Is It Losing an Ear or Using Bloodsuckers?
03 Mar 2006
It was August 16, 1985 and a horrendous way to start the day. Guy Condelli, a five year old boy in Medford, Massachusetts had his right ear bitten off by a dog. Dr. Joseph Upton, a reconstructive surgeon at Children’s Hospital, Boston, reattached the ear during a tedious 12 hour operation.
But three days later an ominous sign of impending disaster appeared. The ear had turned blue-black due to venous congestion. Blood thinners and lancing failed to restore normal blood supply. In desperation Upton telephoned Biopharm, an English company. It sent 30 leeches by air to Boston.
These blood suckers were attached to the boy’s swollen ear. Within minutes venous congestion diminished and normal circulation restored. The ear turned a healthy pink. Upton became the first surgeon to perform a successful microsurgical attachment of a child’s ear.
"Leeching" has been a part of medicine for centuries. Records at St Bartholomew’s Hospital in London, England, show the extent of this treatment. In 1837, some 60,000 leeches were used on 50,557 patients. In fact, the practice became so extensive that leeches were in short supply and had to be imported from India and Mexico.
Eventually, though, leeches fell from favour. Patients developed an enduring repulsion for these slimy creatures.
In 1964 the first successful reattachment of the arm of an accident victim started the "microsurgical goldrush". During this procedure surgeons joined together tiny blood vessels while peering through a microscope. But extensive prolonged surgery is often followed by venous congestion and all the surgeon’s skill goes down the drain when circulation becomes clogged and the transplant dies.
Once again doctors turned their attention to the use of medicinal leeches to circumvent this problem. Or, as one expert explained, to create an "artificial circulation" to keep the attachment alive until the patient grows new veins.
Leeches are parasites between two to four inches long with disklike suction cups at the end of their bodies. They subsist on the blood of mammals. During a meal leeches grow seven times their normal size and they can survive on a single meal for an entire year. They normally complete their meal in 10 to 20 minutes and can remove up to one ounce of blood. Once fed they drop off the wound.
Evolution has made leeches extremely efficient blood suckers. Their jaws contain about 100 teeth that penetrate skin by a sawing action. But luckily for its victim the saliva contains an anesthetic that’s pumped into the skin during the bite. And to keep the patient’s blood from clotting while eating, it releases a powerful anti-coagulant.
There’s one potential hazard in the use of leeches. It’s impossible to make any living organism completely sterile. Roy T. Sawyer, Biopharms founder, estimates that about one in every two thousand patients develops a bacterial infection from a leech. Consequently, antibiotics are often prescribed before a leeching. In addition, the leech’s gut contains a digestive enzyme that can harm humans who have a weakened immune system.
Surgeons admit that convincing patient’s to use leeches requires much persuasion. Particularly, if leeches are needed for as long as 10 days. But doctors state that when the choice is the loss of a finger or using a leech, the leech always wins.
For instance, a 25 year old man suffered severe facial burns causing extensive scarring. Plastic surgery was carried out but within 12 hours the incisions had become deeply engorged. Three leeches were applied over a five day period and the man’s face became pink and healthy. Scarring was greatly diminished.
I believe we’re going to hear more about the lowly leech. A report in The New Yorker magazine states that doctors in Essen, Germany, have claimed success in using leeches to decrease the pain of osteoarthritis and that the effect can last several months.
Researchers explain that the effect is due to the anesthetic properties of leech saliva which may also contain morphine and anti-inflammatory enzymes that penetrate deep into the joints.
Later this year Dr Woodson Merrell, an internist at the Beth Israel Medical Center in New York will begin offering leech therapy to treat osteoarthritis of the knee.
How history has a way of repeating itself!
