# Heroic medicine

Heroic medicine, also referred to as heroic depletion theory, was a therapeutic method advocating for rigorous treatment of bloodletting, purging, and sweating to shock the body back to health after an illness caused by a humoral 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 began to develop.

## History

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. One of Hippocrates' contemporaries, the philosopher Empedocles, proposed a theory of four humors corresponding to qualities of the four terrestrial elements proposed by Aristotle. These four humors were 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. The Huangdi Neijing, likely composed during the Han Dynasty (475 BCE-220 CE), contains several references to bloodletting. 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.
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. 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 on his deathbed in 1799. He was bled repeatedly and given Mercury(I) chloride (calomel) and several blisters of cantharidin to induce sweating. Washington died shortly afterwards.
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, purging, and sweating are cemented firmly in medical tradition back to the advent of humoral theory in the time of Hippocrates and Galen. 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 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.
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 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.

## Fall of heroic medicine

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. For instance, the early 19th century saw skeptics point to the work of Louis Pierre, who found no difference in outcome of pneumonia patients who had undergone bloodletting as opposed to those that had not. 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. In the modern day, there are few proponents of heroic medicine.