August 28, 2015

Dr Jenner's Dead Cut

In the summer of 1808, the already famous Gloucestershire doctor, Edward Jenner, was in London, having a miserable time. The inventor of vaccine inoculation against smallpox was stuck in the City, waiting on the interminable bureaucracy of Parliament to finalise the details for the National Vaccine Establishment. He had many enemies: anti-vaccination pamphleteers who thought his ideas were eyewash; other vaccinators who coveted his glory; and personal nemeses who seemed to block his every move. Holed up in a place he abhorred, Jenner appealed to his friends for succour, but found them wanting. He perceived his opponents, ‘by the most abominable falsities’, endeavouring ‘to ruin my private character’. So much he could bear, ‘but when I find that no friend has step’d forth even to hold an Umbrella over my head it makes me feel miserable’. He went home at the end of the year, only to find out that events had unfolded to his distaste. The new Establishment was to nourish his enemies, and to dishonour Jenner himself. In desperation, he solicited advice: ‘I may most piteously exclaim, what shall I do?’ he asked Thomas Pruen. Pruen’s reply was dismissive: ‘I am sorry for your situation, but can afford you no kind of assistance’. Jenner felt this as a ‘dead Cut’ and told Pruen so:

Dr Jenner's Lancet, Science Museum London, Wellcome Images

What if a Man had met with an old Friend who had tumbled into a Cellar or any other kind of pit & had broke his bones & had pass’d by heedless of his moanings, saying I am sorry for you but cannot stay to help you out, because I have a pressing engagement, that I must attend to in another quarter? Would this have been balsam to his Wounds or a Caustic?

A month later, after some cooling off and some mollifying correspondence, Jenner announced that ‘the Cut is heald’.

Until recently, such talk would have been filed under metaphor and left at that. Jenner was miserable, but not in pain. The ‘cut’ wasn’t real. Recent studies on the ways in which pain experience is managed by the brain have begun to change our approach, casting new light on the affective pain utterances of historical actors. We’re now in a position to say, at least tentatively, that Jenner’s misery hurt.

How so? The turn towards affect in both historical studies and the neurosciences has foregrounded the importance of emotions in giving meaning to, or in defining, painful experiences. In fact, without stimulation of the affective centres of the brain, there is no experience, only pain. On the one hand, studies of people with the rare condition of pain asymbolia have found that without affective involvement, pain is meaningless. People with this condition are fully able to sense pain, but completely unable to interpret it. Bodily injury elicits no fear, no anxiety, no compulsion to flee or fight. A hand is put into the flame and it burns, but there is no reason to withdraw it. On the other hand, there are people who have no bodily injury whatsoever, but who feel the effects of, for example, social exclusion, as physical pain. Brain imaging has discovered that brain activity in affective centres under such conditions accords with what you would expect to see in a person suffering a physical injury. In sum, physical pain requires an emotional component in order to be experienced as pain, while certain ‘negative’ emotions are experienced physically as painful.

What’s the point? The science of pain is finally catching up with what sufferers have known all along: when they communicate that their body is in pain, they’re not making it up. But the specifics of the communication are contextually grounded, culturally formed. To take such utterances seriously is to entertain new potentialities in the history of experience. Much of the emotional suffering of the historical record – hysteria, melancholia, nostalgia, for example (to all of which Dr Jenner was prone) – has been under-treated by the history of medicine, in accord with twentieth-century medicine’s dualistic predilections, where pain is physical and suffering is only emotional or psychological. To enter into the historical experiences and meanings of suffering is to open up the possibility of understanding and interpreting the emotional and physical worlds of historical actors. Both the history of the body and the history of mentalités become united in a monistic history of experience that sets out to understand the dynamic relationship among emotions, their expression, bodily sensations and bodily practices.

This post first appeared on Emotions in Dialogue. You can pre-order Edward Jenner here and here

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