If you lived during England’s Regency era (1811-1820), you considered leeching a standard medical therapy for nearly every ailment. Did you suffer from pleurisy? Then leeches were applied to your rib cage where the stitch or side pain was located. Was your brain inflamed from too much passionate study or hard drinking? Then lessen brain pressure by bleeding, either by sticking a straw or some other sharp tool up your nostril to make your nose bleed or, if you were feeling a bit puny, by applying leeches to the temples. Did you have a red and swollen eye? You might have an inflammation that could be cured by sticking leeches to the temples, under the eye, or even on the eyeball. Did you have inflamed kidneys? Bleeding piles? A toothache? Rheumatism? All of these conditions yielded to leeches. Heaven forbid if you were a small child! Leeches were nearly always chosen for bloodletting because a child’s veins are small. Even during teething, leeches might be applied under each of the infant’s ears if purging, vomiting, or sweating did not relieve the teething fever.1

One Leech—or Dozens—Might Do

Therapeutic use of a leech applied to a person's arm

Leeches were applied to the skin and also private body orifaces to reduce inflammation. (Source: Mumcuoglu KY. Evid Based Complement Altern Med 2014. See reference 5.)

Miss Anne de Bourgh, the protagonist of my novel, Rosings Park, also endures leeching. The story opens with Miss de Bourgh returning home from Tunbridge Wells, where she spent two weeks being treated for her “rheumatic affection.” Over the course of her physicking, she drank the healing waters for which Tunbridge Wells is known and submitted to leeching—a trial in which 15 leeches were placed on her belly and allowed to engorge themselves until fully sated.

Fifteen leeches? Surely that was excessive. No, dear reader. It was not.

Anne’s leech treatment was based on a case history published in 1842 in the Provincial and Medical Surgical Journal, a quaint-sounding periodical established in 1840 and today known simply as The BMJ (formerly the British Medical Journal)—one of the world’s most prestigious medical journals. The case history describes the successful treatment of a 40-year-old woman whose dietary habits tended toward fatty stews and who presented with severe rheumatic fever, tenderness over the stomach and liver, and yellow turbid urine. (The case study can be read here.2) Her symptoms suggested an acute inflammation of the stomach and liver, for which 18 leeches were applied to her abdomen. Thinking 18 leeches were excessive, I cut the number to 15 and felt satisfied. Later I learned that, in fact, dozens of leeches were sometimes employed. A poor gentleman who fell off his horse had 118 leeches applied over the course of four days to relieve a bruised elbow, and a man suffering from gonorrhea had 130 leeches applied to an inflamed testicle.3 (Read Carter’s article here.) Anne de Bourgh may have counted herself fortunate to endure a little more than a baker’s dozen of blood-sucking leeches.

Leeching Was A Good Thing

Leeches were employed to help relieve inflammation, which is the body’s immune response to some harmful stimuli, such as an irritant like an ingrown toenail or a pathogen like a bacterium or virus. Regency doctors readily recognized the signs of a local inflammation: swelling, heat, redness, and pain. These signs suggested an excess quantity of blood in the affected site that might be relieved by withdrawing blood. Thus, leeches were placed close to the site of inflammation. For example, leeches were placed on the temples for relief of a headache; on the epigastrium (the area between the breast and the navel) for gastrointestinal disturbances; on the shaved pubis for a bladder inflammation; and on the thighs or the groin for menstrual disorders.3

Leeches Served Where They Were Needed—Inside or Out

Leeches were often applied to the skin: behind the ear; on the toes or the side of the foot; on the face, arm, finger, thigh, breast, or leg. Indeed, any part of the body, including the privities (a person’s sexual organs or genitals), made a proper kingdom for a leech. But every orifice served equally well: ears, nose, mouth, anus, rectum, and vagina.

Leeches were applied to the larynx and diseased tonsils. This for me is the hardest application to imagine. Picture this: Your doctor tells you to open wide so a leech—a smallish leech, I hope—can be placed in your mouth. You see it coming. You know what it is and what it looks like and what it will do. How does the doctor manage to get the little sucker down your throat? To begin with, he has pushed a silk thread on a needle through the leech’s tail to keep hold of it, somewhat like having a horse take a bridle. Perhaps he loops the silk thread around a finger on one hand while he maneuvers a long, skinny instrument with the other to push the leech past your wisdom teeth, over your tongue, and down your throat. One wonders: Does he shout directions at it? “The inflamed tonsil is on your right, you rascal.” — “No, no! You’ve gone too far.” Does he have some instrument to gauge how far the leech has traveled? Perhaps he uses the length of thread to estimate the distance. One thing he doesn’t want is to lose the leech down the esophagus or trachea, where it can cause all kinds of trouble. Presumably the doctor knows when the leech is sated because it can easily be pulled back into the mouth.

What about the patient? He surely must gag at having a large, moving, bulging mass in his throat. Can he breathe properly? Is he feeling numb after drinking several pints of spiritous liquors to fortify himself for the ordeal? Does he endure because he believes this trauma is a necessary evil? Personally, it would take a large dose of laudanum to make swallowing a leech endurable.

The Leech Craze Continued Well Beyond the Regency Era

Leech therapy grew in popularity during the Regency era and continued for many years. By 1836 the four largest London dealers in leeches reportedly imported about 7 million of the creatures on average per year, mostly from France, Poland, and Germany. By the 1850s leeches were no longer harvested by poor peasant children (who served as bait while swimming in streams and marshes) but by nets (containing the organs from slaughtered animals) trawled through the water. The net method was so successful that some parts of England and western Europe lost their leech populations, leading to leeches being imported from Turkey and Egypt and even from as far away as Australia.3

Photo of Murray River from Wikipedia article

The Murray River Was a Source of Leeches for the U.S. and Europe in the 1860’s (Photo: Mattinbgn, CC BY-SA 3.0)

In 1867 the Murray River Fishing Company of Sydney, Australia, reported that between two and three million leeches passed “through their hands this season,” bound for America and Europe.3 Two to three million! A remarkable feat when you think on it. Having lived in Australia for two years, I mentioned this to my husband who was a commodities trader before retiring. He was very familiar with the Murray River ecosystem and the farmers who depend upon it.4 When I shared some of the history of leeching and explained that by 1879 the demand for leeches had fallen,3 he threw his arms up like a true trader, waved his hands, and cried, “Sell June leeches! Sell June leeches!” We laughed and laughed. The only thing funny about leeching as far as I can tell.

Today leeches have important medical uses. In fact, in 2004 the Food and Drug Administration approved leeches as a medical device for use in the field of plastic and reconstructive surgery. Leeches are applied to surgical flaps and reattached body parts such as fingers and ears to relieve congestion and promote blood flow. Leech therapy is considered safe, beneficial to patients, and cost-effective.5 It seems Regency doctors thought exactly the same thing.

1Buchan W. Domestic Medicine: or a Treatise on the Prevention and Cure of Diseases. (Boston, 1811), pp. 131, 194, 196, 220, 239, 250, 333, 364.
2Anon. Treatment of fever with rheumatic pain. Prov Med J Retrosp Med Sci. 1842 (Sept 24);4(104):501-502.
3Carter KC. Leechcraft in nineteenth century British medicine. J Royal Soc Med. 2001;94:38-42.
4Wikipedia: Murray River. http://en.wikipedia.org/wiki/Murray_river. Accessed July 28, 2014.
5Mumcuoglu KY. Recommendations for the use of leeches in reconstructive plastic surgery. Evid Based Complement Altern Med. 2014. http://dx.doi.org/10.1155/2014/205929