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Chapter 1

Professional Medicine, Democracy, and the Modern Body: The Discovery of Etherization

On October 16, 1846, at Massachusetts General Hospital in Boston, a dentist anesthetized a young man while the renowned surgeon John Collins Warren excised a facial tumor. The next day the dentist anesthetized a female patient as another medical luminary, Dr. George Hayward, removed a fatty tumor from her shoulder. Alert to the possibility of fame and profit, the enterprising dentist, William T. G. Morton, immediately devoted himself to applying for a patent, to designing and manufacturing inhalers, to publishing promotional pamphlets, and to distributing a schedule of rates for the right to use his discovery. His efforts to make money offended some, his claim to being the sole discoverer was challenged by others, and the attempt to silence pain was dangerous, according to many.

The discovery of etherization and Morton’s entrepreneurial schemes generated a wide variety of texts within a few years—biographies defending Morton, congressional inquiries into priority claims, articles about the role of patents in medicine, pamphlets on the nature of scientific discoveries, and medical treatises about the usefulness or danger of deadening pain. These texts are remarkably conflicted. They make logical errors, connect unrelated issues, and speak to disparate concerns at the same time. They bear witness to the uncertain status of professional medicine at mid-century, and they offer a revealing glimpse of regulars’ attempts to negotiate what Paul Starr has called a “dialectic between professionalism and the nation’s democratic culture.”¹

In the 1830s and 1840s, alternative healers mounted a fairly successful attack on professional medicine. They condemned regulars as elitists seeking a monopoly in the health care market, and the charges often stuck. In these years, the repeal of state licensing statutes, the popularity of Thomsonian botanies and other domestic medical practices, and a significant increase in malpractice suits were the results of a rising tide of anti-status sentiments. In part, regulars responded by consolidating their authority without the aid of legislation. State medical societies became active, doctors began to plan for a national medical convention in 1845, a year before Morton’s demonstration of the anesthetic powers of ether, and in 1847 the American Medical Association was founded. These societies gave their imprimatur to particular schools, offered assistance with malpractice defense, adopted codes of ethics that often prohibited any collaboration with or referrals to nonmembers (irregulars), and debated how best to improve the reputation of orthodox physicians.² And yet, regulars were also sensitive to being called elitists. As loyal, prominent citizens, they had a stake in placing themselves within and not against the democratic ideals of the nation. But negotiating the dialectic between professionalism and democracy, as the ether texts suggest, was not always easy.³

Notably, some of the nation’s most elite physicians championed Morton and proclaimed the effectiveness of ether. Henry Bigelow, a young, ambitious physician and the son of the prestigious physician Jacob Bigelow, was one of the most enthusiastic supporters of ether, and his writings reveal the degree to which some regulars engaged the egalitarian ideals of the 1840s. In telling Morton’s story, Bigelow and others fashion an appealing tale of physicians working hand-in-hand with a common dentist. The tale appeals to populist sentiments in that it honors the ingenuity of the common man and yet it insists upon the importance of a professional class of wise, scientifically trained doctors who, as Bigelow suggests in a series of articles that respond to Morton’s patent application, seek no special market privileges. According to Bigelow, medicine’s commitment to ethics positions doctors outside and above the profit-driven world of laissez-faire capitalism. Finally, in championing ether’s universal efficacy, Bigelow infuses medicine’s materialist view of the body with egalitarian rhetoric. Pain, according to Bigelow, is no respecter of position; it is simply a matter of nerves fulfilling their functions. Undoubtedly, this materialist view of pain is reductionist, participating in what one scholar has called a “vast cultural shift” in which the body is almost completely lost as a site for spiritual meaning and recast as a material object of knowledge.⁴ But if Bigelow’s definition of pain as nothing more than nerves testifies to the power of professional medicine to install a view of the body that furthered its interests, it also testifies to Bigelow’s democratic urge to understand medicine’s work as essentially egalitarian. In short, Bigelow suggests that the professional physician is a democrat willing to work with those outside his profession, that professional medicine is not at odds with a free market economy, and that medicine works on behalf of all men.

Bigelow’s attempts to make these arguments are variously awkward and elegant, sometimes self-serving, sometimes illogical, and sometimes passionately democratic. Indeed, I begin with the ether texts precisely because they are conflicted and because I want the study of fiction’s response to medicine that I pursue in subsequent chapters to avoid the teleological habits that can bedevil efforts to read fiction in relation to history I hope to situate fiction’s meditations upon medicine and the body within a history that is attentive both to large patterns in medicine’s emerging authority and to the local debates and contests the outcomes of which neither physicians nor writers could know. As June Howard reminds us, when we read literary texts within historical contexts, the goal is not to set literary texts against a “history” or “reality” whose own textuality is for that purpose repressed.⁵ The ether texts are, I believe, particularly effective reminders of history’s textuality. They reveal the rocky terrain of contemporary medical discussions and the efforts of regulars to position professional medicine within and not against populist and egalitarian sentiments of the day.

The details of the discovery of etherization are difficult to discern amidst the various ideological uses that have been made of the story, but most accounts agree on a basic outline.⁶ Morton’s educational background included a brief course of study at the Baltimore College of Dental Surgery, six months as a student and boarder with physician, chemist, and geologist Charles T. Jackson, and two lecture series at Massachusetts Medical College, where he met Dr. Warren and others on the staff at Massachusetts General Hospital. Morton first set up as a dentist in partnership with Horace Wells, but after an unsuccessful year he left Wells and worked alone. Morton was in frequent contact with Jackson, seeking advice about ingredients for a wide range of dental procedures, including deadening pain for tooth extraction, and in his partnership with Wells he probably learned about the use of nitrous oxide to reduce pain during dental surgery. According to his memoirs, Morton began experimenting with ether in the summer of 1846, and within a few months he realized that he had discovered something remarkable and applied immediately to Dr. Warren for permission to demonstrate a new compound that rendered patients insensible to pain.

Although Morton’s exhibitions at Massachusetts General were probably the first successful public demonstration of the anesthetic properties of ether, his claim to being the sole discoverer of etherization was contested. Jackson insisted that he gave Morton the idea of using ether as an inhalant, and he was the most persistent disputant in what became known as the “ether controversy” Jackson wrote articles on ether and was the first to announce the discovery in Europe, where he was honored by the Academie des Sciences. He persuaded Morton to guarantee him a share in the profits from the patent; and his lawyers persuaded a Congressional subcommittee to reject Morton’s request for an honorarium of one hundred thousand dollars. Horace Wells never mounted a legal challenge, but his work with nitrous oxide and his similar though less successful demonstrations in the same surgical theater two years earlier also cast a shadow on Morton’s claim to be the sole discoverer of anesthesia. In 1852, with the controversy still unsettled, a third disputant, Crawford W. Long, came forward and claimed to be the discoverer of inhalant anesthesia. In 1854 the Senate passed a bill to honor and compensate Morton, but the House rejected it on the grounds that “the multiplicity of claimants” made it impossible to grant an award.⁷ Morton appealed to the president, and he was promised that if he filed a suit against the government for violating his patent by using ether during the Mexican-American War without compensating him, the government would “shoulder all the responsibility” and offer Morton an appropriate reward.⁸ Eight years later Morton’s suit was dismissed on the grounds that the patent was not valid, and he died in 1868, poor but still defending his claims and preparing another suit against Jackson.

Most accounts of the ether controversy focus on the story just outlined. By sorting through the papers of Morton, Wells, Jackson, and Long, the evidence submitted to Congress, legal briefs, and related documents, historians have tried to name the true discoverer of anesthesia. I want to suggest, however, that the most noteworthy feature of the ether controversy was not the dispute over priority,⁹ but the surprising number of physicians, including some of the most prestigious, who championed the beleaguered dentist, defended his efforts to win compensation, and enthusiastically advocated etherization before thorough testing indicated it was safe and effective. In the decade and a half following Morton’s demonstrations at Massachusetts General, Henry Bigelow wrote several articles supporting Morton and etherization, and the popular magazine Littell’s Living Age published a defense of Morton authorized by the trustees of the hospital. In addition, physicians in Boston, New York, and Philadelphia counseled Morton to appeal to the president, circulated a testimonial on his behalf, requested donations to offset his loss of income while pursuing his claim, and commissioned a biography that celebrated him as the sole discoverer of anesthesia. For some in the medical profession, telling Morton’s story became away to fashion their own story, a story of an enlightened, liberal, and ethical profession open to the discoveries of the untutored genius and yet devoted to protecting the nation from charlatans.

Defending Morton was not, however, so easy. A self-promoting opportunist eager to protect his pecuniary interests, Morton was an embarrassment to the idea of professionalism as many physicians wanted to construct it, and the history of his discovery—a story of luck and coincidence—did not conform to the conventions of more traditional histories of scientific progress. According to elite physicians, medical knowledge was gained only by the slow and painstaking accumulation of precise observations. In introductory lectures at medical schools and addresses to medical societies, the medical elite adopted a tone of impersonal reserve and constructed narratives not of individual geniuses, but of collaborative efforts that slowly and carefully added to the store of medical facts. The Paris-trained Philadelphia physician Alfred Stille, for example, prefaced his textbook, Elements of General Pathology (1848), with an essay on “Medical Truth” in which he equated the “dreams of genius” with “the frauds of charlatanism.”¹⁰ Oliver Wendell Holmes, in his lectures on “Homeopathy and Its Kindred Delusions” (1842), insisted that real advances were made only after years of work by highly trained men who cared little for fame and money. For Holmes, William Harvey and Edward Jenner were examples of the selfless men whose hard work was essential to the progress of medicine. Harvey’s discovery of the circulation of blood was the “legitimate result of his severe training and patient study,” and Jenner’s discovery of a smallpox vaccination was the culmination of “twenty-two years of experiment and researches” that he offered “unpurchased, to the public.”¹¹ For Stille, Holmes, and others, true scientific knowledge was untainted by the petty squabbles, self-serving secrecy, and careless errors that inevitably marred the work of ambitious men seeking glory or profit.

The emphasis on painstaking, collaborative, empirical research in such accounts of medical progress allowed regulars to distinguish themselves from irregulars who told narratives of great and original insights by untutored men. Irregulars presented themselves as men who braved ad hominem attacks from regulars in order to bring their remedies to a grateful public. Samuel Thomson, the founder of the eponymously named and widely popular botanic movement, made his story of growing up poor and learning the medicinal values of American herbs from an old Indian woman an integral part of his doctrine and appended an autobiography to his popular medical manual. Sounding the note of martyrdom, one herbalist prefaced his medical guide with an account of how he had to hold his “front bare to the bursting waves of opposition’s rudest shocks, as they have poured with impetuosity from the muddy fountain of ignorance, prejudice, malice and cupidity.”¹² Instead of acceptance by medical colleagues, marketplace success was the mark, in the rhetoric of irregulars, of a true remedy. Holmes and other regulars rejected popularity, however, arguing that vigorous sales were proof only of the credulity of an uneducated public bamboozled by “selfish vendors of secret remedies.”¹³ But Thomsonians, eclectics, patent medicine vendors, hydropaths, and homeopaths insisted that personal testimonials and estimates of the number of their followers were unassailable evidence of the truth and effectiveness of their medicines and regimens.

Morton’s discovery of etherization was not a story easily assimilated into the narrative preferred by regulars. The possibility of painless surgery had not been discovered after years of empirical study, statistical analyses, and tested hypotheses by educated and reputable scientists. Rather, a poor dentist who was eager to improve his practice by advertising painless tooth extractions stumbled upon the possibility of ether-induced insensibility. Morton’s investigation into the safety and universality of etherization was rudimentary, and his experiments with different inhaling apparati were cursory. More disturbingly, Morton wanted to keep his discovery a secret, and he wanted to make money. He added perfumes and burned incense during the demonstrations in order to disguise the strong and well-known smell of ether, and he called the preparation Letheon Gas, thus avoiding all mention of what he knew was the only active ingredient. Morton also refused to consider his work part of a larger scientific effort. He insisted that the discovery was his alone, and he devoted his life to disproving the claims of others to earlier, related discoveries.

Since Morton’s story was more amenable to the irregulars’ narratives of breakthroughs by iconoclastic and untutored geniuses than the narratives regulars told of scientific progress, we might expect the elite, professional medical men in the United States to have shunned Morton and his attempts to promote himself and his product. And, in fact, many did denounce Morton, distancing themselves from the unprofessional and unseemly affair of patent disputes and the dangerous quackery of pain-free surgery. The editor of the Philadelphia Medical Examiner, Robert M. Huston, wrote, “We are persuaded that the surgeons of Philadelphia will not be seduced from the high professional path of duty, into the quagmire of quackery, by this Will-o’-the-wisp.” He warned that “If such things are to be sanctioned by the profession, there is little need of reform conventions, or any other efforts to elevate the professional character: physicians and quacks will soon constitute one fraternity.”¹⁴ Charles A. Lee, editor of the New York Journal of Medicine, suggested that Morton’s supporters were “stooping from the exalted position they occupy in the profession, to hold intercourse with, and become the abettors of, quackery.”¹⁵

But such attacks did not dissuade those among the medical elite of Boston who were determined to make Morton part of their story. Indeed, it was precisely Morton’s unprofessional image and story that made him appealing to the professionals. Acceptance of Morton was evidence that could testify both to the profession’s willingness to accept discoveries made by those outside the profession and, at the same time, to the profession’s dedication to ethics over profits. Those who defended Morton constructed a tale of a lucky and somewhat buffoonish dentist rescued from his misguided entrepreneurial schemes by an enlightened medical community.

Henry Bigelow was one of the first and most ardent defenders of Morton, and he linked his early career and professional status to Morton’s discovery. Although he had been recently appointed to the staff at Massachusetts General, Bigelow became the most public, persistent, and enthusiastic supporter of Morton and etherization. Two weeks after the first demonstration Bigelow proclaimed the advent of a new age in an address to the American Academy of Arts and Sciences on November 3, and six days later, on November 9, he read a similar paper to the Boston Society of Medical Improvement. The publication of this paper, “Insensibility During Surgical Operation Produced by Inhalation,” in the Boston Medical and Surgical Journal (which later became the New England Journal of Medicine) is commonly considered the first official announcement of the discovery of anesthesia.¹⁶ Two years later, in 1848, in the first issue of the journal of the newly formed American Medical Association, Bigelow published an account of the physiological effects of ether; and in 1848 he published Ether and Chloroform: A Compendium of Their History, Surgical Use, Dangers, and Discovery.¹⁷ Notably, in all these texts Bigelow celebrates not only the discovery but also the discoverer.

In order to champion the enterprising dentist and yet follow traditional narratives, Bigelow suggests that the story of the discovery of ether began long before Morton. He implies that Morton achieved what he did because the time was ripe and that “the early narrative of the discovery” reveals “the contemporaneous and accumulating evidence of experiment” (9).¹⁸ Bigelow writes Morton into a grand narrative that includes work done before Morton, experiments conducted after Morton’s demonstration, important responses from the European community, and the numerous trials and observations recorded by reputable scientists. Bigelow clearly believes that the exchange of ideas and results among scientists throughout the world was crucial to the eventual discovery of etherization, and he even makes the bickering that followed the first demonstration part of the larger story.

In addition to writing the dentist into a longer, larger history, Bigelow uses Morton to meditate upon the role of the professional in a democratic nation. Invoking the myths of American originality, freedom from narrow training, and bold disregard for conventions, Bigelow proclaims that the United States will produce the next generation of leaders in science. The inventor, according to Bigelow, displays a willingness to reject accepted wisdom, an almost bullheaded tenacity and perseverance, and an intuitive confidence in his own ideas. Bigelow intones the names of the nation’s great inventors—Franklin, Fulton, and Whitney—and adds Morton to the list. These men, he suggests, are evidence of “American ingenuity”—the nation’s greatest resource (18). But having linked Morton and his medical discovery to the men who invented the bifocal, the steamboat, and the cotton gin, Bigelow suggests there are also important differences between scientific knowledge and mechanical inventions. Science requires training, and when he envisions the future contributions the United States will make to science, he warns that this will only happen if there is a greater “opportunity for education in science and unmerchantable truth.” This education, Bigelow believes, will transform the “thousand nameless artisans” with a “humble genius” for invention into “true philosophers” (18). Thus Bigelow fashions a new nation out of the populist image of the United States as a land of natural inventors, suggesting that with a good education basement tinkerers will become leading scientists.

As Bigelow suggests that ingenuity and independent thinking are the nation’s greatest assets, so he also suggests that U.S. leadership in science will be a natural consequence of the nation’s political and economic structures. Seeking to win for U.S. scientists the same chauvinism that the U.S. political and economic systems enjoy, Bigelow notes that genius in science is often linked to genius in the political sphere. Central to Bigelow’s hagiographies of Franklin, Fulton, and Whitney as scientists are their political contributions.

Franklin was a reformer; Fulton a warm advocate of the principles of free trade; while Whitney . . . anticipated the decline and overthrow of all arbitrary governments, and the substitution in their place of a purely representative system like our own. (17)

Bifocals, steamboats, and cotton gins; reform, capitalism and democracy; these are the fruits of that “uncultivated gift”—American ingenuity (18). Ether, Bigelow suggests, is another. In twenty-seven pages, he constructs a history of discoveries and inventions from Jenner to Leverrier, from Galvani to Schonbein, that ends in Boston with a common dentist. Morton’s discovery, Bigelow insists, is evidence of what native ingenuity, a laissez-faire market economy, and a democratic political system can produce. In the United States, democracy and capitalism promote discovery, and medical science is both beneficiary and promoter of the nation’s political and economic system. In short, Bigelow wraps modern medical science in the mantle of patriotism, and thus he refutes the charges of elitism and protectionism that were often leveled at orthodox medicine in the 1840s.

Bigelow’s paean to the partnership of medical science and democracy is heartfelt, but it is not without problems. The definitions of democracy and professionalism available to Bigelow in the 1840s were in tension, and he cannot, despite his best efforts, completely reconcile his vision of professional medical science with the radical rhetoric of the Jacksonian era. Bigelow’s troubles are most evident in the confusion that marks his discussion of the role of incredulity in science.

According to Bigelow, incredulity is the essential trait of all discoverers, and it is a virtue promoted by democracy and laissez-faire capitalism. Incredulity may come from “knowledge or ignorance,” a crucial caveat that enables Bigelow to include Morton with those more often considered geniuses, but it always indicates a “philosophic mind [that] proposes to think for itself” (15). Such independent thought, however, was precisely what regulars would not tolerate, according to their challengers. Regulars seemed unwilling to countenance the skepticism of irregulars, and irregulars often charged the medical establishment with intolerance to new ideas and alternative therapeutics and theories. And, in fact, Bigelow balances his celebration of independent thinking with a warning about the dangers of unchecked incredulity. He cautions that “incredulity, brought to bear upon an extended system, especially the inexact sciences, is justly viewed with suspicion” and that “the world therefore justly maintains a degree of conservatism and immobility” (15). Although radical incredulity may be appropriate in the physical sciences and the mechanical arts, in medicine, Bigelow insists, we must temper such incredulity and depend upon the conservative check of a professional class of educated, experienced men. In medicine, the unsuspecting patient must be protected from the irresponsible independent thinking of practitioners who dismiss what has become accepted knowledge and practice. In other words, Bigelow reneges on his attempts to link medical science to a radical, independent democratic spirit. He claims that although medicine may advance through discoveries made by renegades and untutored minds, progress depends upon a professional class of men who can be counted on to regulate the practice of medicine and thus protect patients from practitioners who might discard the accumulated wisdom and knowledge of the profession.¹⁹

Bigelow’s version of Morton’s story—a reassuring tale in which an untutored American inventor is guided by noble, far-sighted professional men—was the tale circulated, authorized, and funded by the medical establishment. In 1848, at the request of the trustees of Massachusetts General Hospital, Richard Dana published in Littell’s Living Age “A History of the Ether Discovery,” an exhaustive account of the legal battles over priority, patents, and public recognition. Ten years later Nathan P. Rice published a hagiography of Morton, Trials of a Public Benefactor. Rice was hired by the “Committee to draft a Testimonial to William T. G. Morton,” which met in the home of Bigelow’s father, Dr. Jacob Bigelow. Dr. James Jackson and Dr. Oliver Wendell Holmes presided and the meetings were attended by many of the leading physicians of Boston, New York, and Philadelphia, and well-known literary men such as Henry W. Longfellow, William Prescott, and James T. Fields.²⁰ Although both Dana’s and Rice’s accounts admit much of what Bigelow omits—the story of Morton’s life and the unseemly details of the long, contentious legal battles over priority claims, they ultimately echo Bigelow’s version. Morton represents the independent, inventive American spirit, and the physicians represent the wisdom, care, and foresight offered by educated professional men. Rice’s account, for example, makes it clear that the medical profession is the hero and Morton is a madman who made a lucky discovery. He juxtaposes roll calls of the faculty at Harvard Medical School and the work of these men with Morton’s work as a dentist. While the professors of medicine study and teach anatomy, physiology, chemistry, and surgery, Morton devotes his time to making false teeth, to cosmetic surgery, and—his greatest work before ether—to making a false nose attached to spectacles, with a beauty mark on the forehead to distract attention from the nose.

Within a few years, the ether histories told by Bigelow, Dana, and Rice had been widely circulated, and the discovery of ether had become institutionalized as a national tale, featuring a common, quirky dentist and wise professional men. The popular press was attentive to the story. Almost immediately after the first demonstration, the Boston Daily Advertiser ran Bigelow’s paper in its entirety, the New York Times covered the congressional hearings; and in 1853 Sarah Hale published a shortened version of Dana’s report in Godey’s Lady’s Book.²¹ By the end of the century, the story had become a legend. In 1882 Robert Hinckley began planning an oil painting of the first surgery under ether, and he devoted eleven years to creating a suitable homage to the leading physicians of Massachusetts. Hinckley researched carefully who attended Morton’s demonstration, though in the end he decided to include several luminaries who were not present, and he sought Bigelow’s opinion before the painting was finished. Bigelow replied to Hinckley’s request and the photograph of the painting that Hinckley included with a lengthy letter that suggests making Morton and another figure shorter and making Bigelow one-eighth of an inch taller. Bigelow also gives precise instructions about modifying his clothing, noting that “I had all my clothes from Paris, & that was then the way of making them.”²² Although the painting has not earned much acclaim and it moved about for several years, it now hangs in the Francis A. Countway Library of Harvard Medical School. A few years later, in 1891, Dr. Richard Manning Hodges published A Narrative of Events Connected with the Introduction of Sulphuric Ether into Surgical Uses, and on the fiftieth anniversary of Morton’s first demonstration, McClure’s Magazine published an account by Morton’s wife.²³ Hodges draws directly upon the histories by Bigelow, Dana, and Rice, and he tells essentially the same story: Morton is lucky, intuitive and entrepreneurial, and he rightly defers at the crucial moments to the superior knowledge and ethical standards of Bigelow and the medical profession. The tale begins with Morton—his “common-school education” and his work as a clerk and salesman—and it concludes with a tribute to Bigelow’s “determination, his penetration into actuating motives, his executive ability,—in fact, all his sagacious and active qualities of mind and body.”²⁴ Morton is courageous, persevering, but a man of “no extraordinary degree of scientific attainment,” and the physicians and trustees of Massachusetts General are men of “discretion and moral courage.”²⁵

Twentieth-century versions of the ether story take the same shape.²⁶ As recently as 1988, in a history of famous doctors, Sherwin Nuland describes Morton and the other claimants as a “handful of alert artisans, almost all of whom were enterprising mechanics, but certainly not scientists,” and he describes Warren as an “austere, highly skilled physician . . . one of the country’s most revered senior physicians.”²⁷ Nuland concludes that it was Warren’s “ineluctable destiny to be the medium” through which ether was presented to the world. In short, the ether story has been told again and again in order to suggest that an established class of elite professionals is not anathema to the nation’s democratic ideals. In fact, as I suggest in Chapter 4, it was not only the ether story that was pressed to do this work. Elite literary magazines in the nineteenth century offered similar portraits of the professional physician as a liberal, open-minded democrat, a man poised to dispense wise counsel to temper democracy’s excesses.

Morton’s story not only inspired Bigelow and others to fashion an image of professional medicine that countered charges of elitism, it also challenged regulars to articulate their relationship to the marketplace. Morton wanted to make money on his discovery, and only ten days after the first demonstration at Massachusetts General he applied for a patent. He then placed advertisements in newspapers and magazines and printed handbills in order to announce a price schedule for Letheon licenses. Four weeks later, on November 20, Morton publicly announced his patent claim, and he warned all persons “against making any infringement on the same.” Two weeks later his warning was sterner:

certain unprincipled persons have, in the face of Law and Justice, without any license, instructions or authority from me whatever, used my name and attempted to Pirate said invention, endangering, from their want of skill and knowledge upon the subject, the lives of those whom they have persuaded to undergo their unwarrantable experiments.²⁸

Most versions of the ether story avoid references to Morton’s persistent efforts to sell licenses, and others suggest, contrary to the evidence, that when Morton revealed the ingredient in Letheon before the third demonstration, he nobly relinquished all desire for profit and thus joined the professional class of medical men who stood apart from such marketplace schemes. Bigelow, however, did not avoid the issue. But the confusion and awkwardness that marks his discussion of medical patents testify to the deep tension between laissez-faire capitalism in the professional status that regulars sought.

With the repeal of most state licensing laws, the deregulated healthcare market was crowded, and regulars competed in part by representing themselves as committed to instituting and following the highest ethical standards. One of the first tasks of the American Medical Association (AMA) when it was founded in 1847 was to adopt a code of ethics. Attracting a great deal of attention—both support and criticism—the code attempted to elevate the profession above the contentious fray of marketplace competition. The National Code of Medical Ethics, as it was sometimes called, acknowledged the almost complete withdrawal of legal regulation of medical practice but suggested that rather than lobbying for the return of state licensing, the profession was better served by regulating itself. To this end, the code called upon physicians to shun “unlicensed” or “irregular” practitioners, to refrain from quarreling with one another in public, and never to challenge the opinion of the primary attending physician of a case. Advertising was deemed “derogatory to the dignity of the profession,” and all attempts to compete directly in the marketplace were deemed “the ordinary practices of empirics” and “highly reprehensible in a regular physician.”²⁹ Thus the code suggested that the distinction between regulars and irregulars was that the former were dedicated to ethical, decorous behavior while the latter were willing to use whatever marketing schemes they could to win patients and profits.

Crucial to the profession’s attempts to represent itself as ethically minded and distant from the pettiness and dishonesty of the marketplace was a condemnation of patents. The AMA code linked patents with secrecy, base profiteering, and quackery. Patents, the code suggested, fettered scientific inquiry and turned matters of truth and knowledge into business concerns.

Equally derogatory to professional character is it, for a physician to hold a patent for any surgical instrument, or medicine; or to dispense a secret nostrum, whether it be the composition or exclusive property of himself, or of others. For if such nostrums be of real efficacy, any concealment regarding it is inconsistent with beneficence and professional liberality; and if mystery alone give it value and importance, such craft implies either disgraceful ignorance, or fraudulent avarice. It is also reprehensible for physicians to give certificates attesting the efficacy of patent or secret medicine, or in any way to promote the use of them.³⁰

According to the code, patents were appropriate for ideas and goods traded in the marketplace but not for the facts and truths discovered through scientific inquiry. In an 1849 report on patent medicines to the House of Representatives, one doctor warned that patents were the recourse of “the unprincipled and mercenary, [who] with fertile ingenuity, have been daily prostituting a noble science at the shrine of private interest.”³¹ He insisted that the medical profession opposed the “practice of granting patents for compound medicinal agents as immoral and pernicious in tendency,” and he argued:

[we] oppose it not only with philanthropic views, but as exponents of an intense and universal professional sentiment, and as advocates of a large and liberal class in the body politic, whose lofty ethics repudiate exclusive rights and emoluments, forbid secrecy, and unite all its members in a common search for truth and usefulness.³²

The argument against patents gained few adherents outside the medical profession, and the AMA’s failure to persuade Congress to regulate or ban medical patents suggests the depth of sentiment against legal protection for professions. Congress was more concerned with promoting economic development than regulating medical patents, and patents were considered an effective incentive for encouraging the introduction of new inventions and ideas into the marketplace. Congress revised patent law in 1836, transforming a previously expensive and litigious application process into a relatively quick, easy, and usually successful procedure. Responding to and encouraging the emerging market culture, the new law defined ideas as private property and, more importantly, as commodities that could be developed for business and profit. Not surprisingly, then, Congress was unwilling to renege on this understanding of patents.

The belief that patents were good for the economy combined with the widespread popularity of patent medicines, made it awkward for the medical establishment to condemn Morton’s patent application. Indeed, both Bigelow and Rice suggested that it was precisely the nation’s free market economy that encouraged men like Morton to tinker, invent, and bring their discoveries to the marketplace and thus to the public. But their endorsement of free market principles belied the ambivalent and even antagonistic relationship between the monopoly that the medical establishment sought and laissez-faire economics.

Bigelow attempted a resolution. In his first article on etherization in the Boston Medical and Surgical Journal, Bigelow defends Morton’s patent. He acknowledges that “patents are not usual in medical science” and that usually “fame, honor, position, and, in other countries, funds” are more acceptable.³³ But he insists that Morton’s patent is necessary because it will restrict the use of ether to responsible and knowledgeable practitioners. Here Bigelow misconstrues the purpose of patents: he ignores the accepted definition of patents as economic incentives and suggests instead that patents are a form of regulation, of licensure. He seems to believe that a patent on etherization will prevent unqualified practitioners from using it. Although Bigelow seems confident in his argument, he also adds another defense, one that exposes his own ambivalence about patents. Implying that patents are part of the less prestigious and more profit-minded profession of dentistry, Bigelow suggests that Morton’s patent application is excusable because patents are accepted in dentistry, the profession most likely to use ether.

Not surprisingly, it was a dentist who exposed Bigelow’s misrepresentation of patents and the hypocrisy of a physician defending a medical patent. Perhaps sensitive to Bigelow’s subtle insult of dentistry, Dr. Flagg, a Boston dentist, published an article two weeks later in the Boston Medical and Surgical Journal, suggesting that Bigelow was in defiance of the professional code of the Massachusetts Medical Society when he defended Morton’s patent.³⁴ Flagg also points out that no one, including regulars, will ever honor Morton’s patent. He notes that the physicians at Massachusetts General Hospital in particular will feel free to instruct their students in the art of etherization without compensating Morton. Most embarrassingly, Flagg exposes Bigelow’s self-serving and incorrect definition of patents. Flagg points out that Morton’s patent, like all patents, demands payment, not expertise, for the right to use ether as an anaesthetic.

In the next issue of the journal, Bigelow works more carefully to carve out a viable position for the medical profession on the question of patents. He argues that the medical profession is against secrecy, but not against intellectual property rights. He insists that the Massachusetts Medical Society condemns only those who seek profit by refusing to identify the contents of their drugs, not patents in and of themselves. Bigelow writes that Flagg

confounds the question of secret and that of patent, and infers that what is no longer secret is no longer patent. It is understood that the matter was secret just so long as was necessary to secure patents here and elsewhere, no longer. But the fact of its subsequent publicity does not change the question of property. The discovery and the patent rights still belong to the inventors.³⁵

This time Bigelow gets it right. In the first article he invoked tenets central to professionalism—knowledge is dangerous and its use must be regulated. But confronted with the illogic of equating patents with regulation, Bigelow admits in his response to Flagg that patents protect the intellectual property rights of the patent holder, not the patient from irresponsible practitioners misusing ether. In short, Bigelow must acknowledge, as he does, that medicine would be better served by “discovery unfettered by any restrictions of law and private right.” And yet, he avoids an outright condemnation of patents, insisting not quite honestly that the profession is only against secrecy and not against patents.³⁶

Although Bigelow’s understanding of patents was more accurate in the second article, it was a dangerous argument and one he never repeated. If, as Bigelow argued, the medical profession condemned only secrecy and not property rights, there was no basis for censuring patents at all. Patents are never secret—to apply for a patent is actually to make the new idea public in exchange for seventeen years of exclusive rights to manufacturing and marketing the idea. If Morton’s patent had been accepted and honored by the medical profession, the patent would not have prohibited the use of his discovery; it simply would have required physicians and hospitals to pay Morton.³⁷

Not surprisingly, in a later 1848 account of the discovery of ether, Bigelow revokes his suggestion that regulars have no objection to patents. Now, as in his first article, Bigelow suggests that Morton’s patent application must be understood in light of his work in dentistry: “secrets are common . . . in the profession with which this discovery had an intimate connection in its early history.”³⁸ Distinguishing scientists and doctors from those who work in such mechanical arts as dentistry, Bigelow insists that “in the higher atmosphere of science, which deals with abstract truth, it is not easy, nor is it usual, thus to extort a value for any application growing out of discovery.” Determined to classify the discovery of etherization as part of science and not the mechanical arts, he now suggests that “the patent was an error of judgment as well as a violation of custom.”

It is worth noting that even in this discussion, however, Bigelow cannot avoid using the language of patents.³⁹ Although he suggests that patents are relevant only in the world of commerce, he turns again and again to patent law for a basic definition of what constitutes a true and great scientific discovery. He begins his defense of Morton by suggesting the requirements for securing a patent are valid criteria for judging the value of an invention or discovery:

A writer upon patents has said that an invention is entitled to protection from the law, when it materially modifies the result produced, or the means by which it is produced . . . and I should in like manner, call an invention great, in proportion to the combined amount of mind invested in its production, and its intrinsic ability to minister to the supposed or real comfort and well-being of the race.⁴⁰

Twenty pages later Bigelow concludes by citing a judicial opinion that patent rights belong to the man who “first reduces his invention to a fixed, positive and practical form.”⁴¹ Bigelow then argues that since Morton’s discovery fulfills all patent requirements, his discovery must be defined as a great discovery and Morton should be acknowledged as the true discoverer. It would seem as though Bigelow can find no terms other than marketplace language and patent law by which to validate Morton’s discovery. Although Bigelow insists upon the great beneficence of the discovery to all mankind, he invokes a market notion of value to identify what ether offers and what Morton deserves—“the gratitude and honor conceded by the world is a mere equivalent for value received” (emphasis added).

The AMA code and the medical profession’s condemnation of patents were attempts to shift the terms of public debate about medical practice from questions about the freedom of the marketplace and the rights of buyers and sellers to questions about the ethical use of knowledge. But Bigelow’s failure to provide a coherent argument exposes the difficulties of making such a shift. Bigelow tries to translate economic arguments into moral arguments, questions about property rights into questions about ethics, but he cannot purify medical and scientific discourse of the language and values of nineteenth-century market culture.⁴²

So far I have suggested that regulars’ defense of Morton testifies to their efforts to align professional medicine with democratic and free market ideals. I have also noted that their efforts are bedeviled by contradictions. Bigelow’s celebration of incredulity collapses into an argument for the restraint that professional medicine can exercise upon unchecked iconoclasm, and his attempts to embrace market ideology give way to a definition of science as a discourse of truth that is removed from and above the world of commerce. The ether texts, in other words, reveal a complex portrait of orthodox medicine at midcentury in which regulars argue for their ethical and scientific superiority and yet try to remain loyal to the era’s populist mood. In this section, I want to look more closely at Bigelow’s discussion of the ether trials he conducted and at his career. As an ambitious young man in 1846, he was quick to adopt the most current ideas in medicine, but later in his career he resisted new trends, including developments that followed from the very ideas he had championed years earlier. In Bigelow’s writings from the 1840s, we hear an early articulation of the modern notion of the body as separate from the self, but later in his career we hear him caution young doctors against this very view. In the 1840s, he understood the modern body as an egalitarian notion; toward the end of his career he worried that modern medicine was dehumanizing the patient.

According to recent histories of the body, before the nineteenth century the body was primarily perceived as an extension of the self, as an idiosyncratic, open, and fluid expression of the complex physical, spiritual, and social forces shaping an individual. As Michel Foucault and others have argued, beginning in the late eighteenth century, and as a consequence of changes in economic and social structures, the body came to be defined as a closed, well-bounded, standardized, and normalized system, a discrete object that was not an extension of the self but rather a material possession owned by the self. Knowing the body and knowing when it was healthy or ill became a matter not of listening to the patient’s story but of fixing an impersonal, clinical gaze upon the body. Disease supplanted illness as the primary focus of therapeutics, and the body replaced the patient as the subject of medical knowledge. In short, the modern body is a generic body, known through statistical studies, anatomical atlases, and mathematical averages that have erased the idiosyncratic and the particular.⁴³

When Morton first demonstrated ether in 1846, few U.S. physicians had adopted the new clinical definition of the body. Although many physicians studied in Paris and returned as advocates of the methods of the Paris Clinical School, many others remained committed to an understanding of illness and the patient as highly individualized. Such eminent physicians as Worthington Hooker, Paul Eve, and Josiah Goodhue argued against invariable treatments, distinguishing themselves from the earlier universalist therapeutics of heroic medicine that defined all illness as a problem of inflammation and all cures as a process of depletion, and from contemporary populist practitioners such as Samuel Thomson who claimed that most patients and most illness could be treated by one regimen or a single tonic. In 1850, for example, Eve wrote:

No two human constitutions are precisely alike. A London medical periodical has just affirmed that what cured cholera in one street, would not cure it in another. . . . We cannot, therefore, adopt any routine practice, any invariable system of treating disease; this is the blind and reckless course of empiricism; but we must, in order to apply our agents intelligently and effectually, vary them, according to the peculiar and ever changing circumstances attending each case.⁴⁴

A belief in the individuality of each case and a rejection of therapeutic uniformity were, as Martin Pernick argues in his history of anesthesia and professionalism, central to anesthetic discourse and practice. According to Pernick, although the medical theory of individualization was, in part, an attempt to encourage “greater sensitivity toward the unique needs and individual worth of each patient,” the individualist theory was also a conservative response to the republicanism implicit in Revolutionary physician Benjamin Rush’s universalist theory of the body and to the Jacksonian populist ideology of cure-all therapeutics promulgated by irregulars. Pernick further suggests that when “conservative physicians” applied the theory of “individual patient differences” to the use of anesthesia, most acted on the belief that differences in pain sensitivity could be “studied, classified, and codified into detailed rules.” The result, according to Pernick, was a “calculus of suffering” in which age, race, class, and gender became predictors of a patient’s sensitivity to pain and need for anesthesia.⁴⁵

Although Pernick offers a persuasive and nuanced account of how individualist theories of the human body shaped medical discourse and practice, he does not offer a history of those physicians like Bigelow who found in the discovery of ether not a justification for individualization but rather a theory of somatic egalitarianism.⁴⁶ As the son of a Paris-trained physician, Bigelow embraced the new clinical epistemology of medical science, and his study of the use and effectiveness of ether offers an early and important example in medical history of the emergence of the modern body in the United States and the influence of the ideology of Jacksonian democracy on medical discourse and representations of the body in nineteenth-century U.S. culture.

The reality of Jacksonian egalitarianism is much debated by historians. Were economic conditions relatively equal? Was it easy to move between classes? Did the common man have political power? Traditionally, historians have accepted Alexis de Tocqueville’s evaluation of the United States in the 1830s and 1840s as a place of few hierarchies and widespread social, economic, and political equality. Revisionist historians have suggested that equality in the Jacksonian era was more myth than reality. All agree, however, that egalitarian ideals shaped political rhetoric and even some laws—the repeal of medical licensing requirements, for example. I would suggest that egalitarian ideals as well as Parisian clinical notions of the body shaped Bigelow’s ideas about pain.

Bigelow’s somatic egalitarianism and medical modernity is most immediately evident in his refusal to make distinctions between patients and their responses to pain and to ether. All men, according to Bigelow, suffer pain equally, and he writes not about patients and cases, but about the body, about a system that responds consistently and predictably to the anesthetic properties of such chemical compounds as ether, nitrous oxide, and chloroform. In his first report on the trials carried out by Morton, Bigelow follows convention. He introduces each case by identifying the patient’s sex and age and occasionally adds a note about the patient’s size. But Bigelow draws no conclusions based on these facts. He records every detail—the amount of time required for etherization, the patient’s response, the degree and duration of insensibility exhibited—and there are noteworthy differences in the data. But these differences are immaterial to Bigelow; he makes no comments and suggests no further study. Ignoring the evidence he has presented to the contrary, Bigelow eagerly claims that “Ether is capable of producing, with very rare exceptions if there be any, complete insensibility to pain.”⁴⁷

Bigelow is equally uninterested in distinguishing types, and he makes no distinction between patients based on the categories that Pernick identifies as central to many practitioners’ decisions about using or forgoing anesthesia—age, sex, class, race, presenting symptoms, or surgical procedure to be performed. Indeed, Bigelow is so certain of the universal efficacy of ether that he wants to expand the uses for ether from surgical cases to such complaints as dislocations, strangulated hernia, functional pain, and muscular spasm, including cramps and colic.⁴⁸ And even when he draws upon class stereotypes to describe one case, a story about the difficulty of etherizing a big man, Bigelow is more concerned with establishing a correct method of etherization than with possible implications about types of patients and their susceptibility to etherization. He suggests that “a large and muscular man, perhaps habituated to stimulus, sometimes modifies a grimace into a demonstration of violence; objects to verbal and other interference; at last becomes violent, and if athletic, requires the united force of several assistants to confine him.”⁴⁹

But he concludes only that one should not attempt “the etherization of athletic subjects when such aid is not at hand.” Bigelow draws no conclusions about the man’s physiology or about variations in dose. Instead he insists that the body will succumb, as all bodies do. He instructs the surgeon to

confine the patient, and to apply the ether steadily to the mouth and nose. For some seconds, perhaps many, the patient may refuse to breathe; and bystanders unaccustomed to the phenomena, exchange significant glances. But if the pulse is good there is no real danger, and at last, exhausted nature takes a deep and full inspiration, which while it aerates the blood, is laden with the intoxicating vapour; colour returns; and the patient falls back narcotized.⁵⁰

Thus Bigelow suggests that all bodies, even those socially marked as different, are in essence the same.

Bigelow’s report on the patient’s experience of the anesthetic state reveals a similar lack of interest in the individuality of each patient. Although he concludes each case study with the patient’s description of the experience, he translates the patient’s words into his own. Every quote is indirect, and the voice we hear is not the patient’s but Bigelow’s. He reports that one boy “said he had had a first rate dream,” that one woman “said she had been dreaming a pleasant dream,” and that another patient reported that “‘it was beautiful—she dreamed of being at home—it seemed as if she had been gone a month.’” Bigelow claims to offer the patient’s “own words,” and yet he makes no effort to suggest his renderings of the patient’s words are verbatim. Bigelow erases the marks of individuality that direct quotes seek to represent—he reproduces no syntactical oddities, no grammatical errors, no colloquialisms. For Bigelow the anesthetic state itself erases such distinctions, and he insists that under ether “the patient loses his individuality.”⁵¹

The patient’s words—the peculiarities of language, voice, and story—were irrelevant to Bigelow because the new clinical methods of scientific medicine distinguished between self and body and taught the physician that he could and must listen first and foremost to the body. Of course diagnosis and therapy continued to include close attention to the patient’s report, but with the advent of the stethoscope and other techniques of physical diagnosis, medicine became increasingly confident that it could gain unmediated access to the body. The discovery of ether contributed to this confidence. Not only were doctors inventing tools for listening to and looking at the body’s interior, they could now work without comments, interruptions, or resistance from the patient. Operations could be performed more slowly, more carefully, and more often. Operations also became more decorous.⁵² Rather than scenes of physical struggle—strong men holding patients down, stifling screams, extending limbs taut with muscular spasms—surgery became a theater of professionals working upon a body laid out like those portrayed in anatomical atlases. Silencing the voice of the patient became, many surgeons insisted, essential to their work. And if etherization did not completely relax the body and the etherized patient moaned, resisted, or made comments on the proceedings, surgeons were to ignore such signs. In his outline of the stages of the anesthetic state, Bigelow distinguishes signs of the body from signs of the individual. Vocalizations and movements are incidental and idiosyncratic symptoms, while the primary indicators of the patient’s well-being are somatic signs—pupil dilation, pulse, and breath.

Many disagreed with Bigelow. For irregulars and homeopaths, the patient’s voice was not incidental. Although patent medicines were cure-alls, and thus dependent upon universalist theories of disease, advertising for patent medicine depended heavily upon personal testimonials. Filling newspaper advertising columns with detailed accounts of misery and recovery, patent medicine vendors deployed language that was rich with regionalisms and ungrammatical syntax, marking each testimonial as authentic. Similarly, in Thomsonian medicine the patient’s report is primary. Thomson made personal knowledge of the body the center of his therapeutics, advising his followers—purchasers of his book—to be their own doctors, diagnosing and curing themselves in accordance with the steps outlined in his Guide. Homeopaths also valorized the patient’s voice, suggesting that the patient’s verbal response to pain was perhaps the most authentic and important sound the body ever offered. Condemning etherization, one homeopathic manual warned that “Deadening the nervous system . . . is virtually choking off Nature’s voice,” suggesting that the patient’s words and groans were the “true physician’s best guide to the seat and character of the cause of the pain.”⁵³

Bigelow offers a very different interpretation of pain. Refusing to sanctify pain, he insists that it is not a voice articulating any essential truths. According to Bigelow, pain is simply, and purely, a somatic experience. Bigelow rejects religious and philosophical interpretations of pain, suggesting instead that pain is a material, physical fact best understood by medical science: “Pain is the unhappy lot of animal vitality. The metaphysician finds in it the secret spring of one half of human action; the moralist proclaims it as the impending retribution of terrestrial sin . . . [but] physical suffering grows out of the imperfection of physical existence.” Here Bigelow is an empiricist and a materialist, insisting that pain cannot be understood by the metaphysician and the moralist and must not be read as evidence of man’s wrongs against himself or the divinity. Pain, according to Bigelow, is a mundane fact of animal life, a simple matter of “nerves fulfil [ling] their functions.”⁵⁴

In part, Bigelow’s definition of pain as a mundane physiological fact is an argument against the religiosity typical of some alternative therapeutics. Many irregulars equated nature with goodness and illness with human error or depravity.⁵⁵ Thomsonians eschewed mineral cures as unnatural, botanics claimed to work with nature; hydropaths celebrated the healing powers of water, and patent medicine vendors claimed their nostrums drew upon ancient Indian knowledge of rare herbs. Irregular medicine derived its popularity in part from its successful translation of religious values into reverence for the natural. Good health was evidence of good morals, and illness was a consequence of bad living—physically, morally, and spiritually. Homeopathy, for example, suggested that pain was the “penalty we suffer for violating a physical law.”⁵⁶ Bigelow’s definition of pain is a radical rejection of the valorization of the natural.⁵⁷ He insists that the natural world is imperfect and that pain speaks not of our sins against nature but rather of nature’s sins against man. Pain is evidence of a flawed material world.

Bigelow’s definition of pain may seem to participate in what David Morris has condemned as the trivialization of pain. According to Morris, nineteenth-century scientific medicine ushered in a “vast cultural shift” that “has consistently led us to misinterpret pain as no more than a sensation, a symptom, a problem in biochemistry.” Condemning the materialist interpretation of pain that Bigelow embraces, Morris laments the reduction of pain to “a mechanistic event taking place solely within the circuits of the human nervous system.”⁵⁸ Morris correctly points to the nineteenth century as the moment of a crucial shift in the understanding of pain, and he is right when he notes that pain has been almost completely lost as a site for constructing spiritual meaning. But in his disenchantment with the medical profession and medical science, Morris fails to acknowledge the important cultural work done by this mid-nineteenth-century definition of pain. The success of Bigelow’s definition of pain as nothing more than nerves testifies not only to the power of the medical profession to install a view of the body that furthered its interests, although it was certainly that, but also to the appeal in the nineteenth century of an egalitarian interpretation of pain. Although Bigelow’s definition of pain may seem, after more than a hundred years of medical materialism, a reduction of a complex experience into a trivial malfunctioning of body parts, in 1846 it eschewed moralism and embraced an egalitarian notion of the body. All bodies suffer pain, and Bigelow believes that by using etherization, modern medicine can improve the lot of all men.

Bigelow’s egalitarianism in these texts was contrary to the dominant therapeutic practice of regulars in the United States, and it was not a rhetoric he ever repeated. In the 1840s, the therapeutic practice of regulars emphasized attention to the individual: “Specificity—an individualized match between medical therapy and the specific characteristics of a particular patient and of the social and physical environments—was an essential component of proper therapeutics.”⁵⁹ Although statistics on Bigelow’s own use of ether are not available, he practiced at Massachusetts General Hospital, which, according to Pernick’s study, was no different from other hospitals in administering anaesthesia based on the age, sex, class, and ethnicity of the patient, the patient condition, and the type of operation.⁶⁰ There is no reason to presume that Bigelow’s use of ether differed significantly from the norm, and later in the century Bigelow was an ardent defender of individualist therapeutics. He was suspicious of those who promoted even more radical notions of the body as a material object, a stable fact that could be known through science and described by the laws of physiology. When some professors at Harvard wanted to increase the laboratory requirements in the medical curriculum, he argued against the reformers, warning that excessive confidence in laboratory research would train students to prescribe treatments without regard to the patient: “The student who expects to influence disease because he understands how a drug passes through the visceral cells will get into a habit of therapeutic reasoning and action very likely to damage the man or woman who owns the viscus.”⁶¹ In 1846, by contrast, Bigelow was disinclined to see differences between the effects of etherization on various patients. In truth, in 1846, he has little interest in the man or woman who owns the viscus and a great deal of interest in the universal efficacy of ether in deadening pain during surgery.

The relative merits of universalist and individualist therapeutics are difficult to distinguish. On the one hand, as Pernick notes, individualist therapies invite treatments based on race, class, and gender stereotypes. On the other, universalist therapeutics may ignore the patient and thus participate in the kind of reductionist medicalizing of the body that Morris laments and also contribute to the rise of authoritarian sciences that Foucault condemns. In practice and in most of his rhetoric, Bigelow was a supporter of individualized therapeutics. But I want to suggest that in his ether writings, and in his argument that pain is universal and ether universally effective, we hear a young physician discovering in modern medicine’s approach to the body as a knowable fact an egalitarianism that excited him and that echoed popular political sentiments of the day. In his ether writings, Bigelow draws upon the language and ideology of Jacksonian Democrats, and with remarkable energy and rhetorical flourish he defines pain as the most elemental force in human life, a reminder that we all share bodies vulnerable to disease. He writes that pain “respects neither condition nor external circumstances. In the countless generations which lead us step by step into the remote ages of antiquity, each individual has bowed before this mighty inquisitor. It has borne down the strongest intellect, and sapped and withered the affections.”⁶²

Pain, according to Bigelow, refuses to distinguish between men, indiscriminately leveling all men to their basic animal nature. And ether also makes no distinctions, according to Bigelow’s claim for its universal efficacy, and thus it can free all men: “What is pain, which the race has ceased to know in its more formidable phase, and which in another age will be remembered as a calamity of rude and early science . . . this ‘dreaded misery, the worst of evils,’ now lies prostrate at the feet of science.”⁶³ Science, according to Bigelow, will liberate us from the rude leveling force of pain—science will allow “intellect” and “affections” to flourish, and science will set free talent and genius previously shackled by physical pain. In his paean to science and anesthesia, there is a democratic urge. Science, he believes, is a truly democratic force that promises to liberate every man from the limitations imposed by the physical imperfections of his animal nature and to free him to become human, to participate in the worlds he creates. Thus Bigelow attempts to reconcile egalitarianism and professionalism, defining medicine’s subject—the body—as the common experience that binds together all men and knowledge of the body as the basis for medicine’s authority.

Bigelow’s ether writings are full of enthusiasm and youthful ambition. He eagerly imagines what medical science may achieve, he prophesies that the United States will be the next great leader in scientific inquiry, and he is convinced that professional medicine offers wise, ethical management of possibly dangerous discoveries and knowledge without trampling on market freedoms. The confusion evident in some of Bigelow’s arguments suggests that the tensions between professionalism and democracy were not easily laid to rest. But his writings also bespeak a desire to understand professional, scientific medicine as an integral part of the nation’s democratic ideals. For Bigelow, the professional doctor is an enthusiastic democrat. He honors the ingenuity of the common man, tempers the freedoms of the marketplace with his ethical oversight, and is devoted to freeing all men from the miseries of pain and illness. Although Bigelow was not writing fiction, he was fashioning for himself and for his readers an image of the good doctor that fiction sometimes adopted, sometimes revised, and sometimes challenged.