On 18 February 1871, six-year-old Edward Lee was taken ill with ‘pain in the foot, then in knees and back’. Little Edward had been ‘the healthiest of the family’ until about two years earlier, when he had been an in-patient at Great Ormond Street Hospital for Sick Children in London, with ‘abscess on the Heel, & pains in limbs & joints’.Footnote ¹ He made a good recovery and had remained well until this new bout of pain. After being sick for three days – ‘hot and feverish, especially at night’, when he was restless and ‘in great pain’Footnote ² – his father took him back to the Hospital for Sick Children, where the institution’s founder, the physician Dr Charles West, diagnosed him with acute rheumatism and pericarditis. In September 1874, the ten-year-old girl ‘S.T.’ started complaining of ‘severe pain at the epigastrium’.Footnote ³ ‘S.T.’ had always been healthy until three months before the doctor was sent for, when she had started to suffer ‘of the same pain once or twice a week’, a pain that progressively worsened. The pain was so severe that the girl ‘soon became sallow’, developed an ‘abdominal aspect’ and ‘became quite unable to walk’, eventually succumbing to convulsions and screaming fits.Footnote ⁴ S.T.’s symptoms led the British doctor William H. Spurgin to diagnose hysteria. Almost seventy years later, in March 1941, four-year-old Patrick, ‘of pleasing appearance, well built and rather big for his age’, was sent to the Hampstead War Nurseries.Footnote ⁵ Soon after his mother left, separation became intolerable for Patrick. He refused to eat, play and speak and had to be moved around like an automaton. After a few days, he was reduced to a state of ‘compulsive formula and symptomatic actions’. Finally, Patrick entered a state of nervous compulsion, with a weak and rapid pulse, with no interest in the outside world and ‘with an absolutely tragic expression on his face’.Footnote ⁶ For the psychoanalyst Anna Freud, who was among the first to document how children suffered when separated from their parents during the Second World War, Patrick’s symptoms were directly related to ‘the pain of separation’.

Even though children were often deemed incapable of being able to articulate the nature and characteristics of their own suffering, the archives are full of children in pain. Children who cry out to us from the hospital, the asylum, the therapy session, the nursery and from the bombed cities of the Second World War. Their voices and the accounts of the physicians and scientists who diagnosed and treated them provide insights into the experiences of children from the past and provoke numerous questions about the perception, experience and treatment of pain in childhood. How did ideas of pain in childhood change between the 1870s and the middle of the twentieth century (the period covered by this book) and how do these shifts reflect the cultural beliefs, scientific disciplines and emotional worlds of those times? How and why did the physical and emotional discomfort of a child become understood and accepted historically, and how did this understanding lead to different kinds of clinical treatment? Which cultural elements configured the expression of children’s pain? And what were the cultural conditions that made those experiences possible in the first place? This book explores these questions historically, examining the forms of objectification of painful experience and the rhetorical modalities that have enabled the cultural understanding of childhood pain, with a focus on British medical discourse from the dawn of Darwinism until the advent of the welfare state. It covers the period from the 1870s, when Darwin published his A Biographical Sketch of an Infant (1877), thereby opening the door to the scientific study of childhood,Footnote ⁷ to the end of the Second World War, when there was an major shift in the way that the environments of children’s pain – the institution, the home, the street – were conceived.Footnote ⁸ It is, therefore, a contribution to current knowledge about both the experience of pain and the experience of childhood.

The cases of Edward, S.T. and Patrick show how, during the period under discussion, children’s pain became an unstable object that acquired different properties and meanings within different clinical and scientific disciplines. In this way, similar symptoms received radically different diagnoses and treatments, so that what was seen as ‘rheumatism’ in the late nineteenth century was viewed as ‘anxiety phenomena’ by the middle of the twentieth. This book also exemplifies how the shifts in the medical concepts of pain accompanied radical alterations in the experience and the sense-making of children’s pain. Pain, therefore, does not just have a body – it also has a history.Footnote ⁹

The Child in Pain

The proliferating historical analyses of medical and physiological constructions related either to suffering or to the remedies that prevent and treat it confirm that pain has become an important topic within the historiography of experience and emotions. However, despite the abundant and still-growing body of literature on the human relationship with pain, very little has been written about the historical experience of pain in children, possibly because of the methodological difficulties a history of a subjective phenomenon must confront. When the subject is studied not only as a locus of pain but also as a child in pain, this negative consideration of subjectivity is doubled: very few scholars of science have attempted to approach children’s subjectivity and recognise its irreducible autonomy.Footnote ¹⁰

Under similar coordinates, the ostensible referent of pain might seem doomed to invisibility – children are deemed incapable of properly articulating the nature and characteristics of their suffering. By exploring the attribution of meaning to children’s pain from a historical perspective, this book contributes to historiographical debates about the experience of harm. Situated between cultural history and the history of science, this study asserts that the persuasive forms used to relate to others’ experiences of pain are especially important in cases of individuals who either lack the ability to speak (such as animals) or who lack verbal dexterity (such as children).Footnote ¹¹ To cover this difficult topic, the study explores the physical, emotional and performative dimensions of pain from a cultural perspective – that is, it seeks to explore the relationship between the experience of pain in childhood and the social perception of that experience. This approach enables the understanding of how and why the physical and emotional discomfort of a child became understood and accepted historically, and how it led to clinical treatment and, in some cases, financial support. Through an analysis of written narratives and visual culture, this book emphasises the performative nature of pain as it was enacted in different contexts such as the hospital, the war nursery and the asylum. The drama of pain twists and turns behind and around the child in pain – usually a secondary subject of inquiry – and the sympathetic, impassive or oblivious onlookers, as each of them imbued pain with different meanings, values and emotions, thereby presenting pain as a by-product of a heterogeneous activity. For instance, in the children’s nurseries of the Second World War, the child in pain became a symbol of national resistance and courage in the face of the Blitz. If, as David Morris argues, pain is subjected to historical changes, this book addresses the nature of these shifts and how they are configured.Footnote ¹²

In looking at the figure of the child through the topic of pain, this book offers an approach informed by the history of medicine, the history of childhood and the history of science, yet it is also grounded in the history of emotions and the history of people’s experiences. In these already interdisciplinary fields, scholars theorise about the relationships between power, materiality and inequality in the making of cultural worlds. Taken together, these different areas of study provide indispensable tools for critical thought that can confront the cultural domination of existing hierarchies. Indeed, this book would not be possible without the already massive body of work of theorists who have articulated how the facts, institutions, technologies and meanings that comprise our bodies and worlds simultaneously exert power and exist in a situation of fluid contingency.Footnote ¹³ In looking at the history of childhood through pain, one can see how children’s experiences become the locus of ideological and disciplinary battle. Supplementing the most frequent methods that historians of science have used to shed light on hidden subjectivities, the present study draws on theoretical resources from interdisciplinary work. The objective is to bring childhood into the heart of discussions concerning the construction of historically situated cultural assumptions about human nature, medicine and the nature of suffering. Consequently, I juxtapose scientific figurations of the child in pain with those of other cultural contexts.Footnote ¹⁴ By engaging in a comparative study between different disciplines – physiology, paediatrics, psychiatry, psychology, and psychoanalysis – this book studies the various ways in which the child in pain came into being as a figure, as well as the many forms this figure has then generated. The construction of medical and scientific models of childhood pain reflects and creates a series of paradoxes and tensions in relation to the emergence and consolidation of the various scientific disciplines. The book also advances a strong claim: that the disciplines of physiology, paediatrics, psychiatry, psychology and psychoanalysis never agreed on a standard and unified theory of the child in pain. Instead, the interests of each individual discipline prefigured the way it explained and represented this figure.

This book examines the politics of diagnosis, through which the institution of medicine ascribes meaning or value to different states of pain and suffering, which in turn makes it possible to unveil or reconstruct the sense-making experiences of patients. In other – more explicitly Foucauldian – terms, the examination of authoritative medical discourses allows the framing of specific biopolitics that affect children in situations of harm, while the disciplinary archaeology operating within the margins of an interdisciplinary historical examination constitutes a taxonomy of bodies of knowledge that adopts a critical stance towards those institutionalised practices. At the same time, this approach opens a window that empowers the contemporary subject to deconstruct the often invisible discourses on the nature of pain, suffering and healing. The central argument is that, on the basis of the same symptoms or expressive signs, each discipline constructed its own figurations of childhood: the child without pain, the sick child, the insane child, the nervous child and the uprooted child. These different figurations, in turn, played a unique and constitutive role in the adult construction of worlds, particularly the worlds of nature and culture. To put it simply, the approach adopted in each chapter follows two lines. First, it describes the constellation of practices, materialities and knowledge through which a specific figure arises and is consolidated in the context of disciplines and epistemic communities. Second, it unveils how that figure contributes to broader cultural claims, both within and beyond the disciplinary realms.

One of the justifications for this book’s focus on the perceptions and practices of physicians and scientists regarding pain is that there are few surviving narratives of children’s personal experiences of pain. The detailed examination of the ways in which leading British physicians understood pain does not imply any wish to downplay or invalidate the experiences of pain suffered by the patients themselves. Rather, I suggest, understanding how medical professionals viewed their little patients’ pain is a valid and worthy subject in its own right, particularly because their understanding of pain played an important role in influencing their treatments and in making decisions about their patients, including whether any intervention was necessary.

In a book that covers different disciplines over nearly a century, it is not possible to adopt a uniform approach to sources or their modulations. The subject of this book – pain in childhood – is addressed by a loose community of ‘scientists’ that includes evolutionary theorists, physiologists, medical doctors, public-health officials, political gurus, eugenicists, psychiatrists and psychoanalysts. What unites the disparate band is an interest in the scientific study of childhood. I suggest that the diversification of knowledge about the human body and its treatment that took place during the nineteenth century and that was consolidated in the twentieth century turned children’s pain into an unstable object that was invested with different properties and meanings in each discipline: pain as a sign of illness, as a symptom of an organic lesion, as an element of a child’s emotional development and even as an aspect of a nation’s fortitude. In all cases, the study and understanding of pain follows the same sequence: examining the subject as a sign, taking it as evidence and finally considering it as a fluctuating object of a new science. A similar process can be observed in the intellectual understanding of pain, whether in science, medicine, philosophy, the social sciences or religion. While to the general scientist, pain might be a series of complex neural circuits, a medical professional might see the patient’s experience of pain more than a mere electrical sensation, while the historian or social scientist might focus on how humankind’s views of pain have changed from the idea that it is something that might be good for us (whether to build character, to encourage a change of behaviour or to build up our defences to cope with stronger pain), and whether today the lack of a ‘meaning’ in pain has reduced our ability to cope with it. In this context, I suggest that the figure of the child in pain appears in medical, scientific and popular discourses both in its own right and as a bodily theatre through which other stories are told. In so doing, I also suggest that the history of childhood is important not only with respect to children’s experiences but also as a way to understand how adult worlds are created and to deepen our understanding of the history of medicine and the emotions.Footnote ¹⁵ Asking how and why the figure of the child in pain has been used and categorised for wider cultural endeavours makes the child the focus of an analysis about how it has been deployed and valued in adult discourses.

Just as pain is a concept that does not have a single universal meaning, childhood has been seen differently across cultures and periods. The age at which ‘children’ are deemed to become ‘adults’ varies, and across the world today much variation can still be seen, both in legal terms and in practical ways.Footnote ¹⁶ In the period covered in this book, childhood was valued in terms of personal maturation, initially in a physical sense dominated by ‘biological benchmarks’, but increasingly regarding psychological transformation into adulthood.Footnote ¹⁷ For the purposes of this book, childhood covers the period from birth to puberty or adolescence.Footnote ¹⁸ The guiding principle here is drawn from medical treatises that make a distinction between childhood and puberty based on sexual development, which gives rise to a series of illnesses that are not suffered by children. However, this frontier is culturally bound and fuzzy, as the sexual element in puberty can be stimulated or deflected vis-à-vis the cultural conditions of a particular moment.Footnote ¹⁹ More generally, childhood is far from being a stable essentialised concept, as the extensive variations and partial overlaps between English words for non-adults show (‘child’, ‘kid’, ‘infant’, ‘baby’ and so on).Footnote ²⁰

Several recent historical studies of children have highlighted the fact that the adult population had a vested interested in the development of ‘normal’ healthy children for the continuation of national economic and political status, focusing on the significance of children as future citizens of the British Empire.Footnote ²¹ An analysis of the motivating factors shaping approaches to pain in childhood supports this argument to a degree. It was often a reason publicly presented by different individuals and groups as their source of concern, particularly in the earlier decades of the twentieth century, when issues of eugenics and social hygiene were still prominent.Footnote ²² Harry Hendrick suggests that one defining characteristic of the category of children is that they have no political significance.Footnote ²³ While it is true that individual children did not have the power to vote, this study aims to show that children were of immense political significance, and not only when adults debated child labour policy in the industrial West. In seeking to analyse historical variations in the notions of childhood, Anna Davin has argued that the attainment of adult status and adult authority is confirmed through control and/or support of children. In addition, adults have had the power to set the terms of childhood according to their priorities in the present and for the future.Footnote ²⁴ This study confirms this view by showing that, in many cases, the agents placing emphasis on the health of children in relation to the future of the UK often had different agendas, with alternative motivations, as they used the issue of child health and welfare for political or professional advancement.

Since the early 1990s, the historiography of childhood has swelled. Historians have engaged in the continuing study of the evolution of childhood as a concept, mapping out the social, cultural, economic and political context of the ‘birth of the modern child’.Footnote ²⁵ These efforts have highlighted the absence of adequate representations and understanding of children’s experience in the historic forms of medical and scientific disciplines.Footnote ²⁶ The effect of these varied ideas of childhood on the lives of children has been the focus of recent work on the history of childhood and the history of emotions.Footnote ²⁷ Nonetheless, the question of the child has rarely been considered in wider theoretical debates, and theorists have paid limited attention to the function and roles of the figurations of childhood in the making of adult worlds, resulting in consequences that conflict with the interests of those the category purports to represent.Footnote ²⁸ As Claudia Castañeda has pointed out, this lack of attention to childhood is significant because it means that children are not placed at the centre of social, political and cultural concerns.Footnote ²⁹ I align myself with this approach and attempt to reveal the processes grounded in scientific figurations and artistic representations that have shaped the cultural understanding of children’s experience of pain.

Although the category ‘child’ includes actual children and their experiences, this book does not specifically address that relationship. Although I am convinced that these assumptions affected children, it is not my aim to explain how this might have occurred. This book is, rather, about the creation of different figures of the child in pain and their multiple uses across various cultural sites. It argues that the study of the different categories of children’s pain provides an important context for understanding the emergence of other discourses on childhood in the nineteenth and twentieth centuries. It also offers an opportunity to explore the boundaries of psychiatry, physiology, paediatrics, psychology and psychoanalysis during this period. The scientific texts analysed in this book lead us to an important issue in the history of science, which is also a methodological problem that arises when practising interdisciplinary studies: the lack of scientific unity.Footnote ³⁰ A radical epistemology would see the object of study of each discipline as a disconnected entity: the infant brain of neurology, the infant body of paediatrics and the infant mind of psychology would find no common ground and no common language.

Rather than insisting on the historical disagreements between the disciplines, this book seeks to advance the understanding of the contemporary construction of the relationship between the mind and the body by uncovering the different meanings of children’s pain in the traditions of scientific and medical discourse. It may be surprising to modern readers – who might assume that there is a clear distinction between organic and psychological processes – that there was a considerable overlap between body and mind in much medical thinking in the nineteenth and early twentieth centuries. It is, for example, quite difficult to clearly separate the late nineteenth century speciality of neurology from the earlier discipline of ‘physiological psychology’.Footnote ³¹ Thus, this study illustrates how the variety and complexity of concepts of children’s pain transcended the simple dualistic perspective that treats mind and body as separate entities.

By placing the child in pain at the centre of the debate, this book draws attention to the importance of age as a category in modern medicine. Historians of pain have often overlooked age as a category, concentrating instead on gender as the organising principle of modern medicine. Martin Pernick has shown how, following the great ‘Chain of Feeling’, certain social groups – identified by race, class and gender – were seen as being relatively insensitive to pain.Footnote ³² Many scholars have since engaged with this idea, debating the politics of gender in relation to pain.Footnote ³³ This book argues that gender – though evidently crucial in medical perceptions of adults – was far less significant in the representation of the bodies and minds of children, a point similar to that made by Hannah Newton in her study of early modern England. When they described the constitution of children and the cause of their pain, doctors did not usually distinguish between boys and girls. The reason why gender rarely appears in the medical and scientific observations and treatments of children is probably that the characteristics that define children in medical opinion are largely related to puberty. This argument cuts against the current historical picture regarding children’s gendered identities, which suggests that gender was of considerable importance across the whole life cycle, from the moment of birth and – in particular – after the age of about seven.Footnote ³⁴ In making this argument, I am not seeking to suggest that gender did not affect other areas of children’s lives,Footnote ³⁵ but that, as this book demonstrates, in the context of children’s pain, the most important variable was age and the least important seems to have been gender.

Histories of Childhood and of Pain

Those interested in the existential significance of history – that which Nietzsche claimed as history for lifeFootnote ³⁶ – cannot ignore the importance of the historical study of childhood. Unlike many historical examinations that have an internal vision of periodisation and accuracy, the studies of many practising historians of childhood have a retroactive interest: they are concerned with the world in which they live and feel the urge to explain it through the yet untold ‘history of childhood’.Footnote ³⁷ As with the histories of sexuality, the emotions and the body, the history of childhood has also become a medium used to cast light on present-day situations, most notably situations of violence and abuse committed against children.Footnote ³⁸ It is not surprising therefore that it was precisely the revolution in approaches to history heralded by the French historical magazine Annales that led to a recovery of the child as an object of historical research and to the production of the first significant work on the history of childhood, Philippe Ariès’s Centuries of Childhood.Footnote ³⁹ This ‘new’ history, in approaching areas that had not previously been explored and in investigating the way in which different levels of society experienced the events of daily life, took into consideration social groups that until then had been little regarded and converted them into the preferred subjects of investigation. In the specific case of childhood, it can be said that Ariès’s study led to a surge in publications that have made the subject so fashionable today.

In the last two decades, the history of childhood has expanded considerably. As concerns about children have increased, stories about children of the past have proliferated. Despite these notable developments, the themes of childhood pain and medicine have rarely entered the historiography. Since the 1992 publication of In the Name of the Child: Health and Welfare 1880–1940 – Roger Cooter’s landmark collection of essays – there have been some advances in the historiography of children’s health.Footnote ⁴⁰ Themes that have been addressed (sometimes including consideration of the topic of pain) include children’s hospitals and health, disability and mental deficiency and mental health.Footnote ⁴¹ Hannah Newton’s The Sick Child in Early Modern England, 1580–1720, published in 2012, addressed and developed the issue of the sick child, raised by Cooter in his introduction to the 1992 essay collection, thereby filling one of the gaps in the historiography of child health.Footnote ⁴² My own project also emerges from one of Cooter’s observations and reflects on how, where and why the ‘concept of childhood became far more socially homogeneous by virtue of its reconstruction in predominantly psycho-medical terms’.Footnote ⁴³ I take a new perspective on the history of childhood health and welfare by focusing on an issue that has been a neglected but integral part of the life sciences since antiquity: children’s pain, its negotiation in medical and psychological practices and the underlying philosophical and political debates about the status of children.

Another of the objects of this new history is pain. Despite the recent proliferation of research about the way in which class, race and gender shape an individual’s experiences of pain, the child in pain has also been largely absent from the history of medicine. Joanna Bourke argues that the reluctance of historians ‘to tackle the history of pain’ results from its subjective character.Footnote ⁴⁴ Such subjectivity is doubled if the object of study is a child in pain. An extensive and still-growing body of literature in the humanities has been produced devoted to the subject of the human relationship with pain, but there has been hardly any serious discussion in the history of science and medicine about the systematic reliance on the bodies of children who suffer illness and pain as a source of knowledge about the normal child. Elissa N. Rodkey and Rebecca Pillai Riddell, who devoted an article to the subject in 2013, concluded that despite the importance of the historical record for studying medical assumptions of children’s experiences of pain, few published works have reviewed this history.Footnote ⁴⁵ The phenomenon of infant pain denial – which characterised many medical approaches to children during much of the twentieth century – can be seen as, in part, a consequence of the invisibility of the subject and the consequent lack of investigative focus on children’s experience of pain.

Although the history of children’s pain has stayed hidden to scholars until recently, earlier manifestations of theoretical interest in the history of child medicine cannot be neglected, as they include some insights on the nature of child pain from within specific disciplinary boundaries. From the start of the twentieth century, various paediatricians wrote histories of their specialism, of which the most famous are John Ruhrah’s Pediatrics of the Past (1925) and George Frederic Still’s The History of Paediatrics: The Progress of the Study of Diseases of Children (1931).Footnote ⁴⁶ The subtitle of Still’s book indicates the style of these works, which were written to celebrate the rise of modern paediatrics. They thus tend to be teleological in structure, attempting to uncover the past origins of current medical knowledge and to identify the ‘real condition’ behind the diagnosis. In opposition to the condescending view on past practices, this book explores historical medical views on children’s pain in their own terms, examining the coherence and logic of the medical ideas, however irrational they might seem from a modern perspective.

The child in pain is also mentioned in another context, that of current scientific and psychological articles of research into infant pain. Important articles in this line of research include those by David Chamberlain, who reviews twentieth-century infant pain research from an anti-circumcision perspective; Laura M. Carpenter who explores masculinity and circumcision pain from a sociological perspective; Patrick McGrath, who considers the history of infant pain research in the 1980s; Emilia Pabis, Anita Unruh and colleagues, who review ancient and medieval views of infant pain; and the already cited Elissa N. Rodkey and Rebecca Pillai Riddell, who investigate the origins of infant pain denial.Footnote ⁴⁷ The history of childhood pain has not been neglected entirely by historians. Hannah Newton’s The Sick Child in Early Modern England, 1580–1720 deals with pain in the context of children’s illnesses. In a similar way, Joanna Bourke’s The Story of Pain (2014) examines the history of child pain and calls attention to the way that the understanding of children’s pain has been revised. Bourke argues that for most of the twentieth century ‘many scientists and clinicians [claimed] that infants were almost totally insensible to pain’.Footnote ⁴⁸ However, the argument advanced in the current book is that this theoretical perspective describes only partially the medical, physiological and psychological theories and practices relating to children’s pain that existed in the United Kingdom at the end of the nineteenth century and in the early twentieth century.

Pain and Emotion

The Austrian philosopher Ivan Illich has drawn attention to the central role that culture plays in providing ways to experience, express and understand pain: ‘Precisely because culture provides a mode of organizing this experience, it provides an important condition for health care: it allows individuals to deal with their own pain.’Footnote ⁴⁹ It is through society’s norms and values that pain is culturally obtained and placed.Footnote ⁵⁰ It is not difficult to identify extreme cases in which cultural norms dictate what are unacceptable and acceptable pains. Certain pains, such as menstrual pain or some forms of psychological pain, are expected to remain unvoiced, while others, such as grief and mourning, are required to be displayed in public. As Joanna Bourke has pointed out, even when they are suffering, ‘people adhere to societal norms, rituals, and stories’.Footnote ⁵¹ One could thus say that there is no such thing as ‘pain’: there are only ‘people in pain’, who are joined to a specific society through their feelings and emotions. Thus, pain is not just a physical experience: it is an embodied experience to which meaning is attached through culturally validated and rhetorical artefacts, including societal classifications and norms, codified identities and even moral taboos.Footnote ⁵² There is no single and universally accepted meaning of pain. People who suffer pain appeal to all kinds of different value systems to frame their suffering with meaning.Footnote ⁵³ Similarly, susceptibility to pain has been taken as an indication of civilisation and sensitivity, while pain has also been dismissed as a mere product of neurology. In other words, pain has been read by people in many very different ways as they attempt to make sense of what they feel and to explain these feelings within a coherent worldview.

However, tacit and explicit social norms on what is proper, just and decorous are not the only masters of pain and its sense-making. The ways we express pain are very much influenced by the various theories – medical, religious and concerning the body – that are current at the time in which we live.Footnote ⁵⁴ Therefore, experiences of pain differ between individuals and from one social group to another, and they change according to geography and time. Contrary to the notion that the experience of pain is timeless, the meaning of pain arises from cultural and social interactions.

Rather than infecting the phenomenon of painful experiences with the virus of relativism, sociocultural determination opens the door to the work of historians and cultural theorists who can delve into the specifics of cultural manifestations at a given time. Hannah Newton has argued in The Sick Child that research on the experiences of illness and pain in childhood can be undertaken by studying their expressive metaphors.Footnote ⁵⁵ In The Story of Pain, Joanna Bourke also argues that sufferers in the past used metaphors as a way of conveying their pain, which gives scholars of pain some insight into the subjective experiences of historical individuals.Footnote ⁵⁶ In contrast, in The Body in Pain (1985), Elaine Scarry asserts that the experience of pain cannot be shared because of its essentially private nature. For Scarry, pain’s subjective nature borders on solipsism: it ‘does not simply resist language but actively destroys it’.Footnote ⁵⁷ Following a quite radical interpretation of modern theories of knowledge and perception, she argues that physical pain ‘has no referential content. It is not of or for anything, [and] resists objectification in language’.Footnote ⁵⁸ Despite opposition and criticism, this theory of an insubstantial, noumenal pain has encouraged a new line of scholarship in which the focus has moved away from pain as an entity towards exploring the narratives of ‘people in pain’. Theorists have had to wrestle with the problem that words often seem inadequate for expressing pain, with Virginia Woolf’s essay ‘On Being Ill’ often cited as evidence: ‘The merest schoolgirl, when she falls in love, has Shakespeare, Donne, Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.’Footnote ⁵⁹

In The Representation of Bodily Pain in Late Nineteenth-Century English Culture (2000), Lucy Bending challenges this point of view and argues that ‘physical pain does not entirely resist linguistic expression’ – or at least not to any greater extent than any other sensation or emotion.Footnote ⁶⁰ In fact, Moscoso’s Pain: A Cultural History (2012) reveals that pain experiences and their cultural meaning are based and built upon science, art and legislation. Moscoso sees pain as what Victor Turner in The Anthropology of Performance calls a ‘social drama’, a form of human experience that follows the ritual structure of rites of passage. In his view, the cultural historian should analyse the objectified forms of this subjective experience, together with the rhetorical means employed to relate experiences and expressions.Footnote ⁶¹ Joanna Bourke shifts the focus from ‘illness’ to the ‘body-in-pain’. While Elaine Scarry argues that pain and language are refractory, Bourke assumes that – either directly or indirectly – embodied suffering becomes entangled in social behaviour – whether in observing or adhering to social norms, in reluctance to follow them, or in outright disagreement with them – but always around the complex language of socialisation. According to this approach, certain kinds of pain – notably chronic pain – do not fracture language but rather generate a wide range of linguistic manifestations. Bourke, examining narratives of pain from a historical perspective, argues that it is possible to develop a historical understanding of pain and the different ways in which ‘people-in-pain’ handle it and continue to live meaningful lives.Footnote ⁶²

This book shares the view endorsed by Bending, Moscoso and Bourke that there are linguistic conventions in both fiction and nonfiction for discussing both subjective pain and the pain of others. One of the main goals of this book is to identify how these conventions function in specific historical moments in the discourses of doctors, scientists and in public discourses, thus contributing to the construction of the intersubjective level of discourse on pain – where intersubjective does not refer to the horizontal, dialogical negotiation of sense among subjects with exchangeable positions, but rather to the institutionalised and normalised patterns for determining states and subjects of pain, which are then inherited in exchanges among subjects. Since the methodologies offered by Moscoso and Bourke have not proved helpful for the study of children’s pain – precisely because they are constituted around metaphors and language – this book addresses the more difficult question of what happens in the case of historical subjects, such as children, who either lack verbal dexterity or do not have a recognisable cultural voice. Focusing on how certain adults – the paediatrician, the psychiatrist and the psychoanalyst – approached the experience of pain of their little patients, this study also explores the larger problem of how the historian can approach the past experiences of a person in pain.

As Bourke, Moscoso and Rob Boddice have shown, pain and its understanding as a phenomenon worthy of study beyond the life sciences is embedded in the literature on emotions and experience, and their importance for understanding historical processes. As Boddice argues, ‘as a form of experience, pain is affectively produced’.Footnote ⁶³ Although pain may not be merely an emotion, the experience of pain cannot be separated from its affective component. A child’s expression of a painful experience – whether it be a scream or an outburst of tears – is an emotional experience, closely related to the scene where it takes place and dependent on the child’s repertoire of expression and their own accumulated experiences. This book stands alongside other scholarship that convincingly argues that to treat emotions as entirely natural and independent of the self would, in Monique Sheer’s words, ‘depoliticize emotions by naturalizing them and endowing them with fundamental autonomy, thus denying their social and historical contingency’.Footnote ⁶⁴ As Bourke and historian Keith Wailoo have argued, pain is a political practice.Footnote ⁶⁵ Building on this politics of emotion, this book traces how over time the powerful question of children’s pain became a recurrent site for disciplinary and political conflict. In these battles, as we shall see, theories of children’s pain – medical, physiological, psychological and other views on children’s suffering – become a tool of social and professional power.

Finally, while writing this book, I have encountered some surprising reactions from those around me. These reactions suggest that the topic of the child in pain invites much conjecture. Like David Morris in his book The Culture of Pain, I was repeatedly struck by the consistency with which I was asked, over and over: Are you writing about children’s physical pain or emotional pain? This uniform reaction convinced me that Morris is right in his description of the ‘Myth of Two Pains’ in saying that we live at a time when many people have a deep and unexamined belief that physical and mental pain are separate entities, imagining that there is a huge gulf between them.Footnote ⁶⁶ However, different sources of pain do not necessarily imply different pains. One of the purposes of this book is to support those who want to reject the artificial division of human pain into categories labelled ‘physical’ and ‘mental’.Footnote ⁶⁷