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Ingestion lasts 25 min in Hirudo medicinalis and is characterized by pharyngeal peristalsis which fills the crop. This peristalsis has an initial rate of 2.4 Hz which decays smoothly to 1.2 Hz at termination of ingestion. During ingestion, the leech body wall undergoes peristalsis which appears to aid in filling the crop diverticula. Body peristalsis begins at a rate of 10 min-1 and decreases linearly to 2 min-1 at termination. The body also undergoes dorsoventral flexions when blood flow is occluded. Blood meal size increases slightly with leech size: 8.4 g for 1-g leeches and 9.7 g for 2-g leeches. However, relative meal size decreases markedly with increasing animal size; from 8.15 times body mass for 1-g to 4.80 times for 2-g leeches. When intact leeches were exposed to micromolar concentrations of serotonin, there was an increase in the rate of pharyngeal peristalsis and the size of the blood meals. Leeches excrete the plasma from their ingested blood meals. Excretion is activated during ingestion, which increases feeding efficiency by increasing the proportion of blood cells in the ingestate. Excretion continues for 4–6 days following ingestion, removing all the remaining plasma from the ingestate. Leech ingestion comprises stereotyped muscular movements, secretion of saliva and excretion of plasma. A strikingly similar feeding physiology is seen in the blood-sucking insect Rhodnius, and we suggest that efficient sanguivory may require the convergent evolution of similar ingestive mechanisms.