Publications
APS Bulletin • Volume 9, Number 2, March/April 1999
History of Pain
Marcia Meldrum, PhD, Department Editor
Travels in the East: A Livingston Story
Marcia Meldrum, PhD
DEPARTMENT EDITOR'S NOTE: Members attending APS's 20th anniversary meeting in San Diego received copies of a new book from IASP Press, Pain and Suffering, the first publication of a "lost" manuscript by William K. Livingston (1892-1966), a pioneer pain researcher. The book (Livingston, 1998) tells the story, as Ron Melzack writes in his preface, of "an adventure in ideas," a lifelong quest to understand the nature of pain. The original manuscript is in the William Livingston papers, which are part of the John C. Liebeskind History of Pain Collection at UCLA. Here I draw on some additional material from the papers to tell a little more of the Livingston story.
EDITOR'S NOTE: The quotations in this article do not carry specific page numbers. Please refer to Pain Notebook, William K. Livingston Papers, Box 1, Folder 21, John C. Liebeskind History of Pain Collection, Louise M. Darling Biomedical Library, UCLA.
In the early 1950s, William K. Livingston, chairman of the department of surgery and director of the Pain Project at the University of Oregon, made several trips east to laboratories that were conducting research that appeared to have some bearing on the problem of pain. Among the researchers he visited were Donald Hebb and Herbert Jasper at McGill, Warren McCulloch at MIT, Henry Beecher and Mary Brazier at Massachusetts General Hospital, Paul McLean and Jose Delgado at Yale, Dave Rioch at Walter Reed Army Hospital, and John Lilly at the National Institutes of Health (NIH). The senior scientists introduced him to their fellows and junior colleagues. The day after he had his second meeting with the young Ronald Melzack in Montreal, McCulloch introduced him to "a Dr. Wahl." Livingston kept careful notes of his visits, which he later typed and filed in one of the large black binders he was using to compile research for his next book. These notes document a growing interest in pain in many American laboratories and much original thinking, even at that early date.
There was much discussion of Hardy, Wolff, and Goodell's recently published book, Pain Sensations and Reactions; most of the researchers found this work interesting but were unconvinced by the analgesic comparisons (Hardy, Wolff, & Goodell, 1952). When Livingston visited Massachusetts General Hospital in 1953, he found that Beecher's "copy of their book is underlined and marginally annotated with exclamations like mine." Beecher had outlined a new idea he had for estimating the severity of pain in postoperative patients by comparing the percentage of relief received from the first, second, third, and subsequent doses of morphine, but Livingston was not impressed. Livingston wrote, "He tried to explain... how drugs could be graded against each other by this method, but certainly didn't make it clear." Just as Beecher was critical of Hardy, Wolff, and Goodell for their use of experimental subjects to measure pain, so Livingston was dubious about the anesthesiologist's use of postoperative patients:
I'm not at all sure that the pain suffered by a previously well person for a brief period of days after a surgical operation is comparable to long-continued suffering which affects both mind and body... Nor do I believe that any kind of measurements of pain intensity or drug comparisons can be relied upon... because the base-line is constantly shifting.
Livingston drove across the Charles River, where he found Warren McCulloch "on the top floor of an old, temporary wooden structure in one corner of the MIT area... unable to do much of any work for the past three months because of the flimsy construction of the building which transmits vibrations from the streets." Nevertheless, Livingston wrote, McCulloch thought "his present set-up is ideal for doing decisive work," with an "adequate budget" and Walter Pitts and Jerry Lettvin on his team. He "wanted to hear all about our work—called in Walter—I was surprised at their enthusiasm."
Warren McCulloch explained his method of making "very searching explorations of the cord areas": depression of spontaneous activity with nembutal, severance of cord from brain, and cooling, then sending in a series of volleys and recording output. From these, they mapped "a squared lattice of potentials—so as to be able to identify 'sinks' or sources." The slowest fibers recorded "go to the substantia gelatinosa—the activity here hangs on for a long time."
Livingston had first met John Lilly, "a tall slender Bostonish lad" from the University of Pennsylvania, at an Association for Research on Nervous and Mental Disorders meeting in 1951, and talked to him later on the plane. Lilly was then recording brain activity in animals, using a setup of 25 electrodes implanted in an 8-mm-square area of the cortex, connected to a bank of 25 lights that brightened or dimmed to show cortical activity. "The first thing that impressed him was the tremendous difference" between cortical activity in an anesthetized monkey—"large and slow sweeps"—and the awake animal, which displayed "a constant play of activity playing over cortex like the kaleidoscopic lights that are thrown on skaters at an ice show." These observations fascinated Livingston, who was particularly interested that Lilly "was not getting a linear view of cortical activity" as from an EEG, but "a 2 dimensional pattern, with the implication of a third dimension." In 1954, Livingston visited Lilly again at NIH, where he also met with Wade Marshall, William Landau, and Karl Frank. They talked about Lilly's continuing work with cortical recording, his experiments with human sensory discrimination and sensory deprivation, and the finer points of instrumentation, while other members of the group "interrupted us to argue more about 'pain.'" Frank had been using tooth pulp stimulation on himself and on recovering addicts at the Public Health Hospital in Lexington, KY, finding that no analgesic drugs appeared to alter the pain threshold at all. He suggested that the only good "test for pain would be a 'don't-give-a-damn' measuring machine." Livingston also stopped at Walter Reed while in Washington in 1953 and 1954 and talked with Rioch, Robert Galambos, and "Marrazzi" (probably Moruzzi). He wrote of that visit: "It wasn't always possible to follow Dave Rioch" as he talked about "various 'levels' of consciousness and behavior" and "used many of the terms of the 'cybernetics' group in talking about 'communication'—feedbacks, etc... The more the feedback fails to harmonize the output with the situation, the greater the stress on the organism and the more prone it becomes to revert to 'lower levels'." He illustrated this concept with the story of a lab cat who reacted to a persistent noxious stimulus with mild resistance, then aggression, then attempted flight, and finally exhausted apathy. Rioch doubted "that pain is a primary sensation subserved by special endings... thinks that pain must have a 'conscious' element... always the element of 'What must be done about it?' in every pain experience."
Livingston brought reports of his group's pain studies to his colleagues and took back notes of their work to Oregon, where they went into the growing file he was compiling for his book. He also shared with his hosts news of research elsewhere, telling Rioch this, for example, of Weddell's work: "I am pleased to hear about it." In the absence of a pain society, or a journal such as Pain or Pain Forum, personal journeys like Livingston's and John Bonica's formed a template for a pain community in formation.
References
Hardy, J.D., Wolff, H.G., & Goodell. H. (1952). Pain sensations and reactions. Baltimore: Williams & Wilkins.
Livingston, W.K. (1998). Pain and Suffering. Seattle: IASP Press.