SUPPLEMENT 699 



HIRUDINEI (Leeches). 



THE only one of the leeches that comes under consideration from 

 the clinical point of view is Limnatis nilotica (Hcemopsis sanguisuga), 

 which obtains access to the mouth with drinking water, and becomes 

 lodged, even in the case of man, in the pharynx, larynx, trachea, 

 oesophagus and nose. 



Amongst the causes of severe haemorrhage from the pharynx 

 Jurasz 1 mentions the occurrence of leeches in that region : in 

 Northern Europe this must be accounted one of the greatest of rarities, 

 whilst at all times in southern countries, such as South Italy, Spain, 

 Greece, Algiers, Tunis and Egypt, it appears to have been more 

 frequent. Even the physicians of antiquity had much to say about 

 it. Upon the occurrence of blood-stained expectoration, Hippocrates 

 recommends the oral cavity to be examined to see whether a leech 

 is not present in if. Galen speaks of haematemesis due to the presence 

 of leeches in the pharynx and stomach. Similar mention is found 

 in the writings of Celsus,. Asclepiades, Scribonius Largus, Dioscorides, 

 Aetius, Oribasius, Paulus Aegineta and others. In recent times, 

 Cortial 2 has published observations relating to this subject which 

 he had the opportunity of making in Constantine. Palazzolo 3 

 also in Sicily found leeches in two cases in the pharynx, in one case 

 on the posterior wall, in the other in the crypt over the left tonsil. 

 According to Roset, 4 leeches adhere by preference behind the uvula, 

 simulating haematemesis and haemoptysis, and the persistent haemor- 

 rhages they give rise to may lead to severe anaemia. Leeches are found 

 in still greater frequency in the larynx than in the pharyngeal cavity. 

 Huber 5 records several observations of this kind in his historical 

 and therapeutical study. In the case of a man, aged 64, Ramon 

 de la Sota y Lastra 6 observed a leech on the nodulus epiglottidis ; 

 this was removed with the forceps. In the case recorded by 

 Photiades, 7 a leech had remained adherent to the vocal cord for 

 more than twenty-two days. Maissurianz 8 records two such cases : 

 in one the leech had remained in the sinus morgagni for three weeks,, 

 in the other in the same place for ten days. The case recorded by 



1 Jurasz, Heymann's " Handb. d. Laryng. u. Rhinol.," 1899, ii. 



2 Cortial, Union m&L, 1886. 



3 Palazzolo, Bull. del. mat. delf orecchio, etc., 1895. 



4 Roset, Rev. d. Cienc. med. 'de Barcelona, 1907, ii. 



5 Huber, Deulsch." Arch. f. klin. Med., xlvii. 



6 Ramon de la Sota y Lastra, Rev. med. de Sevilla, 1883. 



7 Photiades, Int. Zentralbl. f. Laryng., 1884. 



8 Maissurianz, St. Petersb. med. Wochenschr., 1883. 



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