A painless surgery on a mesmerised patient

by Ramya Raman and Anantanarayanan Raman

Very little is known about the life of Joseph William Turner Johnstone in Madras. What instigated him to come to Madras to practise medicine is not clear. He lived and practised at ‘23 Pantheon Road, Madras’ in the 1840s for less than four years and died due to liver abscess in Madras in 1848
(Anonymous, 1849).

An oil canvas depicting the use of ether by William Morton as an anaesthetic on a patient before a dental treatment in 1846. Source: Ernest Board, http://catalogue.wellcome.ac.uk/record=b1203716 (Public Domain).

Johnstone’s painless surgical operation via mesmerism

Mesmerism was a significant practice trialed in pain management during surgeries, especially in pre-anaesthesia days. Franz Anton Mesmer’s (1734-815) work stimulated the application of mesmerism in medicine. Johnstone in his 1848 report explains his conviction in applying mesmerism in surgical procedures.

The patient on whom Johnstone operated was the wife of a clergyman of the Church of England. The lady was a person of good health, who developed a field-pea size tumour on the posterior aspect of her right shoulder six years before. When she presented herself to Johnstone, the tumour had enlarged to 6×4×2½” (15×10×6.5 cm. A sensation of weight and modest numbness of the right arm were the principal difficulties she complained of. Johnstone indicates that he advised excision of the tumour six months earlier, which she did not prefer. In the meantime, she had tried phlebotomy using leeches and applying discutient ointments, and other treatments, which were in vain. Finally, she returned to Johnstone accepting excision. Johnstone recommended her to try the effect of mesmerism before the procedure.

We reproduce below his words, wherein he describes the mesmeric practice he applied on the woman in advance of the procedure to be done a few days later:

1st Mesmeric Sitting, January 2nd

Commenced at half past 7 A.M. and continued for two hours. The room was darkened and precautions taken to prevent interruption by noise & c. as was done at all the future sittings. The patient’s pulse was 90 — skin cool — respiration natural. She lay upon her back in bed. … I seated myself on a high chair at the head of the bed, so placed that by slightly bending forwards I could bring my face close to hers. I requested her to fix her eyes steadily on mine till she felt drowsy, when she was to shut them and compose herself to sleep; at the same time I passed my right hand, with the fingers extended and slightly bent, gently over her face, from chin upwards, in close contact with, but not actually touching the skin. I kept my left hand in constant contact with her left shoulder and breathed gently and frequently over her forehead and eyes. About one hour from the commencement, her eyes were shut, and she appeared to be slumbering, as indicated by her tranquil breathing, and the complete state of repose exhibited by her whole body, excepting occasional nervous twitchings of the hands and eyelids. On leaving off the manipulations at the end of two hours, and walking round to her right side, she opened her eyes heavily, and was speedily aroused. She said that she had felt sleepy, but did not think she had been asleep. Pulse still 90. I recommended another trial (though she did not appear very susceptible of the mesmeric influence) to which she consented somewhat reluctantly.
The above was repeated almost for the same length of time over the next seven days. On 9 January, Johnstone mesmerised the woman for three hours commencing a little after 7 a.m. She felt no drowsiness and sickness and sleepiness as had occurred in the preceding days. Body readings were normal. According to Johnstone, ‘pulse – 80, skin cool, respiration slow and tranquil’. She fell into deep sleep shortly at around 10 a.m. Mesmeric trance appeared perfect, cataleptic condition well developed, and sensitivity to pinching, pricking, loud noises, strong light, and ammonia vapour was absent. At quarter past 10, Johnstone turned her full upon face to start the surgery.
He made three incisions, each seven inches (17.8 cm) long. He excised the tumour, which was slightly adherent to tissues below. Three arteries required ligatures. The bleeding was profuse initially, which lessened with time. The edges of the wound were sutured with four stitches and in- between spaces banded with adhesive plaster. The surgery was completed in 18 minutes, during when the patient remained in a state of perfect insensibility.

Johnstone was assisted by Superintending Surgeon D.S. Young of Madras Army, Assistant Surgeon George Smith, a dresser and a nurse (both not named). Smith assisted Johnstone by maintaining the mesmeric passes along the patient’s back throughout the procedure.

Throughout the procedure, the pulse reading remained at 80 and respiration steady. Johnstone indicates that Young, besides assisting Johnstone, satisfied himself with the patient’s basic physiological parameters. The excised tumour tissue weighed 1.45 kg, two hours after the procedure. Pulse reading sustained at 80 for the next two days, which gradually rose to 90, which he deems as her natural value. The patient recovered quickly and felt better than she did before the mesmeric sittings.

Johnstone offers a few conclusions, which we summarise here:

(1) Induced mesmerism can be so deep that the sense of feeling is annihilated.

(2) Such induced mesmerisms are starkly different from normal sleep and that induced by the action of narcotic drugs.

(3) The person subjected to mesmeric process is more readily susceptible to an extreme state of sleep.

(4) Mesmerism-induced sleep is the most perfect state of sleep, when intense surgical procedures can be conducted, and

(5) The excessive bleeding he encountered during the surgery did not appear to be lesser than what would have occurred in surgeries performed otherwise.

Young’s minute to the Madras medical board and follow up

Superintending Surgeon Young participated in the surgery done by Johnstone. We reproduce below the relevant sections from his Minute dispatched to George Pearse, Secretary of the Madras Medical Board, Government letter # 44, dated 19 January 1847 (page 13):

I have the greatest satisfaction in submitting the enclosed statement to the Medical Board, and the subject of ‘Painless Surgical Operations’ under Mesmeric influence, has, since the publication of Dr. Esdaile’s reports [Esdaile and his work are briefly explained subsequently], excited a deep and universal interest. I would express a confident hope, that the present most triumphant illustration of the practice may be brought to the notice of the Government.

In making this request, I am impelled by a sense of justice to call the Board’s especial attention to the merits of Dr. Johnstone, a private practitioner at the Presidency, by whose well-directed and unwearied skill and perseverance, the great work has been achieved for the first time in the case of an European patient in British India, or indeed in the Eastern world. Nor I can close this letter without reminding the Board that Assistant Surgeon G. Smith who so admirably seconded Dr Johnstone’s efforts throughout …

However, a statement in the Minute is fallacious and regrettable. Young exaggerates as though Johnstone’s work of applying mesmerism during the excision of the tumour in Madras is pioneering: this is nothing short of prejudice and hype. Esdaile in Calcutta had preceded Johnstone in performing multiple procedures, retaining patients under mesmeric influence. Johnstone himself acknowledges this in his notes. Pity that a senior medical officer of the Madras Army could make such a flippant statement.

Applying mesmerism in surgeries

The inimitability of Johnstone’s surgery in Madras was applying mesmerism to quieten the patient into deep slumber.
John Bell’s General and Particular Principles of Animal Electricity and Magnetism (1792) is possibly the earliest printed record on using mesmerism in minor surgical procedures, although it includes no explicit details of either the surgical or the mesmeric procedure. Joseph Claude Anthelme Récamier (1774–1856) in Paris performed a surgery with the patient maintained under mesmeric influence. The first recorded painless surgery using mesmerism was a mastectomy performed by the French Surgeon Jules Germain Cloquet in 1829. Cloquet presented a paper on this procedure at L’Académie Royale de Médecine (ARM) in 1829. L’ARM appointed a Committee to verify Cloquet’s claim. The Committee disagreed with Cloquet. Infrequent work using mesmerism in surgical practice did occur; however, the medical community in general was facetious of it. Elliotson resurrected this interest in Britain in 1837.

James Esdaile of the Bengal Medical Establishment (Civil Assistant Surgeon, 1830-1836; Civil Surgeon and Principal of the Hooghly College, Calcutta, 1838–1843) trialed mesmerism variously in mitigating surgical pain. He superintended the Calcutta Mesmeric Hospital. He published three articles on this subject and Mesmerism in India, and its Practical Application in Surgery and Medicine, the first edition of which appeared in 1846.

Johnstone’s interest in applying mesmerism in surgical procedures appears to have principally arisen out of two sources.

(1) He refers to Esdaile’s procedures in Calcutta done under mesmeric influence and the Report of the Committee appointed by the Secretary to the Government of Bengal on 4 November 1846.

(2) He expresses deep confidence in mesmeric practice in surgery after reading Baron Dupotet de Sennevoy’s An Introduction to Animal Magnetism (1838). The following remark in the ‘Miscellaneous’ section in the American Journal of Medical Sciences – ‘animal magnetism is making significant progress in London and some highly distinguished persons of London have become converts to its verity’ – is noteworthy. Johnstone reinforces in his Notes of a Case of a Painless Surgical Operation … that mesmerism was taught in the medical school (i.e., Madras Medical School) – with which he was not associated as an academic – where, he indicates, students have been mesmerising one another under the superintendence of the head surgeon. He endorses his conviction in this procedure because of the success achieved at MMS using native pupils and a few apprentices.

Conclusion

Today a majority of practicing surgeons reject mesmerism (or its derivative, hypnosis) in procedures. However, casual conversations with a few practicing surgeons in India revealed that a few Indian surgeons in the 1980s and 1990s have tried mesmerism (or hypnotism) in surgeries (e.g., tooth extractions, trepanation). Our efforts to locate details of such surgeries in professional journals were in vain.

American psychiatrist David Spiegel (2007) (Stanford University School of Medicine, California) proposes a state of mind, which he describes as ‘suspension of disbelief’ can influence the mind and body. He avers that altering perception using hypnosis results in brain changes that reduces pain perception. He argues that a valid neurophysiological reason exists to accept that hypnosis is a powerful tool to alter perception of pain and associated anxiety. May be that Spiegel’s comment requires some rethinking and reconsideration?

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