Gross medicine - use of leeches and maggots in health care - Cover Story

Science World, Oct 19, 1998 by Maia Weinstock, Mark Bregman

Hundreds of years ago, maggots, leeches, and dirt were "medicine cabinet" staples. Now old is new again: Ready to try them?

You're lying in the emergency room, in agonizing pain from open gash on your leg. You crashed your bike weeks ago, the wound has gotten worse--black, festering, and foul-smelling. Now you have acute gangrene--"flesh-eating" microscopic bacteria are feeding on your live tissue. What would it take to destroy the bacteria causing your leg to rot?

Well, how do maggots sound? That's doctor's recommendation: unleash of tiny worm-like fly larvae to feast your leg. Is this a putrid nightmare? Have become the star of yet another sequel--Holloween: When the Bugs Bite ???

It may curdle your blood, but science is re-examining a host of "folk" remedies to heal all kinds of wounds and diseases. They include maggots, leeches (a type of segmented worm), and even geophagy or dirt-eating (see sidebar, p. 17).

Alternative folk cures were standard medical fare for centuries. But late-19th-century advances like the theory--keeping and instruments from germs promotes healing--and 20th-century drugs called antibiotics, helped banish folk remedies from modern hospitals.

Now, recent studies suggest some old remedies may do the trick as well as, or better than, some techniques that replaced them. "We no longer think of antibiotics as the cure-all for every infection," says Dr. Ronald Sherman, at the University of California at Irvine.

"Almost by chance we're relearning that nature's medicines--often called `gross'--are sometimes the best," adds Michele Root-Bernstein, author of Honey, Mud, Maggots and Other Medical Marvels (Houghton Mifflin, 1997). Maggot and leech therapies are a growing trend, says Root Bernstein, though you probably won't find them in your local doctor's office. "Doctors are likely to turn to maggots and leeches only when nothing else works," she says.

Today, as in the past, maggots are used to eat dead tissue, thereby cleaning open wounds. During the Civil War and again in World War I, battlefield physicians saw that soldiers' wounds infested with maggots tended to heal better than non-infested wounds. Soon maggot therapy was born.

On the other hand, leeches were put to the test in a practice called phlebotomy, or bloodletting, a remedy once as popular as aspirin. A leech's bite was only one tactic used to drain human blood--knives, sharp stones, teeth, and thorns also proved popular. Though they didn't know why at the time, doctors found bloodletting reduced severe fever. A doctor might use leeches to drain ounces or pints of blood--in extreme cases, up to 1/5 of a person's total blood supply! Today, leaches are making a comeback in reconstructive surgery when, for example, surgeons reattach a severed finger.

For more news on some of the world's oldest and grossest medical remedies, turn the page.

Maggot therapy

Today, more than 200 hospitals in the U.S. and Europe have prescribed maggots to treat patients with infections from injuries like pressure ulcers ("bed sores"), leg and foot ulcers, stab wounds, and post-surgical wounds that won't heal. In fact, about 5,000 laboratory grown and disinfected (microorganism-free) maggots are delivered to hospitals across the U.S. every week!

"It's faster than any non-surgical method for wound-healing and not as likely to injure healthy tissue," says Dr. Sherman. He grows the larvae in his Irvine laboratory and ships batches to hospitals around the world. The flies that lay maggot eggs are force-fed on Gainers Fuel 100, a body-building supplement. Sherman puts up to 20,000 maggot eggs in a single vial, and after hatching, feeds them sterilized meat. The larvae are then placed in special bandages which hold the maggots in after they are applied to a human wound.

Here's an example of when and how maggot therapy works: Open, untreated wounds can become infected and gangrenous if left untreated. Gangrene is the death of human cells or tissues caused by a blockage of blood supply to a wound. If gangrenous tissue isn't removed, the affected limb eventually begins to rot. And if bloodless tissue should become infected by poisonous bacteria such as clostridium, results can be fatal.

Maggots are immature blowflies (a type of fly) in their second or larval stage of life. Young blowfly maggots are implanted directly onto a wound, where they eat dead flesh, clean out dead skin, and kill harmful bacteria that need injured tissue to survive. Once maggots reach their fill of dead and dying flesh, they're removed from the wound and new maggots are applied. Blood can then flow throughout the tissue, promoting the growth of new flesh (see below).

Are patients totally grossed out by maggot therapy? "I've never had anyone freak out--not even those who are initially extremely reluctant," says Dr. Jane Petro, a plastic surgeon at Westchester County Medical Center in Valhalla, New York. Maybe someone should conduct a study on how her patients got such strong stomachs!

Leeches: out on a limb