At a certain battle during nineteen seventeen, two soldiers with compound fractures of the femur and large flesh wounds of the abdomen and scrotum were brought into the hospital. For seven days, they lay on the battlefield without water, without food, and exposed to the weather and all the insects which were about that region. On their arrival at the hospital, I found that they had no fever, and that there
was no evidence of septicemia or blood poisoning. Indeed, their condition was remarkably good, and if it had not been for their starvation and thirst, we would have said they were in excellent condition. When I noticed the extent of the wounds, I could not but marvel at the good constitutional condition of the patients. This unusual fact quickly attracted
my attention. I could not understand how a man who had lain on the ground for seven days with a compound fracture of the femur, without food and water should be free of fever and evidence of sepsis. On removing the clothing from the wounded part, much was my surprised to see the wound filled with thousands and thousands of maggots, apparently those of the blowfly. These maggots simply swarmed and filled the entire wounded area.
The site was very.
Disgusting and measures were taken hurriedly to wash out these abominable looking creatures. Instead of having a wound filled with puss as one would have expected, these wounds were filled with the most beautiful pink granulation tissue that one could imagine. These patients went on to healing, notwithstanding the fact that we removed their friends which had been doing such noble work.
I love it. I love how munch Aaron. It's such a noble work.
I can it's such a noble work.
It's I just love maggots, Aaron. This episode has transformed.
It is something I never thought that I would say ever. And I love them so much.
I love them. They're the best. That first hand account was from William bhar from nineteen thirty one in a paper titled the Treatment of Chronic Osteomilitis with the Maggot Larva of the blowfly.
Love it those blowfly larva. Hi, I'm Aaron Welsh and I'm Aaron aman Updyke and.
This is this podcast will kill You.
Welcome to today's episode. It's all about maggots.
It's going to be so much fun. And what makes it even more fun is that this is kind of like a two parter. It is, Yeah, it's like companion pieces.
It was originally intended as a two parter that we realized was really two companion pieces because who knew there was so much to love about both maggots and next week's stars.
Leeches leeches, I mean, and like, I think the connection will become fairly clear as when we get through these. But basically, these are two organisms that carry with them a certain dick or yuck factor. Major They have been used in medicine for centuries, thousands of years even, and have kind of recently experienced a resurgence and popularity, and I just there are so many amazing things about them. So yeah, it's gonna be really fun.
It's really gonna be a fun episode. Next week's also going to be so much fun. I'm thrilled. I just I learned so much researching for this, and like, ugh.
Maggots, maggots who knew a lot of people, A lot of.
People did and now and now we get to know too.
But before we get into all of that good stuff about maggots, it's quarantine time. Is what are we drinking this week?
We're drinking A Tale of two worms?
Wait?
That is oh my gosh, No, that is actually the title.
That is the title. But I like, I made the quarantiney picture and the recipe as the best of both worms.
No, did you really?
Yes? I did. Let me pull it up. I sent it over to you, Aaron. How did I not even notice Aaron, best of both worms? Because that's how it was written down in my notebook, and so I was like, oh yeah, and it literally did not cross my my mem and I obviously I looked at all of your things, didn't even read the title.
Mm hm cool.
Okay, so we're drinking either. It's gonna be easy to change. I think we're drinking A Tale of two worms.
A Tale of two worms. I love it because we're telling tales of these two squirmy worm things asterisk. We know that mackets are not worms. We're very well aware.
Yeah, but a lot so like you know, colloquial spiders are bugs, that kind of thing, like we know the difference, but forgive us, oh bit. But in best of both worms, oh my god, in in a Tale of two worms, we have it's basically like fancy fruit punch with vodka and Fammi worms delicious.
We'll post the full recipe for that quarantine as well as our non alcoholic Plussy burita on our website. This podcast will kill you dot com and on all of our social media channels.
We will. If you're not already following us on our social media channels, you really should because we're having on some pretty cool content. You know. We've got some reels, we got normal posts.
Normal posts.
We we're on TikTok even, we're on TikTok even finally getting with the program right before it probably will be banned, but yep, you know, and check us out there. Also our website. Let's shout out our website, as we usually do. It's got some good stuff. It's got transcripts, it's got our bookshop dot org affiliate account, it's got our Goodreads list, it's got all this. Verses for all of our episodes.
Links to merch links to music by Bloodmobile, links to Patreon, links to a form where you can submit your first hand account, which is plasome. We get so many incredible people who share their stories with us that we cannot think enough, and so if you're interested in sharing a story or have a request for a particular topic, please reach out to us.
Well with that, shall we get into this episode all about maggots.
Let's do it right after this break.
I have to start out just by giving a huge shout out to the pretty much only source that I used for this biology section of maggots, which was a paper, except I think it's more like a book, a compendium, a book called The Complete Guide to Maggot Therapy, Clinical Practice, therapeutic Principles, production, distribution, and ethics.
When they say complete.
That is as complete as it gets.
It was such a gem to read. I love it so much, and I loved it so much that I actually want to start off with a beautiful line from.
The introduction chapter. Are you ready for this?
I think so.
Quote.
The human body is fragile, and therefore wounds acute and chronic have always been part of the human condition since time immemorial. Likewise, flies have evolved to exploit during development the ephemeral cadavers and wounds of living animals. Humans included ephemeral cadavers.
Beautiful.
Loved it so flowery. I don't get to read things like that very often this podcast. So I want to start off, I mean I already started off, but let's first. I want to talk about chronic wounds because they're a really important part of the Maggot story.
Chronic wounds.
The idea of a chronic wound is simply a wound that doesn't heal along a typical trajectory, and so you see this a lot in medicine, and there's not necessarily one specific timeframe on like when you would consider a wound chronic versus acute or something like that. But generally, chronic wounds can be present for months to years, and if something isn't done, some kind of wound care to help chronic wounds heal, they can persist for years or
decades and be very debilitating physically, mentally, emotionally. They can lead to a lot of complications down the line. So
why chronic wounds? Why are these important? Chronic wounds often have a significant amount of necrotic or dead tissue that covers them, and in order for them to heal, part of the wound care process is that they have to be debrided, meaning that the necrotic tissue has to be removed all the way down to a layer of more well vascularized like healthy bleeding tissue what was described in
the first hand account as that granulation tissue. That granulation tissue is our bodies healing from the bottom up, which is actually how wounds heal. So how can we accomplish this process, like what does wound care entail? That is where we can enter maggots sometimes, So maggot for anyone who is uninitiated, is a colloquial term for the larvae of flies flies large group obviously Holometabolis insects, so their larva look nothing like the adult they have to pupate,
they rearrange their whole body. Caterpillars are butterfly larva, grubs, beetle larva, maggots, fly larva. But flies are a huge, huge, huge order of insects that includes mosquitoes, houseflies, horseflies. So when we say maggots, which is not like a scientific term, it's very much a colloquial term. We kind of specifically use that for the larva of flies that you probably
think of when you think of the word fly. Does that make sense, Yeah, Okay, Like it's it's still a pretty general term, but it's like most of the flies that you look at it and you're like, that's a fly, they're larva.
Are maggots.
Okay, So the flies that we talk about in medicine, medicinal maggots generally are from the specific species Lucilla seracatta. I think is how you pronounce it. I tried really hard to look it up. But this is the common green bottlefly, and one other species Lucillia couprina, which is the Australian sheep blowfly. So both of these are blowfly species. They're actually kind of pretty. They're green. They're really shiny and metallic, and again they look like a fly, just green.
Okay, I'm with the maggots.
You're with me, Thank you. Good.
The maggots themselves, if anyone hasn't had the pleasure of seeing maggots look like little wiggly grains of rice. Especially
when they're in their first in star. They're pretty small and they just sort of wiggle around, and then as they molt through their various in stars, they get a little bit larger, and then you can tell that they have little segments on their bodies and they breathe through spiracles on their butts, so they bury their heads into wounds or decaying flesh, and they stick their butts out
in order to breathe. So, when it comes to the use of maggots in medicine, and the reason that I talked about chronic wounds at the top is that the primary use of maggots is in the treatment of chronic wounds. Sometimes maggots can be used for other wounds or acute things like burns, but mostly they're used for chronic wounds. And in this capacity they have three incredible functions that I will get into in detail. First, they can help to remove that dead or necrotic tissue that prevents chronic
wounds from healing. Two is that they help to control infection, which is a huge issue in chronic wounds. And three they actually promote wound healing.
They're really cool.
So how do they do all of these three amazing things? Like they are worm babies, Well, how do they do this? Blowfly larva. Maggots in the wild eat dead animal tissue. That is what they do, that is what they have evolved to do. So they will happily eat the necrotic or dead tissue on a wound like that part makes sense. They will eat dead tissue, any dead tissue that they can find. But there are a few things about these blowflies, especially the ones that we use in medicine, that make
them especially good at wound debreaedment. First, maggots don't have any real mouthparts, so they can't bite you, they can't crush your flesh, they don't pierce you. Instead, they rely on what's called extra corporeal digestion.
It's one of my new favorite.
Phrases, yeah, meaning that they are secreting a whole bunch of digestive enzymes and antimicrobial substances. They're spinning it out out, they're letting that flow over their food, which, if it's a chronic wound, is your wound. And then they have these two little mouth hooks that they use to kind of separate out their food bits. And they also use
these hooks to crawl their little bodies around. That's how they crawl around, and this helps to those digestive enzymes that they've secreted out to penetrate deeper into the surface of the tissue that they're digesting. And then they suck up that juice and that's what they eat, which allows them to grow. Also, this way of feeding this extra corpse. I'm so excited I can't pause for a question yet.
But this way of feeding helps their neighbors as well, because all of the maggots in a group will combine resources, combine all of those digestive enzymes, which increases the efficiency in large populations.
Okay, I have so many thoughts. That is amazing. I assume at a certain point our resources limit to when then it's like not helpful if they run out of tissue or whatever to eat. Yes, okay, so.
Yeah, so they are very efficient at just finding that necrotic tissue for the most part. And we'll get into like there could be complications, but yes, they are going to find like the most necrotic tissue and that is what they are going to specialize on for the most part. And then when they're done, they're going to leave. They're going to go someplace new. Right, So, on a chronic wound that's full of dead tissue, they are secreting these enzymes that are literally digesting it, which is a form
of chemical debreedment. Right, So that's the first way that they're debrading it. But on top of that, their little mouth hooks are also helping to break up that dead tissue, so they're also doing physical debreedment, and not passive the way that like a piece of gauze with bleach sits on the surface and does a chemical debridement, and then when you pull that gauze off, it's going to have
some kind of physical debreatment. But these are active, live maggots who, like you said, erin, are seeking out the deepest, most necrotic tissue because that's the areas of greatest food for them. So they are incredibly efficient at this debreatment process.
Do we know what chemicals and enzymes and what's in their secretions? Can we mimic it? Would we want to ever mimic it?
It's a great, great question.
I feel like that is one of the big questions about so many of the things with maggots and with leeches, like we'll talk about later. We know some of the compounds, A lot of them are like proteolytic enzymes and a bunch of other things as well too. There certainly are compounds that we have that we might use that are very similar. But as we'll see, it's like it's a combination, right, Like it isn't just the chemicals that they're secreting. It's
also the way that they're moving. It's their mouth parts doing the things that they're doing. It's them scooting their bodies along. So yes, it is possible, and I think we'll talk a lot more about that idea of like can we identify these specific compounds and can we mimic them.
Well, it's also like just the removal process, like you said, like it's not just dissolving, yeah or whatever.
Sucking it up too, They're amazing, but that's not all.
That's like not even close to all.
So maggots because in the wild they're feeding on this decaying tissue that's just ripe with other organisms like bacteria, but also viruses, protozoans, other bugs like everything.
So it makes.
Sense that they would have also evolved ways to thrive in an environment that is chalk full of other microbes, right, ways of either outcompeting for food or making sure or and I guess making sure that they don't get infected with all of the other microorganisms that are around. And
they do exactly that. Maggots secrete not just these enzymes that are breaking down tissue, but a whole host of anti microbial compounds that in studies have been shown to be active against things like staff and strep, which are really common skin flora, and interestingly, they're less effective perhaps against other types of bacteria which might be less common
to be found on decaying carcasses. But on top of that, they're also eating a whole bunch of these microbes that could potentially be infecting a wound, so they're disinfecting the wound. They're controlling the infection of chronic wounds, and their little mouth hooks help to disrupt biofilm formation and biofilms win bacteria are able to like latch on and form a biofilm on top of a chronic wound. That is very difficult to deal with. And maggots are great at it.
And if that wasn't enough, you're not yet convinced, listeners, because Aaron, I know you are. I'm sure that maggots are just like the bee's knees when it comes to wound healing. They literally help promote the healing of wounds. How So, wounds in many studies that have been treated with maggot therapy heal faster than wounds not treated with maggot therapy. So let's talk a little bit about what that means, Like, how do wounds actually heal. There's three
major phases of wound healing. There's inflammation, proliferation like of the tissue, and then maturation. Chronic wounds, the type that are really like good for maggot therapy, are usually stuck in an inflammatory state, like they're stuck there and they just can't progress because of the necrotic tissue, because of bacteria,
because of a whole bunch of stuff. Some of the secretions from magots act to inhibit this inflammation and that helps the wound to actually progress further through the stages of healing. And some of these compounds also seem to help to stimulate angiogenesis. Angiogenesis is the process of which we make new blood vessels so that you can get more oxygen to a wound, which, by the way, is
how hyperbaric oxygen therapy works to help here wounds. And so this combination of things also helps to actually speed along the process of wound healing. So it's just amazing that maggots can do all of this.
Yeah, why why do those things help wound? Like not why? But do you know what I mean, why, yeah, why not?
Why? But also why that's all.
I had the same thought, especially the idea that like, why would they be anti inflammatory?
Because if a lot of what they are.
Feeding on is like dead necrotic tissue in my brain, I wouldn't expect for there to necessarily be a lot of inflammation. But it seems like a lot of it is that they reduce some of the pro inflammatory cytokinds that we have circulating and reactive oxygen species. And reactive oxygen is something that definitely is present in the environment when cells start to lice, which is what's going to happen during necrosis and as something is decaying. So in that way, it kind of makes sense that it's to
protect themselves, they're reducing reactive oxygen species. That's my best I didn't read that directly, but that's my best way of understanding it.
Okay, can I ask some questions?
Absolutely, Aaron, please, I have like two more pages of info I thought you might ask me questions about.
Okay, let's stay if we can get through it now, I'm going to hit all those paragraphs. Yeah, okay, So when is maggot therapy indicated and when is it not.
So that's a really good question. Chronic wounds is a very broad category. There's lots of different things that cause chronic wounds. There's lots of different types of chronic wounds. There isn't necessarily like one wound that is like, oh, definitely use maggots for this, and other wounds that you're like, ooh,
never use maggots for this. In general, maggots are really safe to use for most all types of wounds, but any wounds that have a lot of necrotic tissue, like that dead tissue, anything that looks black on top is necrotic, that is going to be an especially good wound for maggots to be able.
To be helpful for.
They can be helpful in things like burns which need to breeding right away and in a pretty like gentle kind of way. And they're very helpful for any anything that's like difficult to reach or difficult to visualize, because they are going to crawl their way into nooks and crannies but then always come back up to the surface, either because they run out of food or because they need air, or because they're done growing and they need
to mold. So really, like any type of skin and soft tissue wound could be amenable to maggot therapy, less so for things like bone and tendons and ligaments, just because all of these things that are so great about maggots don't work as well on those types of tissues.
Interesting, okay, but.
They're still not used as much as you would think.
Given all of the benefits that I just mentioned.
Yeah, So, like how many hospitals have a maggot colony.
It's a great question. I have no idea.
Okay, I think most hospitals probably have access to them in some capacity. I know when I have rotated through wound care they do use them sometimes, but in general they use them very often as kind of like a last resort rather than like a first line therapy, which I.
Find really interesting.
Is that just the ick factor.
I think that's a big part of it. There's definitely a lot of research on like what is preventing people from using maggot therapy, and a lot of it comes back to either education, not knowing how great they can be, not knowing that they're effective, and like, yeah, the yuck factory, interestingly more for practitioners than patients, which I think is very.
Interesting that is really interesting. Yeah, yeah, okay. Let's say that you go in, you have a wound, and your physicians like, we think that maggot therapy is the right call here, and you say, yes, I consent to this because I assume there's like consent involved in magot therapy and like sort of this is so, then what happens next? What can you expect to happen?
So this is such a good question.
So generally with they'll do is they'll take five to ten maggots per square centimeter of area that you need wound a breadment on.
Oh, that's so many maggots, okay, is it?
They're quite small.
I know, I just just jam packing them in there.
Just yeah, you want them to be efficient, and then you basically put them on the wound. There's two different ways to do this. Sometimes you just put them all in a little baggie that they can't escape from, and put that baggie on the wound and then kind of tape it on, and that way you know for sure they can't wander off, and when you're done, you literally
just pick up the bag and toss them. The other option, and that's great, especially if you're like I don't want to touch the maggots, like you're not really ever coming in direct contact with individual maggots. But they're much less efficient that way because they're not going to be able to wander all the way to the edges. You have to make sure, you know. It's just a little less efficient.
So the other way is taking individual maggots and usually putting them in like a gauze or something, but just not a closed system, putting them onto the wound, and then enclosing the edges of that wound, so making sure that they can't just escape from and go wherever wander off. And then you leave them on for a couple of days in both cases, usually forty eight to seventy two hours, maybe a little more depending on the area and things
like that. And then you take them off and you see what it looks like, and if you need another round or a few other rounds, you may or you may not.
And that's it.
What happens to the maggots after they're full, their lives have been sacrificed.
Yeah, they're done, Okay, okay, thank you for giving your lives and service of wound healing.
Of wound healing.
Yeah, and I.
Should also mention that the maggots used for medicinal therapy are like grown in a lab, they're sterilized. They're like, this is a very rigorous it is an FDA regulated process in the US and in most of their countries it's regulated by some capacity.
How does maggot therapy use very globally?
Oh, great question.
I don't know, and I don't think that we have a good sense of it in all honesty from what I read. It's not like I just failed to look for it. It's just that we don't really have a great sense of.
Like it is a great option. It's not.
It's not accessible everywhere necessarily. It's probably used in some places in different ways. So, yeah, we don't have a good sense of like numbers globally.
Okay. So one of the things that I came across in the history of maggots and their use for medicinal purposes was that they began to realize pretty quickly in the twentieth century. After centuries and millennia of using maggots, they were like, oh, we need to have an entomologist on hand who can distinguish between the different types of flies, because not all flies create the type of maggots that will just eat necrotic tissue.
Correct, Yes, so that that is very true. So the types of maggots used for wound care are a couple of very specific species. Maggots in wound care is not the same thing as maggots infesting open wounds or parasitizing healthy flesh. So the technical name for that process is myiasis, which is being parasitized by fly larva, either by healthy flesh or open wounds, and that can be a very serious health problem, both for animals and for humans. And
that is could be from a few different reasons. It could be the right kind of like blowflies, but too many of them, because once they start replicating right like, they grow into adults and then they lay more eggs and then that infection can get out of control pretty quickly. Or it could be that it's the wrong type. There's so literally hundreds of thousands species of flies, many of which love to eat flesh. That's what they do, and so in those cases it is very dangerous to have
a maggot that's infesting a wound. This is in a medical setting, very different. Okay, we also use blowflies for forensics, just tuk it out there. So Aaron, yeah, I know that historically this is not all the maggots were used for.
So please, can you tell me about how we got to this point?
Can't wait? Oh, let's just take a quick break and then I'll get into it. Ancient remedies are one of the staples of our podcast so much. We bring these up all the time, right, Like, I think Rabies featured a lot of these, and when we talk about these, when we bring up these examples, I think it's pretty easy to think, Oh, my gosh, how absurd. Can you believe people ever thought that the ashes of a shrew's tail applied to the bite of a rabid dog would
do anything. We are so guilty of that too, Like, totally, totally, because from our perspective in the twenty first century, we know that rabies is caused by a virus and that there's no effective treatment, and we feel smugly superior to those foolish ideas of the past. But and this is something that I think that we've gained more of an
appreciation for over the course of making this podcast. That attitude, that superior attitude, ignores two crucial things, the first one being that yes, many ancient remedies show little to no efficacy in what they were intended to treat, but many others do and have just been rebranded as modern medical advancements, like digitalis or aspirin, even without their long history and early use acknowledged. And the second thing that is ignored is that we're in the same boat with medicine today.
We may have better methods of testing efficacy and safety, but it's really arrogant to think that we're at the pinnacle of medical knowledge and that our ideas and cures today won't face similar ridicule in the future. And so this is my call, maybe especially for myself but broadly too, to eat some humble pie and consider what these cures have to offer us today, whether that's an insight into the past or novel and effective treatments for today. Let's start with maggots.
I love it.
There is this unavoidable yuck factor that we've talked about when it comes to maggots, and it's for a good reason. The places that we're likely to encounter maggots are things like decomposing carcasses, rotting food, things that can make us sick if we get too close and maggots, along with the stench of rot, provide a pretty good signal to stay away.
Peace out, yep.
But these delightfully disgusting habitat preferences of flies and their larvae have been harnessed by humans for millennia. As you talked about Aaron, the larvae of some fly species are amazing at discerning healthy from dead tissue and just taking care of business to cob by eating that dead tissue. And it turns out that larval therapy or biosurgery as I saw it, rebranded biotherapy. Okay, uhh, It has been
used for a really long time around the world. There's evidence that the Neampar people of New South Wales used larval therapy, as did certain ethnic groups in the hilly regions of Myanmar and Mayan healers in Central America. And I don't really think it's a huge stretch to imagine how people first came up with using larvae from flies to treat wounds. Like you have a wound, it begins to fester, the right flies lay eggs in that wound.
Larvae hatch, they begin feeding on the disease tissue. Your wound heels the larvae leave and hey, you know what, that worked better than expected. Right, I did not expect this, but he love it.
But it worked out.
It worked out.
Try it again.
We know that maggots have infested wounds since ancient times because it's what they do. But if you want written proof, I've got some in the form of some old Testament goodness. So this is from the Book of Job. My body is clothed with worms and scabs. My skin is broken and festering. End quote. That's myiasis, right, it's not.
Yeah, my isis sounds like it. Yeah, sounds like not the.
Good worms, not the good worms. Yeah, my body is clothed with worms. It sounds really painful and miserable. Yeah. But in terms of ancient medical texts mentioning larval therapy, I didn't really come across any specifically interesting. And the first written mentions of using maggots to treat wounds comes from the fifteen hundreds, and again we know that it
goes much further back across the globe. And so this is sort of like what I would say the first documented rediscovery of the practice, or like reclaiming as like, oh wow, I came up with this great idea. Amvois pare the famous French surgeon who I've definitely mentioned on the podcast before I have I have Aaron, I just don't know why. So he used maggots and treating wounds
in the mid fifteen hundreds, especially on the battlefield. It seems like he came across it accidentally, kind of like in the first hand account, one of his patients had a really deep head wound where months later, months later, Aaron a quote, large number of maggots emerged from the wound, and Parey thought it could be the end for that patient because he had seen other times where maggots had just destroyed tissue. But apparently these were more discriminating maggots
eating only dead tissue, and the person recovered. He lost a chunk of bone the size of a hand, but he recovered. Wow, Yeah, I don't know how, but he did. And so after this, Piret would occasionally use maggot therapy. Then fast forward a little over two hundred years and another French surgeon on another battlefield, this time Napoleon's army in Syria would also recognize the benefits of maggots. Baron Dominique Jean Laarat wrote about maggots of the quote unquote bluefly,
removing dead tissue and helping to clean wounds. Quote. They are produced in a few hours and increase with such rapidity that in the course of a night they grow to the size of the barrel of a small quill. Although these insects were troublesome, they expedited the healing of the wounds by shortening the work of nature and causing the sloughs to fall off end quote.
I love that. Wow.
And an about sixty years after that, in the eighteen sixties, yet another war, this time the American Civil War, would provide yet another opportunity for someone to test out maggot therapy. Maryland surgeon John Forney Zacharias wrote, quote during my in the hospital at Danville, Virginia, I first used maggots to remove the decayed tissue in hospital Gangreen, and with eminent satisfaction. In a single day, they would clean a wound much better than any agents we had at our command. I
used them afterwards at various places. I am sure I saved many lives by their use, escaped septocemia, and had
rapid recoveries. End quote Wow, I mean ringing endorsement, and there was another Civil war doctor who also saw the benefits of maggots, but by and large, any pro maggot physician was absolutely in the minority during this time, and that minority would shrink to basically non existent once germ theory came about, because this concept made it very clear that wounds got infected from dirt or things that were dirty, and people definitely saw maggots as dirty and had for
years forever. Maggots fell out of style from the mid eighteen hundreds until yet another war. Are you seeing a pattern here?
Always always a war.
World War One? And that's where our first hand account, of course, came from. That surgeon William Bhaer, was so impressed with those little friends that he went on to use them in non war conditions. But I just have to also add one little thing about the first hand account.
So he pointed out that compound fractures of the femur at that time of that first hand account, which one of those people had led to death in about seventy five to eighty percent of cases, even with all of the care that could be provided, and that person lived.
Wow.
So again like pretty convincing. I would be convinced. I am convinced. And this is a quote from him once he began to use these maggots in non war times. Quote in September night, eighteen twenty eight, there were four cases of children that came into the hospital, each one of whom had been operated upon three or four times, and treatment had covered a period of from one to
five years. Being baffled in their cure by the means usually employed, I thought it was time to put into active use the observation with a capital O, I might add, that I had made on the battlefield. We therefore obtained the maggots from the blowfly from our immediate neighborhood, and without sterilization of the fly or maggot, we loaded the wound up with these maggots and proceeded to watch the results.
At the end of about six weeks, the wounds had entirely healed, not only in the deeper structures, but even as to the skin end.
Quote wow, wow, six weeks. Yeah, yeah, that's incredible.
It's incredible. And also, just to put this in context too, this is prebiotics still, so even in nineteen twenty eight, like peniciline was not going to be widely available. For another, I think this is only when it was first beginning to be discovered, and then it was only in the forties that it was available. So anyway, clearly Bear was onto something something, but his methods needed some refining. I don't know if the.
Phrase starting collect blowfly larvae.
Exactly without sterilization, I don't know if that stuck out to you, But yeah, that was a problem. So one issue though that he had was that the blowflies he used were seasonal, and so he couldn't just go to his backyard or his neighborhood and get them like all during the year. These treatments he could only do in
certain times of year. And secondly was the lack of sterilization. Unfortunately, some of these maggots came with hitchhikers in the form of clustridium, perfringenes and tetany Oh no, yeah, he added quote this was a rather disconcerting observation.
Yeah. Yeah, that's a little bit of an understatement, certainly.
Certainly. Fortunately he was able to get anti toxin tetanus anti tooxin into his patients and most who were infected survived. But he saw he was like, okay, we need to find a way to raise these maggots in a sterile environment if we're going to keep doing this, and that would also eliminate the problem of the flies not being available year round, because he could just have this breeding
ground for maggots. And so he listed the help of some entomologists and they came to a solution, and that really helped maggot therapy to become quite popular in the US in the nineteen thirties and forties, with more than three hundred hospitals in the US introducing a maggot therapy program, which is kind of a like I just had no idea that it was so popular even then, you know, Yeah, but then they fell back out of style. It's like
this waxing and waning, like extreme peaks and popularity. I mean, I.
Feel like it makes sense though in that like there's always going to be that yuck factor, like you said, And it's also like as new it probably correlates with like new therapies, like oh, well, we have this new dressing or we have this new debreder or whatever it is. So then it's like we don't need maggots anymore. So they fall out of favor and things like that.
Yeah.
So the new medical development or technology in the nineteen forties was, of course antibiotics, and you know, and there is something like would you rather take antibiotics and have antiseptics and go through wound debreadment try that first and then go to maggots or would you rather just like, let's hit with maggots straight up right right now.
Yeah.
Some of the description are like you can hear them, depending on where the wound is, like you can hear them feeding. It's incredibly itchy, and there's like, yeah, this this net bandage that keeps them all in, but they're all there.
That's all still, that's all still the case. Yeah, so there are definitely downsides to it, and it's also can be quite painful as well.
Oh that makes sense, Okay, yeah, once they get like closer to the living tissue.
And I think too, just like because they're using their mouth hooks to kind of help break things up. I think that process it's usually not painful right away, but like after that first like twenty four hours or so, it can be. So yeah, okay, downsides, pros cons.
It's a mixed bag, as most things in life are trade offs, right, but Yeah. So once once the nineteen forties came about and antibiotics were available, larval therapy fell out of favor. It still was you used here and there,
but largely was forgotten. I found a paper by a researcher named Milton Wainwright that was published in nineteen eighty eight where he writes, quote, fortunately, maggot therapy is now relegated to a historical backwater of interest, more for its bizarre nature than its effect on the course of medical science end quote. But he spoke too soon.
Yeah, didn't age well.
It did not age well because as this paper was going to press with the first line stating, quote, the conquest of bacterial infection has been one of the major triumphs of modern medicine end quote. Yeah. As this paper was published, antibiotic resistance was on the rise, had been on the rise for a long time, and some physicians and surgeons were resorting back to the old ways to treat those stubborn infected wounds that just didn't seem to
be able to heal. In the nineteen nineties, maggot therapy, rebranded in some cases as biotherapy, experienced yet another renaissance, this time backed by clinical trials and data that supported what amazing healing properties these little guys have. And I feel like there's just like this good lesson in maggot therapy. It reminds me a kind of like fecal transplants or a phage therapy. It's like, sometimes the solution is already there, but we need to challenge ourselves to think more outside
the box. I don't know, but that's what I've got for maggots.
I love it, Aaron, I love it so much too. So should we do sources?
We should? Okay, let me pull up. I have a lot I'm going to shout out too. In particular, one is by Whittaker at All from two thousand and seven titled Larval Therapy from Antiquity to the present Day, Mechanisms of Action, clinical applications and Future Potential. And then there's a paper from two thousand by Sherman, Hall and Thomas titled Medicinal maggots An Ancient Remedy for some contemporary afflictions.
Excellent.
I had shockingly like essentially one which has never happened to me, but it really was so comprehensive. And that was the volume edited by Statler from twenty twenty two titled a Complete Guide to Maggot Therapy, Clinical Practice, therapeutic principles, production, distribution and ethics. Literally such a fun read. Had a
couple of other papers. We'll post the list of all of the sources from this episode and every single one of our episodes on our website, this podcast with kill you dot Com under the episodes tab.
We certainly will a big thank you to Bloodmobile for providing the music for this episode and all of our episodes.
Thank you to Tom Bryfogel and Leona Scolacci for the incredible add you.
Mixing, Thank you to exactly Right.
And thank you so much to you listeners. We hope that you had as much fun as we did this week, and get ready because next week is going to be awesome.
Oh my gosh, it is, and honestly like if you stuck with it the whole way, props. And also I hope that you gained a new appreciation for maggots right, They're kind of cool.
They're very cool.
And a big thank you, of course to our lovely, generous, wonderful patrons. Your support means the world to us.
Thank you, thank you, thank you, thank you
Well until next time wash your hands, you feel the animals u