the leech triumphantly oozed its way back into the hospital

January 20, 2020 11:41 AM

The modern medical leech is not a myth, or a homeopathy you can only find behind the counter at a store selling healing crystals. Indeed, these toothy worms are serious tools for the 21st-century doctor. At Duke and in prominent hospitals around the country, from Johns Hopkins to the Mayo Clinic, leeches have found particular utility in the post-surgical ward doing what they do best: draining blood... “The patients always get a huge kick out of it when we say we’re going to use leeches on something,” says Shammas. “They think it’s the coolest thing in the world.” Bradley Allf writes for Atlas Obscura on The Leech's Journey.
posted by ChuraChura (37 comments total)

I am currently reading the book Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood by Rose George and she has a whole chapter on leeches, where she goes behind the scenes at Biopharm to see how medical leeches are grown, fed, and sterilized, and also how "used" leeches are destroyed because when they are full of blood they are a bioharzard. (It's very gross.) I learned that (1) most nurses hate them because they (and we) are so cued to think of leeches as disgusting, and (2) leeches do not stay still. They move off of the sites where they are supposed to be feeding and they move very fast--a nurse who doesn't stay while the leeches are doing their job will come back to find leeches on the floor, in the curtains, and anywhere else they can get to. The guy she interviews at Biopharm says he sometimes discovers leeches attached to the cuffs of his pants when he gets home. They're very cool. It's an interesting book, btw. I just finished devastatingly sad chapters on HIV, and on hemophiliacs and the money to be made in plasma, and it appears the next chapter is on menstruation huts.
posted by ceejaytee at 12:02 PM on January 20, 2020 [16 favorites]

Leeches and maggots, not actually bad! I don't have an article on maggots, I have just heard that they're also useful in controlled uses for removing dead, infected flesh.
posted by OnTheLastCastle at 12:10 PM on January 20, 2020

don't some modern blood thinners come from like. leech saliva. leech secretions. leech juice. something.

oh i guess i could read the article and find out.
posted by poffin boffin at 12:20 PM on January 20, 2020 [1 favorite]

Leech saliva is thick with hirudin, a natural anticoagulant.

scream
posted by poffin boffin at 12:22 PM on January 20, 2020 [10 favorites]

“The patients always get a huge kick out of it when we say we’re going to use leeches on something,” says Shammas. “They think it’s the coolest thing in the world.”

They move off of the sites where they are supposed to be feeding and they move very fast--a nurse who doesn't stay while the leeches are doing their job will come back to find leeches on the floor, in the curtains, and anywhere else they can get to.

Hard pass.
posted by Splunge at 12:26 PM on January 20, 2020 [7 favorites]

There are ground leeches where I've worked most recently, and I discovered that you can't wear the same pants two days in a row because any leeches you don't brush off the outside will climb onto the inside and then climb into useful within-pants crevices like ankles and knees and hips and stuff and then you'll bleed a lot. If you wait another day, they'll all fall off and you'll be OK. But they are kind of pretty. And I liked to think of it as me becoming part of the rainforest biomass! So I was glad to discover more ways leeches can be useful and good.
posted by ChuraChura at 12:31 PM on January 20, 2020 [18 favorites]

“The patients always get a huge kick out of it when we say we’re going to use leeches on something,” says Shammas. “They think it’s the coolest thing in the world.”

Not always. I once had a patient on an in-patient psychiatric unit who was severely psychotic and who needed therapeutic blood-letting. Transfer to the main hospital to drain off a litre or so was presenting insurmountable problems. My plan to use leeches on the unit was vetoed, due to concerns over strong negative reactions from some of the other patients.
posted by meehawl at 12:35 PM on January 20, 2020 [6 favorites]

"Its leeches breed in special chambers that contain a mossy shelf where the mother leech—or father; they are hermaphrodites—crawls up to lay a cocoon of eggs shaped like a microphone cover."

wait wait whoa whoa yay time to jump down the leechy rabbit hole!
posted by emirenic at 12:46 PM on January 20, 2020

If the process is as painless as the article says, they probably produce an anesthetic, and since they are so disgusting to many people, it wouldn't surprise me if they've got a tranquilizer too.

I don't quite see how we can rule out a paralytic neurotoxin such as ticks make without looking for one, however.
posted by jamjam at 12:58 PM on January 20, 2020

See also: The Leech Barometer, a wonderful essay by Rebecca Giggs.

“Merryweather saw many prognosticators, activated by innumerous leeches, stationed up and down the British coast. The essential mechanism, he proposed, could be linked to major infrastructure. Merryweather contemplated the re-rigging of St Paul’s Cathedral in order that his leeches might ring the great bells and warn the whole of London of bad weather closing in.”

posted by oulipian at 1:13 PM on January 20, 2020 [6 favorites]

Leeches and maggots, not actually bad!

I'd say their medicinal use is like making an alliance with Stalin against the Nazis. Leeches and maggots: somewhat better than gangrene.
posted by justsomebodythatyouusedtoknow at 1:45 PM on January 20, 2020

How does one exercise a leech? “If they are slightly hungry, says Peters-Bond, “you just put your hand in the other end [of the tank] and they’ll come swimming.”

Hirudineaerobics.
posted by mandolin conspiracy at 2:33 PM on January 20, 2020 [4 favorites]

I think the movie Stand By Me has encapsulated my thoughts on (and likely reaction to) leeches.

Also, I cannot get past that places where spiders are larger than your hand, where centipedes feed on mice, where other abominations stalk, slither and ooze their way over the earth, there are often leeches the size of rats lurking in the murky depths of local waterways--probably palling around with snakes 20 feet long and fish that will turn whatever the leeches have drained into skeletons (though the fish probably leave the burrowing parasitic flesh-worms alone, so there is that). Of course, as you travel north you just channel this natural wrath into starling-sized mosquitoes and biting flies. In conclusion, to the moon. Sans leeches.
posted by maxwelton at 2:34 PM on January 20, 2020 [3 favorites]

The movie The African Queen was my introduction to leeches as a child.


Charlie Allnut: Leeches ahhhh!
posted by Splunge at 3:11 PM on January 20, 2020 [4 favorites]

I see leeches pretty often on canoe trips in the Adirondacks. I haven't found any sucking my blood, but I've found small ones on the outside of the canoe during portages. I've seen big, cool-looking, 4 inch long leeches swim past but I'm pretty sure those species don't feed on mammals. Well, that's what I'm assuming. If you know different, keep it to yourself!
posted by Drab_Parts at 3:17 PM on January 20, 2020

^.....no; they simply are waiting for colorful parts.....
posted by mightshould at 4:41 PM on January 20, 2020

If you want to know more about therapeutic maggots, the search term to use is 'maggot debridement therapy.'
posted by porpoise at 5:10 PM on January 20, 2020 [2 favorites]

“The patients always get a huge kick out of it when we say we’re going to use leeches on something,” says Shammas. “They think it’s the coolest thing in the world.”

I’ll be honest — if the choice is leechless and fingerless or leechy fingery, I'll choose the latter but I won’t be happy about it.
posted by Big Al 8000 at 5:26 PM on January 20, 2020 [10 favorites]

The lodge where we’ve spent a week each of the last couple summers has a regular leech race for the kids. They bring out a handful of leeches and a couple of lengths of gutters full of water; the kids pick a leech and face off to see whose goes the fastest.

While the boys were getting mixed results from poking and prodding at their leeches to encourage them to swim, my (then) seven-year-old daughter smoked ‘em by just sticking her finger in the water at the opposite end of the gutter and letting the leech come to her. The boys had to lose to her several times before they figured it out.
posted by nickmark at 5:36 PM on January 20, 2020 [14 favorites]

The movie The African Queen was my introduction to leeches as a child.

The book On The Banks of Plum Creek, for me.
posted by Iris Gambol at 6:14 PM on January 20, 2020 [4 favorites]

any leeches you don't brush off the outside will climb onto the inside and then climb into useful within-pants crevices like ankles and knees and hips and stuff

First, that is a really cool video. Second, I've personally been lucky enough not to experience it, but coworkers have found out the hard way that "and stuff" is a really terrible place to find a leech.
posted by Dip Flash at 6:15 PM on January 20, 2020 [3 favorites]

Ticks are big fans of "and stuff" as well.
posted by Windopaene at 6:21 PM on January 20, 2020

i liked leeches until they sent tanks into hungary back in 1956. then i realized they were bad.
posted by Reclusive Novelist Thomas Pynchon at 7:26 PM on January 20, 2020

ChuraChura that leech right there can fuck the fuck right off.

runs away screaming.
posted by [insert clever name here] at 12:21 AM on January 21, 2020 [4 favorites]

Not always. I once had a patient on an in-patient psychiatric unit who was severely psychotic and who needed therapeutic blood-letting. Transfer to the main hospital to drain off a litre or so was presenting insurmountable problems. My plan to use leeches on the unit was vetoed, due to concerns over strong negative reactions from some of the other patients.

Um. This has been here all night, and no one else has asked, so: is your inpatient psychiatric unit actually a 19th century insane asylum? Or have we circled back to the vitreous humors in all facets of medicine?
posted by Mayor West at 5:47 AM on January 21, 2020 [6 favorites]

“They think it’s the coolest thing in the world.”

Those patients are right, it is the coolest thing in the world.

Great post, ChuraChura, thanks.
posted by soundguy99 at 6:39 AM on January 21, 2020 [1 favorite]

Or have we circled back to the vitreous humors in all facets of medicine?

I assumed the patient had hemochromatosis or something like that. There are diseases that are treated by bloodletting even today.
posted by elizilla at 7:36 AM on January 21, 2020

I assumed the patient had hemochromatosis

There are a bunch of metal-overload diseases that cause neuropsychiatric degeneration. Some interesting studies. Bloodletting is a primary treatment for some of them.
posted by meehawl at 8:10 AM on January 21, 2020 [1 favorite]

Leeches are fine, but I started reconsidering my "eh, Tevas are fine" approach to river-based fieldwork after I drove all the way home before finding the leech between my toes.
posted by pemberkins at 10:30 AM on January 21, 2020

There are ground leeches where I've worked most recently, and I discovered...

ChuraChura: leeches will hide in your pants and eat your nethers alive
me: THAT SOUNDS HORRIFYING
ChuraChura: here's a video
me: omg SO CUTE

Seriously I had no idea what leeches looked like until now, and they are adorable! But also please don't drink my blood unless required for a medical procedure kthx.
posted by chrominance at 12:56 PM on January 21, 2020 [1 favorite]

So I've been dispensing leeches at my hospital for at least a decade, so that makes me something of a self-styled leech expert. The Atlas Obscura article, while mostly accurate, kinda undersells the whole thing.

When we first started doing it, we would call Leeches USA and have them drop ship a supply (leeches fly commercial, BTW), but that was so expensive that we now maintain a constant supply of them in a refrigerator in the corner of our storeroom. The article says that Leeches USA is mysterious and wouldn't return calls, but they always take my call (on the other hand, I call with a PO, so that might have something to do with it). They arrive in plastic bags and we transfer them to a plexiglass container called a Leech Hotel. Bob, one of our senior pharmacists, will occasionally change the specially-salted water (don't use tap water, the chlorine will kill them), keep them refrigerated and in the dark. Bob can keep a leech alive for a few months like this. Don't fuck with Bob's leeches is a saying where I work.

ENT and Plastics use leeches to maintain the patency of a graft. The hirudin in leech saliva prevents clotting, allowing the veins to reattach. They are remarkably good at this hyperlocal anticoagulation. Leech therapy can absolutely be the difference between a successful or failed graft. So after someone orders leeches we will take a bucket of them up to the floor. Invariably there will be a tech or student who has never seen this before and they will have one of two reactions; a, OMG, this is awesome, I need to take a photo and post it to Instagram, or b. Oh, HELL no! Guess which one I make take them up to the floor? I'll give you a hint, it's never the Instagram girl.

All of our leech patients are on the Burn unit and the nurses have come up with all kinds of ways to place them and remove them. They don't teach leeches in nursing school, so all of their techniques are learned on the job (although that could very well apply to everything our nurses do). They (the leeches, not the nurses) feed for an hour or two and are then euthanized in a bucket of rubbing alcohol. So there will be two buckets in the patients room, a bucket of sterile leeches and a bucket of dead, bloody leeches. So if you throw a used leech in the sterile bucket you've now contaminated all of them. The nurses, of course, would never do this, but an ENT resident would (ask me how I know).

The article says that patients get a huge kick out of it. I've never met those patients, all of my patients either barely tolerate it or are sedated. Of course, a lot of that depends on where the leech is placed. We've had orders for leeches on reattached fingers, ears, noses and even a case of reattached lips (bitten off by a dog). The most unusual place was a reattached cheek flap and the kicker was the leech had to be placed on the inside of the cheek. The nurse came up with the idea of suturing the leech in place. That patient wasn't conscious if you're wondering.

So, yeah, leeches!
posted by codex99 at 2:55 PM on January 21, 2020 [85 favorites]

Iris Gambol and others who first encountered leeches through books or films: I envy you. My first leech was a bodily encounter, probably in Northern Ontario in late May of some year between 1976 and 1980.
posted by Lawn Beaver at 10:49 AM on January 22, 2020 [5 favorites]

At least neither of us belatedly learned our first encounter occurred in the aftermath of a serious cheek injury, Lawn Beaver. (Thanks, codex99, my nightmare fodder had grown stale.)
posted by Iris Gambol at 11:45 AM on January 22, 2020 [1 favorite]

did anyone TELL leech cheek sleeper when the sleeper awakened that they had been leech cheeked? imagine seeing that on your EOB months later and having to be like "hey this line item just says LEECHFACE can anyone give me more details?" and then finding out you were leech cheeked while unconscious.

how do i get a medic alert bracelet that says "please obtain my full and informed consent before sewing a leech inside my mouth" that's my question pls advise
posted by poffin boffin at 3:02 PM on January 22, 2020 [14 favorites]

I worked with a patient who was having leech therapy once, when I was a bedside nurse. He'd done something not right with a table saw and cut off his index finger and pinkie finger. The fingers had been reattached by surgery and needed 1 leech per finger applied every 2 hours. The patient was a very good sport about having everybody and their brother-in-law come to see. (The pinkie finger was not a success but they saved the index finger.)

The container of leeches delivered to the patient's room by Pharmacy was called the Leech House.
posted by shiny blue object at 6:19 PM on January 22, 2020 [2 favorites]

It is possible that knowing that there is a possibility of needing leech therapy will add to my caution when using tools that may cause injury leading to necessitate leech therapy. I appreciate it from a scientific perspective, but...apparently I have issues.
posted by blurker at 7:30 AM on January 23, 2020

I feel bad for the leeches that get euthanized. I wonder if a hospital would let a patient take them home as pets instead.
posted by truex at 11:48 AM on January 23, 2020 [2 favorites]