_ CHAPTER VIII. PAIN AND THE WILL
"That the will is infinite and the execution confined."
Troilus and Cressida.
The symptom of disease that humanity dreads the most is pain. Fortunately, it is also the symptom which is most under the control of the will, and which can be greatly relieved by being bravely faced and, to as great an extent as possible, ignored. It requires courage and usually persistent training to succeed in the relief of severe pain in this way, but men have done it, and women too, and men and women
can do it, if they really want to, though unfortunately all of the trend of modern life has been in the opposite direction, of avoiding pain at whatever cost instead of bravely facing it. The American Indian, trained from his youth to stand severe pain, scoffed at even the almost ingeniously diabolical tortures of his enemy captors. After they had pushed slivers beneath his nails or slowly crushed the end of a finger, or put salt in long, superficial wounds that had bared a whole series of sensitive cutaneous nerves, he has been known to laugh at them, and ask them proudly, without giving a sign of the pain that he was enduring, whether that was all that they could do. It was just a question of the human will overcoming even the worst sensations that the body could send up to the brain and deliberately refusing to permit any reactions that would reveal the reflex torment that was actually taking place.
The war has done much to bring back the recognition of that diminution--to a great extent at least--or even almost entire suppression of pain which may occur, indeed almost constantly does occur, as a consequence of a man facing it bravely. We have been accustomed to think of the early martyrs as probably divinely helped in their power to withstand pain. Whatever of celestial aid they had, we know that martyrs for all sorts of causes, some of them certainly not divine, have exhibited some degree of this same steadfastness. Their behavior makes it reasonably clear that as the result of making up their minds to stand the pain involved, they have actually suffered so little that it was not difficult to suppress external manifestations of their sufferings. It is not merely a suppression of the reflexes that has occurred but a minimizing to a very striking degree of the actual sensations felt. We have many stories of the older time before the modern use of anaesthetics, which tell how bravely men endured pain and at the same time retained their power to do things. Indeed, some of them accomplished purposes in the midst of what would seem like supreme agony which made it very clear that pain alone has nothing like the prostrating effect that it is often supposed to have.
For we have well authenticated tales of physicians performing amputations on themselves at times when no other assistance was available, and accomplishing the task so well that they recovered without complications. A blacksmith in the distant West, whose leg had been crushed by the fall of a huge beam, actually had himself carried into his shop and amputated his own limb above the knee, searing the blood vessels with hot irons as he proceeded. Such a manifestation of will power is, of course, exceptional to a degree, and yet it illustrates what men can do in the face of conditions that are usually supposed to be overwhelming. Many a man in lumber camps or in distant island fisheries or on board fishing vessels, far beyond the hope of reaching a physician in time for him to be of service, has done things of this kind. We can be quite sure that the will to accomplish for himself what seemed necessary to save his life lessened his pain, made it ever so much more bearable and generally proved the power of the human will over even these physical manifestations in the body that are commonly supposed to be quite beyond any interference from the psychical part of nature. The spirit can still dominate the flesh, even in matters of pain, and dictate how much it shall be affected. It is a hard lesson to learn, but it is one that can be learned by proper persistence.
In the early part of the war particularly many a young man had to face even serious operations without an anaesthetic. The awful carnage of the first six weeks of the war had not been anticipated and therefore there were not sufficient stores of anaesthetics available to permit of their use in every case. Besides, many operations had to be performed so close to the front and under such circumstances that there could not be anaesthetics for all of them; and it was a never-ending source of surprise to those who witnessed the details to see how bravely and uncomplainingly the young men took their enforced suffering. Many a one, when his turn came to be operated on, quietly asked for a cigarette and then bore unflinchingly painful manipulations that the surgeon was extremely sorry to have to inflict. Over and over again, when there was question of the regular succession of patients, young soldiers in severe pain suggested that some one else who seemed in worse condition than they, or who perhaps was not quite so well able to stand pain and control himself, should be attended to before they were. There is no doubt at all that this very power of self-control lessened their pain and made it ever so much easier to bear and less of a torment than it would have been otherwise.
Any great diversion of mind that turns the attention completely to something else will lessen even severe pain so much as to make it quite negligible for the moment. Headaches disappear promptly when there is an alarm of fire, and toothaches have been known to vanish, for the time at least, as the result of a burglar scare. Much less than this is needed, however, and there are many familiar examples which illustrate the fact that the turning of the attention to something else will greatly diminish or even abolish pain.
The well known story of the French surgeon about to set a dislocation is a typical demonstration. His patient was a woman of the nobility, her dislocation was of the shoulder and it was necessary for him to inflict very severe pain in order to replace it. Besides, as the result of the reflex of that pain, he was certain to meet with great resistance from spasm in the surrounding muscles. It was before the days of anaesthetics, which relieve all of these inconveniences, and above all, relax the muscles. The surgeon got ready to do the ultimate manipulation that would replace the joint in its proper relation, and necessarily inflicted no little pain in his preparations. The lady complained very much, so he turned on her angrily, told her that she must stand it, slapped her in the face, and before she had recovered from the shock, the dislocation had been restored to the normal condition. It was rather heroic treatment, and it is to be hoped that she understood it, but it is easy to understand how much the procedure lessened her physical pain.
When the mind is very much preoccupied and the will intent on accomplishing some immediate purpose, even severe pain will not be felt at all. Instances of this are not rare, and men who are advancing in a charge on a battlefield will often be wounded rather severely, and yet continue to advance without knowing anything about their wounds until a friend calls attention to their bleeding, or they themselves notice it; or perhaps even loss of blood may make them faint. The late President Roosevelt furnished a magnificent illustration of this principle when he was wounded some years ago in the midst of a political campaign. A crank shot at him, in one of the Western cities, and though the bullet penetrated four inches of muscle on his chest wall, and then flattened itself against a rib, he did not know that he was wounded. The flattening of the bullet must have represented at least as much force as would be exerted by a heavy blow on the chest, and yet the Colonel never felt it. His friends congratulated him on his escape from injury until it was noted that blood was oozing through a hole that had been made in his coat. The intense will activity of the President simply kept him from noticing either the shock or the pain.
Not long before the war a striking example was given of how a man may stand suffering in spite of long years of the refining influences of a sedentary scholarly life, most of it spent indoors. The second last General of the Jesuits developed a sarcoma on his upper arm and was advised to submit to an amputation of the arm at the shoulder joint. He was a man well on in the sixties and the operation presented an extremely serious problem. The surgeons suggested that he should be ready for the anaesthetic at a given hour the next morning and then they would proceed to operate. He replied that he would be ready for the operation at the time suggested, but that he would not take an anaesthetic. They argued with him that it would be quite impossible for him to stand unanaesthetized the extensive cutting and dissection necessary to complete an operation of this kind in an extremely important part of the body, where large nerves and arteries would have to be cut through and where the slightest disturbance on the part of the patient might easily lead to serious or even fatal results. Above all, he could not hope to stand it in tissues that had been rendered more sensitive than before by the enlarged circulation to the part, due to the growth of the tumor, and the consequent hyperaemic condition of most of the tissues through which the cutting would have to be done and which were thus hypersensitized.
He insisted, however, that he would not take an anaesthetic, for surely here seemed a chance to welcome suffering voluntarily as his Lord and Master had done. I believe that the head surgeon said at first that he would not operate. He felt sure that the operation would have to be interrupted after it had been begun, because the patient would not be able to stand the pain and there would then be the danger from bleeding as well as from infection which might occur. The General of the Jesuits, however, was so calm and firm that at last it was determined to permit him to try at least to stand it, though most of the surgeons were sure that he would probably have to give up and allow himself to be anaesthetized before they were through.
The event then was most interesting. The patient not only underwent the operation without a murmur, but absolutely without wincing. The surgeon who performed the operation said afterwards, "It was like cutting wax and not human flesh, so far as any reaction was concerned, though of course it bled."
The story carries its lesson of the power of a brave man to face even such awful pain as this and probably actually overcome it to such an extent that he scarcely felt it, simply because he willed that he would do so and occupied himself with other thoughts during the process.
Such an example as that of this General of the Jesuits will seem to most people a reversion to that mystical attitude of mind of the medieval period, when somehow or other people were able to stand ever so much more pain than any one in our time could possibly think of enduring. We hear of saints of the Middle Ages who inflicted what now seem hideous self-tortures on themselves and not only bore them bravely but went about life smiling and doing good to others while they were under the influence of them. It would seem quite impossible, however, for people of the modern time to get into any such state of mind. Our discoveries for the prevention of pain have made it unnecessary to stand much suffering, and as a result mankind would seem to have lost some if not most of the faculty of standing pain. So little of truth is there in any such thought that any number of the young men of the present generation between twenty and thirty, that is, during the very years when mankind most resents pain and therefore reacts most to it, and by the same token feels it the most, have shown during this war that they possessed all the old-fashioned faculty of standing pain without a whimper and thinking of others while they did it.
Lack of advertence always lessens pain and may even nullify it until it becomes exceedingly severe. In his little volume, "A Journey around My Room", Xavier de Maistre dwells particularly on the fact that his body, when his spirit was wandering, would occasionally pick up the fire tongs and burn itself before his
alter ego could rescue it. Concentration of attention on some subject that attracts may neutralize pain and make it utterly unnoticed until physical consequences develop. Undoubtedly dwelling on pain, anticipating it, noting the first sensations that occur, multiplies the painful feeling. The physical reasons for this are to be found in the increased blood supply consequent upon conscious attention to any part, which sensitizes the nerves of the area and the added number of nerve fibers that are at once put into association with the area by the act of concentration of the attention. These serve to render sensation much more acute than it would otherwise be. It might seem impossible to control the attention, but this has been done over and over again, even in the midst of severe pain, until there is no doubt that it is quite possible. As for the increase of pain by deliberate attention, that is so familiar an experience that practically every one has had it at some time.
The reason for it has become very clear as the result of our generation's investigations into the constitution of the nervous system. The central nervous system, instead of being a
continuum, or series of nerve elements which are directly connected with each other, consists of a very large number of separate individual cells which only make contacts with each other, the nerve impulses flowing over across the contact. The demonstration of these we owe originally to Ramon y Cajal, the distinguished Spanish brain anatomist, to whom was awarded some years ago the Nobel Prize as well as the Prize of the City of Paris for his researches.
In connection with his surprising discoveries as to the neurons which make up the brain, he suggested the Law of Avalanche, which would serve to explain the supersensitiveness of parts to which concentrated attention is paid. According to this law, pain felt in any small area of the body may be multiplied very greatly if the sensation from it is distributed over a considerable part of the brain, as happens when attention is centered upon it. A pain message that comes from a localized area of the body disturbs under normal conditions at most a few thousand cells in the brain, because the area is directly represented only by these cells. They are connected however by dendrites and cell branches of various kinds with a great many other cells in different parts of the brain. A pain message that comes up will ordinarily produce only disturbance of the directly connected cells, but it may be transmitted and diffused over a great many of the cells of the cortex of the brain if the attention is focused strongly on it. The area at first affected, but a few thousand cells, may spread to many millions or perhaps even some hundreds of millions of them, if the centering of attention causes them to be "connected up", as the electricians say, with the originally affected small group of cells.
It is just what happens in high mountains when a few stones loosened somewhere near the top by the wind or by melting processes begin their course down the mountain side. On the way they disturb ever more and more of the loose pieces of ice and the shifting snows as well as the rocks near them, until, gathering force, what was at the beginning only a minor movement of small particles becomes a dreaded avalanche, capable not only of sweeping away men in its path but even of obliterating houses and sometimes of changing the whole face of a mountain area. Hence the expression suggested by Ramon y Cajal of the Law of Avalanche for this wide diffusion of sensation, which spreads from a few thousand to millions or billions of cells, and from a rather bearable pain becomes intolerable torture, as a consequence of the brain's complete occupation with it.
Now it is possible for most people, indeed for all who have not some organic morbid condition, to control this spread of pain beyond its original connections, provided only they will to do so, refuse to be ruled by their dreads and proceed to divert attention from the painful condition to other subjects. Here is why the man who bravely faces pain actually lessens the amount that he has to bear. There is no pain in the part affected. That we know, because any interruption of the nerve tract leading from the affected part to the brain eliminates the pain. In the same way, the obtunding of the nerve cells in the cortex by anaesthetics or of the conducting nerve apparatus on the way to the brain by local anaesthesia, will have a like effect. Anything then that will interfere with the further conduction of the pain sensation and the cortical cells directly affected will lessen the sense of pain, and this is what happens when a man settles himself firmly to the thought that he will not allow himself to be affected beyond what is the actual reaction of the nerve tissues to the part.
As a matter of fact, the anticipation of pain due to the dread of it predisposes the part to be much more sensitive than it was before. We can all of us readily make experiments which show this very clearly. Ordinarily we have a stream of sensations flowing up from the surface of the body to the brain, consequent upon the fact that the skin surface is touched by garments over most of the body, and that our nerves of touch respond to their usually rather rough surface. We have learned to pay no attention to these because we have grown accustomed to them, though any one who thinks that they are negligible should witness the writhings of a poor Indian under the stress of being civilized when he is required to wear a starched shirt for the first time. Ordinarily Indians have learned to suppress their feelings, but the shirt with its myriad points of contact, all of them starchily scraping, usually proves too much for his equanimity, and he wiggles and twists to such an extent as shows very clearly that he is extremely uncomfortable. Most people have something of the same feeling the first day that they change into woolen underclothes after they have been wearing cotton for months, and the sensation is by no means easy to bear with equanimity.
Ordinarily from custom and habit in the suppression of feelings we notice none of these contact sensations with their almost inevitable itchy and ticklish feelings, though they are constantly there, but we can reveal them to ourselves by thinking definitely about any part of the body. Such concentration of attention at once brings that part of the body above the threshold of consciousness, and we have distinct feelings there that we did not notice before. If for instance we think about the big toe on the left foot, immediately our attention is turned to it and we note sensations in it that were quite unnoticed before. We can feel the stocking touching any part of it that we think of. Not only that, but if we concentrate attention on a part most uncomfortable sensations develop. If anything calls our attention even to the middle of our backs, we find at once that there is a distinct sensation there, and this may become so insistent as to demand relief.
It is well understood now what happens in these cases. As we have said, the attention given to a part leads to a widening of the minute blood vessels located there so that the nerve endings to the part are supplied with more blood and therefore become more sensitive. We know from experience in cold windy weather that when the cheek is hyperaemic the drawing of a leaf or even of a piece of paper across it may produce a very acute painful sensation. Hyperaemia always makes parts of the body much more sensitive than before. Attention has just this effect over all the surface of the body, as we can demonstrate to ourselves. We can actually, though only gradually, make our feet warm by thinking about them, because the active attention to them sends more blood to them. The dread of pain then, by concentrating attention on the part beforehand, actually increases the pain that has to be suffered and makes the subject ever so much more sensitive. Sensitiveness is of course dependent on other factors, as for instance lack of outdoor air and of oxygenization, which actually seems to hypersensitize people so that even very slight pain becomes extremely difficult to bear, but the question of attention, which is after all almost entirely a voluntary matter, has more to do with making pain harder to bear than anything else.
In the preanaesthetic days, men have been known to sit and watch calmly an amputation of one of their limbs without wincing and apparently without undergoing very much pain. Many are the incidents in history of a favorite general who showed his men how to bear pain by calmly smoking a cigar while a surgeon amputated an arm or a leg or performed some other rather important surgery. Pain is after all like the sense of danger and may be suppressed practically to as great a degree. Once during the present war, when long columns of soldiers going to the front had to pass by the open market place of a town that was being shelled by the Germans, there was danger of the troops losing something of their morale at this point and of confusion ensuing. It would have been disturbing both to discipline and the ordered movement of the troops to divert them by narrower streets, and the shells, though dangerous, were not falling frequently and not working serious havoc. Every one knew, however, that the German gunners had the range, and a shell might land square in the market place at any time; thus there was a feeling of uneasiness and a tendency to nervous lack of self-control, with the inevitable confusion of movement afterwards. One of the French generals ordered an armchair to be brought out of one of the houses near by, took a position in the center of the square, with a little wand in his hand, and calmly joked with the soldiers as they went by about the temperature of the day mentioning occasionally something about a shell that happened to strike not far away. According to the story he was an immense man weighing nearly three hundred pounds, and so provided a very good-sized target for shells, but he was never touched and, almost needless to say, the line of soldiers never wavered while their general sat there joking at the danger.
It is sometimes thought that men in the older, less refined times could stand pain and suffering generally much better than our generation which is supposed to have degenerated in that respect. We have found, however, during the war that the soldiers who could stand supreme suffering the best were very often those who came from better-to-do families, who had been subjected to the most highly refining influences of civilization, but also to that discipline of the repression of the emotions which is recognized as an important phase of civilization. Strange as it may seem, the city boys stood the hardships and the trials of trench life better than the country boys and not only withstood the physical trials but were calmer under fire and ever so much less complaining under injury. After all it is what might be expected, once serious thought is given to the subject, and yet somehow it comes as a surprise, as if the country boy ought to be less sensitive,--as indeed he probably is; but he lacks that training in self-control which enables the city boy to stand suffering.
All our feeling that human nature has degenerated in physical constitution has been completely contradicted by the reaction of our young soldiers to camp and trench life. They have gone back to the lack of comforts and conveniences of the pioneer days and have had to submit to the outdoor life and the hardships that their pioneer grandfathers went through and have not failed under them. The boys have come out of it all demonstrating not only that their courage was capable of supporting them, but with their physical being bettered by the conditions and their power to stand suffering revealed in a way that would scarcely have been believed possible beforehand. _