The Minor Horrors of War

by Sir A. E. Shipley

This particular leech is swallowed by man, by domestic cattle, and doubtlessly by wild animals, with their drinking-water. Amongst the medical writers of the Eastern world in classical times who mention leeches there was always, as there was amongst the authors of the Talmud, a great and haunting fear of leeches being swallowed, and these writers mostly wrote from the area where Limnatis nilotica still abounds.

According to Masterman, who has had, as a medical officer in Palestine, a first-hand opportunity of studying this leech, the pest attaches itself to the mouth or throat or larynx during the process of swallowing, and he is convinced that if it be once really swallowed and reaches the stomach it is killed and digested.

Limnatis nilotica, unlike Hirudo medicinalis the medicinal leech, is unable to bite through the outer integument of man and is only able to feed when it has access to the softer mucous membrane of the mouth or of the pharynx or of the larynx, and of the other thinner and more vascular internal mucous linings.

In Palestine these pests are particularly common in the region of Galilee and in the district of Lebanon. They are, in these and other districts, so plentiful in the autumn that almost every mule and almost every horse the tourist comes across is bleeding from its mouth or from its nose, for this species of leech is by no means only a human parasite. The natives, who know quite a lot about these pests, generally strain them out of their drinking-water by running the water through a piece of muslin or some such sieve when they fill their pitchers at the common well. In certain districts these leeches in the local pools or reservoirs are kept in check by a fish—a species of carp (Capöeta fratercula).

In the cases which recently came under Mr. Masterman’s observation, the leeches were attached to the epiglottis, the nasal cavities, and perhaps most commonly of all to the larynx of their host. When they have been attached to the anterior part of the mouth, or any other easily accessible position, their host or their host’s friends naturally remove them, and such cases do not come to the hospital for treatment.

The effect of the presence of this leech (L. nilotica) on the human being is to produce constant small haemorrhages from the mouth or nose. This haemorrhage, when the leech is ensconced far within the buccal, the nasal, or the pharyngeal passages of the host, may be prolonged, serious, and even fatal. Masterman records two cases under his own observation which ended in death: one of a man and the other of a young girl, both of whom died of anaemia produced by these leeches.

The average patients certainly suffer. They show marked distress, usually accompanied by a complete or partial loss of voice; but all the symptoms disappear, and at once, on the removal of the semi-parasite. Sometimes the leeches are attached so closely to the vocal cords that their bodies flop in and out of the vocal aperture with each act of expiration and inspiration. The hosts of leeches so situated usually suffer from dyspnoea, and at times were hardly able to breathe.

The native treatment is to remove the leech, when accessible, by transfixing it with a sharp thorn; or they dislodge it by touching it with the so-called ‘nicotine’ which accumulates in tobacco-pipes. But nicotine is destroyed at the temperature of a lighted pipe, so whatever the really efficient juice is, it is not nicotine. Still, as long as the fluid proves efficient, the native is hardly likely to worry about its chemical composition.

Masterman says that the two means he has found most effective were: (1) Seizing the leech, when accessible, with suitable forceps; or (2) paralysing the leech with cocaine. In the former case the surgeon is materially assisted by spraying the leech with cocaine, which partially paralyses it and puts it out of action. In the latter case, if the spraying of cocaine is not sufficient, Masterman recommends the application of a small piece of cotton-wool dipped in 30 per cent. cocaine solution, which must be brought into actual contact with the leech’s body. The effect of the cocaine in contact with the skin of the leech is to paralyse it and to cause it at once to relax its hold. In such a case the leech is occasionally swallowed, but it is more often coughed up and out. Headaches and a tendency to vomit are symptoms associated with the presence of this creature in the human body; the removal of the leech or leeches coincides with the cessation of these symptoms.