University of Virginia Library

A CASE OF POSSESSION

BY DONALD FRASER, M. D., GLASGOW

THE Demonaic possession of the middle ages and of times nearer to our own was largely hysterical in character, and generally occurred in Epidemics.

It was associated with the more superstitious and emotional side of religious beliefs, where a real Hell fire and a personal Devil with attendant Angels or Demons were believed in, and feared, much more intensely and widely than they are today even amongst the ignorant and superstitious, while suggestion and contagion played a large part in its spread, as it did in that other and more hateful form of it known as witchcraft.

Esquirol who wrote clearly about it in his "Maladies Mentales" under the heading of "Demonomania,"[1] spoke of it as being propagated "by contagion, and by the force of imitation." This was illustrated in the Epidemic of Loudun, amongst others referred to by him. This epidemic spread to neighbouring towns menaced all the high Languedoc, but was arrested by the wisdom of a Bishop, who did this by depriving the movement of its marvellous elements. In this epidemic form it was in its bodily and mental manifestations really hysteria with characteristic stigmata and convulsions. An excellent example of this religious hysteria was presented as recently as 1857 in an epidemic at Morzines in upper Savoy. It began with two little girls, pious and precocious, who had convulsive attacks. It spread to other children and then to adults. Amongst the younger of those affected, ecstasy, catalepsy, and somnambulism were seen, and later, convulsions only; convulsive attacks returned several times a day. An attack usually began with yawning, restless movements, the aspects of fear passing into fury with violent and impulsive movements, with vociferations and cries that they were lost souls in hell, the mouth-piece of the devil,

etc. These attacks would last from ten minutes to half an hour. A feature of this epidemic was the absence of coarse and erotic speech or gestures. Between the convulsions the victims were restless, idle and inattentive, being altered in character for the worse. In our day such epidemics are represented, though in tamer fashion, by Revivalism in its more noisy and extravagant eruptions. At all times, even when such manifestations are not much if at all out of harmony with ordinary religious feeling and action, there is a tendency to pathological conditions. Often its subjects, in the words of Professor James[2] "carry away a feeling of its being a miracle rather than a natural process, voices are often heard, lights seen, or visions witnessed; automatic motor phenomena occur; and it always seems after the surrender of the personal will as if an extraneous higher power had flooded in and taken possession." These are some of the more striking phenomena of mysticism, and are also largely pathological being amongst the major symptoms of hysteria. The history and course of our case illustrated very well this mixed condition. It has been pointed out that the ecstasies, trances, etc., of the mystic, while essentially pathological, have the evil effects of such morbid manifestations modified or largely neutralized by the idealism behind them, by that measure of true religious faith and feeling which dominates the whole process in the case at least of the higher mystics. The ore may be rough and very mixed, but the precious metal is there also, as it was in our patient, though the divine influence for which she craved was perverted into that of the "Evil one." In the individual cases described by Esquirol we recognize a more profound mental disturbance than is shown in the epidemic or hysterical variety. We indeed see many similar cases in our asylums though we generally speak of them as Religious Melancholics rather than as Demonomaniacs. In such cases recovery is slow or may not occur, the patient passing into a state of chronic mania, or of Dementia. There are other cases where the religious emotions and ideals are completely subordinated to or become identified with feelings of fear or remorse, the result of fixed ideas of a shameful, distressing or frightsome character. A good example of this condition though essentially hysterical in its nature, is detailed by Pierre Janet.[3] The patient, a neurotic, respectable business man thirty-three years of age, a good husband and father, on his return from a business journey of some weeks' duration is found to have become depressed and taciturn, and as the days pass his melancholy deepens. At first he would not speak, but soon when he wished to speak could not, making vain attempts at articulation. Under the influence of medical ideas suggested to him his symptoms simulate first Diabetes next Heart disease and his prostration becomes profound. By and bye he passes into a state only to be described as acute Demonomania marked by maniacal outbreaks in which he cried out and blasphemed, lamenting in quieter intervals his powerlessness to resist the Devil who was, he believed, actually not figuratively within him, who spoke and blasphemed through him, prevented him sleeping, etc. After some months he was sent to the Salpetriere where he came under the observation of Charcot and Pierre Janet. He was cured by means of suggestion by the latter, who also ascertained by his methods that the illness was the result of remorse for an offence committed during the business journey which preceded the outbreak.

In many ways our case differs from cases of this type. An important difference was in the intermittent character of the symptoms. For a period of two years the patient alternated between a condition of acute misery from the delusion that the evil one had entered into her body, and one of apparent sanity. At the end of two years she was dismissed cured, and has remained well for several years. She differed also in the absence of blasphemous, extravagant or obscene speech or action. The Devil never at any time used her as the mouthpiece for devilish words or thoughts. He was there, and as she insisted, in bodily form within her, making her intensely miserable by his presence, and with the feeling that she was cast away from "grace" and the privileges of the religious life. Nor were there, as in the case

above referred to shameful or remorseful complexes at the root of her mental condition. In presenting the facts of the case, names and special marks of identification have been altered.

Mrs. A., a widow, aged fifty-two years, was admitted to the Paisley District Asylum in 1910 with a history of having suffered for a month previously from mental depression said to be due to distressing delusions of a religious character such as that she was lost, was past forgiveness and dominating and originating all such thoughts was the belief that she was possessed by Satan or an evil spirit, who was in bodily form within her. This delusion caused her acute misery, and so absorbed her thoughts that she had ceased to take any interest in her household affairs, and had even talked of suicide.

Her condition on admission and for two years subsequently was that of recurring states of this acute mental distress, when she would rock to and fro, moaning and crying out, often with tears over her lost and dreadful state, and the presence in her inside of Satan or the "Evil one" whom she said she felt within her, and who made her "repulsive." This condition was varied with intervals of usually from one to three days of apparently complete sanity, when though quiet and somewhat reserved in manner, she was quite cheerful. When questioned at such times as to her delusion, she would admit its absurdity, but refer to an uneasy sensation in the region of the left hypochondrium, which, as she put it, surely meant that there was something wrong there. She would be occasionally normal in this way for a week or more, and on more than one occasion was so well as to be allowed out on parole, but had often to be brought back next day as depressed and delusive as ever. She was always worse in the mornings, and often improved as the day went on. She was a stout, pleasant featured and intelligent woman, somewhat anaemic, and with a slight bluish tinge of lips, though beyond a lack of tone in sounds, the heart was normal. Her anaemic condition was accounted for by her having suffered from menorrhagia for the greater part of two years, which only stopped a few months before her admission to the Asylum. It had during its continuance

brought on breathlessness on exertion, and what she called spasms or "grippings at the heart," no doubt the basis of her uneasy feelings in left hypochondrium. There was a slight enlargement of the thyroid gland, but no symptoms referable to it. None of these physical conditions beyond the "grippings at the heart" it maybe, appeared to have any appreciable influence on her mental condition, which as has been noted above was normal until a month before her admission. An interesting feature of the case was the relation between her blood pressure and her varying mental states. Her blood pressure was taken with a Riva Rocci Sphygmomanometer morning and evening, sometimes oftener, during the greater part of 1912-13, and it was noted that her depressed or delusional states were marked by a low pressure, while a high or relatively high pressure marked her sane and cheerful states, contrary to what is usually observed in melancholia, though similar to what is seen in agitated melancholia and mania.[4] Thus at a pressure of 130"HG, she was generally very well; at or about 120"HG she was often well; at 110"HG or 100"HG she was always ill. When recovering, and few weeks before dismissal there was a fairly steady pressure of 118"HG to 120"HG day after day. It had been also noted throughout, that during a continuous period of depression, or of well-being, the pressure kept steadily high or low day after day according to the mental condition. There was obviously then a constant and close relationship between her blood pressure and her mental states. At first sight it looked as though those states were directly affected by the varying pressure as it may have influenced the nutrition and therefore the functions of the brain, and on physiological grounds it is difficult to exclude such an influence altogether, even though we come to the conclusion as we did that the variations followed the emotional conditions, and did not precede or cause them. The broad general statement has been made that "each pleasurable emotion raises the general blood pressure and increases the blood flow through the brain and each painful emotion: brings about the opposite result."[5] It cannot be said, however, that increased blood pressure will give pleasurable emotion. The splanchnic area can be acted on so as to raise the blood pressure without influencing the emotions. We know also that when it is raised in melancholia the increased pressure is associated with the reverse of pleasurable emotion. Still on therapeutical as well as on other grounds it appeared to us important to determine what, if any, influence the raising of her blood pressure by drugs or otherwise would have on her mental state. We did this by baths, by abdominal pressure by means of a large sand-bag laid over the abdomen, and by such drugs as adrenalin and pituitrin. The results were disappointing so far as therapy was concerned though of interest otherwise. The pressure was raised by all these measures without any improvement following such as occurred when it rose naturally. The rise by abdominal pressure was marked and occurred quickly, but without any apparent effect on her mental condition. When it was raised to 140"HG under the influence of pituitrin there was marked depression as is shown in the chart for July, 1912. Pituitrin given in m. v. hypodermically three times a day, and after some days in larger doses by the mouth, kept the pressure between 125"HG and 130"HG, but with no corresponding mental improvement. For some days after the pituitrin was stopped its influence seemed to persist as the pressure kept high while the mental condition was low. One of her longest spells of continuous mental depression which lasted for twenty-seven days, occurred while her pressure was high under the influence of adrenalin. Digitalis, by the way, had no influence in any way on either her blood pressure or her mental condition. The only drug we found of any value was tinctopii in moderate doses three times a day, but it gradually ceased to do any good.

Four charts from a very large number are given which illustrate the above points.

It must be understood that these experiments while accurate so far as they go, and carefully conducted under my supervision by a competent assistant, were not made in a well appointed laboratory, but were clinical observations made in the crowded ward of a hospital for the insane. The central disturbance here was the result of shock from sudden

and excessive fear acting on a highly sensitive subject as will appear later. It has been shown by Cannon[6] that such major emotions as fear, rage, or pain acting upon the adrenal glands through the autonomic nervous system are accompanied by an increased discharge of adrenalin into the blood, and by a passing of stored glycogen from the liver for circulation through the body as dextrose, the object of which is the increasing and liberation of muscular energy for the animal's successful flight or fight. This discharge takes place very quickly, and we are told that fright exhausts the adrenal glands, a somewhat puzzling statement at first sight, but borne out by the experience of our case where a fall of pressure occurred under the paralyzing effect of extreme fear and distress continued not merely for minutes but for hours at a time. By and bye as her distress lessened and her expression of it became more and more automatic, there was a return to the normal adrenal discharge and consequent normal rise in pressure. It is possible, of course, that there may be another explanation in the inhibition of metabolism caused by fear. Most of us have experienced the arrest of salivation and digestion under the influence of fear or rage. This inhibition would affect the products upon which the adrenal secretion depends, but the more likely cause is where this fear, in this case really a recurring representation of the original shock, acts through the autonomic nervous system on the adrenal glands. The emotional disturbance here then was primarily of central origin, and was certainly not originated by circulatory or visceral changes which were secondary to it, and the facts do not support the James, Lange theory of the emotions as it is generally understood. In this connection we may refer very briefly to the laboratory experiments of Sherrington[7] and Bechterew.[8] The former by spinal and vagal transection in a dog removed "completely the sensation of the viscera, of all the skin and muscle behind the shoulder. The procedure at the same time cuts from connection with the organs of consciousness the whole of the circulatory apparatus of the body. Yet the dog exhibited rage, fear, disgust, etc., under appropriate stimuli as a normal dog might do." The conclusion reached after admitting possible objections to them is that, "the vasomotor theory of the production of emotion becomes, I think untenable, also that visceral presentations are necessary to emotion." Bechterew, discussing this question as to whether the vascular changes are anterior to the other processes, which determine the alterations of the neuropsychic tone according to the James, Lange theory, states that the experiments in his laboratory by Dr. Serenewsky, appear to lead to an opposite conclusion having shown that under the effects of fear the alteration of the neuropsychic tone is produced before the appearance of the cardiovascular phenomena. There are no doubt objections to accepting laboratory experiments upon inferior animals as conclusive where the psychic part of the process in question is after all the dominant one, nor must we forget that biochemical changes may be as important as the integrity of nerves. We have however referred to these experiments because of their bearing on the conclusions to be drawn from the above described clinical facts which so far as the initiation of the emotional process is concerned confirm them; though we feel that the bodily concomitants of the emotion are essential to its full development, and that we owe much to James's presentation of his theory even admitting its "slap dash"[9] character to use his own phrase. It was to be expected that the artificially raised blood pressure would have had some effect in improving the patient's mental condition, and in the case of adrenalin, at any rate, some such effect should have occurred if we are to accept the recently published conclusions of Crilel[10] to the effect that "adrenalin causes increased brain action," "that brain and adrenalin action go hand in hand, that is, that the adrenal secretion activates the brain, and that the brain activates the adrenals." More in harmony with the clinical experiences here is the fact according to Biedl[11] "that the adrenalin affects the intracranial and the pulmonary vessels only slightly if at all." We presume that what is true of adrenalin in this respect will be true of all drugs which increase blood pressure. And while the rise of the arterial pressure generally will accelerate the flow of blood through the brain, yet we know that the cerebral circulation is in "all physiological conditions, but slightly variable."[12] Besides, while that increased flow must necessarily lead to increased cerebral activity, that activity may be pathological as well as physiological, as in our patient, who was quite uninfluenced mentally by the rise of blood pressure which followed the administration of those drugs. The nature and genesis of the emotional disturbance in this case may be understood from the following history and observations.

She had married happily at the age of nineteen years, had a family of eight children, but had been a widow for about twenty years. Her husband died suddenly abroad, where she had lived with her family for two years after his death, and acting on the advice of her friends, she came back to this country bringing all her children with her. This involved her in years of struggle and anxiety to bring them up creditably, which she managed to do. During all these years of widowhood and stress she was mentally well, and latterly she described her life as a happy one surrounded as she was by an affectionate and well doing family. She had been brought up in a puritan household. Her father and her husband had been deeply and consistently religious though strict in their belief and observance of the letter. This upbringing favoured a natural tendency towards religious mysticism which was also promoted by the creed of the church to which she latterly belonged, and of which she was a deaconess. In this church the "gift of tongues" and of "prophesying" was recognized as a part of its heritage, and as she informed me in one of her normal times, she occasionally spoke or prophesied in the public assemblies of the congregation. I gathered that her utterances were generally

but a word or two of exhortation or pious aspiration, given expression to in a moment of exaltation. From her description of her state at such times, she was carried out of herself, was oblivious for the moment of the presence and actions of those about her, was in short in a state of ecstasy when she "prophesied." A natural tendency to self-depreciation, and to ideas of unworthiness asserted themselves outside of those periods of exaltation, which were generally followed by doubts as to her fitness to take part in such work, and by the feeling as she expressed it "that she had presumed as she was unworthy," and that God would be angry with her for her presumption. Throughout her religious life she had been always lacking in "assurance." Latterly this feeling had grown in her and was evidently part of a deeper feeling of mental depression, as she began to think often, and with a feeling of dread that she had been surely too happy these later years which stood in such contrast to the poverty, struggles and disappointments of the early years of her widowhood. This was her mental condition for some little time before her attack of acute mental disturbance which began one night a month before admission to the asylum. She went to bed feeling ill and shivering as if from a chill. In the middle of the night she woke up in a fright from a vivid dream the contents of which merged in a strong sensation as of a hand being pressed on her shoulder. She described the sensation as being that of a positive feeling of pressure, and with it came a feeling of dread, and the conviction that it was the hand of Satan, so that she cried out aloud to him to go out of the house, as it was blessed, referring to the fact, as is the custom in her church that the minister had blessed the house when she went to live in it. She thought of calling to her daughter who was asleep near her, but did not, and after a time fell asleep again being "comforted by the feeling that the Lord would take care of her." Next morning the effects of the "chill" had passed off, but there was left a more or less constant feeling of vague dread and fear of death, and with this a haunting idea born of this strongly felt hallucination of external touch that Satan was within her. The feelings of dread and fear grew steadily and became too strong for her faith in the Lord taking care of her, and very quickly her obsession as to possession by Satan, became the definite delusion it was on admission to the asylum. Hallucinations of what might be termed internal touch leading to this idea of possession, are not unknown in the annals of mysticism of the more morbid types of it. Indeed the more ecstatic the mystic becomes, the more he merges himself in his feelings and tends to develop hallucinatory sensations. He is possessed, and desires to be possessed, fortunately for him, by the Divine and not the evil spirit. Hallucinations of external touch are as might be expected more rare, though not uncommon we understand in the more abnormal types, and occur in people supposed to be normal. Havelock Ellis tells of a "Farmer's daughter who dreamt that she saw a brother, dead some years, with blood streaming from his fingers. She awoke in a fright and was comforting herself with the thought that it was only a dream when she felt a hand grip her shoulder three times in succession. There was no one in the room, the door was locked and no explanation seemed possible to her. She was very frightened, got up at once, dressed, and spent the rest of that night downstairs working. She was so convinced that a real hand had touched her, that although it seemed impossible, she asked her brothers if they had not been playing a trick on her. The nervous shock was considerable, and she was unable to sleep well for some weeks afterwards." The writer's[13] explanation is:—"it is well recognized that involuntary muscular twitches may occur in the shoulder, especially after it has become subject to pressure, and that in some cases such contractions may simulate a touch." In illustration of this he quotes from the Psychical Society's Report on the "Census of Hallucination" the case of an overworked, and overworried man who, a few minutes after leaving a car, had the vivid feeling that someone had touched him on the shoulder, though on turning round he had found no one near. He then remembered that on the car he had been leaning on an iron bolt, and therefore what he had experienced was doubtless a spontaneous muscular contraction excited by the pressure. Touches felt on awakening in correspondence with a dream are not so very uncommon. We think as to this likely enough explanation, that whatever the local sensation may have been, or however slight, as it probably was, it could only give rise to an hallucination of having been touched by some external personality when it was absorbed into, and became a part of a considerable emotional disturbance as in the case of the girl above referred to, and of my patient, in both cases associated with a frightsome dream. The illness of the latter began with a dream, and its continuance was in our opinion, largely due to dreams of a painful character. During the whole period of her residence it was noted that she dreamt a great deal, and that they were terrifying or alarming dreams, and that her bad days were generally preceded by a bad dream. Notes of her dreams were regularly made, at one time for ten consecutive nights, and only three of them were so far as she remembered free from dreams. All of her dreams she described as "awful." Many of them were of being mixed up with objectionable people who behaved roughly and used profane language, but, and of this she was very certain, who never talked or acted obscenely. She frequently dreamt of being on high precipitous places from which she was either falling, or could not get away from. She described one vivid dream during which she suffered great misery, and awoke from in great distress. She dreamt that she was listening to a preacher with open Bible in his hand, that he spoke about Peter whom he was accusing of disobedience; a number of people were present but she saw particularly only one man who looked very happy; the sermon ended, and she awoke in "agony," this feeling being due, she said, to the conviction present with her, that the sermon, and the man's happiness were intended to show her how much she had lost since she was cut off from "grace" by Satan dwelling in her body. Again she dreamt of a near relative whom she heard singing, "And they all speak in tongues to magnify the Lord." This brought sorrow to her of which she was conscious during the dream and after she awoke as she thought Satan was putting this before her to show her what she had lost. In another dream she saw three unpleasant looking men talking together. The worst looking of them of Jewish appearance, came close to her face, and argued with her about the evil spirit. She said "he was in her body," and he answered "away with him." She fell asleep and dreamt the same dream again. These dreams were obviously governed by her dread and fear as to her religious position. The following one is somewhat different:—"A big brown beast came up to her and pressed against her face; she slept again and dreamt she was in a big ship sailing in black and dirty water; that she tried hard to get out of the ship, but could not, and awoke in great distress." We presume Freudians would find in the latent content of all these dreams, particularly in this last one, evidence in favour of their positions, though to us they reveal only, in the blurred and broken way dreams do, the prevailing trend of thoughts governed by morbid religious fears and garbed in the phraseology and symbolism of a judaic faith. The sameness of their ending and meaning to her being obviously due to their relation to the dream which ushered in her illness to which indeed most of them were closely related in geneses and content. No doubt Freudian psychoanalysis would be able to carry her memory back into the region of long forgotten infantile or early sex memories where, as in every normal human being they lie, the shadowy outlines of instinctive feelings whose roots are in a far away, phylogenetic past, having apart from suggestion no role as factors in the production of morbid fears or fancies. The fantastical and too often repulsive dream interpretations of this school forcibly remind us of the words of Lord Bacon, "With regard to the interpretation of natural dreams it is a thing that has been laboriously handled by many writers, but it is full of follies." All kinds of trivial incidents of childhood and early youth are stored up by all of us, and are recalled in sudden and unexpected ways, but not because of any relaxation of a supposed "censor," nor necessarily because of any content of a sex nature, but because they are more often than not associated with fear, chief of the coarser emotions, and a more primitive and more enduring emotion than any of those connected with reproduction, and more alien to the organism than sex memories even of a perverse order, their resurrection being due to some subtle association between the present and the past, generally a sensory one, visual or auditory most frequently. In our own case the earliest recollections of childhood are so associated and recollected. Sunshine amongst trees, and birds singing bring back to us at very long intervals a country scene where as a child we were frightened by threats of a "bogie man." The only childish incidents which unexpectedly recur with us were associated with childish fears and disappointments of a usual and ordinary character never with morbid elements or emotional complexes which were repressed or censored in the Freudian sense, and in this we are not singular.

Again and again, association tests, as prescribed by Jung, and repeated examinations of a psychological character were made without our being able to obtain the slightest indication of their being erotic or similar influences of the slightest value as factors in the causation of her mental disturbance. The chief value of Jung's Tests we have found to be the suggestion of lines of inquiry or the confirmation of evidence obtained in other ways. The results here were negative and in that confirmed what we knew from the history and character of our patient as a pure minded woman of blameless life. She was constitutionally timid, and all her life liable to doubts and fears of a morbid type. As an instance of this she told us that when twelve years of age while influenced by the death of her step-mother, which had just taken place, one morning early her father went out to his work leaving her in bed, and alone in the house. Immediately after he left she heard or more likely thought she heard, someone lift the latch of the door, as if to come in, but though no one came in she was left in a state of great fear, so marked that for long afterwards she dreaded being left alone, and still remembers vividly her feelings during that experience. This temperament she carried into her religious life which as we have seen was marked by fears and doubts. "No one will deny that fear is the type of asthenic manifestations. Yet is it not the mother of phantoms of numberless superstitions, of altogether irrational and chimerical religious practices."[14] The strength and character of her beliefs as well as the religious teachings and influences to which she had been subjected from her earliest years, all

tended to develop the mystical in a temperament ready for the dissociation necessary to enable the mystic to attain to that ecstasy or absorption in something outside and beyond the self which is the essence of that state. Why the ecstasy which she knew and desired should pass into its opposite is not difficult to understand when the above history is considered.

The shock which originated the attack gave form and reality to fears and doubts which had been assailing her for some time, and to the influence of which she was specially liable at this time by the lowered physiological tension, the result of her previous menorrhagia, and by the fact that the comparative ease and comfort of her later life had given her opportunities for introspection absent during her previous life of struggle for and interest in others. She was then scrupulous, timid and superstitious, a mystical, a psychopathic temperament, taking her place all the same with John Bunyan and other chief of sinners whose self-depreciation and absorption in the struggle for salvation from sin and the power of the Devil, though morbid in character was not pathological. But when Satan became not merely a spirit influencing her, but had entered bodily into her, the border was crossed, and she was to herself literally possessed, and became filled with fear, a fear pathological in action, dominating her mentally and physically during her dissociated states. Once initiated it is not difficult to see how these dissociated states which recurred so regularly and persisted so long were kept up by her temperament, and her constantly recurring dreams of a terrifying or depressing character, which were, as we have already indicated, but representations of the original shock. The following quotation applies closely to her case. "On this view an intense, sudden painful experience, especially if the significance of it can be dimly felt, but not understood, may persist long and latently unassimilated by the central consciousness and without fusion with it, almost as if it were a foreign body in the psychic system."[15] Professor James has termed the pathological emotion an objectless emotion, but as Professor Dewey puts it "from its own standpoint it is not objectless;

it goes on at once to supply itself with an object, with a rational excuse for being."[16] Here the sensations in the left hypochondrium which she had described as "grippings at the heart," became the object which, under the influence of the initial shock with its unusual and alarming sensations and feelings, she interpreted as she did.

Her recovery was very gradual and marked by many relapses. In her treatment as in our ideas as to the causation of the disorder, we put the accent on the psychic rather than on the physical factors. We did not however underrate the latter but constantly sought to improve her bodily health and condition. When at her worst in 1911 her weight, taken monthly, was round about one hundred and sixty pounds. In 1912 it went up from one hundred and sixty-six to one hundred and eighty-eight pounds and averaged one hundred and seventy-six pounds. But as in the case of her blood pressure, the rise was due largely to her mental improvement. It may be of interest to note here that during and after a somewhat severe attack of diarrhoea with hemorrhage from the bowels, her mental condition was better than usual, as might even have been expected considering the mental distraction the attack involved.

We were satisfied that we could have shortened materially the duration of her illness—two years,—by hypnotic suggestion, but unfortunately her friends objected to this mode of treatment. Suggestion in the waking state had been abundantly used, but with little apparent effect of an immediate kind.