Maggot Therapy

(This 764th Buffalo Sunday News column was first published on November 20, 2005.)

During World War I two soldiers lay seriously injured and isolated on a battlefield for a full week. Their injuries included compound thighbone fractures and various lacerations of the stomach and scrotum. Finally they were brought to the aid station of Dr. William Baer, who found them, despite their having suffered terribly without food or water, remarkably free from fever or blood infections.

What he did find when he removed their clothes, however, were wounds covered with "thousands and thousands" of maggots. Cleansed of those maggots, Baer reported the wounds "as well as the surrounding parts...entirely covered with most beautiful pink granulation [healthy] tissue that one could imagine." The two patients recovered rapidly at a time when over 75% of those suffering compound femur fractures were dying.

Dr. Baer was sold on the role of the maggots by his experience. After the war at Baltimore Children's Hospital, he successfully used them to treat four children with intractable bone infections. In doing so he became the founder of modern maggot therapy -- also known as larval therapy or, together with leeches, biotherapy, probably to avoid the use of those off-putting names. When several of his later patients who were also treated with untreated maggots developed tetanus, Baer also first proposed the use of sterilized maggots.

Maggots are the wormlike larvae of various flies, those same insects that as adults spread contamination to our food. But maggots are different. They feed strictly on unhealthy, abnormal or malignant tissue, in the process allowing healthy tissue to thrive.

Dr. Baer was not the first to notice and even use maggots in treating wounds. Some primitive societies in Australia and Burma apply maggots for this purpose and their effect was observed during the Napoleonic Wars and our Civil War. Lacking medical supplies a Confederate surgeon, J. Zacharias, used them to treat gangrene. He wrote that they "saved many lives" and that his patients "had rapid recoveries."

A Greenbottle Fly, a maggot parent

But in the 1940s maggot therapy was largely replaced by sulfa drugs, penicillin and other antibiotics. Nevertheless, maggots were still around during World War II serving the military. Here, for example, is a report by Dr. Carmen Romero about soldiers returned to the States in body casts: "You take that cast off, and you would see a lot of maggots. But those maggots had cleaned the wound because they ate all the blood and pus."

Slowly, however, led by physicians like Dr. Ronald Sherman of the University of California, the use of maggots has become another tool in the surgeon's equipment. Here, for example, is a brief summary of a case study reported by British Vascular Nurse Debbie Ruff and Nursing Lecturer Melanie Stevens:

A 70-year old diabetic woman with a severe foot ulcer caused by an ill-fitting shoe entered the hospital suffering from a great deal of pain. This kind of problem leads to amputation in as many as half the cases reported. But this woman presented other problems including severe heart disease which precluded surgery.

When it was decided to go ahead with maggot therapy, not only the patient but the ward staff resisted. After some discussion, however, the woman and her nurses agreed to the treatment. Sterile maggots were ordered from the LarvE Biosurgical Research Unit and carefully applied to the wound.

Two days after the initial application it was found that many of the maggots had escaped but that the wound showed some improvement. Later dressings were modified to prevent further loss of maggots and the treatment was continued. After four further maggot applications the wound showed "dramatic improvement" and the treatment was ended.

Within a month not only the patient's foot but her general condition and appetite had improved so much that she was discharged. She returned to the hospital weekly for further assessments until after twelve weeks her foot had completely healed.

Until very recently maggot therapy was only used in experimental settings, but in January 2004, the U.S. Food and Drug Administration issued an order allowing the production and distribution of "Medical Maggots" as a physician's device.

Here then is an important therapy that should be considered despite both patients' and health care workers' natural revulsion.-- Gerry Rising