E. W. G. Masterman 
183 
(during deglutition) when the leech seizes on the throat. One would 
suppose from the great frequency of leeches in the mouths of horses, 
etc., that they must sometimes find a temporary resting place there 
in the human subject; such cases do not however come into the 
hands of a medical man—the patient or his friends readily removes such 
an intruder. In the cases, some three dozen or so, which I have had 
under my own observation the leech has been attached to the epiglottis, 
the pharynx, the nasal cavities, or—most common of all—the larynx. 
The frequency of the last situation in my clinical experience is doubt¬ 
less due to the inability of th e fellahin to do anything themselves for the 
relief of such cases. 
The characteristic symptom produced by Hirudinea is the occuiTence 
of constant small haemorrhages from the mouth or nose. Last summer 
in Safed I had a baby of about seven months brought to me with a 
history of almost continuous slight epistaxis from the left nostril of a 
week’s duration. The child had been brought a considerable distance 
for treatment. On examining the nostril I noticed something blackish 
a little way up, and introducing a pair of fine sinus forceps I had the 
satisfaction of drawing out a slender leech about 1J? ins. long. The 
symptoms were at once relieved. The first case I had, on September 16, 
1893, also at Safed, was remai’kable. The patient, a girl of 12, came 
complaining of constant small haemorrhages from the mouth for three 
days; there was no dyspnoea nor aphonia. I put my right index finger 
well to the back of the tongue to see if I could feel anything abnormal 
in the neighbourhood of the epiglottis, and when I drew it forth was 
astonished to find a small leech looped up upon my finger-nail. These 
are mild cases. When the leech lies deeper the symptoms are much more 
distressing. The haemorrhage, though never great in quantity at any 
one time, may, when prolonged, be very serious and even fatal. I know 
of two cases where the patient actually died from this. One, which 
occurred shortly before I came to Palestine, was narrated to me by 
Dr Torrance of Tiberias. The man came under medical treatment 
already reduced to extreme anaemia by prolonged haemorrhage ; all 
efforts failed to reach the leech and it was only after complete eversion 
of the patient that it was at last extruded, but the patient never 
recovered the loss of blood. The second case is that of a young fellah 
girl who was brought to Safed last summer for the removal of a leech 
which she had harboured in her throat for some weeks. She just 
reached Safed before she died as a result of anaemia. 
The haemorrhagic discharge is pure blood, bright in colour and, 
12—2 
