The Introduction provides an overview of the central questions raised in the book, the arguments presented, and the methodology employed. It frames key questions about the shifting meanings of childhood pain and its implications for the construction of adult worlds. Additionally, it highlights the interplay between the child as an object of clinical observation and as a symbolic figure within cultural and scientific narratives. Through this lens, it contributes to broader debates on the intersections of science, emotion, and society. The methodology used is one of interdisciplinary history, drawn largely from the history of medicine and cultural history, which assesses visual as well as written material.

Pain following surgery continues to be a common experience in children, despite advances in acute pain management. The effective and safe management of pain in children of all ages requires significant knowledge of the biopsychosocial experience of pain and strategies available for its management. Numerous factors can influence the success of analgesic treatment: Developmental age has a profound effect on both the processing of nociceptive information and the response to analgesia; the pharmacology of all drugs is age and size dependent, requiring appropriate dosage adjustments; and communication with the very young or those with developmental delay can influence the ability to assess pain and monitor the response to treatment.

The vivisection debates are an undervalued nexus for nineteenth-century beliefs about pain. Close readings of the Report of the 1876 Royal Commission on Vivisection reveal how conceptualisations of animal physiology, anaesthetic action, reflex responses, and pithing undermined direct correspondences between injury, pain, and expressions of suffering. The chapter then examines representations of graphic registration and recording technologies in laboratory handbooks. These devices seemed to offer a new, universal, wordless language, yet frequently conjured precisely those images of inscription, symbolism, and transliteration that many scientists were anxious to avoid. The chapter then presents animalographies and antivivisection poetry ‘spoken’ by animals. By purporting to access a more complete and individual non-human consciousness, these texts presented themselves as rivals to mechanical laboratory devices. Nevertheless, despite efforts to ‘listen’ to animals, antivivisectionists and experimental scientists encountered the same vexatious problem: Language, like pain, seemed equally troubled by the distance between signifier and signified.

A 48-year-old man had complained about the painful soles of his feet for several months. This pain was present constantly but increased on touch and when walking. He was a marathon runner but could no longer train or walk properly because of the pain. He did not report weakness, sensory disturbances, discoloration of his feet, or swelling of his joints. Otherwise, he was healthy. He was not known to have diabetes mellitus or any other chronic disorder, such as sarcoidosis, which can cause a painful neuropathy. There were no cardiovascular or intestinal complaints, and no symptoms of autonomic dysfunction. Symptoms that could suggest malignancy were absent. He did not use any medication, had not been treated with any neurotoxic drug earlier, did not smoke, and drank only very limited amounts of alcohol. There was no family history of neurological disorders.

A 53-year-old man developed a left-sided foot drop and a painful sensation on the ventral side of the foot and outer part of the lower leg. Two weeks later, the same symptoms also developed on the right side. In addition, he noticed progressive numbness of his lower legs. Three weeks later, he noticed weakness of his right hand, and was unable to spread his fingers. He had no other symptoms, and his medical history was not informative. He did not recall a tick bite or erythema migrans, or any pulmonary abnormality, and had not visited tropical countries. He does not sit with crossed legs.

A 76-year-old man was referred with a diagnosis of ‘motor neuron disease’ or ‘polyneuropathy’. For about eight months he had noticed progressive muscle weakness in his right leg associated with pain, initially more intense than at referral, and a numb feeling around the right knee. Two years previously his left hand had become weak and wasted, associated with loss of sensation of the ring finger, the little finger, and the ulnar part of the palm of his hand. He had lost weight (5 kg) unintentionally over the past six months. He had always been very active, but was now no longer able to walk his dog or do some gardening. He was recently diagnosed with diabetes mellitus (DM) for which oral antidiabetics were prescribed. Family history was unremarkable.

A 33-year-old man was referred because of winging of the right scapula. History taking disclosed that seven months prior to referral he had experienced excruciating pain in the neck, irradiating to the right arm and thumb. The pain, which was particularly severe in the right scapular region, kept him initially awake and lasted for approximately six weeks. A week after the pain had started, he noticed having difficulty raising his right arm and hand. The latter is no longer present but at referral he still had a right-sided winged scapula and sensory disturbances of the radial part of the right medial forearm and of part of his thumb. Family history was negative for neuromuscular diseases.

One of the primary ways we encounter animals is as a food source. The dominant system of animal agriculture is “factory farming,” which is designed to produce the greatest amount of meat at the lowest possible cost. Factory farming is grossly inefficient from an ecological point of view, imposes enormous suffering on animals, and damages both humans and the environment. “Conscientious omnivores” reject factory farming but defend painlessly killing animals for food. Some defend hunting because they think it promotes other important values as well. These arguments are rejected by vegetarians and vegans, but they remind us that concerns about animals exist against the background of other values, including those that relate to the broader value of nature.

Many philosophers who endorse an environmental ethic are uneasy with animal protectionist philosophies. They reject sentientism – the view that sentience is necessary and sufficient for moral considerability – in favor of biocentrism, the view that being alive is necessary and sufficient for moral considerability. It is difficult to characterize both sentience and being alive in ways that are both informative and noncontroversial. Some environmental philosophers reject the individualism of both these views, and embrace instead holistic views that place such entities as ecosystems at the center of moral concern. Deep ecologists go even further, making it difficult to know how to live in accordance with their principles. Such views provide insight, but seem to abandon the fundamental questions of ethics.

The implications of unrecognized pain in those with MNCD are far-reaching.  Untreated pain can lead to the destabilization of psychiatric conditions such as anxiety, depression, and agitation.  Those with cognitive impairments are more likely to have longer waits for the evaluation of pain and receive weaker analgesia.As needed pain medications given to those with MNCD in the LTC setting may depend too heavily on the judgment of those inadequately trained to assess pain.  Regularly scheduled pain medications may be a more appropriate option. Always keep the possibility of medication error in the differential diagnosis for apparent changes in mental status. Inadequate pain control negatively impacts mental health in older adults.  Those with MNCD with inadequately controlled pain may present with atypical symptoms when compared to those without MNCD. Consider both pharmacologic and nonpharmacologic interventions when formulating a treatment plan for chronic pain in older adults. Opiates may have the best benefit/risk ratio for the treatment of chronic pain in some older adults.