i88o 



DISEASES OF THE RESPIRATORY ORGANS 



HIRUDINIASIS. 



Definition. — Hirudiniasis is the invasion of the nose, mouth, 

 pharynx, or larynx by leeches. 



Remarks. — -Leeches have already been described in Chapter 

 XXVII. (p. 683) , when it was mentioned that they were apt to invade 

 the nose, mouth, pharynx, or larynx. Masterman has given a very 

 excellent account of hirudiniasis as seen in Palestine. 



Climatology. — Leeches are most troublesome in Algeria, Palestine, 

 and Ceylon, less so in the Philippine Islands, Java, Sumatra, 

 Australia, and Japan. 



iEtiology. — It is the water-leech, which lives in springs, which is 

 the cause of the trouble to man, as it is apt to be swallowed with 

 drinking-water. This is particularly liable to take place when the 

 traveller drinks the water hastily at dusk. 



Pathology. — The leech, when in the mouth, nose, pharynx, or 

 larynx, does not suck blood until gorged, and then detaches itself 

 from the affected part, as is the rule when it attacks the skin, but 

 apparently bites and sucks a little in one place, and then passes to 

 another, and bites and sucks again, and so on. Of course the sites 

 of the bites bleed, and hence the patient may in course of time 

 become very anaemic, and even die. It is hardly likely that a leech 

 could live in the stomach if swallowed, though such an occurrence 

 has been described. 



Symptomatology. — The patient usually knows that he has 

 swallowed a leech, and has felt the animal catch hold of the mucosa 

 of the pharynx during the swallowing of the water. But children, 

 and even adults, may be quite unaware of the accident having 

 happened. The most important sign is the bleeding from the nose 

 or mouth, or the hawking up of blood from the pharynx, or 

 haemoptysis from the larynx, accompanied by a short irritating 

 cough, dyspnoea, and sometimes cyanosis from the impediment to 

 the respiration. Rhinoscopic or laryngoscopic examination may 

 be necessary in order to see the parasite, and will require to be done 

 with cocaine. In the larynx the head of the leech is usually fixed 

 just inside or outside of the vocal cords, and the body may flop 

 backwards and forwards with respiration. 



Diagnosis. — The bleeding and the examination with a nasal 

 speculum or a laryngoscope make the diagnosis easy. 



Prognosis. — ^This is usually good if the parasite is removed in 

 time, but if left for long, removal may be too late, and the patient 

 succumb. 



Treatment.— Apply a pledget of cotton-wool soaked in 30 per 

 cent, solution of cocaine to the parasite. This produces a paralyzing 

 effect on the animal, and it can then be removed. As, however, the 

 drug requires some time to act, and the leech might fall from the 

 larynx into the trachea, it is advisable to make the patient lie 

 prone on a couch, with the head hanging over, when the paralyzed 

 parasite will be coughed up. 



