6. There Is More Danger Than Is Usually Imagined In Applying Leeches A Second Time

There can be but little doubt that some diseases, particularly Syphilis, and also puerperal fevers, have been transmitted to others by the injudicious and too hasty application of leeches, which have been previously employed in these diseases. Too little attention is usually paid to this point.

7. To remove leeches, if they do not drop off by themselves (which they generally do in fifteen or twenty minutes), sprinkle them with a little cold water, or a little vinegar and water, or powdered sugar.

8. To promote bleeding from leech-bites, apply fomentations or warm dry cloths, which should be changed frequently. The application of cupping-glasses over the bites greatly promotes the flow of blood.

9. To check hAemorrhage from leech-bites, expose them to cold air, carefully removing coagula, or make continued and firm pressure with the finger; or, if these fail, apply styptics, as Matico, Alum, &c. (See Index - HAemorrhage from Leech-bites.)

10. In order to preserve leeches, add a piece of Charcoal to the water, and do not change it too frequently - once or twice a week at the furthest. When they are to be taken a long voyage, they should be carried in well-charred casks. *

* M. Lisfranc's Rules for the Application of Leeches. - 1. The cicatrices of leech-bites being often very apparent, we ought to refrain, if possible, from applying them to parts habitually exposed. 2. In children and females of delicate skin, the course of large veins should be avoided, especially in the neck. 3. Leeches on the eyelids produce unseemly ecchymosis, and often an dema-tous erysipelas; they should be placed instead on the temples, along the roots of the hair, or behind the ears (?). 4. Leeches to the inner surface of the eyelids are ineffectual as evacuants, and the bites prove injuriously irritant; consequently scarifications are here preferable. 5. In inflammation of the fauces, leeches should be placed over the mastoid processes, or behind them; there the results are not seen, and moderate pressure readily commands

3194. Therapeutic Uses

In many cases of Acute Inflammation and in most Subacute and Chronic Inflammations, leeches are preferable to general blood-letting. In some acute local inflammations, e.g. Purulent Ophthalmia, the application of leeches in the neighbourhood of the disease proves highly serviceable; and even when more active treatment appears necessary, they are valuable auxiliaries to general blood-letting and other antiphlogistic measures. In diseases of infants leeches are a valuable resource, and may, in most cases, be employed with safety and advantage. In Acute Carditis and Pericarditis, in Peritonitis, Pleuritis, and Active Inflammation of the Liver, relays of leeches over the diseased part should, as a rule, never be omitted.

3195. In Acute Gastritis, Dr

Stokes* observes, that there are few things more striking in the practice of medicine than the effect of leeches in this disease. The vomiting and burning heat are often relieved as by a charm; and we have, he adds, seen violent cough and delirium subside under the same circumstances. In adults, from 20 to 40 leeches may be safely employed. In children, the number must be regulated by the age of the child, &c, and followed by fomentations or poultices, &c. Dr. Symonds prefers relays of small numbers of leeches, in preference to a large number at one time.

3196. In Acute Laryngitis, leeches applied to the throat are valuable auxiliaries to general treatment, but they are of little service beyond reducing the local heat and swelling. In Chronic Laryngitis, leeches to the sides of the throat may be applied with advantage, and repeated in small numbers every two or three bleeding. 6. In applying leeches to the epigastrium, let none fasten over the costal cartilages, otherwise the movement of these is likely to entail a troublesome bleeding. 7. In leeching a part where there is much subcutaneous fat, but little blood will flow; in such circumstances it will be prudent to increase the number of leeches, or aid them by venAesec-tion. 8. Do not place leeches where there are many subcutaneous nerves; the pain will be great; erysipelas may result. For example, in leeching the forearm, prefer the dorsal to the palmar aspect. 9. Leeches should not be applied to the mucous membrane of the vulva, nor to the immediate neighbourhood of the rectum; the bites are apt to degenerate into troublesome ulcers; applied round the margin, they are equally potent as remedial agents. 10. The scrotum, prepuce, and skin of the penis should not bo directly leeched; the pain is excessive; inflammation and gangiene have resulted; when the leeches are placed behind the scrotum, on the raphe, the result is in every way satisfactory. 11. By leeching the skin investing the mamma great pain is occasioned, and erysipelas not unfrequently results; the surrounding integument is the preferable site. 12. If possible, leeching of inflamed skin ought to be avoided. 13. Leech-bites on a syphilitic bubo are liable (occasionally) to ulcerate and assume a venereal character. 14. Do not leech a fractured limb at the ' site of the injury. 15. Do not apply leeches to a tumour of doubtful character, but near it; otherwise, should the swelling prove carcinomatous, the leech-bites may accelerate the open or advanced condition of that disease. (Brit. and For. Med. Rev., No. xxvii. P. 3.) days, for some length of time. In Tonsillitis, leeches applied, by means of a proper glass, to the tonsils are productive of the best effects, according to the experience of Crampton and others. (Dr. Williams.*)

* Cyc. Pract. Med., vol. ii. p. 325.

3197. In Nephritis and Nephralgia, the local abstraction of blood from the surface over the kidneys, is a valuable auxiliary to general blood-letting, the hip-bath, &c. (Dr. Watson.)

3198. In the Pneumonia of Children, the abstraction of blood by leeches on the chest, is often productive of the best effects. They cannot be applied too early in the disease.

3199. In Subacute Ovaritis, leeches (10 or 12) applied to the inguinal regions are advised by Dr. Tilt. Sufficient blood should be drawn to make an impression on the system. Medicated enemas and frictions should be subsequently applied. In acute cases, general blood-letting may be required.

3200. In Congestion and Inflammation of the Uterus, leeches to the cervix uteri are eminently serviceable. From three to six may be applied every two or three days until the symptoms yield.§ Dr. H. Bennett, however, justly observes that their constant application sometimes does more harm than good, by drawing blood to the uterus.

3201. In Acute Dysentery, leeching the abdominal surface is often attended with the best effects. The application of leeches to the verge of the anus often proves, in the highest degree, beneficial, by removing the congested state of the hAemorrhoidal vessels. On this point, Dr. Mayne,|| in his account of the Acute Dysentery epidemic in Dublin, observes that greater relief was obtained from 12 leeches to the verge of the anus than from triple the number placed on the abdomen. The hAemorrhoidal veins are, in this manner, he observes, most effectually unloaded, and at the same time the distressing tormina and tenesmus are mitigated with great certainty. This fully coincides with my own experience, having in numerous cases seen the most marked benefit from leeches thus applied. In Acute Febrile Diarrhoea, the same treatment proves, in the highest degree, beneficial.

3202. In Congestion of the Brain, in threatened Apoplexy or Paralysis arising from the suppression of an habitual discharge, as from Piles, a few leeches to the verge of the anus often afford more immediate and permanent relief than three times the number applied to the temples or other part of the body. They are equally applicable if the threatened attack arise from suppression of the menses, but in such cases the leeches should be applied to the inner side of the thighs. In reference to this mode of treatment, Dr. Holland* observes, that he knows of no mode in which a given quantity of blood can be removed with equal good effect. In Congestive Headaches, leeches may be applied with advantage to the temples, or in the situation advised above, or to the crown of the head.

* Lib. of Med., vol. iii p. 50, et seq.

Lectures, vol. ii. p. 56S.

Lancet, March and April, 1849.

§ Or. Simpson, Lib. of Med., vol. iv. p. 331.

|| Dub. Quart. Journ., May 1849.

3203. In Acute Hydrocephalus, the local abstraction of blood by leeches sometimes proves serviceable. Dr. West judiciously directs that they should be placed on the crown of the head rather than on the temples. They are inadmissible when the little patient is much debilitated.