The Sensible and Insensible Body : A Visual Essay

Translating pain into tangible images brings it into the public consciousness, raising the spectre of bodily suffering as virtually intrinsic to the human condition. Beginning with Descartes, who famously advanced mind-body theories in the late seventeenth century, this essay explores the effects of his influence together with shifting attitudes towards pain and its role over the long nineteenth century.

The act of translating pain into images converts unique, isolated misery into tangible suffering, imaginable by other people.Pain that is often tucked away in some private, grey-tinged, shadowy space is abruptly allowed to flow into public consciousness, a well of red anguish.In this public sphere, the struggle that many sufferers face -that of distinguishing bodily from mental distress -is particularly acute.Famously, in the seventeenth century, René Descartes drew a distinction between the mind and the body [Fig.1]: this dichotomy dominated thinking throughout the nineteenth century.But, as people-in-pain have often discovered, embodiment is not a mechanistic process as Descartes would have it.The inextricable coupling of mind and body is eloquently observed in Virginia Woolf's On Being Ill (1930).'All day, all night', she writes, the body intervenes; blunts or sharpens, colours or discolours, turns to wax in the warmth of June, hardens to tallow in the murk of February.The creatures within can only gaze through the pane -smudged or rosy; it cannot separate off from the body like the sheath of a knife or the pod of a pea. 1 That inner creature who gazes out is a sociable 'self'.Anxiety and terror can encourage the development of communities of sympathy.The person-in-pain seeks succour [Fig.2].
When overwhelmed with pain as a child, for instance, Harriet Martineau's mother and father would 'tenderly' call for her to come to them, and she would rest her head on her mother's 'warm bosom […] and [wish] that I need never move again'. 2But visions of physical pain can also arouse cruelty.People-in-pain might be accused of fabricating their own rack upon which to writhe [Fig. 2 and Fig. 4].Physicians and other care-givers might be impervious to the sufferers' cries [Fig.3, Fig. 4, and Fig. 5].'Imperturbability' is an 'essential bodily virtue' for physicians, Sir William Osler famously declared in 1904, but might it be an ambiguous blessing for patients? 3Anaesthetics and effective analgesics silence the person-in-pain [Fig.6 and Fig. 7].Pain, once again, retreats to private, silent depths.The most influential model of pain is the mechanistic one espoused by philosopher René Descartes.In 'Meditations on First Philosophy' (1641), Descartes insisted that 'I have a body which is adversely affected when I feel pain'.He went on to say that Nature teaches me by these sensations of pain […] that I am not only lodged in my body as a pilot in a vessel, but that I am very closely united to it, and so to speak so intermingled with it that I seem to compose with it one whole. 4spite Descartes' attempts to show how body and mind 'intermingled', he became known for the Cartesian distinction between body and mind, arising largely from his famous image of the mechanism of pain, which was published in Traité de l'homme, fourteen years after his death. 5In this image [Fig.1], fast-moving particles of fire rush up a nerve fibre from the foot towards the brain, activating animal spirits which then travel back down the nerves, causing the foot to move away from the flame.According to this It was a profoundly influential theory, especially after it became the model of the body propagated by the founder of clinical teaching, Herman Boerhaave.Despite the fact that it has subsequently been dismantled, Descartes' way of conceiving of pain remained remarkably intact throughout the nineteenth and twentieth centuries.joints.According to the cleric and writer Rev. Sydney Smith, it was 'like walking on my eyeballs'. 8In this figurine the sufferer is surrounded by symbols of the cause of his affliction, that is, alcohol, rich foods, and other evidence of profligate living.Sufferers are responsible for their affliction.His son is shown sitting in a miniature chair with his foot slightly raised, indicating the hereditary nature of the disease.The gout sufferer is receiving succour from his wife.Representations of both the disease and the person providing sympathy are highly gendered.The image of the gout sufferer is almost without exception that of a middle-aged or elderly man, while the person responding with sympathy to the person-in-pain is typically a sexually attractive, young woman.'Surely', Nolan argued, 'in a matter of such magnitude to human nature', surgeons should pause before wielding their knives.This was particularly the case given 'the horrible fears that anticipation [of amputation] unavoidably excites in the patient's mind' and the 'excruciating pain' of the actual operation. 9As another critic put it in the 1850s, some physicians had acquired a 'taste for screams and groans' and were unable to 'proceed agreeably in their operations without such a musical accompaniment'. 10When effective anaesthetics were eventually introduced, many physicians argued against their use on the grounds that the tortuous pains of surgical operations were necessary to prevent haemorrhage.As the vice-president of the American Medical Association pronounced in 1849, pain was 'curative […].The actions of life are maintained by it.'Without 'the stimulation induced by pain', surgery would 'more frequently be followed by dissolution'.Indeed, the distinction between the two kinds of practitioners was not as great as it was to become later in the nineteenth century, with the introduction of state regulation and the professionalization of medicine.James Gillray's 1801 satire on 'Metallic Tractors' or Samuel Perkins's needles was an attempt to discredit 'quacks' [Fig.4].Metallic Tractors were two needles -one made of brass and the other of iron -with which practitioners would stroke painful afflictions as varied as rheumatism, gout, inflammation in the eyes, erysipelas, epileptic fits, locked jaw, burns, and all kinds of 'pains in the head, teeth, ears, breast, side, back, and limbs'. 12e pain of gout, Benjamin Douglas Perkins electrified' should hold the Metallic Tractor against the painful toe, effectively communicating his negative electricity to the inflamed toe. 13Tractors were sold in the UK for five guineas, or the annual salary of a female servant.
Gillroy's sketch pits an arrogant, charlatan physician against a 'True Briton' who has been over-indulging in alcohol.On the wall hangs a painting of Dionysus, riding on a West Indian rum barrel, and, on the table, punch made of brandy, tea, sugar, and lemons is brewing.The patient is experiencing extreme pain: his hands are clenched, his teeth are grinding, and his wig is falling from his scalp.His dog howls in sympathy.
'Metallic Tractors' were exposed as a fraud by Dr John Haygarth in Of the Imagination, as a Cause and as a Cure of Disorders of the Body (1800). 14Defenders of the Perkinean Institute, however, claimed to be able to prove the efficacy of the needle.
One defender of metallic tractors claimed to have cured a labouring man from Etton (Yorkshire) of 'violent Rheumatism in his right arm'.Afterwards, when the patient was asked his opinion of the operation, he replied that he thought it was 'very silly'.This response convinced the defender of the tractors that the cure had not been due to 'the imagination, but the Metallic Tractors'.Emile-Edouard Mouchy's oil painting of 1832 shows a 'physiological demonstration' of a dog inside a garret [Fig.5].The dog is tied to the table, which has been specially fitted with metal rings.The dog is clearly howling in pain but the overall arrangement of the painting is of scientific objectivity and manly rationality.Indeed, the painting was intended to valorize physiological experiments as central to scientific progress.There has been some speculation that the surgeon is François Magendie, the foremost French experimental physiologist who, in the 1830s, would start his lecture series by opening the abdomen of a dog.Do dogs like the ones in this painting truly feel pain?For vivisectors, the answer was simple: animals were close enough to humans to make such experiments worthwhile but not so close to make vivisecting them cruel.According to Descartes, animals were mere 'automa' or moving machines, driven by instinct alone.He believed that animals' screams of pain were simply mechanical responses, which functioned as a form of human moral edification. 16More commonly, scientists and philosophers of the early nineteenth century pointed to the existence of a hierarchy of sentience.After all, they insisted, isn't it the case that not all humans are equally sensitive?The ability to feel, both in terms of physical sensation as well as inner sensibilities, was ranked hierarchically.The regulation of vivisection -because it involved cruelty towards animals, but also on the grounds that allowing cruelty to animals would open the door to cruelty towards people -occurred earlier in the UK than in the rest of Europe.Indeed, British physiologists such as Sir Charles Bell were much more likely to emphasize dissection as opposed to the French tradition of vivisection.

Fig 1 :
Fig 1: René Descartes, 'The Path of Burning Pain', 1664.Wellcome Library M0014440 Descartes' filaments and animal spirit were converted into nociceptive impulses and endorphins, but his mechanistic metaphor and the Cartesian distinction between bodily pain and psychological suffering remained in place until Ronald Melzack and Richard Wall invented the Gate Control Theory of Pain in 1965. 7Their model showed how perceptions of pain were modulated by complex feedback systems.Context, including psychological cues, became central to the understanding of pain.

Fig. 2 :
Fig. 2: A Man Suffering from Gout and Surrounded by his Wife and Child.Wellcome Library L0058574

Fig. 4 :
Fig. 4: James Gillray, 'Metallic-Tractors', 1801.Wellcome Library M0010466 (the son of Samuel Perkins and the person who patented the Tractors in the United Kingdom) explained, was caused by a 'want of perspiration' in the toe which made it become 'positively electrified' while the 'other perspiring parts of the body [were] negatively electrified'.The pain would disappear if the 'equilibrium of electricity' could be restored 'by means of the distribution of the negative electricity in the body to the positive'.A healthy physician who was 'negatively Joanna Bourke, The Sensible and Insensible Body: A Visual Essay 19: Interdisciplinary Studies in the Long Nineteenth Century, 15 (2012) <http://19.bbk.ac.uk>