I have been called upon to treat two cases of ' phantom limb,' after amputation, by hypnotism. The treatment seems to be thoroughly indicated in such cases, and it was a great disappointment to find that neither patient was hypnotizable. The first patient was a gentleman of sixty, whose leg had been amputated a few weeks previously. He had intense pains, which he referred to the missing limb. I made many attempts to hypnotize him, but without result.

The second case was that of a colonial gentleman whose arm had been badly shattered by a gun explosion, and had been amputated at the shoulder. For more than ten years he had suffered greatly, especially in damp weather, and he referred the pain to the thumb and fingers.

He also proved quite insusceptible. But I feel confident that hypnotic suggestion is the ideal treatment in such cases, for it exactly fits the indications. They correspond to hysterical joints, which are so troublesome to deal with. The pain, though referred to the joint or limb, depends upon central irritation, and is caused by the unhealthy condition of the cortical cells functioning the part.

Van Eeden tells me that he has seen a case of phantom limb and epilepsy cured by hypnotic suggestion at the Amsterdam Clinique. The patient had had his arm amputated after an injury, and developed traumatic epilepsy. Each fit was preceded by an aura which took the form of a forcible elevation of the amputated limb, accompanied by intense pain. This is a case in which, if hypnotism had failed, one would have urged trephining, and operation on the arm centre in the cortex.

The new theory of nervous action promulgated by Golgi and Ramon y Cajal throws light upon this condition. They have demonstrated that the neurons form combinations through their branches, or dendrons, not by continuity, but by position. When a nerve-current passes from one neuron to another, it does so by their respective dendrons interlocking or embracing, and the current is made in a manner analogous, probably, as Dr. Hedley thinks, to that seen in the coherers of electricians.

When the contact is not complete, no nerve-current or impulse can pass, but a nerve-cell once serving for the passage of nerve-currents undergoes an alteration which allows of a more ready passage of a similar current on a future occasion. Neurons tend to form combinations or 'sets' - to use the language of the compositor - and these ' sets' correspond with habits of thought and their accompanying actions.

Bodily conditions are registered in consciousness, and their physiological expression is the arrangement of the neurons. When the cause of the disturbance of function in a part is removed, the ' set' of the neurons should fall back into its normal position, and pain and discomfort cease to be registered in consciousness; but in some conditions of ill-health the neurons may remain in their abnormal condition, and the subjective symptoms therefore continue.

Thus, in the case of hysterical knee, some injury occurs to the joint, and swelling, stiffness, and tenderness ensue, with pain on movement. These symptoms are registered in consciousness, and a corresponding 'set' of the neurons is the result.

Under ordinary circumstances, as the inflammation subsides the 'set' of the neurons tends to fall back into their old arrangement, which is associated in consciousness with a supple and painless joint. But it sometimes happens that the nervous arrangement does not change with the disappearance of the cause, and the idea of pain and disability continues and becomes fixed in the mind.

Successful treatment must operate centrally by restoring the neurons to their normal relationship and breaking up their faulty 'setting.' Much depends upon the capacity of change and of disjunction or conjunction in the field of contact. This is termed the plasticity of the neuron. Habit implies increased plasticity, and organic memory depends upon plasticity acquired for the good of the organism. In infancy and youth the connections are less rigidly set than in adult life, and consequently it is easy to direct and modify them.

NOTE. - The following cases further illustrate the use of hypnotic suggestion in general practice. During a recent epidemic of influenza I was called to attend a young woman who, in addition to the usual symptoms, was suffering from congestion of the right lung and erysipelas of the face. She complained very much of frontal headache and pains in the limbs, and had not slept the preceding night. The eyes were completely occluded by the erysipelatous swelling, and she experienced much heat and aching in them. I asked her if she would like to sleep and get rid of some of her pain, and she naturally replied that there was nothing she more desired. The ordinary method was out of the question, as she could see nothing, so I gently stroked her forehead and suggested drowsiness and sleep. This simple process rapidly induced somnolence and tranquillity, followed in less than ten minutes by a deep sleep, which lasted for two hours. The patient awoke greatly relieved by the physiological rest the system had enjoyed, and made a good recovery under the usual remedies.

Of course, I do not contend that hypnotism is curative in erysipelas, congestion of the lungs, or any other acute disease; but from a number of experiences similar to the above I know that it quiets the nervous erethism which is so distressing a symptom in many acute cases, and puts the patients into a condition most favourable for recovery and for the action of drugs. I have found it useful as a palliative in cancer and other painful and incurable diseases. The following cases present features of interest:

1. Hystero-epilepsy for five years in a girl aged fourteen. Attacks were caused by touching the region of the right breast (a hysterogenic zone), and were characterized by convulsive movements of the right side. In addition there were nearly daily attacks of what looked suspiciously like epilepsy, with occasional biting of the tongue, and followed by languor and drowsiness. The girl had been an in-patient at several hospitals, without much benefit. After being hypnotized seven or eight times she began to improve. There is now no longer a hysterogenic zone, and she had no fit of any kind for five months. The catamenia, which had been suppressed for six months, did not. however, reappear, in spite of suggestions made to that effect.