Impact of Heroic Medicine on Contemporary Medicin - Research Paper Example

?Impact of Heroic Medicine on Contemporary Medicine Introduction Physical sciences and life sciences in the United s went through a rich historybefore it developed into the diverse and useful tool which it has become in the current industrialized and digital world. These developments in the physical sciences cover numerous areas including education, government, culture, society, law, religion, medicine, and economics. These developments also allowed for much discovery and experimentation to be carried out in these fields, allowing for the refinement in the practice as well as related innovations. This course has evaluated the development of the physical sciences and life sciences in the United States and their application from the colonial era up to the present. This course also evaluated the historical role of science in the US and the link between science and other institutions. This study will focus on heroic medicine and its role in general society and in the current application of the practice. Body Heroic medicine covers therapies which are aggressive medical interventions or remedies which were used mostly during the mid-19th century1. This type of medicine mostly includes risky and unproven options of treatment which the more scientific methods of healing have replaced. Benjamin Rush who was one of the first who helped ratify the US Declaration of Independence is one of the advocates and ‘fathers’ of medicine in America and of heroic medicine. His training in medical practice was at the Edinburgh University2. The age of heroic medicine covers from 1780 to 1850 where many educated medical practitioners actively engaged in this practice. During their practice of this type of medicine, they included practices such as bloodletting, intestinal purging, vomiting, profuse sweating, and blistering3. Doctors during these times mostly managed illnesses such as syphilis using mercury-laden salves4. Although these methods of treatment were very much supported by the intention to treat, these interventions were very much harmful to the patients. Heroic medicine became the norm of treatment during the mid-19th century. This practice actually became the accepted practice at that time, that even the educated and trained doctors were applying it5. The actual doctors who did not apply it were the ones who were actually known as alternative practitioners. Calomel and mercurous chloride was the most commonly used mineral for the purging practices. Illnesses at that point were viewed to be imbalances in the system which were attributed to an under or over stimulation of the body6. As such, purging was needed in order to rid the body of the illness. Bleeding was considered one of the initial remedies for illnesses as it can easily eliminate any poison in the system, allowing for the balance to be renewed in the system. Signs indicated that the practice indeed worked, or that some interventions were working. Most of the people during this time felt that they were being treated even if some of the treatments led them near death7. The doctor also made it appear that he was in control of the situation. This type of treatment is considered heroic for various reasons. The term comes from the significant impact of the treatments and the large dose often needed to carry out the treatment. There is often a huge amount of calomel administered to lead to major and immediate effects, like severe vomiting8. As such, the intervention in this case is dramatic and is very bold. Although, these methods may not have been healing, they were certainly dramatic. During the 19th century, America was going through numerous civil and industrial changes in their lives. However, medicine was hardly within the same steady and progressive pace of growth and development9. The qualities of these practitioners were not the same as those who practiced during the 18th century. As was mentioned above, one of the major health practitioners during this time was Benjamin Rush who supported very much the philosophy of natural law10. Based on this system, the body was considered a machine and diseases were simply an overstimulation of the blood and the nerves. In order to cure such overstimulation, heroic methods needed to be applied including bleeding, blistering, and purging with the hope of tipping the balance over to the middle11. Bloodletting was the initial remedy and it included the opening of the veins, scarifications where small cuts are made on the skin, and cupping where a warm glass cup was placed over a cut, allowing blood to fill in the cup12. Blistering included the placement of hot plasters on the skin to cause the blisters and these blisters soon allowed draining. Benjamin Rush was a firm and avid supporter of heroic medicine and his practices encouraged numerous doctors who followed his practice even when it was not popular among patients13. During this period of heroic medicine in the US, a different development was observed in Paris as French doctors did not feel bound to the practices of their predecessors. They were more willing to consider and observe how the patients responded to treatment and to their disease14. Their practice focused more on using clinical and pathological assessment to secure treatment. The diagnosis was highlighted more than the heroics. US doctors also sought training in France during the mid-1800s, however, even when these more enlightened doctors sought changes in US medicine based on the French training, heroic medicine was still the dominant practice15. However, more skepticism from the people for its practice was noted. More considerations towards what was considered ‘quack’ medicine eventually developed. The US eventually produced better surgeons, but most of these practitioners were those who studied in France. More advancements in surgical techniques were later seen, however, surgery was considered the last resort because it was usually fatal and very painful16. Sterile techniques were not applied and as such infections were a major issue. Opium and alcohol were the only available anesthetics during this time and chloroform, nitrous oxide and ether was only used by the upper class. More trainings in medicine were seen at this point, mostly veering away from heroic medicine practices17. However, scientific medicine did not gain much momentum during the mid-1800s mostly because most of the doctors still lacked the necessary training and heroic medicine was still the dominant practice among the doctors. These elements, alongside the Jacksonian democracy created a more egalitarian America which had no use for the aristocratic doctors. The general public also believed that they can be cured if heroic medicine principles were applied18. Licensing among doctors was eliminated and anyone could practice medicine. Other forms of quack medicine including hydropathy, phrenology and mesmerism were also added into the mix. Religion also found itself into the practice alongside social reforms19. Alternative practices were common until the century’s end. However, major casualties during the Civil War forced a more systematic consideration of the causes of disease20. More studies were carried out in Europe, with scientists like Ingnaz Semmelweis, John Snow, John Lister, and Louis Pasteur making major discoveries in medicine. Their discoveries pushed for the need for sterile techniques in the practice, including better medical education. At some point, alternative medicine was blended into the scientific medical practices21. Competition in the medical practice during the 19th century caused the increase of medical personnel, as well as the increase in theories relating to standard medical practice. The usual practice in medicine during this time mostly focused on symptomatic treatment, mostly applying the different practices in heroic medicine22. These practices caused much death for patients who underwent these forms of treatment. Eclecticism and homeopathy were often seen alongside heroic medicine, and their presence eventually led to the return of licensing laws in the US in order to regulate the practice of medicine. Practitioners like Thompson later disputed the foundations of heroic medicine, calling purging, bloodletting, blistering, and other types of heroic medicine as instruments of death23. An alternative to the medical treatments were therefore introduced into the practice. These developments eventually led to the gradual abandonment of heroic medicine, into more practical, common-sense, and scientifically-based practice. Benjamin Rush, during the 19th century was considered one of the founding fathers of American medicine24. He was a very influential practitioner and teacher. However, the mark and legacy he left in medicine is considered an embarrassing and messianic legacy when scientific and factual evidence would be considered. His heroic medicine practice is supported by unscientific doctrines and concepts, mostly alongside the encompassing nature of disease which he never closely considered25. He perceived nature to be an adversary, one which must be managed within the midst of his dead patients. He considered himself very observant, often carrying his notebook wherever he went, recording observations, conversations, thoughts, and other relevant points. During the epidemic of yellow fever, he discarded this practice, mostly because he simply had no time to take notes. Still, Rush’s purges and bloodletting were still considered wrong and eventually deadly to his patients. He watched numerous deaths occur because of his bloodletting and purges, still, he seemed to find a way to justify his practice26. Despite his colleagues in the medical community pointing out apparent flaws in his beliefs and practices, Rush was persistent in his practice, and eventually he became almost paranoid in his defense of his techniques. At one point, he believed that he was a hero to his patients, one anointed by God to save the people27. His intentions however were unquestionably noble, as he indeed wanted nothing more than to cure the ailments of his patients. However, his intentions were also based on a religious passion which did not leave any room for doubt, much less reason. Bloodletting became one of the more common forms of heroic medicine during the 19th century. As was already mentioned previously, Dr. Benjamin Rush was one of its most staunch practitioners28. His perception of disease however was considered very much simplistic as he perceived all diseases as products of imbalances in the blood and nerves. To his mind therefore, he believed that it was important to apply depletion therapy in order to dampen vascular overexcitement. This made him an aggressive practitioner of bloodletting during the yellow fever epidemic. He often bled his patients several times and he believed that this practice strangled the fever and strengthened the body, increasing the frequency of the pulse and eliminates pain in the body29. He also used calomel purgatives which were high in mercury and he even wrote various articles citing how these forms of treatment were highly effective. As in most practices in the field of medicine, discussions were rich and often contradictory. Both positive and negative reactions were heard, mostly from his colleagues. His feud with other doctors was very much alive30. However, just as he was being rejected by his peers, he was also being honored by others. In general however, many more deaths and negative responses to bloodletting eventually led to the elimination of this practice, including other practices relating to heroic medicine. Questions on why these practices, which were obviously flawed, lasted for so long have often been asked, especially as research and clinical practitioners found no scientific evidence indicating efficacy of these processes31. Kerridge and Lowe point out that bloodletting persisted because it is not considered an anomalous perception per se, but it was born out of the rich interactions relating to social, economic, as well as intellectual demands32. These processes still have an impact on the medical practice. Based on the current conceptualization of pathophysiology, the past applications of heroic medicine would be considered amusing and anomalous. Physicians from the past would be astonished at the current developments in science and medicine including the use of antibiotics, vaccinations, surgeries, as well as chemotherapy33. It can likely be expected in the future that more advances and developments in knowledge and treatment would further be refined, with treatments become not as invasive. These developments all support the current pace of scientific discovery which in a major way veered far away from heroic medicine. Heroic medicine is considered a pre-scientific predecessor to modern medicine. However, at the time it was widely practiced in America, medical opinion was based on four humors: blood, phlegm, yellow bile, and black bile34. Ill health was caused by miasms which interrupted the balance of such humors. Balance was therefore important, and efforts to maintain it including bloodletting, purging, and sweating were made by practitioners of heroic medicine. Kant admitted that these methods were the fastest way of resolving conflicts and illnesses, even as they primarily endangered the life of the patients35. These elements all made up the entire drama of the practice, making it overwhelming, surprising, as well as heroic. The heroism is based here on the enormity of its impact, not its efficacy in healing the patient. For a while, bloodletting was one of the longest running practices in medicine. It started out in Egypt and later to Greece, the Arab and Indian regions, later passed on to the US. Throughout the years, bloodletting has also evolved, from venesection, and then to cupping, and then to the use of leeches. These methods are all based on the removal of blood from the body as a means of securing balance in the body36. Although other methods of bloodletting were soon eliminated from the medical practice, the use of leeches stayed popular in some quarters. During the 19th century, these leeches became very much valuable. They were difficult to find, and also difficult to keep alive. Efforts to artificially mimic their properties were attempted throughout the years and one of the first substitutes was the Sarlandicre’s bdellometer37. This device however only proved as effective as the cupping devices applied at that time. More devices would follow seeking to replace the functions of leeches. Nevertheless, leeches remained a popular option in medicine in terms of striking the balance and gaining efficacy very much needed by the sick individual. Leeching was indicated for numerous diseases including laryngitis, nephritis, mental illness, as well as obesity38. Diseases which were treated under leeching included typhoid fever, syphilis, tuberculosis, and varied mental illnesses. About 10 to 15 leeches would usually be placed on the abdomen of the patient in order to reach desired outcomes. French doctors also applied leeching and other doctors also understood to some extent the relevance of this practice in the management of disease39. American physicians also argued that bleeding is important during congestion and well as inflammation. Failure of the vessels to circulate is noted and leeching is recommended. In relation to myocarditis, hepatitis, tonsillitis, whooping cough, acne, and pimples, leeching has been used and recommended. These leeches were used extensively and at some point, efforts were made to increase their production in streams and ponds40. Live feed for these leeches were planned. Even with efforts to increase their number, these leeches still reached very low numbers and their use was also stopped. The medical community also admitted that the use of leeches implied issues in disease transmission especially as same leeches were used for several patients. Based on these elements, issue on the application leeches in the treatment of disease emerged. Once again, another element of heroic medicine lost its credibility. With these developments, heroic medicine eventually lost its power and influence on the medical community. Conclusion Heroic medicine emerged during the mid-19th century mostly in response to the growing medical needs of the community. During that time, four humors were dominant in society: blood, phlegm, yellow bile, and black bile. Basically, where these humors are in excess, an imbalance in the body is observed. This imbalance manifests through diseases. As such, in order to strike a balance, there is a need to let out the blood and/or purge the body from its excesses. Eventually heroic practice was eliminated due to its inefficacy during the yellow fever epidemic, and because of the number of deaths associated with its use. At present, heroic medicine is not considered scientific or as evidence-based medicine. Consequently, its use has been largely eliminated from the medical practice. Its use however is still important because of the lessons it has transmitted, mostly on ineffective practices in medicine, as well as the importance of evidence-based care. Bibliography Bates, Don G. "Why Not Call Modern Medicine"Alternative"?." Annals of the American Academy of Political and Social Science 583, no. 12 (2002). Cramer, Paige. “History of Bloodletting.” Tutscope 5 (2006). Dary, David. Frontier Medicine: From the Atlantic to the Pacific, 1492-1941. London: Random House, 2008. Divett, Robert T. "Medicine and the Mormons: A Historical Perspective." Dialogue: A Journal of Mormon Thought 12 (1979). Flexner, Simon and James Thomas Flexner. William Henry Welch and the Heroic Age of American Medicine. Baltimore: Johns Hopkins University Press, 1993. Floyd, Barbara. From Quackery to Bacteriology: The Emergence of Modern Medicine in 19th Century America. University of Toledo: Ward M. Canaday Center, 1994. Greenstone, Gerry. "The History of Bloodletting." BC Med J (2010). Hamowy, Ronald. "The Early Development of Medical Licensing Laws in the United States." The Journal of Libertarian Studies 3 (1979). Kerridge, Ian H., Michael Peter Lowe and John McPhee. Ethics and Law for the Health Professions. London: The Federation Press, 2005. Kopperman, Paul E. "" Venerate the Lancet": Benjamin Rush's Yellow Fever Therapy in Context." Bulletin of the History of Medicine 78, no. 3 (2004). North, Robert L. "Benjamin Rush, MD: Assassin Or Beloved Healer?." Proceedings (Baylor University. Medical Center) 13, no. 1 (2000). Parapia, Liakat Ali. “History of Bloodletting by Phlebotomy.” Brit J Haemat 143 (2008). Rush, Benjamin. “A Defence of Blood-letting, as a Remedy for Certain Diseases.” In: Medical Inquiries and Observations. Vol 4. Philadelphia, PA; 1815. Available online at: Arnebeck B. Benjamin Rush’s A Defence of Blood-letting, as a Remedy for Certain Diseases. www.bobarnebeck/defence.html (accessed 16 November 2013). Singh, Simon and Edzard Ernst. Trick or Treatment: The Undeniable Facts about Alternative Medicine. London: W. W. Norton & Company, 2008. Stavrakis, P. "Heroic Medicine, Bloodletting, and the Sad Fate of George Washington." Maryland Medical Journal (Baltimore, Md.: 1985) 46, no. 10 (1997). Sullivan, Robert B. "Sanguine Practices: A Historical and Historiographic Reconsideration of Heroic Therapy in the Age of Rush." Bulletin of the History of Medicine 68, no. 2 (1994). Toledo, Alexander Horacio. "The Medical Legacy of Benjamin Rush." Investigative Surgery 17, no. 2 (2004). Vogel, Morris J., and Charles E. Rosenberg, eds. The Therapeutic Revolution: Essays in the Social History of American Medicine. Pennsylvania: Univ of Pennsylvania Pr., 1979. Whitaker, I. S., J. Rao, D. Izadi et al. “Historical Article: Hirudo Medicinalis: Ancient Origins of and Trends in the Use of Medicinal Leeches throughout History.” Br J Oral Maxillofac Surg, 2004. Young, James Harvey. "American Medical Quackery in the Age of the Common Man." The Mississippi Valley Historical Review 47, no. 4 (1961). Read More