trying to remove a leech Afghan lad of fourteen.

from tlie pharynx of an I told him to carry on while I attended to some other work and present' ly he reported that the leech had gone down into the boy's larynx. With direct sunlight and a laryngoscopic mirror I could see the leech very clearly lying on the ventricular band on the right side. From time to time the patient was seized with paroxysms of coughing and

dyspnoea. I was much puzzled as to the proper treatment of this case. I had no laryngeal forceps, the only instrument with which I could possibly reach and remove the leech being a pair of curved phimosis forceps. I was afraid that an attempt with this instrument would not only fail but might cause the leech to slip into the trachea. I ordered tracheotomy instruments to be sterilised and then

SOME CASES OF LEECH IN THE AIR PASSAGES. By \V.

E.

SC0TT-M0NCR1EFF, MAJOR, I.M.S.,

Pancfimar,

One

day

dispensary

last year on arriving at tlie Panchmar I found 'the Sub-Assistant Surgeon

the patient and his elder brother said they wished to go if I could not remove the leech. Fearing that an unsuccessful attempt with the phimosis forceps would frighten them away across the border the patient with the leech perhaps in his trachea I decided on radical measures. Under chloroform I opened the trachea and prolonged the wound upwards till I had divided the cricoid and the lower part of the thyroid cartilage. Now the leech could be seen projecting from time to time beyond to right vocal cord. I had no difficulty in removing it with a pair of sharp-pointed forceps. The wound was carefully sutured and the patient was soon discharged none the worse of his adventure,

466

THE INDIAN MEDICAL GAZETTE.

two patients at the three with a leech in the nose, the other a lad of about fourteen with, the Sub-Assistant Surgeon said, a leech in his

A few

days ago I found dispensary; one a child of larynx.

For the first case I ordered some tobacco infusion to be made having recently been told by a Civilian that in the Andamans this treatment is employed with invariable success. In the meantime I tried unsuccessfully to see and remove the leech under chloroform. As the child was coming round the leech appeared at the anterior nares and was easily removed. In the second case with the laryngoscope I could see the leech clearly attached to the posterior surface of the epiglottis. Fortunately the lad's throat was not irritable and he showed it very well. This time the phimosis forceps proved useful, and I removed the leech at the first at-

tempt. In this

of the

country leeches are not great difficulty in getting therapeutic use. I would be glad to part

common; I have had

for know what treatment is followed in countries where a leech in the nose or throat may be a more common occurrence than it is in NorthWest India. some

[Dec.,

1911.

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