Medical Maggots Treat As They Eat

Brian Handwerk
National Geographic News
October 24, 2003
The National Geographic Ultimate Explorer television program Creepy Healers airs Sunday, October 26, at 8 p.m. ET/PT on MSNBC.

A few years ago, the Hollywood blockbuster Gladiator had audiences squirming in their seats as the grievous wounds of the film's Roman gladiator protagonist, played by Russell Crowe, were treated (successfully, one might add) by the application of live maggots.

Think it was Tinseltown hyperbole, or perhaps a brief star-turn for an ancient folk remedy? It might be surprising to hear, then, that maggot therapy is enjoying a revival as a modern medical technique—with apparently promising results.

Today doctors use medicinal maggots to clean wounds by dissolving dead tissue and to disinfect them by killing bacteria. These actions stimulate proper healing.

"I call them microsurgeons," said Edgar Maeyens, Jr., a doctor in Coos Bay, Oregon, who employs maggot treatment. "They can do what we can't do with scalpels and lasers."

Only a few species of fly larvae, primarily blowflies, are suitable for such duty. Five to ten maggots are placed on each square centimeter (0.2 square inch) of a wound, which is then covered with a protective dressing that allows the maggots to breath. For the next 48 to 72 hours, the maggots dissolve dead tissue by secreting digestive juices and then ingesting the liquefied tissue and bacteria. The maggots grow from about two millimeters (0.08 inch) to nearly ten millimeters (0.4 inch) while doing the doctor's dirty work.

"I'm just a supporting actor here," Maeyens said. "The maggots are marvelous."

When Other Treatments Fail

Maggot medicine isn't applied to just any case. It's employed on wounds that don't respond to more conventional methods.

"After two or three failures of conventional medical or surgical therapy, maggot therapy should be considered for non-healing wounds, especially those which are infected or contain dead tissue [gangrene]," said Ronald Sherman, a doctor at the department of pathology at the University of California at Irvine.

Wounds commonly treated include foot and leg ulcers, burns, and post-operative wounds that have become infected and re-opened.

There is no shortage of patients eager to give the creatures a try. Suffering the maggots for a few days is small price to treat messy, painful wounds that have lingered for months or even years, doctors say.

"The patients are often more eager to do this than the doctors," Maeyens said. "They're nowhere after several years of treatment. The wounds are chronic. They just don't heal. That's why they send them to us—we're euphemistically referred to as 'the dump.'"

Nature's Course

The maggots perform well because they are doing what comes naturally, experts say.

John Church, an orthopedic surgeon and modern maggot medicine pioneer in the United Kingdom, says picking the right maggot for the job is key.

"Some maggots burrow deep into living flesh, but the ones we use do one thing—recycle organic waste," he said. "In nature they go for naturally decomposing material and not living tissue. They're part of nature's scavenging mechanisms, which we largely take for granted. Nature is in the business of scavenging, and we're just cashing in on that really."

The maggot scavengers compete successfully with bacteria, even with antibiotic resistant strains—as long as the environment is to their liking.

"There is still an art to medicine, and there's very much an art to using maggots," Church said. "You must have a happy, hungry maggot or you will get no results. The environment on the wound must be what they would naturally seek out in nature."

Ticklish Situation

Most patients feel nothing during treatment, but some do feel tickling or itching, like a crawling on the skin.

"A few patients have described discomfort or outright pain once the maggots become large, probably due to them crawling over nerves or squeezing into tight crevices," Sherman said. "Pain is controlled with simple pills, or the maggots can be removed early and the pain disappears immediately."

By the second and third day the wound oozes, becoming a bit sloppy and smelly. However, the process never lasts more than 72 hours.

Other than such minor concerns, the treatment has yet to produce many, if any, serious negative reactions.

Church said he first saw the medical potential of maggots in Central Africa, when some patients brought in from the bush had survived for days without treatment because maggots kept their wounds clean.

But maggot medicine has older roots and its wound-cleansing ability has been noted on battlefields for centuries. In the 1920s and 30s, before the advent of effective antibiotics, maggots were often used. "Military surgeons in the First [World] War saw people come in from no man's land, where they'd been for perhaps days. The ones who were still alive had maggots in their wounds," Church explained. "They hadn't died of gangrene or infection because the maggots in their wounds had mopped up the bacteria."

After World War II, surgical techniques and antibiotics proved highly effective in treating most wounds and skin infections. But increasingly, the medical community has encountered antibiotic-resistant bacterial strains. Re-enter maggot therapy.

Since 1995, the number of practitioners using maggot therapy has increased not only in the U.S. and U.K., but also in Germany, Scandinavia, Ukraine, and the Middle East. Church estimates that there have been at least 25,000 treatments in the U.K. during the last decade.

Yet many medical professionals remain skeptical about maggot medicine, and Ronald Sherman knows there's only one way to get them aboard—show them the scientific data.

"I have spent the past 12 years trying to pool, analyze, and publish that data and to perform the needed clinical trials," he said. "Unfortunately, clinical trials are very expensive. Pharmaceutical companies spend an average of $30 to $50 million dollars [U.S.] for every one drug brought to market. There is little commercial value in the maggots, and not enough financial support to conduct the necessary clinical trials."

The need for more clinical trials gives some in the medical community pause, but it's not a concern for patients who've experienced dramatic benefits from the maggot treatment.

Sherman recalls the case he saw of a woman with perforation of the bowels and an infection that had spread through the abdomen, causing death (gangrene) of her bowel wall and peritoneum. Because it became necessary to remove dead tissue every other day in a risky surgical procedure, the attending physician decided to try the maggots.

"Two thousand of them were sprinkled over her open abdomen, and then covered with a dressing," said Sherman. "Two days later the maggots were washed out, revealing no more gangrene. She healed well, and the abdomen closed, without the need for any further intra-abdominal surgery."

The use of maggots is part of a larger category of medicine in which living organisms, like leeches or bees, are used as a direct part of treatment, a class of procedures known as biotherapy.

Advocates say biotherapy's future is promising. "Biotherapy has got to be an integral part of modern wound care," Church said. "No way is this an alternative. There are no gimmicks. It's a highly sophisticated natural means of achieving certain ends. Nature's been doing research and development on this for 300 million years. All we've got to do is cash in on that fact."

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