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.
Chapter 2
Reading the Body: Hawthorne’s Tales of Medical Ambition
Sir William Bradshaw, a great doctor yet to her obscurely evil,
without sex or lust, extremely polite to women but capable of
some indescribable outrage—forcing your soul, that was it.
—Virginia Woolf, Mrs. Dalloway
While