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Tuesday, May 24, 2016

History of Maggots in Medicine

From: web.stanford.edu


In 1840, Hope came up with the term myiasis to distinguish the human disease caused by dipterous larvae. However, German entomologist Fritz Konrad Ernst Zumpt (1908-1985) is perhaps the name most closely associated with discovery of myiasis (for better or worse). Zumpt worked primarily in Africa and published several articles and a book on myiasis, called “Myiasis in man and animals in the Old World” in 1965. Of course, as many different kinds of flies are associated with myiasis, discovery of these many species were by various other etymologists (and unfortunate myiasis victims!).

Maggots have been used in medicine since before Zumpt’s time. While maggots may have been used in medicine by Mayan Indians and aboriginal tribes of Australia, the first documented uses of maggots were in Napoleon’s armies where surgeons noticed wounded soldiers with blowfly infestations survived better than those without. In 1829, Napoleon’s surgeon general, Baron Dominique Larrey, described observations that some flies destroyed dead tissue and aided wound healing.

American Civil War Army surgeons deliberately used blowfly maggots, placing the maggots into wounds to aid healing. The maggots would clean away decayed tissue and may also have aided in reducing the bacterial activity and incidence of secondary infection.

Continuing in this theme, blowfly maggots were commonly used in World War I to debride deep wounds. This use of blowfly maggots was subsequently continued in civilian practice. Since 1929, flies have also been used to treat chronic osteomyelitis (notably, it was Dr. William S. Baer who first did so. He had been in WWI and saw a patient therapy with maggots quite by accident- when a soldier left on the field returned much less ill than one would have expected given his injury. Once his clothes were removed, Dr. Baer saw that “thousands and thousands of maggots filled the entire wounded area.” Recent evidence points to Procteus mirabilis (which can be found in maggot salivary glands) may produce substances that kill pathogenic bacteria and promote wound healing.

Only a small number of flies that cause human myiasis are used in medicine. Good medicinal maggot candidates do not consume normal human tissue. Weil et al reported that that larvae of L. sericata starved on clean granulation tissue and suggested that they were, therefore, ideally suited for maggot therapy. Lucilia sericata is the most commonly used species in maggot therapy- this is rather ironic, given Sherman reported Lucilia as the species most highly associated with non-therapeutic wound myiasis in hospitalized patients! It is also a bane to the sheep raising populace, as it affects sheep strongly.

Maggot therapy is used most often with very serious infections, including temporal temporal mastoiditis and perineal gangrene (traditional surgical and antibiotic treatments have been ineffective). Rather than being used as a last resort, maggots are used as “an adjunct to modern medicine.” They are also used with diabetic patients, in treating foot wounds (a complication that sometimes occurs with diabetes).

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