A hesitant sermon on the subject of pain
Ihave been thinking about pain, mainly because 1 have been experiencing so much of it recently. It is bone pain, arising from an accident some months ago when I broke my hip. Is pain in the bones worse than any other? Who can say? Thirty years ago or more I had a kidney stone. This caused a series of spasms which came and went at regular intervals as my body tried and failed to expel a piece of chalk stuck in the narrow orifices of the intestines. That was muscular pain, the worst I had experienced up to that time. It is akin to the pain women experience in labour, which is also caused by a muscular effort to extrude something which the body has decided has become alien to it. But in labour the agony at least has a creative purpose, and it is said that once childbirth is over, the mother, delighted, forgets all about the pain. I am not sure that is true in all cases: witness Queen Victoria's bitter complaints in letters to her favourite daughter.
Kidney stones, before chloroform, which did not come in much before the 1850s, were a serious matter. They could grow to a great size — one reads of a stone 'as big as a fist' — and could kill, unless the sufferer submitted to surgery. This was a desperate remedy because the surgeon had to cut very deep to get at the stone, and sometimes he had to break up the stone within the body to get the fragments out separately. Without anaesthetics, the pain became unendurable. In the early 19th century it was calculated that a surgeon had 15 to 20 minutes to do the job, otherwise the poor man would die on the operating table. (I say 'man': one never reads of women getting the stone. Why? Less claret and port or rich, unsuitable food? Different physiology? Not worth the cost of an operation?) Really good surgeons of the day like Sir Anthony Carlisle could do it in the time, as a rule. I imagine the gruesome scene. The agonised patient, often screaming, dosed with strong liquor, held down by male nurses. The surgeon, in black suit spattered with fresh bright gore and stiff with old bloodstains, tense and sweating profusely. A rich man, safely operated on for stone, might tip a skilful surgeon £1,000 above his fee.
In those times the entire pharmacopoeia was pitifully meagre in any effective painkilling substance. Those suffering from rheumatoid arthritis or similar bone or muscular pain, which often strikes the young adolescent, had to put up with it or were given opium in its various forms. That worked up to a point — it was the only painkiller that did — but it was addictive in an age when the problem of addiction was little understood and insufficiently feared. The danger was that sufferers, having experienced the delight and relief that pure opium or a solution of it — like the notorious Kendal Black Drops — could bring, might continue to administer it to themselves after the pain no longer troubled them. That was almost certainly what happened in the case of Coleridge (though he denied it) and to Thomas De Quincey. Many women, such as Coleridge's daughter Sara and Elizabeth Barrett Browning, were mildly addicted to opium. It was imported, mainly from Turkey, in beautifully made wooden caskets and sold freely in apothecaries' shops. A child could be sent off for 'a penn'orth of tincture'.
One of the troubles with opium is that it tends to freeze the bowels. That, of course, is what made it so effective against seasickness, vomiting and bowel spasms generally. But persistent consumption produced constipation in its most acute and dreadful form. Coleridge in his notebooks gives the most horrifying and graphic account of his experience when travelling by sea to Malta in 1804. Any opium-based medicine is liable to have the same effect. I imagine that heroin, an opium or laudanum concentrate invented in the late 19th century, is even more likely to bring the bowels to a full stop. I once had it administered to me, on the kidney-stone occasion. It worked perfectly, as the doctor said it would. It immediately relaxed every muscle in my body, sending me to sleep, during which the particle of chalk hitherto wedged by muscular tension passed easily through into wider regions, and when I awoke all was long over. This experience gave me an unforgettable impression of the medicinal power of this amazing substance, and of its limitless potential for harm too.
When I was in pain as a child, my mother, if unable to alleviate it, would say, 'Offer it up to the souls in purgatory.' What she meant was that my willing acceptance of the pain would be taken by God as a Christian gesture of obedience to His will, and in return He would remit an equivalent amount of pain being suffered by a poor soul in torment. If your pain was bad enough and your acceptance wholehearted enough, it might be sufficient to 'spring' a soul almost at the end of his/her purgatorial term, thus allowing immediate entry
into heaven and reunion with the Blessed. Then, my mother added, the heavenly soul might begin praying for you, and your pain might cease. I am not sure that I believe totally in this neat and reassuring system of moral and penitential economics, in which pain circulates rather like money in a Marshallian society. My mother did not enjoy being crossquestioned by me, a pertinacious and not easily put-off child, on the detail of purgatorial pain-and-virtue transfers. She thought it verged on the borders of impropriety, rather as the Duke of Wellington disapproved of his men cheering him `as it comes close to an expression of opinion'. Why can pain be translated into virtue? Why have it in the first place if the Deity is all-powerful? The greatest transfer of this kind was the Redemption, in which the pain endured by Jesus Christ ransomed the whole of humanity from the punishment of Original Sin (itself a mysterious business). The physical sufferings of Christ are an important part of the redemptive process and were always stressed in mediaeval iconography, witness the Isenheim Altarpiece and many other examples of the most gruesome kind. They shocked — they were meant to shock. The recent Hollywood movie that has led to such gnashing of teeth is in the mediaeval tradition of redemptive realism. I have two crucifixes which illustrate the old and the new styles of portraying the Redemption. One, 18th-century, coming from Spain, where I imagine it was looted from a burning convent during the Civil War in the Thirties, is covered in spots of blood and radiates suffering and grief. It hangs in my study as it was regarded as too brutal to appear in the public rooms of the house ('might frighten the grandchildren). The other, made by an Anglican monk sculptor, which hangs in my bedroom, is clean, bloodless, almost hygienic, and radiates serenity and peace. Well? I don't have to choose: I have both.
What I have discovered in the last few days is the truth of the remark in Macbeth, The labour we delight in physics pain'. While I have had a good deal of agony at night in the past week, not much helped by painkillers, and constant spasms during the day, I find that the moment I sit down at my desk and start to write all pain vanishes. As a result I have been writing like a steam engine, as Macaulay would say, and have finished my book much sooner than I expected. Nor have I had one tiny twinge of suffering while writing this essay. Can you explain that? I can't, but `For this relief, much thanks.'
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