MEDICAL MAGGOTS"Ah, dear Juliet, why art thou still so fair? Shall I believe that insubstantial Death is amorous, And that the lean abhorred monster keeps thee here in dark To be his paramour? For fear of that I still will stay with thee, And never from this palace of dim night depart again. Here, here will I remain With worms that are thy chambermaids." -- Romeo and Juliet
"Never laugh when a hearse goes by 'cause you could be the next to die. They wrap you up in a big white sheet And bury you down about six feet deep. The worms crawl in, the worms crawl out, The worms play pinochle on your snout. They eat your eyes, they eat your nose, They eat the jelly between your toes." -- from an old children's ballad
Death and maggots. From the time we are children, we learn that the two are inextricably linked. We find dead animals in the woods or at the side of the road, and are totally grossed out to see worms squirming in their decaying flesh. No wonder just the thought of maggots makes us all shudder!
So imagine this lovely scenario: You are a patient in the hospital, suffering from an open leg wound that is not healing. One morning your doctor walks in and announces he has your new treatment. He opens a vial and sprinkles this "new" treatment into your wound. And out plop ... maggots?
Nope, it's not your worst nightmare. And if you can stand the thought of worms feeding on your flesh, those maggots may be just what you need.
Maggot debridement therapy (MDT) is not a new thing. It was used by Napoleon's battlefield doctors. During the American Civil War, a Confederate medical officer named Joseph Jones noted: "I have frequently seen neglected wounds ... filled with maggots...as far as my experience extends, these worms only destroy dead tissues, and do not injure specifically the well parts."
And J.F. Zacharias, a Confederate army surgeon, wrote: "I first used maggots to remove the decayed tissue in hospital gangrene and with eminent satisfaction. In a single day, they would clean a wound much better than any agents we had at our command. I used them afterwards at various places. I am sure I saved many lives by their use, escaped septicemia (systemic infection), and had rapid recoveries."
Over fifty years later, during the first world war, an American orthopedic doctor working in France found that two wounded soldiers who had lain on the battlefield for a week had abdominal wounds swarming with maggots -- wounds that had begun to heal without evidence of infection.
Years later at John Hopkis Medical School, recalling his wartime experience, he used maggot therapy and found that his patients' wounds healed much more quickly. During the 1930's, maggots were used routinely in hundreds of North American hospitals for deep tissue infections. But in the 1940's, their use dropped out of favor with the emergence of antibiotics. Only recently, as bacteria have developed resistance to many antibiotics, has maggot therapy come back into use as an adjunct therapy for wound healing.
Maggots, which are the larval stage of flies, work their magic by feeding on decaying tissue. They have a pair of mandibles or hooks, which they attach to the tissue, and use these hooks to scrape off dead membranes. This is, in fact, precisely what "surgical debridement" means: "the removal of foreign matter and dead tissue from a wound." The maggots simply do the surgeon's work on a microscopic level.
They secrete protein-digesting enzymes, which cause the dead tissue to liquefy, and the wriggling movements of the maggots may somehow stimulate wound healing. Maggots do not damage healthy living tissue. THE MARVELOUS MAGGOT The maggots that doctors use for wound debridement are the larvae of green blowflies. Within 12-24 hours after the blow fly lays its eggs, baby maggots hatch. They start off tiny, only 1 mm long, but over the next 5 days, as they feed, they plump up to 10 mm long. At this point they stop eating, and transform into tough-skinned pupae. For the next seven days (or longer, depending on air temperature) they metamorphose into adult blow flies, and finally emerge by rupturing through their pupal skin.
Doctors use maggots at their tiniest stage, soon after they have hatched from their eggs. The number of larvae used depends on the size of the wound. An injured finger tip may need only 5 maggots; a deep wound may need 500. After introducing the maggots to the wound, a piece of netting is laid on top to hold them in place. They feed for three days until they're gorged and plump and juicy from eating dead human flesh. Then they're removed.
(Have I whetted your appetite?)
So how does a doctor order up a batch of maggots? Does he just pick up the phone and call for a shipment?
Well actually... yes.
The world's leading authority on maggot therapy, Dr. Ronald Sherman from the University of California, Irvine, is also a maggot breeder and supplier for doctors around the world, and the only source of medical maggots in the U.S. He collects maggot eggs before they hatch, uses a solution of sodium hypochlorite to prevent them from changing into flies, and stores them in sterile containers until they hatch. The maggots are then disinfected and shipped overnight in sterile containers. (Hmmm. Makes ya think twice about ordering a ham through FedEx, doesn't it?) Dr. Sherman ships about 5-10 vials every week to doctors in the U.S. and Canada, and in one year alone, he shipped 3,000 vials to the U.K.
The major problem with maggot therapy? That "tickling" sensation of having them squirming in your wound. The literature also mentions that "some patients may find the presence of maggots in their wounds to be unacceptable."
Well, duh.
OF MAGGOTS AND MURDER The little critters may also be saving lives in the field of criminal investigation. In a June 6, 2000 story from Associated Press, it was reported that a man who has spent seven years on death row, and who was scheduled for execution on June 28, 2000, may be exonerated thanks to maggot evidence.
Anthony M. Spears was convicted of fatally shooting a woman outside Mesa, Arizona. He insists he's innocent of the murder of Jeanette Beaulieu, whose body was found on January 19, infested with maggots.
David Faulkner, head of the entomology department at the San Diego Natural History Museum examined the maggots and concluded that, based on their larval development, the victim died no earlier than January 9.
Anthony Spears left Arizona and was home in California on January 4.
The forensic entomology evidence was strong enough to make the forewoman of the jury that convicted Spears recant her guilty vote and claim that fellow jurors had bullied her.
At last report, Mr. Spears is still appealing his conviction.
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MORE CREEPY FACTS Take Two Worms and Call Me In the Morning
Immunoparasitologist Joel Weinstock of the University of Iowa has discovered a revolutionary new treatment for inflammatory bowel diseases such as ulcerative colitis. He has his patients swallow worm eggs.
Dr. Weinstock noted that people who live in third-world countries with unclean water sources often are hosts to parasitic worms in their intestines. But in such countries, ulcerative colitis is extremely rare. Putting two and two together, he wondered: could parasitic infections be protective against such inflammatory diseases?
He tested his hypothesis on six patients with inflammatory bowel disease by asking them to ingest worm eggs. Five of the six went into complete remission, and the sixth showed significant improvement.
The worms may work by inhibiting the body's immune system, preventing it from attacking not only the worms, but also the host's own healthy tissue. As Dr. Weinstock noted, parasitic worms have been a part of the human organism throughout most of man's history, and perhaps we have come to rely on each other for optimum health. Because of the cleanliness of modern society, we are no longer hosts to parasitic worms. The result? We are now suffering from diseases seldom seen in more unhygienic times.
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Remember the Questions from Readers that forbade using leeches to help with medical problems (swelling) because it is sinful to feed blood to animals, even those who were designed only to eat blood?
