Hirudo medicinalis

Image by István Asztalos from Pixabay 

Every summer, when school let out, I took my kids, those too young to work, to a cottage by Lake Huron, Michigan for the summer. It was my first introduction to leeches, slug-like worm creatures that clung to my children’s legs after swimming in a nearby lake. The leeches were tough to pull off and left a mark that resembled a Mercedes-Benz logo. That may have been wishful thinking or a way to drown out my kids’ yelling for me to save them. Taking pity on them, an unfazed elder told them to sprinkle salt on the wormy critters (aka filthy little devils), and they’d fall off. They did. 

With kids grown and cottage sold the only place I can now possibly come in contact with leeches is in a sterile hospital room. I’d be asleep while doctors carefully put the blood-sucking animals on a surgical incision.

For most of human history, bloodletting was used to cure diseases from headaches to depression, menstrual pain to broken hearts. Whenever the cause of your ailment was uncertain, which was probably a good percent of the time, people in the “health” business withdrew blood from your body. Rose George writes in her book, Nine Pints,  A Journey Through the Money, Medicine, and Mysteries of Blood, “The first barber-surgeon on the registry of the Worshipful Company of Barbers, was recorded in 1312. The bleeding barber is the reason modern barbers display red and white striped poles: the pole was a stick for the patient to grip; the white stripes were the bandages, the red stripes the blood. The ball on the top was probably a deformation of the blood-gathering bowl.” It’s easy to scoff at long past practices, but sixty years ago my tonsils were removed to cure my long-suffering sore throats. It was standard procedure. My pain had nothing to do with my sore throat and everything to with my allergy to second-hand-smoke. Today, tonsillectomy is performed as a last resort. 

Using leeches for medical treatment dates back 3,000 years. The  Egyptians and Greeks claimed illness was the result of an imbalance in bodily fluids: blood, phlegm, yellow bile (digestion), and black bile (melancholy). Using leeches was said to restore a patient’s blood to a proper balance. Bleeding was done using knives. Before that, they’d use fish teeth and stones, or whatever could slash the skin. Leeches popularity bloomed and withered over the years, reaching such a peak between 1825 and 1850 (Leech mania era) that supplies were exhausted.   

By the 20th century, bloodletting and leeching were replaced with improved surgery, medicine, and germ theory. But not completely. In the last twenty years, both have enjoyed a renaissance in reconstructive microsurgery.  (PubMed)  

Ms. Andersen, do you prefer we cut you open with a scalpel or have black worms (that provide a natural anesthetic) bite and suck your blood? My research suggests that sometimes, under some circumstances, the latter may be a better choice. But could I get over my disgust? Good lord, let’s hope I never face this choice. (YouTube)

When Dr. Rudolf Buntic does hand surgery, attaching fingers, he has to repair small arteries that transport blood into the severed digits. When the tiny veins are too damaged to carry blood back out, the blood stagnates, and in time the fingers swell and turn black. This is the time he calls for the Hirudo medicinal (leeches).  

“The leech acts as a vein,” Buntic explains. “It draws stale blood out of the reattached finger as it feeds, allowing fresh, oxygenated blood to come in. Chemicals in the leech’s saliva also help prevent blood clots from forming in the damaged tissue.” Fresh leeches are applied over the course of ten days or so depending on the surgery. “This provides enough time for new, tiny veins to regrow and create channels for blood to leave the patient’s finger on its own.” (NPR

Leeches are also used to help heal skin grafts, transferring blood tissue from one part of the body to another. They suck the blood pooled under the graft, restoring circulation in blocked veins. Our skin cannot survive without oxygen. (Health-How Stuff Works)

Leeches are applied after surgery while the patient is asleep. In the days that follow, nurses take over the leech therapy with the patient awake. An Irish plastic surgery nurse, Reynolds, did her masters thesis describing the work of a leech therapist. She interviewed seven plastic surgery nurses and wrote: 

They [the nurses] might visibly squirm and distort their faces as they described the leeches and their need to be close to and manipulate them. They described them as “the black slug,” “blood-sucking, slimy bugs,” and “creepy crawlies.” Other things they didn’t like: that the leech, that “dirty walking needle,” went against all their training: hygiene control was paramount, yet alive creature full of potentially toxic blood was moving around their hygienic hospital ward. They always move. “They’d be anywhere. Anywhere. Especially when you’re on nights, the lights are down, we’ve got a little nightlight, but you’re walking in watching your step because you could walk on one.” She has found leeches up curtains, on the radiator, on the floor, in the bathroom, in the shower. “You try to go in every fifteen minutes or half an hour, but if it’s fallen off, it can fall anywhere, and then they just slide around, so you have trails of blood.” (George, Rose. Nine Pints (pp. 49-50). Kindle Edition.) 

But just as tonsillectomy was the last resort in 1960, often that’s the case today with leech therapy. Rose George writes, “Only patients whose transplantation has failed are offered leech therapy, and the leech is the last resort.” It’s the surgeon who suggests it to the patients, explaining why leeches are their best option. The stakes are high. Refusing can mean a missing finger or having no ear flap.  

In 2002, when Rose George telephoned all the sixty-two plastic surgery units across the UK, 80 percent of the fifty that replied had used leeches. “Three units had used leeches more than sixteen times a year; fifteen had used them up to five times.” 

In 2004, the FDA (Food and Drug Administration) approved the use of leeches for blood congestion after surgery. It’s the only time the FDA considered a living, breathing animal as a medical device. They also stipulated that the leeches must be disposed of after a single use, like needles. That seems unfair. Free labor and then we exterminate you. Why not toss them into a lake?  Dr. Konstantin Lakeev in Philadelphia teaches leech therapy in the US. Two videos on his website give the history and show the procedure. (Dr. Konstantin’s web site)