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(BQ) As Joanna Bourke shows in this fascinating investigation, people have come up with many different answers to these questions over time. And a history of pain can tell us a great deal about how we might respond to our own suffering in the present - and, just as importantly, to the suffering of those around us.
6 Gesture Some acute observers have drawn such secrets from the expression of the countenance, that it has been to them the place almost of all other symptoms (Peter Mere Latham, 1837)1 W ords are never enough Pain is communicated through gestures, inarticulate utterances, facial expressions, posture, and other nonlinguistic movements of the body A piece of doggerel, published in The London Hospital Gazette in 1900, satirized this aspect of pain in the context of a person having a tooth extracted Once seated in the dentist’s chair, the patient regresses He squirms, an’ squeals, an’ screeches, sometimes I gives a shout, I weeps, an’ wails, an’ wriggles, and wags my tongue about I shrieks, an’ kicks, an’ scratches, and then I tries to bite.2 Some of these gestures are performances, that is, deliberate signs conveyed by people-in-pain seeking sympathy and succour Others arise from some unconscious realm, rooted in physiological impulses or assimilated involuntarily during processes of socialization Irrespective of origin, a world of meaning is conveyed in the whimper, the wince, the sweat on the upper lip, the tremor, the shuffle, the shielding motion, the closed fist resting on the bed linen, the compulsive rubbing, and the shrill cry ‘Ouch!’ In the words of an unnamed mother writing in 1819, ‘bodily torture’ was ‘too palpably indicated by the starting dew, the cold brow, the blanched lip, and bloodless cheek’.3 Functional behaviours—such as excessive sleeping or assuming the foetal position in bed—also quietly convey a message of suffering, as acts that deliberately attempt to suggest that gestures are being suppressed 16 g e sture (the stoical pursing of the lips or the stiffened gait, for instance) For convenience, I will be referring to these physiological responses (sweating, pallor, or muscular tension), facial expressions (grimacing), and paralinguistic vocalizations (groaning or screaming) as ‘gestural languages’ It is important, however, to acknowledge the intentional or self-reflective nature of some of these languages and not others Gestural languages are invaluable to the assessment of pain Witnesses to pain ‘depend upon the sufferer of pain for all information about its amount and its quality’, physician John Kent Spender noted in his prize-winning essay of 1874, but they not rely on language alone Thankfully, Spender reminded his readers, the ‘gestures and postures which a sufferer exhibits; the cries, the pathos, the very tone of the voice; the expression and the changes of countenance’ are all clues to the person’s sufferings.4 Indeed, disembodied, abstract speech sounds are a small component of face-to-face communication Formal linguistic mechanisms, such as vocabulary, syntax, tense, intonation, and so on, routinely fail to convey even a minuscule part of the person-in-pain’s lived experience.The body itself is a semiotic instrument Agony is ‘stamped on every feature’; it ‘speaks in every line of the countenance’, as the author of ‘The Toothache’ (1849) noted.5 Typically, descriptions of pain-gestures adopt metaphors and analogies borrowed from textual sources As poet William Cowper put it, ‘I am . persuaded that faces are as legible as books’, with the advantage that ‘they are read in much less time, and are much less likely to deceive’.6 Academic analyses too are partial to the textual metaphor, earnestly presenting the body as a ‘semiotic instrument’, claiming that pain is ‘written on the countenance’, and even proposing (as I here) that bodily movements are ‘gestural languages’ However, it is important not to get (metaphorically) carried away Crucially, gestural signs of pain can constitute a separate, and sometimes even autonomous, component of communication As historian Michael Braddick observes, gestures ‘punctuate speech’, but they also complement, enhance, replace, or serve as alternatives to speech; they may even ‘constitute a distinct domain of communicative action’.7 Gestures and bodily expressions not simply contribute to those linguistic meanings given to pain, but may independently constitute meaning as well Surprisingly, then, gestures have only recently attracted the attention of historians.8 In part, this is due to the assumed transient qualities of face, hand, and body movements Historians have tended to favour approaches that analyse tangible objects embedded in archaeological sites, archives, and g e sture 161 la culture matérielle As philosopher Francis Bacon put it, gestures are ‘transitory Hieroglyphics’: like hieroglyphics they ‘abide not’ However, he continued, they also ‘have evermore . an affinity with the thing signified’.9 This was perhaps what cultural theorist Pierre Bourdieu had in mind when he observed that it was precisely ‘because agents never know completely what they are doing’ that ‘what they has more sense than they know’.10 It was an insight that Freud used to startling effect As we will see, despite the almost feverish insistence that the body-in-pain speaks a ‘natural’ language, it turns out that it moves in highly staged, historically contingent, and contextually intricate ways Gestures of Suffering in the Clinic The unmistakable gestural aspects of pain were particularly poignant en masse This was what Joseph Townend (in the chapter on ‘Religion’) meant when he reflected upon his time as a patient in the Manchester Infirmary in the middle of the nineteenth century He wrote eloquently of the ‘world of woe compressed within the walls of that hospital!’ ‘Here’, he remarked, was ‘a convulsive sob; there a deep groan; yonder a piercing shriek What dreary, lonely nights, and how deep and solemn the midnight tongue of time, as heard by the agonised, wakeful patients!’11 From the perspective of his hospital bed, communication was entirely gestural Townend conceived of pain as a convulsion, deeply embedded within damaged flesh Pain swallowed up entire worlds, compressed them into claustrophobic spaces, and destroyed the possibility of coherent communion with others.With agonizing slowness, the ‘tongue of time’ spoke all night, demanding that its victims remain wakeful throughout their ordained hours of torment Similar metaphors were used three-quarters of a century later, albeit in the context of a wartime Field Hospital rather than a pauper one Like Townend, Robert Wistrand emphasized the gestural performances of people-in-pain In his poem ‘Field Hospital’ (1944), words had been banished, forcing wounded men to make ‘language out of sobs’, as ‘evocative as song’ For Wistrand, Here words are out of bounds The pulse of silence throbs Reason, licking wounds, Makes language out of sobs 16 g e sture Evocative as song The literate groans explain That terror’s clumsy hand Pokes at the source of pain Words are flecked with foam They spread a stain of sound But thought is haunted home By voices underground.12 Wistrand’s Field Hospital was a place where reason had been banished Language was incapable of conveying the horror of combat and wounding: words were nothing more than blood-specked foam Terrifying thoughts of what they had gone through only exacerbated the men’s suffering; their memories kept pain alive by continuing to clumsily prod their wounds The only ‘literate’ language that remained was that of groans Townend’s and Wistrand’s evocations of the writhing body-in-pain, stripped of articulate language, were unremittingly negative Both were writing as wounded men, crushed in the pitiless crucibles of the cotton mills of early industrialization and the battlefields of modernity In contrast, physicians and other caregivers could go to the opposite extreme: for them, gestural languages might be important in at least three ways: physiologically, they were sometimes beneficial (even for the person-in-pain); they might elicit sympathy from witnesses; and they might provide valuable diagnostic clues In all three cases, we shall see, there were important shifts over the centuries The first function of gestural expressiveness was that it could help the healing process Throughout the period explored in this book, both anecdotal and experimental evidence suggested that gestures (such as stroking the arm of the person-in-pain) effectively reduced the sufferer’s subjective experience of pain Commentators adhering to a vast array of traditions (including humoral, nervous, biomedical, holistic, and neurological ones) insisted upon this positive function of gestures The point here, though, is a different one: prior to the biochemical revolution of the twentieth century, with its obsessive interest in the total eradication of the ‘evil’ that was pain, commentators routinely insisted that the expressive face, contorted body, and inarticulate groans of a person-in-pain might often be physiologically necessary if a suffering person was to find respite This was the point of an article entitled ‘Crying,Weeping, and Sighing’ (1852), in which the author advised people experiencing ‘bodily pain’ to cry loudly because g e sture 16 this would have the effect of ‘diminishing the circulation of the pulmonary arteries’ and ‘unloading the left heart and large arteries, of any surplus quantity of blood’.13 As a mid-nineteenth-century expert in diseases of the testes and rectum explained, ‘cries and groans, though denoting pain, really serve to alleviate suffering, and to counteract the shock produced by it’.14 The Lancet also referred to this aspect of pain in an article published in 1904 According to the author, the ‘cry of pain’ was important for the person doing the crying Indeed, the person who uttered the cry did not even need to hear his own vocalization He would be equally relieved if his ears were stopped and he did not hear his own cry, so long as he was conscious of performing the muscular exercises that should result in such a cry The ‘relief of his sufferings’ required the spontaneous and ‘violent expenditure of nerve force’, which ‘Nature provides’.15 Conversely, too much self-control in extreme pain-states was physiologically damaging: this explained why a man who ‘made no signs of great suffering during a military flogging’ subsequently ‘dropped down lifeless’.16 Refusing to express oneself through gestures was destructive because it denied the organism a diversion from the ‘excitability and excitement’ intrinsic to bodily torment This was the point made in 1834 by a distinguished Pennsylvania physician He warned against gestural restraint by giving the example of a gentleman who was ‘about to be cut for the [kidney] stone’, without anaesthetic, of course.The doctor deplored the fact that ‘this gentleman thought it beneath the dignity of a man, to express pain upon any occasion’ and described how the patient refused to submit to the usual precaution of securing the hands and feet by bandages, declaring to his surgeon, he had nothing to fear from his being untied, as he would not move a muscle of his body,—and he truly kept his word: but he died instantly after the operation from apoplexy By refusing to allow the ‘natural’ expressivity of the body, the man provided no outlet or diversion for the ‘excitability and excitement’ of intense pain.17 Death would have been averted if he had screamed and struggled There was another way that gestural languages might help the healing process This was the opposite of the one just mentioned It had long been observed that facial expressions possessed a kind of ‘feedback mechanism’: facial movements could actually influence the ‘feeling’ of being in pain A person who adopted the external signs of extreme agony might increase 164 g e sture her subjective feeling of pain Conversely, the deliberate donning of a placid face might help soothe a person’s distress In the words of philosopher Edmund Burke, ‘I have often observed, that on mimicking the looks and gestures of the angry, or placid, or frightened, or daring men, I have involuntarily found my mind turned to that passion, whose appearance I endeavoured to imitate.’18 Much later, William James in ‘What is an Emotion?’ (1884) devoted considerable space to this phenomenon, as did Charles Darwin, who wrote in The Expressions of the Emotions in Man and Animals that ‘He who gives way to violent gestures will increase his rage; he who does not control the signs of fear will experience fear in a greater degree’.19 More recently, psychologist Paul Ekman found that when people were asked to make the expressions for negative emotions such as anger, disgust, and fear, rather than positive ones (like happiness), their heart rate quickened and they began sweating Even more interesting, 78 per cent of the subjects claimed that they felt the emotion they were asked to generate In other words, voluntarily performed facial muscular actions result in ‘involutary [sic] changes in autonomic nervous system (ANS) activity’.20 Secondly, gestural languages functioned as a tool for social cohesion.This argument had been made throughout the centuries Pain-gestures were functional in the sense that they were expected to elicit sympathetic responses from witnesses ‘Sobs, loud complaints, all forms of groaning are useful’, physiologist Paolo Mantegazza reminded readers in 1904, ‘because thereby we excite in those who listen to us a compassion, which may be of aid to us’.21 In recent years, different explanations have been posited.The most radical have been drawn from evolutionary theory As psychologists put it in the official journal of the International Association for the Study of Pain, ‘A general tendency to know that others are hurt would clearly confer an adaptive advantage to the group, insofar as the perceptual ability is linked to lending assistance or feeling threatened in times of peril’.22 I will explore this function of pain-expressions in the chapter entitled ‘Sympathy’, but it is worth noting here that witnesses to the pained-face might reject the plea, turning away from suffering Indeed, gestural languages were dependent upon the presence of a particular human face: one that could be recognized as ‘expressive of pain’ Certain people were observed not to show pain on their faces: indeed, in one experiment in 1995, between 13 and 50 per cent of volunteers displayed no facial evidence of pain, despite receiving severe pain stimuli.23 In other cases, it was found that some faces were ‘easier to g e sture 165 read’ than others; and certain people (women, people with chronic pain sufferers in their families, and non-professionals) were better at reading them.24 A study conducted in the 1990s, for example, found that when observers relied on expressive behaviour alone to evaluate pain, their reports were between 50 to 80 per cent lower than the patients’ verbal reports of the amount of pain they were experiencing.25 According to one of the most influential scientists working in the field, facial expressions gave no more than ‘coarse distinctions among patients’ pain states’ and were likely to ‘systematically downgrade the intensity of a patient’s suffering’.26 Gestures and Diagnosis The third argument about the value of gestural languages asked whether they were diagnostically constructive This is the other side of the debates in the last chapter about the diagnostic value of narrative Simply by observing a patient, a doctor would know whether her pain was organic or ‘stimulative or sympathetic’, for example As The London Encyclopædia informed readers in 1829, patients experiencing pain as a result of ‘organic disease’ bore ‘a continued sharpness and fixedness of feature which is very observable, and which the mere nervous patient is without’.When the stomach or liver was causing pain, ‘this fixed cast of countenance’ would be ‘accompanied by a peculiar anxiety of expression, or rather perhaps, I should say, of despondent indication’.27 The view that chronic conditions were ‘set’ in a person’s face was also common In 1886, for instance, phrenologists concluded that just as ‘habitual states of mind tend to produce habitual forms and expressions of face and body’, any person who experienced prolonged pain would ‘have in the face an expression of the internal state’.28 Pain left its mark on the expressive body The same was true of acute pain When a physician in 1817 was called to minister to a man with a ‘pendulous projection’ emerging from his anus, no words were needed since the ‘expression of this gentleman’s face was quite indicative of his suffering’.29 Neuralgia, too, ‘spoke’ in distinctive gestures.‘When the paroxysm comes on’, a physician in 1816 observed, the sufferer’s whole body is convulsed from the excess of agony; the eyes are intensely closed; and tears trickle down the cheek; the mouth is distorted, and, with the whole cheek, quivers; the body unconsciously waves backwards and forwards, 16 g e sture and the foot of the distressed side is involuntarily moved in conformity with the flexure of the body.30 As a surgeon observed a century later, physicians only had to observe the ‘pinched features, the knotted brow, the rolling eyes with widely dilated pupils, the ashen countenance’, to know that they were witnessing pain.The patient’s hands might be ‘alternately clenched and opened, grasping wildly at surrounding objects or persons’, or they might be ‘pressed firmly over the painful area’, but, in either case, there would be ‘cries and groans . bodily contortions and writhings’.31 Indeed, authentic pain-vocalizations could be rendered in musical notation As Colombat de L’Isere explained in A Treatise Upon the Diseases and Hygiene of the Organs of the Voice (1857), ‘every pain has its particular intonation’, and he even insisted that, by listening carefully to the tone, register, and pitch of pain-vocalizations, surgeons and physicians could more accurately diagnose the cause of suffering In his words, I have observed, that cries caused by the application of fire are grave and deep, and that the double sound resulting from them may be represented by the base octave and its third; for example, the I have just mentioned, and the mi on the first line Cries which are drawn forth by the action of a cutting instrument during an operation are acute and piercing, and may be expressed, at first, by a rapid sound, or a double crotchet of the middle octave, which will be about sol on the second line; and afterwards, and almost at the same time, by a very acute and prolonged sound, or a semibreve of the octave of the faucette, which gives sol above the staff He went on to insist that the ‘cries from the tearing pains of labor’ were ‘more acute and intense than all the others’ He described their ‘peculiar expression’ as being & h h x ˙ U q H U q H h E H Figure 6.1 The Music of Pain: ‘Every Pain has its Peculiar Intonation’, from Colombat de L’Isere, A Treatise Upon the Diseases and Hygiene of the Organs of the Voice, 1st pub 1834, trans J F W Lane (Boston: Redding and Co., 1857), 85 Image from Carl Ludwig Merkel, Anatomie und Physiologie des menschlichen Stimm- und Sprach-organs (Anthropophonik) (Leipzig:Verlag von Ambrosius Abel, 1863), 638 g e sture 167 represented by the base octave and the seventeenth; for example, the and re, upon the sharp of the second register It seems that the atrocious pangs of labor elevate the diapason of the voice, and at the same time augment its extent.32 The body-in-pain was a vocal instrument, unerringly echoing the character of suffering from surgery, being burnt, or giving birth Many physicians swore that observing gestural languages alone could result in accurate diagnoses In ‘The Significance of Pain’ (1896), for instance, W H Thomson provided physicians with a detailed semaphore of pain gestures, illuminating subtle distinctions based on spatial and tactile interactions between the patient and his surroundings He observed that sufferers of inflammatory pains avoided touching ‘the painful part, or he approaches it in a respectful way’, while those with arthritis could not stop their hand from passing ‘over the joint in a hovering fashion’ The ‘diffused soreness of a mucous membrane inflammation’ caused sufferers to lay their hands on their sternum (breastbone) and then pass it ‘over and across the chest’ In contrast, a ‘similar movement of the hand across the abdomen never means a peritonitis, but a catarrhal intestinal inflammation’, while, with pleurisy, ‘the tips of the straightened fingers are used to indicate the stabbing nature of the pain’ (the tips of the figures are ‘brought down with very much more caution’ in cases of peritonitis, he patiently explained) Even pain-gestures produced by tumours, abscesses, or cramps were distinctive, causing sufferers to touch the affected part, forcibly grasp their abdomen, or (in the case of colic) make a ‘characteristic radiation’ movement For Thompson, different gestures were ‘characteristic of the different varieties of pain’ and were superior to verbal descriptions, which were ‘so extremely indefinite’.33 John Musser’s A Practical Treatise of Medical Diagnosis for Students and Physicians (1901) also placed great emphasis on the precise diagnostic value of posture and gesture Physicians should observe the sudden fixity of heart-pang; the retracted head of meningitis; the immobile side of pleurisy; the crouching attitude or restlessness of colic; the flexed thighs and immobile trunk of peritonitis; the shoulder drooping to the affected side in renal colic; or the bent knee of arthritis.34 A similar, diagnostic aim was pursued by René Leriche when, in The Surgery of Pain (1938), he described a consultation with a man suffering from trigeminal neuralgia (or tic douloureux, an agonizing nerve disorder of the face) He instructed readers to 16 g e sture Look at him: while you are speaking to him, there he is listening to you, calm, normal, perhaps a little preoccupied Of a sudden, he becomes rigid: the pain is there His face becomes screwed up There is depicted in it a terrible expression of pain, of grievous pain His eyes are closed, his face is drawn, his features distorted And immediately he lays his hand on his cheek, presses it against his nose, sometimes rubbing it vigorously; or, more frequently, he remains rigid in his pain, which appears to bring everything in him to a stop In fact, everything is arrested for the moment, and you yourself are pulled up short, not daring to make a movement, and even restraining yourself from speaking.35 For Leriche, the inimitable expressions of agonizing pain were communicative in two senses On the one hand, they served as a uni-directional message from the sufferer to his physician, thus aiding diagnosis On the other hand, Leriche believed that gestural languages were transmittable (or to use the language of eighteenth-century physiologists, they were ‘sympathetic’), in the sense that witnesses to pain were unwittingly compelled to freeze in horror Both kinds of bodies ‘spoke’ the inarticulate, yet unmistakable, language of distress Learning to See There is nothing ‘natural’ about such gestures, however From the moment of birth, infants observe the facial expressions of people around them; they mimic their bodily movements When the child falls over, caregivers cluck, coo, rub, and ‘kiss it better’ Children are taught when to ‘have a good cry’ and when ‘not to be a baby’ Indeed, there is a vast literature documenting the different ‘gestural styles’ in pain-instructions, with rules and expectations varying by age, ethnicity, religious beliefs, and so on Gender expectations are particularly striking In one study of expressions of pain amongst Arab-American girls and boys, for instance, the boys noted that pain made them feel ‘brave’, ‘like crying and they don’t’, and ‘angry’ while pain made girls feel ‘sad’, ‘embarrassed’, and ‘like running away’.36 There is even some research showing that infants as young as two months of age showed different facial expressions depending on the ethnic origins of their parents.37 American infants were schooled in self-assertive display-rules, while their Korean and Japanese counterparts had other-centred comportment drummed into them.38 That these gestures are not innate has been shown by the many studies of immigrant populations, tracing how (with increased 38 b i bl i og raphy Mintz, Susannah B., ‘On a Scale from to 10: Life Writing and Lyrical Pain’, Journal of Literary and Cultural Disability Studies, 5.3 (2011) Mitchell, Silas Weir, ‘The Birth and Death of Pain’, in Complete Poems of S Weir Mitchell, the American Verse Project, online http://quod.lib.umich.edu/cgi/t/ text/text-idx?c=amverse;idno=BAP5347.0001.001;rgn=div1;view=text;cc=am verse;node=BAP5347.0001.001%3A7 [viewed February 2012] Montgomery, Scott L., ‘Codes and Combat in Biomedical Discourse’, Science as Culture, 2.3 (1991) Montgomery, Scott L., ‘Illness and Image in Holistic Discourse: How Alternative is “Alternative”?’, Cultural Critique, 25 (Autumn 1993) Morris, David B., The Culture of Pain (Berkeley: University of California Press, 1991) Moscoso, Javier, Pain: A Cultural History (Basingstoke: Palgrave Macmillan, 2012) Niv, David, ‘The Chronic Pain Narrative and Quality of Life’, in Daniel B Carr, John D Loeser, and David B Morris (eds), Narrative, Pain, and Suffering (Seattle: IASP Press, 2005) Papper, Emanuel Martin, Romance Poetry and Surgical Sleep: Literature Influences Medicine (Westport: Greenwood Press, 1995) Pernick, Martin S., A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth Century America (New York: Columbia University Press, 1985) Porter, Roy and Rousseau, G S., Gout: The Patrician Malady (New Haven: Yale University Press, 1998) Priel, Beatrice, Rabinowitz, Betty, and Pels, Richard J., ‘A Semiotic Perspective on Chronic Pain: Implications for the Interaction between Patient and Physician’, British Journal of Medical Psychology, 64.1 (1991) Reiser, Stanley Joel, ‘Science, Pedagogy, and the Transformation of Empathy in Medicine’, in Howard M Spiro, Mary G McCrea Curmen, Enid Peschel, and Deborah St John (eds), Empathy and the Practice of Medicine: Beyond Pills and the Scalpel (New Haven:Yale University Press, 1993) Rey, Roselyne, The History of Pain, trans Louise Elliott Wallace (Cambridge, Mass.: Harvard University Press, 1995) Reynolds, L A and Tansey, E M (eds), Innovation in Pain Management: The Transcript of a Witness Seminar Held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 12 December 2002, 21 (London: The Wellcome Trust, 2004) Robinson,Victor, Victory Over Pain: A History of Anesthesia (New York: Henry Schuman, 1946) Rublack, Ulinka, ‘Fluxes:The Early Modern Body and the Emotions’, trans Pamela Selwyn, History Workshop Journal, 53 (2002) Sandelowki, Margarete, Pain, Pleasure, and American Childbirth: From the Twilight Sleep to the Read Method, 1914–1960 (Westport: Greenwood Press, 1984) Scarry, Elaine, The Body in Pain: The Making and Unmaking of the World (New York: Oxford University Press, 1985) Scarry, Elaine, ‘Among Schoolchildren:The Use of Body Damage to Express Physical Pain’, in Sarah Coakley and Kay Kaufman Shelemay (eds), Pain and Its Transformations: The Interface of Biology and Culture (Cambridge, Mass.: Harvard University Press, 2007) b i bl i og raphy 383 Schott, G D., ‘Communicating the Experience of Pain: The Role of Analogy’, Pain, 108 (2004) Smith, Lisa Wynne, ‘An Account of an Unaccountable Distemper: The Experience of Pain in Early Eighteenth Century England and France’, Eighteenth-Century Studies, 41.4 (Summer 2008) Snow, Stephanie J., Operations Without Pain: The Practice and Science of Anaesthesia in Victorian Britain (Basingstoke: Palgrave Macmillan, 2006) Snow, Stephanie J., Blessed Days of Anaesthesia: How Anaesthetics Changed the World (Oxford: Oxford University Press, 2009) Sontag, Susan, ‘Man With a Pain: A Story’, Harper’s Magazine (April 1964) Sontag, Susan, Illness as Metaphor and AIDS and its Metaphors (New York: Doubleday, 1990) Spiro, Harold, ‘Clinical Reflections on the Placebo Phenomenon’, in Anne Harrington (ed.), The Placebo Effect: An Interdisciplinary Exploration (1997) Stanley, Peter, For Fear of Pain: British Surgery, 1790–1850 (Amsterdam: Rodopi, 2003) Sullivan, Mark D., ‘Finding Pain Between Minds and Bodies’, The Clinical Journal of Pain, 17.2 (June 2001) Tilburt, Jon, ‘Enlightenment Values, Intraculture, and the Origins of Patient Mistrust’, The Pluralist, 1.2 (Summer 2006) Vrancken, Mariet A E., ‘Schools of Thought on Pain’, Social Science and Medicine, 29.3 (1989) Wear, Andrew, ‘Perceptions of Pain in Seventeenth Century England’, The Society for the Social History of Medicine Bulletin, 36 (1985) Weiner, Saul J and Auster, Simon, ‘From Empathy to Caring: Defining the Ideal Approach to a Healing Relationship’, Yale Journal of Biology and Medicine, 80 (2007) Whittier, Gayle, ‘The Ethics of Metaphor and the Infant Body in Pain’, Literature and Medicine, 18.2 (1999) Williams, Amanda C de C., Talfryn Oakley Davies, Huw, and Chadury, Yasmin, ‘Simple Pain Rating Scales Hide Complex Idiosyncratic Meanings’, Pain, 85 (2000) Wolf, Jacqueline H., Deliver Me From Pain: Anesthesia and Birth in America (Baltimore: The Johns Hopkins University Press, 2009) Woolf, Virginia, On Being Ill, intro by Hermione Lee, 1st pub 1930 (Ashfield, Mass.: Paris Press, 2002) Yu, Ning, ‘The Relationship Between Metaphor, Body, and Culture’, in Tom Ziemka, Jordan Ziatev, and Roselyn M Frank (eds), Body, Language, and Mind, vol. 2 (New York: Mouton de Gruyter, 2008) Index Drawings and pictures are given in italics Abercrombie, John 10 abortion 218–22 A Calculus of Suffering: Pain, Professionalism, and Anesthesia in NineteenthCentury America (Pernick) 275 acetaminophen 21 Acker, Caroline Jean 272, 281, 361 n. 4, 364 n. 50 Adams, John 264–5 Advice to a Mother on the Management of her Children (Chavasse) 215 ‘Age as a Factor’ (Canadian Medical Association Journal) 137 Agnew, David C. 83, 148–9, 323 n. 160 alcohol 24, 64, 66, 90, 272, 281, 285 Alcott, Louisa May 275 Améry, Jean 30 amputation: attitudes to pain of 278–9 description of 35 Jackson’s memory of 271 medication for post-operative pain 292 phantom limb pain 138, 153–4 surgeons to eager for 235 without anesthetic 275–6 anaesthetics: absence of 275–85 and acute pain sufferers 137 affect on coping with acute afflictions 199–200 a blow to spiritual good argument 124 defence of not giving 292, 296–7 for infants 218 introduction in 1846: 271–2 invention/proliferation of 22 meaning of 272–5 and sympathy 256–7 analgesics 124, 137, 199–200, 214, 296–8 An Essay on the Beneficent Distribution of the Sense of Pain (Rowell) 187 ‘Angel of Pain, The’ 94–5 angina 138, 173 anti-narrative tools 154 antipyrine 200–1 ‘A Professional Planter’ (Collins) 194 Argyle, John Duke of 176 Aring, Charles 262 Aristotle 54 Arnold, David 17, 305 n. 41 Arnold, James 281–2 Arp, Bill 60–1 ‘Art of Medicine, The’ (Cutter) 260 Art of Suffering,The (Bertrand) 48, 197 aspirin 200–1, 272, 280 Atkins, Josiah 93–4 Atkinson, J H. 150 Auster, Simon 268, 361 n. 122 Australia 195–6 ‘Australie’ (poet) 23 autonomic nervous system (ANS) 164 back pain 56, 59, 157, 291 Baillie, E C C. 195 Bain, Alexander 252 Balance of Pain,The 49 Ballingall, Sir George 142 Barnes, Roger 122 Barzini, Luigi 85 Bavarians 197 Beddoes, Thomas 273 Beecher, Henry K. 16–17, 225–6, 229 38 i nde x ‘beetle in the box’ (Wittgenstein) 6–7, 54 Bell, Sir Charles 10, 95–6, 169, 170, 177 Bendelow, Gillian A. 29, 122, 308 n. 8, 328 n. 84 Bending, Lucy 17, 28, 128, 199, 308 n. 5 Bennett, Francis 45 Bennett, Sir William 201 Bergman, Norman A. 272, 274, 361 n. 4, 362 n. 13 Berkowitz, Dr Richard 220–1 Bertrand, Louis 48–9, 197 Betts, Rachael 21, 39, 108 Billard, Charles-Michel 215 Biro, David 25, 307 n. 66 Birth Trauma Association 24 Biss, Eula 156 Blumgart, Hermann 263 Blundell, Walter 257, 279 Body in Pain,The (Scarry) 4, 30 Boerhaave, Herman 242 Bonica, John 291 Bottalico, Barbara 9, 303 n. 16 brain: activity in the anterior cingulate 267 activity in a foetus 221–2 affective centres of 15 centres and bodily/emotional pain 21 in infants 216 mirror neurons in 18 and neuro-imaging 157 pain as response to stimuli 10 and racial sciences 196 breast cancer 38, 44, 132, 135 Brief Account of Charles Dunsdon (Tract Association of Society of Friends) 109–10 Bright, Richard 10 Brock, Revd Thomas 98–9 ‘Brompton Cocktail’ 289 bronze bull, made for Phalaris 80 Brookes, Frederick 100–1 Brookes, George 100–1 Brown, John 100, 104, 274 Brown, Theodore M. 260, 359 n. 97 Bruce, Revd John 104–5 Brunless, Annie Mary 207 Buchanan, Joseph 247 Buchanan, William 98 Bullar, Joseph 286–7 Bunbury, Henry William 66 Burke, Edmund 15, 18, 164, 170 Burney, Fanny 34–5, 38–9 Burns, Robert 33 Butler, Glentworth Reeve 140–1, 158, 203 Cambodia 152 Campanella, Tommaso 15 Camparesi, Silvia 9, 303 n. 16 Camper, Petrus 210 Canada 195–6 cancer: breast 38, 44, 132, 135 cauterization 281 and chronic pain 16 half of suffering unnecessary 291–2 hiding pain 39 isolation fear by admitting suffering 43 metaphors for pain 62, 64, 75, 77, 84 metastatic ovarian 27 and morphia 286 pain as normal 299 pain rating scales 156 pain relief for metastatic prostate 293 in poorer households 38 sufferers in the 1950s 21 in the tongue 138 uterus 277 Cardiac Pain (Fisher) 144–5 Carey, Revd Henry 98–9 Carlyle, Jane 37 Carmichael, Jennings 127 Carr, Daniel B. 293, 295, 297, 369 n. 101, 370 n. 115, 372 n. 135 Chain of Feeling 96, 196, 223, 230, 272 charity hospitals 136 Charon, Rita 269, 361 nn. 123/6 Chavasse, Pye Henry 215 Cheering Views of Man and Providence (Burton) 82, 97 Cheever, David 257 Cheyne, George 72 childbirth: and abortion 219–20 and anaesthetics 271 endurance through pride 16 husbands experiencing discomforts of 51 i nde x 38 as the ‘natural’ consequence of Original Sin 284 pangs of labour in another woman 250 and sentience 208–13 woman in the 1940s 123 children: anaesthetics for infants 218 brains of infants 216 and Christianity 115, 117, 118 difficulties in assessing pain in 275, 292–3 and gesture 181–6 need for ‘small talk’ when examining 176 in pain 112–18 pain gesture in infants 181–6 pain sentience in infants 214–18 provision of extra-dural anaesthesia 294 rich pain-languages 153 sensitivities of male schoolchildren in Michigan 198 teething infants 278 ‘Child’s Companion, The’ 117 Chinese 152, 293 chloroform 256–7, 271, 275–8, 280, 282–4, 287; see also anaesthetics Christianity: and analgesics for people dying 286–7 and an ‘inalienable right’ to face death consciously 288 belief in a ‘life of pain’ 82–3 comportment when in pain 105–9 and endurance of flames in this world 104–5 pain in children 115, 117, 118 pain as the consequence of sin 93–5 pain as spiritual guidance 95–100 pertinence of religious interpretations of pain 123 and the suffering community 49–50 suffering as mechanism for spiritual renewal 109–12 survivors and excruciating deaths 101–2 see also religion Christian Lady’s Magazine,The 115 circumcision 217–18 Clapp, Theodore 38, 46–7 Clark, Sir Andrew 132 Clark, William Fairlie 278 Clarke, Elizabeth 106–7 Clarke, Joseph 106 ‘Clinical Notes on Some Common Ailments’ (Knyvett Gordon) 208 ‘Clinical Significance of Pain, The’ (British Medical Journal) 138 Coakley, Sarah 13, 91, 304 n. 28, 324 n. 3 Cohen, Esther 17, 305 n. 41 Coleridge, Samuel Taylor 273 ‘Comparative Psychology of Man’ (Spencer) 252 computerized tomography (CT) 255 Cooper, Bransby B. 135, 140 Cooper, C M. 172–3 Cooper, Richard Tennant 280 Cope, Sir Zachary 296 Copeman, W S C. 145–6 Coulson, William 85–6 couvade 18, 51 Cowper, William 30–1, 37–8, 46, 206–7 Crawford, Cassandra 153 Crawford, James 242 ‘creative computation’ 154 Creator, the 19, 92, 96–7 Critchley, MacDonald 262 Crozier, Ivan 209, 348 n. 64 Cruikshank, George 64, 64, 82 ‘Crying, Weeping, and Sighing’ (SouthWestern Monthly) 162–3 ‘Cry of Pain, The’ (The Lancet) 163 Csordas, Thomas J. 17, 305 n. 41 Curmen, Mary G. 255, 358 n. 78 Dale, Doctor William 281 Darwin, Charles 164, 185, 188–9 Daughter of Affliction,The (Rankin) 285 Davies, Elizabeth 128–9 Davy, Humphry 273–4, 274 deathbed declarations 179 death pangs 285–90 de la Flechere, Revd John William 106 dentistry 198, 200, 203, 257, 278 Derbyshire, Stuart 221–2 Dervishers 195 Descartes, René 10, 12–13, 14, 25, 241–2 ‘Detecting Deception in Pain Expressions’ (Hill/Craig) 177–8 Devotions on Emergent Occasions (Donne) 74 388 i nde x Diagnosis of Internal Medicine,The (Butler) 140 diagnostic classification systems 137 Diagnostics of Internal Medicine,The (Butler) 196–7 ‘Diagnostic Value of Pain, The’ (Alvin) 133 ‘Dialogue Between Mother and Daughter’ 115–16 diarrhoea 23, 142 Dickson, Samuel 286 Differential Diagnosis (Cabot) 139 Diffusion Tensor Imaging (DTI) 157 Dijkhuizen, Jans Frans von 92, 324 n. 7 ‘Disappearance of the Patients, The’ (Fissell) 136 Dissertation on the Duty of Mercy and Sin of Cruelty to Brute Animals, A (Primatt) 188 Doctor in War,The (Hutchinson) 224 dogs 18, 81 Donne, John 74 Dormandy, Thomas 22, 272, 306 n. 56, 361 n. 4 Douglas, Guy 7, 15 Downman, Hugh 183–4, 214 Draper, Elizabeth 42 Duden, Barbara 17, 305 n. 41 dyspepsia 63 Eadie, Mervyn J. 272, 361 n. 4 Edinburgh Philosophical Society 244 Edmonds, Emma 36–7, 237 Edson, Margaret 27, 52 Eisenberger, Naomi 21 Ekman, Paul 18, 164 electrocardiograms 173–4 electroconvulsive therapy (ECT) 227 Eliphalet, Charles 96–7 embryology 219 empathy 263–4, 267 E.M.P (medical student) 192–3, 196, 230 Encyclopaedia Britannica 243 Enenkel, Karl A E. 92, 324 n. 7 Engel, George 57, 141–3 Erichsen, John Eric 224 Essay on the Beneficent Distribution of the Sense of Pain (Rowell) 96 Essay on Humanity, An (Nolan) 95, 235 Essays on the Anatomy and Philosophy of Expression (Bell) 96 Essays on Physiognomy (Lavater) 170 ether 5, 271–3, 275–6; see also anaesthetics ‘Ether Day address’ 102 Evans, William 173–4 Evidences of Natural and Revealed Theology (Lord) 96–7 ‘Experimental Pharmacology and Measurement of the Subjective Response’ (Beecher) 229 Expression of the Emotions in Man and Animals,The (Darwin) 164, 188 Fabrega, Horacio 152 Facial Action Coding System (FACS) 177, 186 facial coding techniques 177 facial expressions 164–5, 177–8, 188–9 Fellman, Anita Clair 279, 346 n. 42 Fellman, Michael 279, 346 n. 42 ‘Field Hospital’ (Wistrand) 161–2 Fields, Howard L. 13–14, 304 n. 28 Finney, John M T. 102, 135, 142, 205–6 Finnish speakers 152 Fissell, Mary 136, 331 n. 18 Flechsig, Paul Emil 215–16 Flood, Peter 287–8 fMRI technologies 267 For Future Doctors (Gregg) 265 Forth, Christopher E. 209, 348 n. 64 Fox, Renée C. 263, 359 n. 103 Freeman, Walter 227 Frémont, General John Charles 276 From Detached Concern to Empathy (Halpern) 262, 268 Functional Magnetic Resonance Imaging (fMRI) 157 ‘Function of Physical Pain: Anaesthetics’ 124 gall bladder disease 138 Galt, Geoffrey 4–5 Galton, Francis 208–9 Gate Control Theory 229 gender 19, 84 Gervis, Henry 44 Gibbs, Raymond 54 i nde x 38 Girdlestone, Edward 187, 222–3 Glasgow Cancer Hospital 38, 43 Glucklich, Ariel 57–8 Goldberg, Daniel S. 299–300, 373 n. 146 Golinski, Jan 274, 362 n. 13 gout 64–5, 66, 72, 82 ‘Gout A Sonnet’ 65 G P (Rainow) 57, 275 Gray, John 126–7 Gray, Thomas 72, 80 Great Ormond Street Hospital, see London’s Hospital for Sick Children Gregory, John 249, 251, 254 Gross, Samuel David 134, 171 Grubb, Sarah 115 Gurney, Rachel 103–4 Hall, Marshall 184–5 Halpern, Jodi 262, 265, 268, 359–60 n. 109 Hamilton, Frank 275 Hand: Its Mechanism and Vital Endowments as Evincing Design (Bell) 95–6 Haraway, Donna 70, 319 n. 93 Harper, Elizabeth 81 Harrison, Mark 17, 305 n. 41 Harrison Narcotic Act 1914 (US) 281 Hay, Anna 31 Haymaker, Webb 197 headaches 1, 33, 68, 80, 98–9, 138, 148, 152, 205 Head, Henry 216 Heads and Faces and How to Study Them (Sizer/Drayton) 237 hearsay evidence 179–81 Hering, Constantine 134 Herrade of Landsberg 93 Hervey, John 71–2 Hicks, James 40 Hilbert, Richard A. 132, 330 n. 5 Hilliard, Harvey 282–3 Hinton, James 91, 102 Hints on the Sources of Happiness, Addressed to Her Children 48, 113–14 Hip disease 138 Hispanics 293 Holifield, E Brooks 112 holistic medicine 260 Holland, Sir Henry 144, 236 Hooker, Worthington 248–9 Horemans, Johan Joseph 234 Horne, John 20–1 Howell, Joel D. 256, 358 n. 80 ‘How to Endure Pain’ 280 Hoyle, Clifford 289 Hume, David 240, 251 humoral theory 71, 201 Hunter, William 268 iatroculture 264 Illness as Metaphor (Sontag) 55 India 152 infants, see children Infant Stress Under Intensive Care (Gottfried/Gaiter) 294 inflammation 114, 134–5 ‘Inflammation’ (Simon) 134–5 Infrared Imaging Thermography 156 Inquiries into Human Faculty and its Development (Galton) 209 Insurance Law Journal 180 International Association for the Study of Pain (IASP) 10–12, 291 ‘International Frontiers of Pain’ (Haymaker) 197 International Headache Society 291 Intractable Pain Society 290 ‘Invention of Hospital Medicine’ (Fissell) 136 in vitro fertilization 219 in vivo proton magnetic-resonance spectrometry 157 Irishmen 197 Islam 122–3 ‘Is There Such a Thing as Psychological Pain?’ Biro 25 ‘Is There Such a Thing as Pure Malevolence?’ (Bain) 252 Italians,The (Barzini) 85 Jackson, Jean 17, 42, 305 n. 41, 312 n. 69 Jackson, Seguin Henry 34, 242–4, 251 Jackson, Thomas 270–1, 299–300 Jackson, Thomas J ‘Stonewall’ 284–5 Jacob, Margaret C. 273–4, 362 n. 11 James, Alice 38, 44, 131–2, 157 James, William 164 Jews 196–9, 228 39 i nde x Kimmel, Michael 20 King, Margaret 30 Kinsella,Victor John 187 Kleinman, Arthur 17, 305 n. 41 ‘Knackers, Pork-Sausages, and Virtue’ (The Penny Satirist) 188 Kremer, Edwin 150 Latham, Dr Peter Mere: acknowledged that ‘pain kills’ 37 comments on pain 301 dismissive of patient ‘tales’ 158 early advocate of auscultation 137 and the expression of the countenance 191 introduction 1–5, life writing about fever 12 and opium 277 pain as an entity 8–9 pain and the mind 21 pain not a symptom 131 the pain of others 23 personal character influences painnarratives 140 and ‘victims of extreme intemperance’ 199 Lavater, Johann Kaspar 170 Lawrence, Christopher 136, 244, 250–1, 260, 331 n. 18, 356 n. 42, 357 n. 60, 359 n. 96 Lectures on the Duties and Qualifications of a Physician (Gregory) 249, 254 Lectures on Man (Vogt) 194 Lectures on Sympathy (Lamont) 249 Leif, Harold I. 263, 359 n. 103 Leriche, René: exploration of surgical pain 224–5 pain as a continuous phenomenon 228–9 and pain diagnosis 144 pain ‘like a storm’ 231, 267, 301 reducing pain and shock 200–1 and sympathy 261–2 and trigeminal neuralgia consultation 167–8 Lewins, Anne 117 Lewis, Sir Thomas 144 Leys, Ruth 38, 310 n. 45 Liley, A William 218–19 Lincoln, Abraham 194 L’Isere, Colombat de 166 Liston, Sir Robert 232 lobotomies 15, 227 Loeser, John D. 291, 293, 295, 297, 369 n. 101, 370 n. 115, 372 n. 135 London Ambulance Column 37 London Encyclopaedia,The 165 London Hospital Gazette,The 141, 193 London’s Hospital for Sick Children 114 Lord, Charles Eliphalet 96–7 Love, David 44 LSD 227 McGill Pain Questionnaire 134, 147–8, 149, 150–4, 158 McGraw, Myrtle 216–17 McTavish, Jan R. 75, 272, 321 n.119, 361n.4 Magendie, Franỗois 10 magnetic resonance imaging (MRI) 255 malingering 141, 177, 180 Mandeville, Bernard 133–4, 136 Mann, Ronald D. 22, 306 n. 56 Mantegazza, Paolo 164 Maoris 196 Marie de L’Incarnation, Reverend Mother 111–12 Marland, Hilary 24, 307 n. 62 Martineau, Harriet 28, 34–5, 51, 99, 114–15, 123–4, 277 Martin, Revd George 99 Massachusetts General Hospital 114 Maudsley, Henry 58 Maxwell, Lady 98 Mayhew, Jenny 92, 324 n. 7 Mechanism of Abdominal Pain,The (Kinsella) 187 Medicaid 294 Medical Notes and Reflections (Holland) 138, 236 ‘Meditations on First Philosophy’ (Descartes) 241 Meigs, John Forsyth 183 Meldrum, Marcia L. 272, 281, 299, 361 n. 4, 364 n. 50, 372 n. 143 Melvill, Henry 120–1 Melzack, Ronald 18, 147–8, 150, 152, 229, 305 n. 43 Memoir of the Last Illness and Death of Rachel Betts 107 i nde x 391 Memoir of Thomas Hamitah Patoo (New York Religious Tract Society) 108 Mengert, William E. 212 Mental Deficiency (Tredgold) 204 Mersky, Harold 83, 148–9, 323 n. 160 metaphors: commonplace usage for pain 58–66 decline in usage 80–7 description of 53–4 diversity 66–79 and figurative languages 54–8 migraine 8, 24, 65 Miller, James 256–7, 282 Mills, Pauline 295–6 mind-body dualism 87 mirror neurons 38 miscegenation 210 Mitchell, Silas Weir 23, 32, 125, 199, 232, 281, 299 Modern Surgical Technique (Thorek) 276 Montgomery, Scott 77 Montgomery, S L. 74, 321 n. 110 Moodie, Suzanna 63 Moore, James 248 ‘Morning Prayer, The’ (Epp) 116 morphine 272, 276, 286, 289, 292, 296, 298; see also anaesthetics Morris, David B. 12, 293, 295, 297, 304 n. 24, 369 n. 101, 370 n. 115, 372 n. 135 Moscoso, Javier 17, 304 n. 22 Mother’s Medical Pocket Book,The 278 Mott,Valentine 77–8, 125, 257 Mouse Grimace Scale (MGS) 189–90 Müller, Johannes 10 music of pain 166–7, 166 Musmanno, Justice Michael 178–9 Musser, John H. 140–1, 167 Mystery of Pain,The (Hinton) 91 myths 121–3 Nathanson, Dr Bernard 219–21, 220 Natural Theology (Paley) 48 Neal, Helen 292, 367 n. 89 Negroes 194–5, 210–14, 252 nervous system, sympathetic 18 Neuralgia 59 neuralgia: agony of 77–8 conjecture as to origin of pain 138 ‘Cured by a New Process’ 245–6 a ‘demon’ that could be driven away 82 a form of ‘excruciating agony’ 79 ‘sharp and lancinating’ 134 speaking in distinctive gestures 165–6 trigeminal 31, 75 neuro-imaging 157 Newman, John Henry 91 New Problems in Medical Ethics (Flood) 287–8 New York Religious Tract Society 108 New Zealand 196 Nichols, L A. 174–5 Nietzsche, Friedrich 9, 61 nitrous oxide 274, 283; see also anaesthetics Nolan, William 95, 235 Nurses Manual (Australia) 294 nursing 171–2 ‘Of Voluntary Suffering’ (Harper’s Weekly) 110 ‘olioanalgesia’ 291, 295 On the Diseases of the Bladder and Prostate Gland (Coulson) 85–6 opium 272, 277, 287; see also anaesthetics Ord, John Walker 243–4 ‘Organ of Courage’ 202–3 ‘Organ of Destructiveness’ 201–2, 202, 236–7 ‘Organ of Fighting’ 201–2 ‘Origin of the Gout’ (Bunbury) 66 Osler, Sir William 122, 258, 259, 260 Outlines of Lectures on the Neurological System of Anthropology (Buchanan) 247 Outlines of Military Surgery (Ballingall) 142 ovarian cancer 27 Oxycontin 297 Packham, Catherine 244, 251, 356 n. 42 pain: as an event 5–7, 16, 18–19, 25 on the battlefield 222–5 beyond words 27–8 and the body 19–22 and children 112–18 chronic 266 392 i nde x pain: (cont.) as a complex phenomenon 12–17 and culture 17–19 definitions of 1–5, 9–12 demands of 28–34 diagnosis of 131–3 as a divine purpose 91–4 ‘Facial Expression of Sympathy’ 47 Gate Control Theory of 10–11 importance of 22–6 instructions on suffering 105–12 in-utera/in-vitro 219 Joseph Townend’s experiences 88–90 mechanistic model of 13, 14 as mode of perception 7–8 as nature’s sentinel 83 physical 25 pious struggles 118–21 and salvation 102–5 and secularism 123–30 as a separate entity 61 silent suffering 114 and sin 93–4 as spiritual guidance 95–100 and spiritual rebirth 100–2 sympathetic communities 46–52 sympathy, see sympathy Pain: A Cultural History (Moscoso) 17, 304 n. 22 pain-dog (Nietzsche) 9, 13 pain gesture: in animals 186–91, 219 diagnosis 165–8 doubting 175–8 in infants 181–6 introduction 159–61 learning 168–75 legal issues 178–81 suffering in the clinic 161–5 pain language: eradication 154–8 revival 147–54 ‘Pain Language as a Measure of Affect in Chronic Pain Patients’ (Kremer/ Atkinson) 150 Painless Tooth-Extraction Without Chloroform (Blundell) 257 pain metaphors: diversity 73–9 dogs 81 electrical 79 evidence of suffering 178 flickering 81 gender 64–5 of Joseph Townend 161 mechanical 79 militarist 74–7 myths 121–3 railway 77–8 religious 81 of Robert Wistrand 161–2 rupture 62–5 temperature change 65–6, 66 torture 80 usage 83–6 usage generally 53–4, 87–8 using humoral theory 71–2 weight 65 pain narratives: dangers of 39–46 description using figurative languages 54–8 diagnostic value 133–5 distress of 34–9 not dismissed 256 problems 135–47 pain questionnaires 134, 147–8, 149, 150–4, 158 pain rating scales 154–6, 155 pain relief: and anaesthetics, see anaesthetics anxieties 275–85 death pangs 285–90 introduction 270–2 modern 290–302 ‘Pain Relief in the Pediatric Patient’ (Swafford/Allan) 292 ‘Pain Scale, The’ (Biss) 156 pain sentience: and foetuses 218–22 and infants 214–18 innate 201–3 introduction 192–3 mental factors 222–30 not-fully-human peoples 193–9 social 203–6, 204 and women 205, 206–14 ‘pain smile’ 177 Pain and Sympathy (McCormick) 196 Pain (Wolff/Wolf ) 147 i nde x 393 Pain (Zolinsky) 59–60 Paley, William 48 Pancuronium 292 Papper, Emanuel Martin 273, 362 n. 10 Paradoxical Reflex (Head) 216 Passages from the Diary (Warren) 57 Path of Improvement in Cancer Treatment, The (Snow) 285–6 Pati, Biswamoy 17, 305 n. 41 Pavlov, Ivan 15 Peabody, Francis 238, 260–2 Pels, Richard J. 122, 328 n. 84 pelvic angle 210 Pendleton, Jill 291 Pernick, Martin S. 22, 194, 275, 306 n. 56, 344 n. 4, 362 n. 16 Perry’s Treatise on the Prevention and Cure of the Tooth-Ache 215, 232 personality types 71 Peschel, Enid. 255, 358 n. 78 Philoctetes (Sophocles) 27 Philosophical Investigations (Wittgenstein) 5–6 Philosophy of the Active and Moral Powers of Man,The (Stewart) 36, 246 phrenology 165, 201–3, 236–7 physiognomy 170–1, 171, 174, 188, 203 Poetics,The (Aristotle) 54 Positron Emission Tomography (PET) 157 Post-Traumatic Stress Disorder (PTSD) 24 Pott’s disease 138 Practical Treatise on the Diseases of Children, A (Meigs) 183 Practical Treatise of Medical Diagnosis for Students and Physicians, A (Musser) 140–1, 167 Priel, Beatrice 122, 328 n. 84 Primatt, Humphrey 188 p.r.n (pro re nata) 172 ‘Properties of Cultural Embodiment’ (Kimmel) 20 prostate cancer 293 Protestants 228 Proverbs (3:11-12) 94 Prussians 197 psychogenic suffering 142 ‘Psychology of the Surgical Patient, The’ (British Medical Journal) 139 Psychosurgery: In the Treatment of Mental Disorders and Intractable Pain (Freeman/Watts) 227 puerperal mania 24 Pugh, Judy F. 17, 305 n. 41 Pulvermacher machine 79 Rabinowitz, Betty 122, 328 n. 84 race 110–11, 196, 210 Rai, Amit 268–9 railway metaphors 77–8 Rainow, G K. 275–6 Raja, Anand 221–2 Ralston, Aron Lee 276 Rankin, Mary 35, 285–6 Reagan, Ronald 219 Rees, George 81 Reeve, Glentworth 140 Reiser, Stanley Joel 255, 358 n. 78 ‘Relief of Pain in Childhood, The’ (Henderson) 217 religion: chloroform as a decoy of Satan 283–4 decline in pain metaphorical usage 81–3 Joseph Townend’s experiences 88–90 pain and children 112–18 pain as a divine purpose 91–5 pain and salvation 102–5 and pain as spiritual guidance 95–100 pain and spiritual rebirth 100–2 pious struggles with pain 118–21, 125–30 scientists/physicians views on pain 121 religious metaphors 81 Religious Tract Society 98 Remarks on the Sympathetic Connection Existing Between the Body and Mind (Ord) 223–4, 243–4 Representation of Bodily Pain in Late Nineteenth-Century English Culture (Bending) 17, 199 retrojection 20–1, 92 Reynolds, L A. 272, 361 n. 4 Rey, Roselyne 22, 216, 306 n. 56, 349 n. 87 rheumatism 64, 79 Ricoeur, Paul Robinson,Victor 22, 306 n. 56 394 i nde x Rodent Face Finder 190 Roesly, Mary 40 Roe v.Wade 219 Romaine, William 103 Rothwell, Richard 48 Rowell, George Augustus 96, 187 Rowe, Thomas Smith 257 Rowlandson, Thomas 233, 274 Royal Society of Medicine and Surgery 49 Rublack, Ulinka 71 Rule of Sympathy (Rai) 268–9 Rundell, Maria Eliza 284 Rush, Benjamin 254–5 Russell, W H. 179 Rutherford, John 133, 140 Rutkow, Ira M. 276, 362 n. 21 ‘Sacred Pain and the Phenomenal Self ’ (Glucklich) 57 St John, Deborah 255, 358 n. 78 salicylate (willow bark) 272 Sandelowki, Margarete 22, 306 n. 56 Sandrin, Dilma 218 Saunders, Cicely 290 Sauter, Michael J. 273–4, 373n.11 Scarry, Elaine 4–5, 30, 55 Schiebinger, Londa 210, 348 n. 66 Schott, G D. 66, 319 n. 79 Science of Ethics,The (Stephen) 245, 252 ‘Science, Pedagogy, and the Transformation of Empathy in Medicine’ (Reiser) 255 ‘Screaming Yellow Zonkers’ 59, 59 secularism 123–30 ‘Self-Indulgent Man Afflicted with Gout’ (Cruikshank) 82 ‘Sensibility to Pain’ (Swift) 203 ‘sentient principle’ (Whytt) 242 Shapcott, Jo 56, 314 n. 8 Shelemay, Kay Kaufman 13, 304 n. 28 Shelley, Percy Bysshe 273 Sidgwick, Henry 45, 247 Sieveking, Edward Henry 207–9 Significance and Effect of Pain,The (Finney) 135, 205–6 ‘Significance of Pain, The’ (Thomson) 167 Silent Scream,The (film 1984) 219 Simpson, James Young 210, 284 Sinhalese speakers 152 Sketches of Life and Character in the Children’s Hospital Melbourne (Carmichael) 127 Skott, Carola 84 slavery 194, 230 Smith, Adam 35–7, 234, 240–1, 246–7, 251 Smith, E B. 274, 362 n. 13 Smith, Thomas 80, 80–1 Smyth, Thomas 20, 60–1, 118–19 Snow, Herbert 285–6 Snow, Stephanie J. 272, 274–5, 361 n. 4, 362 n. 14 Society for the Protection of the Unborn Child 218 Somerville, Alexander 175 Sontag, Susan 55–6 Sophia, Princess 175 Southey, Robert 273 Spain 197 ‘spatiotemporal patterns of the sensation’ 58 Spencer, Herbert 252 spinal cord 10 gating mechanism in 10–11, 11, 13 Spiro, Harold 10, 304 n. 23 Spiro, Howard M. 255, 358 n. 78 Spurzheim, Johann Gaspar 236 Stanhope, Philip Dormer (4th Earl of Chesterfield) 42 Stanley, Peter 272, 361 n. 4 Stanton, Elizabeth Cady 209–10 Stephen, Leslie 245, 252 Sterne, Laurence 42–3 stethoscopes 137 Stewart, Dugald 36, 246 stomach irritation 138 Stone, Revd Andrew 245 Strauss, Edgar 180–1 Suicide Disease, see trigeminal neuralgia Sullivan, Mark D. 8, 303 n. 13 Surgery of Pain,The (Leriche) 167–8, 231, 261 Surgical Experience of Chloroform (Miller) 256 suxamethonium 292 Swerdlow, Mark 290 Swift, Jonathan 33, 80 Sydenham, Thomas 255 i nde x 395 sympathy: case for 248–52 correct manner 253–8, 259, 260–5 development of 240–4 introduction 231–4 of medical practitioners 235–40 modern problems 265–9 unravelling of 244–7 Sympathy; or the Mourner Advised and Consoled (Bruce) 104 syphilis 185–6 System of Clinical Medicine, A (Savill) 139 System of Surgery: Pathological, Diagnostic, Therapeutic, and Operative (Gross) 134 Tabe dorsalis 75 ‘Taking the Narrative Out of Pain’ (Tracey) 157 Tamagawa, Kathleen 213–14 Tansey, E M. 272, 361n.4 Tasistro, Louis Fitzgerald 33 teething 215; see also dentistry temperature change metaphors 65–6, 66 Tesson, Eugene 288 Textbook of the Rheumatic Diseases (Copeman) 145–6 Thai speakers 152 ‘The Assessment of Post-Vasectomy Pain in Mice’ (Leach and ors) 189 ‘The Head-Ache, Or an Ode to Health’ (Winscom) 232–3 ‘The Nervous System and Society in the Scottish Enlightenment’ (Lawrence) 250 Theory of Moral Sentiments,The 240–1 Thomson, W H. 167 Tighe, Dr Mary 219 Tilburt, Jon 257, 264, 358 n. 88, 359 n. 106 Tisdall, Claire 50–1 toothache 113, 115–17, 125; see also dentistry Torgerson, Warren 147–8, 152 torture 30, 80 ‘total pain’ concept 290 Townend, Joseph 88–90, 101, 110, 129, 161–2 Townsend, Revd John 108 Tracey, Irene 157 ‘Training for “Detached Concern” in Medical Students’ (Leif/Fox) 263 Traité de l’homme (Descartes) 241–2 Treatise on the Diseases of Children, A (Hall) 184 Treatise on the Diseases of Children (Underwood) 182 Treatise on the Diseases of Infants, A (Billard) 215 Treatise of Human Nature, A (Hume) 240, 251 Treatise of the Hypochondriack and Hysterick Diseases (Mandeville) 133–4 Treatise on Sympathy in Two Parts, A ( Jackson) 34, 242–3, 251 Treatise Upon the Diseases and Hygiene of the Organs of the Voice (L’Iserer) 166 Tredgold, Alfred Frank 204 trigeminal neuralgia 31, 75 Turner, Thomas 236 Two Introductory Lectures (Hunter) 268 Tyma, Stephen 152 Underwood, Michael 182, 214–15 Unwin, Mary 37, 46 Vaughan, Kathleen 211 venereal disease 42–3 Vietnam 297 Visual Analog Scales 154 vivisection 187–8, 237, 239 ‘Vivisector, The’ 237–8 Vogt, Karl Christoph 194 voluntary hospitals 136 Vrancken, Mariet A E. 29, 308 n. 8 Wall, Patrick 229 Walpole, Horace 72 Warnock Committee report (1984) 219 Warnock, Fay 218 Waterhouse, Sir Herbert 249 Watts, James W. 227 Wear, Andrew 17, 305 n. 41 Webb, Sarah 210–11 weight metaphors 65 Weiner, Saul 268, 361 n. 122 Wesley, Charles 117 West, Paul 239 39 ‘What has Anaesthetics Done for Surgery?’ (Cheever) 257 ‘What is an Emotion?’ ( James) 164 Whittier, Gayle 292, 367 n. 91 ‘Why is Pain a Mystery?’ (Yeo) 244–5 Whytt, Robert 242–3 Williams, John Whitridge 212 Williams, Simon J. 29, 308 n. 8 Williams, Sir John 250 Wilson, James 291 Winscom, Jane 33, 232–3 Wistrand, Robert 161–2 Wit (Edson) 27, 52 WITSENDO (online discussion group) 51–2 Wittgenstein, Ludwig 5–7, 17, 54, 73 Wolcott’s Instant Pain Annihilator 76 Wolff, Harold 226 Wolf, Stewart 226 i nde x ‘Woman Suffering the Pain of Cholic’ (Cruikshank) 64 Woolf,Virginia 28–9, 53–4, 302 ‘Words of Chronic Pain’ (Agnew/ Merskey) 83, 148 World Health Organization 281 Wynne Smith, Lisa 17, 305 n. 41 Yale Journal of Biology and Medicine (Weiner/Auster) 268 Yeo, Isaac Burney 127 Yorke, Susan Liddell 175 Young, Edward 33, 72, 100, 126, 264 Zaimi, Nexhmie 41 Zamboni, Giovanni 9, 303 n. 16 Zborowski, Mark 85, 228 Zola, Irving Kenneth 85 Zolinsky, Henry Saul 59–60 ... blood, and the veins of the temple and forehead distended; the breath being checked, and the descent of blood from the head impeded by the agony of the chest, the cutaneous muscles of the neck... by the base octave and the seventeenth; for example, the and re, upon the sharp of the second register It seems that the atrocious pangs of labor elevate the diapason of the voice, and at the. .. Diagnosis The third argument about the value of gestural languages asked whether they were diagnostically constructive This is the other side of the debates in the last chapter about the diagnostic