We have described the alterations produced by hypnosis in the perceptive and conceptive activity of the individual and have shown how will and actions are influenced by hypnosis. This by no means exhausts the effects of hypnosis, as is apparent if only from the fact that even the apparatus of motion presents alterations which cannot—in our description—be regarded as direct consequences of a suggestively produced idea or feeling. Furthermore, in the course of the hypnosis, a state ensues which we must consider as in many ways resembling sleep. The beginning of profound hypnosis, as well as profound sleep in general, is not characterized by any increase in blood pressure after the injection of adrenalin, according to Heilig and Hoff (data as yet unpublished). A "vagotonic" reaction here takes the place of the normal adrenalin reaction.

Alterations of the body take place in hypnosis, and these alterations are not subject to the individual's direct caprice, in other words, they are alterations in the vasovegetative system, in the widest sense of the term. With regard to the effect of hypnosis on these " bodily systems " we must distinguish between two possible effects: (*) Those effects ensuing upon the beginning of hypnosis, without any suggestion of ideas; to this class belong the muscular rigidity and catalepsy on the part of subjects who have not had such conditions expressly suggested to them; (**) those effects on the vasovegetative system that are the result of an idea, and that have therefore been, in the narrower sense of the word, suggested.

(*) One patient of mine on whom hypnosis was attempted, told me later of the fears he had in being hypnotized and the effect that it had on him caused him to wake up after he had already been asleep.—Trans.

(*) The effects experienced in hypnosis may result from unconscious resistances against being hypnotized upon the vasovegetative system.— Trans.

In general, little is known concerning the direct, nonsuggestive effect of hypnosis.¹ Some authors, for instance, Kronfeld and Friedrichs, even deny all nonsuggestive phenomena in hypnosis. But very probably the effects experienced in hypnosis work directly upon the vasovegetative system.² However we shall dwell in more detail on the suggestive effects in hypnosis. The following conditions may be obtained by appropriate suggestions:

1. In the transversely striated muscles. Muscular relaxation, muscular rigidity, muscular tremors, may be suggested. Muscular relaxation may be quite pronounced even in persons who have not fallen asleep. Tensions may be of various kinds. We are dealing either with a catalepsy in the narrower sense, i.e., the part moved remains in any position assigned to it, but with the minimum of muscular tension required for a retention of the position. But we occasionally observe tensions which are far more marked. In some cases, not even those positions that have been passively assumed are retained, and there is a tendency toward overextension. Even though the statements of Frohlich and Meyer, to the effect that action streams are lacking in cataleptic tension, have been refuted by the investigations of Rehn and DeJongh, and though it has been proved that tetanic innervation streams are running down even during the cataleptic innervation, as in a voluntary muscular contraction, it must not be forgotten that the cross-striated muscle has the sympathetic-parasympathic innervation as well as its cerebral-spinal innervation. We may state this in other words by saying that every cross-striated muscle also includes a smooth muscle. There may be a difference of opinion in specific cases as to what part of the muscular functions is due to the sympathetic parasympathically innervated section (compare F. H. Lewy's data on this point). But this phase of the matter may not be overlooked either in tremors nor in a relaxation of muscles due to fright.(*) We may even go so far as to emphasize a. further point in these discussions, namely, that " the affective-vegetative " factor is not equally present to the same degree in the various cross-striated muscles. Doubtless there are muscles which serve the function of expression and the feelings in a far higher measure than others. The muscles of the eye are of this class, and we again point out that in negative hallucination the hypnotized individual ordinarily looks away from the hallucinated objects. It will be necessary to ask whether the specific predilection for the muscles of the jaw and neck, in the case of the negativistic tension of dementia precox patients may not be explained by similar factors. Similar considerations must be raised in connection with the are de cercle(**) of hysterical individuals. It may be objected, in opposition to this attitude, that the specific behavior of the above named groups of muscles is conditioned by psychological reasons. We take the liberty to anticipate the fundamental idea of our study to the extent of emphasizing that a specific psychic attitude certainly must have its specific cerebral-physiological concomitant.

(*)Grafe and Traumann have shown that hypnotic rigidity of muscle simulates metabolism less than voluntary contraction. (**) Opisthotonos.

2. The innervation of the heart and of the vessels depends very much, of course, on the emotions. Much has been said about the bodily expression and bodily effects of feeling, and not always with reason, for there are no feelings that are not related with some conceptual, perceptual, or ideological content or other. It would therefore be more reasonable to speak of the bodily effect of the emotions. All the effects which may be produced by the operation of the emotions may also be called forth by the operation of suggested emotions ; for instance, accelerations and retardations of the number of heart beats may be produced as the result of suggested emotions, Astruch succeeded in depressing the frequency of the pulse in hypnosis to thirty beats per minute. He even obtained heart fibrillations, but Braun declares that this observation is not free from criticism from the methodological side. There is no doubt that a sudden emotion may produce death in the case of persons suffering from heart trouble.(*) The line of demarcation between health and disease is by no means a sharp one, and in the case of primitive persons sudden deaths due to fright are said to have been observed (compare Braun's data on this subject). These points are adduced merely to visualize the powerful effect of the emotions on the heart.

(*) The effect of emotion on the heart was illustrated in a patient who swooned and vomited when seeing another patient being pricked in the neck with a needle and anticipating the same procedure upon herself.—■ Trans.

When Isuggest anger I never suggest this feeling alone, but must always suggest a content of reproduction or of conception together with the idea. In fact, in general, much better results will be obtained in suggestions of this type by emphasizing the content and not the feeling or the emotion as such. It is easy in general to suggest a quickening of the pulse because it is easier to select key conceptions of a terrifying and fearsome kind, such as would naturally produce an accelerated pulse, than to fix upon key conceptions with a concomitant retardation of the pulse. This attitude simultanously furnishes us with the general formulation that every conception, every perception, every idea, has its appropriate vasovegetative consequences, and that in order to attain a certain result within the vasovegetative system it is necessary to ascertain the content of the corresponding conception. This fact makes it possible for us also to determine the difference between a desired event in the vasovegetative system and an act of caprice. In a capricious act I have, in addition to the conceptual, perceptual, or ideologic aspect of the action, also an express intention with regard to my motion, my innervation. If I desire an acceleration of my heart beat, I can attain it by visualizing a terrifying conception. The acceleration of the heart beat will then follow without any specific concentration on the cardiac muscle. I am aware of the relation between a terrifying conception and an acceleration of the pulse only because of purely intellectual considerations and not because of any specific intention directed to the cardiac muscle. We have formulated the matter thus only with respect to the cardiac muscle, but the same holds good of all the organs of vasovegetative innervation. We may apply it, for instance, to the so-called voluntary alteration of the diameter of the pupil as a result of the idea of light and dark. With regard to the effect of the emotions on the vascular system, we may refer to the presentation of the subject to be found in the Medizinische Psychologie by one of the present authors. It is a well known fact that every emotion involves dislocations of the blood which may be represented plethysmographically. While it was formerly assumed that the volume curve of the arm varies with the presence of either pleasure or pain, recent investigations (Kuppers, DeJongh, Weinberg) show that the volume curve for pleasure is identical with that for pain, and that it serves in this connection only as an expression of the presence of psychical activity as such. To be sure, the presence of psychical tension does customarily express itself also in the volume curve. The investigations of Weber afford information concerning the dislocation of the blood in the various parts of the human body. There is no doubt, at any rate, that the volume curve reacts most sensitively to fluctuation of the feelings, although the capacity for the expression of these fluctuations may be limited. The dislocation of the blood in the extremities, in the region of the head and in the abdominal organs, isnot identical. Alterations of blood pressure accompanying psychical activity are explained by Bickel as due to changes in the activity of the heart and not to the vascular system. The suggestions of "warmth," " cold," in hypnosis, may have a considerable influence on the vascular system. Forel, Heller, and Schultz, as well as Alrutz. have succeeded in calling forth blisters, as from a burn or scald, by making a corresponding suggestion. Of course, it is not certain that the attainment of these blisters is to be explained only as an effect on the vascular system. Direct trophic effects must not be overlooked. The importance of the effects of emotions and suggested emotions on the vascular system cannot be overestimated when we remember that every organ of the body is supplied with blood vessels and that the most remote regions of the body are therefore accessible to suggestion by way of the vascular system. To be sure, we have also to consider, in addition to the influence of suggestion on the vascular system, other effects, concerned with the quite differently constituted smooth muscular tissue, the glands, and the trophic functions.

3. Since Pavlov's brilliant studies, there has been no doubt of the great influence of the emotions on the intestinal tract. The functions of the salivary glands, as well as the secretion of the gastric juices, may be influenced psychically, not only in general, but the secretion of gastric juices is adapted in its quality to the food stuffs that are fixated. Bickel showed that the secretion of gastric juices in a dog ceased when he was shown a cat. We must therefore point out as a principle that the effect of the emotions on the digestive glands is of two-fold nature. On the one hand, emotions may operate as a stimulus or as an inhibition of the secretion of the gastric juices. This secretion is therefore an expression of the general emotional state of the individual; on the other hand, the secretion of gastric juices is stimulated in a definite direction by specific psychical contents. Investigations by Heyer, Schrottenbach, Langheinrich, Heilig, and Hoff have shown that the results thus obtained in experiments on animals are also valid for man. While Schrottenbach studied the influence of the emotions as such, the other authorities are concerned with the effect of the conceptions (perceptions) and emotions produced in hypnosis on the secretion of gastric juices in an empty stomach, and also on secretion after the consumption of food. Langheinrich has investigated the effects of conceptions of hypnotic origin on the secretion of bile. Not only the secretion of the intestinal tract, but also its motility, is dependent in great measure on psychical factors, as may be shown by the most ordinary daily experience. Cannon showed that intestinal peristalsis of a cat ceased when her young were taken away. Heyer eliminated abdominal atonies in man by means of suggestion. Forel and others have repeatedly overcome constipation by means of suggestion.

Diarrheas may be brought about by emotions and by suggested emotions.

4. The skin may be influenced by suggestion, in the first place, by an alteration in the local circulation. But in the production of the scald blisters by hypnotic suggestion we are also dealing, probably, with a direct trophic influence. This is the same trophic influence to which must be ascribed a sudden turning gray of the hair after a violent shock or fright. We must, for the rest, refer to the experiments of Kreibich and the observations of Bunnerman and Stern.

5. An influencing of the sexual organs by psychic means is of great importance even in the normal functioning of these organs.

The orgasm in man as in woman is accompanied by extensive somatic phenomena, phenomena both of vasomotor and secretory variety, in which movements of the smooth and cross-striated muscles play an important part. Secretory anomalies such as leucorrhea and menstrual difficulties have been overcome by gynecologists by means of suggestive therapy. In this connection we must also point out the data of Forel, who reports a permanent influence on menstruation by means of hypnosis. (Cf. also the article by Mayer in O. Schwartz's book on the psychogenesis of organic symptoms.)

6. We shall merely refer in passing to the susceptibility to hypnosis, of respiration, of the pupil, and of the genito-urinary system, concerning which little specific information is available.

Experiments by Heilig and Hoff which have not yet been published show the effects of suggestion of pleasure or of pleasurable sensations upon the secretion of urine and the retention of sodium chloride. Anxiety and shock, increase the volume of urine, with a lower sodium chloride content. According to the view of these scholars, the secretion of the kidneys may be hypnotically influenced, but they do not attempt to solve the question of whether this is an effect of an altered supply of blood to the blood vessels or of an effect on the tissues, or—what is most probable—an effect on both at once. It has long been known that the volume of urine may be increased and suppressed by suggestion.

7. It is an important fact that the glands of internal secretions may be influenced by suggestion. To be sure, as we well know, this not true of directly suggested effects, but of the effects of the emotions, which are in turn, however, produced by suggestion. Thus, according to Cannon, the quantity of adrenalin in the venous blood is lowered if the animal is suddenly terrified. Clinical experiences make it very probable that the emotions have an influence on the thyroid gland (*) in the direction of a change to the Basedow condition (Kohts). The fact that the sugar contents are changed in depressive affects, and that hyperglycemia and glycosuria may ensue, has been made certain by the investigations of Raimon and Knauer and Schultze. But no material exists—as far as we know—concerning the influence of hypnotic suggestion on the glands of internal secretion.

(*)I have for many years studied the psychogenic causes of Basedow's disease, and have been able to influence their recovery by suggesting the elimination in their lives of such psychic factors. One case of exophthalmic goiter was recovering nicely and her goiter disappearing when she was told of the syphilitic infection of her fiance. This shock caused complete recurrence of symptoms.—Trans.

8. Eichelberg succeeded in producing fever by suggestion. Grafe has shown in experiments on metabolism that the basic metabolism may suffer a number of very considerable changes under the influence of suggested emotions. Glaser has altered the calcium index of the blood by means of suggestion, but of course we have yet to see whether the alteration of the calcium index of the blood is not a secondary consequence of an alteration in respiration, for forced respiration (compare Adlersberg and Porges on this point) produces changes in the calcium content of the blood. We refer the reader to the fact of neurotic respiratory tetany with its alteration of the calcium content of the blood, which has been given due attention by the above named authors. We may also make here the general remark that the directly suggested conceptions and affects may give rise indirectly to effects on the body. Thus, for instance, in the case of respiratory tetany, which may thus originate psychogenically. In this manner even a suggested contracture might call forth secondary changes in the musculature. If I suggest to a person that it will be necessary for him to turn about ten times on his own axis, the simple issuance of the command will produce nystagmus as well as the other changes naturally involved in a revolution on one's own axis.

9. The fact that conceptions during hypnosis may rise to the stage of actual perceptions has already been repeatedly mentioned by us. This change must be a consequence of some effects on the cerebral process itself. These effects must partially have been shunted over the path of the affectivity, a remark which we beg to emphasize at this early stage for theoretical reasons. Bauer and Schilder succeeded in producing past pointing in a person experimented on—by means of the suggestion that the objects in the environment were rapidly revolving around him and making him very dizzy. In many ways this past pointing resembled a similar past pointing ensuing upon vestibular excitation. To be sure, nystagmus was absent. They have interpreted this phenomenon by assuming a direct influence on cerebellar excitation. P. Lowy explains these phenomena as due to a change in the conception of direction, but in an essay written together with Leidler he points out that the forms of dizziness in neurotics correspond precisely with the experiences of dizziness in vestibular lesions. These authors also resort to an intermediary action of the blood vessels in their explanation. We should ourselves prefer, on the contrary, to retain our conception of the possibility of influencing directly the vestibulo-cerebellar functions by means of suggestion. It is clear here also, as well as in the case of the power of suggestive hallucination, that the cerebral mechanism as such may be influenced by the path of suggestion.

10. This question may be answered even more definitely if we recall sleep and the possibility of influencing it by means of hypnosis. In giving more detailed treatment of this example, we are actuated by the consideration that sleep is of fundamental importance in the theory of hypnosis. The fact that sleep may be produced by suggestion through hypnosis is beyond dispute. The identity of the sleep produced by hypnosis and spontaneous sleep is evident also from a number of more specific traits. The eyes of a hypnotized man, as well as those of a man going to sleep, will close as a result of the feeling of fatigue. He may open them once or twice before sleep finally comes. A person falling asleep frequently contracts convulsively, sometimes with the sensation of falling. Slight motor muscular disturbances are not unusual. Obviously, we are describing releases of subcortical motor mechanisms from the cortical restraint. This assumption is supported, for instance, by the case of Haenel and Bielschowsky, in which a myoclonia ensued as the patient was about to fall asleep. The post-mortem examination showed a grave alteration in the Purkinje cells of the cerebellum. We are not in a position to state that the sensation of falling which a person falling asleep occasionally experiences together with his sudden twitch also includes vestibular components, nor have we been able to observe any such thing in hypnotized persons as yet. We have already pointed out the similarity of the adrenalin values in natural and suggested

In hypnosis, as well as in sleep, the pupils are frequently contracted; to be sure, the contraction of the pupil is not universal in hypnosis; there is a frequent alteration in the diameter of the pupil (see Moll). Sleep of hypnotic origin and natural sleep must not be distinguished in any way in their form or in their regular course. The sleeper who enters the state by hypnosis is also very reluctant to leave it. After awakening, he rubs his eyes, looks around, and may even present that short phase of blankness which occasionally marks the transition between profound slumber and awakening. Concerning the physiology of sleep we have excellent data, thanks to the investigations of v. Economo, who based his studies on Tromner and Mautner. There is no doubt that in the vicinity of the third ventricle there is a relatively circumscribed region that is of great importance in the genesis of sleep. For the sake of brevity we shall call it a sleep center. V. Economo made these observations in connection with his well known investigations concerning encephalitis lethargica, also refuting the view that an interruption in the conductivity produces the disturbance of sleep in encephalitis lethargica. In one form of this disease, usually when accompanying infiltrations in the region of the third ventricle, there is in the acute stage a well known pronounced tendency to sleep. Hoff and Kauders(*) (unpublished experiments), proceeding from the investigations of v. Economo, produced a chronic experimental medinal intoxication in dogs, with persistent conditions of sleep, and were able to find in the brains of the animals experimented on not only serious changes of ganglionic cells in the inferior olive, but also extensive ganglionic processes of degeneration in the central gray matter surrounding the aqueductus Sylvii, and also in the infundibular region. Even more instructive are the hyperkinetic forms of encephalitis, which usually ensue in the form of a serious insomnia. Precisely these hyperkinetic initial stages of encephalitis are furthermore, as one of us (Kauders) has already pointed out, often capable of being alleviated of its motor symptoms ** by means of hypnosis, even yielding to a temporary condition of sleep. This is a further evidence of the already mentioned direct influence of suggestion on cerebral mechanisms, if we may assume that as early as in the hyperkinetic stage a certain irritation of the subcortical sleep centers exists, owing to the process of infection, and which is further exaggerated by the serious phenomena of motor affections; this irritation becomes quite manifest in the subsequent lethargic stage. This stage is characterized by a stubborn tendency to sleep, which may under certain circumstances be operative only by day, while the patient is restless and unable to sleep at night. V. Economo speaks of a shifting of the natural divisions of time. This author has also refuted the view that is occasionally set forth to the effect that disturbances of sleep in encephalitis are connected with the pituitary body. The facts communicated permit us to assume with certainty that there is a sleeping mechanism located in the vicinity of the third ventricle (cf. also Leyser), which in encephalitic cases is sometimes in a condition of overexcitability and over functioning and at other times of underexcitability and underfunctioning. Furthermore, there are also conditions of functional disturbances. Cases like those of Luksch and Pette, in which a lesion of the brain localized at the junction of the third ventricle at the aqueductus Sylvii indicates a specific function in determining sleep, are of great importance. Forel has explained in detail that the setting in motion of the mechanism of sleep—when one falls asleep—is, in natural sleep, determined by the desire to sleep, the psychology of which will take up a good deal of our attention in the sequel. In hypnosis the desire to sleep is produced by suggestion, or, in other words, the psychic effects of hypnosis set the sleep mechanism in motion. We have thus furnished evidence that a cerebral mechanism located in the vicinity of the third ventricle may be influenced by psychic means. But are we not concerned here with something quite similar to the other effects of hypnosis on vasovegetative systems ? We prefer not to give a more detailed proof for our affirmative answer to this question until we have gone more thoroughly into the psychology of the sleeper and of the hypnotic subject.

(*)I have been privileged to see the slides of v. Economo and those of Kauders whose experiments on dogs corroborate the findings of v. Economo. I found them very convincing.—Trans,

(*)Similar results were obtained by me in myoclonic cases of encephalitis in which hypnotism was used. I was in doubt often whether these symptoms were not merely hysterical and I was often corroborated in my opinion when the symptoms yielded to hypnosis. Kauders pointed out to me the error of differentiating with the use of hypnotism instead of recognizing its influence on both conditions.—Trans.