Themes

"By reading a man does as it were antedate his life, and makes himself contemporary with the ages past. And this way of running up beyond one's nativity is much better than Plato's pre-existence, because here a man knows something of the state, and is the wiser for it, which he is not in the other."

"A man may as well expect to grow stronger by always eating, as wiser by always reading. Too much over-charges nature, and turns more into disease than nourishment. 'Tis thought and digestion which makes books serviceable, and gives health and vigour to the mind."

"Finally, from so little sleeping and so much reading, his brain dried up and he went completely out of his mind."

"Reading … is an activity subsequent to writing: more resigned, more civil, more intellectual."

"Reading is the way out of ignorance, and the road to achievement."

"To my mind there are no advantages and many disadvantages in lectures compared with reading."

"Libros lege. Quae legeris memento. Liberos erudi."

"Some books are to be tasted, others to be swallowed, and some few to be chewed and digested; that is, some books are to be read only in parts; others to be read, but not curiously; and some few to be read wholly, and with diligence and attention."

"People who read are a lot more tolerant and open-minded than those who don't."

"READING, n. The general body of what one reads. In our country it consists, as a rule, of Indiana novels, short stories in "dialect" and humor in slang."

"Read not to contradict and confute, nor to believe and take for granted, nor to find talk and discourse, but to weigh and consider."

"The thing I like about reading is that it puts you in charge. You can stop and start, you can reread something, and you can imagine what the characters and places look alike. When you read, you're participant in the story. When you're watching television, you're not."

"I write what I would like to read – what I think other women would like to read. If what I write makes a woman in the Canadian mountains cry and she writes and tells me about it, especially if she says ‘I read it to Tom when he came in from work and he cried too,’ I feel I have succeeded."

"Others such as these met him in the outer mountain and thought to mock him because he had not learned letters. And Antony said to them, 'What do you say? Which is first, mind or letters? And which is the cause of which— mind of letters or letters of mind.' And when they answered mind is first and the inventor of letters, Antony said, 'Whoever, therefore, has a sound mind has not need of letters.'"

"Reading maketh a full man; conference a ready man; and writing an exact man."

"The problem in our country isn't with books being banned, but with people no longer reading. Look at the magazines, the newspapers around us – it's all junk, all trash, tidbits of news. The average TV ad has 120 images a minute. Everything just falls off your mind. … You don't have to burn books to destroy a culture. Just get people to stop reading them."

"I read my eyes out and can't read half enough…. The more one reads the more one sees we have to read."

"God often works more by the life of the illiterate seeking the things that are God's, than by the ability of the learned seeking the things that are their own."

"Reading one book is like eating one potato chip."

"When we read, we are not looking for new ideas, but to see our own thoughts given the seal of confirmation on the printed page. The words that strike us are those that awake an echo in a zone we have already made our own—the place where we live—and the vibration enables us to find fresh starting points within ourselves."

"Properly, we should read for power. Man reading should be man intensely alive. The book should be a ball of light in one's hand."

"O thou covering yourself up! wake to worship during the night, even briefly, half of it, or shorter of it, or add to it, Then read Quran calmly. Wake by night is surely the appropriate and the most effective time for contemplation. Truly by daytime you have prolonged with occupation."

"The experience of pain needs cognitive, sensory, and affective components, as well as the necessary anatomical and physiological neural connections. Nociceptors first appear at 10 weeks of gestation in the fetus but they are not sufficient for the experience of pain in themselves. That requires that electrical activity is conducted from the receptors into the spinal cord and to the brain. Fibers to nociceptor terminals in the spinal cord have not been demonstrated before 19 weeks of gestation, although it is known that the fetus withdraws from a needle and may exhibit a stress response from about 18 weeks. At this stage, it is apparent that activity in the spinal cord, brain stem and mid-brain structures are sufficient to generate reflex and humoral responses but not sufficient to support pain awareness. At the same time, completion of the major neural pathways from the periphery to the cortex, at around 24 weeks of gestation, heralds the beginning of further neuronal maturation. The proliferation of cortical neurons and synaptic contacts begins prenatally but continues postnatally. Magnetic imaging techniques have recorded fetal auditory and visual responses from 28 weeks but it has not been possible to record directly when cortical neurons first begin to respond to tissue damaging inputs, although there is evidence of neural activity in primary sensory cortex in premature infants (around 24 weeks). It has been suggested that subcortical regions can organise responses to noxious stimuli and provide for the pain experience complete within itself but there is no evidence (or rationale) that the subcortical and transient brain regions support mature function. Thus, although the cortex can process sensory input from 24 weeks, it does not mean that the fetus is aware of pain. There is sound evidence for claiming the cortex is necessary for pain experience but this is not to say that it is sufficient."

"[N]one of us has any memory of the pain of being born, which is not to say that birth, from the fetus’ point aaof view, could not still have been a painful process."

"[I]n the previous report, it was recommended that the use of analgesia be considered where the fetus was over 24 weeks of gestational age. However, this more recent review has concluded that the evidence that the fetus can and does experience pain is less compelling and accordingly the benefit of administering analgesia is less evident, while the risks and practicalities of so doing remain. So on the basis of ‘first do no harm’, prior to the procedures described in this report, analgesia is no longer considered necessary, from the perspective of fetal pain or awareness."

"Will the baby be in pain in the womb because of the condition that has been diagnosed? This is very unlikely. Current research shows that the sensory structures are not developed or specialised enough to respond to pain in a fetus of less than 24 weeks. Even after 24 weeks it is difficult to say that the fetus experiences pain, because this, like all other experiences, develops postnatally along with memory and other learned behaviours. Moreover, the environment of the womb is usually protective with the fetus floating in the warm amniotic fluid."

"Does an anaesthetic or the pain relief I receive affect the baby? If you are given a general anaesthetic for a diagnostic procedure, the substances used in this will cross the placenta to the baby. The effect will happen more slowly to the baby and will not cause any harm to the baby. If you are given other forms of pain relief, there is evidence that they will cross the placenta to the baby, but the doses are not large enough to cause any harm."

"Can the baby be given pain relief? No. Current research shows that the sensory structures are not developed enough or specialized enough to respond to pain in a fetus of less than 24 weeks. See question on ‘Will the fetus/baby feel pain?’ In later pregnancy, when the fetus/baby is over 24 weeks, we do not yet have enough knowledge to know if providing pain relief would be beneficial. This means that it is extremely difficult to know what kind of pain relief should be used, how any pain relief should be given and whether it would be safe and effective. If pain relief was to reach the baby inside the womb, this would mean giving the mother larger and potentially dangerous doses to try and make sure enough crossed the placenta to the baby. This may cause more harm than benefit. Injecting pain relief drugs directly into the baby would increase the risk of miscarriage."

"Will the baby suffer/feel pain? No, the fetus does not experience pain. In addition, increasing evidence suggests that the fetus never enters a state of wakefulness inside the womb and that the placenta produces chemicals that suppress nervous system activity and awareness. Feticide is always offered when an abortion is carried out after 21 weeks and 6 days, unless the fetal abnormality is lethal and will cause death of the fetus during or immediately after delivery. A doctor who is specially trained in fetal medicine carries out feticide. To ensure the baby is not born alive, the doctor will inject a solution of potassium chloride directly into the fetal heart. Before anything else is done, the fetal heart will be checked to ensure it has stopped. Death is extremely quick after feticide."

"[A]s current evidence indicates the inability of the fetus to experience pain, certainly before the end of the second trimester, it should not be necessary to consider the need for fetal analgesia."

"The implications for clinical practice of the neurobiological evidence presented in section 2 have been considered. Interpretation of existing data suggests that cortical processing and therefore fetal perception of pain cannot occur before 24 weeks of gestation. It is reasonable to infer from this that the fetus does not require analgesia for interventions occurring before 24 weeks of gestation. Diagnostic or therapeutic procedures that involve the fetus directly are very uncommon but do occur and can be associated with a stress response. However, this does not indicate that the fetus is aware or can feel pain. The case for administering analgesia before an invasive procedure (in addition to maternal general anaesthesia) after 24 weeks when the neuroanatomical connections are in place, needs to be considered together with the practicalities and risks of administration of fetal analgesia in continuing pregnancies and the uncertainties over long-term effects. Evidence that analgesia confers any benefit on the fetus at any gestation is lacking but should be a focus of future research that will need to include medium and longer-term as well as immediate outcomes."

"Will the fetus/baby feel pain? No, the fetus does not experience pain. Pain relates to an unpleasant sensory or emotional response to tissue damage. To be aware of something or have pain, the body has to have developed special sensory structures and a joined-up nerve system between the brain and the rest of the body to communicate such a feeling. Although the framework for the nervous system in the growing fetus occurs early, it actually develops very slowly. Current research shows that the sensory structures are not developed or specialised enough to experience pain in a fetus less than 24 weeks. After 24 weeks, it is difficult to say that the fetus experiences pain because this, like all other experiences, develops postnatally along with memory and other learned behaviours. In addition, increasing evidence suggests that the fetus never enters a state of wakefulness inside the womb. The placenta produces chemicals that suppress nervous system activity and awareness."

"In contrast to the endocrine and haemodynamic responses to a noxious stimulus, which are easily quantified, it has not been possible to directly measure the cortical response to such a stimulus. Assessments about the gestation at which a fetus could feel pain are therefore made on the basis of the existence of the necessary neural pathways for pain perception, particularly the nature of thalamocortical connections (see section 2), as well as indirect evidence for functionality based on evoked responses and evidence for a sleep–wake cycle of EEG activity. Interpretation of existing data indicates that cortical processing of pain perception, and therefore the ability of the fetus to feel pain, cannot occur before 24 weeks of gestation and that the nature of cortical activity becomes more complex as gestation advances from this point. It is reasonable to infer from this that the fetus does not require analgesia for interventions occurring before 24 weeks of gestation. Furthermore, and importantly, the evidence that analgesia confers any benefit on the fetus at any gestation is lacking."

"Will the process hurt the baby? No. To be hurt, you need to feel pain. Current research shows that the sensory structures are not developed or specialised enough for a fetus to experience pain less than 24 weeks. Pain experience after 24 weeks depends upon a psychological development that is restricted before birth. See the question ‘Will the fetus/baby feel pain?’"

"The cortex is required for both the discriminative and emotional aspects of the processing of noxious stimuli and both anatomical and functional studies show that cortical neurons begin to receive input about sensory events in the body and the external environment from 24 weeks. Long axonal tracts now course through the brain to the cortex and evoked responses in the primary sensory cortex indicate the presence of a spinothalamic connection and the ability of somatosensory cortical neurons to generate specific activity in response to tissue damaging stimulation. The primary sensory cortex is an important area in pain processing but it is only one of many areas that are active during pain experience. Other important areas include the secondary somatosensory, the anterior cingulate and the insular cortices. Although we may speculate that these regions will also be functionally active from 24 weeks, similar to primary sensory cortex, there is no evidence for this at the moment. It has been suggested that subcortical regions, including the brainstem, and transient brain structures, including the subplate, organise responses to noxious information at each stage of development and provide for a pain experience complete within itself at each stage. There is, however, no evidence or rationale for subcortical and transient brain regions supporting mature function. Although developing brain circuits often display spontaneous neuronal activity this activity is a fundamental developmental process and not evidence of mature function."

"The fact that the cortex can receive and process sensory inputs from 24 weeks is only the beginning of the story and does not necessarily mean that the fetus is aware of pain or knows that it is in pain. It is only after birth, when the development, organisation and reorganisation of the cortex occurs in relation to the action and reaction of the neonate and infant to a world of meaning and symbols, that the cortex can be assumed to have mature features. The cortex is an important step beyond the spinal cord and brainstem because it facilitates pain experience by enabling the higher functions of cognition, emotion and self-awareness that are realized in the postnatal environment. Thus, there is good evidence for claiming that the cortex is necessary for pain experience but not sufficient."

"It has been proposed that arguments around fetal pain can be resolved by the fact that the fetus never enters a state of wakefulness in utero."

"Fetal behavioural responses have also been used as indicators of stress or pain. Shortly after the development of skin sensitivity, around 10 weeks, repeated stimulation results in hyperexcitability and a generalised movement of all limbs. After 26 weeks, this generalized movement gradually gives way to more coordinated behavioural responses that indicate improved organisation within the nervous system. Infants delivered at 26–31 weeks, for example, show coordinated facial expressions in response to heel prick, although these are immature compared to older infants. Four-D images of the fetus have also been reported to show fetuses ‘scratching’, ‘smiling’, ‘crying’ and ‘sucking’ at 26 weeks of gestational age. Although these later behavioural responses are not spinal cord reflexes, the responses are still unlikely to involve higher cortical centres. An anencephalic fetus withdraws from noxious stimulation, demonstrating that this response is mediated at a subcortical level. Similarly, infants with significant neonatal neurological injury due to a parenchymal brain injury respond to noxious stimulation with a pattern of behavioural reactions similar to infants without brain injury."

"At 8 weeks, the fetal brain is profoundly immature and its surface layer, the cerebral cortex, is smooth, with no indication of the folds (sulci and gyri) that are so prominent later. There is also no internal cellular organisation in either the thalamus, which is the main source of sensory input to the cortex, or the cortex itself. The limbic system, an evolutionary older part of the brain, consisting of interconnected deep brain structures involved in various fundamental drives and regulatory functions, is already discernable and has began to form interconnections. The external surface of the brain is about 1 mm thick and consists of an inner and outer layer with no cortical plate, the structure that will gradually develop into the layers of the cortex proper."

"[T]he relocation of neurons from the subplate to the cortical plate also begins around 24 weeks, thus coinciding with the invasion of thalamic afferents. This relocation is extremely rapid from about 34 weeks, leading to the dissolution of the subplate as the extracellular matrix and other growth-related and guidance molecules disappear.21 The subplate has been observed to thin in the insula and in areas where cortical folding occurs rather earlier than the rest of the cortex, from at least 20 weeks. It is currently uncertain whether this thinning is due to earlier maturation and potentially earlier synaptic activity in these regions, some of which are key areas in the experience of pain in adults, 3 or attributable to incidental morphological changes."

"Connections from the periphery to the cortex are not intact before 24 weeks of gestation. Most pain neuroscientists believe that the cortex is necessary for pain perception; cortical activation correlates strongly with pain experience and an absence of cortical activity generally indicates an absence of pain experience. The lack of cortical connections before 24 weeks, therefore, implies that pain is not possible until after 24 weeks. Even after 24 weeks, there is continuing development and elaboration of intracortical networks. Furthermore, there is good evidence that the fetus is sedated by the physical environment of the womb and usually does not awaken before birth."

"While the study of anatomical connections between brain regions provides important information about developing pain processes, the existence of a connection is not evidence of its function. Connections viewed under the microscope between the thalamus and the cortical plate at 24 weeks, for example, may or may not transmit information from nociceptors upon tissue damage. Fetal magnetoencephalography has been used to effectively record fetal auditory and visual evoked responses and spontaneous brain activity of cortical origin from 28 weeks and fetal brain activation to sound has been demonstrated using functional magnetic resonance imaging (fMRI) from 33 weeks. It has not been possible to record directly from human fetal cortex to establish when cortical neurons first begin to respond to tissue damaging inputs. Near infrared spectroscopy with preterm infants in intensive care, however, has demonstrated localised somatosensory cortical responses in premature newborn infants (from 24 weeks) following noxious heel lance36 and venepuncture. More recently, EEG has demonstrated a clear, time-locked, nociceptive-evoked potential in preterm infants following heel lance. Thus, there is direct evidence of neural activity in primary sensory cortex following tissue damage in very premature infants equivalent to 24 weeks of gestational age."

"The word ‘pain’ is used in different ways. The most frequent use, especially with respect to subjects that cannot communicate verbally, is in describing the behavioural response to noxious stimulation. However, if we accept this use, we are presented with the difficulty of distinguishing between the responses of simple versus complex organisms. Fruit fly larvae, for example, have been demonstrated to bend and roll away when approached with a naked flame but most people would agree that larvae do not feel pain in the way that we do. Ruling out the responses of larvae and similarly simple organisms as indicating pain is possible if we suggest that responses must include more than mere reflex responses to be labelled as a pain response. When someone reaches out and accidentally touches something very hot, there is an immediate tendency to drop the object. That reaction is entirely regulated by a simple loop of sensory neurons speaking to motor neurons in the spinal cord. Typically, the person will drop the object before there is any conscious appreciation of pain. The action of dropping the object indicates the presence of something noxious but does not necessarily indicate the presence of pain."

"Most pain researchers adopt a definition of pain that emphasises the sensory, cognitive and affective response to a noxious event. This understanding of pain is supported by the International Association of Pain (IASP) which defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage,or described in terms of such damage...pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life’.1 By this definition, pain does not have primacy over subjectivity, existing before and in addition to subjectivity, but is experienced through subjectivity. It suggests that pain is a part of knowledge and requires the existence of a conceptual apparatus that can marshal all its dimensions into a coherent experience. Although there is considerable merit in the IASP definition of pain, it does tend towards a view of pain as being a constituent part of higher cognitive function. There is disquiet in denying a rawer, more primitive, form of pain or suffering that the fetus, neonate and many animals might experience.2–4 One possible solution is to recognise that the newborn infant might be said to feel pain, whereas only the older infant can experience that they are in pain and explicitly share their condition with others as an acknowledged fact of being.5 Currently there is no immediately obvious way of resolving these arguments empirically. It is possible, however, to argue that even a raw sense of pain involves more than reflex activity and will, therefore, require the higher regions of the cortex to be connected and functional. The age when this minimum requirement is fulfilled is explored in the rest of this chapter."

"A connection from the skin to the spinal cord and brain is a basic requirement for the fetus to feel or be aware of pain. Again, it is important to emphasise that, while such input to the spinal cord and brain is necessary for perception of acute surgical pain, it is not sufficient. Activity in the spinal cord, brainstem and subcortical midbrain structures are sufficient to generate reflexive behaviours and hormonal responses but are not sufficient to support pain awareness."

"The exact timing of the first nociceptive reflex responses to more traumatic mechanical stimulation is not known but they are unlikely to occur before the second trimester, somewhat later than responses to touch. It is known that the fetus withdraws from a needle from about 18 weeks and also launches a stress response following needle puncture. This stress response includes the release of hormones and neurotransmitters dependent on activity in areas of the midbrain. These findings confirm that signals about tissue damage are transmitted from the spinal cord and brainstem to the midbrain from at least 18 weeks."

"Vaginal delivery may be considered a stress-inducing event to which most fetuses are subject. Fetuses born vaginally have higher levels of catecholamines, cortisol and endorphins than those born by elective caesarean section. It is unclear whether this stress response is related to the painful stimulus of head compression or to other factors, such as mild hypoxaemia or maternal stress. In normal labour, this evidence of fetal stress would be considered a normal fetal physiological response and the stress is thought to have benefits for fetal survival. The labour-related surge in steroids and catecholamines is an important factor in activating sodium channels and promoting the clearance of lung fluid. Babies born by caesarean section before the onset of labour have an increased incidence of respiratory complications, such as transient tachypnoea of the newborn. In addition, recent data show that elements of the stress response, perhaps noradrenaline or endorphins, have a short-term analgesic effect, so that babies born vaginally have an attenuated physiological and behavioural response to a painful stimulus compared with those born by elective caesarean section. Evidence of endogenous fetal analgesia during vaginal birth, as well as the role of catecholamines in promoting lung fluid reabsorption and the respiratory depressant actions of fetal opiate exposure, all suggest that the current approach to intrapartum analgesia, centred around maternal, rather than fetal, requirements for pain relief, is the correct one. The evidence that stress responses during normal vaginal delivery have benefits cannot, however, be readily extrapolated to stress responses during pregnancy."

"Specialised nerve terminals, nociceptors, are likely to detect surgical tissue damage from early in fetal life (around 10 weeks for the skin and 13 weeks for the internal organs). These nociceptors gradually mature over the next 6–8 weeks and the strength of their signals increases over fetal life. The presence of nociceptors is necessary for perception of acute surgical pain and so pain is clearly not possible before the nociceptors first appear at 10 weeks. The presence of nociceptors alone, however, is not a sufficient condition for pain experience. The electrical activity that is generated at nociceptor terminals by tissue damage must also be conducted along nerve fibres from the skin and into the spinal cord and brain. It is only when the brain receives information about the damage that the fetus can have any potential of awareness of it."

"Before any information about a noxious or tissue damaging stimulus can reach the brain, it has to be transmitted through the spinal cord (for the body) or the brainstem (for the head and neck). This transmission requires the growth of nerve fibres from the skin to the spinal cord or brainstem and then further growth of nerve fibres along the spinal cord or brainstem and into the brain. Staining of postmortem tissue reveals that nerve fibres grow into the fetal spinal cord from 8 weeks. These fibres, however, are specialised for the control of movement and some aspects of touching or prodding the body or positioning a limb. The growth of nerve fibres connecting nociceptive terminals to the spinal cord lags behind that of other sensory inputs in non-human mammals. Similar connections in the human are also likely to lag but the specific timings remain unknown. Preliminary studies have failed to demonstrate nerve fibres from nociceptive terminals in the fetal post-mortem spinal cord before 19 weeks."

"Hormonal responses to needling show that there are functional brainstem and midbrain mediated reactions to noxious events but they, too, do not require higher brain processing to take place and can occur independently of sensory awareness. The specific relationship between pain and the release of hormones and neurotransmitters is unclear. In a prospective crossover study on 50 extremely low gestational age infants (less than 28 weeks of gestation), no difference in hormonal response was observed after heel lance15 and, in adult mice, it is difficult to distinguish changes in levels of naturally occurring opioids due to stressful handling from those due to tissue damage."