- Maggots have been used in medicine throughout history
- Their use declined with the invention of penicillin
- Some doctors are returning to them as antibiotic resistance increases
As a surgical resident, I spent several months working in the local wound clinic. One day, a 60-year-old old man named John arrived, several weeks after undergoing a cardiac bypass. The surgeon had harvested a large vein from his leg for the operation.
I entered the exam room. John's left leg was elevated on the exam table, exposing an open wound.
"Something's wrong with my leg, doc."
I stepped closer. Dozens of small white larvae wiggled and squirmed in his open flesh.
Maggots! Not good.
Or are they?
The use of medicinal maggots, sometimes called maggot debridement therapy, was first widely reported during the time of Napoleon. His general surgeon reportedly used maggots as a technique of cleaning soldiers' battlefield wounds. Maggot therapy was also a common practice during the Civil War and World War I.
Scientific studies on medicinal maggot use began in the 1920s. These studies revealed that maggots helped clean dirty and necrotic wounds by feeding on the dead tissue while leaving the healthy tissue unaffected.
During the 1930s, thousands of surgeons used maggots to effectively treat chronic or infected wounds such as abscesses, burns and even bone infections.
The use of maggots sharply declined in the 1940s with the introduction of penicillin. Doctors and patients could now replace the unpleasant creepy-crawlies with a simple medication.
However, with the advent of antibiotic-resistant bacteria, many physicians have returned to maggots as a viable therapeutic option.
In 1989, Dr. Ronald Sherman reintroduced maggot therapy by setting up fly breeding facilities at the Veterans Affairs Medical Center in Long Beach, California. In 2004, the Food and Drug Administration granted clearance for medical firms to market and produce maggots as a medical device.
Studies supporting the use of medicinal maggots have continued through today. Most recently, a study published in the Archives of Dermatology found that maggot therapy was a more effective treatment than conventional surgical debridement during the first week in 119 people with non-healing wounds.
After 15 days, however, the results between the two groups became similar. Strangely, even though the patients were blindfolded for the treatment, both groups reported a crawling sensation in their wounds on the eighth day.
While maggot therapy in a controlled hospital environment can be a useful method of treating difficult wounds, patients should not try this at home. Uncontrolled maggots in large numbers can lead to infestation, infection and other major complications.
In my patient John's case, his wound was briefly improved by the inadvertent home maggot therapy, but he arrived at the hospital just in time to avoid serious problems.
So how did this happen?
John was a widower who lived alone. After being discharged from the hospital, he spent the next week at home, trying to survive the oppressive summer heat by keeping the windows and doors open.
The incision on his leg became infected, causing it to open and drain pus. Alone and recovering from a massive operation, John wasn't able to properly clean it. Pretty soon, he noticed movement in the wound. It was alive.
We dunked John's leg into the whirlpool bathtub. Water swirled into and out of the tunnels in his soft tissue. One by one, the maggots floated to the surface. Afterward, turpentine and povidone-iodine soaked gauze was applied, forcing the larvae from the wound margins.
John's first day in the wound care center corresponded with my last. This was not a good thing. Unbeknownst to me, the nurses had a tradition of throwing residents into the whirlpool on the final day of their rotation.
At the end of my shift, several pairs of hands gripped me from behind. My legs lifted, and for a second I hovered over a large tub of swirling water.
The hands released, dropping me into the whirlpool tub.
The same one used to wash John's leg, just a few hours ago.