Social Studies: 'My anguish is great, and I weep as I write", declared the novelist, Alphonse Daudet, in a fragment of his (perforce unfinished) book In the Land of Pain. Daudet's account of the "despotic and possessive" agony of tertiary syphilis proves, with its haggard prose snapshots of a body and mind at the edge of extinction, that the literature of physical suffering must proceed by fits and starts, or not at all.
A lucid and sustained account, impossible in the midst of pain, would be a mere gloss in retrospect - assuming the author is allowed a backward glance. Pain is always novel, shocking, not easily turned to narrative ends; it is a matter, says John Donne in his sickly Meditations, of composing a frieze of flashes, eclipses, blazing stars and fiery exhalations. As Thomas Dormandy points out early on in his fascinating history of stabs and aches, the story will be marked by "blips, bumps, backtrackings".
The Worst of Evils (the title is Milton's: 'Pain is perfect misery . . .') is essentially a medical history, not a compendium of pains recalled; but among its intriguing narrative disjunctures is the way it keeps snagging on personal testimony, lending this sympathetic book a certain Gothic drama. Syphilitics' diaries are among the worst: "lightning" strikes the legs; a "girdle" constricts the torso. Fanny Burney describes her mastectomy in 1810: "When again I felt the instrument, describing a curve, cutting against the grain, while the flesh resisted in a manner so forcible as to oppose and tire the hand, then, indeed, I thought I must have expired."
The horrors are not reserved for the distant past; some extreme pains, such as trigeminal neuralgia, remain untouchably obscure to modern medicine (as a relative of mine put it, she was "ready to jump in the river"). Literature has only ever touched gingerly on the subject of what such torment feels like.
In a way, Dormandy skirts it too, preferring to tell the tale of the alleviation of pain rather than dwell at length on its sudden invasion or long, slow settling in. The story of pain is also, of course, the story of anaesthesia, and Dormandy is engagingly thorough on the remedies, both illusory and effective, to which we have turned over the centuries. Predictably, that history is dominated by opium: from its first discovery by the Greeks, through its 19th-century ubiquity - such proprietary brands as Street's Infant Quieter and Atkinson's Baby Preservative give some idea of how unworried the Victorians were by their opiated ways - to its condemnation in the early 20th century and sensible, if belated, rehabilitation in contemporary cancer care. Cocaine briefly overtook opium a century ago, helped along by Freud, whose enthusiastic recommendation inadvertently hurried the death of a colleague.
Drugs, however, are only half of the story: the "most important single advance in man's fight against pain" was the advent of surgical anaesthesia in the mid-19th century. In an era in which a surgeon would routinely shout "time it, gentlemen!" before making the first incision (speed was the only defence against pain-related shock and subsequent death), the rag-and-bottle man was a modern hero. Still, his skills were not universally welcomed: physical pain was seen by some as an essential part of the healing process. In particular, the pain of childbirth was not to be allayed, lest the mother think less of a baby born without pangs. As always, pain was also a symbol, illness a metaphor.
In that sense, the most pressing theme is what Montaigne called "the narrow suture of the spirit and the body": pathology and pharmacology can only go so far in explaining the mysteries of pain and its relief. The case of Anton Mesmer is instructive: in advancing his theory of "animal magnetism" - he de-electrified Marie- Antoinette's poodle, and treated a sightless pianist, who preferred to remain blind for the sake of her prodigious career - he also invented medical hypnosis. Dormandy is open-minded about such alternative methods, up to and including, apparently, the power of prayer: his description of the shrine at Lourdes, and the frail hopes floated there, is sympathetic, even somewhat transfixed by the image of the consumptive Bernadette Soubirous. Which makes his brusque dismissal of the "Dolourist" movement in French literature after the first World War - an admittedly morbid cult of pain, by which a generation tried to account for the late cataclysm - a little unthinking.
Dormandy treats elegantly of complex medicine and particularly knotted history: the American discovery of ether, for example, is sufficiently twisted to warrant a dramatis personae of scurrilous pretenders. But he is occasionally awkward and long-winded: his habit of interjecting a biography of each and every historical figure he comes across (followed by a footnote giving his or her date of death, which is at least mordantly appropriate) leaves the book feeling swollen and tender. And there are some bizarrely tendentious, eccentric and unexplained asides - as when he avers that Michel Foucault's History of Madness is "strictly for those who can take Foucault" (whatever that means), or claims that Freud "never missed a chance to display his familiarity with the Classics" (why single Freud out for this bit of bitterness?) - that an editor at Yale really ought to have excised. For the most part, however, The Worst of Evils is an intrepid, and tentatively hopeful, account of a territory few of us will not come to know.
The Worst of Evils: The Fight Against Pain By Thomas Dormandy Yale University Press, 547pp. £19.99
Brian Dillon's memoir, In the Dark Room, was published by Penguin Ireland last year. He is an editor of Cabinet, an art and culture quarterly and is working on his next book, Tormented Hope: Nine Hypochondriac Lives
