Ingenious Pain by Andrew Miller

Andrew Miller’s ( and extraordinary first novel, Ingenious Pain (1997), concerns the curious defect that seems to be the source of Dr. James Dyer’s ‘genius’ for the knife. It is his inability, since birth, to feel physical pain. Drive a pin through his hand, tear off a thumbnail, break his leg, flog him raw: he feels nothing, and his flesh heals over with astonishing rapidity. How can this have come about? While skating by night on a frozen river, his mother impulsively coupled with a stranger, and thus was the boy conceived. An ancient theory – not yet entirely discredited, despite this being the Age of Enlightenment – holds that by means of what is called the ‘forming faculty,’ which mediates in complex ways between mind and body, a pregnant woman’s experience might somehow be imprinted upon her unborn child. A child conceived on ice would by this theory be cold.

So cold is the young James, so odd and mute, so impervious to pain, that he gives everyone including his mother the creeps. It’s not long before he’s taken up in best 18th century manner by a roguish huckster called Marley Gummer (possibly his father), who calls him a ‘most delightful, cold-blooded monster of a boy.’ James is put to work at country fairs, promoting a quack nostrum for pain relief. A gentleman scientist named Canning watches the boy performing and quickly divines his secret. Soon enough, James has been whisked off to Mr. Canning’s stately home, there to be studied along with other human oddities like the Siamese twins Ann and Anna, and what seems to be a mermaid: ‘A shape – a head? – skims just below the skin of the pool. There is a flash of bronze, a cry, gull-like, forlorn, awful. For an instant James sees it, outlined in the boil of its own movement; an eye, unmistakably human, unmistakably alien’.

The 18th century had a strong appetite for the freaks and peculiarities of the natural world, and Andrew Miller has cleverly deployed his various specimens so as to draw out characteristic features of the period: the casual cruelty and sheer hard slog of life; the gullibility and superstition of the popular mind; but mostly the vigorous new spirit of scientific inquiry, particularly in the fields of medicine and anatomy, then sweeping away established patterns of thought. Here the author sinks his thematic probes and comes up with the question: What would it mean for a man of the Enlightenment to be spared the distorting effects of physical sensation? For reason to have total sway over the suffering, fallible flesh and all its attendant emotions? Or, as a clergyman puts it late in the story: ‘What does the world need most – a good, ordinary man, or one who is outstanding, albeit with a heart of ice?’ This question permeates the narrative, although it never for a second slows it down. Miller knows the intellectual temper of his period, but he also understands how it tells its stories. He has appropriated for his purposes the picaresque of Sterne and Smollett, an episodic genre teeming with ribaldry, gusto and a delight in villains and dupes, along with an implicit conviction that life is dominated by chance, greed, treachery and malice.

James Dyer certainly sees the seamy side of 18th-century life. He leaves Mr. Canning – having glimpsed that gentleman’s own exotic physical secret – and returns to Marley Gummer and his companion, Grace Boylan, ‘former prostitute, though still available to those who favour a large, motherly sort of whore’.  After a night of serious drinking, Marley and James end up aboard a ship of the line, and thus, like Smollett’s Roderick Random, does James begin his career in medicine, as assistant to a naval surgeon.

Now his character begins properly to announce itself. He displays an utter disregard for physical danger and a callous indifference to the feelings of his fellows – both corollaries of his insensitivity to pain. His callousness serves him well when he takes over from the surgeon during a naval battle: ‘We brought the worst cases to him – dangling arms, crushed legs, gaping bellies – and he cut and sewed and pushed men’s innards back into their natural cavities. I swear to you, Sir, he took pleasure in it, this demonstration of his genius, and I cannot believe any man ever cut human flesh with a cooler head or a steadier hand. . . . The last occasion on which I saw your friend was when I was carried past the dispensary and happened to look in with my one good eye and see him there apparently dissecting a human hand’.

And it is here, in the very dawn of James’s distinguished career, that we glimpse the novel’s stark central paradox: to do good for others, it is not necessary to feel for them. A small but utterly chilling incident occurs a few pages on, when we see James back on dry land, at an inn in Bath, being propositioned by a maid. James feels her breast and finds two hard lumps. The girl tells him that her price is five shillings. He says he will not give sixpence for her. ‘In the gray rainlight of the passage she is already half ghost’. But he is not interested in cutting lumps from a breast. He has bigger fish to fry. He will remove gallstones in near-record times. He will successfully perform a Caesarean section. He will trepan the skull of a man kicked in the head by a horse, then hand him back to his friends, ‘feeble, bewildered, but very much alive’.

He will also shoot off a man’s nose in a duel, and then design and fit a prosthetic replacement made of polished ivory, attached to a pair of spectacles. He tells his patient: ‘It will outlast you, sir, by some considerable margin. You shall be outlived by your nose’. The patient is grateful. He bears James no ill will. ‘Between them is an odd complicity, peculiar perhaps to lovers, or to those who have offered each other death’. Peculiar to lovers indeed: the duel was fought over the injured man’s wife, with whom James had been conducting a torrid affair while living under their roof.

And so this peculiar, colourful, complicated story rattles on. James Dyer is hardly a sympathetic protagonist, but he is never dull. For at the heart of him is a splendidly intriguing mystery – that is, whether he actually has a heart – a mystery his maker keeps alive by slyly straddling two distinct paradigms, two contradictory modes of apprehending the world, the one magical, the other empirical. The upshot is that the reader has the sensation of being ignorant not merely as to where the narrative is headed but also under what sort of governing principles it is heading there. This uncertainty is pleasurable for the simple reason that we feel ourselves to be in such safe hands. Andrew Miller has researched diligently, and he writes a fine strong prose thickly larded with the sights, sounds and smells of the period, such that one is constantly delighted with strange and vivid imagery, fresh and startling metaphors, flashes of insight, deft twists of plot and resonant variations on dominant themes. He has also paced his story beautifully. Just as the question grows pressing as to where this is all going, comes the answer: Russia – Catherine the Great wishes to be inoculated against smallpox by an English doctor. Several of the best qualified will be assembled in London. The first to reach St. Petersburg will have the honour. James Dyer is, of course, among them, and he intends to win.

With this development a number of the novel’s strands begin to get spliced together. As a place of ice, a cold place, Russia has special meaning for James and his wintry soul. We sense too that the climax of his brilliant medical career will come at the finish of this race – and that the mystery of his heart will begin to unravel. We also prepare to enjoy a very 18th-century spectacle, the racing doctors, flying across the snowy wastes in pursuit of professional glory. James does reach St. Petersburg, and in the course of a most eventful journey the dark secret of his heart is subtly revealed. What follows is unexpected but perfect; suffice it to say that the element within him which has been repressed must, and does, return.

Ingenious Pain reminds one at times of John Fowles’s novel The French Lieutenant’s Woman ( and the wry historical intelligence manifest in every line of that book; also, a little, in the depth and honesty with which it explores its themes, of Graham Swift’s Waterland (; and, occasionally, in its fidelity to the tones and nuances of the period, of Peter Ackroyd’s early flamboyant historical pastiches. But in the end the book is entirely its own creature, a mature novel of ideas soaked in the sensory detail of its turbulent times. Working at that moment when ‘the secret arts of the old world’ still clung on, even as the West trembled before the bright future promised in the emerging age of reason, the novel displays a sort of inverted image of the present. Having seen the promise of the Enlightenment founder, and with it emerge a spreading skepticism about the applications of scientific knowledge, the contemporary world wrestles with competing paradigms and gropes for a renewal of old religious certainties. This subtle, negative resonance with our own times is just one of the many serious pleasures to be had from Ingenious Pain.

352 pages in Sceptre paperback edition

ISBN 978-0340682081

Andrew Miller

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