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Saturday, October 1, 2022

Quack Medicine or Medical Miracle?


Pity the poor leech. For greater than a century, it has been a poster little one for the once-decrepit state of drugs. Nothing illustrates the relative backwardness of pre-20th 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.

But as soon as the leech reigned supreme. Docs 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 12 months.

By the 20th century, leeching got here to be seen in most international locations as quackery of the worst type. However over the previous couple of many years, the leech has been quietly making a comeback. This time within the extra fashionable subject of reconstructive microsurgery, the place surgeons reattach arteries to avoid wasting severed tissue, corresponding to a chunk of the scalp or a finger.

“The issue that surgeons had confronted was that they might transfer or reattach arteries to carry blood into the world of the surgical procedure, however couldn’t reattach the little veins that carry the blood away,” says Ron Sherman, MD, govt director of the BioTherapeutics, Schooling and Analysis Basis. With out 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. Able to drawing 10 occasions its weight in blood, leeches act as an escape valve, drawing outdated blood away and permitting recent blood to enter. They usually 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 store,” says Adnan Prsic, MD, an assistant professor of plastic and reconstructive surgical procedure at Yale Medical Faculty. “They do the job of eradicating blood, but additionally secrete compounds that act as anticoagulants, platelet inhibitors, and vasodilators, all meant to make the blood thinner and extra conductive.”

With out using leeches, some microsurgical reattachments merely wouldn’t be potential, says Vishal Thanik, MD, a plastic surgeon at New York College’s Langone Well being Medical Middle. “Leeches improve the variety of fingers we are able to connect,” he says. “Whether or not we’re speaking about scalps, penises, ears, they’re like a bridge, permitting the physique to hook its personal veins again collectively.”

The usage of leeches remains to be slim sufficient that almost all medical professionals are shocked to search out them nonetheless in use. Surgeon Patrick Reavey, MD, an assistant professor of cosmetic surgery on the College of Rochester Medical Middle, says his first encounter with leeches was throughout his residency, when his supervisor ordered him to get leeches from the pharmacy. “We had been doing a finger reattachment,” he says. “The primary time I needed to take a leech out of a bucket of water and fasten it, nicely, that was a brand new expertise for me.”

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

Within the historical world, multitudes of civilizations – the Greeks, the Romans, the Chinese language – embraced its supposed healing energy. Directions for leech therapies may be present in historical Sanskrit medical texts and in hieroglyphics on the wall work of Egyptian pharaohs.

The heyday of the European medical leech got here within the 19th century. Docs had been enraptured with the speculation that the basis 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 Insanity 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 nearly vanished in lots of European international locations.

Return of the Leech

The primary use of leeches in fashionable reconstructive microsurgery was in France within the early Nineteen Eighties. However the observe took off after 1985, when a Harvard surgeon made headlines by utilizing 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 units.

Exterior of precise docs, there are nonetheless clinics that carry out leech remedy akin the 19th century type, 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 making an attempt to smuggle practically 5,000 leeches in his suitcase whereas getting back from Russia.

However 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. “Sufferers are at first in disbelief,” says Prsic. “Lots of them are afraid to take a look at it.”

Reavey says most of his sufferers react the identical means. “However as soon as they understand the leeches are serving to, and that it doesn’t harm, they form of get into the entire course of,” he says. “It’s not unusual for them to begin naming the leeches.”

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