Medicine, as practiced in antebellum America, was not very different from that of the late Middle Ages. Yet Rebecca Gratz and her family relied completely on their doctors' opinions, and often attributed their recovery to treatments which could not possibly have been responsible.
The placebo effect was probably the physicians' greatest ally, buttressed by patients' renewed confidence in medicine following a real scientific triumph: the smallpox vaccine. Most of Philadelphia's eminent doctors advised their patients to be vaccinated -- with beneficial results which went beyond the subjective. The same men ordered purging and bleeding and their patients accepted these treatments as well.
Her doctors would not have recognized Sarah Gratz's symptoms -- episodes of intense irritability and sleeplessness followed by depression -- as a specific syndrome. (What we call today "bipolar disorder" did not enter the medical literature until the mid-nineteenth century.) They would have realized, however, that it was a disease of the nerves; hence, the trips to places of natural beauty, the accepted remedy for soothing the nervous system.
During the five years of Sarah's illness, family letters referred to her condition only briefly with no hint of its nature or its treatment, except during September 1814, a time of turmoil for not only Sarah, but for the nation. Sarah was already irritable and difficult by the time she and Rebecca reached Saratoga Springs that August. When word was received that the British had burned Washington, everyone scrambled to get home quickly. Rebecca wrote that "the bustle and continual change of travelling, crowded steamboats and company increased [Sally's malady] to a very distressing degree."
Back in Philadelphia, there was no peace at home. The sisters' three younger brothers had been called up to their units and their eldest brother Simon was helping with the civilian defense of the city in the face of what everyone believed was an impending attack by the British. (It never came.) The atmosphere of fear and uncertainty did nothing to alleviate Sarah's symptoms.
Writing to her brothers at military camps outside the city, Rebecca described the methods being used to treat Sarah, all of which had one thing in common: they so debilitated her physically, her manic symptoms weakened as well.
The first of these was blistering, which, along with bleeding and purging, was one of the most frequently used weapons in the medical arsenal. To raise a blister, an irritating substance was applied, usually to the back or the arm. The medical theorists of the time posited that the body could hold only one malady at a time, and, thus, a new disorder (the blister) would drive out Sarah's nervous problem. I feel sure that some practitioners also realized that a new, intense pain would displace the patient's attention from practically anything else from which she was suffering.
(To be continued in the next post here.
(The quote is from an undated letter, but since it is to Benjamin Gratz at Washington Barracks, Kennett Square, it can only be from 1814. It is printed in The Letters of Rebecca Gratz which is accessible through Google Books.)
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