The Worst of Evils: The Fight against Pain
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《新英格兰医药杂志》
The history of our explorations of the nature, meaning, and treatment of pain opens a window on multiple aspects of human culture: physiology and pharmacology, obstetrics and bacteriology, psychology and philosophy, art and literature, and politics and religion. Thomas Dormandy's The Worst of Evils attends to all of these contexts and then some. As he chronicles religious objections to the successful use of anesthesia in surgery and obstetrics in the mid-19th century, for example, Dormandy also considers resistance to "the death of pain" in the broader context of a culture that included dueling societies, public executions, military floggings, public-school punishments, and slavery. Similarly, because the use of obstetrical anesthesia catalyzed anxieties about women's sexuality while they were under the influence of ether, and surgical anesthesia made the profession of surgery less brutal and more open to women, these medical and pharmacologic developments were inextricably intertwined with the history of gender. These are just two examples of how Dormandy reads the relevance of scientific and medical events through their cultural milieus, and vice versa.
(Figure)
"Easing the Tooth-ach."
Colored stipple engraving by James Gillray, 1796. Published by H. Humphrey, London.
From the Wellcome Library, London.
Following the lead of the late, great Roy Porter, this history is often rendered through first-person and patient-centered accounts. To Fanny Burney's chilling record of her unanesthetized mastectomy, Dormandy adds chemistry professor George Wilson's account of the amputation of his foot: "I can recall the black whirlwind of emotion, the horror of great darkness, the sense of desertion by God and man." Still worse is the story of Hoo Loo, a Chinese laborer brought from a village near Canton to London for the removal of a 65-pound groin tumor. Drawing on contemporary periodical accounts, Dormandy brings us into the company of more than 500 spectators in an oppressively hot auditorium to watch as the laughing, joking patient loses blood and begins to call out, "Let it be — let it remain. Unloose me! I can bear no more," before convulsing and dying.
Surgical pain before and after the era of anesthesia constitutes only part of this ambitious book, which moves from the ancient world to the present day, interweaving descriptions of the development of familiar medications such as morphine and aspirin with anecdotes about the use of stoicism, snow, and mesmerism to quell pain. Dormandy is as comfortable explaining the Gate Control theory of pain as he is sharing gossipy bits about the personalities of key figures in the development of pain medications or wonderful details about Victorian packaging and pricing of opium.
However, the book's inclusiveness and the author's versatility can thwart development. In the case of Hoo Loo, why did the East India Company bring the man to Guy's Hospital? What beliefs about the differential sensitivity to pain of nonwhite, non-Europeans — addressed in a later chapter — informed the event, its horrific outcomes, and the larger work of empire that created this medicalized "contact zone"? This is a lost opportunity to explore the very global nature of this history of pain, toward which Dormandy commendably gestures elsewhere in the book. The many references to literature and art are welcome, but their treatment can also be somewhat cursory. Furthermore, this learned author has so many threads at his disposal that disjunctiveness sometimes results. He moves from tic douloureux, to twilight sleep, to a chapter on the painter Pierre-Auguste Renoir (as a positive answer to the question "can creative work suppress a comparatively low-grade pain?"), without the guidance of a tightly framed argument.
Inevitably, in a book this ambitious, there are some errors. Phineas Gage, the famous Vermont man who was lobotomized and made antisocial in an industrial accident, here becomes Philip Gage of Connecticut, whose catastrophe makes him nicer. Herbert Snow, the creator of the famous Brompton's cocktail of morphine and cocaine for patients with cancer, becomes John Snow.
Quibbles aside, Dormandy offers both a lively historical panorama and some astute commentary on key issues. Attending throughout to the shifting relationships between body and mind in theories of pain, he notes the "great schism" between cure and care in medical culture, the former emphasis exacerbating the situation of people with chronic pain. At its best, reading the book feels like attending a year-long seminar in the history of medicine led by an erudite, personable, and passionate educator. The Worst of Evils is a valuable addition to studies in the history of pain and is recommended for both general readers and scholars.
Martha Stoddard Holmes, Ph.D.
California State University, San Marcos
San Marcos, CA 92096
mstoddar@csusm.edu(By Thomas Dormandy. 547 p)
(Figure)
"Easing the Tooth-ach."
Colored stipple engraving by James Gillray, 1796. Published by H. Humphrey, London.
From the Wellcome Library, London.
Following the lead of the late, great Roy Porter, this history is often rendered through first-person and patient-centered accounts. To Fanny Burney's chilling record of her unanesthetized mastectomy, Dormandy adds chemistry professor George Wilson's account of the amputation of his foot: "I can recall the black whirlwind of emotion, the horror of great darkness, the sense of desertion by God and man." Still worse is the story of Hoo Loo, a Chinese laborer brought from a village near Canton to London for the removal of a 65-pound groin tumor. Drawing on contemporary periodical accounts, Dormandy brings us into the company of more than 500 spectators in an oppressively hot auditorium to watch as the laughing, joking patient loses blood and begins to call out, "Let it be — let it remain. Unloose me! I can bear no more," before convulsing and dying.
Surgical pain before and after the era of anesthesia constitutes only part of this ambitious book, which moves from the ancient world to the present day, interweaving descriptions of the development of familiar medications such as morphine and aspirin with anecdotes about the use of stoicism, snow, and mesmerism to quell pain. Dormandy is as comfortable explaining the Gate Control theory of pain as he is sharing gossipy bits about the personalities of key figures in the development of pain medications or wonderful details about Victorian packaging and pricing of opium.
However, the book's inclusiveness and the author's versatility can thwart development. In the case of Hoo Loo, why did the East India Company bring the man to Guy's Hospital? What beliefs about the differential sensitivity to pain of nonwhite, non-Europeans — addressed in a later chapter — informed the event, its horrific outcomes, and the larger work of empire that created this medicalized "contact zone"? This is a lost opportunity to explore the very global nature of this history of pain, toward which Dormandy commendably gestures elsewhere in the book. The many references to literature and art are welcome, but their treatment can also be somewhat cursory. Furthermore, this learned author has so many threads at his disposal that disjunctiveness sometimes results. He moves from tic douloureux, to twilight sleep, to a chapter on the painter Pierre-Auguste Renoir (as a positive answer to the question "can creative work suppress a comparatively low-grade pain?"), without the guidance of a tightly framed argument.
Inevitably, in a book this ambitious, there are some errors. Phineas Gage, the famous Vermont man who was lobotomized and made antisocial in an industrial accident, here becomes Philip Gage of Connecticut, whose catastrophe makes him nicer. Herbert Snow, the creator of the famous Brompton's cocktail of morphine and cocaine for patients with cancer, becomes John Snow.
Quibbles aside, Dormandy offers both a lively historical panorama and some astute commentary on key issues. Attending throughout to the shifting relationships between body and mind in theories of pain, he notes the "great schism" between cure and care in medical culture, the former emphasis exacerbating the situation of people with chronic pain. At its best, reading the book feels like attending a year-long seminar in the history of medicine led by an erudite, personable, and passionate educator. The Worst of Evils is a valuable addition to studies in the history of pain and is recommended for both general readers and scholars.
Martha Stoddard Holmes, Ph.D.
California State University, San Marcos
San Marcos, CA 92096
mstoddar@csusm.edu(By Thomas Dormandy. 547 p)