‘We must remain absolutely silent on what we cannot talk about’. Wittgenstein’s interdict would surely apply to the mystery of human suffering; at certain intensities of pain it becomes literally as well as idiomatically unspeakable. Even to allude to the educative value of pain is to risk an inhuman glibness, a coldblooded reduction of the specificity of suffering to chill, abstract formulae. We must begin by confessing the ultimate intractability of the problem. Against pain and death we fight a losing battle; and the mystery, always insoluble, has, if anything, become more agonisingly problematic in our own time. Caring for the chronically and terminally ill has always been intensely difficult; in the modem world, technological advances notwithstanding, it has become immeasurably more so.

A world without anaesthetics would be a hell; deprived of analgesics even so routine an event as a visit to the dentist would be something to be dreaded and shunned. To avoid or to minimise pain is an instinctive natural reflex; the deliberate search for suffering is a perversion to which we give the name masochism. Yet it is equally true that a world without pain would be calamitous. Pain is essential to survival—without it we would perish. It is an early warning system, a defence mechanism, vital in preventive medicine against incipient and impending evil. Without pain teeth would rot insensibly in our gums, limbs quietly crumble to ash in the flames or be mangled beyond repair in the machinery, cancers placidly proliferate in our bodies. Once bitten, twice shy. The old adage crystallises the argument that pain educates, teaches us to avoid certain courses of action harmful or destructive to us. Pain is a necessary part of a rational world, regulating behaviour, signalling the need for treatment.