Hirudo medicinalis: Difference between revisions
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| status_ref = <ref name="iucn status 19 November 2021">{{cite iucn | |
| status_ref = <ref name="iucn status 19 November 2021">{{cite iucn | vauthors = Utevsky S, Zagmajster M, Trontelj P |date=2014 |title=''Hirudo medicinalis'' |volume=2014 |page=e.T10190A21415816 |doi=10.2305/IUCN.UK.2014-1.RLTS.T10190A21415816.en |access-date=19 November 2021}}</ref> |
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Other species of ''[[Hirudo]]'' sometimes also used as medicinal leeches include ''[[Hirudo orientalis|H. orientalis]]'', ''H. troctina'', and ''[[Hirudo verbana|H. verbana]]''. The Asian medicinal leech includes ''[[Hirudinaria (annelid)|Hirudinaria]] manillensis'', and the North American medicinal leech is ''[[Macrobdella]] decora''. |
Other species of ''[[Hirudo]]'' sometimes also used as medicinal leeches include ''[[Hirudo orientalis|H. orientalis]]'', ''H. troctina'', and ''[[Hirudo verbana|H. verbana]]''. The Asian medicinal leech includes ''[[Hirudinaria (annelid)|Hirudinaria]] manillensis'', and the North American medicinal leech is ''[[Macrobdella]] decora''. |
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Medicinal leech populations were severely reduced in many countries during the 19th century due to the high demand in medical contexts, and remain endangered in many countries today.<ref name=":0">{{Cite journal | |
Medicinal leech populations were severely reduced in many countries during the 19th century due to the high demand in medical contexts, and remain endangered in many countries today.<ref name=":0">{{Cite journal | vauthors = Kutschera U, Elliott J |date=2014-11-18 |title=The European medicinal leech Hirudo medicinalis L.: Morphology and occurrence of an endangered species |url=http://zse.pensoft.net/articles.php?id=4256 |journal=Zoosystematics and Evolution |volume=90 |issue=2 |pages=271–280 |doi=10.3897/zse.90.8715 |issn=1860-0743}}</ref> |
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==Morphology== |
==Morphology== |
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The general [[morphology (biology)|morphology]] of medicinal leeches follows that of most other leeches. Fully mature adults can be up to 20 centimeters in length, and are green, brown, or greenish-brown with a darker tone on the [[Dorsum (biology)|dorsal]] side and a lighter [[ventral]] side. The dorsal side also has a thin red stripe. These organisms have two suckers, one at each end, called the [[anterior]] and [[Posterior (anatomy)|posterior]] suckers. The posterior is used mainly for leverage, whereas the anterior sucker, consisting of the [[jaw]] and [[teeth]], is where the feeding takes place. Medicinal leeches have three jaws (tripartite) that resemble saws, on which are approximately 100 sharp edges used to incise the host. The incision leaves a mark that is an inverted Y inside of a circle. After piercing the skin, they suck out [[blood]] while injecting [[anticoagulant]]s ([[hirudin]]).<ref>{{cite journal | |
The general [[morphology (biology)|morphology]] of medicinal leeches follows that of most other leeches. Fully mature adults can be up to 20 centimeters in length, and are green, brown, or greenish-brown with a darker tone on the [[Dorsum (biology)|dorsal]] side and a lighter [[ventral]] side. The dorsal side also has a thin red stripe. These organisms have two suckers, one at each end, called the [[anterior]] and [[Posterior (anatomy)|posterior]] suckers. The posterior is used mainly for leverage, whereas the anterior sucker, consisting of the [[jaw]] and [[teeth]], is where the feeding takes place. Medicinal leeches have three jaws (tripartite) that resemble saws, on which are approximately 100 sharp edges used to incise the host. The incision leaves a mark that is an inverted Y inside of a circle. After piercing the skin, they suck out [[blood]] while injecting [[anticoagulant]]s ([[hirudin]]).<ref>{{cite journal | vauthors = Rigbi M, Levy H, Eldor A, Iraqi F, Teitelbaum M, Orevi M, Horovitz A, Galun R | display-authors = 6 | title = The saliva of the medicinal leech Hirudo medicinalis--II. Inhibition of platelet aggregation and of leukocyte activity and examination of reputed anaesthetic effects | journal = Comparative Biochemistry and Physiology. C, Comparative Pharmacology and Toxicology | volume = 88 | issue = 1 | pages = 95–98 | date = 1987 | pmid = 2890494 | doi = 10.1016/0742-8413(87)90052-1 }}</ref> Large adults can consume up to ten times their body weight in a single meal, with 5–15 mL being the average volume taken.<ref name=wells>{{cite journal | vauthors = Wells MD, Manktelow RT, Boyd JB, Bowen V | title = The medical leech: an old treatment revisited | journal = Microsurgery | volume = 14 | issue = 3 | pages = 183–186 | year = 1993 | pmid = 8479316 | doi = 10.1002/micr.1920140309 | s2cid = 27891377 }}</ref> These leeches can live for up to a year between feedings.<ref>{{cite journal|vauthors=Lent CM, Fliegner KH, Freedman E, Dickinsont MH |title=Ingestive behaviour and physiology of the medicinal leech|journal=[[Journal Experimental Biology ]] |volume=137 |pages=513-27|year=1988}}</ref> |
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Medicinal leeches are [[hermaphrodite]]s that reproduce by [[sex]]ual mating, laying eggs in clutches of up to 50 near (but not under) water, and in shaded, humid places. A study done in Poland found that medicinal leeches sometimes breed inside the nests of large aquatic birds, noting that conservation efforts directed at bird habitats may also indirectly help preserve dwindling leech populations.<ref>{{Cite journal| |
Medicinal leeches are [[hermaphrodite]]s that reproduce by [[sex]]ual mating, laying eggs in clutches of up to 50 near (but not under) water, and in shaded, humid places. A study done in Poland found that medicinal leeches sometimes breed inside the nests of large aquatic birds, noting that conservation efforts directed at bird habitats may also indirectly help preserve dwindling leech populations.<ref>{{Cite journal| vauthors = Buczyński P, Tończyk G, Bielecki A, Cichocka J, Kitowski I, Grzywaczewski G, Krawczyk R, Nieoczym M, Jabłońska A, Pakulnicka J, Buczyńska E | display-authors = 6 |date=April 2014|title=Occurrence of the medicinal leech (Hirudo medicinalis) in birds’ nests|url=http://link.springer.com/10.2478/s11756-014-0329-0|journal=Biologia|language=en|volume=69|issue=4|pages=484–488|doi=10.2478/s11756-014-0329-0|issn=0006-3088}}</ref> |
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==Range and ecology== |
==Range and ecology== |
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===Beneficial secretions=== |
===Beneficial secretions=== |
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Medicinal leeches have been found to secrete [[saliva]] containing about 60 different [[proteins]].<ref>{{cite journal| |
Medicinal leeches have been found to secrete [[saliva]] containing about 60 different [[proteins]].<ref>{{cite journal | vauthors = Baskova IP, Zavalova LL, Basanova AV, Moshkovskii SA, Zgoda VG | title = Protein profiling of the medicinal leech salivary gland secretion by proteomic analytical methods | journal = Biochemistry. Biokhimiia | volume = 69 | issue = 7 | pages = 770–775 | date = July 2004 | pmid = 15310277 | doi = 10.1023/b:biry.0000040202.21965.2a | s2cid = 22828659 }}<!--|access-date=November 26, 2012--></ref> These achieve a wide variety of goals useful to the leech as it feeds, helping to keep the blood in liquid form and increasing blood flow in the affected area. Several of these secreted proteins serve as [[anticoagulant]]s (such as [[hirudin]]), [[Platelet aggregation#Adhesion and aggregation|platelet aggregation]] inhibitors (most notably [[apyrase]], [[collagenase]], and calin), [[Vasodilation|vasodilators]], and [[Protease|proteinase]] inhibitors.<ref>{{cite web|title=Biology|url=http://leeches-medicinalis.com/the-leeches/biology/|work=Sangues Medicinales|publisher=[[Ricarimpex]]|access-date=November 26, 2012|archive-url=https://web.archive.org/web/20181010031550/http://leeches-medicinalis.com/the-leeches/biology/|archive-date=October 10, 2018|url-status=dead}}</ref> It is also thought that the saliva contains an [[anesthetic]],<ref>{{cite journal | vauthors = Mory RN, Mindell D, Bloom DA | title = The leech and the physician: biology, etymology, and medical practice with Hirudinea medicinalis | journal = World Journal of Surgery | volume = 24 | issue = 7 | pages = 878–883 | date = July 2000 | pmid = 10833259 | doi = 10.1007/s002680010141 | hdl-access = free | s2cid = 18166996 | hdl = 2027.42/42411 }} {{Dead link|date=February 2015}}</ref> as leech bites are generally not painful. |
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[[File:Leach on cow teat.jpg|thumb|Treating [[mastitis]] of a cattle with leech]] |
[[File:Leach on cow teat.jpg|thumb|Treating [[mastitis]] of a cattle with leech]] |
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===Historically=== |
===Historically=== |
||
[[File:A corpulent physician diagnoses more leeches for a young woman Wellcome V0011771.jpg|thumb|right|A [[caricature]] of a physician prescribing leeches for a weak, bedbound woman]] |
[[File:A corpulent physician diagnoses more leeches for a young woman Wellcome V0011771.jpg|thumb|right|A [[caricature]] of a physician prescribing leeches for a weak, bedbound woman]] |
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The first recorded use of leech therapy was in 3,500 years ago in ancient egypt.<ref>{{Cite web |title=History |url=https://arizonaleechtherapy.com/history/ |access-date=2023-01-19 |website=Arizona Leech Therapy |language=en-US}}</ref> The next recorded uses of leeches in medicine come in the last few centuries BCE, by the Greek physician [[Nicander]] in [[Colophon (city)|Colophon]]<ref name="wells" /> and in the ancient Sanskrit text [[Sushruta Samhita]].<ref>{{ |
The first recorded use of leech therapy was in 3,500 years ago in ancient egypt.<ref>{{Cite web |title=History |url=https://arizonaleechtherapy.com/history/ |access-date=2023-01-19 |website=Arizona Leech Therapy |language=en-US}}</ref> The next recorded uses of leeches in medicine come in the last few centuries BCE, by the Greek physician [[Nicander]] in [[Colophon (city)|Colophon]]<ref name="wells" /> and in the ancient Sanskrit text [[Sushruta Samhita]].<ref name = "Şenel_2020">{{cite journal | vauthors = Şenel E, Taylan Özkan A, Mumcuoglu KY | title = Scientometric analysis of medicinal leech therapy | journal = Journal of Ayurveda and Integrative Medicine | volume = 11 | issue = 4 | pages = 534–538 | date = October 2020 | pmid = 31289001 | doi = 10.1016/j.jaim.2018.11.006 }}</ref> Leech therapy is mentioned a few hundred years later in [[Shennong Ben Cao Jing]], a 3rd century CE book of traditional Chinese medicine.<ref name=":1">{{Cite web |title=网刊 |
||
Medical use of leeches was discussed by [[Avicenna]] in ''[[The Canon of Medicine]]'' (1020s), and by [[Abd al-Latif al-Baghdadi]] in the 12th century.{{Citation needed|date=May 2011}} |
Medical use of leeches was discussed by [[Avicenna]] in ''[[The Canon of Medicine]]'' (1020s), and by [[Abd al-Latif al-Baghdadi]] in the 12th century.{{Citation needed|date=May 2011}} |
||
These sources indicated leech therapy for a wide variety of ailments, including [[edema]],<ref |
These sources indicated leech therapy for a wide variety of ailments, including [[edema]],.<ref name = "Şenel_2020" /> "blood stasis",<ref name=":1" /> and skin diseases.<ref>{{cite journal | vauthors = Montinari MR, Minelli S | title = From ancient leech to direct thrombin inhibitors and beyond: New from old | journal = Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie | volume = 149 | pages = 112878 | date = May 2022 | pmid = 35364378 | doi = 10.1016/j.biopha.2022.112878 }}</ref> |
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[[File:LeechJarBedfordMuseum.JPG|thumb|left|upright|Earthenware jar for holding medicinal leeches]] |
[[File:LeechJarBedfordMuseum.JPG|thumb|left|upright|Earthenware jar for holding medicinal leeches]] |
||
In medieval and early modern European medicine, the medicinal leech (''Hirudo medicinalis'' and its congeners ''H. verbana'', ''H. troctina'', and ''H. orientalis'') was used to remove blood from a patient as part of a process to balance the [[Humorism|humors]] that, according to [[Galen]], must be kept in balance for the human body to function properly. (The four humors of ancient medical philosophy were blood, [[phlegm]], [[black bile]], and [[yellow bile]].) Any sickness that caused the subject's skin to become red (e.g. [[fever]] and inflammation), so the theory went, must have arisen from too much blood in the body. Similarly, any person whose behavior was strident and sanguine was thought to be suffering from an excess of blood. Leeches, by removing blood, were thought to help with these kinds of conditions — a wide range which included illnesses like [[polio]] and [[laryngitis]].<ref name="wells" /> Leeches were often gathered by leech collectors and were eventually farmed in large numbers. A unique 19th-century "[[Bedale Leech House|Leech House]]" survives in [[Bedale]], [[North Yorkshire]] on the bank of the Bedale Beck, used to store medicinal leeches until the early 20th century. |
In medieval and early modern European medicine, the medicinal leech (''Hirudo medicinalis'' and its congeners ''H. verbana'', ''H. troctina'', and ''H. orientalis'') was used to remove blood from a patient as part of a process to balance the [[Humorism|humors]] that, according to [[Galen]], must be kept in balance for the human body to function properly. (The four humors of ancient medical philosophy were blood, [[phlegm]], [[black bile]], and [[yellow bile]].) Any sickness that caused the subject's skin to become red (e.g. [[fever]] and inflammation), so the theory went, must have arisen from too much blood in the body. Similarly, any person whose behavior was strident and sanguine was thought to be suffering from an excess of blood. Leeches, by removing blood, were thought to help with these kinds of conditions — a wide range which included illnesses like [[polio]] and [[laryngitis]].<ref name="wells" /> Leeches were often gathered by leech collectors and were eventually farmed in large numbers. A unique 19th-century "[[Bedale Leech House|Leech House]]" survives in [[Bedale]], [[North Yorkshire]] on the bank of the Bedale Beck, used to store medicinal leeches until the early 20th century. |
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[[Manchester Royal Infirmary]] used 50,000 leeches a year in 1831. The price of leeches varied between one penny and threepence halfpenny each. In 1832 leeches accounted for 4.4% of the total hospital expenditure. The hospital maintained an aquarium for leeches until the 1930s.<ref>{{cite book| |
[[Manchester Royal Infirmary]] used 50,000 leeches a year in 1831. The price of leeches varied between one penny and threepence halfpenny each. In 1832 leeches accounted for 4.4% of the total hospital expenditure. The hospital maintained an aquarium for leeches until the 1930s.<ref>{{cite book| vauthors = Brockbank W |title=Portrait of a Hospital|date=1952|publisher=William Heinemann|location=London|page=73}}</ref> The use of leeches began to become less widespread towards the end of the 19th century.<ref name="wells" /> |
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===Today=== |
===Today=== |
||
Medicinal leech therapy (also referred to as ''Hirudotherapy'' or ''Hirudin therapy'') made an international comeback in the 1970s in [[microsurgery]],<ref name="MichalsenRoth2007">{{cite book| |
Medicinal leech therapy (also referred to as ''Hirudotherapy'' or ''Hirudin therapy'') made an international comeback in the 1970s in [[microsurgery]],<ref name="MichalsenRoth2007">{{cite book| vauthors = Wittke-Michalsen E | veditors = Michaelsen A, Roth M, Dobos G |title= Medicinal Leech Therapy|chapter-url=https://books.google.com/books?id=MwlmGPHg2CsC&pg=PA12|access-date=December 18, 2013|date=March 14, 2007|publisher=Thieme|isbn=978-3-13-161891-7|pages=4–12|chapter=2: The History of Leech Therapy}}</ref><ref name=Altman1981>{{cite news| vauthors = Altman LK |title=The doctor's world; leeches still have their medical uses|work=[[The New York Times]]| page=2|date=February 17, 1981|url=https://www.nytimes.com/1981/02/17/science/the-doctor-s-world-leeches-still-have-their-medical-uses.html}}</ref> <ref>{{cite journal | vauthors = Mumcuoglu KY | title = Recommendations for the use of leeches in reconstructive plastic surgery | journal = Evidence-Based Complementary and Alternative Medicine | volume = 2014 | pages = 205929 | year = 2014 | pmid = 24653746 | doi = 10.1155/2014/205929 }}</ref> used to stimulate circulation to salvage flaps and other tissue threatened by postoperative venous congestion,<ref name="MichalsenRoth2007"/><ref name=abdelgabar2003>{{cite journal | vauthors = Abdelgabar AM, Bhowmick BK | title = The return of the leech | journal = International Journal of Clinical Practice | volume = 57 | issue = 2 | pages = 103–105 | date = March 2003 | pmid = 12661792 }}</ref> particularly in finger reattachment and [[reconstructive surgery]] of the ear, nose, lip, and eyelid.<ref name=Altman1981/><ref name=frodel2004>{{cite journal | vauthors = Frodel JL, Barth P, Wagner J | title = Salvage of partial facial soft tissue avulsions with medicinal leeches | journal = Otolaryngology--Head and Neck Surgery | volume = 131 | issue = 6 | pages = 934–939 | date = December 2004 | pmid = 15577793 | doi = 10.1016/j.otohns.2004.07.005 | s2cid = 34041779 }}<!--|access-date=December 18, 2013--></ref> Other clinical applications of medicinal leech therapy include [[varicose veins]], muscle cramps, [[thrombophlebitis]], and [[osteoarthritis]], among many varied conditions.<ref>{{cite web|title=Applications in General Medicine|url=http://leeches-medicinalis.com/medical-applications/applications-in-general-medicine/|work=Sangues Medicinales|publisher=Ricarimpex|access-date=November 26, 2012|archive-url=https://web.archive.org/web/20130306014506/http://leeches-medicinalis.com/medical-applications/applications-in-general-medicine/|archive-date=March 6, 2013|url-status=dead}}</ref> The therapeutic effect is not from the small amount of blood taken in the meal, but from the continued and steady bleeding from the wound left after the leech has detached, as well as the anesthetizing, anti-inflammatory, and vasodilating properties of the secreted leech saliva.<ref name=wells/> The most common complication from leech treatment is prolonged bleeding, which can easily be treated, but more serious allergic reactions and bacterial infections may also occur.<ref name=wells/> Leech therapy was classified by the US [[Food and Drug Administration]] as a medical device in 2004.<ref>{{cite web |title=Product Classification: Leeches, Medicinal |url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=NRN |website=www.accessdata.fda.gov |access-date=19 August 2019}}</ref> |
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Because of the minuscule amounts of [[hirudin]] present in leeches, it is impractical to harvest the substance for widespread medical use. Hirudin (and related substances) are synthesized using [[Recombinant DNA|recombinant]] techniques. Devices called "mechanical leeches" that dispense [[heparin]] and perform the same function as medicinal leeches have been developed, but they are not yet commercially available.<ref>Salleh |
Because of the minuscule amounts of [[hirudin]] present in leeches, it is impractical to harvest the substance for widespread medical use. Hirudin (and related substances) are synthesized using [[Recombinant DNA|recombinant]] techniques. Devices called "mechanical leeches" that dispense [[heparin]] and perform the same function as medicinal leeches have been developed, but they are not yet commercially available.<ref>{{cite web | vauthors = Salleh A | url = http://www.abc.net.au/science/news/health/HealthRepublish_439856.htm | title = A mechanical medicinal leech? | work = ABC Science Online | date = 14 December 2001 | access-date = 29 July 2007 }}</ref><ref>{{cite web | vauthors = Crystal C | url = https://web.archive.org/web/20010414043340/http://www.virginia.edu/topnews/releases2000/cottlerleech-dec-14-2000.html | title = Biomedical Engineering Student Invents Mechanical Leech | work = [[University of Virginia]] News | date = 14 December 2000 | access-date = 29 July 2007 }}</ref><ref>{{cite news | vauthors = Fox M |url=http://www.otoweb.org/news_folder/mech_leech/mech_leech_A.htm|title=ENT Research Group Recognized for Mechanical Leech Project|work=[[Otoweb News]]|publisher=[[University of Wisconsin]], Madison, Division of Otolaryngology | archive-url=https://web.archive.org/web/20061211152532/http://www.otoweb.org/news_folder/mech_leech/mech_leech_A.htm | archive-date=December 11, 2006|access-date=December 16, 2013}}</ref> |
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==See also== |
== See also == |
||
*[[Helminthic therapy]] – other medical use of parasites |
*[[Helminthic therapy]] – other medical use of parasites |
||
*[[Ichthyotherapy]] – medical use of fish |
*[[Ichthyotherapy]] – medical use of fish |
||
==References== |
== References == |
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{{Reflist}} |
{{Reflist}} |
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==External links== |
== External links == |
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{{Commons category-inline|Hirudo medicinalis}} |
{{Commons category-inline|Hirudo medicinalis}} |
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*[https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?name=Hirudo+medicinalis Taxonomy page] in [[PubMed]] with many excellent references |
*[https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?name=Hirudo+medicinalis Taxonomy page] in [[PubMed]] with many excellent references |
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Revision as of 12:43, 30 January 2023
 | This article needs to be updated. (September 2021) |
| Hirudo medicinalis | |
|---|---|
| |
Scientific classification 
| |
| Domain: | Eukaryota |
| Kingdom: | Animalia |
| Phylum: | Annelida |
| Clade: | Pleistoannelida |
| Clade: | Sedentaria |
| Class: | Clitellata |
| Subclass: | Hirudinea |
| Order: | Arhynchobdellida |
| Family: | Hirudinidae |
| Genus: | Hirudo |
| Species: | H. medicinalis
|
| Binomial name | |
| Hirudo medicinalis | |
Hirudo medicinalis, the European medicinal leech, is one of several species of leeches used as "medicinal leeches".
Other species of Hirudo sometimes also used as medicinal leeches include H. orientalis, H. troctina, and H. verbana. The Asian medicinal leech includes Hirudinaria manillensis, and the North American medicinal leech is Macrobdella decora.
Medicinal leech populations were severely reduced in many countries during the 19th century due to the high demand in medical contexts, and remain endangered in many countries today.[3]
Morphology
The general morphology of medicinal leeches follows that of most other leeches. Fully mature adults can be up to 20 centimeters in length, and are green, brown, or greenish-brown with a darker tone on the dorsal side and a lighter ventral side. The dorsal side also has a thin red stripe. These organisms have two suckers, one at each end, called the anterior and posterior suckers. The posterior is used mainly for leverage, whereas the anterior sucker, consisting of the jaw and teeth, is where the feeding takes place. Medicinal leeches have three jaws (tripartite) that resemble saws, on which are approximately 100 sharp edges used to incise the host. The incision leaves a mark that is an inverted Y inside of a circle. After piercing the skin, they suck out blood while injecting anticoagulants (hirudin).[4] Large adults can consume up to ten times their body weight in a single meal, with 5–15 mL being the average volume taken.[5] These leeches can live for up to a year between feedings.[6]
Medicinal leeches are hermaphrodites that reproduce by sexual mating, laying eggs in clutches of up to 50 near (but not under) water, and in shaded, humid places. A study done in Poland found that medicinal leeches sometimes breed inside the nests of large aquatic birds, noting that conservation efforts directed at bird habitats may also indirectly help preserve dwindling leech populations.[7]
Range and ecology
Their range extends over almost the whole of Europe and into Asia as far as Kazakhstan and Uzbekistan. The preferred habitat for this species is muddy freshwater pools and ditches with plentiful weed growth in temperate climates.
Over-exploitation by leech collectors in the 19th century has left only scattered populations,[3] and reduction in natural habitat through drainage has also contributed to their decline. Another factor has been the replacement of horses in farming (horses were medicinal leeches' preferred food source) and provision of artificial water supplies for cattle. As a result, this species is now considered near threatened by the IUCN, and European medicinal leeches are legally protected through nearly all of their natural range. They are particularly sparsely distributed in France and Belgium, and in the UK there may be as few as 20 remaining isolated populations (all widely scattered). The largest (at Lydd) is estimated to contain several thousand individuals; 12 of these areas have been designated Sites of Special Scientific Interest. There are small, transplanted populations in several countries outside their natural range, including the USA. The species is protected under Appendix II of CITES meaning international trade (including in parts and derivatives) is regulated by the CITES permitting system.[2]
Medical usage
Beneficial secretions
Medicinal leeches have been found to secrete saliva containing about 60 different proteins.[8] These achieve a wide variety of goals useful to the leech as it feeds, helping to keep the blood in liquid form and increasing blood flow in the affected area. Several of these secreted proteins serve as anticoagulants (such as hirudin), platelet aggregation inhibitors (most notably apyrase, collagenase, and calin), vasodilators, and proteinase inhibitors.[9] It is also thought that the saliva contains an anesthetic,[10] as leech bites are generally not painful.
Historically
The first recorded use of leech therapy was in 3,500 years ago in ancient egypt.[11] The next recorded uses of leeches in medicine come in the last few centuries BCE, by the Greek physician Nicander in Colophon[5] and in the ancient Sanskrit text Sushruta Samhita.[12] Leech therapy is mentioned a few hundred years later in Shennong Ben Cao Jing, a 3rd century CE book of traditional Chinese medicine.[13]
Medical use of leeches was discussed by Avicenna in The Canon of Medicine (1020s), and by Abd al-Latif al-Baghdadi in the 12th century.[citation needed]
These sources indicated leech therapy for a wide variety of ailments, including edema,.[12] "blood stasis",[13] and skin diseases.[14]
In medieval and early modern European medicine, the medicinal leech (Hirudo medicinalis and its congeners H. verbana, H. troctina, and H. orientalis) was used to remove blood from a patient as part of a process to balance the humors that, according to Galen, must be kept in balance for the human body to function properly. (The four humors of ancient medical philosophy were blood, phlegm, black bile, and yellow bile.) Any sickness that caused the subject's skin to become red (e.g. fever and inflammation), so the theory went, must have arisen from too much blood in the body. Similarly, any person whose behavior was strident and sanguine was thought to be suffering from an excess of blood. Leeches, by removing blood, were thought to help with these kinds of conditions — a wide range which included illnesses like polio and laryngitis.[5] Leeches were often gathered by leech collectors and were eventually farmed in large numbers. A unique 19th-century "Leech House" survives in Bedale, North Yorkshire on the bank of the Bedale Beck, used to store medicinal leeches until the early 20th century.
Manchester Royal Infirmary used 50,000 leeches a year in 1831. The price of leeches varied between one penny and threepence halfpenny each. In 1832 leeches accounted for 4.4% of the total hospital expenditure. The hospital maintained an aquarium for leeches until the 1930s.[15] The use of leeches began to become less widespread towards the end of the 19th century.[5]
Today
Medicinal leech therapy (also referred to as Hirudotherapy or Hirudin therapy) made an international comeback in the 1970s in microsurgery,[16][17] [18] used to stimulate circulation to salvage flaps and other tissue threatened by postoperative venous congestion,[16][19] particularly in finger reattachment and reconstructive surgery of the ear, nose, lip, and eyelid.[17][20] Other clinical applications of medicinal leech therapy include varicose veins, muscle cramps, thrombophlebitis, and osteoarthritis, among many varied conditions.[21] The therapeutic effect is not from the small amount of blood taken in the meal, but from the continued and steady bleeding from the wound left after the leech has detached, as well as the anesthetizing, anti-inflammatory, and vasodilating properties of the secreted leech saliva.[5] The most common complication from leech treatment is prolonged bleeding, which can easily be treated, but more serious allergic reactions and bacterial infections may also occur.[5] Leech therapy was classified by the US Food and Drug Administration as a medical device in 2004.[22]
Because of the minuscule amounts of hirudin present in leeches, it is impractical to harvest the substance for widespread medical use. Hirudin (and related substances) are synthesized using recombinant techniques. Devices called "mechanical leeches" that dispense heparin and perform the same function as medicinal leeches have been developed, but they are not yet commercially available.[23][24][25]
See also
- Helminthic therapy – other medical use of parasites
- Ichthyotherapy – medical use of fish
References
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加 载中。。。". www.tmrjournals.com. Retrieved 2023-01-19. - ^ Montinari MR, Minelli S (May 2022). "From ancient leech to direct thrombin inhibitors and beyond: New from old". Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 149: 112878. doi:10.1016/j.biopha.2022.112878. PMID 35364378.
- ^ Brockbank W (1952). Portrait of a Hospital. London: William Heinemann. p. 73.
- ^ a b Wittke-Michalsen E (March 14, 2007). "2: The History of Leech Therapy". In Michaelsen A, Roth M, Dobos G (eds.). Medicinal Leech Therapy. Thieme. pp. 4–12. ISBN 978-3-13-161891-7. Retrieved December 18, 2013.
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{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Abdelgabar AM, Bhowmick BK (March 2003). "The return of the leech". International Journal of Clinical Practice. 57 (2): 103–105. PMID 12661792.
- ^ Frodel JL, Barth P, Wagner J (December 2004). "Salvage of partial facial soft tissue avulsions with medicinal leeches". Otolaryngology--Head and Neck Surgery. 131 (6): 934–939. doi:10.1016/j.otohns.2004.07.005. PMID 15577793. S2CID 34041779.
- ^ "Applications in General Medicine". Sangues Medicinales. Ricarimpex. Archived from the original on March 6, 2013. Retrieved November 26, 2012.
- ^ "Product Classification: Leeches, Medicinal". www.accessdata.fda.gov. Retrieved 19 August 2019.
- ^ Salleh A (14 December 2001). "A mechanical medicinal leech?". ABC Science Online. Retrieved 29 July 2007.
- ^ Crystal C (14 December 2000). "Biomedical Engineering Student Invents Mechanical Leech". University of Virginia News. Retrieved 29 July 2007.
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External links
Media related to Hirudo medicinalis at Wikimedia Commons
- Taxonomy page in PubMed with many excellent references
- Hirudotherapy in Plastic Surgery https://hirudotherapy.net/
- Documentary about alternative medicine with leeches and maggots
- Early Practices: A Brief History of Bloodletting: Bloodletting Over the Centuries
- Video footage of the unique Bedale Leech House
- Leeches eshop in Lodeksa with many excellent references