Nine Pints

by Rose George

  The farmer and Michelle and other broad-minded patients: they’re the easy ones. “Some people,” says Reynolds, “just don’t want to know. ‘Don’t tell me, I’m not going to look, come in, come out, do what you need to do, but I’m not an active participant.’” The face and breasts are the hardest. Women undergoing breast construction are “already emotionally distressed and they find it harder.” Delayed reconstruction therapy, for example: these women have had chemotherapy and radiotherapy, and only then a reconstruction. Already they have waited months, and they have the surgery and then one breast fails. “That’s so huge for a woman. It’s part of your identity, it’s who you are, and it’s not going well and then you have leeches stuck on your boobs as well.”

  Some of the nurses Reynolds interviewed can’t bear leeches, either, but because they are nurses, and wonderful, they suck it up. In one newspaper article titled “A Sucker’s Born Every Minute,” an unnamed doctor at Cedars Medical Centre reported an interesting technique for getting nurses used to the idea. “‘We first ask them if they like animals,” the physician says. “Then we work up to leeches.”73 Or the more junior nurses do trade-offs with more veteran ones who don’t mind the creatures. Reynolds knows better but, despite her knowledge and expertise, thinks leeches are “slugs. One hundred percent slugs.”

  They are also trickier to dispose of than a sharp needle into a bin. From Biopharm, I’d got the sense of a dispatch method that was clean and humane, if animal murder can be humane. No, says Reynolds. It’s nothing like that. Wild Hirudo medicinalis or verbana may live for twenty-seven years,74 but these are service animals with a human-dictated life span. Its job done, the useful leech is placed in a plastic pot—like the urine sample ones—and sprayed with alcohol solution. Rather than it being anesthetized and dying painlessly as I’d imagined, there is an explosion. “They’re so big,” says Reynolds. “And you spray them with seventy percent alcohol, and they burst open with all the blood.”

  * * *

  You will not find many vivid news reports about patients who have successfully undergone surgery and overcome venous congestion of a free flap. They are quiet, the successfully leeched, and there is no public triumph. Perhaps they need to forget. Perhaps they can’t square the instinctive horror of the leech with its powerful ability to heal. Perhaps they cannot summon gratitude for these slug-like creatures. They should.

  In the nineteenth century, a man named Thomas Erskine was convinced that being bled by two leeches had saved his life. Despite the abundant use of leeches, gratitude to them was rarely expressed. But Erskine—who served as Lord Chancellor in the most optimistic Ministry of All the Talents—named his leeches Home and Cline, after two eminent Victorian surgeons, and made them pets.75 Another man who gave leeches their due was George Merryweather, a family doctor in the Yorkshire port of Whitby, famous for being a setting in Dracula but also where Dr. Merryweather devised the Tempest Prognosticator. In a long submission to the Whitby Literary and Philosophical Society in 1851, Merryweather set out his startling claim: that a leech could feel weather, and that many leeches could predict it.76 This barometer ability of the leech had been reported anecdotally before. The eighteenth-century poet William Cowper wrote to his cousin of a storm and of “a leech in a bottle that foretells all these prodigies and convulsions of nature. […] No change of weather surprises him, and that in point of the earliest and most accurate intelligence, he is worth all the barometers in the world.”

  Merryweather read of this and went further. Rather than one leech, his barometer featured twelve, each in a white glass bottle, pint-size. He took care that they could see one another, because he thought leeches could get lonely. He called them his “jury of philosophical counsellors” and “my little comrades.” In his writing, a kindness percolates. He is apologetic in his submission that he must predict yet another storm, though the sky is blue. “I am sorry to interfere with your engagements this beautiful weather,” he writes in February 1850. “I do not trouble you with a little blustering of the wind.” But he is rare in that his kindness extends to leeches, these animals thought to be only useful or to be abused.

  He thought of calling his device the Atmospheric, Electro-Magnetic Telegraph, conducted by Animal Instinct, but somehow decided that Tempest Prognosticator was more straightforward for foreigners to understand. He suggested that it be placed in stations around the coast to serve all shipping, along with life boats, and that mariners be issued a book of tempest signals, to interpret better. The prognosticator appeared at the Great Exhibition of 1851, and Lloyds of London did its own tests.77 But the leech machine failed: the mechanical barometer, using a sealed liquid, was adopted instead, partly because it didn’t require maintenance, feeding, or the changing of water every few months. Merryweather’s comrades were retired, and the leech returned to its role as an unloved worm.

  * * *

  Leeches are called upon less often now, because surgery is better. “We’re a bit flat really,” says Carl, when I ask how business is. The young nurses at Biopharm thought their hospital used to keep them on the burn unit, but they don’t anymore. Surgeons are defter at reattaching veins and getting drainage, but only with clean cuts and decent-size veins. “Where there is trauma,” says Carl, “someone is burnt or something gets caught in a chain or a belt: that’s when they can’t stretch the veins to get them together. So they attach as many arteries and veins as they can and use leeches to borrow a bit of time.” In America, Biopharm’s leeches are used frequently for scalp injuries. “Bears,” says Carl. “They tear the scalp off. It’s one of the few things when there’s very little that they can do surgically. They attach the scalp and then plaster it with leeches. It works very well.” Canning factories used to be good for business. Carl remembers one case where a canning employee in Finland had two fingers and a thumb ripped off. “I think they used something like eight hundred leeches over five days. I don’t know how they used so many.” Degloving cases, where the skin is ripped off, have also dropped.

  But in disasters overwhelmed surgeons can’t afford to spend ten or twenty-five hours of surgery on each patient, and leeches can save time. After the San Francisco earthquake in 1985, Roy Sawyer wrote in a biographical account that Biopharm had requests for hundreds of leeches. The same after the terrorist attacks of 7/7 in London.78 Wars often require leeches: according to Carl, the Royal Centre for Defence Medicine in Birmingham keeps two hundred leeches in its pharmacy. “They have a really big stock,” says Carl, because they have people coming in with no leg, no foot. It’s not a case of putting one or two on, they’ve got to put fifty on.” Regular hospitals used to keep a leech buffer—half a dozen or so, in the pharmacy—but most don’t now.

  July has been quieter than expected. In summer, people do DIY, and, Carl says with meaning, “They cut the hedge…” I ask if they attend surgery conferences to increase trade. “When we can afford it.” It’s a rare chance for them to meet surgeons and doctors: usually they only deal with the pharmacist, who orders the leeches in and sometimes not expertly. “We’ll get a pharmacist ringing in at six in the morning and saying, can I have six leeches, and we’ll say, no you don’t want six because by the time the courier gets to you, you’ll be needing more.”

  Surely there’s an untapped leeching population in the rugby and boxing worlds where cauliflower ears and contusions abound? For now they just get the odd human kickboxer from a local club. They are walk-ins, popping in for leeches when required, no need to book. Carl can’t remember what the boxers were charged, but the usual price is £9.50 to £10 ($13.35 to $14.07) a leech. Whichever way you look at it—compare it to the painstaking two-year breeding process, or calculate it against three or more visits to a casualty department for a cauliflower ear, or a lost finger or breast or scalp—that is a bargain.

  What about diversifying into hirudotherapy? The general public already thinks leeching is quackery, say Bethany and Carl. Or that it’s something to do with maggots. But when I bring up
hirudotherapy, their reaction is dour and sour and no wonder. The website of the British Association of Hirudotherapy is accompanied by images of women with leeches hanging out of their mouths or in their genitalia. In the curious minds of hirudotherapists, leeches applied correctly will treat diseases caused by “insufficient micro-circulation.” These include blood defects, joint disorders, neuroses, boils, hemorrhoids, varicose veins, asthma, heart attack, stroke, depression, infertility, memory disorders, diabetes, hair loss, and detached retinas. The actress Demi Moore told talk show hosts that leeches had fed on her to “detoxify my blood,” saying they released a cleansing enzyme. This is scientific nonsense: if the leech’s decongestant ability was not localized, its host would bleed to death. The only thing hirudotherapy claims it can’t treat, says Carl, is death. But science is immaterial to hirudotherapists, as are laws. I ask Carl where hirudotherapists get their leeches from if it’s not Biopharm. He says nothing for a while, then relents. “A pond somewhere. A lot of them come from Russia without CITES. All the leeches that come in are smuggled, in a suitcase. They get their relatives to bring them in.” It’s easy to check: CITES regulates imports and exports. In 2017, Romania was allowed to export forty thousand Hirudo medicinalis; Turkey was allowed a quota of 200 kilograms of Hirudo verbana. Russia had no leech quota for 2016–17.79 Carl says Russia exports two hundred leeches every few years. “But the hirudotherapists are using five hundred a week.”

  Perhaps a few things on that long hirudotherapy shopping list of conditions are not entirely lunatic. Carl has heard that they’re good for tendonitis. Their saliva has some kind of anti-inflammatory effect. “But there’s no exact science as to why it works.” In 2003, the surgeon Richard Fiddian-Green wrote a letter to the British Medical Journal. He remembered doing a ward round at St. Mary’s Hospital in London with a senior consultant and encountering a patient with extremely painful pericarditis (a swelling of the fluid-filled sac enclosing the heart). It is usually treated with anti-inflammatory drugs. But the consultant thought differently. “The most effective treatment for pericarditis I have ever seen,” he told us, “was three leeches applied to the precordium.”80

  Anecdotes abound of leech application helping to relieve arthritis or other inflammation. I’d like to ask Roy Sawyer about it, but Bethany says he doesn’t do interviews anymore. She nods in the direction of the cream mansion house, where he is. I start to think of Jane Eyre and attics but I tell them that I picture him as an Indiana Jones figure, striding through swamps for science, his movement purposeful and his legs bare and ready. They don’t stop laughing for a good while. “Not quite,” says Bethany. Her parents are planning a holiday, she says. “My mother thinks it’s going to be a relaxing holiday, but he’s already got plans to find a swamp somewhere.” Neither she nor Carl looks like they relish this idea. When Sawyer is out leech hunting, he sends them regular e-mails of his progress. Images of dissected leech gonads in their morning in-boxes are not uncommon.

  Sawyer is going swamping because he may be retired from giving interviews but not from learning about leeches. There is so much to discover about these multisegmented annelid worms, this bane and troublemaker and parasite, this bloodsucking creature that straddles old and new medicine as serenely as it moves through water or attaches itself to Carl’s trouser leg. It has given us much, this wee black slug, but Roy Sawyer is convinced it has more. “Secretions from bloodsucking animals,” he told a reporter, “could be to cardiovascular diseases what penicillin was to infectious disease in the past.” He listed the possibilities, and his belief was as high as the rain forest. “Blood clotting, digestion, connective tissue, disease, pain, inhibition of enzymes, anti-inflammation. You name it, the leech has it.”81

  Janet Vaughan on a medical mission, India, 1950

  THREE

  JANET AND PERCY

  She was a name on a plaque and a face on a wall. I ate beneath her portrait for three years and gave it little attention except to notice that the artist had made her look square. There were other portraits of women to hold my attention on the walls of Somerville, my Oxford college: Indira Gandhi, who left without a degree, and Dorothy Hodgkin, a Nobel Prize winner in chemistry. Vera Brittain, Iris Murdoch, Dorothy L. Sayers. In a room where we had our French-language classes, behind glass that was rumored to be bulletproof, there was also a bust of Margaret Thatcher, a former chemistry undergraduate. Somerville was one of only two women’s colleges at the University of Oxford while I was there, from 1988 to 1992, and the walls were crowded with strong, notable women. (The college now admits men.)

  The plaque was on the exterior wall of my first-year student residence, a building named after Dame Janet Maria Vaughan, the woman in the portrait and principal of Somerville between 1945 and 1967.1 She was alive when I was an undergraduate and, according to obituaries, was known for always dressing in tweeds and for going to the Bodleian Library even in her late eighties, inadvertently annoying other readers when her hearing aid hummed and whistled. (She turned it off when asked.) But when I arrived at Somerville and was assigned a room in Vaughan, I thought only with some relief that everyone would finally be able to spell my Welsh third name—Vaughan, too—that is usually a puzzle even to English speakers. The name did not make me think back to the three surgical procedures I have had, or to my birth, where bags of someone’s blood may have hung from hooks to help or save me. I did not look up from my dinner plate at Janet Vaughan’s portrait and thank her for her role in helping to make blood transfusion standard medical practice. I should have.

  * * *

  In any developed country with good health care and blood to give, someone receives blood every two seconds, more or less.2 This is an American figure, but it can be applied widely. Yet the system of widespread donation of blood by anonymous volunteers, and its transfusion into people who need it, dates back not even a century. In England, where I live, the National Health Service Blood and Transplant (NHSBT) began as the Blood Transfusion Service in 1946; the National Health Service was founded only two years later.3 Last year NHSBT collected nearly 2 million units of blood; in the United States, where 36,000 units of red blood cells are used daily, the figure is 13.6 million.4 Globally, 112.5 million donations of blood are made annually.5 But in 1920s Oxford, when Janet Vaughan was a medical sciences undergraduate at Somerville, the mass donation, storage, and delivery of blood was unthinkable.

  Vaughan was born to privilege and story. She was descended from a noble line of physicians: William Vaughan ministered to William and Mary of Orange; Henry Halford Vaughan was physician-in-ordinary to Georges III and IV, and to William IV and Queen Victoria. Vaughan’s grandmother Adeline Maria Jackson was “one of the seven famous Pattle sisters, famous for their great beauty and for the wild ways of their father James Pattle of the Bengal Civil Service, ‘the biggest liar in India.’” Even when he had drunk himself to death, Pattle was trouble. His corpse, due to be transported to England in a barrel of rum—not an outlandish storage device, given its preservative properties—exploded during the night while stored outside his widow’s room. “There was a loud explosion,” wrote Vaughan in an unpublished autobiography titled “Jogging Along,” “[and] she rushed out and found Pattle her husband menacing her in death as he had menaced her in life.”6

  Janet’s mother, Madge Symonds, was also a beauty. She had grown up the daughter of John Addington Symonds, a poet and Renaissance scholar who spent much of his married life exploring homosexual relationships. Accounts of his life sound suitably glamorous—houses in Perugia, Venice, and Davos—but I guess that behind that glitter was distress for his wife and daughters, obliged to tolerate his affairs with young men. When Madge married William Wyamar Vaughan, she exchanged the dazzle for a suburban house in Bristol, where Janet was born, then headmaster’s residences at Giggleswick, Wellington College, and Rugby. She was, wrote her daughter, “a caged butterfly or hummingbird,” and the cage was her life as a headmaster’s wife. At Wellington, she made sure to eat chicken of
f the bone with her fingers to shock the butler. She must have got out sometimes, enough to make great friends with her husband’s cousin Virginia Woolf. Madge is Sally Seton in Mrs. Dalloway, who “sat on the floor with her arms around her knees, smoking a cigarette. […] It was an extraordinary beauty of the kind she most admired … a sort of abandonment, as if she could say anything, do anything.”7 (Bloomsbury enthusiasts think Madge was Virginia’s first love.)

  The Vaughans were connected but not wealthy. Janet was given an indifferent education by governess, while her two brothers were sent to good schools. At fifteen, she was enrolled at a school where the headmistress believed in training girls only to be well-read wives. She thought Janet “too stupid to be educated.” She was almost too dead to be educated: it was the First World War, the school was evacuated to “four empty houses at Great Malvern,” and she came close to dying of pneumonia. Of the war, she remembered cold and never-satisfied hunger, both at home and at school. Even so, she ignored her head teacher’s dismissal of her brain and read voraciously. She took the entrance exam for Oxford, a test known formally as responsions and informally as the Smalls (at Cambridge it was the Little-Go),8 and failed twice. Just before her third little go, her mother booked them both in at the Mitre hotel in Oxford “and firmly ordered a bottle of claret every evening.”9 She passed, and was accepted at Somerville College, one of four women’s colleges at Oxford, to study medical sciences.

  Janet arrived at Somerville in January 1919 with nothing more than “a little ladylike botany.”10 For her first year, she wasn’t a proper Oxford student: until 1920, the university allowed women only to study, not graduate.11 Janet found physics a mystery; she had never heard of acid and alkali. “I was a public danger,” she told the journalist Polly Toynbee, when she was interviewed as one of six women featured in the BBC series Women of Our Century. “[I was] … in the lab handling phosphorus and I knew nothing about it at all.”12 She learned fast. When her exam results landed on the mat at home in Rugby, Janet was even more surprised by the first-class degree than her family, who were bewildered by this daughter too stupid to be educated, now with an education pedigree better than anyone else’s, and one that hardly any women had been granted. She was especially surprised because during her final oral examination, the senior examiner shook his head at her, saying, “And to think that a B.A. of Oxford should spell vomiting with two t’s.” (She was probably dyslexic.)