Bugs as medicine?

It may sound gross to most but insects and arachnids and bugs of all sorts have been part of traditional and folk medicines for millennia and examples can be found on near every continent.

Ancient Egyptians used bee venom to treat arthritis, while the Greeks and Romans powdered blister beetles to treat skin conditions. In traditional Chinese medicine, the Chinese Black Mountain Ant was said to have anti-aging properties and increase fertility. (Recent studies have revealed the insect to contain at least 60 bioactive components with medicinal potential.) And in the ancient Indian practice of Ayurveda, termites and termite mounds were ground into a topical paste for ulcers, rheumatic diseases and a pain reliever.

A similar practice could be found across Africa, where termite paste was used to prevent infection in open wounds. To "inject" the medicine, a live angry termite would be used to bite the patient through the paste, effectively pushing it into the bloodstream. And in Central and South America, grasshoppers were eaten to treat kidney diseases and reduce swelling, Army ants were used as living antibiotic sutures, and immature silkworms were boiled and consumed to treat everything from apoplexy and aphasia to bronchitis, pneumonia and frequent urination.

While many of these practices can still be found in folk remedies, very few are considered modern medicine in the Western tradition. One, however, made a comeback in the late 20th century and remains, shall we say, firmly latched since:

Leeches.

“Patients can be a little surprised at first,” says First Physicians Group Reconstructive Surgeon Justin R. Bryant, DO, FACS. “But when they find out it can save their finger, their lip, their ear—whatever that tissue is—I’ve never had anyone say No.”

“Frequently,” he adds, “patients will even name their leeches.”
 

Medieval Myth

Although the first recorded use of leech therapy dates back 3,500 years ago to Ancient Egypt, and evidence of its use is widespread through Hellenistic Greece, Early China, and even in the foundational Hindu texts on medicine from Ancient India and in the writings of Avicenna, one of the fathers of early modern medicine, most people today associate its use with Medieval Europe and the humors.

The theory at the time was that the human body contained four humors-blood, phlegm, black bile, and yellow bile-which must be kept in balance to maintain good health. Following from that, physicians of the time believed that diseases could be cured by adding or removing humors from the body. For example, if a patient suffered from fever and inflammation, turning bright red like a tomato, they were thought to have too much blood in their body, which leeches can remove naturally. It was also believed that diseases like smallpox, plague and typhoid fever could be caused by "stagnant blood," which leeches could also remedy.

Not a fringe theory, leech therapy was so common up through the 18th and 19th centuries that leech collectors turned into leech farms and, at one point, infirmaries were using tens of thousands of leeches every year. Today, physicians simply order them from the pharmacy.

Why, you ask?
 

Modern Medicine & Microsurgery

With the rise of modern scientific medicine, the humors theory faded into the background and leech therapy became less and less common. By the mid-20th century, the whole idea seemed a comically grotesque oddity from a bygone era. But it was about to make a comeback, as surgeons discovered a novel use for the little bloodsuckers.

Poke a hole in a water balloon and the water drains out until the balloon is empty. The same, thankfully, cannot be said for a human being. Platelets in our blood act quickly to cause coagulation, clumping blood cells together and essentially plugging the hole to stop the bleeding. While great for humans, this is not great for leeches, which would prefer the drinks keep flowing. So how do they feed? Their saliva contains an effective anticoagulant that overpowers the body's platelets and encourages blood flow, allowing the leech to feed to its little tubular stomach's content, while a powerful anesthetic prevents the host from ever feeling the bite.

Scary? Scary effective.

With the rise of microsurgery in the 1970s, which included delicate vascular reconstruction, such as reattaching tiny blood vessels and arteries, physicians and surgeons suddenly had need for a powerful and reliable anticoagulant that could keep blood flowing to vulnerable tissue while the body heals and grows new blood vessels of its own. Today, leeches are recognized as an integral part of the reconstructive surgeon's toolkit, and leech therapy is officially recognized by the FDA.

"Without leech therapy, sometimes you're pretty much guaranteed to lose the tissue," says Dr. Bryant, who just recently prescribed leech therapy to a patient whose upper lip was torn off by a dog bite, left dangling by only one or two blood vessels. Reconstructing and reattaching the lip was one thing, but without functional veins to carry blood back out of the injured area, the surgery would not succeed and the lip would be lost. But through a series of painless, 20-minute leech therapy sessions, it can be saved. The leeches will remove excess blood, painlessly and reliably, while the body undergoes its healing process, building the new blood vessels until leech therapy is no longer required.

In this way, leeches have become integral in reconnecting limbs, digits, ears, scalps, noses and more, acting like little surgical assistants, bloodthirsty in the best way possible. It's a reminder that healing and medicine don't always follow expected paths, that help can be found in the most unlikely places, and that sometimes our past contains the answers to our future. At Sarasota Memorial, we're proud to seamlessly blend innovation and tradition in our mission to provide the best care possible.

Even if that means leeches.

Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH's in-house wordsmith, Lederer earned his Master's degree in Public Administration and Political Philosophy from Morehead State University, KY.