incision into the abscess, and gave exit to an enormous quantity of fœtid pus. A slight cry, lasting less than a second, was the only sign of consciousness given by the patient. There was not the least quivering of the muscles of the face, nor of those of the extremities; the two arms remained without any deviation whatever from the position they had now kept for several minutes. "Two minutes later, the same attitude persisting, the eyes were wide open and a little injected, the features fixed like a mask, the pulse exactly as before the experiment, the breathing perfectly easy; but the woman continued insensible. The left heel, raised from the bed, remained suspended, the two upper limbs being steadily in their former position. Yet in the morning, the patient, tormented by her burns, had not been able to move in her bed except with much pain and difficulty.

"The bright object being now removed from before the eyes, the state of insensibility and cataleptic rigidity still persisted. Friction and a breath of cold air being used to the eyelids, the patient made some little movement; she was asked if she felt anything, and answered that she knew nothing about it. For the rest, her three limbs remain always suspended and fixed in the positions that had been given to them, the left arm having now been rigid for the space of full thirteen minutes. A puncture which brought a drop of blood was made into this arm, but no sign of sensibility was given, and the fingers preserved their complete immobility.

"At last, eighteen or twenty minutes from the beginning of the experiment, and more than twelve minutes after the operation, M. Broca again employed friction over the eyes, smarter than before, and blew over the face a large quantity of cold air. This time the patient woke up almost suddenly. Her two arms and her left leg became relaxed together, and fell instantly upon the bed. She then rubbed her eyes, and recovered consciousness absolutely. She remembered nothing, and was astonished to hear that the operation was over. Her state was to be compared, up to a certain point, with that of persons awaking from a sleep produced by ordinary anaesthetics, with the difference, however, that her waking was much more sudden, and was without excitement or loquacity.

"After a few moments, she complained of a little suffering in the wound, but the pain was very trifling. The whole period of insensibility lasted at the least twelve minutes or a quarter of an hour."

The notoriety which has attended this case of M. Broca's has led all Paris to set spoons before the eyes of the sick, and multitudes of results are being announced. Many persons are put to sleep, dogs, cats, and chickens, as well as men and women. There are pricks on many Parisian skins, and bruises on many Parisian arms. M. Velpeau is ostentatiously announced as a convert to the "reality of hypnotism." But when we come to inquire into the practical issue to which all this enthusiastic experimenting acknowledgedly tends-the application to surgery-we find M. Broca's operation standing almost alone. A most persevering French surgeon-M. Richet, of Saint-Louis-failing utterly to produce any anesthetic effect upon three patients in whom operations were needed, had recourse to the assistance of the most eager hypnotist of France, M. Azam. Two young females were chosen, the one with an anchylosed elbow, the other with a tumour at the wrist. In each case the patients performed most docilely the requisite act of gazing upwards at a polished spatula placed six inches in front of the forehead, the one girl for ten, the other for eleven minutes, but in neither case was the slightest symptom of insensibility evoked. In all,

six cases for operation were tested by this surgeon without the slightest result. In the hands of Prof. Denonvilliers no better success has attended the method: a few nervous symptoms were indeed provoked, but for the purposes of the surgeon, not the slightest effect. Again, M. Forget having chosen a very nervous, excitable subject—a young man of eighteen years old-practised on him the usual experiment for twenty-two minutes, producing, as we may readily believe, contraction and dilatation of the pupils, twitching of the eyelids, and a few other trifling nervous symptoms, but of anaesthesia absolutely nothing.

In short, with a view to immediate operative procedure, we have sixteen instances of the faithful employment of the hypnotic method, in not one of which was the slightest result obtained. Another case is indeed put forth as a successful example of complete unconsciousness to pain from hypnotism." Here Dr. Guerineau, of Poitiers, amputated the thigh of a man who had suffered for two years from a white swelling of the knee, and had tubercles also in his lungs. The only record we have seen of this case, professing to come from the pen of the operator, is so wonderfully imperfect, that beyond the fact of insensibility we are perhaps not justified in drawing any conclusion as to the state of the patient, but such as it is, the narrative leaves on one's mind a conviction that the patient was in a state of syncope at the moment of the operation, and that there was no direct affection whatever of the nervous system.

These being the facts concerning the success and failure of the method as an anesthetic power, distinguished from the epidemic belief in "Hypnotism" at present prevalent in French medical circles, let us now examine the received explanation of the nature of this condition, and try to obtain therefrom some assistance in forming a judgment as to its practical utility. Let us see what probability there is in the statement, confidently made by the devotees of hypnotism who acknowledge how often it disappoints the operating surgeon, that by modifications in the present procedures or otherwise, a larger number of persons will be ultimately rendered susceptible to its anæsthetic influence. An explanation of the nature of the hypnotic anesthesia— assigning to this condition its right place among other similar conditions already understood and classified-is little more than an application of the views which are now pretty generally received as to the nature of the hypnotic state as a whole. Still a recapitulation of these views with special regard to the phenomena of insensibility will be found to lead directly to an estimate of the practical worth of hypnotism as an anesthetic.

As opposed to ordinary insensibility from syncope, coma, or chloroform, where the whole of the mental faculties are for a while dormant, there exist a well-known series of conditions, in which objective evidence of pain is lost, and in which its perception is largely impaired, but in which, nevertheless, other mental faculties remain more or less active. Somnambulism, catalepsy, hysteria, and ecstasy, in their spontaneous manifestations, may be regarded as consisting of certain mental and bodily conditions resulting from a disturbed relation between the will, the emotions, and simple idea; the common feature of these states being an

intense absorption of the faculties, apparently consequent on the possession of the mind by some single idea or train of ideas. These disorders run into one another by indefinable transitions, but in their most typical forms they may perhaps be distinguished as much by differences in the accompanying mental state as by varieties in their bodily manifestations. Thus the condition of spontaneous somnambulism differs from that of hysteria or ecstasy in being less dependent on the emotional state associated in these latter disorders with the absorbing idea. The somnambulistic state would seem to consist in an involuntary flow of simple ideas, the one suggested by the preceding or by some external impression, and giving rise directly to appropriate muscular actions without the intervention of the will or of the emotions. Close to this comes the condition of spontaneous catalepsy, in which the idea and its muscular manifestation are single and immovable, and in the production of which some emotional state usually plays a considerable part. Then follow the states of ecstasy and hysteria, having a still more uniform connexion with the feelings, but in their development being also under some influence (at least for control) of the will.-In the same series we recognise the hypnotic state, distinguished from the rest almost solely by the mode of its induction and by the possibility thence arising of its phenomena becoming available for therapeutical purposes. It differs from the other conditions enumerated by its dependence at the outset upon an operation of the will, dwelling deliberately and of purpose on a single idea, and encouraging the spread of its fascination over every faculty. It is not very plain whether this result is obtained immediately by the simple concentration of the will, which then becomes fixed at the point of regard, and cannot be extricated by any action of its own; or whether it comes indirectly through the supervention of some emotional state, which is able to bind and overmaster the will. From the facility with which the hypnotic state is developed in persons of susceptible feelings, and in a condition of body favourable to emotional exaggeration, it might be presumed that the state of abstraction voluntarily induced served only to prepare for the onset of an emotional condition like that under which the hysterical fit is evolved; but on the other hand, the frequent induction of this condition in individuals of the opposite temperament and of robust bodies, renders it probable that the requisite concentration and abstraction are producible by a direct act of volition.

If it be agreed that the hypnotic condition is thus related in its symptoms to somnambulism, hysteria, and the rest of these very inconstant conditions, and differs from them in little else than the degree to which the will and the emotions are concerned in its production, we should be led prima facie to fear that its development, like its symptoms, could never be sufficiently certain and constant to allow of its general employment as a therapeutic agent. But supposing it to be producible at pleasure, in a large proportion of cases, we should further be led to expect that patients preparing for surgical operations would be the most unlikely of all persons to be susceptible of its influence. For the essential condition demanded for the hypnotic sleep is a concentration of thought upon some one object, to the ex

clusion of all other ideas. Now, in the presence of disease, and in the face of an impending operation, the matter uppermost in the patient's brain can scarcely fail to be his present suffering and the expectation of acuter pain. Concentration of thought on these topics would be of little avail in lessening his pain. We can indeed conceive that by the supervention of an intense emotional excitement so profound as to dissociate itself from its cause, there would be exceptional cases where intense dread of suffering might bring on a state of unconsciousness, but that this should be voluntarily induced by any procedure of the patient would seem to the highest degree improbable. In employing his will to produce abstraction, our aim would be to take his consciousness as far as possible from the operation and himself, and to fix it vividly on some other subject. But supposing we have done so, and that the earlier phenomena of hypnotism are elicited, the success of the sleep for the operating surgeon demands that it shall not be disturbed by the arrival of any new impression. Now, if the somnambulist be abruptly addressed, his trance is usually broken; if some unexpected or distasteful proceeding is used to a person in an hysterical fit, she is probably aroused from it; and in the hypnotic state itself there are few phases in which clapping of the hands or fanning of the face will not suffice to break the sway of the dominant idea, and to restore the ordinary waking state. How little, then, does analogy give us any right to expect that the state of hypnotic anæsthesia should remain unbroken, when any wandering idea, or the recurrence of any timidity, would at once bring the patient face to face with his disease and the operation !-But even the actual passage of the knife through his tissues must not recal the patient's sensibility! That any voluntarily induced condition should be capable of resisting this test, we can only conceive to result from the superinduction of some other state wholly beyond the control of the will; and it must appear extremely improbable that such a total abeyance of volition should be a sequel to any sort of proceeding in which the will is concerned. Yet the distinguishing mark of the hypnotic sleep, and all that gives it a chance of usefulness for the surgeon, consists in this very production of it at pleasure, by a process which involves certain voluntary acts of the patient.

These are the considerations, derived from what we hold to be the true interpretation of the hypnotic sleep, which we would place by the side of the experience of the Paris hospitals, in estimating the probability of the dominion of chloroform being shaken by the pretensions of hypnotism. Those who hold other ideas as to the nature of the hypnotic phenomena may still find in the views we have put forward, some reason to modify a too ardent hope of the anæsthetic value of the method. For the rest, the negative character of the facts recorded by very competent observers demand from all a present scepticism. M. Azam, who has been before referred to as an earnest student of the system, and who regards the cerebral symptoms as being directly connected in some way with the convergence upwards of the optic axes, must adduce many more successful applications of hypnotism to the purposes of the surgeon, before he justifies to others

his belief "that some day we shall achieve the discovery of a ready and easy means of operating thus at our pleasure upon every one alike.” At the same time we do not doubt that other instances of the surgical use of hypnotism will be put on record, and these may possibly be of increasing number as the predisposition to an hysterical condition grows in the community by force of example and faith. But soon will come a time when the epidemic influence will fade, and the sporadic cases of belief in the method as an anesthetic will be again for a while confined to the "seekers after many inventions," and these will be found to furnish the requisite mental condition for an attack as numerously and as readily under the sky of London as of Paris.

REVIEW X.

Eight Cases of Ovariotomy, with Remarks on the Means of Diminishing the Mortality after this Operation. By T. SPENCER WELLS, F.R.C.S., Lecturer on Surgery at the Grosvenor-place School of Medicine, Surgeon to the Samaritan Hospital, &c. &c.-Dublin, 1859. pp. 42.

Of the eight cases of ovariotomy reported by Mr. Spencer Wells in the body of this pamphlet, only two proved fatal; this remarkable success is somewhat diminished by the addition of two other fatal cases, which have occurred more recently, and to which the author adverts in a prefatory notice; but with the two successful cases which have also fallen to Mr. Wells' lot since the publication of his paper, the general results are still sufficiently satisfactory to arrest attention and to force upon surgeons the duty of reconsidering the whole question of ovariotomy. Mr. Wells, we think very reasonably, draws a parallel between the operation for lithotomy and ovariotomy. In both there is a disease causing great pains or discomfort, which may continue for a greater or less period, without inducing death; but which must inevitably prove fatal after protracted misery and suffering. The removal of the stone or the tumour may hasten death, or it may establish a perfect cure; and as the mortality after ovariotomy appears, even under the most unfavourable view of the opponents of the operation, not to be very much greater than after lithotomy in the adult, Mr. Spencer Wells argues that we are not justified in discarding the former. On the other hand, he quotes the results obtained by Dr. Clay, of Manchester, who out of 87 cases has only lost 27, or about 1 in 3; and he also points to his own operations in proof of the fact that the mortality is capable of a much further reduction.

The following are the principal features of the eight cases now before us

1. A single woman, aged twenty-nine, had an ovarian tumour of four years' growth, for which she had been tapped seven times; her health was failing when Mr. Wells determined upon operating. A three-inch incision was made below the umbilicus; old and firm adhesions had to be broken down by the hand; the peduncle, which was on the left side, and of the breadth of three fingers, was transfixed, and tied in three portions by whipcord ligature. The peduncle was too