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