Esdaile’s Operations under Hypnosis—Removal of Tamours—Amputations—The Author’s Cases—The Demonstration at Leeds in 1890—Dr. Fairley’s Experience of Hypnosis as a Patient
The following is Esdaile’s description of two typical operations:—
No. 1. Removal of a large scrotal tumour.— “S., aged 27, came to the Native Hospital with an immense scrotal tumour as heavy as the remainder of his body. He was mesmerised for the first time on October 10th, 1846, then on the 1lth and 13th, on which latter day he was ready for the operation, which was performed on the 14th. The tumour was tied up in a sheet to which a rope was attached, and passed through a pulley in the rafter. The neck was dissected out and the mattress then hauled down to the end of the bed; the patient’s legs were held asunder, and the pulley put in motion to support the tumour. It was transfixed with the longest two-edged knife, which was found to be too short, as I had to dig the haft into the mass to make the point appear below it, and it was removed by two semicircular incisions right and left. The flow of venous blood was prodigious, but soon, moderated under pressure of the hand; the vessels being picked up as fast as possible. During the whole operation, I was not sensible of a quiver of his flesh. The tumour weighed 103 pounds. The patient made a good recovery.”
No. 2. Removal of an antral tumour.—“Two years previously the patient, a peasant, aged 40, began to suffer from a tumour in the antrum, which had pushed up the orbit of the eye, filled up the nose, passed into the throat and caused an enlargement of the glands of the neck.”
An assistant having failed to mesmerise this patient in a fortnight, Esdaile took him in hand, and thus describes the result:—“In half an hour he was cataleptic, and a quarter of an hour later I performed one of the most severe and protracted operations in surgery; the man was totally unconscious. I put a long knife in at the corner of his mouth and brought the point out over the cheek-bone, dividing the parts between; from this, I pushed it through the skin at the inner corner of the eye and dissected the cheek-bone to the nose. The pressure of the tumour had caused absorption of the anterior wall of the antrum, and, on pressing my fingers between it and the bone, it burst, and a shocking gush of blood and matter followed. The tumour extended as far as my fingers could reach under the, orbit and the cheek-bone, and passed into the gullet—having destroyed the bones and partition of the nose. No one touched the man, and I turned his head in any position I desired, where it remained until I wished to move it again; when the blood accumulated, I bent his head forward and it ran from his mouth as if from a spout. The man never moved, nor showed any signs of life except an occasional indistinct moan; but when I threw back his head, and passed my fingers into his throat to detach the mass in that direction, the stream of blood was directed into his windpipe and some instinctive effort became necessary for existence; he therefore coughed and leaned forward to get rid of the blood, and I supposed that he then awoke. The operation was finished and he was laid on the floor to have his face sewn up, and, -while this was being done, he for the first time opened his eyes.”
The patient afterwards informed Esdaile that he did not know he had coughed and was quite unconscious up to the termination of the operation. The dressings were removed three days afterwards, when it was found that the wounds in the face had healed by first intention. The recovery was satisfactory.
The following two cases were reported by visitors to the hospital:
No. 3. Amputation of the leg.—The patient was sinking: she had been attacked with fever, and Dr. Esdaile, though he was not satisfied that she had been mesmerised sufficiently, determined to operate at once, as further delay endangered her life. The leg was taken off a. little below the knee: The thigh and knee from which the leg had been taken were perfectly motionless, and the only evidence of life was her respiration. She was not held or tied down in any way, and, during the whole operation, not the least movement or change in her limbs, body or countenance took place. Dr. Esdaile left her to wake naturally, which she did in about a, quarter of an hour. She then told us that she had had a good and undisturbed sleep, without dreams or pain, and that she was ready to have her leg amputated. Upon receiving ocular demonstration that the operation had been performed, her countenance expressed surprise and pleasure, and, as if doubtful of the fact, we observed her pass her hand over the stump, apparently to test the reality of what she saw. Shortly afterwards, when we left the hospital she was composedly waving a punkah over her face.”
No. 4. “The patient had not been previously mesmerised, and Dr. Esdaile was doubtful whether this could be done deeply enough for operative purposes. He instructed a native assistant to commence the process and the patient quickly passed into a state of deep coma. Esdaile then amputated the leg six inches above the knee; not a muscle moved, the pulse was steady and regular, there was no perspiration on the forehead, no paleness of the countenance; in fact, the patient was as motionless as a corpse. Shortly after the operation, he awoke in the most natural manner, stretching out his arms, yawning and rubbing his eyes. He said, in reply to questions, that he had had a good sleep and felt all the better for it. He was intensely surprised when told that the operation was over; and showed his gratitude in the usual native manner placing his hands upon his breast and murmurings “blessings on the doctor.”
Among many other interesting cases cited by Esdaile there was a case of compound fracture of the leg, in which a portion of bone was sawn off and the fracture set during the mesmeric trance, with several cases of strangulated hernia, which had resisted all attempts at reduction: during mesmeric sleep there was complete relaxation of the abdominal muscles; and in every instance, the hernia was easily reduced. Esdaile also recorded cases of stricture of the urethra, with retention of urine, successfully treated during mesmeric trance; as well as a case of labour, which took place painlessly during the same condition.
Personal cases.—Shortly after commencing hypnotic work, I often found I could induce anaesthesia by suggestion, and performed many minor surgical operations during hypnosis. Sometimes, however, while I hypnotised the patients, the operations were performed by others. The following is an extract from the account of one series of these operations, published by the late Mr. Arthur Turner, of Leeds, in the Journal of the British Dental Association for March 15th, 1890:—
“I had a large choice of patients and selected those which I considered would afford a severe trial of this method. One upper molar, which another dentist had on three occasions failed to remove, I extracted without difficulty, and with no signs of pain from the patient. She then, without awakening, rinsed her mouth, and I extracted the fellow-tooth on the opposite side. Hypnosis was induced and removed almost instantaneously. The patient stated emphatically that she had, no recollection of the operation being performed, that she had felt no pain, and there was no resulting tenderness of the gums.
“Another case, that of a young girl suffering from valvular disease; a weak anaemic subject, whom one would expect to find ‘deepen’ considerably under nitrous oxide, and remain in a state of collapse for a whole day after ether, was quickly and quietly rendered unconscious. I then extracted two lower molars, which were decayed down to a level with the alveolus, with pulps exposed; also two right lower molar stumps and a lower bicuspid: all difficult teeth. There were slight muscular twitchings, such as one often finds under an anaesthetic, but there was no complaint of pain after the operation, and the patient was quickly restored to her normal condition.
“I extracted in all about forty teeth, tried mybest to discover defects and questioned the patients myself, but the results were most satisfactory. Three typical cases are here appended:—Miss A., aged 15. Teeth extracted right upper molar, left upper molar, caries; left lower molar, abscess; temporary canine, persistent. Remarks: No conjunctival reflex, dilated pupils; no pain. .
“Mrs. B., aged 36. Teeth extracted: upper molar right, first and, second lower molars right, left lower wisdom, and right lower bicuspid—stump forceps used in each case. Remarks: Conjunctival reflex absent, oo sign of pain. -
“Miss C., aged 24. This patient was sent to me from another room with a note from Dr. Bramwell, stating that he would not be present during the operation, and enclosing a written and signed, order for her to sleep and submit herself to my control. Upon presenting this the patient at once fell asleep. I extracted two upper bicuspid stumps, quite buried by congested gums and very tender to the touch. I then awakened the patient and found that she was quite free from pain. This is important as showing that patients may be sent from a distance without necessitating the personal attendance of the hypnotiser.
“A great advantage of hypnosis over narcosis is that no gag is required in the former, as the patient is entirely under the control of the operator, opening the mouth at command or altering position as suggested.
“I hope to get Dr. Bramwell to give a demonstration to a meeting of the Society, when those interested will be able to judge for themselves.
“W. ARTHUR TURNER, L.D.S. Eng.”
The demonstration referred to was given at Leeds shortly afterwards, a report of it being sent, without myknowledge, to the British Medical Journal and the Lancet. The following is an extract from the account which appeared in the latter:—
“Demonstration of Hypnotism as an Anaesthetic during the Performance of Dental and Surgical Operations.
“A correspondent, on whom we can rely, kindly furnishes us with the following remarkable report. Great interest was evinced in the meeting . . . . upwards of sixty medical men and dental surgeons accepted the invitation. A letter expressing regret at his inability to be present was read from Dr. Clifford Allbutt, .in which he reminded the meeting that he remembered the time— thirty-five years ago—when Liston performed several serious operations, using hypnotism as the anaesthetic.
”The first case brought into the room was a woman of 25. She was hypnotised at a word by Dr. Bramwell, and told. She was to submit to three teeth being extracted without pain at the hands of Mr T. Carter, and further that she was to do anything that Mr. Carter asked her—such as to open her mouth, spit out and the like. This was perfectly successful. There was no expression of pain in the face, no cry; and when told to wake she said she had not the least pain in the gums, nor had she felt the operation.
“The next case was that of a servant girl, aged 19, on whom, under the hypnotic influence induced by Dr. Bramwell, a large lacrymal abscess, extending into the cheek, had a fortnight previously been opened and scraped freely without knowledge or pain. Furthermore, the dressing had been daily performed and the cavity freely syringed out under hypnotic anaesthesia. To the curative suggestions, daily given to the patient, Dr. Bramwell in a great measure attributes the very rapid healing, which took place in ten days--a remarkably short space of time in a girl affected by inherited syphilis, and in a by no means good state of health. She was put to sleep by the following letter from Dr. Bramwell addressed to Mr. Turner, the operating dentist in the case
Burlington Crescent, Goole, Yorks.
“DEAR Mr. TURNER,—I send you a patient with enclosed order. When you give it to her, she will fall asleep at once and obey your commands. “J. MILNE BRAMWELL.
“Go to sleep by order of Dr. Bramwell and obey Mr. Turner’s commands.
“J. MILNE BRAKWELL.’
This experiment answered perfectly. Sleep was induced at once by reading the note, and was so profound that, at the end of a lengthy operation in which sixteen stumps were removed, she awoke smiling and insisted that she had felt no pain. She was observed, some time after, reading the Graphic in the waiting-room as if nothing had happened. During the whole time she did everything that Mr. Turner suggested, but it was observed that there was a diminished flow of saliva, and that the corneal reflexes were absent; the breathing was more noisy than ordinarily and the pulse slower.
“Dr. Bramwell explained that the next case, a boy of 8, was a severe test and would probably not succeed; partly because the patient was so young, but chiefly because he had only attempted to induce hypnotic anaesthesia two days before. He also explained that patients require training in this form of anatsthesia, the time of preparation varying with each individual. However, he was so far hypnotised that he allowed Mr. Mayo Robson to operate on the great toe, removing a bony growth and part of the first phalanx, with no more than a few cries towards the close of the operation; and with the result that, when questioned afterwards, he appeared to know very little of what had been done. It was necessary in his case for Dr. Bramwell to repeat the hypnotic suggestions. Dr. Bramwell remarked that he wished to show a case that was less likely to be perfectly successful than the others, so as to enable those present to see the difficult, as well as the apparently straightforward, cases.”
In the article from which I am quoting, several other successful operations are recorded in detail, and then the account finishes thus:—
“At the conclusion of this most interesting and successful series of hypnotic experiments, a vote of thanks to Dr. Bramwell, for his kindness in giving the demonstration, was proposed by Mr. Scattergood, Dean of the Yorkshire College, and seconded by Mr. Pridgin [sic] Teale, F.R.S., who remarked that the experiments were deeply interesting, and had been marvellously successful. The latter also said he felt sure that the time had now come when we should have to recognise hypnotism as a necessary part of our study. The vote was carried by loud acclamations.
“Messrs. Carter Brothers and Turner were cordially thanked for the great scientific treat they had so kindly prepared for the many to whom hypnotism had been first introduced that day, and for the further opportunity, afforded to the few who had seen Dr. Bramwell’s work previously, of studying its application as an anaesthetic. Mr. Henry Carter replied for the firm, and the meeting closed; the patients looking as little like patients as persons well could, giving neither by their manners nor expression the slightest suggestion (except when external ‘dressings -were visible) that they had suffered, or were suffering from, extensive surgical interference.” (The Lancet, April 5th, 1890, page 771.)
The above account, except a few -unimportant details, is correct. The removal of the exostosis was rendered a more severe operation by a preliminary evulsion of the great toenail, and, although the patient showed slight signs of pain, he was afterwards unable to recall what had happened. The after-condition, of the patients was remarkable; and the unpleasant symptoms which sometimes follow the use of anaesthetics were absent. They all made a hearty meal, and then returned to Goole, a journey of over an hour by train. The nurse in charge told me she might have been conducting a party home from a fair, as they passed the time in laughing and singing. With the exception of the boy whose toe had been operated on, and who was unable to put on his boot, none of them kept the house; while in every case the healing process was remarkably rapid and unaccompanied by pain.
From that date, I employed hypnotic anaesthesia in a number of minor operations, but, with the exception of the following, few are worthy of special note.
No. 5. Mr. ---, aged 40, was run over by a loaded railway wagon, and sustained severe comminuted fracture of the right clavicle, scapula, humerus, radius and ulna. The elbow joint was opened, and gangrene of the lower arm followed. The patient ultimately recovered; but all the joints of the right arm, shoulder, elbow, wrist and fingers were ankylosed. On several occasions he was put under chloroform and the adhesions broken down; this was always followed by swelling, inflammation and return of the immobility. Later, he would neither take an anesthetic, nor allow any attempt at passive movement to be made without one. He was easily hypnotised at, the first attempt and analgesia induced. For some weeks this was repeated frequently, and on each occasion the adhesions were broken down and the mobility of the joints increased. He ultimately returned to his employment, with a strong and useful, though somewhat. deformed, arm. This case was seen by Mr.Mayo Robson, both before and after hypnotic treatment.
At a meeting of the Medical Society for the Study of Suggestive Therapeutics, London, January, 1909, Dr. Douglas Bryan, of Leicester, read the notes made by Dr. Fairley, whom he had hypnotised for the extraction of a tooth. Dr. Bryan said: “This record of Dr. Fairley’s experiences during hypnosis is extremely interesting and valuable, because it is made by a medical man who has himself treated many cases successfully by hypnotic suggestion, and who, though a willing subject, was very critical.”
No. 6. Dr. Fairlers notes.—“On November 23rd, 1908, at 10.30 p.m., I had my first experience of hypnotism as a patient: this as a preliminary to tooth extraction on the 21th. I was hypnotised three times, and each tinde the sensations were the same. The operator (Dr. Douglas Bryan) held up his fingers to fix the eyes, and suggested a feeling of heaviness and tired feeling in the eyes, restfulness, etc. The first thing noticeable was a blurring of vision, the same as one not infrequently experiences after fixing the eyes on any object for a time, everything else seeming ouf of focus. To this blurring there was added a feeling of strain, a half-conscious feeling that if it continued a headache would result, so that on closing the eyes, which one felt, naturally inclined to do, some relief was experienced. The relief, however, was not complete, perhaps due to the attention being still kept on the fingers through the closed lids. A feeling of tiredness of the eyes seemed to persist, hut no heaviness or numbness was felt in the limbs or body generally, though this was suggested. The condition was similar to what one experiences on resting after straining the eyes, after microscopic work or reading too closely.
“The mind was active, so active and so conscious that it kept continually asking itself, ‘Was it not shamming? ‘Had one not closed the eyes too soon?’ etc. I kept thinking too, of various other things, e.g. about cycling home that night, about the tooth extraction on the morrow, etc., and was analytical as regards the operator’s methods, comparing them -with what was expected, with what the patient would have done had he been the operator. It was critical too, e.g. when fixation of an arm was suggested it was noticed that the operator’s hand grasped the arm very firmly at first and this was at once recognised as a better method than the patient had used on his own subjects, as the grasp helped to give at once a feeling of rigidity. Also, when warmth was suggested, the mind critically considered where the hand was laid on the trunk, with what pressure, how little friction was employed, the words used, etc., each point being noted and considered quite as quickly as in the normal waking state. When passes were made down the body, a distinct half-tingling, half-numbed sensation was experienced, travelling down with the hand apparently. Although no shadow came on the face at the time, the sleeve of the operator could be heard rubbing on his coat, and one was therefore quite conscious of what he was doing, but the feeling was so definite that it is hardly possible it could be all the result of imagination.
“The condition might then be described as one in which the inclination to do anything was at a minimum, e.g. in the resting position which had been taken up, the collar was felt pressing a little on the neck at one side. One felt inclined in a half-hearted way to pull it down and be more comfortable, but—and here for the first time a feeling of heaviness was felt in the limbs—when the intention was about to be carried out, the wrist and hand seemed a little more difficult to move than usual, and one did not feel inclined to take the trouble. Again, the legs were crossed, and, on becoming conscious of this, one felt inclined to uncross them, but in such a half-hearted way that no attempt was made to do it; and again, the flicker of the Ere was seen through the closed, eyelids and one felt inclined in a general way to look at it, but without any definite attempt being made to open the lids. It was felt that they were closed, that it would be a trouble to open them, and indeed that it would be hardly fair, as one wished the hypnosis to succeed, so they were therefore allowed to remain closed. Not that any definite feeling of inability to perform any of these movements was experienced; on the contrary, although quite alive to the fact that patients are at times unable to open the eyes when they think they are able to, one felt and feels absolutely certain that if the wish had been there the eyes would have been opened.
“On numbness being suggested to a limb, no such feeling was at first experienced. After a little, however, one felt that one could let it get numb if one wanted to; something the same as when one’s arm is hanging over the back of a chair, one knows that by placing it in another position no numbness will be experienced, the arm will not ‘go to sleep‘; so by a simple effort of will one felt the arm might easily be kept from getting numb. Instead of wanting it not to get numb, one almost wished for the success of the experiment that it should become so, and one therefore allowed it to get numb, and thus it gradually ‘became so, i.e. the same feeling was experienced in it as when a limb ‘goes to sleep,’ a mixture of tingling and numbness, and this was the same sensation as was felt when passes were made.
“Next day, on being hypnotised for tooth extraction, the eyes were a little longer in closing, partly because the mind was dwelling to some extent on the extraction, wondering how painful it would be (as complete success was not expected), and partly because it was thought to be good not to close the eyes too soon and have the operation done perhaps too early. After the eyes closed, sensations were as before, except that to a great extent the mind was fixed by the auto-suggestion No pain.’ No numbness was felt in the cheek or jaw when suggested; and when told to open the mouth this was done, though no good result was expected. Indeed at this time a temptation was present to say that things were not quite ready and to ask the hypnotist to go on with suggestions for a longer time, and it was not due to inability to speak that this was not done, as proved by the fact that immediately after the operation the question was asked, Is it out Have you finished?’; but more due to a feeling that this would be interfering. At this time probably as much as at any other, the fixing of the mind by the auto-suggestion “No pain” had a good effect. Sensation was much dulled, as proved by the fact that though the forceps were felt distinctly going into the mouth and gripping the tooth, their exit was hardly appreciated, only the fact of their absence after they were gone, this being the case on both occasions, as the roots (second upper molar left) were removed separately. Analgesia was quite complete. After the second root was removed, a sensation of fluid, which was known to be blood, was felt in the pharynx, and at the same time one was told to sit forward and wash out the mouth. Suggestions of ‘No pain’ were repeated, and then ‘Open your eyes.’ At any stage of the operation the power to open the eyes was certainly present, and, now that the operation is past, the conviction is felt that without the wish for it to succeed, and the active co-operation of the mind of the patient with the suggestions of the hypnotist, success would not have been so complete. That faith was not necessary was proved by the fact that the maximum result expected was a dulling of the pain. Having had teeth extracted previously, it did not seem possible that such an acute pain could be completely checked by what seemed to the patient to be a very light degree of hypnosis.”
Dr. Bryan said: “Dr. Fairley has, I consider, given us some very useful information in this interesting and able record of his experiences as a patient, and I am sure we are indebted to him for his fair and unbiassed narration of undoubted facts. I should like to add that the dentist had previously told him that he would advise him to have a local anaesthetic and bear it as long as he could, for the roots were so embedded that nitrous oxide gas would not give him long enough, so it is seen that the extraction was a severe one. Regarding the auto-suggestion ‘No pain,’ mentioned by Dr. Fairley; after the trial on the evening of the 23rd, having found that Dr. Fairley only went into a light degree of hypnotic sleep, I told him that as soon as he sat down in the dentist’s chair he was to commence repeating No pain ‘to himself, and continue to do so until the operation was finished. As soon as the extraction was about to commence I kept repeating ‘No pain’ until both roots were removed. If a person is susceptible to the suggestion of ‘No pain,’ it is without doubt the best means of extracting teeth painlessly, as there are no after-effects, no risk, and the dentist has ample time for the extraction.”
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