Thursday, May 16, 2013

Maggots and Rats: Nature's Surgeons

By Alfred Jay Bollet, M,D.

According to soldiers' letters, swarms of flies harassed them in every encampment and hospital. Because flies deposited their eggs in any open wound or in wounds covered with the standard moist dressings (apparently, the eggs could penetrate through several layers of moist muslin), maggots rapidly appeared in wounds. Although the maggots caused no pain, they disgusted the volunteer female nurses and their wiggling bothered the wounded men. Clinicians, therefore, used oil of turpentine, petroleum, kerosene, tobacco, chloroform, and antiseptics to kill the maggots when flies were present. In well-run hospitals, strict cleanliness usually prevented their appearance.

Yet, some Civil War surgeons ultimately realized that maggots could have beneficial effects: they painlessly cleansed wounds by digesting and removing dead tissue without injuring healthy tissue. Confederate Surgeon Joseph Jones, for example, reported that "a gangrenous wound which had been thoroughly cleansed by maggots healed more rapidly than if it had been left by itself." In recent times, physicians have rediscovered the ability of maggots to debride wounds, often more carefully than the best surgeon.

In her memoirs, Phoebe Pember noted the skill of rats in removing dead tissues in a wound without damaging healthy tissue or hurting the soldier. "The rat surgeons," she noted, "could have passed the [medical examining] board." A Virginian named Patterson was wounded in the center of the instep of a foot; the wound sloughed, and a large mass of "proud flesh" (newly formed growing tissue, now called "granulation") formed an island in its center. According to Pember,

"The surgeons feared to remove the mass, thinking it was connected to the nerves of the foot and lockjaw might ensue. Patterson was very glum, but [after the rats got to his wound, he] brightened one morning, and he exhibited the foot with great glee, the little island gone, and a deep hollow left, but the wound was washed clean and looking healthy."

FROM: Civil War Medicine: Challenges and Triumphs


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