E. W. G. Masterman 
185 
In a certain proportion of cases it is possible to seize the leech. 
With pharyngeal cases this should be the rule and perhaps with throat 
specialists it might also be the case with laryngeal cases. For the 
ordinary surgeon, though it is simple enough to watch the worm through 
laryngoscope mirror, it is very difficult to seize the writhing, slippery 
creature amidst the spasmodic contractions of the larynx and the 
frequent coughing. Spraying with cocaine is a great help, but I must 
admit that in mechanically removing the leech I have several times had 
failures. The second method, which I have never yet known to fail, 
I owe to the suggestion of Dr Mackinnon of Damascus—this is the 
application of a strong solution of cocaine to the parasite. It is not 
enough to spray in cocaine or paint it indiscriminately. For sure 
success a small pledget of cotton-wool, saturated with a 30 °/o cocaine 
solution, should be actually brought in contact with the parasite by 
carefully directed movements guided by the help of the laryngoscopic 
mirror. The strong cocaine solution, if it reaches the surface of the leech 
undiluted always produces in a few minutes— not, in my experience, instan¬ 
taneously—a paralysing effect, causing it to relinquish its hold. My last 
three cases, all treated in this way, were speedily successful. In the case 
of one of these patients the man apparently swallowed the leech for he 
had no more symptoms from a few minutes after treatment; in the second 
case the leech was suddenly coughed into the mouth about five minutes 
after the cocaine application and I removed it from the mouth with my 
finger. The last case was one I found in our Hospital in Jerusalem 
immediately on my return from Safed. The man had for nearly a week 
been ‘spitting blood,’ and when I was called to see him a spittoon full 
of practically pure blood was lying on the locker by his side and every 
few minutes he was adding more: his lips were cyanosed; he was unable 
to speak above a whisper and every few seconds he had a short cough. 
I sprayed cocaine solution upon the fauces and the laryngeal mirror at once 
revealed a lai’ge leech attached close to one of the vocal cords. After 
several vain efforts to seize it with curved forceps I applied cocaine as 
described and then made the man lie prone upon his bed with his head 
hanging over the edge. After a few minutes he coughed up the leech on 
to the floor. I have heard it stated that there is a danger that the parasite 
on leaving its hold may fall downwards and lodge on one of the bronchi, 
then die and set up septic changes. I have never seen such a case, but 
such a danger is doubtless obviated by making the patient assume the 
position I have described when the cocaine is commencing to have its 
effect. 
