II. How can pain be identified?

Physicians in the 16th-18th centuries often mention their patients' pain without specifying the signs that allow them to recognize it. However, there are a number of documents that allow us to identify the signs of pain that were most frequently observed during this period:

  • Screams and moans are obvious signs of pain, especially in people unable to speak. In 1636, the physician Lazare Rivière refers to these “complaints” as an indication of the “cruelty” of the “abdominal pain” suffered by his 4-month-old babyLazare Rivière, Les Observations de médecine de Lazare Rivière, conseiller et médecin du Roi, et Doyen des médecins en l’Université de Montpellier [1646], trans. from Latin by F. Deboze, Lyon, chez Jean Certe, 1680, centurie II, observation XXVII, p. 222..

    Lazare Rivière - A Baby's Abdominal Pain
  • Some physicians list the different “characters” of pain in their theoretical writings: the patient's face is reddened, sullen, his eyebrows are turned down in a frown, his teeth are clenched; one examines or presses the painful area; his pulse accelerates; his fists tighten; his limbs retract.

    Marin Cureau de La Chambre - The Signs of Bodily Pain
  • A state of agitation in which the patient constantly changes position, indicating a profound level of pain, is described as “uneasinessFor instance in Marin Cureau de La Chambre, Les Charactères des Passions, t. IV, De la douleur [1659], Paris, Jacques d’Allin, 1662, p. 167.”.

  • When doctors want to warn about the vital need to relieve pain, they highlight its most harmful effects: prolonged sleeplessness or insomnia, anorexia, burning thirst, “extraordinary sweating“, fever, spasms and convulsions, syncope.

  • A number of diseases have typical pain symptoms, which can lead to a refined clinical description: nocturnal pain for syphilitic patients, or extreme sensitivity to sound and light caused by migraines.

    Thomas Willis - Rebellious Headaches

Thus, the patient's facial expression, gestures and certain physiological changes make it possible to detect pain that an injury or a specific complaint do not render visible.

Localizing pain

In his book La Présence des absents [The Presence of the Absent] (1642), Théophraste Renaudot provides a model for remote consultations, to make up for the lack of competent physicians in some regions.

The patient is supposed to use a pencil to indicate the area in which he is experiencing pain, circle the appropriate term (pain, itching, numbness, burning, stinging, abrasion...) and specify whether the pain is slight, moderate, strong or unbearableThéophraste Renaudot, La presence des absens ou facile moyen de rendre présent au Médecin l'estat d’un malade absent..., Paris, au bureau d’adresse, 1642, p. 15. The words are identical for men and women, but not the four images that represent male and female bodies from the front and the back.

For the face, the line is dotted if the pain is internal, continuous if the pain is external.

Today, children are sometimes asked to localize their pain using this type of non-gendered diagram: