The founder of modern maggot therapy was William Baer (1872-1931), Clinical Professor of Orthopaedic Surgery at the John Hopkins School of Medicine in Maryland. He described how, during the First World War, he had treated two wounded soldiers who had remained overlooked on the battlefield for seven days having sustained compound fractures of the femur and large flesh wounds of the abdomen and scrotum. On arrival at the field hospital they showed no sign of fever or septicaemia despite the very serious nature of their injuries and their prolonged exposure to the elements without food or water. Their wounds, although filled with maggots, were beautifully clean and showing obvious signs of healing. Remembering these wartime experiences, Baer subsequently used maggots to treat four children with intractable bone infections (osteomyelitis) at the Children's Hospital in Baltimore in 1928. The treatment was very successful and the wounds healed within six weeks. In the absence of any equally effective alternative for the treatment of osteomyelitis or infected soft tissue injuries, the use of maggots spread quickly during the 1930s and remained popular for about a decade until the advent of sulphonamides and antibiotics offered a more attractive method for dealing with the problems of wound infections. In recent years, however, serious problems associated with the development of multi-resistant strains of bacteria, coupled with recognition of the limitations of other forms of wound debridement, led to the reintroduction of maggot therapy as a standard wound treatment.
Experience has shown that compared with conventional therapies, the application of maggots reduces treatment times by weeks or even months. Maggots do not have teeth and therefore cannot actively 'chew away' dead tissue. They feed by secreting a mixture of powerful enzymes into the wound, which break-down the necrotic tissue into a semi-liquid form that the creatures can ingest. They also reduce or eliminate odour and combat wound infections including those caused by the so-called 'super-bugs' that are resistant to most antibiotics in common use. It is believed that the ability of maggots to combat wound infection is partly due to the antimicrobial nature of their secretions, but it has also been demonstrated that actively feeding larvae ingest bacteria and destroy them as they pass through their gut.
WOUND MANAGEMENT
LarvE; The World 's Smallest Surgeons
NHS Trusts
Commissioners Review 2002
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Introduction
The practice of using first instar larvae (maggots) of flies to heal wounds has been around for centuries. In the pre-antibiotic era, physicians noted that larvae would debride wounds of necrotic tissue and greatly improve the prognosis for disease in their patients. Larvae work continually to remove the dead tissue and cleanse it of bacteria while leaving the viable cells alone. Larval therapy gained acceptance and was widely used until the discovery of antibiotics in the 1940's. With the emergence of antibiotic-resistant strains of microbes, larval therapy is again being investigated as a viable treatment of wounds. Veterinary medicine appears to be falling behind human medicine in utilizing maggots. Fly larvae can be used to heal ulcerative lesions, burns, certain types of benign and malignant tumors, abscesses, and osteomyelitis when conventional treatments fail or are inappropriate. They are easy to apply, relatively inexpensive, and do not destroy normal gastrointestinal flora or leave violative residues as do systemic antibiotics.History
Reports of the deliberate introduction of maggots into infected and gangrenous wounds, followed by successful healing, date back to ancient times and span various cultures world-wide. The Mayan Indians wrapped wounds with a dressing made of sun-exposed beef blood that would pulsate, apparently with maggots, a few days after it was applied. An aboriginal tribe in Australia cleansed wounds with maggots by following the protocols handed down for generations. In Newfoundland, a severe infection in a fisherman's hand was treated by an elderly woman who used maggots the, 'old way my mother show me.'Larval Therapy: A Review of Clinical Human and Veterinary Studies
Janet Hinshaw,
Veterinary Student,
Kansas State University
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Sprawled in this crater was a wounded German soldier. They drank the water together, then the American fell back, exhausted. He lay there for 24 hours before he was found. Maggots found his wound and swarmed into it with avidity.
When I cut away the cloth of his breeches, I could not see his wound. It was black with burrowed maggots. In some alarm I cleansed the wound and destroyed the maggots, and then stared at the flesh in amazement. It was glisteningly pink and clean, with firm, healthy granulation tissue and not even the suspicion of infection.
This was my first experience with so-called maggot therapy, an aspect of surgery that today is well known and infinitely more advanced than it was in 1918. The principle in itself was not new. Ambroise Par� had commented on it in 1557; it was known to Baron D. J. Larrey, Napoleon's famous military surgeon, who in 1799 observed the curative effects of live maggots on the badly infected wounds of French soldiers. Dr. J. F. Zacharias, a surgeon of Cumberland, Maryland, who served in the Confederate army during the Civil War, actually employed maggots in caring for the wounds of Rebel soldiers.
But it was Dr. William S. Baer, clinical professor of orthopedic surgery in the Johns Hopkins University School of Medicine, who placed this age-old procedure on a scientific basis, and amplified it so that it could be used in civil medicine. Baer had reached France in June, 1917 as a member of the Johns Hopkins Unit (Base No. 18), but he was soon transferred to the headquarters of the American Expeditionary Forces at Chaumont as orthopedic consultant, and his duties took him into all sectors held by American troops. One day in 1917 he had occasion to care for two American soldiers suffering from large flesh wounds in the scrotum and abdomen, and compound fractures of the femur. Yet these men, who had lain in No Man's Land for seven days without food, water or medical care, had neither fever nor any evidence of sepsis when Baer saw them. He did notice that their wounds were filled with thousands of maggots, a sight that disgusted him, as it did me. In spite of the fact that the mortality among soldiers having compound fractures during the World War was very great, the condition of Baer's two patients, except for the effects of starvation and thirst, was excellent. He was amazed.
HARRY L. SMITH, M.D.
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