system is largely responsible for most of the phenomena of hysteria and of many of those of neurasthenia and allied conditions. It is not under the control of the ordinary will or consciousness, but can be profoundly influenced in the hypnotic and allied states, as is seen by the occasional production of stigmata in religious ecstasy and of inflammation of the skin by suggestion in deep hypnosis. It is this action on the sympathetic system - the brain of systemic consciousness and organic life - through the highest cortical centres, constituting the ultimate court of appeal, that enables us to effect cures of functional and relief of organic troubles by suggestion. In a successful case it is very striking to see how the objective symptoms, such as distension of the stomach, and mucous colitis, rapidly improve together with the subjective ones of mental depression, painful sensations, etc. Food is properly digested, and fermentation, with its resulting auto-intoxication, is arrested.

I relate later on several cases from my own and other physicians' practices to illustrate these points, and I strongly advocate the use of hypnotism in the early treatment of the disease before the patient's constitution is seriously affected, before he has lost confidence in doctors and remedies, and before he has become hypochondriacal and hopeless. There is only one serious drawback to hypnotic treatment in neurasthenia - inability to fix the attention is one of the characteristics of the disease, and that and a low state of vitality render hypnosis difficult. Sometimes one meets with very susceptible neurasthenic subjects, and in such cases I look upon hypnotism as the ideal remedy. During hypnotic rest repair and recuperation of the weakened organs proceed rapidly, physiological rest of the damaged central nervous system is assured, and a short cut to complete cure is within our reach. But, as Savill points out, neurasthenia is a very chronic disease, and requires time for cure. He gives a month's treatment for every year it has lasted. Hypnotic treatment is apt to be so brilliantly successful in its first effects in good cases that both patient and doctor are likely to be rendered unduly confident.

I had this experience many times formerly, and found that disappointment and reaction often followed these exaggerated expectations. The first thing to do is to build up a strong reserve of nerve force, for the patient has been living from hand to mouth, as it were, for months or years. This takes time; and we must insist on the essentials of rest, careful dietary, open air, and proper exercise being maintained. The restoration of natural sleep and the establishment of natural action of the bowels are among the first-fruits of successful hypnotic suggestion. *

* ' Dyspepsies Nerveuses et Neurasthenic,' par Dr. Paul Glatz Bale et Geneve, 1898.