What we do not know is why a warm bath is beneficial in one case and a cold one in another, why static electricity succeeds in one case and the galvanic current in another, quite apart from the question whether these methods have only a mental action or not, or whether spontaneous improvement may not be mistaken for the effect of the remedy applied. Certainly these considerations do not agree with the fairy tales which many authors tell us about "exact indications," and which Ewald seems to have believed in when he tried to place hypnotic treatment on so low a grade. Medicine consists to a great extent in the careful selection, by trial, of that treatment which seems most suited to each case. This by no means disparages the functions of the physician; at the most it militates against medicine's claim to being considered an "exact science." It is just because the indications are so often indefinite that the physician is necessary; it is for him to decide from his own observations whether the remedy employed is acting beneficially, and should therefore be persevered with, or not.1 It is the same with hypnosis. We can put forward general indications for its use, but we cannot guarantee a cure in any particular case.

Ewald overlooked the fact that there are rarely definite indications in internal diseases, as may be clearly seen by comparing various text-books, and from the numerous contradictory statements made by different doctors. He also overlooked the fact that the indications for hypnotic treatment are quite as clear as those for treatment by electricity, massage, drugs, and baths.

1 For further details see Arztliche Ethik, by Albert Moll; Stuttgart, 1902, p. 476 et. seq.

Before proceeding to discuss the general indications for hypnotic treatment, I must say a few words on the idea conveyed by the term "hysteria." Unfortunately, several authors - chief among them Mendel, of Berlin - have done much to obscure hypnotism through the very vague meaning that attaches to " hysteria." Binswanger admits in his great monograph on the subject, that no definite idea has yet been constructed that would enable us to recognize hysteria as a clinical entity, a well-defined nervous complaint. In reality, the question as to what is meant by hysteria is considered from two totally different points of view in the present day, the theoretical and the clinical. " All morbid bodily changes caused by ideas are hysterical." This is Mobius's conception of hysteria, and it is accepted by many other authors. Eulenburg takes essentially the same view, which also agrees to a certain extent with that finally held by Charcot. There is justification for Mobius's definition from the theoretical standpoint, and also from Binswanger's not quite identical view that all hysterical morbid phenomena are indissolubly connected with functional disturbances in the cerebral cortex, though Binswanger explicitly explains that he does not mean solely disturbances of mental origin.

No matter how well-grounded these theoretical definitions may be, we have to reckon with the fact that a theoretically constructed conception of a disease does not as a rule cover the clinical conception of the malady, unless investigation has led to a definite result - i.e., unless the clinical material has been sufficiently examined and classified from the theoretical point of view. Unfortunately, we cannot say that this has happened in the case of hysteria. But the confusion of such theoretical definitions with clinical ideas has led to much misunderstanding. It is not so long ago that we in Germany described hysteria clinically as a disease of an essentially functional nature, and then again as typified by the multiplicity and variability of its symptoms. Certainly there has been a change in this respect during the last ten to fifteen years, and we no longer consider that the multiplicity and variability of symptoms justify the diagnosis hysteria. But this by no means implies a fusion of the clinical picture of hysteria as recognized to-day with the theoretical definitions given above, and it may well happen that when several authors write of hysteria each means something different from that discussed by the others.

Mobius tries to avoid this difficulty by pointing out that hysteria, in his sense of the word, may be accompanied by symptoms which do not belong to hysteria; he considers such symptoms - e.g., the hysterical character and hysterical mental troubles - complications, and not symptoms, of hysteria. Other observers think these phenomena essential symptoms of hysteria. From all of this it is easy to see how great a difference there is between the clinical and the theoretical idea of hysteria.

Indeed, as already pointed out, the word hysteria is variously employed in a clinical sense, and by using the term in one sense or another at pleasure erroneous conclusions are drawn which even many doctors fail to recognize. We have seen that it was at one time almost universal in Germany - it is so, to an extent, in the present day - to consider hysteria a functional disease which has numerous and variable symptoms - to-day one symptom, to-morrow another predominating; now headache, now ovarian pain, now pain in the side, and now weakness in the legs, etc. The patient is called "hysterical" as well as the symptoms. As such patients are sometimes obstinate and capricious, this word "hysterical" has a somewhat unpleasant after-taste; some authors go so far as to say that a tendency to falsehood and hypocrisy is a chief symptom of such hysteria. This is evidently an unfair generalization. At all events the multiplicity and variability of the symptoms are the main characteristics of hysteria taken in this sense.

In another sense the word "hysterical" has quite a different meaning. It is used to describe morbid symptoms which have no anatomical basis and which are therefore merely "nervous" - e.g., headache, pains in the muscles, certain tremors, vomiting, etc.; even when the symptom is solitary and constant. Now, if in such a case the patient, as well as the symptoms, is to be called "hysterical," we have two totally different meanings for the clinical conception of a "hysterical patient."