Have pity on the poor leech. For more than a century, it has been the poster child for the once decrepit state of medicine. Nothing illustrates the relative backwardness of the pre-20se healthcare of the century than the image of an unhappy patient covered in bloodsuckers, or the cringe-inducing curiosities that lure onlookers in medical museums, like the vaginal specula used to insert leeches into regions where leeches should never go.
However, in the past, the leech reigned supreme. Doctors were likely to put leeches anywhere – on a cervix; tied to a string and lowered into the throat, like little speleologists, to treat tonsillitis; inserted deep into the rectum to treat bowel pain, using a specialized metal rod to overcome what a medical text describes as “violent sphincter contractions”. The common European variety, Hirudo medicinalis, literally means “medical leech”. Until the 1830s, France alone used about 35 million medical leeches a year.
Around the 20e century, the leech has come to be regarded in most countries as quackery of the worst kind. But in recent decades, the leech has quietly made a comeback. This time in the more modern field of reconstructive microsurgery, where surgeons reattach arteries to save severed tissue, such as a piece of scalp or a finger.
“The problem surgeons faced was that they could move or reattach arteries to bring blood to the surgery area, but could not reattach the small veins that carry blood,” says Ron Sherman, MD, director executive of BioTherapeutics. , Education and Research Foundation. Without the small veins, too much blood accumulates and fresh blood cannot enter the new tissue.
It turns out that the solution had already been provided by evolution. Capable of sucking up 10 times its weight in blood, leeches act as an escape valve, squeezing out old blood and allowing fresh blood to enter. And they secrete hirudin, an anticoagulant that serves as a localized blood thinner, allowing a leech bite to bleed long after the leech has finished feeding and buying crucial time for the body to connect its own veins.
“Leech is a one-stop shop,” says Adnan Prsic, MD, assistant professor of plastic and reconstructive surgery at Yale Medical School. “They do the job of clearing the blood, but also secrete compounds that act as anticoagulants, platelet inhibitors and vasodilators, all intended to make the blood more fluid and conductive.”
Without the use of leeches, some microsurgical attachments simply wouldn’t be possible, says Vishal Thanik, MD, a plastic surgeon at New York University’s Langone Health Medical Center. “Leeches increase the number of fingers we can attach,” he says. “Whether it’s scalps, penises, ears, they are like a bridge, allowing the body to reconnect its own veins.”
The use of leeches is still restricted enough that most medical professionals are surprised to find them still in use. Surgeon Patrick Reavey, MD, assistant professor of plastic surgery at the University of Rochester Medical Center, says his first encounter with leeches was during his residency, when his supervisor ordered him to obtain leeches at the pharmacy. “We were doing finger pegging,” he says. “The first time I had to pull a leech out of a bucket of water and tie it up, well, that was a new experience for me.”
Reavey says that while the use of leeches is common in his field, the only thing he was taught about them in medical school was their outsized role in the history of medicine when the leech ruled. in master.
In the ancient world, multitudes of civilizations – the Greeks, the Romans, the Chinese – embraced its supposed healing power. Instructions for leech treatments can be found in ancient Sanskrit medical texts and in hieroglyphics on the wall paintings of Egyptian pharaohs.
The heyday of the European medical leech took place in the 19e century. Doctors were thrilled with the theory that the root of the disease was largely bad blood that needed to be eliminated, and they treated the bloodsucking leech as some kind of all-purpose panacea. They prescribed them for just about anything: from headaches to joint pain, from hemorrhoids to nymphomania. The British physicians of King George III (he The Madness of King George) applied leeches to his eyeballs for cataracts and to his temples for insanity. The demand for leeches was so great that they practically disappeared in many European countries.
Return of the leech
The first use of leeches in modern reconstructive microsurgery was in France in the early 1980s. But the practice took off after 1985, when a Harvard surgeon made headlines by using them to reattach a patient’s ear. a teenager who had been bitten by a dog. Demand for medical leeches has surged. In 2004, the FDA approved them for use as medical devices.
Apart from real doctors, there are still clinics that perform leech therapy like 19e sort of century, claiming to be able to cure things like high cholesterol and infertility. Demi Moore once made headlines when she said she was leeched to “detoxify” her blood. The demand is high enough that a Canadian was arrested trying to smuggle nearly 5,000 leeches in his suitcase on his way back from Russia.
But few patients have heard of leeches being used in surgery before knowing they were going to be treated with them. “Patients are initially incredulous,” says Prsic. “A lot of them are afraid to look at it.”
Reavey says most of his patients react the same way. “But once they realize the leeches are helping and not hurting, they kind of get into the whole process,” he says. “It’s not uncommon for them to start naming the leeches.”