Medieval Medicine Reemerges

Bloodletting has, for a hundred years or more, been viewed as a pointless and barbaric practice. It was based on the theory of "bad blood," which was thought to be either contaminated or stagnant. Releasing this bad blood supposedly allowed a person to recover from a number of ailments, from Plague to depression. During the 1800's, medical science proved that blood did not get stagnant, and that while the blood did carry things through the body, including poisons and diseases, bloodletting would not help to cure any problems and, in fact, the patient was made worse due to the blood loss and general weakening.

But modern medical studies are finding that bloodletting may have actually done some good. Bacteria-especially the staph germ, which causes everything from pneumonia to wound infections-need iron to survive and breed. Iron is contained in our red blood cells. Scientists now believe that if bloodletting occurred at the onset of a bacterial illness, it might have been possible to arrest the growth of the bacteria by starving them. However, don't look for a surgeon to be performing this service anytime soon; as long as we have antibiotics to combat bacteria, we can forgo the bloodletting. However, as antibiotics become less effective against super-bugs, medical practice might return to the idea of starving bacteria by depriving them of iron (although this will probably be affected in some way other than actual bloodletting); this could weaken or slow an infection's spread to the point that traditional antibiotics could finally eliminate it.

There is some evidence that the healing properties of maggots were known in the middle ages, although there is no specific evidence that they were ever used intentionally. Maggots most commonly occurred during times of war, when many wounds went unattended and injured men were exposed to the kinds of conditions that allowed the green blowfly to lay its eggs in their open and infected wounds (yes, gross, isn't it?). Military doctors/surgeons were quick to notice that those patients who had gone without treatment for an extended amount of time-and who had been infested with the fly larvae-managed to survive wounds that otherwise were almost always fatal; they did not contract gangrene or other infections that usually killed most people with similar wounds.

I know everyone, at this point, is just so interested in hearing how maggots work. As anyone who's left unsealed trash outside knows, maggots feed on spoiled meat. We humans are a type of meat too; when we get an open wound that becomes infected, our meat is "spoiled." Maggots introduced into a wound that is infected or in which a lot of dead tissue is present, will eat the bacteria that cause the infection and will eat the dead tissue. They will also secrete an enzyme which further kills bacteria (the bacteria, after all, is competing with the maggots for food), and which modern studies show also helps promote blood flow and healing.

You may ask, "Why would anyone allow themselves to be covered in bugs?" Well, for a lot of people, there is no choice. In countries where antibiotics and doctors are scarce, maggots are the only way to keep from dying from an infection. Even here in America there are wounds that defy treatment. Many diabetics are not only susceptible to getting open wounds on their extremities (due to poor circulation which causes numbness, which in turn causes the patient to accidentally injure himself), but they also have a hard time healing those wounds (also because of poor circulation). Surgeons may cut the dead and infected parts of the tissue away, but this is problematic. One, it can be difficult to know where the dead tissue ends and the healthy begins. As it is pointless to leave dead, infected tissue in the wound, surgeons are forced to cut into healthy tissue in order to not miss any bad tissue, thus making the wound even larger. Then, after surgery, there is still the chance that the wound will not heal, become infected again, and now there is an even bigger wound than before. It is usually in those instances where amputation is the next option.

Maggots can potentially save limbs as they do not make the wound any larger-they eat nothing which is not dead or infected-and their antibiotic and healing secretions tend to make the wound close and heal after the first full treatment. If the wound does not fully heal and does become infected again, more maggots can be applied since they will not make the wound larger or cause any problems in and of themselves (as drugs can). This treatment can be used repeatedly until the wound is fully healed, thus sparing the patient his limb.

Nothing says "middle ages" like a little leech therapy. As with bloodletting, it was disregarded as a barbaric and superstitious custom as modern medicine emerged. Also like bloodletting, leech therapy was based on the idea of having "bad" or stagnant blood. However, modern medicine has found that hirudotherapy (the use of leeches) does help in certain ways (whether these ways were completely understood in the middle ages is debatable).

For instance, the saliva of the leech is an anti-coagulant. While most people do not want to be a "free bleeder," there are actually instances where it is necessary to bleed. For example, after a major accident, blood can become trapped under the skin; this is similar to a normal bruise, except that too much blood under the skin can cause extremely painful swelling and impair movement, and it can be hard for the body to reabsorb the blood. The modern cure for this problem is a short surgical procedure in which the hematoma is lanced and the blood allowed to drain. However, surgery is not always an option for some patients, such as those with a heart condition. Enter the humble leech: when applied to the hematoma, it will reduce the blood under the skin and encourage healing (because it injects an anti-coagulant, the clotted blood can be freed and the body can better reabsorb some of it on its own). Unlike a surgical incision, a leech is capable of doing this with little to no pain (it has a numbing agent in its saliva) and the incision a leech creates is less likely to become infected with staph or other dangerous bacteria (a common problem in American hospitals).

Diabetics and others who suffer from very poor circulation in the legs and feet, or from blood clots, find that their circulation improves after a few treatments with leeches. Of course the affects are not permanent, but unlike some drugs and treatments, leech therapy can be repeated as often and for as long as necessary, and they don't cause dangerous interactions with other medicines.

However, leeches have had their greatest success in the field of extremity reattachment. While doctors can perform micro surgery to reattach veins and arteries which have been severed, they oftentimes cannot reattach all of them. If they fail to reattach enough such conduits, then blood flow will be too restricted, the flesh will "die" and the reattached digit or limb will be a loss. For some body parts, like ears, successful reattachment is almost impossible, as the ear is fed by the tiniest of capillaries which no surgeon can rejoin. However, leeches that are attached to the ends of these extremities pump anti-coagulant enzymes in and suck blood out. This causes the blood in the digit to thin and move more freely, and by being attached to the far end of the extremity, blood is drawn all the way through, thus maintaining proper blood flow and allowing the tissue to stay properly nourished.

One of the other great benefits to leeches, more recently discovered (or, more likely, "rediscovered"), is that the saliva of leeches contains an anti-inflammatory. There has been some success with treating severe cases of osteoarthritis with leeches. The leeches are placed on the offending joint (a knee, for example) and they go to work improving circulation and injecting anti-inflammatory enzymes. The numbing properties of their saliva can also help temporarily reduce pain.

The most amazing thing about leeches and maggots is that modern medicine has been unable to wholly reproduce their abilities chemically or mechanically (although the anti-clotting enzyme in leech saliva has been synthetically reproduced); oddly enough, there's just no real substitute for a leech or maggot. While our forbearers didn't understand why bloodletting, maggots and leeches sometimes produced improvements in patients, they were at least capable of seeing the improvement; thus they didn't use these techniques out of ignorance, but because it was their best hope of a cure. It has only been very recently that we, with all our modern medical knowledge, have been able to figure out why they work and when to apply them for greatest effect.

See also:

Medieval History Magazine. "Body and Soul: Medicine Among Our Forbearers." Issue 3, November 2003.