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surgeon the leech crawled right into the nose ; it was impossible to 

 extract the leech or to kill it, and it produced a severe haemorrhage 

 which led to the death of the patient within two days. In a case recorded 

 by Sinclair, 1 a leech, Hcvmopsis sanguisuga, gained access to the nose 

 of a boy, aged 3 ; it remained there a fortnight ; it caused frequent 

 attacks of epistaxis and in the end it was removed by means of 

 forceps. Condorelli-Francaviglia 2 records a case in which severe 

 epistaxis was caused by a leech which had probably entered the 

 anterior portion of the left nostril by way of the pharynx and become 

 tightly fixed there. It was seen by posterior rhinoscopy, and 

 was removed from in front by means of slightly curved forceps. 

 Sota y Lastra 3 mentions the occurrence of leeches in the nose, and 

 Keng 4 reports the case of nasal obstruction from a leech. The 

 removal of leeches is effected by means of injections or by the direct 

 sprinkling of salt or acid solutions on their bodies, which brings about 

 their detachment. When possible a previous attempt should be made 

 to seize them with forceps so as to make their immediate extraction 

 possible. The species of Haemadipsa (Looss 5 ) live in tropical regions 

 in moist places on the ground or in the jungle. They climb bushes 

 and even trees with astonishing rapidity upon the approach of larger 

 animals and also of man (whom they clearly recognize from the 

 vibration of the ground caused by footsteps). From thence they let 

 themselves fall on their victims to suck their blood. Their bites are 

 generally painless, and of themselves not dangerous, but if they are 

 unusually numerous they rapidly accumulate on the body in large 

 numbers and give rise to marked debility and, if the wound become 

 infected, to severe complications and even death. On the other hand, 

 under careful treatment the wounds heal easily and fairly rapidly. 



Firm leather and firmly adhering clothes afford no certain pro- 

 tection against the attacks of these leeches, as they know how to 

 force themselves with extraordinary rapidity through the narrowest 

 interstices between the clothes and thus gain access to the skin. 

 When they have sucked their fill and this may take several hours to 

 accomplish they fall off of themselves. To effect an earlier removal 

 drops of irritative or corrosive fluids are employed (salt solutions, 

 acids, etc.). Tearing away the leech by force should be avoided, 

 as in this way portions of the leech's body may be left behind in the 

 wound and inflammation be set up. 



1 Sinclair, Brit. Med. fourn., June 20, 1885, i. 

 ' 2 Condorelli-Francaviglia, Spallangini, 1892. 

 8 Sota y Lastra, Rev. med. de Sevilla, 1887. 



4 Keng, Scot. Med. and Surg. Journ., October, 1899. 



5 Looss, " Handb. d. Tropenkrankh.," v. Mense, i, p. 194. 



