Medical Heroics

As part of my continuing effort to understand what I am part of....

“Doctors are men who prescribed medicine of which they know little to cure disease of which they know less in human beings of which they know nothing

.”

---Voltaire

Drugs, such as were available to mid 19th-century regular physicians, were usually mineral in origin. Primarily because of their speed of onset and severity of action, they were initially favored over botanical derivatives for they quickly authenticated the power of a physician’s intervention.

Included in this pharmacopoeia, for example, were alkaloid preparations of mercury, strychnine, and antimony, all of which are poisonous in varying degrees. All of which led, quickly, to vomiting and diarrhea. Medical procedures, performed when indicated, were likewise severe. They included bleeding, enemas, cupping (the application of heated glass chambers which, by inducing a mild vacuum upon cooling, bring blood to the skin surface), leaching, blistering, purging, and stomach pumping.

In this era, the efforts to reduce a patient's fever and inflammation by using these agents was referred to as "Heroic Therapy." (In retrospect, it is debatable what earned the "Heroics" label -- the therapeutics as applied by the physician or the effort to survive them by the patient.)

Today we have Tylenol.

There were other reasons why the regular physicians acted boldly to take charge of a situation by using these painful and powerful mineral medicinals. They felt the need to distinguish their ability from those of the Native Americans and their folk remedies, many of which had been shared with early settlers. Besides, they did not bill their patients but expected payment for services on the spot. They needed to demonstrate dramatic results of their intervention, even if it was counterproductive, so the patient got their money's worth.

Folk remedies, on the other hand, were exclusively botanically based, slow to act (if at all), and less dramatic. Physicians of this era preached that botanicals had minimal potency, producing their benefits through sham, suggestion, or merely the soothing effects of the heated water in which they were administered. Mineral remedies were clearly and visibly potent, their effects often seen and felt within hours. There were also political, if not racist, needs to amplify these differences in order to demonstrate the superiority of the physician over the folk healers.

Benjamin Rush, one of the leading medical teachers of the late 18th and early 19th-century (who was all the more influential because of his success as a politician and founding father of our Republic) wrote,

"We have no discoveries in the materia medica to hope for from the Indian in North America. It would be a reproach to our schools of physic if modern physicians where not more successful than the Indians, even in the treatment of their own diseases".

What he meant by "successful" remains unclear to this day.

Increasing public resistance to the practice of "Heroic" medicine with its therapeutic discomfort and lack of perceived efficacy, coupled to a new cultural open-mindedness to the potential in native remedies and other approaches, gradually turned the American patient to the gentler ministrations of the homeopathic and botanical practitioners. Their applied agents were much less caustic and less likely to produce cataclysmic results. But, they were likewise ineffective.

preventing

Modern, "scientific" medicine has since raised the bar. "Heroic" medicine no longer means reducing fever, as it once did, when an unremitting fever meant death. Today, "Heroic" medicine means reducing death. (We're not quite at the point of death. As a friend of mine pointed out, nobody gets off this planet alive.)

Two hundred years ago, fearful, desperate people demanded cures and chased all therapeutic modalities to find answers, even when none was available. Aspirin, the first modern fever reducing agent, appeared in 1899 courtesy of the Bayer people. Fever, no longer exotic and unmanageable, was no longer an "Heroic" struggle.

Today we have cancer and cisplatinum compounds. And Laetrile and alternative therapeutics.

"The more things change, the more they remain the same"

Alphonse Karr (1808- 1890)