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