Today, we are happy to bring you our conversation with Marshall Foletta, author of Purge and Bleed: Philadelphia’s Yellow Fever Epidemic and the Stagnation of American Medicine

What inspired you to write this book? 

I stumbled into the questions that drove this book while researching another topic—the perception and experience of mental illness in the early nineteenth century. For this original topic I figured that I needed to read the works of Benjamin Rush, the physician usually credited with producing America’s first text on mental illness. And once I began reading Rush, I realized that I needed to understand his role in Philadelphia’s yellow fever epidemic.

From there the project took on a life of its own as the questions piled on top of one another. Before long, my original project had fallen by the wayside as I struggled to understand why American medicine—and perhaps more specifically, American disease theory—failed to advance over the course of the nineteenth century. This question took me well beyond the Philadelphia epidemic—and inspired me to think about producing a book with enough range to serve the interests of folks both inside and outside academia—a book that explored the issue of stagnation through the cholera epidemic and Civil War, a book that looked at the medical mainstream as well as the irregular medical movements and critical voices that went unpursued.

What did you learn and what are you hoping readers will learn from your book? 

I’m hoping that readers will see what I did—that the “stagnation” with American medicine cannot be casually dismissed as part of a general malaise surrounding Western medical science. I hope that readers will recognize that the failure to move beyond a set of ideas about disease and therapeutics, which dated back centuries, was informed by a set of “American” circumstances. Perhaps more broadly, I hope that they will see this book as representative of what I think is the best sort of history—history that while acknowledging that broad forces that shape the past also looks closely at the particular—in this case, the personalities of the physicians at the forefront of medicine as well as the conflicts between them, the purposes of the journals that hosted their arguments, and the popular attitudes that grew to play a large part in shaping American medicine.

What surprised you the most in the process of writing your book? 

It was the incredible persistence of ideas about disease and treatment that were centuries old yet then the incredibly rapid acceptance by physicians and scientists of the new science following the discovery of “germs” in the last decades of the nineteenth century. It speaks in part to the brilliance of the bacteriological breakthroughs coming from Europe but suggests also that America’s physicians and scientists were poised for a something new. You can sense the intellectual exhaustion following the vicious debates over causes and cures as early as the epidemics of the 1790s; you can detect a growing fatalism among physicians about their inability to understand and treat illness during the cholera and puerperal epidemics of the 1830s and 40s; and you can identify a readiness to break from inherited ideas in the research efforts of miliary physicians during the Civil War. In other words, while I was surprised by the rapidity with which the vast majority of America’s physicians and scientists followed the paradigm-shifting path laid out by Robert Koch and others, once I dug deeper, I was not.

What’s your favorite anecdote from your book?

It might be Samuel Thomson boasting that he “successfully” removed the canker from his two-year-old daughter’s eye, although the “sight came out with it.” It might be the words of an elderly patient mocking the cowardice of others while celebrating his own fortitude in enduring Benjammin Rush’s harsh depletion therapies: “if my poor frame, reduced by previous sickness, great anxiety, and fatigue, and a very low diet, could bear seven bleedings in five days, besides purging and no diet but toast and water, what shall we say to physicians who bleed but once.” Or it might be a General Martin’s account of his own self-treatment when his physician failed to cure his bladder “stones.” Using a steel wire (and incredible grit) Martin fished the wire through his urethra, and filed down the recurring stones. He could only work for five minutes at a time—or until the pain became unbearable—but in this way he managed to break up and pass the stones that had plagued him for decades.

What’s next? 

Good question. I may return to the project I was pursuing before getting sidetracked by this book. I’m still intrigued by the way that mental illness was experienced in the early- to mid-nineteenth century—and with the ways sufferers self-managed their illness in the absence of any type of real professional support. For example, I was fascinated by the way that Angelina Grimke developed a religion-based process for managing the crippling depression that drove her out of the reform movement. I was intrigued by the way that Pamela Sedgwick, mother of the novelist Catharine Maria Sedgwick, used her periodic bouts with depression to tap into a creative, even norm-busting side that she revealed in her correspondence.

I intend to spend more time exploring these accounts alongside the growing interest in mental illness as a discrete medical condition—an interest that inspired new institutions, creative discourse surrounding the accommodations that suffers should be accorded in the legal system, and a host of therapeutic innovations from mesmerism to psychoanalysis.