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Maggot therapy is a method that has been used for hundreds of years and possibly thousands. It is a successful procedure that has been continually used for so long. The Maya civilization is believed to have used maggots for wound care purposes. There have been advances made in the process, which is constantly happening in medical practices. Therefore, it is expected to only get better. Maggot therapy is the application of living blowfly larvae, or maggots, to wound to treat soft tissue wounds. While it may seem unbelievable, it has had a very high success rate over the years.
The history of maggot therapy is extensive. The Old Testament is the oldest written piece of evidence confirming the infestation of a wound by fly larvae on a man. ‘My body is clothed with worms and scabs, my skin is broken and festering…’ The Holy Bible, Old Testament, Job 7:5. Ancient tribes in South Wales, Burma, and Central America have also been seen in history to use this method. This dates back over the last thousand years. In the 1500’s, the French surgeon Ambroise Pare, was the first doctor to take note of the benefits of maggot therapy. However, in his early methods, he tried to control the maggots because of their destructive behavior. This would prevent an infestation. He would later discover that it was necessary for an infestation to take place for success to occur.
The first official publication of the method was performed by John Forney Zacharias during the American Civil War in the 1800’s. He documented how well the maggots removed the dead tissue in wounds. There was also a surgeon of the army of the North States, William Williams Keen, who reported the presence of fly larvae in wounds that appeared to have no negative affect even though it was a sickening sight. During this time, the popular belief among scientists was that the maggots were introducing bacteria to the wound sites, causing infection.
In the 19th century, the germ theory of microbiologists Robert Koch and Louis Pasteur put an end to the willingness and confidence needed for doctors to use contaminated live matter to an open wound. By the end of the 19th century, there were very few doctors that would use maggot therapy. This had a drastic affect during World War I when the mortality rate from open wounds increased to seventy percent. However, in 1917 a French military surgeon named William Baer reported his outcomes of use of maggot therapy. Then he went on to begin an experiment with twenty-one patients who had previously had failed primary treatments for osteomyelitis. Osteomyelitis is an infection of the bone. In this experiment, he exposed the affected areas to maggots and found that after two months, the wounds of all of the patients were completely healed. This led to maggot therapy becoming the fastest and most successful form of treatment for osteomyelitis specifically. It also led to Baer discovering that it was crucial for sterile larvae to be used because otherwise there was an infection of Clostridium tetani. He would then work with colleagues to create special maggots to be used for therapy. They developed a number of different ways to sterilize the eggs.
After the death of Michael Baer, maggot therapy experienced a rise in popularity, even though there was a large number of his colleagues that disliked the method. In a ten year time span beginning in 1930, over three hundred hospitals in the United States introduced the use of maggots into their procedures and also more than one hundred publications were created. Not too long after the increase in use of maggot therapy, there was a sudden decrease. This was due to the widespread use of sulphonamides in the 1940’s. Penicillin was produced along with the development of many new antiseptics. Therefore, the use of larvae in wounds rapidly declined. It was mostly considered in extreme situations in the military. This decline would not lead to the demise of maggot therapy.
In the beginning of the 1990’s, two men named Ronald Sherman and Edward Pechter established a fly-culturing facility in Long Beach, California. There was beginning to be a high demand for sterile larvae due to its success in decubitus ulcers. Maggot therapy was being compared to conventional forms of therapy. In the evidence, maggots led to a more rapid removal of necrotic tissue and a faster healing rate than all other non-surgical treatments. This was a new start for the continued use and advancement of maggot therapy.
As the public becomes more accepting and more aware of the medical success of fly larvae in wound treatment, it will become more used. Along with the ever problematic, increasing rates of antibiotic resistance, chronic infection, immunosuppressive illnesses, and diabetes, maggot therapy may become a first line of defense for treatment. Although it has competition with tissue engineering and modern wound dressing, it will be a formidable weapon in difficult cases especially. For example, in many cases of infected limbs with peripheral vascular disease there is the decision for larvae treatment when conventional treatment of repeated antibiotics has failed. A combination of intravenous antibiotics and maggot therapy has been proven to be more effective than either treatments alone. As wound healing is constantly evolving, it is possible that practitioners will be encouraged to use maggot therapy. It is beneficial that this practice becomes normalized because it could eventually be prescribed for at home use. This would be cost effective and it would decrease hospital admissions. In current times, maggot therapy is only used in the primary care setting.
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