Saturday, February 5, 2011

Medieval Medicine, 21st Century Style (Nonfiction)

Warning: Not For the Squeamish.

1.Biotherapeutics. 2.Hirudotherapy. 3.Biodebridement. 4.Ichthiotherapy. It's very kind of the medical world to use scientific jargon to disguise some rather unpleasant aspects of medicine. So let's redefine them in everyday language, in order:  1.organisms used for therapeutic purposes. 2.Bloodsucking leech therapy. 3. Removal of dead/decaying flesh by application of maggots. 4. Removal of dead skin bits by nibbling little fish.

The use of leeches goes back at least as far as the ancient Greeks and Romans, based on the idea that illness was the result of imbalances in the 'four humours', and that draining off bodily fluids, including blood, would restore a proper balance. Bloodletting was prescribed for everything from headaches to morning sickness to drunkenness. The application of leeches was a kinder and gentler treatment than some of the other options, including venesection (opening a vein to let blood) and the use of harsh purgatives and laxatives. The leech bite may feel like a little pinprick, but supposedly contains a compound which acts as an anesthetic so the host doesn't detect its presence. To keep the blood flowing, leech saliva also contains an anticoagulant called hirudin. Once they've drunk their fill, they simply drop off; the contact site will continue to bleed for a short time. Leeches were extremely popular in medieval times; Henry VIII in particular was bled frequently. (He probably would have benefited more from  biodebridement, due to the ulcers on his legs, but more on that later.) Leeching was popular well into the late 1800s, then began to taper off gradually as medicine evolved more technologically advanced methods of surgery and wound care. In 1960, two Yugoslavian surgeons used leeches during skin transplants, and were published in the British Journal of Plastic Surgery. Through the years, leeches gradually gained more acceptance, most notably in cases of limb reattachment and to reduce swelling and blood congestion in areas of the body not easily lanced or which are unresponsive to 'conventional' treatment.  You can easily buy leeches through several different suppliers. (Please consult your physician or health care provider before applying. As they are classified as medical devices, they might even be covered under your health insurance plan...if you've got one.)

Maggots are a little less popular, but still have their uses. Not just any maggots, however. Some species are inclined to destroy living tissue, so the larvae of the blowfly are used, since they strictly consume dead and/or decaying matter. They ooze digestive juices into the wound, then suck up the resulting slurry of liquefied tissue and bacteria, leaving healthy tissue untouched. This makes them useful in treating wounds which won't heal properly or which are infected with resistant bacteria. Pam Mitchell benefited from maggot therapy when she developed an infected foot due to diabetes and it didn't respond to any other treatment including antibiotics. It probably saved her foot from amputation. She went on to serve on the board of the Biotherapeutics Education and Research Foundation, which champions the use of maggots and leeches and sometimes provides them to patients who lack insurance coverage. (If you've seen the movie Gladiator, you might remember Russell Crowe's character having his wounds treated with them.)

Ichthiotherapy commonly uses the Garra rufa species of fish to treat skin conditions such as psoriasis and eczema; it has also been popping up at various spas and salons as a means of removing dead skin and callouses from the foot as part of a pedicure. The fish have no teeth, so it's not painful; people describe it as feeling 'ticklish' or 'nibbly'. Several states in the US ban the use of them in non-medical settings, mostly out of concern that people sharing the same fish/water/container could conceivably pass on or contract disease. I have to admit it; I'd like to give it a try. Maybe the next time I'm visiting Virginia, home of Doctor Fish Massage Inc.

In this age of robotics and advanced technology, isn't it nice to know that we can still depend on earth's friendly little creatures to save the day?

                                                      Maggots at work. NIH US photo.

Further information: Book, Honey, Mud, Maggots and Other Medical Marvels by Robert and MicheleRoot-Bernstein (Houghton Mifflin Company, New York, 1997)

TV, Creepy Healers, National Geographic special which aired in 2003. Maybe they'll run it again sometime. Worth watching. Especially with snacks.


                BTERFoundation   Bio Therapeutics, Education and Research Foundation

                science3point0   In the comments section of my article reprint here, Sheri Rosen has left a great synopsis of recent content updates and developments on the BTERF site. Unfortunately, when I originally reviewed the site, there didn't appear to be much recent activity or recent news/announcements, and I jumped to the conclusion that the site might not be current. I chose not to include a link, which was obviously the wrong thing to do. The professional and courteous thing for me to do would have been to contact them and inquire. And so I offer my apologies again, thank Dr. Ronald Sherman MD and Ms. Rosen for gently correcting me, and have  included a link. Check them out - it's a fascinating topic!



  1. Okay, I know you warned me that it's not for the squeamish but I went ahead and read it anyway.

    Need to go find something decidedly more cheerful now. :)

  2. I wasn't expecting this, but this was SO cool. Have you read Mary Roach's book Stiff? I think you'd enjoy it.