December 24, 1997

Ingenious Pain

Author Affiliations

Benton, Ill


by Andrew Miller, 337 pp, $24, ISBNO-15-100258-4, New York, NY, Harcourt Brace &Co, 1997.

JAMA. 1997;278(24):2194. doi:10.1001/jama.1997.03550240086047

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Imagine a man untouched by pain. Consider the possibility of an individual who until his late twenties has never experienced suffering. No, this is an episode of "The X-Files" or a comic book character but rather the premise of a splendid novel, Ingenious Pain. It is a book so unique and powerful that it dares to begin with the autopsy of its main character.

Dr James Dyer is an 18th-century English physician who is both a prodigy and enigma. He is an illegitimate child who enters the world without crying at birth and discovers he is insensitive to pain. He cannot be hurt. Unlike the rest of us, even life is unable to teach the young Dyer how to suffer.

In an age devoid of miracles and characterized by limited medical skills, Dyer becomes a remarkable surgeon though only in his early twenties. Dyer is an efficient cutting machine, a