Heroic medicine

This article is about an outdated model of medicine. For "last ditch" medical treatments, see heroic measures.

Heroic medicine can either refer to heroic therapy or to heroic drugs.

Heroic therapy, 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 North America in the "Age of Heroic Medicine" (1780–1850), ^[1] 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. ^[2]

Heroic drugs, also called in English potent medicaments, was also a term used in Europe from the 18th to the 20th century to refer to certain potent pharmaceutical drugs.

Heroic therapy

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. ^[3] 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.

Historian Robert Sullivan reminded that "heroic therapy is not a concept about which historians are unified, whether discussing its definition or its duration." ^[3]

Breathing a Vein, a caricature of bloodletting by venesection by James Gillray, 1804

United States

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. ^[5] 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.^{[ citation needed ]} 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. ^[3]

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. ^{[6] [7] [8] [9] [10]}

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. ^[11]

Clinical 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. ^[12] 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. ^[5]

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. ^[5] 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. ^[3]

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. ^[13] In the modern day, there are few proponents of heroic medicine.

Heroic drugs

In Diderot's Encyclopedia (1765) the following definition is given for heroic remedies:

This term is used to refer to the type of treatment or remedies whose effects produce considerable and quick changes in the animal economy; whether by violent stimulation of efforts, movements, extraordinary irritations in parts which are susceptible to it, sudden shakings, strong shakings in the whole body; or by producing a spasm, a constriction or a relaxation, an excessive muscle loss in the parts; or by providing liquifications, evacuations of humors that seem excessive, but are necessary; in all the cases where nature demands to be rescued in a pressing and decisive manner by means appropriate to change the vitiated disposition of the affected parts, and to transform them to an opposite state from one extremity to another. The means appropriate to bring about these different effects, are plentiful and repeated bleedings in a short span of time, purgative medications, emetics, perspirants and all the strongest evacuants; stimulants, cordials, aperitifs, the most active liquifiers; acrids, epispastics, and astringents of all kinds, used both internally and externally; scarring, scathing, narcotics that are most efficient and at high dosage; numbings, ligatures of nerves, of large vessels, of membranes, etc.; and violent, active, and passive exercises, etc.… ^[14]

This term would get on being used in the field of pharmacy, sometimes translated as "potent" in English. ^[15] It may have influence the name given to Heroin upon its discovery. ^[16]

In 1902 and 1925, two treaties standardized the monographs of certain heroic medicines, as a first step towards the standardization of more types of drugs (which became eventually The International Pharmacopoeia). ^[15]

See also

• Heroic measure
• Brussels Pharmacopoeia Agreement (1902)
• Brussels Pharmacopoeia Agreement (1925)

References

1. Singh, Simon; Ernst, Edzard (2008). Trick Or Treatment: The Undeniable Facts about Alternative Medicine. W. W. Norton & Company. p. 108. ISBN   978-0-393-06661-6.
2. Flint, August (1874) Essays on Conservative Medicine
3. Sullivan, R. B. (1994). "Sanguine practices: A historical and historiographic reconsideration of heroic therapy in the age of Rush". Bulletin of the History of Medicine. 68 (2): 211–34. PMID   8049598.
4. "English Caricature: Heroic Medicine--Bloodletting, Emetics, and Laxatives". exhibits.hsl.virginia.edi. Retrieved December 22, 2022.
5. Lindemann, Mary (2010). Medicine and Society in Early Modern Europe. Cambridge: Cambridge. p. 117. ISBN   978-0-521-73256-7.
6. Stavrakis, P (1997). "Heroic medicine, bloodletting, and the sad fate of George Washington". Maryland Medical Journal. 46 (10): 539–40. PMID   9392943.
7. Cohen, Ben (2005). "The Death of George Washington (1732–99) and the History of Cynanche". Journal of Medical Biography. 13 (4): 225–31. doi:10.1177/096777200501300410. PMID   16244717. S2CID   2766668.
8. Schmidt, P. J. (2002). "Transfuse George Washington!". Transfusion. 42 (2): 275–7. doi: 10.1046/j.1537-2995.2002.00033.x . PMID   11896346. S2CID   37897549.
9. Howard Markel (14 December 2014). "Dec. 14, 1799: The excruciating final hours of President George Washington". www.pbs.org.
10. Cheatham, M. L. (2008). "The death of George Washington: An end to the controversy?". The American Surgeon. 74 (8): 770–4. doi: 10.1177/000313480807400821 . PMID   18705585. S2CID   31457820.
11. Lyng, Stephen (1990). Holistic Health and Biomedical Medicine: A Countersystem Analysis. SUNY Press. pp. 175–9. ISBN   978-0-7914-0256-6.
12. Bynum, W. E. (1996). Scientific Practice of Medicine in the Nineteenth Century. Cambridge: Cambridge University Press. p. 18. ISBN   0-521-25109-5.
13. Whorton, James C. (2002). Nature Cures: The History of Alternative Medicine in America. Oxford University Press. ISBN   0-19-514071-0.^{[ page needed ]}
14. Académie des Sciences (2020-04-17). "Heroic". Encyclopedia of Diderot & d'Alembert - Collaborative Translation Project. Translation: Lisa Lee.
15. Riboulet-Zemouli, Kenzi (2025). "1925–2025: a century of international pharmaceutical law". Journal of Pharmaceutical Policy and Practice. 18 (1): 2470840. doi:10.1080/20523211.2025.2470840. PMC   11892055 . PMID   40066186.
16. "Diacétylmorphine : la médecine héroïque". Le Quotidien du Pharmacien (in French). Retrieved 2025-12-26.