So much for hypnotism today. Now let us turn back to the past and see what lessons the history of hypnotism has to teach. Among the books in my library are two rather battered volumes—Mesmerism in India, by James Esdaile, M.D., first published in 1846, and Mesmerism, in its Relation to Health and Disease, and the Present State of Medicine, by William Neilson, published at Edinburgh in 1855. Esdaile was a Scottish physician and surgeon, who went out to India as a young man and was put in charge of two hospitals in Bengal—one a hospital for prisoners in the local jail, the other a charity hospital for the general public. In these hospitals and, later, in a hospital at Calcutta, Esdaile performed more than three hundred major operations on patients in a state of hypnotic (or as it was then called, “mesmeric” or “magnetic”) anesthesia. These operations included amputations of limbs, removals of cancerous breasts, numerous operations for varicocele, cataract and chronic ulcers, removals of tumors in the throat and mouth, and of the enormous tumors, weighing from thirty to more than a hundred pounds apiece, caused by elephantiasis, then exceedingly prevalent in Bengal. Esdaile’s Indian patients felt no pain, even during the most drastic operations. What was still more remarkable, they survived. In 1846—the year in which Esdaile published his book—Semmelweiss had not yet taught his students to wash their hands when they came from the dissecting room to the maternity ward, Pasteur was years away from his discovery of bacterial infection, Lister, a mere boy in his teens. Surgery was strictly septic. In the words of a historian of medicine, “suppuration and septic poisonings of the system carried away even the most promising patients and followed even trifling operations. Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, feared the very name of hospital, and the most skillful surgeons distrusted their own craft.” Before the advent of ether and chloroform (which began to be used about 1847), the mortality of patients after surgery averaged twenty-nine per cent in a well-run hospital and would rise, when the streps and staphs were more than usually active, to over fifty per cent. Chloroform changed the techniques of surgery, but not, to any marked extent, its results. The agonies of the fully conscious patient “had naturally and rightly compelled the public to demand rapid if not slapdash surgery, and the surgeon to pride himself on it. Within decent limits of precision, the quickest craftsman was the best.” (There were famous specialists who could perform an operation for stone in fifty-eight seconds flat.) Thanks to chloroform, “the surgeon was enabled to be not only as cautious and sedulous as he was dexterous, but also to venture on long, profound and intricate operations which, before the coming of anesthetics, had been out of the question. But unfortunately this new enfranchisement seemed to be but an ironic liberty of Nature, who with the other hand took away what she had given.” Bigger and better operations were performed under chemical anesthesia, but the patients went on dying at almost the same ghastly rate. In the twenty years following the introduction of chloroform and preceding Lister’s advocacy of aseptic surgery, the death rate from postoperative infections fell by only six percentage points—from twenty-nine in every hundred cases to twenty-three. In other words, almost a quarter of every Early Victorian surgeon’s clients were still regularly slaughtered. Chloroform had abolished the pain of operations, but not the virtual certainty of infection afterwards, nor the one-in-four chance of a lingering and unpleasant death.
Meanwhile, what was happening in Bengal? The answer is startling in the extreme. In a debilitating climate and among sickly and undernourished patients, Doctor Esdaile was performing major surgery without any deaths on the operating table (a distressingly frequent event in the early days of badly administered chloroform) and with a mortality from postoperative infection of only five per cent. How are we to account for this extraordinary state of affairs? First of all, Esdaile never allowed his patients’ morale to be undermined by apprehension. The men and women who came to him were not told in advance when they were to be operated, nor even, in many cases, that an operation would be necessary. After examination by the surgeon, they were taken into a dark room, asked to lie down on a couch, and then put to sleep by “magnetic passes,” which were made by relays of orderlies, who would work on the patient, if it seemed necessary, for three and four hours at a stretch. When the passes had taken effect and the patient was in a deep hypnotic coma, he would be taken into the operating room, have his leg cut off, or his forty-pound elephantiasis tumor removed, be stitched up and carried, still unconscious, to his bed. In most cases patients remained in trance for several hours after being operated, and would wake up unaware of what had happened and feeling no pain whatever. In the days that followed they were frequently re-mesmerized, and so spent most of their time in a state of trance. But in trance, as in natural sleep, the vis medicatrix naturae, nature’s healing power, is able to do its work with the greatest possible effectiveness. The agitated and anxious ego is put to sleep and can make no trouble; left to its own devices, the autonomic system or Vegetative Soul (as it used to be called) goes about its business with infallible skill. In order to be freed from pain and self-consciousness, Esdaile’s patients did not have to be poisoned by narcotics and analgesics; thanks to hypnotism, they were spared most of the miseries that normally follow an operation, and, thanks to hypnotism, their resistance was raised to such an extent that they could easily get the better of the deadly microorganisms associated with septic surgery.
Five deaths to every hundred operations—it was the biggest medical news since the days of Hippocrates! But when Esdaile published the facts, what happened? Were his colleagues delighted? Did they hasten in a body to follow his example? Not at all. Most of them were extremely angry when they heard of his achievement, and the bigwigs of the faculty did everything in their power to prevent Dr. Esdaile from continuing his beneficient work and, when that proved impossible (for Esdaile was backed up by the Governor General of India), to suppress the, to them, embarrassing and distasteful facts.
Doctor James Simpson, the first surgeon to advocate the use of chloroform and a most courageous crusader, in the teeth of Fundamentalist opposition, for painless childbirth, was at first intensely interested in mesmeric anesthesia. In a letter to Esdaile he wrote that he had “always considered the few deaths out of so many formidable operations one of the most remarkable things in the history of surgery.” Furthermore, says Esdaile, “Dr. Simpson sent me a message that I owed it to myself and my profession to let my proceedings be known in England, and that, if I wrote an article, he would get it published in the journal he was connected with. I therefore sent him an account of one hundred and sixty-one scrotal tumors removed in the mesmeric trance.” This paper was rejected on the ground that parts of it had appeared (in a greatly garbled form) in another medical journal. “A more general paper was offered; but after some compliments and considerable delay,” Esdaile was informed that Dr. Simpson’s brother editors had declined it as “not being sufficiently practical.” “One of the most remarkable things in the history of surgery!” is Neilson’s justifiably bitter comment. “Namely, how to reduce 23 per cent of deaths to 5 per cent—not practical.” And he adds that “it is very curious that, when Dr. Simpson professed to publish an account of all the means that have ever been used to prevent the pain of operations, he quite forgot to mention mesmerism.”
This sort of thing had happened before Esdaile’s day and was destined to happen again, and yet again, thereafter. Doctor John Elliotson, an eminent physician and Professor of Physiology at the University of London, had been derided and boycotted for his advocacy of mesmerism in surgery and general practice. Some of his critics had gone so far as to assert that a mesmerized man who had a leg amputated without showing the slightest sign of discomfort was a mere impostor—pretending that he felt no pain just to annoy the orthodox doctors. And one of them, Doctor Copland, solemnly declared that “pain is a wise provision of Nature; and patients ought to suffer pain, while their surgeon is operating; they are all the better for it and recover better.” Later on, when the anesthetic properties of ether and chloroform had been discovered, the first reaction of many doctors was not to give thanks that the pain of operations had been abolished. No, their first reaction was to gloat over the discomfiture of the mesmerists. “Hurrah!” wrote Robert Listen, the first surgeon to perform an operation under ether. “Rejoice! Mesmerism and its professors have met with a heavy blow and great discouragement.” More soberly, but with equal satisfaction, the official Lancet smugly editorialized: “We suppose that we shall hear no more of mesmerism and its absurdities.” And, in effect, the absurdity of a five per cent death rate was not heard of again until Lister discovered that, if the surgeon used aseptic methods, the patient could survive in spite of lowered resistance and systematic poisoning by chemical anesthetics, narcotics and analgesics.