_Leeches_
The word "leech" derives from the Anglo-Saxon _loece_, "to heal." Thus,
the Anglo-Saxon physician was called a "leech" and his textbook of
therapeutic methods a "leechdom." The animal itself was already known to
the ancients under its Latin name _hirudino_. It appears, however, that
the introduction of leeches into Western medicine came somewhat later than
that of phlebotomy or cupping, for Hippocrates made no mention of them.
The earliest references to the use of leeches in medicine are found in
Nicander of Colophon (2nd century B.C.) and in Themison (1st century
B.C.). Thereafter they were mentioned by most Greek, Roman, and Arabic
medical writers.[172]
The leech is a fresh-water parasitic invertebrate belonging to the Phylum
Annelida. On one end of its worm-like body is a large sucker by which the
animal fastens itself to the ground, and at the other end is a smaller
sucker, in the middle of which is a chitinous mouth that makes a
triangular puncture. As items of _materia medica_, leeches were described
in dispensatories, or compilations of medicaments, and sold by
apothecaries, both to physicians and directly to patients. The species
most commonly used for bleeding was _Hirudo medicinalis_, indigenous to
the streams and swamps of Central and Northern Europe, and known in
commerce as the Swedish or German leech. It was 50-75 mm long, with a dull
olive green back and four yellow longitudinal lines, the central two
broken with black. Somewhat less popular was the Hungarian leech,
indigenous to Southern Europe. In addition, there was an American species
of leech, _Hirudo decora_, which was gathered principally from the lower
Delaware River, but, since it drew much less blood than the Swedish leech,
it was regarded as greatly inferior.[173] Most American physicians
imported their leeches. In the late nineteenth century, one could buy
Swedish leeches for $5.00 per hundred.[174]
Leeches were gathered in the spring of the year either by means of a pole
net, or, more primitively, by wading into the water and allowing the
leeches to fasten themselves onto the legs. Sometimes horses and cattle
were driven into the water to serve as bait for the leeches.[175] (Figure
19.)
[Illustration: FIGURE 19.--Lithograph published in London in 1814 showing
three women gathering leeches by a stream. (NMHT 320033.08; SI photo
76-7741.)]
Leeching, like other forms of bloodletting, enjoyed a revival in the early
nineteenth century, particularly in France, where the doctrines of heroic
medicine preached by Broussais[176] led to an increase of leech usage from
about 3 million in 1824 to 41.5 million in 1833.[177] Leechers, although
not as high in status as professional cuppers, practiced in many large
cities, and numerous tracts were written on the care and breeding of
leeches. "Leech farms" were unable to increase the leech supply to meet
the rising demand, and most leechers complained of the scarcity and great
expense of the little animals.[178]
Leeching and cupping each had their advocates. The major advantage of the
leech over the cup was that the leech could be employed on almost any part
of the anatomy, including around the eyes, in the mouth, the anus, and the
vagina. In fact, leeching the internal membranes enjoyed quite a vogue in
the early nineteenth century. Leeches were applied to the larynx and the
trachea for bronchitis and laryngitis and for relieving the cough of
phthisis. For inflammations of the conjunctiva (the membrane lining the
eyelids) they were applied to the nasal membrances of the adjacent
nostril, and for inflammations of the ear they were applied to the meatus
of the ear and behind the ear. The French popularized the practice of
leeching the anus to treat inflammations of the mucous membranes of the
bowel. To prevent leeches from getting lost in the body cavities, Jonathan
Osborne, a British physician, recommended in 1833 that a thread should be
passed through the leech's tail. In addition, he invented a device, which
he called a "polytome," specifically for introducing leeches into the
rectum.[179] In the mid-nineteenth century, special leech tubes were
widely sold for applying leeches to internal membranes.[180]
A second advantage of leeches over cupping was that leeches could extract
blood more readily. Not only was dexterity not required in order to apply
a leech, but also it was soon noticed that leech bites continued to bleed
even after the leech let go, while scarificator incisions often coagulated
before any blood was obtained. In 1884 it was shown by John Berry
Haycroft, a Birmingham chemist, that this phenomenon was due to an
anti-coagulant, now called "hirudin," that the leech injected into the
blood.[181]
To apply a leech, the animal was first dried with a bit of linen, and the
skin of the patient was prepared by washing with warm water and then
shaving. To direct it to the right spot, the leech was often placed in a
small wine glass that was inverted over the area to be bitten. Since
leeches were sometimes perversely unwilling to bite, they were enticed by
the placement of a bit of milk or blood on the patient's skin. Small
children were given one or two leeches, and adults 20 or more. Broussais
employed up to 50 leeches at one time.[182] The leech was usually allowed
to drop off of its own accord when it had satiated itself, which took
about an hour. Sometimes the tail of the leech was cut off so that it
would continue to suck. Once used, leeches could not be reused for several
months unless they were made to disgorge their meal by dropping them in
salt water or weak vinegar. A healthy leech drew one or two fluid drachms
of blood, and as much would flow after the leech had dropped off. Thus a
good Swedish leech could remove about an ounce of blood. This quantity
could be increased by employing a cupping glass over the bite.[183]
Leeches were kept in a glass container of water covered with gauze or
muslin and placed in a cool, dark room. The water had to be changed
frequently, as much as every other day in summer. Pebbles or moss were
placed in the bottom of the vessel to aid the leech in removing the slimy
epidermis that it shed every four or five days. In the nineteenth century
leeches were often sold in drug stores from large, elegant containers with
perforated caps. Actually, only the day's supply of the pharmacist's
leeches was kept in the attractive storefront jars; the rest were kept out
of sight. While most leech jars were simple white crockery pieces with
"leeches" lettered in black on the front, some leech jars were over two
feet tall and decorated with elegant floral and scroll work. Among the
most ornate leech jars were those made in Staffordshire, England.[184]
(Figure 20.)
_Artificial Leeches_
One of the characteristics of nineteenth-century technology was the
attempt to replace natural materials and processes by imitations and
mechanisms. Considering the properties of the natural leech, it is no
wonder that very early in the nineteenth century inventors began to seek a
mechanical substitute. The disadvantages of the leech were many. Wrote
one inventor of an artificial leech:
In the first place the appearance of the animal is repulsive and
disgusting, and delicate and sensitive persons find it difficult to
overcome their repugnance to contact with the cold and slimy reptile.
This is especially the case when it is a question of their
application about or within the mouth. Then again, their disposition
to crawl into cavities or passages results sometimes in very annoying
accidents. Another source of annoyance is that they are often
unwilling to bite--the patience of all concerned being exhausted in
fruitless efforts to induce them to take hold.
The expense, too, of a considerable number is by no means
trifling.[185]
[Illustration: FIGURE 20.--Staffordshire leech jars, 19th century. (NMHT
263554 [M-11504]; SI photo 73-4231.)]
In addition, leeches were often difficult to obtain, and the rural
physician could not easily carry them about. Leech bites could have
unfortunate consequences, for many times the bleeding could not be
stopped. For these and other reasons, several inventors in Europe and
America sought to create a mechanical or artificial leech.[186] Such
artificial leeches are often difficult to distinguish from cupping
devices, because both sorts of instruments employed some form of
scarification and suction. Artificial leeches however, were usually
adaptable to small areas of the anatomy, and the puncture wound generally
attempted to imitate a leech bite.
Perhaps the earliest instrument offered as a substitute for leeches was
Sarlandiere's "bdellometer," from the Greek _bdello_, "leech."
Sarlandiere, a French manufacturer, introduced his instrument in 1819 and,
incidentally, had the prototype sent to New Orleans. The bdellometer
consisted of a glass bell with two protruding tubes, one perpendicular for
performing scarification, and the other oblique, for attaching the
aspirating pump. A plug could be removed to allow air to enter the bell
after the operation was completed, and a faucet allowed for drainage of
blood without having to remove the apparatus from the body. A curved
cannula could be attached to the bdellometer for bleeding in the nasal
passages, the mouth, the vagina, and the rectum. For internal
bloodletting, the disk, with lancets, normally used for scarification, was
replaced by a small brush of hog bristles.[187] Sarlandiere's bdellometer
attracted sufficient attention in America to be included in the numerous
editions of Robley Dunglison's medical dictionary,[188] but it was
ultimately no more successful than the complicated cupping devices
discussed in the previous chapter.
A second French invention, also given a pretentious name, was Damoiseau's
"terabdella" (meaning "large leech"), or pneumatic leech. This invention,
introduced some time before 1862, met with skepticism at the outset on the
part of the reviewers at the French Academy of Medicine. It consisted of
two pistons attached to a plate to be placed on the floor and held down by
the feet of the operator. Each piston was connected by a tube to a cup,
and the whole apparatus was operated by means of a hand lever connected
with both pistons. More a cupping device than an artificial leech, the
terabdella met with little success beyond the French province where
Damoiseau practiced.[189] (Figure 21.)
Perhaps the most successful of the mechanical leeches was known as
Heurteloup's leech, after its inventor, the Frenchman, Charles Louis
Heurteloup (1793-1864). Sold in most late nineteenth-century surgical
catalogs for as much as $15.00, the device consisted of two parts, one a
spring scarificator that made a small circular incision (about 5 mm in
diameter) and the other, a suction pump, holding an ounce of blood, whose
piston was raised by means of a screw. For the treatment of eye ailments,
one of the major purposes for which the device was invented, it was
applied to the temples.[190] A similar two-part mechanical leech was sold
under the name "Luer's Leech."
One of the most interesting leech substitutes, sold by George Teimann &
Co. as its "Patent Artificial Leech," employed ether in exhausting the
glass "leeches." Patented by F. A. Stohlmann and A. H. Smith of New York
in 1870, the "leech" consisted of a glass tube, either straight or with a
mouth on the side so that the tube would hang somewhat like a living
leech. To expel air from the tube, a few drops of ether were placed in it,
after which it was immersed to its mouth in hot water until the ether
vaporized. The tube was then applied to the skin and allowed to cool, thus
sucking blood from a wound made by the scarificator, a long metal tube
that was rotated to make a circular incision. One of the patentees
explained the advantages of the device:
In all previous attempts at an artificial leech the vacuum has been
produced by the action of a piston. This renders the instrument too
heavy to retain its position, and necessitates its constantly being
held. This precludes the application of any number at once, even if
the cost of half-a-dozen such instruments were left out of the
account. But in the case of this leech, the tubes, being exceedingly
light, attach themselves at once, remaining in position until filled;
and as the cost of them is but a few cents, there is no limit to the
number which may be applied.[191]
To take the place of leeches in the uterus, quite a number of uterine
scarificators were sold. These were generally simple puncturing
instruments without spring mechanisms. If insufficient blood flowed from
the scarification, Thomas's Dry Cupper, a widely available vulcanite
syringe, could be inserted into the vagina to cup the cervix before
puncturing.[192] At least one attempt was made to combine puncture and
suction in a device for uterine application. This was Dr. William Reese's
"Uterine Leech," introduced in 1876. It consisted of a graduated glass
cylinder 190 mm long and 12 mm in diameter containing a piston and a rod
with a spear point. The rod was surrounded by a spring that withdrew the
blade after it punctured the cervix. Several American companies, including
George Tiemann & Co., offered the device for sale.[193]
[Illustration: FIGURE 21.--Damoiseau's terabdella. (From Damoiseau, _La
Terabdelle ou machine pneumatique_, Paris, 1862. Photo courtesy of NLM.)]
Despite all the efforts to find a suitable substitute, the use of natural
leeches persisted until the practice of local bloodletting gradually
disappeared in America. By the 1920s leeches were difficult to find except
in pharmacies in immigrant sections of large cities like New York or
Boston. One of the last ailments to be regularly treated by leeches was
the common black eye. Leeches commanded rather high prices in the 1920s,
if they could be found at all. One Brooklyn pharmacist, who deliberately
kept an old-fashioned drugstore with the motto "No Cigars, No Candy, No
Ice Cream, No Soda Water, But I Do Sell Pure Medicines," wrote in 1923:
Here in this atmosphere free from the lunch room odor my
armamentarium consists of drugs and preparations from the vegetable,
mineral and animal kingdoms. Among the latter are leeches,
prominently displayed in a number of glass jars in different parts of
the store, including one in the show window. Anything moving,
anything odd, arouses the curiosity of the public, and my reputation
as a "leecher" has spread far beyond the "City of Churches." Besides,
this leech business is also profitable, as they are retailed at $1.00
per head without any trouble; in fact patients are only too glad to
be able to obtain them.[194]