Alternative Medicine: Leeches, Bloodletting and Laudable Pus

It all sounds positively medieval, doesn't it? Surprisingly, two of the three medical practices in the title are still in use, albeit not quite as frequently, or enthusiastically, as in the past.

Several years ago, I read an article in the newspaper about a man whose finger had been surgically reattached. The finger kept filling up with blood, to the point that it looked like a sausage ready to burst. Eventually, the doctors attached leeches to the finger at regular intervals; within a few days, the finger was healing nicely. I read the article out loud to my husband at the breakfast table. He barely looked up.

"Oh yes," he replied, as he chewed thoughtfully, "when I was little, back in the 30s, they had leeches at the chemists." He thought for a moment. "You know, my father used to tell me that they used maggots on injuries during World War I. They only eat the dead material, leaving the healthy tissue to heal."

My breakfast went in the sink.

I didn't think any more about it (who would?) until I began researching an article for AC on alternative medicine and palliative care. There, amongst the books on alternative medicine and natural healing, was a book entitled Honey, Mud, Maggots and Other Medical Marvels by Robert and Michele Root-Bernstein (Houghton Mifflin Company, New York, 1997). Of course I had to have a look.

Leeching, of course, shows up in all sorts of history books, both fictional and non-fictional. The practice goes back as far as the ancient Greeks and Romans, but more or less died out in the late 1800s with the advent of more acceptable (and less repugnant) means of lancing and cauterizing wounds. Still, it remained in use in some areas of Europe, as well as remote areas all over the world which had little or no access to modern medical equipment. Root-Bernstein describe how, in 1960, two Yugoslavian surgeons used leeches during skin transplants, and published their work in the British Journal of Plastic Surgery. Within ten years, a few others were trying it, mostly in cases of surgical reattachment of limbs, skin transplants, and to reduce swelling in areas of the body not easily lanced. Leech saliva also contains an anticoagulant, hirudin, which has been genetically engineered and is used for various coronary problems (European Heart Journal,1996 Aug;17(8).

It isn't all that difficult to procure leeches, either. By simply using the search phrase "buy medicinal leeches", I found two dozen sites offering them for sale. As always, please consult your doctor or health professional before applying them.

I would be remiss if I didn't give maggots a mention. They are, indeed, still in use, as evidenced by a special produced by National Geographic entitled Creepy Healers, which aired on television back in 2003. The maggots ooze digestive juices into the wound, then suck up the liquefied decayed flesh and bacteria. The species of maggot matters; while some will bury into, and destroy, living tissue, others, primarily the blowfly, strictly consume only dead and decaying tissue. Maggots can be particularly effective in wounds which refuse to heal, or are infected with bacteria resistant to antibiotics. Considering the fact that more and more bacteria are becoming resistant to our antibiotic arsenal, we should be grateful that we have our little friends, the maggots, to turn to.

Now let's turn to bloodletting. Venesection (opening a vein to let blood) has been documented since at least the time of Hippocrates, who taught that disease was caused by an imbalance of the body's four "humors": blood, phlegm, yellow bile, and black bile. One way to restore balance was to release the offending fluid. Stories abound of patients during medieval times being practically bled to death, although much depended on the amount of blood drawn each time. Back then, bloodletting was prescribed for just about everything, from headaches to morning sickness to drunkenness.

Today, bloodletting (phlebotomy) is used to treat disorders of the blood. Hemochromatosis, for example, is a condition where the body absorbs too much iron, and it builds up in organs, causing damage (AMA Medical Guide, Random House, 1996). A person with severe iron load may need to be bled as often as eight times a month. Polycythemia vera, another blood disorder, also requires regular bloodletting.

Laudable pus, or the idea that pus formation is natural and necessary for healing, goes back to the Middle Ages, according to Root-Bernstein's book. Apparently, they went so far as to irritate or contaminate wounds to induce large amounts of pus.

This was a new one on me, until a familiar name jumped out at me; that of James Herriot, of All Creatures Great and Small fame. Root-Bernstein retell Herriot's tale of a dog he treated for a mangled leg. At the time, Herriot was taking another vet's place in a small, poor, and utterly unequipped surgery. Without the proper medical supplies, he was at a loss as to what to do for the dog. Then, he happened on a box of plaster-of -Paris. Recalling stories from the Spanish Civil War, when some of the soldiers had their grievous wounds encased in plaster and left to "stew in their own juice", he decided to do the same with the dog. He expected the limb to be gangrenous when he removed the plaster, but it was actually healing quite well!

I couldn't find any similar medical practice in use today, although there are multiple mentions of the benefits of maintaining a moist environment for wound care (Moist Wound Healing,The Diabetic Foot Vol 6 No 3, 2003).

Every family, of course, has its patent remedies handed down from generation to generation. Some have been proven to have some medical value (honey, for example, makes a fine wound dressing; it has also helped to relieve my seasonal hay fever, which a cabinet full of prescription drugs never did), and some which are, at the very least, questionable (my mom swore by using bacon fat to "draw" splinters; unfortunately, I never got over the fact that the bandage came off during the night, and I awoke with the knowledge that there was a nasty bit of cold fat loose in my bed somewhere).

Cost-cutting is a big part of the health care reform movement; perhaps, if we get over the squeamishness factor, we can replace some expensive drugs and procedures with the humble denizens of the insect world.