Archives, Methodologies, Predecessors
There are two questions about texts and methodologies that should be addressed up front. Does a study that focuses only on U.S. medicine and literature endorse a notion of American exceptionalism? And is a study that focuses on “regular” medicine merely a history of the winners? Recent attention to the discourse of American exceptionalism has helped to make visible just how deeply nationalist habits are embedded in our thinking. But, as Michael Kammen points out, when evidence suggests that the United States at some moments and in some areas is distinct, then we need not run from the observation. In his study of literature and medicine in Europe, Lawrence Rothfield notes that he excludes United States literary and medical culture, despite extensive exchanges across the Atlantic, because the “history of American medicine during the nineteenth century is so different, both in professional and intellectual conditions, as to constitute an entirely separate field of inquiry”33 Historians and sociologists of medicine agree. For example, Paul Starr notes in his introduction to The Social Transformation of American Medicine that “not all societies with scientifically advanced medical institutions have powerful medical professions” and that “hardly anywhere have doctors been as successful as American physicians.”34 Indeed, the distinct and remarkable success of nineteenth-century U.S. physicians both in marginalizing other medical paradigms and in becoming the most prestigious and well-paid profession in the nation has shaped U.S. healthcare ever since.
By focusing on “regulars,” I do not mean to endorse the marginalization of other paradigms. The impact of “irregular” medicine (a term devised by regulars to discredit all others) on individual lives, literary discourse, and elite, popular, local, and national culture was significant and has earned astute scholarly commentary. This study seeks to provide a fresh perspective on the remarkable and rapid rise of regular medicine, even though its boundaries were not firmly in place until the first years of the twentieth century, when the Flexner report led to medical school closings and certification. And it seeks to do this by looking closely, though not exclusively, at fictional representations of doctors. Cynthia Davis, in her study of literature and medicine in these same years, examines the power of literary forms to determine the contours of bodily representations.35 I hope to add to her fine work by examining fiction’s intervention in the rise of professional medicine and the modern body.
Salman Rushdie is right: the doctor is never a minor character, not in our lives and not in nineteenth-century American fiction. Indeed, the simplest point of Profound Science and Elegant Literature is that representations of healers tell us much about a culture and that every portrait of a doctor, nurse, shaman, or lay healer deserves a second look. More specifically, I want to suggest that representations of doctors in the second half of the nineteenth century are particularly telling because in these years modern, scientific, professionalized medicine was established in the United States.
Historians have tended to tell two distinct though not necessarily incompatible stories of professional medicine’s rise. One is an account of progress. Through access to bodies in clinics, observations at the bedside, statistical studies, the development of new tools, and conceptual innovations, there was a “gradual triumph of a critical spirit over ancient obscurantism.”36 In the second account, economically motivated regulars squeeze folk healers out of a crowded healthcare market and scientific medicine “converts the body into an object of knowledge.”37 In the first account, medical scientists discover the real body and practitioners apply this knowledge skillfully as they treat individual cases. In the second, medical scientists colonize the body and regulars seek power.
Nineteenth-century fiction considers both accounts. In some tales, the doctor is skillful, in others he is cruel; sometimes he is wise, sometimes merely ambitious; sometimes he invades the body, sometimes he is racist, and sometimes he leads a community. In short, representations of doctors interrogate the dangers posed and promises offered by the establishment of an exclusive class of esteemed, scientifically trained professional healers. The value of individual texts is that they offer local history and intervene in debates of the day. Each fictional portrait speaks to specific issues such as new ideas about interiority, the increased use of dissection, the gender identity of authorship, and the limits of empiricism. Each is also shaped by a writer’s lived experience of medicine. Louisa May Alcott’s uncle was active in health reform, Herman Melville watched a respected fleet surgeon authorize floggings, Henry James never forgot being dismissed with a comparative “pooh-pooh” by a Boston specialist. William Dean Howells was devastated when his daughter died despite visits to homeopaths, nerve specialists, and the renowned S. Weir Mitchell; and Charles Chesnutt considered becoming a doctor.38 In addition to serving as individual case studies, the texts taken together testify to a broader picture, to increased acceptance of medicine’s prestige and scientific authority and to continued questioning of the implications—political, physical, and psychological—of medicine’s claim to exclusive and complete somatic authority.
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