[Reprinted from The Medical News, June 17, 1893.] 
PAIN AND SHOCK. 
To the Editor of The Medical News. 
Sir : To the layman there are few medico-lay topics, if 
I may coin the word, which are of more interest than the 
relative amount of pain felt by individuals and races. 
A great deal of writing, most of it sentimental, but part 
of it pseudo-scientific, assumes that the capacity to suffer 
pain exists with tolerable equality in the different ranges 
of life, after the nervous system is developed at all, and 
that in man pain has been felt equally at different his- 
toric periods, and in different races of the same period. 
A great deal of the discussion on the ameliorating con- 
sequences of the use of chloroform and ether has, for 
instance, as its assumed premise, the implied assertion 
that the subjects under the knife of Pare, at the battle of 
Pavia, were conscious of as much pain as the subjects 
on the operating-table at Gettysburg. 
It has occurred to me, perhaps wrongly, that the extent 
to which patients suffer from shock under surgical 
operations is a tolerably fair gauge of the measure of 
nervous disturbance created by the operation, and this 
in its turn is but another name for pain. I was familiar 
in childhood with the fact that missionary surgeons in 
Southeast Turkey paid little or no attention to shock in 
their operations, or, to be more accurate, I never heard 
any allusion to shock as a thing to be considered at all. 
Dr. Henry West, one of the most skilful and distin- 
guished of the many men who have dedicated great 
ability to the obscure path of medical and surgical work 
at a missionary station (Livas, Turkey-in-Asia), I know, 
during a long experience, never found it necessary to 2 
pay any attention to shock in operations upon the 
natives. I venture to think that the following letter on 
the subject, which I have received from Dr. V. M. B. 
Thom, who has established a hospital in Mardin, Tur- 
key, may be of interest to members of the profession in 
this country, as throwing light on the subject of which I 
have just spoken. 
May I add that Dr. Thom has established the begin- 
nings of a medical school in connection with his hos- 
pital, and that any gifts of instruments, of books, and 
still more of pecuniary aid, will be of the utmost service 
in the work of this hospital and school, one of the great 
difficulties of the missionary medical teacher being the 
extreme poverty of those whom he is endeavoring to 
train, which prevents them from providing themselves 
with even the smallest appliances. There are many 
instruments laid aside for better inventions that might 
be given a useful term of service on missionary ground it 
they were contributed for this purpose. 
Dr. Thom, after alluding to a question of mine on the 
subject, says: 
'' I had forgotten that shock was such a formidable 
enemy to operations in America. In all my operations 
in Turkey I do not recall an instance where I had any 
unfavorable results from shock, and I have had patients 
on the table for two hours or more, submitting to very 
trying operations, having all ages, from the year-or-two- 
old child to the threescore-and ten or more. 
''Thiswinter I removed a very extensive cancer from 
the breast of a woman that would have been looked upon 
at home as delicate-not only the loss of an extensive 
amount of flesh, the loss of blood, and a very great 
strain upon the system in bringing the edges of the wound 
together and retaining them there, and yet we had not 
the indication of shock. Only recently I was called to 
a case of labor which had been three days in pain. It 
was an arm presentation, with a narrow pelvis. It was 3 
impossible to deliver the child until I dismembered it, 
and being dead before I called, I had less compunctions 
in doing so. Yet the woman showed no evidence ot 
shock. Time and again young brides, of from thirteen 
to fourteen years of age, will be in labor with their first 
child from three to five days, until they are all exhausted 
and worn out, but not an indication of shock. As to 
exercising any precautions after the operations in putting 
them to bed, with warm applications to keep up the cir- 
culation, or giving internal stimulants, hypodermatic or 
otherwise, I have never once had to do it." 
Respectfully, 
Talcott Williams.