Heroic medicine

The theory behind heroic medicine has been in place for thousands of years. Chinese and Greek cultures were among the earliest to document the practice of heroic medicine, particularly bloodletting.{{Cite journal |last=Kuriyama |first=Shigehisa |date=1995 |title=Interpreting the History of Bloodletting |url=http://www.jstor.org/stable/24623553 |journal=Journal of the History of Medicine and Allied Sciences |volume=50 |issue=1 |pages=11–46 |issn=0022-5045}} One of Hippocrates' contemporaries, the philosopher Empedocles, proposed a theory of four humors corresponding to qualities of the four terrestrial elements proposed by Aristotle: phlegm (associated with water), blood (associated with air), black bile (associated with earth), and yellow bile (associated with fire). Illness would arise from an imbalance of humors, and the physician would then either restore or remove the humor that was deficient or excessive, respectively.{{Cite journal |last=Lagay |first=Faith |date=2002-07-01 |title=The Legacy of Humoral Medicine |url=https://journalofethics.ama-assn.org/article/legacy-humoral-medicine/2002-07 |journal=AMA Journal of Ethics |volume=4 |issue=7 |pages=206–208 |doi=10.1001/virtualmentor.2002.4.7.mhst1-0207 |issn=2376-6980}} The Huangdi Neijing, likely composed during the Han Dynasty (475 BCE-220 CE), contains several references to bloodletting.{{Cite web |last=Studies |first=Neijing |title=Huangdi Neijing |url=https://neijingstudies.com/huangdi-neijing/ |access-date=2025-03-09 |website=Neijing Nature-Based Medicine }}{{Cite journal |last=Moran |first=Bruce T. |date=1995 |title=Bloodletting in Ancient Greek and Chinese Traditions |url=http://www.jstor.org/stable/41111713 |journal=Pharmacy in History |volume=37 |issue=4 |pages=190–191 |issn=0031-7047}} In traditional Chinese medicine, the practice often targeted major arteries; however, improper use of these sites could have severe repercussions, ultimately leading to the discontinuation of this practice in China.

Heroic medicine, particularly bloodletting, was seen as a form of therapy by some. It was believed that blood had neurotic effects, and the imbalance could cause madness or discomfort.{{Cite journal |last=Meek |first=Heather |date=2023 |title=‘Meanders of [the] Purple Flood’: Blood and Bloodletting in Eighteenth-Century Literature and Medicine |url=https://onlinelibrary.wiley.com/doi/10.1111/1754-0208.12872 |journal=Journal for Eighteenth-Century Studies |language=en |volume=46 |issue=1 |pages=33-34 |doi=10.1111/1754-0208.12872 |issn=1754-0208}} To treat this mental instability, the practice of bloodletting was widely used and even accepted by many, as they claimed to witness the effects of bloodletting.{{Cite journal |last=Meek |first=Heather |date=2023 |title=‘Meanders of [the] Purple Flood’: Blood and Bloodletting in Eighteenth-Century Literature and Medicine |url=https://onlinelibrary.wiley.com/doi/10.1111/1754-0208.12872 |journal=Journal for Eighteenth-Century Studies |language=en |volume=46 |issue=1 |pages=52 |doi=10.1111/1754-0208.12872 |issn=1754-0208}}Pockets of medical methodology that can be classified as "heroic" appear in the early 17th century with Parisian physician Guy Patin and French anatomist Jean Riolan the Younger. 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 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.{{Cite journal |last=Meek |first=Heather |date=March 2023 |title='Meanders of [the] Purple Flood': Blood and Bloodletting in Eighteenth‐Century Literature and Medicine |url=https://onlinelibrary.wiley.com/doi/10.1111/1754-0208.12872 |journal=Journal for Eighteenth-Century Studies |volume=46 |issue=1 |pages=46 |doi=10.1111/1754-0208.12872 |issn=1754-0194}} 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, particularly aggressive bloodletting, played a tragic role in the treatment of George Washington during his final illness in 1799. When Washington fell severely ill with a serious throat infection that made breathing increasingly difficult, his physicians turned to repeated and extensive bloodletting, a common heroic practice at the time, to reduce inflammation and restore bodily balance​.{{Cite journal |last=Copeman |first=E. |date=1879 |title=On Bloodletting |url=https://www.jstor.org/stable/25252605 |journal=The British Medical Journal |volume=2 |issue=989 |pages=932–933 |issn=0007-1447}} The rationale was based on the widely accepted idea that removing large amounts of blood could relieve internal pressures and congestion, thus promoting healing​.{{Cite journal |last=Risse |first=Guenter B. |date=1979 |title=The Renaissance of Bloodletting: a Chapter in Modern Therapeutics |url=https://www.jstor.org/stable/24625607 |journal=Journal of the History of Medicine and Allied Sciences |volume=34 |issue=1 |pages=3–22 |issn=0022-5045}} Unfortunately, rather than helping, these intense treatments left Washington severely weakened and hastened his decline. The circumstances surrounding Washington's death soon became a cautionary tale, highlighting the risks associated with heroic medical practices and encouraging a growing skepticism toward such aggressive therapies.

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.{{cite book|author=Lyng, Stephen|title=Holistic Health and Biomedical Medicine: A Countersystem Analysis |url={{Google books|J24_NDF_zhQC|page=175|plainurl=yes}} |year=1990 |publisher=SUNY Press |isbn=978-0-7914-0256-6 |pages=175–9}}

Heroic medicine does not have a definitive start date, as its treatments themselves were not new to the field of medicine. Bloodletting, purging, and sweating are cemented firmly in medical tradition back to the advent of humoral theory in the time of Hippocrates and Galen.{{Cite book|title=Scientific Practice of Medicine in the Nineteenth Century|last=Bynum|first=W. E.|publisher=Cambridge University Press|year=1996|isbn=0-521-25109-5|location=Cambridge|pages=18}} 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.{{Cite book|title=Medicine and Society in Early Modern Europe|last=Lindemann|first=Mary|publisher=Cambridge|year=2010|isbn=978-0-521-73256-7|location=Cambridge|pages=117}}

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 and laxatives, induced the forceful removal of bodily fluid. Commonly used emetics include senna and tartar emetic. General intestinal cleansing was instigated by massive doses of calomel, to the point of acute mercury poisoning. Sweating was also induced using blisters of cantharidin and diaphoretic.{{cite journal |pmid=8049598 |year=1994 |last1=Sullivan |first1=R. B. |title=Sanguine practices: A historical and historiographic reconsideration of heroic therapy in the age of Rush |journal=Bulletin of the History of Medicine |volume=68 |issue=2 |pages=211–34 }}

In the treatment of nervous system diseases, "heroic" methods were commonly employed well into the 19th century. Aggressive treatments such as bloodletting, the use of leeches, and purgatives like calomel were standard practices for patients with conditions like epilepsy, hydrophobia, and even neurosyphilis. Clinical reports from Vilnius University clinics between 1806 and 1842, as well as case studies, reveal the regular use of intense regimens aimed at managing these neurological diseases. These practices were based on humoral theory and Brunonian medicine, which posited that nervous system disorders were due to an imbalance of bodily humors. Treatments such as copious bloodletting, cupping therapy, and leeching were considered necessary to "rebalance" the patient’s humors. For instance, acidum borussicum was prescribed for hydrophobia, and purgatives like calomel were used to treat nervous disorders through their anti-inflammatory effects.

Despite the often harmful effects of such treatments, including toxicity from calomel and mercury poisoning, these methods were seen as the most potent tools available to physicians of the time. The application of these therapies in neurology{{Cite journal |last=Sakalauskaitė-Juodeikienė |first=Eglė |date=2024 |title=“Heroic” medicine in neurology: A historical perspective |url=https://onlinelibrary.wiley.com/doi/full/10.1111/ene.16135 |journal=European Journal of Neurology |language=en |volume=31 |issue=11 |pages=e16135 |doi=10.1111/ene.16135 |issn=1468-1331 |pmc=11464392 |pmid=37986650}} illustrates how the principles of "heroic" medicine extended into the treatment of nervous system diseases, demonstrating the reliance on intense and aggressive interventions during this era.{{Cite journal |last=Sakalauskaitė-Juodeikienė |first=Eglė |date=2024 |title="Heroic" medicine in neurology: A historical perspective |url=https://onlinelibrary.wiley.com/doi/10.1111/ene.16135 |journal=European Journal of Neurology |volume=31 |issue=11 |pages=e16135 |doi=10.1111/ene.16135 |issn=1468-1331 |pmc=11464392 |pmid=37986650}}

Phlebotomy, the main form of bloodletting, a practice that has been the focus of most medical practitioners for countless of years.This practice was previously for unproven symptoms/indications for diagnoses. But is now used for major therapeutic procedures performed by physicians. The effects of this procedure cause the patient to weaken, resulting in his/hers death.

Heroic medicine became less favoured with the advent of medical science. Even during its heyday, heroic medicine faced criticism from physicians and alternative medicine healers like the Homeopaths, who pushed for more natural cures.{{Cite book|title=Nature Cures: The History of Alternative Medicine in America|last=Whorton|first=James C.|publisher=Oxford University Press|year=2002|isbn=0-19-514071-0}}{{page needed|date=June 2017}} When bloodletting was at its peak in Europe, there were risks like a lack of scientific research and ethical practice. During this time the risk of infection was very common and could lead to harmful side effects. For instance, the early 19th century saw skeptics point to the work of Pierre Charles Alexandre Louis, who found no difference in outcome of pneumonia patients who had undergone bloodletting as opposed to those that had not.{{Cite journal |last=Greene |first=Jeremy A. |last2=Jones |first2=David S. |last3=Podolsky |first3=Scott H. |date=2012-09-20 |title=Therapeutic Evolution and the Challenge of Rational Medicine |url=https://www.nejm.org/doi/full/10.1056/NEJMp1113570 |journal=New England Journal of Medicine |volume=367 |issue=12 |pages=1077–1082 |doi=10.1056/NEJMp1113570 |issn=0028-4793}} Benjamin Rush eventually began attesting to the dangers and problems bloodletting posed.{{Cite journal |last=Leitch |first=AG |date=1970 |title=BLEEDING: ITS USES FROM THE EIGHTEENTH TO THE TWENTIETH CENTURY. |url=https://era.ed.ac.uk/bitstream/handle/1842/24821/Leitch_1970redux.pdf?sequence=1&isAllowed=y |journal= |pages=8-9 |via=University of Edinburgh}} John Hughes Bennet also gave a lecture in which he pointed out the uselessness of bloodletting in 1855. {{Cite journal |last=Leitch |first=AG |date=1970 |title=BLEEDING: ITS USES FROM THE EIGHTEENTH TO THE TWENTIETH CENTURY. |url=https://era.ed.ac.uk/bitstream/handle/1842/24821/Leitch_1970redux.pdf?sequence=1&isAllowed=y |journal= |pages=17 |via=University of Edinburgh}}Further erosion of its credibility came from Rudolf Virchow's establishment of cellular pathology, the idea that all disease stemmed from abnormalities in cells. With that, there was less need for the sweeping, drastic treatments of heroic medicine.{{Cite journal |last=Schultz |first=Myron |date=September 2008 |title=Rudolf Virchow |url=http://wwwnc.cdc.gov/eid/article/14/9/08-6672_article.htm |journal=Emerging Infectious Diseases |volume=14 |issue=9 |pages=1480–1481 |doi=10.3201/eid1409.086672 |issn=1080-6040 |pmc=2603088}} In the modern day, there are few proponents of heroic medicine, as there has been a widespread shift to incremental medicine, which is the concept of regular visits to the doctor for a check-up, rather than massive procedures with questionable outcomes.{{Cite web |last=wendysalkin |date=2017-02-21 |title=ACA Repeal and the End of Heroic Medicine - Petrie-Flom Center |url=https://petrieflom.law.harvard.edu/2017/02/21/aca-repeal-and-the-end-of-heroic-medicine/#:~:text=While%20the%20structures%20of%20the,dictates%20of%20their%20own%20genes. |access-date=2025-04-13 |website=petrieflom.law.harvard.edu |language=en-US}}

• Heroic measure

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Category:History of medicine