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NOTES, COMMENTS, AND ABSTRACTS

HYPNOTISM *

BY HILDRED CARLILL, M.D. Camb.PHYSICIAN TO WESTMINSTER HOSPITAL

HYPNOTISM has been known for centuries and

probably it was discovered indirectly by the effectsproduced in the laying on of hands. It remains

mysterious and it will never cease to interest, butas it has come into line to some extent with modernpsychological conceptions it is no longer regardedas magical or occult. By its means a process ofunconscious motivation has been demonstrated,and also the probability of a series of mental levelsat which different processes take place. It is difficultfor anyone to get a grasp of the subject merely byreading, and it is no less difficult for the hypnotisthimself, even in the presence of the results which areproduced. Hypnotism can be described althoughit cannot be explained and, although no one fullyunderstands it, an account of an individual experiencemay be helpful. My own experience is derived frompractice as a general physician, and a habit of inquiryis set against a poverty of knowledge and a stillgreater poverty of understanding. The directionof a man’s thought is necessarily guided by theexpression of the thoughts of others, and in this sensethere are many to whom I owe a debt ; but what Ishall say here is drawn from my own experience.

Some General Considerations

The ability of any individual to hypnotise certainpeople is probably universal, but there are not manywho have the wish to try their hand at it. Possiblythere are many patients who remain uncured becauseof this. On the other hand, the capability of a manto be hypnotised, quite apart from those who havecertain varieties of insanity, is probably not universal.A madman, may be a hypnotist. If a hypnotistbecomes insane it will not be solely because he isa hypnotist. Delusions of magnetic influence and thehypnotic power of secret societies are common.

Some hypnotists can be hypnotised, but T have notheard of anyone who can alternate with the sameindividual the role of hypnotist and subject. Never-theless, in terms of the activity displayed, it is thesubject rather than the hypnotist who excels, althoughhe does so in a negative sense. The hypnotistis not aware of anything proceding from him tohis subject and any fatigue he may feel is due eitherto time or to his anxiety to succeed, conditions whichare merely incidental to his association with thepatient. I have wondered whether a man who ishypnotised can of his own volition hypnotise someoneelse.Some writers explain the phenomena of hypnosis

in terms of two factors, dissociation and increasedsuggestibility. These are related to each other, butthey are not identical. They mutually interact, butnot invariably, and each may occur in the absenceof the other. Dissociation with consequent loss ofidentity, which is spontaneous in the sense that nocause is apparent at the time, occurs fairly commonly,and often it is amenable to hypnotic treatment.whereas the very similar dissociation which followsepilepsy and cerebral trauma is not. Day-dreamsalso are common and probably there is a tendencytowards dissociation in everyone, owing to emotionalconflicts.In 1918 I treated a soldier for complete loss of identity.

His condition was associated with a resumption of theattributes of babyhood. The illness occurred suddenlyin England three months after the cerebral corrmotionin France to which it was attributed. He had not suffered

* A lecture-demonstration to the London Hospital MedicalSociety on Feb. 8th, 1934.

a skull injury. He was taught as a baby is taught. Aftertwo months he suddenly recovered his identity but atthe expense of all he had been taught, and cnce againhe had to be educated.

Some say that it is only hysterical patients whocan be readily hypnotised and that hypnosis is anartificially produced manifestation of hysteria. Thehypnotist thus exploits their extra-suggestibilityand makes use of it further to impose his suggestion.The subjects of hysteria however are far from beinguniversally hypnotisable. Healthy people have thefaculty of becoming extra-suggestible when they arepassing into natural sleep, and a man who cannotby any standard be said to be hypnotised may acceptsuggestions more readily then than at any other time.Complete and permanent psychological good healthis uncommon. It appears to depend on the efficiencyof repressing forces, for the subconscious minditself never sleeps..A man who is psychologicallyill may or may not be hypnotisable, but a man whois psychologically whole must be regarded as

unhypnotisable. If we assume for the sake ofdescription that such a man is hypnotised the inferenceis that the estimate of his health was inaccurate,and in any case the train of dissociation which heembarks on makes him, in this sense and from thatmoment, a hysterical patient.

There is no universal law of conduct in hypnosis.Patients show degrees of ability to accept suggestionand maintain its influence even although the inductionhas been easy and an apparently deep sleep has beenproduced. Symptoms may persistently resist pro-longed counter-suggestion, even although the causeappeared to be clear enough to both parties beforethe induction and although no fresh facts emergedfrom hypnotic conversation. In some of these cases,however, the cause does not emerge even in hypnoticsleep and the obscurity may prove to be due to thehypnotist having been misled by the story as narratedawake and thus having covered in hypnosis a partonly of the patient’s life area.

Hypnosis of itself does not help a sick man although,often, involuntary movements cease and, always,so it is said, a stammerer speaks without a stammer.I have seen several cases in which movements haveceased at the moment of transference, but have erecurred at once and persisted.In 1919 I treated a soldier for mutism. He had enlisted

in 1915 and became a corporal. He had stammeredoccasionally since childhood but only when he was excited.In November, 1916, he stammered at the moment ofgiving an order and two months later, when he was inhospital, he became mute. When I first saw him threeyears later he was still mute and every attempt to speakwas associated with clonic spasm of his jaw. I hypnotisedhim, and so did others, but the spasm persisted and heremained mute even when the jaw was held.

In natural sleep hysterical palsies and spasms maydisappear, but in hypnotic sleep suggestion is necessaryif they are to be cured and the deformity of spasmmay need manipulation. Hysterical rapid breathinglikewise remains unaltered. It is sometimes saidthat in hypnosis the uncritical element of the mindbecomes dominant at the expense of that which wasdeveloped later, but a hypnotised man may neverthe-less wake spontaneously, at any rate from the earlierphases of dissociation, rather than accept suggestionswhich involve antisocial conduct.

It is unjustifiable to employ hypnotism save for aspecific medical purpose. There is no discredit indissociation either when it is spontaneous or induced,but nevertheless it cannot, by our standards, beregarded as laudable. A subnormal intellectualefficiency is implied. A man who has been repeatedlyhypnotised may become so dependent on his hypnotistthat he cannot maintain his improvement in hisabsence, and moreover a blind obedience may resultwhich can be embarrassing and even dangerous.

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The Purposes of HypnotismIn any consideration of hypnotism it is right to

think carefully about the ways in which a patientmay be helped. There are two legitimate purposesand they often interact. They are investigation andtreatment. There is a third reason, which is subsidiaryto and included by the others-namely, the teachingof doctors. A hypnotist discovers by trial what iscalled his power, but he does not try until he haswatched the technique of others.

Consciousness is not the whole of mental life,and the purpose of investigation is for the discoveryof forgotten experiences. These can often be provedto act harmfully, in the form of conflicts. They arenot recalled by the patient after he is waked, and itis the hypnotist who makes use of them, both whenthey emerge and afterwards. He employs his freshknowledge in such a way that the patient’s mentalcontinuity is restored and phobias and split person-alities are thus sometimes resolved. It is necessaryfor the hypnotist to employ a correct and sufficienttechnique and instruct the patient if his experiencesare to be recalled. Hypnotism is by no means theonly way of achieving this. All emotions, motives,and experiences are stored in the mind. A manduring the course of general ansesthesia may speakin a language which he has completely forgotten andwhich indeed he may deny having ever known.Some people are able by a natural effort to recall tomemory very distant experiences, but the memoryof most seems to become automatically better in

hypnosis. The truth emerges, uncoloured by thefaults of memory. A man in open conversation maypurposely withhold his emotional content. He may,for example, be on his guard if he knows he is homo-sexual. On the other hand, he may withhold it outof ignorance. There is often considerable dramain listening to a hypnotised patient narrating hisearly experience, and I remember a stammererrecalling the onset of his stammer at the age of fouras he ran home crying from a pond where he had beenpaddling after hearing his nurse shout to him thatthe snakes would bite him. If confirmation of theexperiences can be obtained it may be helpful, butit is not necessary, for, as I have said, there is nooccasion for doubt. I believe that experiences whichcan be confirmed may be recalled out of the secondyear of life and not earlier. Abreaction, which isthe emotional re-living of a man’s experience, mayoccur during hypnosis and if it occurs it may removethe cause of his symptoms. The hypnotist, as a rule,leads him towards it but it may occur naturally.On the other hand, it may be counter-suggestedand the story obtained without it. When it occursit is not always complete. It may be very consider-able, or slight only. One of my patients showedsevere abreaction in 1930 when he was taken over aterrifying experience of 1917. He was, however,soon able to speak about it calmly, but in spite ofthis he sweated copiously and being unaware onbeing waked of what he had been saying, wasalways astonished at his condition. Some physi-cians deny the need of the revival of the emotionalcomponent in order to cure symptoms ; theytrust to the revival of the unpleasant componentalone.

Often in the natural sleep of healthy people there isan escape by some of the mental elements which, inthe waking state, are set apart. They take advantageas it were of the sentry’s inattention and demonstratetheir freedom in the form of dreams. Sometimesthese dreams remain vivid after the patient wakes.If, however, they are but vaguely remembered andare thus of no value to the physician they are nonethe less of considerable potential value, for they maybe re-dreamed in detail in hypnosis and by a purelyspontaneous process. Sleep-walking, which alwayshas a mental cause, is the reaction to a dream, butit is a dream which is not in the patient’s consciousnessafter he wakes. It is said that sleep-walkers areinvariably hypnotisable and that their dreams may

be recalled in this way, but I have failed to hypnotisea number of them.

Hypnotic experiences and conversation, whetherdirect or overheard, are not always recalled by thepatient after he is waked, even although the hypnotistduring hypnosis has directed that they shall be. Butoften something is recalled although the patientdoes not know what it is, for in order to obey ordersfor the future which were given during hypnosis here-enters the hypnotist’s influence and then executesthem without further suggestion. But some patientsrecall nothing at all after they have been waked andconsequently neither re-enter nor obey. The man’smental scene as set by the hypnotist before inductionis commenced may be dreamed throughout hypnosisand referred to, as a dream, on waking. All hypnoticexperience as a rule is recalled in subsequent hypnosis,at any rate when it is produced by the originalhypnotist and provided he has not, during hypnosis,forbidden its recall, and the patient may talk aboutit spontaneously as well as in conversation. In acase where the nature of fits is uncertain the diagnosiswill be aided if, in hypnosis, a hysterical attack issuccessfully suggested. But in order to witness anattack it is not always necessary to employ hypnoticsuggestion.

The second purpose of hypnotism is therapeutic,and treatment may help a man even although theexact cause of the symptoms has not emerged.He may be taught to make a better adjustment tothe conditions in which he is compelled to live ,also hysterical symptoms maybe removed. Inwmniais sometimes treated by hypnotism whether it isdue to pain or is merely the result of habit, andhypnotism has often been used as a substitute fora general anaesthetic. I tried to hypnotise a man fora major operation by using scent instead of ether.Nothing was said to him of the substitution. Theexperiment failed, although he had proved easilyhypnotisable by ordinary method The wholeor any part of sensibility can be abolished in hypnosisbut in many hysterical patients it can be abolishedequally readily by mere verbal suggestion, withouthypnosis. One patient, for example, shows thatshe feels the touch of a wisp of wool whereas sheallows me at the same moment to transfix her tissueswith safety pins in the same area and elsewhere.Tickle sense differs from other forms of sensibilityin being most acute when the skin is stimulated bysomeone else. The hypnotist has to be careful aboutthe form of his suggestion. For example theexpression " You will sleep lightly," or " You willwake promptly " may be misinterpreted and theman may wake during treatment. If a patienthas had a hysterical symptom and has recovered,the hypnotist should be careful to exclude from hisdemonstration the part which was affected.

Hypnotism without a HypnotistA man may appear to hypnotise himself whereas

in reality he has re-entered the hypnotist’s influence.This re-entry may have been ordered or it may bevoluntary on the patient’s part so as to do somethingwhich has been ordered. The order to sleep may beconveyed by a signal or merely a glance or thehypnotist may communicate it by telephone or

through the post. The man is under the controlof the hypnotist and, although he may wake of hisown accord, the hypnotist alone can rouse him.

In 1926 I saw the Egyptian fakir who appeared on aLondon stage. He claimed to hypnotise himself. Ifthis was the case, was the method he employed his owndiscovery or the result of imitation, or had he originallybeen hypnotised and taught the method ? Again, was henot demonstrating re-entry although at a distance fromhis hypnotist or was the hypnotist present on the platform ?The audience were told that tongue-swallowing was anecessary part of the ritual of the fakir’s self-hypnotismbut I find it difficult to accept this. A man can be

hypnotised without even a close observer being aware thathypnotism has been employed. If during hypnosis a

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man’s conduct is controlled even a little by someone elsethe inference is that he has been hypnotised by him.The fakir’s demonstration was vastly interesting, but,for me, it was spoilt when it was claimed by the interpreterthat, in hypnosis, the fakir would prophesy the winnerof the Derby. He did in fact closely approach the nameof the horse that won. It is within the province of anyoneto prophesy from guess, deduction, observation, and

information, but it is not to be believed that a man,solely because he is hypnotised, has any peculiar power ofinterpreting the future. I have no experience of telepathy,but it is claimed for some people that during hypnosisthey have telepathic power or that their existing power ismuch enhanced. I have no special difficulty in subscribingto this view.

There are some hysterical people who pass intotrance without clear cause and who remain therefor a prolonged period, often exhibiting katatoniaand spontaneous anaesthesia. No one can influencetheir behaviour and no one can rouse them.

In 1918 a boy of 16 was under my care who was affectedin this way. The attacks had occurred twice or thriceweekly since he was seven and he said that his father,aged 42, and his brother, aged 18, were similarly affected.His longest trance had lasted two days. I witnessedseveral attacks. They occurred, as a rule, suddenly.The lids remained open, the eyes staring and directedforwards, without squint. He blinked at unexpectedsounds. The forehead was puckered. He took no noticeof any cutaneous stimulus, although no word was saidto him about this. On one occasion after six hours he

spontaneously recovered his sense of pressure-pain andthis was a long time before his attack resolved. Oncein an attack he appeared to be asleep and took no noticeof his food. He was anaesthetic save on the cornea,but he blinked in the presence of light. On recovery hecomplained of headache. On another occasion he wokeat 2 A,1B!. saying that he felt queer. In ten minutes hewas in a trance and the loudest noise failed to rouse him.He remained thus for ten hours and then, after a dramaticdisplay of opisthotonus, he woke. Once, in an attackwhen he was standing up, he was roused to a slight extentby faradism. When he was immersed he uttered a few

grunts. To all other stimuli he was anaesthetic. Hestood motionless for two hours and the chalk lines roundhis feet were undisturbed. He then dropped quietly tothe ground, had an attack of opisthotonus, woke up,asked where he had been and ate his dinner. I entirelyfailed to hypnotise him.

Precautions

It is unwise to say that you can or will hypnotiseanyone until you have made a trial, but the factthat a previous hypnotist was unsuccessful is notnecessarily proof that you will fail. Success isnot precluded by the patient being restless or showinguncontrolled movements. Obtain the patient’sconsent and, in some cases, have it in writing. Dis-regard a statement such as " I had such a good nightthat I do not feel sleepy." Often on the first occasionan audience may distract the patient and the hypnotistand yet you should not be alone with a woman.Before you start, write down the headings of whatyou wish to find out or suggest, and write down alsothe results directly they occur as it may be impossibleto remember the phase to which each of them belongs.If you propose to suggest or demonstrate sensoryanomalies you should first know accurately theexisting reactions to stimuli. Successful inductionin my experience occurs the first time or not at all,and even at the first trial hypnosis may be deep ;I am not concerned here with light hypnosis, in whichthe patient remains associated although in a stateof enhanced suggestibility. A man’s reaction tohypnotic induction seems to be based sometimeson fear, sometimes on confidence. It is said thatsleep can be encouraged by a few days’ premedicationwith 20 drops of cannabis indica, given thrice daily ;I have no experience of premedication in any form.The first attempt to hypnotise may produce eithera slow or rapid result, but afterwards the resultas a rule is rapid.

Occasionally after a rapid first induction the patientresists sleep subsequently and the second inductionis slow. The patient’s cooperation, as well as hisconsent, is necessary at the outset, but once the manhas been hypnotised the hypnotist will succeedeven against the man’s will, in the sense that he willno longer be able to exert it. This increasedsusceptibility as time goes on is regarded by someas evidence of the hypnotist’s unsuccessful resynthesis.If the man is hypnotised lying down he may requireto lie down in the future before he will sleep, but hecan be taught in sleep to ignore his position. Oncethe hypnotist has obtained control the positionis immaterial; the man will sleep where he stands.

TechniqueLet the patient lie down and relax his muscles.

Many people find it difficult to relax, even althoughtheir attention has been immobilised. Do not tellhim to think of nothing at all, for this is impossible.Ask him to imagine himself somewhere where thescene is familiar, pleasant, and neutral, such as apunt in a backwater, and to pretend to feel drowsy.He may be able to help this simulation by emphasisinghis expiration. He should pay no attention to thehypnotist, once the procedure has been commenced ;for illustration, the ease of inattention in church canbe employed. Tell him that you will instruct himwhen he is to start listening, for this is not requireduntil after dissociation has occurred. I then tellmy patients to look at me and at once to transfertheir gaze to some object which I hold in front oftheir eyes. They are told to continue to stare at it,if possible without blinking. As a rule a brightobject is used, a watch, an eyeglass, a torch, butthe object is immaterial. During this stage thehypnotist suggests ocular fatigue, speaking in a

monotone but confidently. It is seldom necessaryto make passes and many patients dislike it, althoughit may be useful in obtaining relaxation. Thehypnotist brings the light nearer and nearer to theman’s eyes and tells him that he can no longer keepthem open. When the lids have closed he tellshim that he is unable to open them of his own accord.If dissociation takes place the faculties are at oncereduced but they can be restored to full activityat a word, without waking the patient. There areseveral features in a technique of this kind whichresemble those of sending a child to natural sleep.The relationship between hypnotist and patient isa peculiar one and hypnotism lends itself to greatelaboration of technique. This is not necessary,but it may produce an enhanced effect on an expectantaudience and, also, it may cover deception.The familiar conception of the hypnotic eye becomes

less attractive when you have seen a blind manhypnotised. The hypnotist himself may be blind-folded. The effect produced by eye on eye isconsiderable and may be unpleasant. It may bealmost impossible to avoid re-seeking the staie whichwe know is upon us. The feeling invoked is commonlyone of guilt or fear, but we are not hypnotised. Thehuman eye can influence animals, and animals caninfluence man as well as their kind. A rabbit mayremain motionless in the presence of a weasel, nothypnotised but from fear.

Rotation of the EyesAt the moment of dissociation the eyes rotate

upwards and the expression alters. The patientmay become restless for a few moments. Rotationoccurs the instant before the lids close. It is outsidethe range of voluntary power. Sometimes a manwill appear to make a great effort to remain associated,opening his eyes at once and relaxing his rotation ;he may repeat this behaviour several times. A fewmore words by the hypnotist makes dissociationcomplete. Rotation takes place in the naturalmovements of blinking and also in natural sleep,although it is absent in general anaesthesia. It doesnot always persist during sleep. In blinking itoccurs simultaneously with the dropping of the lids

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and is thus unobserved. The individual himselfis unaware of it, and if, when he is hypnotised, heis asked the position of his eyes he does not know.Very occasionally the rotation takes place just inadvance of the movement of blinking ; it can thusbe observed, but it is not pleasant to see. A commonopportunity of observing rotation is afforded whena patient with facial palsy tries even gently to shuthis eve, but rotation even so is not invariable. Iam treating a patient who has complete right-sidedfacial palsy. All her voluntary ocular movementsare healthy but neither of the eyes rotates, eitherwhen she shuts the unaffected eye or exerts herselfto close them bilaterally. I do not know thesignificance or mechanism of this rotation. It issymmetrical. Its direction upwards is invariable and,if the muscles of upward rotation are paralysed, itdoes not occur in any other direction. A few caseshave been described in which rotation occurs inassociation with eye closure in spite of palsy ofvoluntary movement. Encephalitis lethargica maybe associated with attacks of oculogyric rotation.The appearance of a man who looks upwards whenhe has incomplete bilateral ptosis closely resemblesthat of dissociation.

If the hypnotist opens the man’s lids the rotatedeyes are seen not to be squinting, and in this respectthey differ from the state in natural sleep. Theyusually come down and are directed forwards as thelids are separated, and then they may wander laterally,with squint. This is because the man is unseeing andthe squint disappears directly he is told to see. Ifthe eyes are already directed forwards at the timethe lids are opened they may rotate upwards underobservation ; also if the man is told that his lidsare going to be closed he may rotate the eyes upwardsin anticipation. Dissociation can be taught tooccur without any rotation and indeed without anyclosure of the lids. Re-association can similarly betaught. If a hypnotised man who has his eyesopen is told to wake his lids close for an instantas he does so. but even this can successfully be counter-suggested. Interference with the eves often wakesthe patient, just as it does in natural sleep.

Rapid HypnotismOnce a man has been successfully hypnotised he

can be taught to become dissociated instantly andapparently deeply on future occasions, in responseto any signal which has been selected. This maybe a stare, a click of the fingers, a written wordor a word spoken in a whisper. It is immaterialwhether he is alone or amongst a crowd, but he mustunderstand the significance of the signal. It is alsoimmaterial whether or not he is with the hypnotist,for he can be hypnotised by telephone and wireless.This is important in relation to the association ofhypnotism with crime and alibi. The suggestionto sleep thus becomes a conditioned stimulus, afterthe manner of Pavlov’s experiments, the man’ssuggestible state being due to a suppression of naturalresponses which might otherwise be expected tocompete with those which the hypnotist evokes.Re-association in response to a signal occurs equallyrapidly and, once again, dissociation, and as bothphases can be produced without any coincident eyechange or alteration of the features it may be impossiblefor an observer, even with the closest scrutiny, toidentify the man’s condition. It is difficult to believethat these rapid and repeated alterations are harmlessbut I have no evidence that harm results.The patient sleeps only if he is satisfied that it is

the hypnotist who addresses him, but as voicessometimes are very similar and as a voice can becleverly imitated there must be opportunities of

deceiving a man. The chances of two professedhypnotists having similar voices are small. Myexperience does not extend to these matters, but Ithink that the man would wake rather than obeydirectly he found himself in doubt. If a pretenderhypnotised him by a coincidence of voice and gavehim orders, he would obey him as he would obey

his own hypnotist. If no orders were forthcominghe would awake, from ignorance of what to do.I have often hypnotised hospital patients by telephonefrom my house. I ask them to tell me when theyare asleep.

Post-hypnotic BehaviourIf the hvpnotist wishes the patient to ie-enter

his influence he can usually ensure it even at a distanceby giving instructions either before, during, or afterhypnosis, but if re-entry is not desired he shouldcounter-order it before he wakes him, for, as I havesaid, it may otherwise occur spontaneously. Sleepof re-entry may thus resemble spontaneous trance orthe loss of identity as in epilepsy. When the manis once again awake he will have no knowledge ofwhat he has done but, unlike the other conditions,he will recount it in subsequent hypnosis. I havefailed to produce any post-hypnotic behaviourin the absence of re-entry. The fact that re-entryhas taken place may easily escape observation. Itdoes not follow that an order to re-enter, given inhypnosis, will be obeyed.The difficulties in identifying a man’s state can be

illustrated by a patient who has multiple forms of sleepin varying sequence, natural, pathological, hypnotic, andsleep due to spontaneous re-entry. Transferences fromone variety to another take place frequently and some ofthem I can direct. In hypnotic sleep and re-entry Ialone can influence him : in pathological sleep no one canrouse him. His original attack was during the war anddeveloped as a mechanism of escape from terror, the reasonfor terror being at the time unproved and the cause

unshared. I have often hypnotised him and when Itell him to wait a little after I have waked him and thencount aloud to six he invariably re-enters and then obeys.He is proved to be under my influence at these times, butI am never required to remind him what to do. Some-times he has an attack of pathological sleep during hypnosisor directly after he has been waked, but this does notinterfere with his re-entry for, when everyone has forgottenthat there was anything to witness, he re-enters in themiddle of what he is doing and promptly counts aloud.

If the influence of another hypnotist is not desiredit should be counter-ordered during hypnosis, butsome patients already have the ability to resist,and neither when hypnotised nor awake can they saywhy others fail. I have a patient who is able toresist with ease although I have tried hard to breakdown his resistance both when he is awake andduring hypnosis. If a man understands from hishypnotist that a second hypnotist is to act as hisdeputy he may sleep for him, and a child may thusproduce hypnosis or even a man who is himselfhypnotised. If the original hypnotist remains inthe room a man may resist the substitute. It mustbe remembered that in the course of time the forceof any suggestion is apt to grow less and an ordermay thus be forgotten. I hypnotised a man

repeatedly during the war and eventually orderedhim in hypnosis to resist my influence in the future.The result was that I failed to hypnotise him. Idid not see him or communicate with him for tenyears, but nevertheless when he came to see me

I hypnotised him instantly with a single word andwithout leaving my chair.A man who has been told before hypnosis what

to do during hypnosis will do it without the hypnotistmaking any further hypnotic suggestion, but afterhe has been waked he will not recall what he dideven though he was told before hypnosis that hewould. If he is told before he is hypnotised thathis conduct at that moment will be unrememberedafter he has been waked he will not remember it,although during hypnosis he has spontaneouslyrecalled it in detail. If the hypnotist, before hypnosis,has said nothing about recollection the man willrecall by the ordinary process of memory. Non-recollection during hypnosis of prehypnotic behaviourcan also be successfully suggested before a man is

hypnotised as well as during sleep. Thus if a manhands me :65 before I hypnotise him I can arrange

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both at the time he gives it to me or in his sleep thatboth when he is asleep and after he has been wakenedhe will forget what he did with it. I do not knowwhether a hypnotist can obliterate a man’s identityalthough he can be taught to forget his name andaddress. If after he has been waked he is told to

repeat his hypnotic conduct he will do so only aftera process of re-entry.During hypnotic sleep a man can be taught to

recall his hypnotic actions after waking. Post-

hypnotic conduct, ordered during sleep, will bedemonstrated according to my experience only if

re-entry takes place, and although re-entry may havebeen suggested during sleep it will occur just the samewithout the suggestion. If, however, there has beenno hypnotic suggestion towards re-entry it may notoccur; if it has been forbidden there will be no

post-hypnotic manifestations. Re-entry takes place,as the patient explains both when he is hypnotisedor awake, without anything requiring to be donehaving been in his mind at the time. He may saymerely that he felt the presence of the hypnotist.u’hat has to be done becomes clear to him only afterhe has re-entered.

Evidence of HypnotisationA careful consideration of the evidence is important,

for a man may pretend that he is hypnotised ; alsohe may deny afterwards that he was hypnotised.There are several pitfalls. There is no yawningand no laughter, although the man will laugh ifhe has been told to behave naturally. I asked ahypnotised man why he never laughed, and he saidthat laughter had not been ordered but that he oftenlaughed inwardly. I have watched a man playbridge in such a natural manner that the others didnot suspect his condition. He is obedient only tothe hypnotist, in the absence of suggestion otherwise,and his passivity is notable ; he does not ask thehypnotist to wake him, or that he may wake himself.When he is told to walk about and do things hiseyes are as a rule directed forwards and the lids almostclosed. He opens his eyes directly he is told to.Some patients maintain the upward rotation as theywalk about and. being unable to see where they aregoing, bump against the furniture; it is notablehowever that they do not grope their way as a blindman does and as a man might if he was pretendingto be hypnotised. The persistence of rotation andeye closing may be due to the hypnotist’s insistenceon

" You cannot open your eyes," during the induc-tion. Persistent rotation sometimes occurs butwith the lids open. It ceases when the patient istold to look forwards. Some patients, before theyachieve a forward gaze and apparently in an effortto avoid it, bring the eyes by a sudden movementfrom elevation to extreme depression. Flickeringof the lids indicates that the man is not hypnotised ;it is due to restless eyes. You might expect thata man, at the moment of dissociation, would dropsomething which you had put into his hand, buthe does not let go unless you have told him to. Yourinfluence over his conduct has no special valuefor differential diagnosis for, if he is pretending,he will do most unexpected things if he is told to.Note what you say to him and his replies, and testhim later. If he has been hypnotised he will recallnothing but if he has been pretending he may repeatthe conversation out of ignorance. If during explora-tion a man’s story varies in detail from that whichhe told before, it can be inferred that he is hypnotised,particularly if the story can be corroborated. Ifyou ask a man whom you think is hypnotised whetherhe is or not he may reply that he knows he is becauseof a " drawing feeling."You may believe that a patient is hypnotised

whereas he has merely fallen asleep. Although aman becomes hypnotised during your procedure itdoes not follow that he is under your influence ;you may find that he does not talk to you andthat you cannot rouse him. This condition maybe due to his re-entry into the influence of a

previous hypnotist, a state which your procedure hassuggested.The failure of your suggestions is no evidence that

you have failed to hypnotise. In seeking to demon-strate your influence on a man’s muscular powerremember that he may show very great power byan effort of will, although it is in hypnosis that theextremes of flaccidity will be manifested. As regardsthe sensory side a patient awake may bear a greatdeal of pain without showing it, if he is so minded, andyou have seen that without hypnotism the mostprofound alterations in sensibility, involving eventhe cornea, can be produced at a word in a hystericalpatient. Hypnotic suggestion in the field of sensationshould have comprehensiveness, otherwise you maybe surprised when a man whom you cannot hurt witha pin tells you that he can hurt himself very muchwith it. Sometimes there is analgesia in hypnosiswithout any suggestion towards it.

There is a common fallacy that when analgesiais due to hypnotic suggestion the tissues can withcertainty be transfixed bloodlessly. This howevercan sometimes be done in health, when sensation isperfect, and in cases of analgesia it can be done justas certainly when this is due to physical disease aswhen it is hysterical. In none of these conditionsis transfixion necessarily bloodless. There is a

reputed association between dermographia andhysteria ; I have found it far more commonly invagotonia. A form of dermographia which mayresemble the physician’s skin-writing has beenobserved to occur spontaneously in emotionalindividuals.

I do not know any reliable criterion of the depthof sleep, but perhaps the distance of memory recalland the subject’s readiness, after being waked,spontaneously to re-enter the hypnotist’s influencemay be so regarded. A man has no better knowledgeof the duration of his hypnotic sleep than of healthysleep. Failure to obey is apparently no criterionof the depth of sleep, nor is difficulty in waking theman up ; the hypnotist has no difficulty, providedthat the subject slept for him and has remained underhis influence. Whatever the apparent depth of thesleep a man may wake spontaneously even in theface of a continued order not to do so, and this isparticularly liable to occur if the eyes are investigatedor when the order is unconvincing. >On waking the man may rub his eyes and seem dazed,

but he does not yawn. If he complains of headacheit is slight and transient. Some patients appearto have no knowledge whether sleep has been artificialor natural. A patient who had often been hypnotisedre-lived on one occasion, after being waked, his lifeof 12 years before, when his hypnotic treatment hadcommenced. No allusion to that period had beenmade. He did not know that his spectacles belongedto him and he asked what the ear-phones were for.He came back into the present gradually and withoutassistance.

If during hypnosis the hypnotist had arranged fora substitute to wake the patient he could leave theman without feeling anxiety, but if this had not beendone the man would either remain hypnotised untilhe woke spontaneously, or he would transfer himselfinto natural sleep from which he would wake indue course or could be roused by anyone. If apatient of mine persisted in remaining hypnotisedand I could not reach him to wake him I shouldsuggest a general anaesthetic in the hope that hisdissociation would give way. A woman who re-

entered my influence in my absence half an hourafter I had waked her and left the hospital was stillunable to be roused by anyone 24 hours later. Iwas sent for and waked her. I could have saved ajourney if she had been taken to a telephone.

Some Causes of Failure to HypnotiseFailure is fairly common even although success

is ultimately attained, and the reasons lie with thepatient rather than the hypnotist. He may be over-interested or distracted ; - a distended bladder is

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enough to prevent hypnosis. The man may fallinto natural sleep or he may sleep naturally afterfirst passing through a brief stage of hypnotic sleep.There may be cooperation and yet sleep may have ebeen forbidden by a previous hypnotist, either whenthe man was awake or hypnotised. My housephysician failed to hypnotise a man whom I hadhypnotised. The patient could not account forit but, as soon as I hypnotised him and asked himhow it was, he said that in previous hypnosis I hadforbidden him to be influenced by anyone else.Presumably this was accurate, but I had forgottenit. The patient may protest that he is cooperating,whereas he is stoutly resisting, and this may be dueto an anxiety about the procedure in general or toa fear of what he may be caused to do or say.

Relationship Between Hypnotism and CrimeIn the opinion of Baudouin and others the

dependence of a subject on his hypnotist is a resultof an autosuggestion on the subject’s part which ismerely the outcome of a superstition about hypnotism.Accordingly the important thing is to destroy thesuperstition about hypnotic dependence, for therisk of a patient obeying orders which may involvecriminal conduct will then become small. A recitalof the dangers of hypnotism, in this sense, is supposedto keep the superstition alive and consequentlyis dangerous. It is said moreover that hypnoticconduct which the hypnotist may think is due to hisown suggestion is really dictated by the’ hypnoticliberation of the subject’s autosuggestion, and thatin this lies a safety against criminal behaviour.But although this view may well be the correctone, how is the superstition to be destroyed andhow long will it take to do so ? In the meantimesome attempt must be made to protect the publicagainst possible results of the superstition. Thefixity of superstitions in a changing world is notable,and is an indictment against progress in education.I believe that it is right to face the fact that theremay be a close relationship between hypnotism andcrime and that, accordingly, it may be assumedsometimes to be demonstrated.

I do not know whether a hypnotised man is likelyto be provoked spontaneously into committing crimebut presumably, if he is like other people andsusceptible to it when awake, he would not acquirecomplete immunity solely because of hypnosis.If the hypnotist orders antisocial conduct thesubject usually shows his natural resistance by arefusal and, often enough, by waking up. Thisresistance becomes less, however, after repeatedhypnosis and finally is overcome, so that the manbecomes dependent on the hypnotist and hisbehaviour automatic. Even if he retains any auto-

’

suggestions derived from his emotional deductionsand which are separate from the hypnotist’s inten-tions and instructions, his behaviour is no longerinfluenced by them. If the hypnotist is unscrupulousthere is cause for considerable anxiety, whatevertheory of psychology you may hold. The subject,reawakened, would recall nothing of value and hewould already have been taught in hypnosis not torepeat anything to a subsequent hypnotist. Perhapsthe greatest danger lies in the hypnotist becomingunscrupulous merely in the presence of opportunity.I have in my possession a form of will in whichthe testator has made the hypnotist his beneficiary.The man signed it solely because it was presentedto him during hypnosis ; he had read it aloud andbeen told that it lacked his signature. Previously,when awake, he had declined to sign it. Finally,and also in virtue of his opportunity, the hypnotistmay commit crime against his subject. For examplehe may rob him. Murder may simulate accidentor suicide. A man may be hypnotised as he swims,and told to drown. If you are still in doubt aboutthe perils of hypnotism you can try this experimentprovided that you are skilled in life-saving, but thedemonstration will lose its force if the man knowsthat you are skilled. _

THE TRAINING OF NURSES

THE departmental committee which is inquiringinto the question of the training and registration ofnurses in Scotland has held a further meeting at whichevidence was given by the Department of Healthfor Scotland, the Scottish Education Department, andthe General Board of Control for Scotland. TheDepartment of Health’s evidence, which summarisedthe history of nurses’ training over the last 50 years,emphasised that the training of nurses had arisenout of the needs of the hospitals to minister to theirpatients and that, naturally, that training was

conditioned by and directed to assist other functionsof the particular hospital. Other interests are,however, concerned in the training given-namely,the nurses themselves and the public. The status ofnurses had improved greatly in the last 20 or 30 years,but a still greater improvement might be looked forwhich would bring the profession nearer the standardof other professions. At present, training was toosectionalised. This applied even to general hospitals,for while 50 years ago general hospitals were practicallythe only hospitals and as such gave a training thatwas in fact " general," general hospitals were now,as a result of the development of special hospitals,dealing with a much narrower field of diseases.Under existing circumstances, a nurse wishing toobtain an all-round training, embracing all sectionsof nursing, must spend much longer than traineesin other professions, and one of the main questionswas whether by cooperation between the varioushospitals it would be possible for a nurse to pass fromhospital to hospital and obtain such an all-roundgeneral training in a reasonable number of years. If atraining of this kind could be taken in, say, fiveyears, the nurse would be free thereafter to specialisein any branch she felt drawn to.The questions discussed with the Scottish Educa-

tion Department’s representative related chieflyto the educational standard that might be requiredof nurses entering the profession if a standard wereto be laid down, and whether it would be possibleto make arrangements for suitable instruction beinggiven if any proposal were made for the theoreticalsubjects being taken before nurses entered hospital.It also emerged that nurses did not have the samebenefits of financial aid in training as are enjoyedby most other professions either directly or indirectly.In the opinion of the witnesses from the GeneralBoard of Control it would be of advantage if nursesin mental institutions were general-trained. Ifthey had a general training first, it was thought thatthe period of further training in the mental hospitalcould be substantially reduced without detriment tothe institutions or the nurses.

INSTINCT AND DEVELOPMENT" INSTINKT das eine Mal aussert sich in der

Umbildung der Formen und das andere Mal in derHandling des ganzen Organismus." That thebehaviour of the cells during development and theinstinctive reactions of the organism as a whole arein reality two manifestations of the same pheno-menon-namely, instinct-is an idea which hasalready been developed by Bergson. In illustrationof this idea Prof. Demoll gives some lively descrip-tions of a few fascinating examples of instinct amonginsects. He makes the interesting suggestion thatthere is a connexion between the rigidity of thedevelopmental processes characteristic of insectsand the determined nature of their instinctivereactions. In vertebrates, where development ismore plastic, the instinctive reactions are to a greateror less extent modifiable by the nerve centres. Theseand other related ideas outlined in this book affordfood for interesting speculation. But until more isknown of the factors involved in development onthe one hand and in the reactions of the wholeorganism on the other, it is impossible to assess

1 Instinkt und Entwicklung. By Reinhard Demoll. Munich:J. F. Lehmann. Pp. 80. M.2.

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their real value. If Prof. Demoll is right, theexperimental embryologist and the comparativepsychologist will eventually discover that they areinvestigating the same problem.

A MEDICAL PRACTITIONER’S VISITING BOOK

WE have received from Messrs. S. Straker ando ns, Ltd., 49, Fenchurch-street, London, a new com-

bination ot

visiting book,day book,address book,diary, andwallet, which issmall enoughto go into thewaistcoat tpocket. In aslot on thecover of thevisiting bookis a dailyrecord card onwhich names

can be enteredand added towithout re-moving thecard. There isa space at thetop of the card

for the name of the patient and the date of the visit,and at the side of the card there is a column forledger entry. The outfitincludes a small filingcabinet into which therecord cards can be placedfor posting direct to a

ledger; the use of a daybook is thus eliminatedand book-keeping greatlysimplified. An indexat the back of thebook is provided forthe entry ofaddresses,while a

diary is madeto fit thefront ; thecase or cover 4

of the bookis durablymade so thatit will lastfor someyears. Acomplete trial outfit consisting of ledger, case, diary,visiting book, 100 daily record cards and the filingcabinet costs 12s.

REPOPULATION OF THE HIGHLANDSIT is said that " the eyes of the fool are on the ends

of the earth," and Dr. Lachlan Grant of the Bacterio-logical Laboratory, Ballachulish, in an address tothe Clan MacColl Society, Glasgow, declared thattoo often the eyes of the Scots are bent in the samedirection. Dr. Grant deplored Scotland’s loss byemigration in the last 50 years of over one millionof her inhabitants, while the Highlands had becomea sportsman’s and tourist’s paradise which was

rapidly losing its natural heritage and traditions. Hepointed out the close connexion between agricultureand industry and stated his belief that the repopula-tion of the Highlands was an important economicissue. To achieve this he advocated a policy ofintensive cultivation of the land, development ofnatural resources, and help for the industries of thenorth. His schemes for the reconstruction andregeneration of the Highlands and Islands includeda Highland University and a Scottish Parliamentsitting in Edinburgh. A bold peasantry once destroyed,

he said, can never be replaced, and he called uponall Gaels to help in the work before it was too late.In the course of his address, Dr. Grant read asympathetic letter he had received from the PrimeMinister.

TESTIMONIAL TO SIR THOMAS OLIVERIN recognition of 55 years spent in the service of

Durham University school of medicine, the last eightas president of the College, the Council is offeringthe colleagues and friends of Sir Thomas Oliver theopportunity of subscribing to a testimonial fund.One of the objects of this fund will be to procure aportrait of Sir Thomas. Contributions should reachthe treasurer, Sir Joseph Reed, University of DurhamCollege of Medicine. Newcastle-upon-Tyne, not laterthan Jan. 31st. Later a meeting of subscribers willbe called to decide the final form of testimonial andthe mode and time of its presentation.

WHO’S WHOTHE eighty-seventh year of issue of this invaluable

book of reference contains over 40,000 biographies,some 500 more than last year, since the 1000 entriesdeleted on account of death are more than balancedby the 1500 new names. Most of the entries, weare told, have been personally revised and amplified,but fortunately less than 50 new pages have beenneeded to do this. Apart from its more serious usethe volume has its attraction as light reading. Theprice remains the same, 60s., in buckram binding.Messrs. A. and C. Black, Ltd., are the publishers.

A CALENDAR OF MEDICAL HISTORYTHE calendar (or rather diary) issued to members

of the medical profession by Messrs. William R.Warner and Co., Ltd., has pages for every day ofthe year, and a useful section devoted to the kindof fact which is often required in practice but noteasily carried in the head. Looking at his diarydaily the practitioner will find on his left a statementrecalling the activities of his predecessors (" Beren-garius between 1502 and 1527 is said to have dis-sected more than 100 cadavers "), and on the right asentiment or proverb which may prove consoling oradmonitory (An unruly patient makes a harshphysician.-It is probable that some things con-

trary to probability will happen.-Take away aman’s illusions and you’ take away his happiness.)Copies may be had on application to Messrs. Warnerat 300, Gray’s Inn-road, London, W.C. 1.

THE HOSPITAL DIARYTHE HOSPITAL DIARY for 1935 retains the attrac-

tive features of its first issue, and has responded,as does all good editing, to the suggestions of critics.The diary, which contains four days on an opening,provides the space which even the most conscientioushospital administrator would require for his dailynotes ; the format and paper are all that could bedesired. But to hospital administrators and to

many others interested in hospital administrationthe value of the diary is greatly enhanced by aseries of signed articles which occupy the first 80 pagesor so of the volume. Major Raphael Jackson opens ’

with a description of hospital administration as acareer, followed by Miss Cherry Morris on the dutyof an almoner, Miss G. M. Bowes on nursing as acareer, and by a series of experts on the constructionof a modern hospital and on a number of the problemswhich confront the hospital to-day. The diary,which is edited by Lieut.-Colonel C. Cobbold, secre-tary to the London Cancer Hospital, and Mr. H. F.Shrimpton, house governor to the BirminghamChildren’s Hospital, may be had from Messrs. G. R. C.Brook and Co., 27, Old Bond-street, London, W. 1, .

for 5s. 6d.. A GREEN SKELETON

IN the course of road excavations undertaken atLyons an entirely green skeleton has been exhumed.A description of the bones was given in the Matinon Dec. 29th from which we learn that the teeth

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are of a brilliant light green and the bones of a dulluniform green. The skeleton was transported to thepolice laboratory at Lyons, when Dr. Locard consideredthat the bones were extremely old, dating backperhaps to the Gallo-Roman period. He found animpregnation of copper which could not have beendue to any absorption by the individual, and con-cluded that bronze objects had been placed in thetomb in contact with the skeleton.

NEW PREPARATIONSLAROSTTDIN. - Hoffmann-La Roche Chemical

Works Ltd. (51, Bowes-road, London, N.13) haveplaced on the market a histidine preparation entitledLarostidin, the exhibition of which in the treatmentof gastric and duodenal ulcers is reasonable, whileit is held that these ulcers are in many cases the localmanifestation of metabolic disturbances producedby an amino-acid deficiency. In support of theefficiency of larostidin in suitable cases the work ofDrs. E. Aron and A. G. Weiss is quoted. The formerpublished in the Presse Médicale clinical investigationswith histidine, the work being based on observationsfollowing the artificial production of peptic ulcers,when good results were obtained in a large percentageof cases of acute and chronic ulcers in various places.Evidence is thus brought forward justifying a trialof the preparation, and is strengthened by a com-munication from Dr. Ernest Bulmer to THE LANCETon Dec. 8th, in which a review of the histidine treat-ment of peptic ulcer is given.

RBDOXON.—The same firm calls attention toRedoxon. Until recently vitamin C was regardedas a vitally important but somewhat elusive sub-stance contained in various fresh fruits and vegetables.Research work carried out in this country and abroadhas enabled Szent-Gyorgyi to show that vitamin Cis identical with ascorbic acid. Further recent workhas made it possible to produce vitamin C on a largescale, and it is now available for scientific and clinicalinvestigation under the name " Redoxon." In THELANCET of June 16th, 1934, Dr. J. Gough, lecturerin pathology in the Welsh National School of Medicine,Cardiff, referred to the distribution of ascorbic acidin human tissuesa-especially to the quantity foundin the pituitary gland in illness and health-andbefore the section of chemistry of the British Asso-ciation on Sept. 7th last Prof. Szent-Gyorgyi statedthat it had proved useful in a wide variety of diseases.Apart from scurvy, it is suggested that many dis-orders, including anaemias and dystrophies, mightbenefit from the use of Redoxon.

A BUREAU OF INFORMATION.-We are informed thatMessrs. E. Merck, the well-known Darmstadt chemicalfirm, opened at the beginning of the year a bureauat 37, Golden-square, London, where informationconcerning their manufactures will be available inreply to inquiries from the medical profession. Theypoint out that the distribution of the preparationswill be conducted as before by Messrs. H. R. NappLtd., 3 and 4, Clement’s-inn, Kingsway, London.CORRIGENDUM.-The first annotation in our last issue,

entitled Drugs and the Epileptic Subject, reviewed thepossibility that bromide taken in large amount maycause mental deterioration. Reference was made todoses as high as 450 g. per day, and it will be obviousthat such doses could never have been given. The

quantities were grains, not grammes, and to accord withour usual practice the abbreviation throughout thearticle should have been " grs." placed before the figure-e.g., grs. 450.

MENTAL AFTER-CARE ASSOCIATION.—This association,which exists to help those who have suffered from mentalillness, is making an appeal for funds. During the pastyear over 3000 people have been assisted, and theextension of the work to "early care " for incipientmental disorder is giving encouraging results. Contribu-tions may be sent to the secretary, Miss E. D. Vickers,Church House, Westminster, S.W. 1.

Medical DiarySOCIETIES

ROYAL SOCIETY OF MEDICINE, 1, W’impole-street, W.TUESDAY, Jan. 8th.

Therapeutics and Pharmacology. 5 P.M., Dr. R. G. RanyardWest: The Pharmacology and Therapeutics of Curareand its Constituents.

FRIDAY.Ophthalmology. 8.30 p.w. (Cases at 8 P.M.) Mr. Arnold

Sorsby: Choroidal Sclerosis. Dr. D. V. Giri: ARetention Cyst of Unusual Size, probably of Krause’sGland, Simulating Angioma of the Orbit.

PADDINGTON MEDICAL SOCIETY.TUESDAY, Jan. 8th.-9 P.M. (Great Western Royal

Hotel, W.), Dr. G. de Bec Turtle : Some Points onthe Management and Treatment of Pneumonia.

SOCIETY FOR THE STUDY OF INEBRIETY.TUESDAY, Jan. 8th.-4 P.M. (11, Chandos-street, W.),

Dr. Percy Turner : Methylated Spirit Drinking.WEST LONDON MEDICO-CHIRURGICAL SOCIETY.

FRIDAY, Jan. llth.-8.30 P.M. (West London Hospital, W.),Mr. Hugh Cairns : Recent Advances in IntracranialSurgery.

SOUTH-WEST LONDON MEDICAL SOCIETY.WEDNESDAY, Jan. 9th.-9 P.M. (Bolingbroke Hospital,

Bolingbroke-grove, Wandsworth Common), Mr. B.Whitchurch Howell: Orthopaedic Cases in GeneralPractice.

LECTURES. ADDRESSES. DEMONSTRATIONS. lieFELLOWSHIP OF MEDICINE AND POST-GRADUATEMEDICAL ASSOCIATION, 1, Wimpole-street, W.MONDAY, Jan. 7th, to SATURDAY, Jan. 12th.-MEDICAL

SOCIETY OF LONDON, 11, Chandos-street, W., Friday,4.15 P.M., Dr. A. E. Clark-Kennedy : FunctionalDyspepsia.-NATIONAL HOSPITAL, Queen-square, W.C.Saturday, 3 P.M., Dr. Macdonald Critchley : Neuro-logical Cases.-Courses and clinics are open only tomembers and associates of the Fellowship.

LONDON SCHOOL OF DERMATOLOGY, 49, Leicester-square, W.C.TUESDAY, Jan. 8th.-5 P.M., Dr. G. B. Dowling : Seborrhoea,

and Seborrhaeic Dermatitis.WEDNESDAY.-5 P.M., Dr. I. Muende : Histopathology of

Some Common Skin Diseases. (Chesterfield lectures.)THURSDAY.-5 P.M., Dr. J. A. Drake : " Dermatological

Neuroses."LONDON HOM(EOPATHIC HOSPITAL, Great Ormond-

street, W.C.THURSDAY, Jan. 10th.-5 P.M., Dr. Elizabeth Casson :

Some Investigations on Non-lactose Fermenters.CANCER HOSPITAL (FREE), Fulham-road, S.W.

THURSDAY, Jan. 10th.-4 P.m., Mr. Cecil Rowntree:Treatment of Cancer of the Breast.

CENTRAL LONDON THROAT, NOSE AND EARHOSPITAL, Gray’s Inn-road, W.C.FRIDAY, Jan. llth.-4 P.M., Mr. W. G. Scott-Brown:

Allergy.KING’S COLLEGE HOSPITAL MEDICAL SCHOOL,

Denmark-hill, S.E.THURSDAY, Jan. 10th.-Mr. Harold Edwards : Diseases of

the Colon.HOSPITAL FOR SICK CHILDREN, Great Ormond-st., W.C.

MOoDAY, Jan. 7th.-Noon, Dr. W. W. Payne : TheSedimentation Rate.

WEDNESDAY.-2 P.M., Dr. J. H. Thursfield : Causes andTreatment of Diarrhoea in Children after Infancy.

THURSDAY.-Noon, Dr. A. G. Signy : The Cerebro-spinalFluid in Clinical Diagnosis.

FRIDAY.-Noon, Dr. B. E. Schlesinger: The Prognosisand Treatment of Pneumonia in Children.

There will be out-patient clinics every day at 10 A.M.and Ward Visits (except on Wednesday) at 2 P.M.

WEST LONDON HOSPITAL POST-GRADUATE COLLEGE,Hammersmith, W.MONDAY, Jan. 7th.-10 A.M., medical wards, skin clinic.

2 P.M., surgical and gynaecological wards, eye andgynaecological clinics. 4.15 P.M., Mr. Green-Armytage :Pelvic Tuniours in Youth and Age.

TUESDAY.-10 A.M., medical wards. 11 A.M., surgical wards.2 throat clinic.

WEDNESDAY.—10 A.M., children’s m-ard and clinic. 2 P.M.,medical wards, eye clinic. 4.15 P.M., Dr. Maurice Shaw :Medical Aspects of Life Assurance.

THURSDAY.-I0 A.M., neurological and gynecologicalclinics. 11 A.M., fracture clinic. 2 P.M., eye and genito’urinary clinics. 4.15 P.M., Mr. G. F. G. Batchelor:Appendicitis.

FRIDAY.-I0 A.M., skin clinic. Noon, lecture on treatment.2 P.M., throat clinic. 4.15 P.M., Dr. Sydney Owen :Difficult and Delicate Infants.

STL’RVaY.-10 A.M., medical wards, children’s and surgicalclinics.

The lectures at 4.15 P.M. are open to all medical prac-titioners without fee.

LEEDS PUBLIC DISPENSARY AND HOSPITAL.WEDNESDAY, Jan. 9th.-4 P.M., Dr. H. H. Moll:

Bronchiectasis.LEEDS GENERAL INFIRMARY.

TUESDAY, Jan. 8th.-3.30 P.M., Dr. MacAdam : Demonstra-tion of Some Metabolic and Minor Endocrine Disorders.

SALFORD MUNICIPAL CLINIC.TUESDAY, Jan. 8th.-6 P.M., Dr. E. Tytler Burke : Syphilis,

Historical Survey.THURSDAY.-6 P.M., Dr. E. Tytler Burke : Syphilis, the

Callbal Parasite. (First two lectures of course.)