Hypnotism - A Universal Anaesthetic in Surgery
( Originally Published 1904 )
THE question has often been asked, " Can hypnotism be generally used as an anesthetic in surgery?" The answer has uniformly been that it cannot. Both of the great schools of hypnotism - the Nancy and the Paris school — unite in the emphatic declaration that " it cannot take the place of chloroform." The reason given is that it is impossible to hypnotize a person at the time of an operation except in the comparatively rare cases where the patient has previously been in the habit of being hypnotized. It is generally admitted by all modern scientific writers on the subject that hypnotism can be successfully employed as an anaesthetic in the most severe surgical operations, under certain exceptionally favorable conditions. The first of these is stated above, and the second is that a state of profound hypnotic sleep must first be induced. Most writers dismiss the subject with a statement equivalent to the foregoing.
The object of this paper is not so much to call in question the correctness of the conclusions of writers on this subject as to suggest an entirely new line of inquiry with a view of ascertaining if Nature has not provided a universal anaesthetic in a condition cognate to that of hypnosis. Confining the latter to its original signification, or to that of its Greek radix, it means, simply, " sleep." And it seems probable that the conclusion of the hypnotists regarding the use of hypnotism in surgery may have been influenced by the limitations of the signification of the term ; although Bernheim has pointed out that the power of suggestion (which is the potent factor in hypnotism) is not confined to the sleeping patient. Indeed, Bernheim's definition of hypnotism enlarges its scope far beyond the limitations of the Braidian definition, which is "induced sleep." He says: " I define hypnotism as the induction of a peculiar psychical condition, which increases the susceptibility to suggestion." 1 For the purposes of this article this definition will be accepted as substantially correct.
Before proceeding to the main line of argument it may be well to give the non-professional reader a clear idea of the meaning of the word " suggestion" as it is employed in hypnotic science. Suggestion is a statement (true or false) made to a hypnotized subject. Its potency consists in the fact that in the hypnotic condition the subject unhesitatingly believes the statement or suggestion, and acts upon it just as though it were true. Its potency as a therapeutic agent consists in the fact, first, that a subject in the hypnotic state is constantly amenable to control by suggestion; second, that in the hypnotic state the subject has complete control over the functions and sensations of his body; and, consequently, that if the suggestion is made to a hypnotized subject that he feels no pain, all pain instantly ceases. It is thus that a state of anaesthesia is induced which enables a surgeon to amputate a limb without inflicting the slightest pain upon the patient.
Bernheim pertinently remarks that " it is suggestion that rules hypnotism." This is true in the sense that when a subject is in the hypnotic state he is constantly amenable to control by the power of suggestion. This is the fundamental law of hypnotism. It is also true that hypnotism may be induced by suggestion. The Nancy school holds that it is and can be induced in no other way. This, as I have elsewhere pointed out, is a fundamental error; and it is an error that has led to many erroneous conclusions regarding psychic phenomena of various classes.
It is also an error to suppose that it requires a state of profound hypnotic sleep to induce a state of anaesthesia. It is this error that has led to the belief that hypnotism cannot be generally employed as an anaesthetic in surgery. It is my belief that in a great majority of cases it can be successfully so employed. I do not pretend to dogmatize on the subject. It is too early for that. But I do say that there are facts in abundance which point in that direction ; and they are facts within the common knowledge and experience of mankind. I propose to invite the attention of the medical profession to a few of these facts for the sole purpose of stimulating inquiry and suggesting a line of experiment, which may or may not lead to important results, but which can at least do no harm. If successful, they will demonstrate the existence of a law, hitherto unsuspected, which, properly understood and intelligently applied, will enable the profession to employ hypnotism as a universal anaesthetic in surgery.
The fundamental propositions of my hypothesis are few and easily understood. They are :
1. Persons in the hypnotic state are constantly amen-able to control by suggestion.
2. The hypnotic state can be induced without the aid of suggestion.
The first of these propositions no hypnotist of intelligence will question. It is, as before remarked, the fundamental law of hypnotism, and little time will be employed in its elucidation. It is, however, not so generally known that the proposition is true of all grades and degrees of hypnotism. Bernheim has very clearly pointed out the fact that suggestion is potent in many subjects even in what he terms the " waking state"; although it must be doubted whether any one in a perfectly normal condition can be influenced by suggestion so far as to produce a hallucination. That is to say, it must not be understood that the term " waking state " implies that the patient is in no degree hypnotized. It only means that the patient is hypnotized in so slight a degree that he appears to be awake and in his normal condition. There must always be some degree of hypnosis — some abeyance of the objective faculties — to render the subject amenable to control by suggestion. But that degree may be very slight, as the following observations by Bernheim will demonstrate :
"Some of them at least show exactly the same phenomena in the waking condition as in the hypnotic state; some exhibit suggestive catalepsy with muscular contraction, or' a varying contracture only; others, catalepsy with automatic movements ; others, at the same time, suggestive sensitivo-sensorial ana;sthesia; and others still, all suggestive phenomena up to hallucination." (Suggestive Theraj5eutics, p. 79.)
Again, on page 81, we find the following:
"In one of my somnambulistic cases (S—, whose history I have already given) I can obtain all possible modifications of sensibility in the waking condition. It suffices to say, ` Your left side is insensible.' Then, if I prick his left arm with a pin, stick the pin into his nostril, touch the mucous membrane of his eye, or tickle his throat, he does not move. The other side of his body reacts. I transfer the anaesthesia from the left to the right side. I produce total anaesthesia, which was, on one occasion so profound that my chef de clinigue pulled out the roots of five teeth which were deeply imbedded in the gums, twisting them around in their sockets for more than ten minutes. I simply said to the patient, ' You will have no feeling whatever.' He laughed as he spit out the blood, and did not show the least symptom of pain."
On page 83 the following case is related :
"In G-- (Marie, whose case I have already related) I can induce catalepsy, automatic movements, anaesthesia, and hallucinations in the waking condition. I wish only to speak of the anaesthesia. After having ascertained that sensation throughout the body was perfect, I said to her, ' You have absolutely no more feeling in your right upper limb, it is just as if dead.' With her eyes closed she no longer reacts to the pin. She does not know whether her arm is up or on the bed ; her muscular sense is gone. In order to exclude all idea of deception, I use Du Bois-Reymond's apparatus, varying the intensity of the cur-rent by alternately separating and approximating the coils of the induction apparatus. A rule graded into centimetres indicates the degree of separation of the coils. Now I have already determined that the tingling caused by the electricity was perceived by this subject when the separation between the ends was five centimetres, and that the pain became unendurable, the patient drawing back the arm suddenly, when the separation was from three to two centimetres. These figures remained absolutely the same when her eyes were tightly closed, so that she could not have observed the degree of separation, and I have proved this several times. By this means I determined that the pain is really perceived and not pretended.
"This being granted, I provoke anaesthesia by affirmation, and place the electrodes on her arm with the greatest current attain-able with the greatest approximation of the coils. The painful sensation thus produced is normally absolutely unbearable."
Professor Bernheim was, I believe, the first to mention these phenomena of suggestion in the waking condition, in a report made to the Congress for the Advancement of Science in 1883. They have since been confirmed by his European contemporaries, Bottoy, Dumontpallier, Richet, and others ; and in this country the same phenomenon was independently observed by Dr. Hammond.
It must be remembered, however, that these subjects were patients of Professor Bernheim, and had frequently been hypnotized by him before the experiments were tried. The cases have, however, a direct bearing upon the question before us, inasmuch as they show how slight a degree of hypnosis is necessary to enable the operator to produce a state of complete analgesia by suggestion; for it is obvious that a surgical operation of the most severe character could have been performed upon either of the patients mentioned. They are demonstrative that it is not necessary to induce a state of profound hypnotic lethargy in order to perform a painless surgical operation.
My second proposition, that " the hypnotic state can be induced without the aid of suggestion," will now be discussed. I have shown, in The Law of Psychic Phenomena, by quotations from the works of Dr. Braid, the father of modern scientific hypnotism and the originator of the term, that a state of profound hypnosis can be induced without the aid of suggestion. I shall not repeat my observations there made, but will attempt to show that Nature has provided a means for the induction of the hypnotic state in all cases where a surgical operation becomes a necessity.
In attempting to do this I shall rest content if I can make a prima facie case. I will endeavor to show that the law (of nature) is on my side, and will then submit the case to a jury of experts consisting of the medical profession.
I will now invite attention to a few well-known facts the significance of which never seems to have been appredated. In the work before mentioned I have drawn attention to the fact that when a person is in imminent and deadly peril he is instantly thrown into a state of anaesthesia ; or, in other words, into a partially hypnotic condition. It is the universal testimony of soldiers who have been in battle that the moment the fight commences all fear vanishes. It is also the universal testimony of those who have been wounded that a stricken soldier never feels a wound, and never knows he is wounded until he is disabled. Surgeon-General Hammond once remarked in my hearing : A soldier never knows he is wounded unless he is stricken down; and, if his wound is mortal, he dies without pain and without regret." It seems to be a universal law that, when death is inevitable, the nearer it approaches the less it is feared ; and that, when it comes, it brings no pain and no sorrow to its victim. The reason is obvious. The patient passes into a hypnotic state, or a condition cognate thereto; and he is in a complete state of analgesia, body and mind, if the term may be applied to the condition of exemption from mental suffering. The phenomenon is strikingly exhibited in cases of criminals who have been sentenced to be hanged. The moment all hope is lost and death is inevitable, they relapse into a state of pro-found indifference; and, when the fatal hour arrives, they march to their doom without fear, without emotion, and without regret. It is often said of them that they " exhibited great courage " and " died game." The truth is that Nature has done for them just what it does for all living creatures, — namely, it has, upon the approach of death, thrown them into that subjective or hypnotic condition which banishes pain and robs death of its terrors.
Volumes might be filled with illustrations of the fact, which is well known to the medical profession, that when death is imminent or inevitable Nature provides an anaesthetic in the hypnotic condition which insures an easy and painless, if not a pleasurable, passage to the other side. I say " hypnotic condition," because it possesses all the salient characteristics of that state, even to suggestibility, as is shown in the well-known fact that the hallucinations of the dying invariably correspond to the suggestions embraced in their lifelong beliefs.
I now desire to invite attention to another class of facts, which are equally well known, but the significance of which does not seem to have been appreciated. I will begin by citing one which almost any one of adult age can verify from experience. Did any one ever go to a dentist's office with a raging toothache and a firm resolution to have the offending member removed, without finding that all pain ceased as soon as the dentist's office was reached? If any one has had a different experience the fact has not been recorded. There may have been apparent exceptions to the rule, but it will be found that, in every cage where the tooth did not cease to ache when the dentist's office was reached, it was because the patient had not fully made up his mind to part with the tooth without first making an effort to save it by some means less heroic than elimination. It may be safely said that, in all cases of toothache where extraction is resolved upon, the pain ceases when the patient approaches the operating chair. This phenomenon means.. something. Nature does not produce phenomena for fun, and it is the province of science to interpret this meaning on lines which will relieve Nature from the imputation of habitually perpetrating a joke on the victims of tooth-ache. Here, then, is a state of local anaesthesia induced by a mental emotion. That emotion is produced by an approach to a surgical operation. The question is, What is the mental condition thus produced? Is it not a condition cognate to that of hypnotism, and identical with that induced by imminent and deadly peril? Certainly the phenomena are the same, and we have therefore a right to infer that the cause is the same. Nor does this phenomenon stand alone. It is more frequently observed than any other, because every one has had teeth pulled. But it is also true that in other surgical operations all pain ceases when the surgeon begins to display his instruments in presence of the patient. This being true, it may be set down as a general proposition, provisionally at least, that the near approach to a surgical operation will always induce the hypnotic state in a degree sufficient to produce local anaesthesia in the part about to be amputated or operated upon.
We have now seen how slight a degree of hypnosis is required to render a subject amenable to control by suggestion. We have seen that the subject, even in the " waking condition," may be so completely anaesthetized by suggestion as to bear without the slightest sensation a torture which is normally absolutely unbearable." It is also well known to every intelligent student of hypnotism that persons in the hypnotic state are constantly amenable to control by suggestion. This, as has been remarked, is the fundamental law of hypnotism. It is a corollary of these propositions that, when a patient is about to undergo a surgical operation, he is invariably thrown into a partially hypnotic state, and that consequently all that is needed to insure a painless operation is a vigorous and an intelligent suggestion that he will feel no pain.
I cannot but be aware that this is a conclusion so radically at variance with all that has been written on the subject that credulity will be taxed and proofs demanded. I will therefore present a few of the many facts which might be cited in support of my hypothesis. An eye-witness, well known to me to be entirely trust-worthy, relates the following :
"A boy in St. Louis had one of his legs crushed in a street-cat accident, and amputation became necessary. A local hypnotist undertook to hypnotize the patient, but failed to produce anything approaching sleep. In making the attempt, however, he strongly suggested ana;sthesia. When it became apparent that the boy could not be put to sleep, the surgeon proceeded with the operation without administering anaesthetics; and, to the surprise of every one present, the hypnotist included, the boy felt not the slightest pain, and conversed coolly and cheerfully during the whole operation."
In this case the boy knew nothing of hypnotism or its expected effect upon him, save that it would secure immunity from pain, and he believed that the mysterious passes were all that were required.
A prominent Washington physician relates the following, not of his own experience, but the facts of which he verified beyond doubt :
" A country fiddler had a bad leg which it became necessary to amputate. The surgeon came at the appointed time, prepared with an anaesthetic, which he was about to administer. The patient refused to take it, however, and insisted upon having his fiddle brought to him, saying : ' Just give me my old fiddle. I have always fiddled my pains away, and I can do it now.' The fiddle was brought and he played during the whole operation, and declared that he felt no pain whatever."
It will be observed that this case illustrates very clearly the fact that auto-suggestion is as potent a factor in hypnotism as suggestion by another.
Another case of auto-suggestion was related by the same physician "The patient had been a sufferer for many years from a disease of the knee-cap. The skill of the medical profession had been taxed to the utmost limit in a vain effort to mitigate his sufferings, and finally it was decided that amputation was necessary. It was proposed to administer chloroform, but the patient refused. ' I have suffered so much misery from the thing,' said he, 'that I am determined to be an eye-witness to my own deliverance. I am sure it will feel good to have it removed.' The operation was proceeded with, and the patient declared that the sensation was actually pleasurable, and his actions verified his statement."
A lady of my acquaintance informs me that she possesses the power to prevent all pain when having her own teeth drawn, or when having them filled, by " treating herself" mentally, after the manner of the " Christian Scientists." A case of effective auto-suggestion, pure and simple.
A few years ago an itinerant lecturer (subject not now remembered) was in the habit of closing his evening's entertainment by offering to pull teeth, " without pay, pain, or anaesthetics." To inspire confidence and make it a possible object, he offered to give twenty dol"lars to any one who would submit to the operation and assert upon honor that any pain was felt. Two eye-witnesses of undoubted probity have informed me that they saw several teeth drawn under those conditions, and that each patient declared that it was a painless operation.
Surgeon-General Hammond, in a clinical lecture de-livered at the New York Post-Graduate Medical School some years ago, referred to a hysterical patient of his who was so absolutely controllable by suggestion that a hallucination of any kind could be produced in her waking condition. He adds
"I could at any time render this patient insensible to pain by simply telling her emphatically that all sense or feeling was abolished. I once opened a ' bone felon' on the index finger of her right hand, carrying the knife down to the bone and incising the periosteum without her being sensible of the slightest sensation, and without her being hypnotized in the sense that we give to the word. I merely told her decidedly that she would feel no pain, and she felt none."
Those who have had a bone felon" lanced will admit that this was a crucial test of anaesthesia.
It should not be forgotten in this connection that the same law applies with equal, or even greater, force to obstetrical cases. The writer has personal knowledge of several cases of painless childbirth where the suggestion of anaesthesia was given by professed " mental healers." If a suggestion in this form is thus effective, how much more potent must be a suggestion made by one who is present and reinforced by such auxiliary manipulations as hypnotists know how to employ!
Many other cases might be cited, but space forbids. The salient point to be observed in all these cases is that they are illustrative of a universal principle or law of nature; and that law is that the emotion of fear or of dread, as of death, or of a surgical operation, or of imminent parturition, will invariably throw the patient into the subjective condition; and that, in that condition, the subject is constantly amenable to control by suggestion. This appears to be a universal law, and it applies alike to animals' as to mankind, modified by the different degrees of intelligence and the consequent facility for imparting a suggestion. It is well known that many animals can be readily hypnotized by seizure and forcible confinement for a short time, as was demonstrated as early as 1646 by Kircher's well-known experiment with a hen. Since then many other animals have been hypnotized by a similar means; and in some cases it has been demonstrated that a perfect state of analgesia is produced. Thus, Surgeon-General Hammond, whose reputation as an accurate scientific observer is international, has succeeded in hypnotizing frogs, by seizure, so profoundly that he was enabled to cut the animal open its whole length without its moving, or apparently experiencing the least sensation.) Dr. Hammond also succeeded in hypnotizing crabs to the extent of producing a state of perfect analgesia ; and many other animals were hypnotized by him, both by seizure and by Braid's methods. A volume might be filled with illustrative incidents showing that animals and men are alike susceptible to hypnotization by exciting the emotion of fear or dread. One of the favorite methods of inducing hypnosis, employed by the late Professor Charcot, was by suddenly and unexpectedly sounding a gong near the patient's ears ; or by flashing a Drummond light in his eyes.
I cannot more appropriately conclude this part of my theme than by calling attention to the well-known facts of the history of the Christian martyrs, and their alleged immunity from pain while undergoing the most horrible tortures. The following quotation from Dr. Charpignon must suffice :
" Among the martyrs of Christianity many escaped pain through the ecstasy which came from the ardor of their faith, a phenomenon well known to their executioners, who increased their fury and improved their inventions for punishment. In the same way, at the time of the tortures of the Inquisition, certain individuals became insensible under the influence of their faith in the somniferous virtue of some talisman. Upon this point I will give the following passage, an extract from Secrets merveil-leux de la magie naturelle et cabalistique (12mo, Lyons, 1629). Some rascals trusted so strongly in the secrets they possessed to make themselves insensible to pain, that they voluntarily gave themselves up as prisoners, to cleanse themselves of certain sins. Some use certain words pronounced in a low voice, and others writings which they hide on some part of their body. The first one I recognized as using some sort of charm surprised us by his more than natural firmness, because after the first stretching of the rack, he seemed to sleep as quietly as if he had been in a good bed, without lamenting, complaining, or crying, and when the stretching was repeated two or three times, he still remained as motionless as a statue. This made us suspect that he was provided with some charm, and to resolve the doubt he was stripped as naked as his hand. Yet after a careful search nothing was found on him but a little piece of paper on which were the figures of the three kings, with these words on the other side : " Beautiful star which delivered the Magi from Herod's persecution, deliver me from all torment." This paper was stuffed in his left ear. Now, although the paper had been taken away from him, he still appeared insensible to the torture, because when it was applied he muttered words between his teeth which we could not hear, and as he persevered in his denials it was necessary to send him back to prison.'"
It will be obvious to the intelligent reader that the emotion of fear induced the hypnotic state, and that the talisman operated as a suggestion which produced a state of perfect analgesia.
That these facts have some significance goes without saying. That they point to some universal law of nature is self-evident. That that law, when once discovered, will be found to be for the highest good of mankind is a proposition sanctioned by the results of every discovery yet made in the realm of natural law.
Nature is ever kind to the victim of the inevitable. The truth of this proposition is exemplified in the universal immunity from suffering of all animate creatures during the process of dissolution. We have seen that the process by which this immunity is secured is by the spontaneous induction of the hypnotic condition at the approach of death. We have also seen that the same hypnotic condition is spontaneously induced when a surgical operation becomes inevitable. Have we not a right to infer that Nature has provided for the same immunity from suffering during a surgical operation, or during parturition, as it has for those who are called upon to undergo the process of dissolution? The conditions are the same ; but the suggestion has been different, owing to our ignorance of the law. We have been taught that death "eases us of all (bodily) pain" ; and it does. The suggestion in that case is on the side of immunity; and the result is that, no matter what form death may assume, the victim dies " without pain and without regret." On the other hand, our daily experience constitutes a suggestion that cutting and mutilation cause pain. That suggestion, in the absence of a contrary one, is carried over into the subjective condition which precedes and accompanies a surgical operation, and the patient suffers accordingly. Again, the curse pronounced upon our grandmother Eve operates as an ever-present suggestion to the mothers of Christendom that painful parturition is an inalienable inheritance; whereas, among other races, this inevitable crisis in every normal woman's life is attended with comparatively little pain or inconvenience. Now, is it not obvious that all we have to do in order to overcome the suggestion conveyed by our ordinary normal experience is to offer to the already hypnotized patient a counter-suggestion to the effect that no pain will be felt during the operation? The patient is in that condition which renders all mankind amen-able to control by suggestion ; and the suggestion of immunity from pain operates on the lines of nature's least resistance.
One word as to the practical method of applying these principles. It is obvious that, in order to overcome the suggestion embraced in the daily normal experience of mankind, the counter-suggestion should be made in some way that will strongly appeal to the imagination of the patient. It should be made strongly, vigorously, positively, but with due regard to the beliefs, the prejudices, and the general idiosyncrasies of the individual. As in other cases where suggestion is employed, success depends upon the manner in which it is enforced. Hypnotists will readily understand my meaning, and those who are not hypnotists can readily acquire the necessary information by consulting any modern standard work of the Nancy school. One thing, however, should never be lost sight of, and that is the necessity of impressing upon the mind of the patient the fact that a profound hypnotic sleep is not an essential prerequisite to the successful employment of hypnotism as an anesthetic in surgery.