Pain is mysterious in many ways. It is experienced by almost all of us at one time or another in our lives and some of us experience it almost continuously. Its near-universality suggests that it must be a basic neurological phenomenon, yet it is still possible to argue about whether pain is felt by non-human organisms and, if so, by which of them. In this as in many other respects pain differs from sensory modalities such as sight and hearing. And pain has philosophical and even theological implications which other sensory modalities do not share.
Because it is such a basic function of the nervous system a book on the history of pain is pretty well obliged to be to some extent a history of neurology. Rey's task is therefore an ambitious one. She starts in antiquity and traces the evolution in our understanding of pain up to the early twentieth century; a brief postscript by J. Cambier looks at the modern view of pain. Since this is a neurophysiological rather than a philosophical treatment of the matter, much more space is devoted to the nineteenth century than to earlier periods; hardly any scientific advances in pain occurred between antiquity and 1800. The subjective and cultural aspects of people's attitudes to pain in different epochs are also considered, though wholly within a Western context. Indeed, most of the discussion concerns French science. This is fair enough, however, given the great importance of the French contribution to physiology and neurology in the nineteenth century.
During the nineteenth century researchers were much preoccupied with the search for a means of reducing or eliminating the pain of surgery. Opium had of course been known for a long time, but in 1817 the active principle was isolated and named 'morphine'. Later in the century chemical anaesthesia came into use: ether, chloroform, and nitrous oxide were found to be effective for this purpose. There were disputes about priority in the invention of anaesthesia and one pioneer, an American dentist called Horace Wells, committed suicide with chloroform before receiving the letter from the Societé Médicale de Paris which acknowledged his discovery and first use of the substance. Local anaesthesia was also introduced in the mid-nineteenth century.
Quite a different approach to the control of pain was offered by hypnosis. James Braid in Manchester tried to separate this technique from its somewhat suspect antecedents in Mesmerism and showed that it was possible to use it to eliminate pain during surgery as well as to produce cures of various diseases, but hypnotic pain control has always remained something of a medical curiosity and has never threatened to displace chemical anaesthesia. Rey touches on the reasons for this but does not make them entirely clear.
Meanwhile research at a neurophysiological level was going on, with much argument centered on the question whether specific pain mechanisms exist or not. Are there specific pain receptors, pain nerve fibres, and pain centres in the brain? The deep scientific and philosophical implications of this question are discussed in a concluding section. Rey believes that the specificity idea is heuristically useful and so must be retained for the moment, although it is probably invalid and may need to be replaced eventually.
A measure of how far our modern awareness differs from that of the nineteenth century comes is afforded by Rey's account of the views of the Catholic Church on pain in the nineteenth century. Numerous clerics maintained that pain has a redeeming function, that suffering individuals are closer to Christ, that pain could be offered up in penitence for sins, and even that it is only the elect that God subjects to terrible trials. Such ideas have still not been wholly eliminated within Catholic writing even today. At least some French physicians have reacted by becoming free-thinkers.
This is an interesting and important study. The translation has been well done, but the book is nevertheless not easy to read; the style is somewhat verbose and the author goes in for huge paragraphs, which are often more than a page in length. Like most French books, this one lacks an index. This is an unforgivable omission in a scholarly history and it would have added enormously to its value if the publishers had commissioned one.