MODIFICATION OF THE ARTIFICIAL LEECH. 
By FRANCIS B. LORING, M.tf, Washington D. C, 
Instructor of Ophthalmology and Otology in National Medical College, Sur- 
geon-in-Charge Washington Eye and Ear Infirmary, one of the 
Consulting Ophthalmic and Aural Surgeons to the-P«*«eton Q 
Hospital, etc., etc. 
THE principal faults in the cutting apparatus of the 
leech introduced by Baron Heurteloup, are due to 
the facts that the “ drill,” being worked by a lateral motion, 
is apt to produce a rough and uneven incision, often leading 
to a subsequent scar, and that after a short period of use 
the set-screw, regulating the extent of the knife exposed 
(and the consequent depth of the incision), is apt to become 
so worn that it is no longer safe to apply the motion di- 
rectly with the fingers—discarding the string entirely, as 1 
have been accustomed to, in cases where I was particularly 
anxious to avoid permanent scars. So frequently, however, 
has this occurred, even with the greatest care, that I have 
for the last few years adopted the plan of first having a na- 
tural leech applied and then putting the cylinder directly 
over the recent bite. This, however, is not always conven- 
ient, and is sometimes objected to by the patient, so that 
I venture to hope that the instrument now described will 
prove useful, particularly in those places where leeches are 
not always attainable. The first change necessary was to 
reduce the lateral motion of the string or cord to a vertical 
one, and this was accomplished by fixing the drill in a cylin- 
der, the motion to which was given by two lateral pistons, 
joined at their extremities to a disk of the same diameter 
as the enclosing cylinder. A perforation was then made 
* Read before Med. Society, Dist. Columbia, Oct., 1879. 2 
Francis B. Loring. 
through the centre of the disk, in which was ground 
a female screw, and through this the drill, armed with a 
spiral screw, was led, so that the revolution was made in 
very much the same manner as the instrument now shown 
in the shops, by simply moving the piston, as in the com- 
mon syringe. The amount of knife exposed is regulated, 
not by a set-screw, but by a sheath that screws over 
the cutting-edge of the drill, and is an inch in length, 
so that it cannot yield to any force of pressure that can be 
applied to it. This sheath is the same as that in the other 
instrument, with the exception that instead of being bevel- 
led at the extremity it is perfectly even, and is armed with 
a circle of thick plate glass. This glass is of the same 
diameter as that of the exhausting cylinder, and serves two 
purposes : First, in the original Heurteloup the extremity 
is of brass, and naturally obscures most of the tissues 
from the eye of the operator, while they are now directly 
in sight, even to the edge of the drill; in the second place, 
on removing the instrument from the temple, the incision is. 
found to be directly in the centre of a ring formed by the 
pressure of the glass against the skin, so that the air-tight 
exhausting cylinder has to be placed against the outer circle, 
which it exactly fits, to ensure a rapid and speedy flow of 
blood. For any one that has been in the habit of using the 
instrument, must have been troubled by the difficulty of 
having a deep incision strangulated by the drawing in and 
compression of the tissues, particularly when in a flabby and 
relaxed condition, and this difficulty I have always found to 
be increased when the incision was not directly in the cen- 
tre, from the pressure of the wound against the walls of the 
glass cylinder. As the end of the piston with its washers 
fills the mouth of the receiver when it is first applied to the 
temple, it is often most difficult to place it directly over the 
centre of the incision, and the circle from the pressure of 
the glass is therefore a most valuable and reliable guide. 
By a very simple mechanism the glass disk may be unscrew- 
ed, and various sizes corresponding to different cylinders 
easily fitted. I have now had the instrument in use for 
some little time, both in private practice and in the hospi- Modification of the Artificial Leech. 
3 
tals, and I find that patients complain but very slightly of 
the pain of its application, and that in no case has a scar 
resulted. This is due, doubtless, to the fact that the incision 
produced is clear and even, there being no lateral traction 
with a plowing up of the tissues on one side, and that the 
cut being directly in the centre, the blood flowed from the 
entire circle, so that one part of it was not more elevated 
than the other by the force of the vacuum. I am in the 
habit of allowing the blood to follow the washer very 
closely, and to regulate its flow by the depth of the incision, 
and not by increased suction. The wound is dressed with 
vaseline or simple cerate, and a piece of plaster applied 
some few hours after the removal of the cylinder. 
The instrument weighs but three ounces, and is contained 
in a case measuring six inches by three ; it cannot easily 
get out of order, and is but slightly more expensive than 
the original design. It can be obtained from Shepard & 
Dudley, 150 William Street, New York. Price of the Leech 
$9.00; price of the Leech with cylinders in case $15.00.