Publications
APS Bulletin • Volume 12, Number 4, July/August 2002
Resource Reviews
John D. Loeser, Department Editor
From Lesion to Metaphor: Chronic Pain in British, French, and German Medical Writings, 1800 - 1914
Reviewed by Marcia L. Meldrum, PhD
Andrew Hodgkiss, Amsterdam/Atlanta, GA, Editions Rodopi (Clio Medica 58/The Wellcome Institute Series in the History of Medicine), 2000, 218 pages, $51 (hard cover), $17 (soft cover), ISBN 90-420-00831-8
This well-researched and incisively written little book considers how the problem of “lesionless pain,” what the modern field calls “chronic unexplained pain,” appeared to physicians in the 1800s. Hodgkiss challenges the common assumption that, as medicine strengthened its basis in anatomy and physiology during the 19th century, a patient presenting with such pain was likely to be regarded by doctors as a liar or a neurotic. Through careful reading of texts from Great Britain, France, and Germany, including the work of several writers not well known today, he shows that debate over the origins, nature, and meaning of lesionless pain continued throughout the century and “drove medical authors to improvise at the limits of current medical theory again and again” (p. 132).
Among the improvisations discussed are François J.V. Broussais’ concept of functional lesions and Benjamin Brodie’s description of spinal irritation. Of particular interest is Hodgkiss’ analysis of the influential theory of specific nerve energies presented by Johannes Müller in 1838. He argues that Müller intended to describe not a specific sensory response of dedicated nerve fibers, but the mechanism of Gemeingefühl, or cenesthesis, the organism’s ability to perceive its internal sensations. Lesionless pain, understood as a disorder of cenesthesis, was physiologically equivalent to pain resulting from the lesions of an injury or illness, in that the state and activity of the nervous system were the same.
The separation of lesionless from lesion-based pain, in Hodgkiss’ account, followed not the localization and tracing of the somatosensory nerve pathways by neurophysiologists, but the definition of professional boundaries and the development of diagnostic methods by clinicians. As neurologists defined their field and improved their skills of examination and recognition of meaningful signs, they began to exclude many forms of “neuralgia” from their practice. At the same time, alienists and psychoanalysts were learning to read the patient’s complaints of pain as evidence of mental or emotional disease.
A fascinating story, in which the pain clinician will see echoes of his own dilemmas in the writings of an earlier time and the reader with even a mild historical interest may come to a new realization of how important—though unacknowledged—a role the problem of pain has played in the history of medicine.
Marcia Meldrum is codirector of the John C. Liebeskind History of Pain Library at the University of California in Los Angeles.