A special place in the field of hypnotic therapy is occupied by the application of hypnosis for the elimination of pain. There is no doubt that psychogenic pains may be influenced by hypnosis. But even a slight acquaintance with the problem of pain makes it apparent that the general attitude of the individual is of very great importance in his observation and estimate of the pain. The pain must pass through a number of psychic stages before it appears in its final form. The final forms are without doubt very susceptible to hypnosis. Of course, hypnosis will also alter the distribution of the blood to the regions that have been rendered analgesic, and a number of investigations have shown that extremities after having been rendered analgesic by suggestion will bleed less profusely on being pricked. We therefore believe that analgesic suggestions also alter the vasovegetative apparatus, and it is by no means certain as yet that these alterations are limited to the vascular system. It should give pause for thought, at any rate, that pains originating in the organs with smooth muscles are more readily susceptible to influence than pains of other regions. Yet the experimental material available on this point is not sufficiently extensive to justify a general inference. Hypnosis as such may be utilized for the carrying out of minor operations. Profound hypnosis will in general be most expedient in these cases. Dental operations have been repeatedly made under hypnosis. It is not certain that the quite questionable results obtained by such efforts are at all commensurate with the labor expended. At any rate, hypnosis by no means suffices for the carrying out of major operations. Here it may be particularly valuable to use a procedure recently recommended particularly by Friedlander, namely, that of hypnonarcosis; since this method involves not an influencing of the pain in hypnosis, but a support of narcosis by hypnosis, we shall not discuss this subject now, but leave it for later, and shall for the present turn to the attempts to alleviate and remove the pains of childbirth by means of hypnosis. Hallawer makes use of psychic treatment also in support of the narcosis and thus saves narcotics. Vice versa, he applies chloroform to facilitate hypnosis.

Attempts to render deliveries painless by means of hypnosis go back to the earliest period of the use of hypnosis. Kogerer has recently reported favorable results. The patients may be put into a hypnotic sleep during labor. After awaking from the hypnotic sleep these patients know nothing of the delivery, they have amnesized their delivery. A number of authors fear that this process deprives these women of the experience of birth, and may thus diminish the proper proportion of maternal affection. Kogerer therefore prefers a process in which he suggests only anesthesia during birth, and thus deprives these women only of the pains of birth and not of the experience of birth. From a general standpoint, and disregarding the psychological value of the birth experience for women, we must point out that even experiences in profound hypnosis are a portion of the individual psychic aggregate, and that mothers thus have had the experience of birth even though they amnesize it. This experience may therefore be made perfectly accessible again to the consciousness by means of a repetition of hypnosis. It would be worth while to make such experiments, and it would be of special interest to determine to what extent the pangs of birth would be reexperienced in such cases. In hypnotic experiments we have repeatedly observed that in the illumination of amnesias, pain stimuli applied during hypnosis to portions of the body that had been rendered analgesic, may frequently be awakened with particular severity. Yet, the general problem of hypnotic analgesia appears to us at present as not sufficiently cleared up, as we do not know the extent of the share of the peripheral influencing and reduction of pain. It is worthy of note, moreover, that almost all the authors who take up the question of freeing from pain in childbirth by means of hypnosis maintain that they have also been able to enhance the functions of labor. In general, an influencing of the pain of women in labor will require a preliminary preparation during pregnancy. It is improbable that any rapport between hypnotizer and patient can be established at the pinnacle of labor. The procedure of hypnotic childbirth analgesia and of childbirth in hypnosis is perhaps not capable of very widespread application by reason of the quite detailed preparation required, but is truly worthy of application in specific cases.

It has already been pointed out that hypnosis is not sufficient for the carrying out of major operations, but even here hypnosis may be a useful support to narcosis. Friedlander states that considerable quantities of the narcotic may be saved if the patient has been hypnotized in advance (likewise Hallawer). We consider this statement as quite credible, as it is perfectly in accord with our theoretical convictions with regard to the close interrelation between psychic and physical factors. As it is doubtless of great importance to the patient to limit the amount of the narcotic, it would be reasonable to demand—assuming the procedure to be likewise expedient—the application of hypnosis in every narcosis. Hyponarcosis is a theoretical counterpart to narcotic hypnosis and appears to us as a reasonable emphasis of a therapeutic principle which may in the future be of great importance not only in the fields of narcotics and hypnotics, but of very general application. We mean the principle that psychic influences may be supported by medical devices, and that, vice versa, medicinal and physical influences may be brought to their full effectiveness by psychic means. We here have a prospect of a new important application of a future pharmaco-psychoanalysis. One of the present authors has already repeatedly called attention to this important domain of future investigation.