"Heroic" medicine in neurology: A historical perspective

Background and purpose: Repetitive bloodletting, promoting profuse diarrhoea and vomiting, the formation of artificial ulcers, and other aggressive treatment methods based on humoral theory and Brunonian medicine were used for patients with nervous system (NS) diseases until the end of the 19th century. These methods are also termed "heroic" medicine by modern medical historians.Methods: I analysed doctoral dissertations on the subject of NS diseases, clinical reports from 1806 to 1842 from the Vilnius University clinics, and other primary sources. This study was conducted in the vein of a historical-medical analysis and synthesis of primary sources, using comparative analysis, analogy, descriptive methods, and the method of retrospective diagnosis.Results: Copious bloodletting, purgatives, leeches, cupping therapy, and other potentially harmful methods were frequently employed as habitual treatments for patients with NS diseases. Calomel was used as a purgative and an anti-inflammatory drug, and acidum borussicum was prescribed for patients with hydrophobia. After analysing three clinical cases, I revealed how principles of desperate, "heroic" medicine were applied to treat severe NS diseases with the "strongest" drugs, described in the scientific literature of the time.Conclusions: My work was not intended to judge or criticize historical treatment methods but to demonstrate on what contemporary scientific theories they were based. We should not rule out the idea that some aggressive treatment methods used nowadays, although they eradicate or reduce the burden of a NS disease, or even prolong patients' lives, may offer exceptional examples of 21st century "heroic" medicine for future generations.