318 LEECHES 



The blood flows out of the nose or into the throat or trachea, in 

 the latter cases being constantly " hawked " up. Masterman 

 describes the case of a man in Palestine, attacked by leeches, who 

 for nearly a week had been " spitting blood " and had a spittoon 

 full of practically pure blood by his side, every few minutes adding 

 more. His lips were blue, and he was unable to speak above 

 a whisper. Every few minutes he had a short cough. Often 

 when the leech is attached in the larynx beside the vocal cords, 

 the body flops back and forth during breathing, and has been 

 known to cause asphyxiation by blocking the trachea. Cases are 

 on record where leeches, having fallen into one of the bronchi, 

 have died and disintegrated, and thus caused destructive bac- 

 terial infections to set in. The presence of leeches in the mucous 

 membranes is often accompanied by severe headaches. Some- 

 times leeches which have settled in the nose have the revolting 

 habit of protruding themselves from the nostrils and allowing a 

 portion of the body to wander over the upper lip. They are, 

 however, so elusive that they can be captured only with great 

 difficulty. 



The treatment employed for leech infestations of the nose 

 or mouth varies greatly in different countries. According to 

 Masterman the natives of Palestine transfix the leech, if within 

 reach, with a thorn from a native tree, and muleteers extract 

 leeches from mules' mouths with packing needles. When the 

 parasite is beyond reach of this transfixing process these people 

 smear some of the thick deposit which collects in their tobacco 

 pipes on a splinter of wood and endeavor to touch the leech with 

 it; this is said to cause the leech to lose its hold. Masterman 

 found the most successful means of removing a leech to be either 

 to seize it with a suitable forceps, or to paralyze it with cocaine. 

 Much difficulty is often experienced in seizing the writhing, 

 slippery creature with a pair of forceps even when it can be seen 

 clearly with a mouth mirror, partly on account of the spasmodic 

 contractions of the larynx and the frequent coughing. The 

 paralyzing of the worms with cocaine is a very successful method; 

 it is done by touching the worm with a 30 per cent cocaine solu- 

 tion on a bit of cotton. The worm becomes paralyzed in a few 

 minutes after being touched, and releases its hold. To avoid 

 the possibility of the leech falling into the trachea the patient is 

 made to lie on a couch with his head hanging over the edge. 



