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One can imagine that during her final illness, Jane Austen was no stranger to leeches. This method of bloodletting was so common in Great Britain (Wales especially) and France that by the 1830’s Hirudo medicinal leeches (common in Europe) were hard to find and had to be imported or home grown .

Leech finders, 1814. George Havell, Costumes of Yorkshire.

Gathering leeches was a traditional female occupation, although there are always exceptions to the rule. Take this passage about leech-fishers in France from the Gazette des Hopitaux:

Man leech fishing in a marsh in Bretagne. 1857. Image @Shutter Stock

If ever you pass through La Brenne, you will see a man, pale and straight-haired with a woollen cap on his head, and his legs and arms naked; he walks along the borders of a marsh, among the spots left dry by the surrounding waters. This man is a leech- fisher. To see him from a distance,—his wo-begone aspect, his hollow eyes, his livid lips, his singular gestures,—you would take him for a maniac. If you observe him every now and then raising his legs and examining them one after another, you might suppose him a fool ; but he is an intelligent leech-fisher. The leeches attach themselves to his legs and feet as he moves among their haunts; he feels their bite, and gathers them as they cluster about the roots of the bulrushes and aquatic weeds, or beneath the stones covered with a green and slimy moss. He may thus collect, ten or twelve dozen in three or four hours. In summer, when the leeches retire into deep water, the fishers move about upon rafts made of twigs and rushes.”  – Excerpt taken from Curiosities of Medical Experience (1838) by John Gideon Millingen, via The Condenser: Hunting Down Good Bits

Despite the many strides that were made in medicine regarding human anatomy and diseases, the knowledge about treatments lagged behind. Lack of anesthetics made surgery an excruciating experience, and there were no antibiotics. Useful plants, such as digitalis, were discovered more by luck than by science. Bloodletting or ‘breathing a vein’ was one way in which a patient could be treated by a physician who had few options. Applying leeches often resulted  in a severe loss of blood, which was more detrimental to the patient’s condition than not. A human with a poor immune response could suffer from wound infections, diarrhea and septicemia, all influenced by the bacterium, Aeromonas veronii, carried in the leeche’s gut.

19th century leech advertisement

Regardless of adverse consequences, bloodletting has been practiced for at least 2,500 years. The earliest instruments, or lancets, were sharpened pieces of wood or stone, but it is leeches that I want to write about. (I am more repulsed by their sight than a snake’s, and had a hard time searching for an image that did not make me gag.)  The ancient Greeks believed in the humoral theory, which proposed that when the four humors, blood, phlegm, black and yellow bile in the human body were in balance, good health was guaranteed. An unbalance in these four humors led to ill health. Fast forward to the middle ages, when superstition and religion gave weight to the art of bleeding. If you recall, the earliest surgeons were barbers as well. Their leeches cured anything from headaches to gout!

Bloodletting with leeches is an ancient tradition

Leeches are commonly affixed by inverting a wine-glass containing as many as may be required, upon the part affected. The great disadvantage of this practice is, that some of them frequently retire to the upper part of the glass and remain at rest, defying all attempts to dislodge them, without incurring the risk of removing those that may have fastened.” – James Rawlins Johnson, A Treatise on the Medicinal Leech

Francois Broussais proposed in  his Histoire des phlegmasies ou inflammations chroniques (1808) that all disease resulted from excess build up of blood. The alleviation of this condition required heavy leeching and starvation. Leeches subsequently became the most prevalent way of treating a patient, especially in France, where tens of million of leeches were used per year, resulting in a drastic leech shortage. The British were equally enamored with this form of therapy. It is conjectured that Princess Charlotte’s death in childbirth in 1817 was exacerbated by her physician, who prescribed a rigorous course of blood letting and starvation diet during her pregnancy, weakening her before her agonizing 50+ hours of labor. (Read my article on this topic.)

In 1833, bloodletting became so popular in Europe, that the commercial trade in leeches became a major industry. France, suffering a deficiency, had to import 41.5 million leeches. The medicinal leech almost became extinct in Europe due to the extremely high demand for them. Leeches were collected in a particularly creepy way. Leech collectors would wade in leech infested waters allowing the leeches to attach themselves to the collector’s legs. In this way as many as 2,500 leeches could be gathered per day. When the numbers became insufficient, the French and Germans started the practice of leech farming. Elderly horses were used as leech feed where they would be sent into the water and would later die of blood loss. – Maggots and Leeches Make a Comeback

Oh, how I pity those elderly horses!

 

Large leech collector jar.

Intestinal tract of the hirudo leech

Leeches are quite extraordinary in that they have 31 brains and can gorge themselves up to five times their body weight before falling off their host. Afterward they require no feeding for another 6 months. There are over 650 known species of leeches, not all of which are bloodsuckers (some eat earthworms, for example). Placing leeches onto a patient (making sure the frontal sucker with teeth was directed to the skin) is relatively pain free, for their bite releases an anaesthetic. During feeding they secrete compounds, such as a vasodilator that dilates blood vessels and anticoagulant that prevents the blood from clotting. The worms are hermaphrodites, functioning as both the male and female sex. Even after being frozen, leeches can be coaxed back to life!  Needless to say, these creatures must provide an endless source of interest to scientists.

Early 19th century rare cobalt blue transportable leech jar. These were mostly made of clear glass. Cloth covered the everted lip to prevent escapees.

People (meaning mostly women) stood in fresh water marshes, lakes, pools, and the edges of river banks, and allowed the leeches to attach to their legs. (I shudder as I type this.) Once the leeches were gathered, they were placed in a basket, ceramic pot with breathing holes, or a reservoir.

One of these traders was known to collect, with the aid of his children, seventeen thousand five hundred leeches in the course of a few months; these he had deposited in a reservoir, where, in one night, they were all frozen en masse.” But congelation does not kill them, and they can easily be thawed into life, by melting the ice that surrounds them. Leeches, it appears, can bear much rougher usage than one might imagine: they are packed up closely in wet bags, carried on pack-saddles, and it is well known that they will attach themselves with more avidity when rubbed in a dry napkin previous to their application. Leech-gatherers are in general short-lived, and become early victims to agues, and other diseases brought on by the damp and noxious air that constantly surrounds them ; the effects of which they seek to counteract by the use of strong liquors.”  Excerpt taken from Curiosities of Medical Experience (1838) by John Gideon Millingen, via The Condenser: Hunting Down Good Bits

Pewter box for transporting leeches. Image @Science Museum of london

Leeches were carried in a variety of containers made of glass, silver, or pewter. Small bowls were portable, and the larger ones were probably kept in an apothecary’s shop or pharmacy. The everted lips were used to attach a cloth, which prevented the hapless creatures from escaping.

Portable leech carriers made of glass, silver and pewter. Small leech tubes directed the worm to difficult to reach places in the mouth, larynx, ear, conjunctiva, rectum and vagina, begging this question: How did one retrieve the engorged leech?

After the 1830s, the practice of leeching began to decline as medical diagnostic skills improved. Physicians realized that patients who were leeched did not often recover more fully than those who were not, and other, more beneficial treatments,  including pharmaceutical and homeopathic remedies, began to replace leeching

Red and cream Staffordshire leech jar

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Leech bowl

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