Quack Medicine or Medical Miracle?

Pity the poor leech. For greater than a century, it has been a poster youngster for the once-decrepit state of drugs. Nothing illustrates the relative backwardness of pre-Twentieth century well being care than the picture of a hapless affected person coated in bloodsuckers, or the cringe-inducing curios that draw spectators to medical museums, just like the vaginal speculums used to insert leeches into areas leeches ought to by no means go.

Yet as soon as the leech reigned supreme. Doctors had been liable to place leeches anyplace – on a cervix; tied to a string and lowered into the throat, like little spelunkers, to deal with tonsillitis; inserted deep into the rectum to deal with intestinal ache, by use of a specialised metallic rod to beat what a medical textual content described as “violent contractions of the sphincter.” The frequent European selection, Hirudo medicinalis, actually means “medical leech.” As late because the 1830s, France alone used about 35 million medical leeches a yr.

By the Twentieth century, leeching got here to be seen in most international locations as quackery of the worst kind. But over the previous few a long time, the leech has been quietly making a comeback. This time within the extra fashionable subject of reconstructive microsurgery, the place surgeons reattach arteries to save lots of severed tissue, similar to a bit of the scalp or a finger.

“The problem that surgeons had faced was that they could move or reattach arteries to bring blood into the area of the surgery, but could not reattach the little veins that carry the blood away,” says Ron Sherman, MD, govt director of the BioTherapeutics, Education and Research Foundation. Without the little veins, an excessive amount of blood swimming pools, and recent blood can’t make it into the brand new tissue.

Surgical Symbiont

The answer, it seems, had already been supplied by evolution. Capable of drawing 10 occasions its weight in blood, leeches act as an escape valve, drawing outdated blood away and permitting recent blood to enter. And they secrete hirudin, an anticoagulant that serves as a localized blood thinner, permitting a leech chew to bleed lengthy after the leech is finished feeding and shopping for essential time for the physique to attach its personal veins.

“The leech is a one-stop shop,” says Adnan Prsic, MD, an assistant professor of plastic and reconstructive surgical procedure at Yale Medical School. “They do the job of removing blood, but also secrete compounds that act as anticoagulants, platelet inhibitors, and vasodilators, all meant to make the blood thinner and more conductive.”

Without the usage of leeches, some microsurgical reattachments merely wouldn’t be attainable, 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 we’re talking about scalps, penises, ears, they are like a bridge, allowing the body to hook its own veins back together.”

The use of leeches continues to be slim sufficient that almost all medical professionals are stunned to seek out them nonetheless in use. Surgeon Patrick Reavey, MD, an assistant professor of cosmetic surgery on the University of Rochester Medical Center, says his first encounter with leeches was throughout his residency, when his supervisor ordered him to get leeches from the pharmacy. “We were doing a finger reattachment,” he says. “The first time I had to take a leech out of a bucket of water and attach it, well, that was a new experience for me.”

Reavey says that despite the fact that the usage of leeches is frequent in his subject, the one factor he was taught about them in medical faculty was their outsized function within the historical past of drugs, when the leech had reigned supreme.

In the traditional world, multitudes of civilizations – the Greeks, the Romans, the Chinese – embraced its supposed healing energy. Instructions for leech remedies could be present in historic Sanskrit medical texts and in hieroglyphics on the wall work of Egyptian pharaohs.

The heyday of the European medical leech got here within the nineteenth century. Doctors had been enraptured with the speculation that the foundation of sickness was largely unhealthy blood that wanted to be eliminated, they usually handled the blood-sucking leech as a form of jack-of-all-trades cure-all. They prescribed them for absolutely anything: complications to joint ache, hemorrhoids to nymphomania. The British docs of King George III (he of The Madness of King George) utilized leeches to his eyeballs for cataracts and to his temples for madness. The demand for leeches was so nice that they just about vanished in lots of European international locations.

Return of the Leech

The first use of leeches in fashionable reconstructive microsurgery was in France within the early Nineteen Eighties. But the apply took off after 1985, when a Harvard surgeon made headlines through the use of them to reattach a teen’s ear that had been bitten off by a canine. The demand for medical leeches surged. In 2004, the FDA accepted them to be used as medical gadgets.

Outside of precise docs, there are nonetheless clinics that carry out leech remedy akin the nineteenth century kind, claiming to have the ability to remedy issues like excessive ldl cholesterol and infertility. Demi Moore as soon as made headlines for saying she was leeched to “detoxify” her blood. The demand is excessive sufficient {that a} Canadian man was arrested attempting to smuggle almost 5,000 leeches in his suitcase whereas coming back from Russia.

But few sufferers have heard of leeches being utilized in precise surgical procedure earlier than discovering out they had been going to be handled with them. “Patients are at first in disbelief,” says Prsic. “Many of them are afraid to look at it.”

Reavey says most of his sufferers react the identical means. “But once they realize the leeches are helping, and that it doesn’t hurt, they kind of get into the whole process,” he says. “It’s not uncommon for them to start naming the leeches.”