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H I S TO RY I N M E D I C I N E
624..627
Key words
history of leech, medicinal leech, antiquity,
leech.
Correspondence
Helen Christopoulou-Aletra, 73 Nikis Avenue,
54622, Thessaloniki, Greece.
Email: ealetra@hotmail.com; ealetra@
med.auth.gr
Received 24 September 2008; accepted 10
October 2008.
doi:10.1111/j.1445-5994.2009.01965.x
Abstract
Blood-letting was a common therapeutic method in antiquity; many means
were used to draw blood, including the application of leeches. In this paper,
ancient Greek, Roman and Byzantine authors up to the 7th century AD were
studied, a research that provided us with references that may be divided into
two groups: those related to the medicinal use of leeches, and those related to
cases in which leeches were swallowed and had to be removed. In the first
group, detailed descriptions of the method of usage and of the diseases requiring leeching were found. In the second group, brief reference is made to the
problems caused by swallowing leeches, and to the methods used to expel
them from the human organism. The earliest references to the medicinal use
of leeches may be found in the writings of Theocritus (3rd century BC),
Nicander (2nd century BC) and Horace (1st century BC, while the phenomenon of swallowing a leech is first mentioned in one of the Epidaurian iamata
dating to the 4th century BC.
Introduction
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Leeches in antiquity
In the same period (2nd century AD), another physician, Menemachus from Aphrodisias, wrote numerous
works no longer extant. We have his views on the use
of leeches via Oribasius (4th century AD). According to
Menemachus, leeches are applied on ailing parts or on
places adjacent to them. The site of application of leeches
should be free of fat, because the fat stops their appetite.
In order to extract the leeches from the affected bodily
part, Menemachus proposes the use of hot oil, and
renounces Galens use of salt. If the leeches are slow in
drawing blood, the physician should superficially scarificate the skin, because when leeches taste blood, they
search for it even more. The quantity of blood sucked
may be evaluated either by squeezing the leeches and
emptying the blood or by gathering the blood they
vomit after detachment from the body.16
The Emperor Flavius Claudius Julianus, also known as
Julian the Apostate, whose physician was Oribasius,12
refers to leeches and their ability to suck unhealthy
blood from the body and leave the healthy blood
untouched.17
At the same time, Antyllus, another surgeon, refers to
the medicinal use of leeches in his treatise On the means of
depletion. Again, none of his works has been preserved
and we know of his opinions through the writings of
Oribasius, Paulus of Aegina and Aetius of Amida. Antyllus suggests the use of leeches 1 day after they have been
found. After being stored and fed with some blood, they
are left for a period of time to move about, so as to
diminish their venom. Before leeches are applied to the
skin, the affected part should be rubbed with unrefined
soda and coated with the blood of animal or damp clay, or
scratched by the physicians nails. Thanks to these preparations, the leeches suck blood more promptly.16 In order
for the leeches to keep sucking blood, the physician
should cut their tails with scissors. To extract them from
the skin, salt, ash or unrefined soda should be applied on
their mouth. Their venom should then be removed from
the affected part with a specific instrument, or by fumigation. If blood leaks from the wound left by the leeches
bite, it should be sprinkled with ash from frankincense,
cumin or flour, and then be covered with linen soaked in
oil. In case extremities are involved, a bandage is used,
and if the bleeding has stopped on the second day, then
the area is washed. According to Antyllus, leeches do not
draw blood from the inner structures, only from superficial ones. Leeches are applied to those patients that are
afraid of scarification or on those body parts where
cupping cannot be applied, due to their small size or their
curvature. The leeches are removed from the body when
they have sucked half the blood initially scheduled for
removal. The physician should then allow blood to run
from the wound for a while.16
625
Caelius Aurelianus, another famous physician, suggests the use of leeches in cases of headache or mania,
with their application on the head, and in cases of inflammation of the throat, with their application to the neck.18
Two centuries later, in the 6th century AD, Aetius of
Amida notes that leeches should be used in two cases: in
that of catharsis13 or in the case of an eye disease called
onychia. Catharsis is the restoration of the distorted
balance of bodily fluids, specifically blood. Onychia is
described as a disease where pus accumulates from a deep
ulcer between the folds of the eye and forms a circle
around the iris. In this case, leeches should be applied to
the temples.13
Alexander of Tralles, at the same period, prescribes the
application of leeches to the head for the treatment of
melancholy.19 Such application makes sense, bearing in
mind that in ancient times, melancholy was thought to
be caused by an excess of black bile resulting in diseased
condition of either the brain or the entire bloodstream.20
In the latter case, extracting the diseased blood with the
aid of leeches could solve the problem.
Paulus Aegineta, a celebrated physician of the 7th
century AD, suggests the use of leeches in many cases. He
prescribes leeching in the case of cephalea, a permanent
pain of the head aggravated by noises, cries, bright light,
wine-drinking and intense smells. When cephalea
becomes chronic, the use of leeches is indicated.18 Paulus
also suggests leeches for two eye diseases: amaurosis
and ophthalmy. Amaurosis was defined as a complete
impediment of the sight without any apparent affection
about the eye, without any sensible cause. For its treatment, the application of leeches to the temples was necessary.18 Ophthalmy was an inflammation of one or
more membranes of the eye, especially the conjunctiva.21
So, if the cause of this disease is a congestion of the
humours accumulated in the head, leeches should be
applied to the forehead, near the affected eye.18 Another
disease requiring leeching to which Paulus Aegineta
refers is synanche, which appears to be an inflammation
of the throat. In this case, leeches should be applied to the
chin and neck of the patient.18 Finally, leeching is prescribed for headaches accompanied by fever, and in the
case of mania, in which cases they are applied especially
to the head.18
Discussion
The Greek word bdlla derives from the verb bdllw,
to suck,22 so one of the abilities of leeches is indicated by
the animals name itself. In his Natural History, Pliny the
Elder refers to leeches by their Latin name sanguisuga
(sanguis = blood, suctus = to suck).9 Here as well, the
ability of leeches is clearly denoted. A new name was
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Leeches in antiquity
References
1 Bible. The Old Testament; Proverbs 30: 15. Athens: The
Greek Bible Society, 1997; 990.
2 Aristotle. De Incessu Animalium (Farquharson ASL, trans.).
Oxford: Clarendon Press; 1912; 9.
3 Theocritus. The sorceress. In: Hunter R, trans. Theocritus.
Idylls. London: Oxford University Press; 2002; 8.
4 Horace. The art of poetry: to the Pisos. In: Smart C,
trans. Horace. The Works of Horace. New York: Harper &
Brothers; 1863; v. 476.
5 Dioscorides. De venenis eorumque praecautione et
medicatione. In: Sprengel K, ed. Pedanii Dioscoridis
Anazarbei Per dhlhthrwn, ioblwn kai euporstwn
Spuria. Lipsia: Car. Cnoblochii; 1830; 14.
6 Whitaker IS, Rao J, Izadi D, Butler PE. Hirudo
medicinalis: ancient origins of leeches, and trends in the
use of medicinal leeches throughout history. Br J Oral
Maxillofac Surg 2004; 42: 1337.
7 Caelius Aurelianus. On Chronic Diseases. In: Drabkin IE,
ed. and trans. Caelius Aurelianus: On Acute and on Chronic
Diseases. Chicago, IL: The University of Chicago Press;
1950; 286.
8 Schneider O. Nicandrea, Theriaca et Alexipharmaca. Lipsia:
BG. Teubneri; 1856; 271.
9 Pliny the Elder. Natural History. Cambridge, MA: Harvard
University Press; 1989; 539.
10 Aretaeus. De Curatione Acutorum Morborum. Athens:
Kaktos; 1997; 142, 165.
11 Aretaeus. De Curatione Diuturnorum Morborum. Athens:
Kaktos; 1997; 233.
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