For Schopenhauer, life without pain had no meaning. But Thomas Dormandy, former professor of chemical pathology at the Whittington Hospital, has little time for such Prussian dolorism. In this massive new work Dormandy—the author of several books on the history of medicine, including a well-received history of tuberculosis—provides a panoramic survey of “the fight against pain” in the west from “the mists of history” (his words) to the latest developments in palliative care. As Dormandy acknowledges in his introduction, pain is more than the stimulation of certain afferent nerve fibres: it has a history and many, many meanings. This reflects a central problem in the historiography of pain and “the fight against pain” (military metaphors being de rigueur in the literature on this subject). Most cultures seem to have viewed physical pain as a Bad Thing. Well, duh, you might say. But histories that take this observation as their central theme too often result in leaden, triumphalist celebrations of modern surgical anaesthesia. Is it possible to write a history of pain (and pain relief) that speaks both to the fleeting, fragmentary, experiential nature of its subject and to the scale and depth of human suffering? Dormandy's answer to this question is not entirely satisfactory. The worst of evils is at heart a fairly traditional practitioner-history of medicine, albeit one with some of the rougher edges of the genre knocked off. This is sweeping, progressivist history, with heroes and villains, great moments and missed opportunities—and is, as such, an engaging and enlightening read. Dormandy is an excellent synthesist, with a novelistic eye for character and a talent for breathing life into overlooked cul-de-sacs and overworked stories alike. His illuminating disquisition on the different forms in which opium was sold and used in Georgian England (p. 129) is one of many fascinating details that seem to litter every page. But this approach brings its own drawbacks. In his introduction Dormandy acknowledges—quite rightly—that the history of pain contains many distinct threads: bodily pain, mental alienation, spiritual agony, theodicy, unconsciousness, anaesthesia, analgesia, surgery, physiology and so forth. But he fails to follow this observation, and its implied demand for clarity, through into his text. Dormandy leaps from thread to thread, always construing “pain” as a trans-historical part of human experience, but only rarely explaining which sense of the word “pain” he is using at a particular point. Is he talking about physical pain in its modern neurophysiological sense, or heartbreak, or melancholy, or vastation, or Weltschmerz? The answer is not always clear, and this problem is worsened by Dormandy's failure to engage with the sizeable body of work on the cultural history of pain. Dormandy also falls too easily into anachronism. “Reversible anaesthesia” was not “old hat” to Shakespeare's Friar Lawrence (p. 3): “a sleep most like death” is nearer the mark. And references to what seems like modern surgical anaesthesia in ancient texts might reflect knowledge of powerful pain-relieving botanical agents; but they might also be a rhetorical strategy for heightening the reputation of the practitioners concerned. Dormandy's anachronisms are particularly galling, because in this and in his previous books he gives the distinct impression that he knows better. If he had taken more time to relate the different meanings and cultural constructions of pain this would be a longer book, but a far more rewarding one. If he had focused on one of these themes (perhaps bodily pain, which seems to be his main interest) it would be shorter, tighter and more digestible for a non-academic audience. As it is, The worst of evils falls between two stools—a painful experience in more than one sense.