Heroic Medicine
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Heroic medicine, also referred to as heroic depletion theory, was a therapeutic method advocating for rigorous treatment of
bloodletting Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily flu ...
, purging, and sweating to shock the body back to health after an illness caused by a
humoral Humoral immunity is the aspect of immunity that is mediated by macromolecules - including secreted antibodies, complement proteins, and certain antimicrobial peptides - located in extracellular fluids. Humoral immunity is named so because it invo ...
imbalance. Rising to the front of orthodox medical practice in the "Age of Heroic Medicine" (1780–1850), it fell out of favor in the mid-19th century as gentler treatments were shown to be more effective and the idea of
palliative treatment Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...
began to develop.


History

Pockets of medical methodology that can be classified as "heroic" appear in the early 17th century with Parisian physician
Guy Patin Guy (or Guido) Patin (1601 in Hodenc-en-Bray, Oise – 30 August 1672 in Paris) was a French doctor and man of letters. Patin was doyen (or dean) of the Faculty of Medicine in Paris (1650–1652) and professor in the Collège de France starti ...
and French anatomist
Jean Riolan the Younger Jean Riolan (the Younger) (15 February 1577 or 1580 – 19 February 1657) was a French anatomist who was an influential member of the Medical Faculty of Paris. His father, Jean Riolan (the Elder) (1539–1605) was also a noted French anatomist. Ri ...
. Patin, nicknamed "Le Grand Saigneur" (the Grand Bloodletter), was infamous for his rigorous procedure plans, which included intensive courses of bloodletting and application of senna. Because heroic medicine used popular techniques, it is difficult to absolutely classify a healer's therapeutic epistemology as heroic. Intensive bloodletting treatments can be identified throughout American history, with William Douglass in Massachusetts advocating for a heroic treatment plan in the early 18th century. While there were practitioners here and there who were particularly eager to perform aggressive treatment, heroic medicine did not become a concentrated school of thought until later in the 18th century. Many associate
Benjamin Rush Benjamin Rush (April 19, 1813) was a Founding Fathers of the United States, Founding Father of the United States who signed the United States Declaration of Independence, and a civic leader in Philadelphia, where he was a physician, politician, ...
with an abrupt acceptance of heroic techniques into the realm of mainstream medicine, especially in America. Founding father, creator of University of Pennsylvania’s medical school, and known as the "American Hippocrates," Rush was well respected and revered in the medical field. The Philadelphia Yellow Fever outbreak in 1793 is looked upon as a major event in the merging of heroic medicine into the course of best practices in the medical profession. Much of the city was left incapacitated by the rampant epidemic. As healers fled the city, Rush bravely remained to treat people, and ultimately himself, with drastic regimens of intensive bloodlettings and purgatives. He taught many students who then carried the tradition to other parts of the United States. Varied in its influence, heroic medicine was particularly concentrated around Pennsylvania and spread into other locations. The term "heroic medicine" was coined later in the mid-19th century to describe extreme treatment. Heroic medicine was used to treat
George Washington George Washington (February 22, 1732, 1799) was an American military officer, statesman, and Founding Father who served as the first president of the United States from 1789 to 1797. Appointed by the Continental Congress as commander of th ...
on his deathbed in 1799. He was bled repeatedly and given
Mercury(I) chloride Mercury(I) chloride is the chemical compound with the formula Hg2Cl2. Also known as the mineral calomel (a rare mineral) or mercurous chloride, this dense white or yellowish-white, odorless solid is the principal example of a mercury(I) compound ...
(calomel) and several blisters of
cantharidin Cantharidin is an odorless, colorless fatty substance of the terpenoid class, which is secreted by many species of blister beetles. It is a burn agent or a poison in large doses, but preparations containing it were historically used as aphrodisiac ...
to induce sweating. Washington died shortly after receiving this rigorous heroic treatment. Heroic medicine was very much in the hands of the professional, as the invasive interventions involved were beyond the capabilities of rustic practitioners. Symptoms were not regarded as the body's attempt to fight the disease, but were considered a complication that would exacerbate the patient's condition and do further harm. Practitioners believed that a fever should be suppressed and any drugs used should be powerful and given in large dosages. Under this onslaught, domestic medicine dwindled in importance; even treatments that had been found effective in the past were relegated to the realms of old-fashioned folk medicine.


Practices

Heroic medicine does not have a definitive start date, as its treatments themselves were not new to the field of medicine.
Bloodletting Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily flu ...
, purging, and sweating are cemented firmly in medical tradition back to the advent of humoral theory in the time of
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
and
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
. With hopes of rebalancing the body's delicate homeostasis of four humors – black bile, yellow bile, phlegm, and blood – the careful manipulation of bodily discharge, like bleeding and evacuation, was believed to nudge the body back to its healthy, natural state. The physician's role was always to monitor the path of the body's humoral levels back to normal. Heroic medicine takes this methodology to the extreme, draining significant volumes of blood and ordering intensive regimens of evacuation. It was not uncommon for physicians to strive to drain up to 80 percent of a patient's blood volume. Likewise, dramatic evacuations, both by pharmacological
emetics Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis ...
and
laxative Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation. Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lubri ...
s, induced the forceful removal of bodily fluid. Commonly used emetics include senna and
tartar emetic Antimony potassium tartrate, also known as potassium antimonyl tartrate, potassium antimontarterate, or tartar emetic, has the formula K2Sb2(C4H2O6)2. The compound has long been known as a powerful emetic, and was used in the treatment of schistos ...
. General intestinal cleansing was instigated by massive doses of
calomel Calomel is a mercury chloride mineral with formula Hg2Cl2 (see mercury(I) chloride). The name derives from Greek ''kalos'' (beautiful) and ''melas'' (black) because it turns black on reaction with ammonia. This was known to alchemists. Calomel ...
, to the point of acute mercury poisoning. Sweating was also induced using blisters of
cantharidin Cantharidin is an odorless, colorless fatty substance of the terpenoid class, which is secreted by many species of blister beetles. It is a burn agent or a poison in large doses, but preparations containing it were historically used as aphrodisiac ...
and
diaphoretic Perspiration, also known as sweating, is the production of fluids secreted by the sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are distri ...
.


Fall of heroic medicine

Heroic medicine became less favoured with the rise of safer
placebos A placebo ( ) is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham surgery, and other procedures. In general, placebos can af ...
such as
hydrotherapy Hydrotherapy, formerly called hydropathy and also called water cure, is a branch of alternative medicine (particularly naturopathy), occupational therapy, and physiotherapy, that involves the use of water for pain relief and treatment. The term ...
and
homeopathy Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a dis ...
. Even during its heyday, heroic medicine faced criticism from physicians and alternative medicine healers, who pushed for more natural cures. While it is easy to discuss and question the ethical implications of such a severe course of treatment, it is important to remember that in that time period physicians were operating under their best understanding of the body and its physiology. There were dissenting voices at the time, but heroic medicine remained an important, legitimate part of the medical tradition in that era.


See also

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Heroic measure In medicine, heroic treatment or course of therapy is one which possesses a high risk of causing further damage to a patient's health, but is undertaken as a last resort with the understanding that any lesser treatment will surely result in failur ...


References

{{DEFAULTSORT:Heroic medicine History of medicine