Bloodletting Instruments in the National Museum of History and Technology

by Audrey B. Davis; Toby A. Appel

Leeching

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].)

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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]

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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 Sarlandière’s “bdellometer,” from the Greek bdello, “leech.” Sarlandière, 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] Sarlandière’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]

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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]