Sunday, July 10, 2016

History of Maggot Debridement Therapy


It's not clear at what point in history people observed that there were positive results from myiasis - maggot infection. One of the first European medical reference to maggots appears in 1491 in the Hortus Sanitatus, a German medical text. In the 1500's, Ambroise Pare, a butcher-surgeon, noted that maggots helped the healing of war wounds.

There are indications that in the mid-1800's, during the Civil War, maggots were purposely introduced to wounds when physicians noted that wounds that maggots infested tended to heal better and more quickly. Zacharias, a Confederate medical officer in the Civil War, reported that he used the larvae of the green blow fly to prevent gangrene in wounded soldiers.

The modern era of maggot debridement therapy was ushered in by William Baer (1872-1931), Clinical Professor of Orthopedic Surgery at the Johns Hopkins School of Medicine in Maryland. During World War I, he had observed soldiers whose wounds were infested with maggots, but clean and healing. After he returned from the war, he used maggots to treat 4 children with intractable osteomyelitis with good success. He continued to use maggot debridement therapy, but some patients developed tetanus, and so he undertook to find a method to sterilize maggots. After trial and error, he found a way to sterilize the eggs.

During the 1930's and 1940's and into the 1950's, maggot debridement therapy gained in acceptance and was used fairly routinely. Maggots were used extensively during World War II. Lederle Laboratories produced and distributed huge numbers of maggots, however, with the discovery of sulfa, penicillin, and other antibiotics to treat infection, maggots fell out of favor and Lederle stopped producing them. Realistically, given the choice of worm-like maggots crawling about in a wound or receiving injections or pills, very few people would opt for maggots.

The one person who is responsible for the resurrection of the humble maggot as a medical treatment is Dr. Ronald A. Sherman, of the University of California, Irvine. Sherman, who had a background in entomology, became interested in maggot therapy in 1983 and began clinical trials in 1989, using maggots in treatment. Sherman, and associates from the Veterans Affairs Medical Center, pioneered the reintroduction of maggots and found that maggot therapy was very successful for the treatment of various types of wounds. They began to promote maggot debridement therapy. In 1990, Sherman completed a study of the use of maggots on non-healing wounds. He found that the maggots completely debrided most necrotic wounds within a week, with better rates of healing than the conventional treatment.

During the mid 1990's, interest spread to the United Kingdom, Europe and Israel, where today maggot debridement therapy is more common than it is in the United States. In the United Kingdom alone, maggot debridement therapy has been estimated as saving the equivalent of $1 billion dollars annually in health care costs. Maggot debridement therapy has been reintroduced to Australia and increasingly Australian physicians are requesting maggots for therapy.

In 1995, Sherman, currently director of the non-profit organization Bio-Therapeutics, Education and Research Foundation, took his colony of flies to the University of Irvine, CA, establishing the UC Irvine Maggot Therapy Laboratory, making maggots available to physicians throughout North America. Initially, the maggots were used without FDA approval, a legal practice, but insurance companies often will not pay for unapproved treatments. In January 2004, maggots became the first live animals to win U.S. Food and Drug Administration (FDA) approval as a medical device to clean out wounds. The Maggot Therapy Laboratory is now marketing and selling maggots with the brand name Medical Maggots. Especially now, with the advent of antibiotic-resistant bacteria, maggot therapy is looking more and more promising.


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