Maggot Therapy
Maggot therapy, also known as maggot debridement therapy, is an ancient medical practice that involves using sterile fly larvae to clean wounds by consuming dead tissue. This method dates back centuries, with notable use among the Mayans and battlefield doctors during the Napoleonic Wars and the American Civil War, where it was observed that wounds treated with maggots healed faster, resulting in fewer amputations and higher survival rates. Although largely replaced by antibiotics in the mid-20th century, the rise of antibiotic-resistant bacteria has prompted a resurgence in the use of maggot therapy as a viable treatment option for difficult wounds, ulcers, and burns.
During the therapy, sterilized larvae are placed on the wound, where they consume necrotic tissue and secrete enzymes that help eliminate bacteria, promoting healthy tissue growth. The treatment typically lasts around two days and can be repeated multiple times in a month. While maggot therapy is more affordable than many modern treatments, it can be uncomfortable for patients, and issues such as dislodging bandages or larvae migrating from the wound are considerations. Despite these challenges, the U.S. Food and Drug Administration has approved maggots for specific types of wounds, and tens of thousands of treatments are administered worldwide each year, highlighting a growing interest in this unique biotherapy.
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Maggot Therapy
The science—and the logic—behind maggot therapy is basic. Fly larvae, or maggots, eat dead tissue. Dead tissue prevents the proper healing of a wound. For centuries, before the widespread use of antibiotics, doctors treated difficult open wounds, ulcers, and even burns with medical-grade sterile live fly larvae that would feed on the bacteria in the dead or decomposing organic matter around the wound, thus cleaning it. The advent of antibiotics made the practice obsolete. However, bacteria have became more tolerant of antibiotics in recent years, and doctors have begun reintroducing this ancient biotherapy. Although maggot therapy does not cure anything, the maggots remove (or debride) dead tissue, and, as a result of the alkaline enzymes they secrete while ingesting the dead tissue, they actually kill bacteria. This encourages new blood vessel development and ultimately healthy new tissue growth.
Overview
Maggot debridement therapy dates back centuries; the Mayas were among the earliest practitioners. The practice was widespread among battlefield doctors during the Napoleonic Wars and the American Civil War, where, given limited availability of medical attention, combat wounds were often infested with maggots. Doctors noticed, however, that such wounds tended to heal quicker and that patients faced fewer amputations and had higher survival rates than those whose wounds were not infested with maggots. Before World War II and the advent of antibiotics, most prominently penicillin, research supported using maggots for successful short-term treatment of special-grade infected wounds. The sterilized larvae of green bottle flies, or blowflies, were introduced to a cleaned open wound. Most often dozens of living maggots, each roughly two millimeters long, would be placed in an aerated container above the wound, with the wound itself serving as the bottom. The wound would then be secured to the box with a bandage. Most often, the therapy lasted for two days. Often the patient was immobilized for short periods of time as the biting and sucking of the maggots' hook-like mouths created discomfort and, as the maggots swelled in size engorging on the dead tissue, the biting would hurt as they would inadvertently cut into healthy nerve endings. The maggots would be removed after the treatment and destroyed. The treatment could be repeated up to ten times in a single month.
Given the evolution of bacterial resistance to postwar antibiotics, researchers in the 1990s took a new look at larvae therapy. Although far less expensive than high-tech methodologies, maggot therapy posed problems: patients often find the treatment uncomfortable and maggots can displace the wound dressing and migrate. In 2013, the therapy’s reliability remained unconfirmed by scientists. In 2004, however, the US Food and Drug Administration approved marketing of maggots specifically for limited types of ulcers and for traumatic or postsurgical wounds. Any doctor can prescribe the treatment; estimates by the Centers for Disease Control and Prevention suggest that tens of thousands of treatments are administered worldwide annually.
Bibliography
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Fleischmann, Wim, Martin Grassberger, and Ronald Sherman. Maggot Therapy: A Handbook of Maggot-Assisted Wound Healing. New York: Thieme, 2004. Print.
Grassberger, Martin, Ronald Sherman, Olga S. Gileva, and Christopher M. H. Kim. Biotherapy: History, Principles, and Practice. New York: Springer, 2013. Print.
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Rubin, Rita. “Maggots and Leeches: Good Medicine.” USA Today. USA Today, 7 July 2004. Web. 31 July 2013.
Schroeder-Lein, Glenna R. The Encyclopedia of Civil War Medicine. Armonk: Sharpe, 2008. Print.
Sherman, Ronald. “Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century.” Journal of Diabetes Science and Technology 3.2 (2009): 336–44. Print.
Sherman, Ronald, M. Hall, and J. R. Thomas. “Medicinal Maggots: An Ancient Remedy for Some Contemporary Afflictions.” Annual Review of Entomology 45 (2000): 55–81. Print.