THE USE OF IN THE CARE OF THE CANCER PATIENT

BYRONBUTLER, M.D., MED.SC.D.

T IS ONLY THE MIND that is important in can- understanding of the mind. Since it has been I cer, for it alone carries the burden of the Iclearly indicated that there are important emo- disease.37 Hans Zinsser expressed this thought tional disturbances in patients with cancer,68it when he said: “As it is, my mind and my spirit, is to be expected that these reactions will vary my thoughts and my love, all that I really am, from patient to patient. If the emotional ten- is inseparably tied up with the failing capacities sion present in these patients can be channeled of these outworn organs.” Philosophically, only away from a neurotic exaggeration of fear and mind is important. !self-pity to a more constructive and realistic We need not stress the treatment of cancer, point of view, then this energy could be avail- for that is the main intent today. The attack able to support the patient during therapy and, on cancer has been so consistently emphasized when that is finished, to give him a more serene that the emotional aspect of this disease is en- and confident attitude until the end. With tirely in the background. At this time when such an approach there will be less pain, less radical surgery, high-voltage radiotherapy, disturbance in bodily function, and a reduc- glandular extirpation, hormone administra- tion in the degree of dread that surrounds tion, and radioactive drugs are used freely, it the subject of cancer. may be timely to appraise that cancer patient Hypnosis has many attributes that lend who is an individual with a death sentence. themselves to this problem. Indeed, it can be Most of us with our occidental philosopsy of used to suppress symptoms or through applica- life, believe that death is the end of conscious- tion of analytical principles to express emo- ness, and few approach it without the feeling tionally charged ideas. It allows, at least in of Hamleto? when he said that death is a land some patients, a control over the subconscious Erom which no traveler returns. Certainly, this mind in spite of resistance by and without the threat of extinction is the most difficult prob- knowledge of the conscious mind. Thus, the lem the conscious mind has to reconcile. mind can be maneuvered to aid the cancer This psychological approach may be traced patient in his struggle for survival. The thera- to Freud’s4 revolt against the cellular philos- pist is like the master of a marionette, who can ophy of Virchow, and, as a result, our knowl- manipulate his charge as required by the occa- edge of functional disease has been greatly sion. The act can run smoothly if the master is enriched.3. % 16, 22* Mental factors in what capable of his task, but it may be disastrous if were previously considered to be purely organic he does not know each phase of the plot. disease, such as hypertension,2, 48 diabetes29 tuberculosis,6 ulcerative colitis,17 and peptic ul- HISTORY cer, Cave been demonstrated. Finally Virchow’s Arnold J. Toynbee has made history a useful own citadel has been invaded, and the cancer patient has been found to exhibit defenses iden- study, for from it one learns not only what has tical with those observed in psychoneurotics.e* happened in the past, but also what may occur at the present, and what is likely to develop in As the microscope, Virchow, and Pathology the future. It is in this vein that a brief sketch led to the great advances in exact laboratory investigation and physical medicine, so did of the history of hypnosis is presented. Hypnosis older than medicine. It was used mesmerism, Freud, and Psychiatry lead to an is by the adepts before the medicine men had From the Department of Obstetrics and Gynecology, separated from the priests. More than 3000 College of Physicians and Surgeons, Columbia Univer- years ago it was used in India2’ and in the sity, Sloan Hospital for Women [Columbia-Presbyterian Medical Center] and the Francis Delafield Hospital, British Museum there is a bas-relief taken from New York, New York. a tomb in Thebes that shows an Egyptian hyp- Partially supported by a grant from the American notist and his ~atient.~TAesculapiusl5. 72 was Cancer Society, Lnc. Received for publication. April 24. 1953. able to relieve pain by stroking with his hands 1 2 CANCERJanuary 1954 VOl. 7 to induce long and refreshing in his pa- sia for the trance period. He also called atten- tients, while, according to Tacitus,lb Hippoc- tion to the ability of the somnambulist to feel rates spoke of impressing health on the ill by and describe accurately conditions in other “passes.” bodies and to prescribe cures for them. Edgar The pertinent history of hypnosis can be Cayce’s work utilizing this phenomenon ten to divided into four periods. Each period has been fifteen years ago has been reported in Theye characterized by a crescendo, a fortissimo, and Is a River.71 PuysCgur’s work, however, could finally a pianissimo. not reverse the charges already made, and ani- I. Period of Magnetism (1587-1789). The mal magnetism slipped from prominence with first period began with Cardan’s Works on the upheaval of the French Revolution in 1789. Precious Stones, 1584,s in which he reported an II. Mesmerism (1823-1860). When the experiment whereby anesthesia was produced French Academy appointed a second Commis- by a magnet. Paracel~us~~believed that the sion of nine men to restudy magnetism in 1823, human body exhibited magnetic properties, a revival of interest occurred. After a five and and in forbidden writings Maxwel1,s van Hel- a half year period this Commission reversed mont,72 and others propounded the theory that the opinion of the first. They concluded that in the magnet one could find the universal “research on magnetism should be encouraged principle that could explain all natural phe- as constituting a most curious branch of psy- nomena. Influenced by these writings and his chology.”B own doctorate thesis, De Planetorunz Influxir, The Commission undoubtedly realized that 1766,53 Franz Anton Mesmer formulated his there was something to mesmerism when they brilliant theory on , which observed the following case, which was referred he published in Paris in 1779.30 This theory to by Pyne, Elliotson, Hollander, and Didier. was summarized in twenty-seven propositions or axioms, which postulate that there is a “mag- Briefly, M. le Docteur Chapelain had used mes- netic fluid” that permeates the whole universe. merism over a period of several months to re- It is because of this that “impressions” from one lieve the suffering of Madame Plantin, who had part may be transmitted to and may influence an ulcerated cancer of the right breast with massive enlargement of the right axillary another; for to this incomparably rarified sub- lymph nodes. He was able to induce “a pro- stance there is no vacuum. This material may found sleep in which sensation appeared sus- be communicated, propagated, and concen- pended, but intellect remained perfect.” On trated by sound, mirrors, and light. He believed April 1, 1829, in Paris, Chapelain “threw her that his “fluid” was important in medicine and into a mesmeric sleep” and Jules Cloquet re- that, when the physician understood it, he moved the breast and dissected out the axillary could diagnose, cure, and prevent disease. This nodes. The operation lasted ten to twelve min- theory is today still thought-provoking, for utes and during this time the patient conversed fundamentally the first part differs little from calmly with the operator and gave not the slightest indication of pain. The wound was a theory of the universe presented recently by closed with sticking plaster. The patient was Herbert L. Samuel. Mesmer became fascinated pvt to bed and left in a mesmeric state for ten with the “crises” he produced and thought the hours. proof of his theory required curing of illness by this means. The Commission appointed by An important figure at this time was John Louis XVI denied him this evidence, and from ElliotsonzE of London, who introduced Laen- their experimental studies they concluded that nec’s stethoscope into England. He was also these “crises” were due to the imagination of the first Professor of the Practice of Medicine the patient. The investigators coidd neither at the University Hospital, 1831. Elliotson be- feel, hear, nor see “animal magnetism,” there- lieved in Mesmer’s theory and staked his rep- fore how could it exist? Also they showed great utation upon the belief that a coin of nickel concern about the possible moral abuses of would mesmerize, while a coin of lead would it,a*52 for was not the subject the pawn of the not. When, in a crucial experiment, Thomas magnetizer’s will? With this crushing defeat Wakely, the editor of the powerful Lancet, Mesmer left Paris, but before this great first switched the coins by subterfuge, of course, chapter closed Count Maxime de Puys6gur,lg Elliotson was defeated. He was forced to give a pupil of Mesmer, demonstrated the phenom- up his academic position but continued to enon of “somnambulism” and described how, have a large practice, published a new journal, on awakening, the subject had complete amne- , and had such eminent admirers as No. 1 USE OF HYPNOSISIN CAREOF CANCERPATIENT - Butler 3 Charles Dickens and William Thackeray. El- With the discovery of chloroform62 and liotson described: ether13 this period of attempted useful appli- cation of mesmerism came to an end. The case of a man whose right knee was like “a ZZZ. Braidism-Hypnotism (18434900). bag of bones.” The patient was in such agony that he had not slept for three weeks, could With , a Manchester surgeon and not eat, and had excruciating pain if anyone oculist, we enter the scientific phase of hyp- walked heavily across the room. He was mes- nosis.9 Braid recognized that with the induc- merized on three successive days. His pain tion of the mesmeric state, the eyes exhibited was relieved and he ate and slept. On the third a peculiar type of movement that he thought day his leg was amputated above the knee was of a reflex nat~re.7~He broke away from without evidence of pain. When he was awak- Mesmer’s theory and believed that the “state” ened, he did not know the operation had resulted from some physiological change in the occurred. individual induced by tiring the eyes, and this , inspired by Elliotson, used resulted in a peculiar physiological condition mesmerism to perform painless operations up- of the brain and the spinal cord. It was Braid on the natives of Bengal. In 1846, he per- who recognized the importance of formed seventy-three major operations and re- and devised the name “hypnosis.” Volgyesi lieved pain in eighteen medical conditions. He considers that he was not only the founder of used trained natives to perform the mesmeriza- scientific hypnotism but also the father of tion, while he performed the operations. Most psychosomatic medicine. of his cases were witnessed by reliable observers, The , largely represented by who traveled great distances to his little coun- LiCbeault56 and Bernheim, believed that hyp- try hospital in Hooghly, India. He was later notism was closely allied to natural sleep and to learn upon his return to England that the was largely a product of suggestion, while the philosophical, oriental mind of the Bengalese Paris School, headed by the noted neurologist, lends itself to a greater depth and a greater Charcot, thought that it was a pathological ease of induction than the mind of the average state, a neurosis, and that it was due to a Englishman. The native magnetizers used somatic change. There was great rivalry be- passes mainly, and certainly, in this accurate tween these two groups, but the Nancy School record of profound mesmerism, there was little won out and received official recognition from use made of suggestion, which is thought to be the Academy of Medicine in Paris.7. 86 The use all-important today. In every case reported by of hypnotic and suggestive therapy became Esdaile there was irrefutable evidence of con- comonplace throughout the world, but there trol of pain, and at least twelve of his cases was little attempt to select suitable cases, nor could have been cancerous tumors. Typical of could it live up to the exaggerated claims made his cases is the following report: by its proponents. By 1900, it fell into disuse again. “Oct. 25, 1845. G. S., a shop-keeper, aged 40. During this period, however, it was directly He has a ‘monster tumour,’ which prevents him from moving because of its great weight. He applied to the control of pain in a few cancer has used it for a writing desk for years. He be- patients. Tuckey referred to reports by Arthur came insensible on the fourth day of mesmer- of the East-End Wesleyan Hospital: ism, and I removed it with a circular incision. Arthur used hypnotism to relieve pain in cases The rush of blood was great, but was soon of cancer of the uterus and breast and, by this arrested. The tumour weighed eighty pounds. means, he achieved excellent palliative results. On recovery, he said that nothing had dis- The pains, however, returned from time to turbed him.” time, and it was impossible for the patients Didier reports in detail: always to go to him for relief. He, therefore, hypnotized them and told them that, whenever A case of cancer of the breast which was re- their symptoms recurred, they had only to take moved by Mr. Tubbs in 1854. The patient was a dose of the medicine he would give them, and mesmerized, the breast and axillary nodes re- they would experience immediate relief. This moved, and the wound edges sutured. The pa- procedure was successful and he termed this tient was awakened and stated without res- method “treatment by indirect suggestion.” ervation that she felt no pain during or after the procedure. Doctor Elliotson, Col. Baynold, IV. Hypnology, Narcoanalysis, Hypnoanaly- Dr. Symes, Mr. Goff, and Mr. Amon were sis (2900-1953). During the past fifty years witnesses. through the application of laboratory experi- 4 CANCERJanuay 1954 VOl. 7 mental techniques, hypnotism has become es- eating and digesting ordinary food with ease, tablished as a science.36 “hypnology.”12. 75 to all appearance in good health and weighing Those who use this science constructively may two stones heavier; nothing but a little weak- be called “hypnologists.” This science has a ness in the back after his long suffering and secure basis with its tenets anchored on ex- illness remaining. In any case, hypnotic sug- gestion has done more for him than I believe perimental measurements. Thus, muscular any other treatment could have done.” strength,57. 81 cerebral function,28*46* 69 gastric secretion,45 and respirat0ry3~and cardiovascu- In 1932, Hollander reported a personal ex- lar actions39.449 76 have been studied as they are perience on relieving the pain of a cancer pa- influenced by the hypnotic state. Also pertinent tient with hypnosis: to this report are experimental investigations “Once I was asked by a surgeon to go to a of hypnotic anesthesiaz3-59v upon which is nursing home in Hampstead, where a young based the rationality for the use of hypnosis to woman, dying from cancer of the uterus, suf- relieve pain in cancer. Its effect upon recall of fered great pain which caused her to be sleep- past memories,38 the duration of posthypnotic less. Within a few minutes the patient was amnesia,TO and even its possible antisocial asleep, and, in a few minutes more, wide awake useslo. 259 64, 77, 79, 80 have been scrutinized. Be- with spasmodic pain. I persevered for an hour, cause of this, there has gradually been a dimi- at the end of which she seemed more peaceful. nution in both professional and popular re- I heard no more for a week, when I received a letter thanking me for what I had done, stating sistance to hypnosis. that the patient had slept free from pain every Another impetus to social acceptance was the night since my visit.” development of narcohypnosis and narcoanaly- si~.~~~34 The use of drugs made these pro- Rosen reported the use of hypnosis to con- cedures more acceptable. trol pain in seven patients with various condi- It has been said that if psychotherapy is ever tions. He was able to obtain hypnotic anesthe- to reach the masses, it will be through a method sia in 25 per cent of his cases. more rapid than , such as hyp- His only cancer patient was a 39-year-oldwom- nosis. This challenge has been acted upon by an with bone metastases from a carcinoma Brenman and Gill11 and Wolberg, who have of the breast. Because of severe hip pain, un- combined hypnosis and psychoanalytical prin- controlled by morphine, she was hypnotized ciples into an integrated form of mental ther- twenty-four times during the last six weeks of apy, “hypnoanalysis.” life. She was undisturbed by pain during the During this fourth period there were also hypnotic period, but the pain was not con- a few isolated reports on the use of hypnotism trolled posthypnotically. Rosen thought that a prefrontal lobotomy would have been pre- to relieve the pain of cancer. Miller refers to ferred to , since the patient had a case treated by Betts Taplin: derived only partial relief from the latter. His patient was a 66-year-old man who had a carcinoma of the cardiac end of the stomach THEHYPOTHESIS diagnosed by a laparotomy. Taplin describes The hypothesis that the mental and physical his results in the relief of suffering in this pa- disturbances of the cancer patient may be fa- tient who was getting morphine frequently vorably influenced by hypnotic and was losing ground rapidly one month post- operatively. “I resolved to try what hypnotic evolved during thirteen years of critical inves- suggestion would do toward smoothing the tigation of hypnotic phenomena by the author. way to the inevitable end. The result exceeded At first, over a period of six years, hypnosis was my expectations. After the first sitting he was used as a tool to study psychological functions much easier, and slept fairly without his mor- of the mind. Experience was gained in selec- phia; after the second, the pain disappeared tion of suitable patients, means for allaying for three days, and returned (not severely) just unfounded fears and misapprehensions, meth- before the third sitting; after that it passed ods for inducing the hypnotic state, and pro- away altogether, leaving slight discomfort after cedures of elicitation of various hypnotic phe- food only. As the sittings continued, even this nomena. Approached critically and skeptically, disappeared; he was able to take solid food with comfort, his out-standing trouble, consti- it was only after repeatedly reproducing the pation, passed away, he slept well nightly, and various phenomena of hypnosis that the con- began to gain strength and to put on flesh, and clusion that hypnotism is a “real” phenom- is now, three months after I began treatment, enon became inescapable. No. 1 USEOF HYPNOSISIN CAREOF CANCERPATIENT - Butler 5 Defined broadly, mind and body are insep- These were patients with pain and widespread arable, and, as a corollary, since hypnotism is cancer. Frequently, they were emotionally dis- a means of control of the mind, it can also turbed and had been difficult nursing prob- regulate the body and its functions. With this lems. In these cases the usual form of medical hypothesis one can extend the use of hypnosis care, including sympathetic and understanding beyond psychological processes and apply it to attention and the administration of various the vast field of psychosomatic medicine. Exem- pain-killing drugs, had not been entirely satis- plary of this field, seven cases of severe primary factory. Also, hypnosis was suggested as a last dysmenorrhea were treated. The hypnotic resort before considering a prefrontal lobot- states were induced, painful periods were “ab- omy. reacted,” and positive posthypnotic suggestions The patient referred for treatment was inter- were given for the patient to be free of menstru- viewed, and a detailed history was obtained al cramps, headaches, nausea, and vomiting. with special attention to psychosomatic factors, From two to twelve treatments were given at previous impressions of hypnosis, and the pres- monthly intervals. Superficial psychotherapy ent social mesh in which the patient was was also utilized. Six of these cases, which were caught. completely unamenable to all other medical The subject of hypnosis was forthrightly dis- therapy, were symptomatically cured to a fol- cussed, and, if the patient was co-operative, the low-up of two to five years. Others have also hypnotic procedure was started. Attempts were found hypnotherapy effective in otherwise re- made to have the patient in a relaxed position, fractory cases.20~41 42 either sitting or prone, in a darkened, quiet When this hypothesis is carried a step fur- room. There was always a “disinterested” third ther, control of painful organic conditions person present. The techniques used to induce should be possible. In this respect during the hypnosis were eye-fixation with attention fo- past six years, the author used hypnosis to cussed on a small bright light, coin, or crystal,9 facilitate the care of twenty selected obstetrical hand levitation,gO*82 or lid closure with eyeball patients. Hypnosis was used successfully in re- pressure by the fingertips.s lieving severe nausea and vomiting during the Appropriate verbal suggestions were given early months of pregnancy, in the elimination depending on the style of induction and the of heartburn, in alleviating back and muscular personality of the patient. Soft, soothing, classi- pains, and in allaying fear and anxiety. Also, cal music was played on a phonograph, not at the time of labor and delivery, it was suc- only to help the patient relax but also to elimi- cessful in partially or completely relieving the nate extraneous noise. When the operator sus- pain of the entire labor. Through the use of pected a light stage of hypnosis had been ob- hypnosis, infants were delivered spontaneously, tained, he commanded that the patient could and by breech, without anesthesia. In two cases, not open his eyes. If this order was effective, episiotomies were made and repaired with the progressively more complicated and more elab- patient experiencing or remembering little or orate mental pictures were constructed. A float- no pain. Postpartum, lactation could be in- ing or light feeling was usually easily obtain- fluenced. In two cases, postpartum depression able, as well as epigastric warmth. Then, in responded to positive supportive suggestions. sequence, extremity rigidity, “automatic” Similar results have been obtained by others.’, movements, visual and auditory hallucinations, 40. 41. 43, 64 and anesthesia were elicited. Posthypnotic phe- The application of this same successful tech- nomena were produced when the depth of nique to gynecological cancer patients being hypnosis obtained would permit it. After the cared for concurrently by the author was an greatest depth possible was reached, pertinent unavoidable progression; for, more than any suggestions were made to remove disabilities other group of patients, the cancer patients and pains, and positive commands given as need mental-physical therapy. demanded by the situation. When of some relevant event in the patient’s memory METHODSAND PROCEDURE was indicated, this was elicited. The patient was then awakened. His experience was dis- Cases for this study were gradually accumu- cussed with the hypnologist and superficial lated from referrals by various physicians who psychosomatic guidance was given. thought their patients were particularly in Narcohypnosis was used in some patients need of and suited for this form of therapy. who had a superficial resistance to the usual 6 CANCERJanuary 1954 VOl. I technique of . While either the patient that his course had again turned sodium pentothal or sodium amytal was given downward. Then hypnosis was used again to slowly intravenously in a very low concentra- recover lost ground, but, each time this hap- tion, the hypnotic techniques were followed as pened, it was more and more difficult to return used in the regular patients. A state of con- the patient to the same emotional level of scibusness was maintained as much of the time confidence and cheerfulness; for, each time, the as:‘possible. Some patients, following this pro- “truth” became more firmly imprinted and cedure, became excellent hypnotic subjects and harder to erase. no longer required the drug. In strongly re- In all of this, the depth of hypnosis is the sistant cases, the drug did not influence the pa- deciding factor. For practical purposes there tient, and resistance was evident even when the are three stages: light, medium, and deep maximum drug was given. It appears that nar- trance. In a light trance, the patient recognizes cosis and hypnosis are dissimilar states, al- some “influence” but doubts that he was hyp- though one may aid the other when used con- notized. In a medium trance, the patient is sure jointly. Narcohypnosis was not used to any he was hypnotized, but he can recall freely all great extent because of the ever-present risk of the events that occurred. In a deep trance, the sudden respiratory or cardiac failure. subject realizes that he was hypnotized, but his The frequency of the treatments varied recall of the trance period is under the control, greatly. Out-patients were seen daily or weekly; to some extent, of the hypnologist’s sugges- hospitalized patients were seen at least daily tions. After three one-hour periods of inten- and sometimes two to four times a day. Because sive work, cancer patients who reach only the of the amount of time required, phonograph light trance cannot be helped. Those who go recordings were made for specific patients on into a medium trance can be helped but, the twelve-inch records at 33% r.p.m. in a record- more severe and “organic” the pain, the more ing studio. Agairi, the technique and sugges- ephemeral the hypnotic control. Those who tions previously found effective for that patient reach the deep or somnambulistic trance can be were specifically recorded, and effective, se- helped. Unfortunately these people are rare lected music was recorded simultaneously as and constitute only 10 to 20 per cent of the a background. An automatic phonograph was population. Extensive disease, a distraught placed at the patient’s bedside, and, when the mind, pain, and the fear of death make induc- patient was in a ward, the phonograph was sup- tion of hypnosis more difficult than in normal plied with headphones, so that adjacent pa- people, because it seems that the most difficult tients were not disturbed. Either the patient, thing to control under hypnosis is the function doctor, or nurse could start the recording; it you want most to affect. would stop automatically. The hypnologist is an important factor in The effect of the phonograph records was this problem, for hypnosis is a transference and usually good, but they were not so effective as countertransference relationship just as is psy- personal contact with the hypnologist. Also, choanalysis. In hypnosis this interplay is not the patient soon memorized the record and well understood by either party and is not well tired of it. New records were made to combat handled. Here, the differences in sex, age, race, this, and new suggestions included when indi- and social station of the patient and the hyp- cated. Personal hypnosis was continued at in- nologist become acutely important and may, if tervals while the records were being used to these factors are adverse, militate against give the patient further support. success. When hypnotherapy was stopped for the Since Braid limited the role of the hypnol- purpose of determining the effect of its with- ogist and expanded the importance of the sub- drawal, if done suddenly, there was a dra- ject, there has been practically no study of the matic and severe change for the worse. It effect of hypnosis upon the hypnologist. The was as if a prop had been knocked away. Pain hypnologist is, however, affected by the treat- became more intense, disabilities increased, ments. He gives of himself to the patients, and and the patient was now more difficult to care he receives the discards from them. If he is in for than before. If the hypnotherapy was gradu- good health, comes in contact with the patient ally withdrawn, the patient could be main- only at intervals, and takes his work lightly, he tained greatly improved without the actual use will be unaware of this, and there will be little of hypnosis until that time when pain suddenly affect. If the reverse is true, however, he will recurred or some other event demonstrated to gradually feel his vitality become reduced and No. 1 USEOF HYPNOSISIN CAREOF CANCERPATIENT - Butler 7 will become more susceptible to illness himself. the second attempt that there was complete loss Even an hour’s treatment with a very sick pa- of the corneal reflex, loss of sensation to painful tient can produce an appreciable tiring of the stimuli, and complete amnesia to the entire hypnologist, and, as the sympathetic bond be- trance period. She was a somnambulist. tween the two grows stronger, the hypnologist On the third day, it was decided that the diagnosis must be confirmed, and then an ex. may even “feel” the symptoms he is trying to ploratory operation was indicated. Since the eradicate from the patient. patient was in a poor physical condition, hyp W. L. Howard also found that the effect nosis was suggested as the form of anesthesia. upon the operator may be “very severe,” and Again the patient was placed in a deep trance. that, when the hypnotic treatments are “con- After two hours, when she had lost the corneal tinually kept up on several cases without men- reflex but still carried out suggestions, she was tal rest, it may produce some very injurious taken to the operating room. The abdomen conditions” in the operator. William Davey was prepared and draped, and, with no other advised, “If the operator labours under any form of analgesia or anesthesia except hypno- sis, an incision 10 in. long was made from the deficiency of healthful vigour, the frequent umbilicus to the symphysis pubis. Skin towels contact with diseased individuals will be sure, were applied, and the incision was carried by the law of mesmeric sympathy, to affect him down to the fascia through 3 to 4 ,in. of subcu- with pains and disquietudes, if not perfectly taneous fat. As the fascia was being incised, analogous to those of his patients, yet bearing the patient moved but did not complain of such relationship to them, as will suffice to pain. With this, however, cyclopropane anes- make him painfully conscious of the source thesia was started, and without waiting the whence they are derived.” exploration was continued. Carcinomatosis was However, with an expenditure of consider- found; the ovarian tumor was biopsied, and able time, energy, and ingenuity, a very sick the incision closed. Postoperatively, the patient stated that she suffering patient may live his last months of had felt no pain at any time; however, she also life with a minimum of drugs, a sense of hope- had no memory concerning the period of time fulness and cheerfulness, and relative freedom during which she was hypnotized. from pain. His mind becomes more acute Her physical condition then deteriorated rather than dulled, as with drugs. The rest of rapidly, and she died three days later. Since his body functions as well as it can without she had no further severe pain, hypnosis was being further inhibited by drug side-action. not used after the operation. He is a rational thinking human until death, Case 2. Mrs. M. R., age 48, was admitted to rather than a “vegetating” invalid as may hap- the hospital because of a tumor the size of a pen after a prefrontal lobotomy. He has been six-month pregnancy that filled the pelvis and supported in the last days of his life by the lower abdomen. It was a rapidly growing sar- compassion of his physician rather than let coma of the uterus. The patient was in severe down with drug addiction and destructive pain. It required the assistance of three people surgery. to move her in bed, for movement made the In summary we have the mind of the patient pain more acutely excruciating. She had been struggling for survival, aided by the mental bedridden for six weeks and was anorexic and constipated. Consequently, she was depressed, support of the hypnologist; both are fighting frightened, and morbid. She suspected that she a losing battle, for, in the end, cancer and was dying of cancer. death will win. With the first attempt at induction she en- tered a deep somnambulistic trance. It was CASEHISTORIES suggested that she was free of pain, fear, and anxiety. She was told to get out of bed and Case 1. Mrs. M. B., age 55, received mor- walk. This she did with but little support. phine, 15 mg., every four hours for relief of When she was awakened and told of her prog- lower abdominal pain. The tentative diagnosis ress, it seemed incredible to her. Actually she on admission was carcinoma of the ovary with was free of pain and could move in bed easily. metastasis. A hypnotic state was induced easily She ate better than she had in weeks and slept during which suggestions were made for the without medication. patient to be free of pain and to become calm During the next three weeks, the patient was and relaxed. After the second treatment her kept in a hypnotic state 30 to 40 per cent of pain was improved, and she required one half the time, and she found that she could take of her usual amount of morphine to keep her food and control her bowel elimination by giv- free of pain. She was so deeply entranced on ing herself suggestions. She was able to get out 8 CANCERJanuary 1954 Vol. 7 of bed alone and to walk unaided; also, sht been given to the cervical region without relief was eating well. She required no analgesic of pain. agent. Over a period of two weeks the patient was She had a particular dread of her daily trip hypnotized ten times. She entered the som- to the radiotherapy department. Since she nambulistic stage and could be made anesthetic would stay in a trance two to three hours with- to painful stimuli. During this period she was out waking, she was hypnotized in her room able to get out of bed and walk unassisted. Her and told not to awaken until after she had pain became less and she regained the use of returned from her treatment. Thereby, she had her right arm so that she could lift a pitcher no memory of this experience and, hence, no filled with water and could write. She regained dread. It is pertinent to state that the tumor her courage. grew rapidly in spite of radiotherapy. When she was in the hospital she used a When hypnosis was discontinued, but the record to help her at night. At the end of this same amount of personal attention to the pa- time she returned to her studio and actively tient was maintained, the patient did well for taught dramatics again. No further hypno- thirty-six to forty-eight hours; then she would therapy was used. gradually slip back into her previous condi- One month later, however, the pain re- tion. She would con,,Aain of severe abdominal turned and the patient had to be readmitted pain and weakness, be unable to get out of to the hospital. Finally, a prefrontal lobotomy bed, and have again a strong fear of dying. was performed on the right side of the brain, Then, with as little as five minutes of hypnosis but, when the pain continued unabated, in with appropriate suggestions, she would awak- fact was even more severe, hypnotherapy was en free of pain, strong, and liberated from tried again. Now, five months after the first anguish. successful use of hypnosis and one month after By the end of the second month, a phono- the lobotomy, the patient had a clear sensori- graph record was made from a tape-recording um and a good memory, but it was difficult for of a hypnotic treatment at the patient’s bed- her to concentrate. She complained of severe side. The record was then available for the pa- pain in her right thigh, where she had a patho- tient to play on a portable phonograph in her logical fracture of the femur, a severe pain over room. This record, at first, induced a deep the left side of her head, and a heaviness of state of hypnosis, but later, as the patient her face. Pain had become so severe that she memorized the words, she became annoyed required morphine every four hours. with it, and it became less effective. Then other Hypnotic techniques were used, but she was records were made for specific uses: to induce now very sick and debilitated. She said that sleep, to relieve pain, to restore calmness and she wanted to die and resisted my suggestions. confidence. By using a variety of records, the Also, since she had had the lobotomy, con- patient was maintained and required personal centration was difficult. Only a medium trance hypnosis only once a day. could be induced and that required great effort By the end of the third month of hypnotic and time. After five long sessions over a period treatment, the tumor had grown to the size of eight days, there was subjective improve- of a term pregnancy. The bowel was partially ment. The phonograph and recordings were obstructed and vomiting became difficult to used at night. Pain became less and appetite control. The records were not effective, and the returned. There was some improvement be- patient was kept in a trance most of the time cause of the hypnotic treatments, but it was by personal hypnosis. Even when the tumor neither striking nor dramatic. Soon after this ruptured and drained a copious foul necrotic the right hip was nailed, her condition became material out of the vagina, the excruciating rapidly worse, and she died. pain was quickly relieved by inducing a deep trance. Soon after this the patient died. It is worthy to note, first, that this woman Case 3. Mrs. I. M. was a 65-year-old actress who was very intelligent, independent, re- and dramatic coach, who had had a radical sourceful, and successful, found it difficult to mastectomy two years previously because of adjust to a dependent role. Also, there was a cancer of the breast. She complained of pain certain sense of persecution about her pain, in the occipital portion of her head that radi- which came in “spasms” and which she associ- ated down both arms. Her right arm was weak, ated with “people coming after her.” She be- so that she could no longer lift a glass or cup. lieved her present suffering was a punishment She could not write, and she was incapacitated by the pain so that she could not teach. Roent- for her inconsideration of others during her gen-ray examination disclosed that she had life. Prefrontal lobotomy in this patient inter- metastatic lesions in the cervical vertebrae, ribs, fered with the hypnotic state because concen- ischiurn, and right femur. Radiotherapy had tration was more difficult. No. 1 USEOF HYPNOSISIN CAREOF CANCERPATIENT - Butler 9 Case 4. G. P. was a 14-year-oldboy who had there was no improvement. The patient was acute myelogenous leukemia. He was referred very weak and bedridden. Two weeks later for treatment because of severe pain in the hypnotherapy was tried again. Although diffi- coccyx, depression, apathy, and anorexia. He cult to evaluate because of a mental lethargy was anemic and had responded poorly to trans- and dullness, it was possible to elicit a few fusions. hypnotic phenomena during two interviews. This boy was interviewed and hypnotized The depth of hypnosis, however, was definitely six times over a period of one week. On two not so great as had been obtained before the occasions he was in a somnambulistic trance lobotomy had been performed, and the efficacy and on the other four reached only a medium of the treatment was doubtful. Because of the trance. Nevertheless, his pain was entirely re- patient’s poor condition further attempts at lieved while under hypnosis, although it would hypnosis were not tried. She died ten days return three to six hours after the treatment. later. He became congenial, his appetite returned, and he felt a return of his normal vigor. Case 6. E. B. was a 49-year-old man with sec- Actually, his hemoglobin increased 1.0 gm.dur- ondary carcinoma of the liver. The primary site ing this period, although he received no trans- was unknown. He was jaundiced, the liver fusions, and, by the end of the week, he re- reached the iliac crests, and he was unable to quired no medication for pain. eat. Hypnotherapy was utilized in an attempt Six days after this a perirectal abscess was to combat the anorexia. discovered as the cause of the coccygeal pain After five interviews during one week only, and, following incision and drainage, there a medium trance could be induced. However, was continued subjective improvement. The a definite and prolonged improvement in his patient left the hospital and returned home. appetite occurred with a consumption of a He did well on supportive therapy. Four greater amount of food than previously. Real months later, he inadvertently read a letter hunger could also be suggested. After therapv that disclosed to him the lethal nature of his was stopped, the anorexia returned, and threc disease. A relapse immediately followed this weeks later the atient left the hospital. He experience, and he was readmitted to the hos- died at the end oF ten weeks. pital. He died eight weeks later. Hypnotherapy was not used during this last admission. Case 7. Mr. M. R. was a 72-year-old Hun- garian, who had had a carcinoma of the right Case 5. Mrs. I. R. was a 72-year-old colored breast removed twenty years previously. He was woman, who had a carcinoma of the right admitted because of a three-month history of parotid gland, which had been treated with intractable pain in his right hip, thigh, knee, radiotherapy during the past year. As a result and to some extent where his right leg had been her face was distorted by a seventh nerve (his right leg had been amputated below the paralysis, and, from the onset of the radio- knee during World War I, because of injuries therapy, she had a bad taste in her mouth. and subsequent infection). Neurological exam- She was troubled mostly, however, by excessive ination failed to reveal any abnormality and salivation that had not responded to any type there were significant emotional factors in his of treatment and by the anorexia related to background. For these reasons hypnotherapy these disturbing symptoms. She also had pain was suggested. in the right side of her face and neck. In addi- He was a translator of scientific articles, had tion she was confined to bed or a wheelchair been a teacher of natural sciences, and, when for the past month owing to deformity of her he lived in Vienna, hypnosis was a new develop- legs by rheumatoid arthritis. ment used in the detection of crime and in the The patient would enter a medium trance treatment of shell shock. Although he was fear- and, during one week when she was seen six ful of being hypnotized, he quickly entered a times, the bad taste, face pain, and excessive deep trance and was made to relive his past salivation were controlled during the hypnotic life, which he described in German. In doing period and for as long as twenty-four hours so he re-experienced pain in his right extremity posthypnotically. First, while in a trance, and and abreacted the appropriate emotional con- then, when entirely awake, the patient was comitants-a phenomenon like the “crises” de- ambulated, and by the end of the week she scribed by Mesmer. Following this the patient was walking around the ward unassisted. Her was awakened. His pain had disappeared. The appetite improved &d she ate well as long as next day he said he felt as though “his body her symptoms were under control. and soul had been torn apart,” and that he Hypnotherapy was stopped and all her symp- remembered people he had not seen for dec- toms returned. ades. Although he continued to complain of Three weeks later a prefrontal lobotomy was pain in his thigh, it was not severe and in no performed on the right side, but following this way did it affect his sleeping. He refused fur- 10 CANCER.January 1954 VOl. 7 ther hypnosis, and a contemplated neurosurgi- CASES SEEN ON AN OUT-PATIENT BASIS cal operation was decided not to be indicated. He left the hospital two weeks later and did Case 10. Mrs. J. B., age 35, was seen weekly not return for follow-up. over a period of two and a half months. Two years previously she had had a radical mastec- Case 8. H. J. was a 50-year-oldman who had tomy on the right for carcinoma. She then de- had a radical removal of a malignant testicular veloped an inflammatory carcinoma of the left tumor nine months previously. Following this, breast with secondary metastases of the lung. extensive radiotherapy was given to his abdo- There was considerable unrest at home because men and lower back. For the past four months, of a 3-year-old daughter, religious differences, he has had low-back and bilateral leg pain; and a difficult, demanding husband. She com- for two months, spasms of the lower abdomen plained mainly of a burning pain and a tight and legs shook the patient rhythmically and feeling over her right chest, which accompanied spasmodically day and night. An electromyo- anxiety states precipitated by arguments at gram demonstrated forty regular spasms per home. She frequently had terrifying dreams minute. A myelogram and roentgenograms re- and her sleep was disturbed by protracted peri- vealed no evidence of a metastatic tumor. ods of coughing. The patient said on his first interview, “The A medium trance could be induced, and by only time I’ve been free of pain in the past four suggestion her anxiety and fear could be less- months was when my mind didn’t know it.” ened. Her chest pain and cough, however, When only a medium trance could he obtained showed little response. When she went home, after three attempts at hypnosis, intravenous the arguments and disagreements that ensued sodium amytal was combined with the hyp- negated these effects quickly; hypnotherapy notic procedure. During this interview it was was stopped and she died two months later. learned how he had been affected by the suffer- ing of his father, who had died of cancer a few Case II. Mr. A. M. was a 55-year-old man years previously. His father had had severe who had had a carcinoma of the right lung leg pains comparable to the patient’s. The partially removed by pneumonectomy five patient had also tried to get some drug to put months previously. He ascribed his illness to a his father “out of his misery,” but, before he blow on the chest while boxing twenty years could accomplish this act, his father died. ago. The patient was a food fadist and came to There was considerable expression of feeling the hospital for weekly visits, stooped over and about this by the patient. The parallelism he complaining of severe chest pain. A medium had made between himself and his father, as trance was induced on three separate inter- well as his self-imposed punishment, was views. When awakened, the patient would cry pointed out to him. During this interview the and claim that he was finally free of pain. He lower abdominal and leg spasms stopped com- would leave the hospital walking straight and pletely, and following it the patient said that smiling, but, by the time he had taken an he felt “at peace with the world,” and “his legs hour’s subway ride home, he was in pain again. were absolutely quiet for the first time in He died six weeks later. three months.” A similar result followed a second interview of narcohypnosis and in a few Case 12. Mrs. B. L. was a 46-year-old woman days the patient was discharged from the hos- who had had a carcinoma of the left breast re- pital 90 per cent improved. moved locally and treated with radiotherapy Not long after returning home where family, fifteen years ago. Eight years ago she had a re- relatives, and well-meaning friends gave him currence and finally submitted to a radical consolation, his spasms and pains returned mastectomy but she would not permit further with even greater severity. radiotherapy. She noticed a lump in the right axilla four years ago, which has continued to Case 9. Mrs. E. S. was a 52-year-old colored grow slowly, and she has gradually been dis- woman with a stage-IV carcinoma of the cervix. turbed by pain and swelling of her right arm. Weekly cervical biopsies were taken for a re- This area was again treated with radiotherapy. search study until the patient became so afraid When seen for the first time for hypnother- of the pain of the procedure she would not apy, the patient had been having pain for five permit it. Hypnosis was induced and a medium months and was taking 60 mg. of codeine every trance with partial skin anesthesia was ob- four to six hours. She was seen twice a week tained. The cervical biopsy was taken easily. for seven weeks. She entered only a medium The next week, the patient resisted being hyp- trance state, but her axillary and arm pains notized, but in spite of this the biopsy was could be relieved while entranced. During this taken in a medium trance. The third week it entire time, she became less anxious, her pain was impossible to induce a hypnotic state and lessened, and for twenty-four hours after an the biopsy could not be taken. interview her drug requirement was reduced. No. 1 USEOF HYPNOSISIN CAREOF CANCERPATIENT * Butler 11 Deeply rooted obsessional neuroses that pre- lized by a physician in the care of someone who vented her from riding in a car, walking alone had a longer life expectancy. At least, in order on the street, and visiting friends were resolved to gain maximum relief for the time spent, one by hypnotic suggestion. Besides the interviews, should select patients who enter’a deep or som- the patient was relieved of two attacks of acute nambulistic trance, for in these patients or- anxiety and pain through the use of hypnosis ganic pain and subjective symptoms can be‘ over the telephone. relieved, and through posthypnotic suggestions Hypnotherapy was stopped and, within a few days, the patient regressed to her former relief may be continued after the period of state. Then her mother died. Immediately she hypnosis. Phonograph recordings are of defi- became worse and again had excruciating nite value in this respect, but specificity, flexi- pains. Codeine was no longer adequate and she bility, and variety of suggested mental pictures required 10 to 20 mg. of morphine sulfate every and musical background must be kept con- four hours. T.hree and one-half months after stantly in mind. hypnotherapy had been stopped, the patient The results of this study would not indicate was seen again. Only a medium trance could be that further efforts should be made to expand induced; pain was relieved during the trance this type of therapy. However, there are two but recurred quickly afterward. However, again her fears and anxieties were quickly and aspects of it that are obscure but, nevertheless, effectively brought under control. The possi- very important. The first is the intuitive knowl- bility of living six months, however, precluded edge gained by intimate association with these the use of hypnosis for this length of time and patients that there is a cancer personality. It is a chordotomy was advised. intangible and from this small experience diffi- cult to delineate in distinctive features, but DISCUSSION nevertheless it is a possibility worthy of further investigation. A rough sketch of this personal- Hypnosis is an altered state of mind. Philos- ity reveals an individual who fails to express ophers, theologians, and scientists cannot ade- himself; who represses hate, anger, dissatisfac- quately explain what mind is, and therefore tions, and grudges; or, on the other hand, is a hypnosis, which is a state of ,mind, also remains very “good“ person, who is consumed with self- an enigma. To describe it as a neurosis,sl a pity and suffers in stoic silence. The future of state of hypersuggeslibility,ll* 36 a period of cancer could lie in the psychosomatic approach, dissociation of the brain,47 a type of condi- and the precancerous personality might be tioned reflex,60 or a hysteria19 does not take treated with psychological means. In this study into account the facts we know about it. Let us of personality, one should inquire into the psy- call hypnosis that state of mind in which phe- chodynamic basis for pain, for, of two patients nomena described as hypnotic occur. with apparently equal metastatic spread of Hypnotic techniques as used. in this study disease, one will have pain and the other will did reduce pain, allay anxiety, and aid in organ not. ‘One factor demonstrated in these cases function; but the results were proportional to was the influence of a sense of guilt and of a the depth, and only five of these selected twelve need for punishment. Disease and death were cases, who were somnambulistic, can be said not adequate retribution for the unconscious to be unequivocally benefited by this therapy. impulse to kill, to lead an immoral life, or to The remainder of the patients who could enter compensate for the lack of kindness to others. a medium trance were helped, but it is doubt- It was necessary to add pain to balance the ful if this improvement is adequate compensa- moral budget. tion for the time spent to obtain it. Certainly, The second important finding is not the prac- an out-patient basis is not satisfactory if the tical therapeutic aspect of emotional control, patient is in as much distress on returning pain elimination, and organic function by home as when he left it. means of “words,” but rather fundamental and The great amount of time and energy, pa- basic evaluation of the fact that by “controlled tience, and ingenuity required of the hypnolo- thoughts” alone these things are possible. gist to produce these results has not been ade- Electricity and mesmerism were discovered quately emphasized, for herein lies the chief and condemned respectively by Benjamin defect in th& procedure. Certainly, we want Franklin. Electricity has been made the servant each person to end his life with as little suffer- of man, while our understanding of hypnotism ing as possible, but from a practical point of has not advanced; in fact, there are reasons to view this same energy and time could be uti- suspect that Mesmer knew more about it than 12 CANCERJanuary 1954 Vol. 7 he conveyed in his writings, and there is avail- CONCLUSIONS able scientific evidence to support Mesmer’s original contentions or propositions. If we 1. Pain, anxiety, and organ dysfunction in knew fundamentally how the mind could the cancer patient can be aided by the intensive eliminate pain, then possibly this knowledge use of hypnotherapy. The results are propor- could be used, freed from the disadvantages tional to the depth of trance and the efficiency that now surround hypnotism. of the program of therapy employed. Our present-day knowledge of hypnosis does 2. Patients who easily enter a deep trance not elucidate or consider the role of the hyp- can be helped; those who reach only a medium nologist. He might as well be a flashing light state can be aided, although the more “organic” or a phonograph record, but this does not ex- the complaints, the more ephemeral the re- plain how hypnosis affects him deleteriously. sponse; while patients who, after repeated Possibly he is imperceptibly hypnotized him- trials, can only enter a light stage cannot be self and identifies himself so closely with the helped by this means. patient that, without his knowledge, he “be- 3. The main disadvantages of this form of comes the patient” and after the treatment feels therapy are the few good subjects, the large the negative affect he has been trying to remove amount of time required, and the necessity of with positive suggestions. It may later be an experienced and well-trained hypnologist proved that this results from a mesmeric to govern each case. The possible deleterious influence. However, if self-analysis may be cred- etfect upon the health of the hypnologist and ited, there is this side of the problem of which the long period of time required for one patient anyone who engages in hypnosis with very sick between onset of symptoms and death, thus patients must be cognizant. limit the number of patients a single therapist The suggestion that hypnosis is a “psycho- could manage. Then, too, public resistance to logical” prefrontal lobotomyw has no basis in hypnosis persists. fact. At least in the cases reported here in which 4. The advantages of hypnotherapy for pa- hypnosis was tried before and after lobotomy, tients who enter a deep trance are numerous. hypnotizability was roughly directly propor- Drug requirements are lessened, pain is re- tional to the remaining ability to concentrate lieved, organ dysfunction can be corrected as and inversely proportional to the completeness much as possible, and depression, anxiety, and of the operation. It did not make the patient fear are minimized. Life is prolonged and death more easily hypnotized, as it should if it were is approached as is a night’s sleep. a surgical and permanent form of the same 5. Prefrontal lobotomy interferes with the state of mind. induction of the hypnotic state in proportion Hypnotism is not to be considered lightly, to the decreased ability of the patient to con- for as Sir William Osle96 said, “It is a two- centrate and, therefore, appears to be different edged sword, and needs careful handling.” Its from the hypnotic state. use must be restricted and it is safest in the 6. Narcohypnosis helps to counteract super- hands of the competent psychiatrist, who has ficial resistance but does not appear to aid had a particular interest and experience with otherwise in obtaining greater true hypnotic it. Other specialists and general practitioners depth. It does not eliminate all resistance. should use it only after adequate training, and 7. Future efforts should be expended to then only when other methods available are learn what hypnosis is and how it alters physio- inadequate. The use of hypnotism can be com- logical function. When these fundamentals are pared to the performance of a difficult opera- understood, its advantages will have a wider tion. Anyone can cut the skin, many may re- and more satisfactory application. move an appendix, but who should remove a 8. There may be a “cancer personality.” stomach, a pancreas, or a lung? The same is From a very intensive study of these cases, true of hypnosis-anyone can learn to induce either an irihibited individual with repressed it, some can get therapeutic results, but only anger, hatred, and jealousy or a “good” per- those with experience and training should at- son consumed with self-pity may be prototypes tempt to cut out pieces of mind. of this personality. No. 1 USEOF HYPNOSISIN CAREOF CANCERPATIENT - Butler 13 REFERENCES 1. ABRAMSON,M., and HERON,W. T.: An objective erations Without Pain in the Mesmeric State with Re- evaluation of hypnosis in obstetrics; preliminary report. marks upon the Opposition of Many Members of the Am. J. Obst. 6 Gynec. 59: 1069-1074, 1950. Royal Medical and Chirurgical Society and Others to 2. ALEXANDER,F.: Emotional factors in essential hy- the Reception of the Inestimable Blessings of Mes- pertension; presentation of a tentative hypothesis. merism. London. Lee & Blanchard. 1843. Psychosom. Med. 1: 173-179, 1939. 25. ERICKSON.M. H.: An experimental investigation 3. ALEXANDER,F.: Psychological aspects of medicine. of the possible anti-social use; of hypnosis. Psychtry Psychosom. Med. 1: 7-18, 1939. 2: 391-414, 1939. 4. ALEXANDER,F.: : 1856-1939. Psycho- 26. ESDAILE,J .: Mesmerism in India; and its Practical som. Med. 68-73,1940. Application in Surgery and Medicine. Chicago. Psychic 2: Research Co. 1902. 5. ALEXANDER,F.: Psychosomatic Medicine; Its Princi- 27. FELKIN,R. W.: Hypnotism or Psycho-Therapeu- ples and Applications. New York. W. W. Norton & Co. tics. Edinburgh. Young J. Pentland. 1890. 1950. 6. AXELRAD,R. K.: Some aspects of the treatment of 28. FORD,W. L., and YEAGER,C. L.: Changes in the the emotional problems of the tuberculous. News-Letter electroencephalogram in subjects under hypnosis. Dis. Am. A. Psychiatric Social Workers 15: 81-84, 1946. New. System 9: 190-192, 1948. 7. BERNHEIM,H.: Suggestive Therapeutics; a Treatise 29. FOREL,A.: Hypnotism; or Suggestion and Psycho- on the Nature and Uses of Hypnotism. (Transl. from therapy; a Study of the Psychological Psycho-physio- logical and Therapeutic Aspects of Hypnotism. (Transl. 2d French ed. by S. A. Herter.) G. P. Putnam's Sons. from 5th German ed. by H. W. Armit.) New York. Allied 1900. Publications. 1949. 8. BINET,A., and Fk~i,C.: Animal Magnetism, 2d ed. 30. FRANKAU,G.: Introductory Monograph. In Mes- London. Kegan Paul, Trench & Co. 1888. mer, F. A.: Mesmerism. London. MacDonald. 1948. 9. BRAID,J.: Neurypnology or, the Rationale of Nerv- 31. GALICIA,J. C.: The psychogenesis of hypnotic ous Sleep, Considered in Relation with Animal Mag- suggestion; a survey and critical commentary. Brit. J. netism. London. John Churchill. 1843. Med. Hypnotism 4(2): 2-13, 1952. 10. BRENMAN,M.: Experiments in the hypnotic pro- 32. GRINKER,R. R., and SPIEGEL,J. P.: War Neurosis duction of anti-social and self-injurious behavior. Psy- in North Africa; the Tunisian Campaign (January-May chiatry 5: 49-61, 1942. 1943). New York. Josiah Macy, Jr. Foundation. 1943. 11. BRENMAN,M., and GILL, M. M.: Hypnotherapy, 33. HOLLANDER,B.: Hypnosis and anesthesia. Proc. a Survey of the Literature. New York. International Universities Press. 1947. Roy. SOC. Med. 25: 597-610, 1932. 34. HORSLEY,J. S.: Narco-analysis; a New Technique 12. CANNON,A.: The Invisible Influence; a Story of in Short-cut Psychotherapy: a Comparison with Other the Mystic Orient with Great Truths which Can Never Methods: and Notes on the Barbiturates. London. Ox- Die. New York. E. P. Dutton & Co., Inc. 1934. ford University Press. 1943. 13. CARTWRICHT,F. F.: The English Pioneers of Anaes- 35. HOWARD,W. L.: Hypnotism as a therapeutic thesia. Bristol. John Wright & Sons, Ltd. 1952. agent. Tr. M. SOC. Virginia 23: 71-85, 1892. 14. CHARCOT,J. M.: Clinical Lectures on Diseases of 36. HULL,C. L.: Hypnosis and : an Ex- the Nervous System, Vol. 3. (Transl. by Savill.) Lon- perimental Approach. New York. D. Appleton-Century don. New Sydenham Society. 1889. Co. 1933. 15. COATES,J.: Human Magnetism: or How to Hyp- 37. HUNT,J. R.: Nature and treatment of psychic. notise, a Practical Handbook for Students of Mesmer- and emotional factors in disease. J. A. M. A. 89: 1014- ism. London. George Redway. 1897. 1017, 1927. 16. DANIELS,G. E.: Practical aspects of psychiatric 38. HUSE,B.: Does the hypnotic trance favor the recall management in psychosomatic problems. New York J. of faint memories? J. Exper. Psychol. 13: 519-629, 1930. Med. 41: 1727-1732, 1941. 39. IENNESS.A.. and WIBLE.C. L.: Remiration and 17. DANIELS,G. E.: Psychiatric factors in ulcerative heart &ion in sleep and hypnosis. J. Gen.' Psychol. 16: colitis. Gastroenterology 10: 59-62, 1948. 197-222, 1937. 18. DAVEY,W.: The Illustrated Practical Mesmerist; 40. KROGER,W. S., and DE LEE, S. T.: The use of Curative and Scientific, 2d ed. Edinburgh. MacLachlan the hypnoidal state as an amnesic, analgesic and anes- & Stewart. 1856. thetic agent in obstetrics. Am. J. Obst. & Gynec. 46: 19. DE ST. DOMINIQUE,C.: Animal Magnetism (Mes- 655-661, 1943. merism) and Artificial Somnambulism: Being a Com- 41. KROGER,W. S., and DE LEE,S. T.: The psychoso- plete and Practical Treatise on That Science, and Its matic treatment of hyperemesis gravidarum by hypnosis. Application to Medical Purposes. Followed by Obser- Am. J. Obst. 6 Cynec. 51: 544-552, 1946. vations on the Affinity Existing Between Magnetism and Spiritualism Ancient and Modern. London. Tinsley 42. KROCER,W. S., and FREED,S. C.: The psychoso- Brothers. 1874. matic treatment of functional dysmenorrhea by hyp- nosis. Am. J. Obst. Q Gynec. 46: 817-822, 1943. 20. DICK.W.: Die Dsvchische Form der Dvsmenorrhiie und deren' hypnotis'hk Behandlung. Arch. f. Gynak. 43. KROCER,W. S., and FREED,S. C.: Psychosomatic 124: 345-366, 1925. Gynecology: Including Problems of Obstetrical Care. Philadelphia. W. B. Saunders Co. 1951. 21. DIDIER,A.: Animal Magnetism and Somnambu- lism. London. T. C..Newby. 1856. 44. LIPKIN,M.; MCDEVI~T.E.; SCRWARTZ,M. S., and DURYEE,A. On the effects of suggestion in the treat- 22. DUNBAR,H. F.: Emotions and Bodily Changes; a W.: Survey of Literature on Psychosomatic Interrelation- ment of vases astic disorders of the extremities. psy. ships 1910-1933. 2d ed. New York. Columbia University chosom. Med. 5: 152-157. 1945. Press. 1938. 45. LUCKHARDT,A. B., and JOHNSTON,R. L.: The 23. DYNES,J. B.: An experimental study in hypnotic psychic secretion of gastric juice under hypnosis. Am. anesthesia. J. Abnorm. 6 Social Psychol. 27: 79-88, 1932. J. Physiol. 70: 174-182, 1924. 24. ELLIOTSON.J.: Numemus Cases of Surgical Op- 46. LUNDHOLM.H., and LBWENBACH,H.: Hypnosis 14 CANCERJanuary 1954 Vol. 7

and the alpha activity of the electroencephalogram. 65. SAMUEL,H. L.: Essay in Physics. New York. Har- Char. 6 Personal. 11: 145-149, 1942. court, Brace & Co.. Inc. 1952. 47. MCDOUCALL,W.: Outline of Abnormal Psychol- 66. SEARS,R. R.: An experimental stud of hypnotic ogy. New York. Charles Scribner’s Sons. 1926. anesthesia. J. Exper. Psychol. 15: 1-22, 193 2. 48. MENNINGER,K.: Emotional factors in hyperten- 67. SHAKESPEARE,W.: The Tragedy of Hamlet, Act 3, sion. Bull. New York Acad. Med. 14: 198-211. 1938. Scene 1. London. Oxford University Press. 1938. 49. MEYER,A.: BOLLMEIER,L. N., and ALEXANDER,F.: 68. SHANDS,H. C.; FINESINGER.J. E.: COBB,S., and Correlation between emotions and carbohydrate metab- ABRAMS,R. D.: Psychological mechanisms in patients olism in two cases of diabetes mellitus. Psychosom. Med. with cancer. Cancer 4: 1159-1170, 1951. 7: 335-341. 1945. 69. SIRNA,A. A.: An electroencephalographic study 50. MILLER,H. C.: Hypnotism and Disease; a Plea of the hypnotic dream. J. Psychol. 20: 109-113, 1945. for Rational Psychotherapy. Boston. Gorham Press. 70. STRICKLER,C. B.: A quantitative study of post- 1912. hypnotic amnesia. J. Abnorm. & Social Psychol. 24: 108- 51. MITTLEMANN,B., and WOLFF,H. G.: Emotions 119, 1929. and gastroduodenal function; experimental studies on 71. SUCRUE,T.: There Is a River; the Story of Edgar patients with gastritis, duodenitis and peptic ulcer. Cayce. New York. Henry Holt & Co. 1943. Psychosom. Med. 4: 5-61, 1942. 72. TESTE,A.: A Practical Manual of Animal Mag- 52. MOLL,A.: Hypnotism: Including a Study of the netism: Containing an Exposition of the Methods Em- Chief Points of Psycho-therapeutics and Occultism. ployed in Producing the Magnetic Phenomena: with its (Transl. from 4th German ed. by A. F. Hopkirk.) Lon- Application to the Treatment and Cure of Diseases. don. Walter Scott Pub. Co. Ltd. 1909. (Transl. from 2d French ed. by D. Spillan.) London. 53. NEWBOLD,G.: Famous names in hypnotism: (1) H. Bailliere. 1843. Franz Anton Mesmer (1733-1815). Brit. J. Med. Hyp- 73. TOYNBEE,A. J.: A Study of History. (Abridgement notism l(2): 3-8, 1949. of Vol. I-VI by D. C. Somervell.) London. Oxford Uni- 54. NEWBOLD,G.: The use of hypnosis in obstetrics. versity Press. 1947. Brit. J. Med. Hypnotism l(1): 36-38, 1949. 74. TUCKEY,C. L.: Psycho-therapeutics: or, Treat- 55. NEWBOLD,G.: Famous names in hypnotism; (2) ment by Hypnotism and Suggestion, 3d ed. New York. (1791-1868). Brit. J. Med. Hypnbtisni C. P. Putnam’s Sons. 1892. l(3): 2-7, 1950. 75. VOLGYESI,F. A.: James Braid’s discoveries and 56. NEWBOLD,G.: Famous names in hypnotism; (4) psychotherapeutic merits. Med. Zllus. 3: 217-222, 1949. Antoine Likbeault (1823-1904). Brit. J. Med. Hypnotism 76. WALDEN,E. C.: A plethysmographic study of the 3(3): 2-7, 1952. vascular condition during hypnotic sleep. Am. J. Physiol. 57. NICHOLSON,N. C.: Notes on muscular work dur- 4: 124-161, 1900. ing hypnosis. Bull. Johns Hopkins Hosp. 31: 89-91,1920. 77. WATKINS,J. G.: Antisocial compulsions induced 58. PACHTER,H. M.: Paracelsus; Magic into Science. under hypnotic trance. J. Abnorm. & Social Psychol. 42: New York. Henry Schuman, Inc. 1951. 256-259, 1949. 59. PAT~IE,F. A., JR.: The genuineness of hypnoti- 78. WEISS,E., and ENGLISH,0. S.: Psychosomatic Med- cally produced anesthesia of the skin. Am. J. Pyschol. icine; the Clinical Application of Psychopathology to 49: 435-443, 1937. General Medical Problems, 2d ed. Philadelphia. W. B. Saunders Co. 1949. 60. PAVLOV,I. P.: Conditioned Reflexes: an Investi- gation of the Physiological Activities of the Cerebral 79. WEITZENHOFFER,A. M.: The production of anti- Cortex. (Transl. by G. V. Anrep.) London. Oxford Uni- social acts under hypnosis. J. Abnorm. 6 Social Psychol. versity Press. 1927. 44: 420-422, 1941. 61. PYNE,T.: Vital Magnetism: a Remedy. London. 80. WELLS,W. R.: Experiments in the hypnotic pro- Samuel Highley. 1845. duction of crime. J. Psychol. 11: 63-102, 1941. 62. ROBINSON,V.: Victory Over Pain; a History of 81. WILLIAMS,G. W.: The effect of hypnosis on mus- Anesthesia. New York. Henry Schuman, Inc. 1946. cular fatigue. J. Abnorm. & Social Psychol. 24: 318-329, 63. ROSEN,H.: The hypnotic and hypnotherapeutic 1929. control of severe pain. Am. J. Psychiat. 107: 917-925, 82. WOLBERG,L. R.: Medical Hypnosis: the Princi- 1951. ples of Hypnotherapy. New York. Grune & Stratton, Inc. 64. ROWLAND.L. W.: Will hvmotized Dersons trv to 1948. harm themselves or others? J. ATnorm. & Social Psyihol. 83. ZINSSER,H.: As I Remember Him: the Biography 34: 114-117, 1939. of R. S. Boston. Little, Brown and Co. 1940.