Imagine surgery before anaesthesia. Patients were held down. Speed was the surgeon’s chief skill. Many died of shock. In the middle of the 1840s, in a small hospital up-river from Calcutta, a Scottish doctor claimed to have found a way of operating without pain, and without the terror.
The surgeon
James Esdaile was born in Scotland in 1808 and took his medical degree at Edinburgh. Troubled by weak lungs, he was advised to seek a warm climate and joined the East India Company. In 1839 he arrived at Hooghly, a town about 38 kilometres up-river from Calcutta, to take charge of its hospital.
He had read about mesmerism but had never seen it done.
The first operation
In April 1845 a prisoner from the local jail, Madhab Kaura, was sent to him with a painful condition requiring surgery to the scrotum. Seeing the man’s agony, Esdaile decided to try what he had read about. After prolonged mesmeric passes, the patient became still and unresponsive, and Esdaile operated. The man showed no sign of pain.
Esdaile repeated the experiment, with the same result. He then began using it routinely.
The method
This was nothing like a modern induction. The patient lay in a darkened room. An assistant sat at the head of the bed and made slow passes with his hands from the head down the body, without touching, sometimes breathing on the patient’s head and eyes. It continued for an hour or more, and was often repeated daily for several days before the patient was judged ready.
Because it was so laborious, Esdaile trained Indian hospital assistants to do the mesmerising. He then tested the patient, by pricking or pinching, before he began to cut.
The operations
In eight months of 1846 alone he recorded seventy-three painless operations. Over his years in India the total ran into the hundreds, with thousands of minor procedures.
Many were for a condition then common in Bengal: enormous scrotal tumours caused by filarial infection, sometimes weighing more than the rest of the patient. Removing them without anaesthesia was so dangerous that many surgeons would not attempt it. Esdaile also performed amputations and other major surgery.
The most startling figure was the death rate. Records are said to show mortality for these operations falling from around 50 per cent to about 5 per cent. Esdaile attributed it to the absence of surgical shock: patients who did not suffer did not collapse.
The investigation
His reports met disbelief. In 1846 the Deputy Governor of Bengal appointed a committee of seven, including medical men, to investigate. They watched a series of operations and submitted a favourable report in October 1846.
As a result Esdaile was given a small hospital in Calcutta to continue the work, and by 1848 a mesmeric hospital supported by public subscription had opened there. He described it all in a book, Mesmerism in India.
Why it ended
Two things overtook him.
Chemical anaesthesia. Ether was first demonstrated publicly in Boston in October 1846, and chloroform followed the next year. They were quick, reliable and worked on nearly everyone. Mesmerism took hours and did not work on all.
Professional hostility. British medical journals were scornful. Critics suggested his patients were merely stoical, or were shamming to please him. Some of the commentary was plainly racist.
Esdaile left India in 1851 and retired to Scotland, and later to the south of England for his health. He found he could not reproduce his results on Scottish patients with anything like the same ease. He died in 1859.
What should we make of it?
Esdaile’s work is often cited as proof that hypnosis can replace anaesthesia. The truth is more interesting.
In its favour:
- Independent observers watched the operations.
- The fall in mortality is hard to explain away.
- Modern research confirms that hypnotic suggestion can produce substantial pain relief in responsive people, and that hypnosis is used alongside local anaesthetic in surgery today.
Reasons for caution:
- There were no controls of the kind we would now require.
- Not all patients were successfully mesmerised, and we do not know exactly how many attempts failed.
- The committee itself noted that some patients showed signs of pain during operations even though they later denied feeling any.
- Some of the fall in deaths may reflect Esdaile’s skill, speed and attention to care.
- His patients were poor, colonised people being treated by a British official. How freely they could decline, or report pain, is an open question.
The difference in Scotland is revealing. It suggests that context, expectation and the relationship between doctor and patient mattered a great deal, which fits what we now understand about how hypnosis works.
The “Esdaile state”
A century later the American hypnotist Dave Elman gave the name “Esdaile state” to a very deep level of hypnosis. Esdaile himself never used such a term, practised mesmerism and not verbal hypnosis, and would not have recognised a five-minute induction. The label is a tribute, not a description of what he did.
The bottom line
James Esdaile showed, at a time when surgery meant agony, that a patient’s own mind could be enlisted against pain. He was overtaken by ether within months. But the phenomenon he reported was real, and hospitals are still finding uses for it.
Next in the series: Milton Erickson: The Farm Boy Who Reinvented Hypnotherapy
This article is for general information and is not medical advice.