Speaker 1: At a certain battle during nineteen seventeen, two soldiers with
Speaker 1: compound fractures of the femur and large flesh wounds of
Speaker 1: the abdomen and scrotum were brought into the hospital. For
Speaker 1: seven days, they lay on the battlefield without water, without food,
Speaker 1: and exposed to the weather and all the insects which
Speaker 1: were about that region. On their arrival at the hospital,
Speaker 1: I found that they had no fever, and that there
Speaker 1: was no evidence of septicemia or blood poisoning. Indeed, their
Speaker 1: condition was remarkably good, and if it had not been
Speaker 1: for their starvation and thirst, we would have said they
Speaker 1: were in excellent condition. When I noticed the extent of
Speaker 1: the wounds, I could not but marvel at the good
Speaker 1: constitutional condition of the patients. This unusual fact quickly attracted
Speaker 1: my attention. I could not understand how a man who
Speaker 1: had lain on the ground for seven days with a
Speaker 1: compound fracture of the femur, without food and water should
Speaker 1: be free of fever and evidence of sepsis. On removing
Speaker 1: the clothing from the wounded part, much was my surprised
Speaker 1: to see the wound filled with thousands and thousands of maggots,
Speaker 1: apparently those of the blowfly. These maggots simply swarmed and
Speaker 1: filled the entire wounded area.
Speaker 2: The site was very.
Speaker 1: Disgusting and measures were taken hurriedly to wash out these
Speaker 1: abominable looking creatures. Instead of having a wound filled with
Speaker 1: puss as one would have expected, these wounds were filled
Speaker 1: with the most beautiful pink granulation tissue that one could imagine.
Speaker 1: These patients went on to healing, notwithstanding the fact that
Speaker 1: we removed their friends which had been doing such noble work.
Speaker 3: I love it. I love how munch Aaron. It's such
Speaker 3: a noble work.
Speaker 2: I can it's such a noble work.
Speaker 3: It's I just love maggots, Aaron. This episode has transformed.
Speaker 1: It is something I never thought that I would say ever.
Speaker 1: And I love them so much.
Speaker 3: I love them. They're the best. That first hand account
Speaker 3: was from William bhar from nineteen thirty one in a
Speaker 3: paper titled the Treatment of Chronic Osteomilitis with the Maggot
Speaker 3: Larva of the blowfly.
Speaker 2: Love it those blowfly larva. Hi, I'm Aaron Welsh and
Speaker 2: I'm Aaron aman Updyke and.
Speaker 3: This is this podcast will kill You.
Speaker 1: Welcome to today's episode. It's all about maggots.
Speaker 3: It's going to be so much fun. And what makes
Speaker 3: it even more fun is that this is kind of
Speaker 3: like a two parter. It is, Yeah, it's like companion pieces.
Speaker 1: It was originally intended as a two parter that we
Speaker 1: realized was really two companion pieces because who knew there
Speaker 1: was so much to love about both maggots and next
Speaker 1: week's stars.
Speaker 3: Leeches leeches, I mean, and like, I think the connection
Speaker 3: will become fairly clear as when we get through these.
Speaker 3: But basically, these are two organisms that carry with them
Speaker 3: a certain dick or yuck factor. Major They have been
Speaker 3: used in medicine for centuries, thousands of years even, and
Speaker 3: have kind of recently experienced a resurgence and popularity, and
Speaker 3: I just there are so many amazing things about them.
Speaker 3: So yeah, it's gonna be really fun.
Speaker 1: It's really gonna be a fun episode. Next week's also
Speaker 1: going to be so much fun. I'm thrilled. I just
Speaker 1: I learned so much researching for this, and like, ugh.
Speaker 3: Maggots, maggots who knew a lot of people, A lot of.
Speaker 2: People did and now and now we get to know too.
Speaker 3: But before we get into all of that good stuff
Speaker 3: about maggots, it's quarantine time. Is what are we drinking
Speaker 3: this week?
Speaker 2: We're drinking A Tale of two worms?
Speaker 3: Wait?
Speaker 2: That is oh my gosh, No, that is actually the title.
Speaker 3: That is the title. But I like, I made the
Speaker 3: quarantiney picture and the recipe as the best of both worms.
Speaker 2: No, did you really?
Speaker 3: Yes? I did. Let me pull it up. I sent
Speaker 3: it over to you, Aaron. How did I not even
Speaker 3: notice Aaron, best of both worms? Because that's how it
Speaker 3: was written down in my notebook, and so I was like,
Speaker 3: oh yeah, and it literally did not cross my my
Speaker 3: mem and I obviously I looked at all of your things,
Speaker 3: didn't even read the title.
Speaker 2: Mm hm cool.
Speaker 3: Okay, so we're drinking either. It's gonna be easy to change.
Speaker 3: I think we're drinking A Tale of two worms.
Speaker 1: A Tale of two worms. I love it because we're
Speaker 1: telling tales of these two squirmy worm things asterisk. We
Speaker 1: know that mackets are not worms. We're very well aware.
Speaker 3: Yeah, but a lot so like you know, colloquial spiders
Speaker 3: are bugs, that kind of thing, like we know the difference,
Speaker 3: but forgive us, oh bit. But in best of both worms,
Speaker 3: oh my god, in in a Tale of two worms,
Speaker 3: we have it's basically like fancy fruit punch with vodka
Speaker 3: and Fammi worms delicious.
Speaker 1: We'll post the full recipe for that quarantine as well
Speaker 1: as our non alcoholic Plussy burita on our website. This
Speaker 1: podcast will kill you dot com and on all of
Speaker 1: our social media channels.
Speaker 3: We will. If you're not already following us on our
Speaker 3: social media channels, you really should because we're having on
Speaker 3: some pretty cool content. You know. We've got some reels,
Speaker 3: we got normal posts.
Speaker 2: Normal posts.
Speaker 3: We we're on TikTok even, we're on TikTok even finally
Speaker 3: getting with the program right before it probably will be banned,
Speaker 3: but yep, you know, and check us out there. Also
Speaker 3: our website. Let's shout out our website, as we usually do.
Speaker 3: It's got some good stuff. It's got transcripts, it's got
Speaker 3: our bookshop dot org affiliate account, it's got our Goodreads list,
Speaker 3: it's got all this. Verses for all of our episodes.
Speaker 3: Links to merch links to music by Bloodmobile, links to Patreon,
Speaker 3: links to a form where you can submit your first
Speaker 3: hand account, which is plasome. We get so many incredible
Speaker 3: people who share their stories with us that we cannot
Speaker 3: think enough, and so if you're interested in sharing a
Speaker 3: story or have a request for a particular topic, please
Speaker 3: reach out to us.
Speaker 1: Well with that, shall we get into this episode all
Speaker 1: about maggots.
Speaker 3: Let's do it right after this break.
Speaker 1: I have to start out just by giving a huge
Speaker 1: shout out to the pretty much only source that I
Speaker 1: used for this biology section of maggots, which was a paper,
Speaker 1: except I think it's more like a book, a compendium,
Speaker 1: a book called The Complete Guide to Maggot Therapy, Clinical Practice,
Speaker 1: therapeutic Principles, production, distribution, and ethics.
Speaker 2: When they say complete.
Speaker 3: That is as complete as it gets.
Speaker 1: It was such a gem to read. I love it
Speaker 1: so much, and I loved it so much that I
Speaker 1: actually want to start off with a beautiful line from.
Speaker 2: The introduction chapter. Are you ready for this?
Speaker 3: I think so.
Speaker 2: Quote.
Speaker 1: The human body is fragile, and therefore wounds acute and
Speaker 1: chronic have always been part of the human condition since
Speaker 1: time immemorial. Likewise, flies have evolved to exploit during development
Speaker 1: the ephemeral cadavers and wounds of living animals. Humans included
Speaker 1: ephemeral cadavers.
Speaker 3: Beautiful.
Speaker 1: Loved it so flowery. I don't get to read things
Speaker 1: like that very often this podcast. So I want to
Speaker 1: start off, I mean I already started off, but let's first.
Speaker 1: I want to talk about chronic wounds because they're a
Speaker 1: really important part of the Maggot story.
Speaker 2: Chronic wounds.
Speaker 1: The idea of a chronic wound is simply a wound
Speaker 1: that doesn't heal along a typical trajectory, and so you
Speaker 1: see this a lot in medicine, and there's not necessarily
Speaker 1: one specific timeframe on like when you would consider a
Speaker 1: wound chronic versus acute or something like that. But generally,
Speaker 1: chronic wounds can be present for months to years, and
Speaker 1: if something isn't done, some kind of wound care to
Speaker 1: help chronic wounds heal, they can persist for years or
Speaker 1: decades and be very debilitating physically, mentally, emotionally. They can
Speaker 1: lead to a lot of complications down the line. So
Speaker 1: why chronic wounds? Why are these important? Chronic wounds often
Speaker 1: have a significant amount of necrotic or dead tissue that
Speaker 1: covers them, and in order for them to heal, part
Speaker 1: of the wound care process is that they have to
Speaker 1: be debrided, meaning that the necrotic tissue has to be
Speaker 1: removed all the way down to a layer of more
Speaker 1: well vascularized like healthy bleeding tissue what was described in
Speaker 1: the first hand account as that granulation tissue. That granulation
Speaker 1: tissue is our bodies healing from the bottom up, which
Speaker 1: is actually how wounds heal. So how can we accomplish
Speaker 1: this process, like what does wound care entail? That is
Speaker 1: where we can enter maggots sometimes, So maggot for anyone
Speaker 1: who is uninitiated, is a colloquial term for the larvae
Speaker 1: of flies flies large group obviously Holometabolis insects, so their
Speaker 1: larva look nothing like the adult they have to pupate,
Speaker 1: they rearrange their whole body. Caterpillars are butterfly larva, grubs,
Speaker 1: beetle larva, maggots, fly larva. But flies are a huge, huge,
Speaker 1: huge order of insects that includes mosquitoes, houseflies, horseflies. So
Speaker 1: when we say maggots, which is not like a scientific term,
Speaker 1: it's very much a colloquial term. We kind of specifically
Speaker 1: use that for the larva of flies that you probably
Speaker 1: think of when you think of the word fly. Does
Speaker 1: that make sense, Yeah, Okay, Like it's it's still a
Speaker 1: pretty general term, but it's like most of the flies
Speaker 1: that you look at it and you're like, that's a fly,
Speaker 1: they're larva.
Speaker 2: Are maggots.
Speaker 1: Okay, So the flies that we talk about in medicine,
Speaker 1: medicinal maggots generally are from the specific species Lucilla seracatta.
Speaker 1: I think is how you pronounce it. I tried really
Speaker 1: hard to look it up. But this is the common
Speaker 1: green bottlefly, and one other species Lucillia couprina, which is
Speaker 1: the Australian sheep blowfly. So both of these are blowfly species.
Speaker 1: They're actually kind of pretty. They're green. They're really shiny
Speaker 1: and metallic, and again they look like a fly, just green.
Speaker 3: Okay, I'm with the maggots.
Speaker 2: You're with me, Thank you. Good.
Speaker 1: The maggots themselves, if anyone hasn't had the pleasure of
Speaker 1: seeing maggots look like little wiggly grains of rice. Especially
Speaker 1: when they're in their first in star. They're pretty small
Speaker 1: and they just sort of wiggle around, and then as
Speaker 1: they molt through their various in stars, they get a
Speaker 1: little bit larger, and then you can tell that they
Speaker 1: have little segments on their bodies and they breathe through
Speaker 1: spiracles on their butts, so they bury their heads into
Speaker 1: wounds or decaying flesh, and they stick their butts out
Speaker 1: in order to breathe. So, when it comes to the
Speaker 1: use of maggots in medicine, and the reason that I
Speaker 1: talked about chronic wounds at the top is that the
Speaker 1: primary use of maggots is in the treatment of chronic wounds.
Speaker 1: Sometimes maggots can be used for other wounds or acute
Speaker 1: things like burns, but mostly they're used for chronic wounds.
Speaker 1: And in this capacity they have three incredible functions that
Speaker 1: I will get into in detail. First, they can help
Speaker 1: to remove that dead or necrotic tissue that prevents chronic
Speaker 1: wounds from healing. Two is that they help to control infection,
Speaker 1: which is a huge issue in chronic wounds. And three
Speaker 1: they actually promote wound healing.
Speaker 2: They're really cool.
Speaker 1: So how do they do all of these three amazing things?
Speaker 1: Like they are worm babies, Well, how do they do this?
Speaker 1: Blowfly larva. Maggots in the wild eat dead animal tissue.
Speaker 1: That is what they do, that is what they have
Speaker 1: evolved to do. So they will happily eat the necrotic
Speaker 1: or dead tissue on a wound like that part makes sense.
Speaker 1: They will eat dead tissue, any dead tissue that they
Speaker 1: can find. But there are a few things about these blowflies,
Speaker 1: especially the ones that we use in medicine, that make
Speaker 1: them especially good at wound debreaedment. First, maggots don't have
Speaker 1: any real mouthparts, so they can't bite you, they can't
Speaker 1: crush your flesh, they don't pierce you. Instead, they rely
Speaker 1: on what's called extra corporeal digestion.
Speaker 2: It's one of my new favorite.
Speaker 1: Phrases, yeah, meaning that they are secreting a whole bunch
Speaker 1: of digestive enzymes and antimicrobial substances. They're spinning it out out,
Speaker 1: they're letting that flow over their food, which, if it's
Speaker 1: a chronic wound, is your wound. And then they have
Speaker 1: these two little mouth hooks that they use to kind
Speaker 1: of separate out their food bits. And they also use
Speaker 1: these hooks to crawl their little bodies around. That's how
Speaker 1: they crawl around, and this helps to those digestive enzymes
Speaker 1: that they've secreted out to penetrate deeper into the surface
Speaker 1: of the tissue that they're digesting. And then they suck
Speaker 1: up that juice and that's what they eat, which allows
Speaker 1: them to grow. Also, this way of feeding this extra corpse.
Speaker 1: I'm so excited I can't pause for a question yet.
Speaker 1: But this way of feeding helps their neighbors as well,
Speaker 1: because all of the maggots in a group will combine resources,
Speaker 1: combine all of those digestive enzymes, which increases the efficiency
Speaker 1: in large populations.
Speaker 3: Okay, I have so many thoughts. That is amazing. I
Speaker 3: assume at a certain point our resources limit to when
Speaker 3: then it's like not helpful if they run out of
Speaker 3: tissue or whatever to eat. Yes, okay, so.
Speaker 1: Yeah, so they are very efficient at just finding that
Speaker 1: necrotic tissue for the most part. And we'll get into
Speaker 1: like there could be complications, but yes, they are going
Speaker 1: to find like the most necrotic tissue and that is
Speaker 1: what they are going to specialize on for the most part.
Speaker 1: And then when they're done, they're going to leave. They're
Speaker 1: going to go someplace new. Right, So, on a chronic
Speaker 1: wound that's full of dead tissue, they are secreting these
Speaker 1: enzymes that are literally digesting it, which is a form
Speaker 1: of chemical debreedment. Right, So that's the first way that
Speaker 1: they're debrading it. But on top of that, their little
Speaker 1: mouth hooks are also helping to break up that dead tissue,
Speaker 1: so they're also doing physical debreedment, and not passive the
Speaker 1: way that like a piece of gauze with bleach sits
Speaker 1: on the surface and does a chemical debridement, and then
Speaker 1: when you pull that gauze off, it's going to have
Speaker 1: some kind of physical debreatment. But these are active, live
Speaker 1: maggots who, like you said, erin, are seeking out the deepest,
Speaker 1: most necrotic tissue because that's the areas of greatest food
Speaker 1: for them. So they are incredibly efficient at this debreatment process.
Speaker 3: Do we know what chemicals and enzymes and what's in
Speaker 3: their secretions? Can we mimic it? Would we want to
Speaker 3: ever mimic it?
Speaker 2: It's a great, great question.
Speaker 1: I feel like that is one of the big questions
Speaker 1: about so many of the things with maggots and with leeches,
Speaker 1: like we'll talk about later. We know some of the compounds,
Speaker 1: A lot of them are like proteolytic enzymes and a
Speaker 1: bunch of other things as well too. There certainly are
Speaker 1: compounds that we have that we might use that are
Speaker 1: very similar. But as we'll see, it's like it's a combination, right,
Speaker 1: Like it isn't just the chemicals that they're secreting. It's
Speaker 1: also the way that they're moving. It's their mouth parts
Speaker 1: doing the things that they're doing. It's them scooting their
Speaker 1: bodies along. So yes, it is possible, and I think
Speaker 1: we'll talk a lot more about that idea of like
Speaker 1: can we identify these specific compounds and can we mimic them.
Speaker 3: Well, it's also like just the removal process, like you said,
Speaker 3: like it's not just dissolving, yeah or whatever.
Speaker 4: Sucking it up too, They're amazing, but that's not all.
Speaker 2: That's like not even close to all.
Speaker 1: So maggots because in the wild they're feeding on this
Speaker 1: decaying tissue that's just ripe with other organisms like bacteria,
Speaker 1: but also viruses, protozoans, other bugs like everything.
Speaker 2: So it makes.
Speaker 1: Sense that they would have also evolved ways to thrive
Speaker 1: in an environment that is chalk full of other microbes, right,
Speaker 1: ways of either outcompeting for food or making sure or
Speaker 1: and I guess making sure that they don't get infected
Speaker 1: with all of the other microorganisms that are around. And
Speaker 1: they do exactly that. Maggots secrete not just these enzymes
Speaker 1: that are breaking down tissue, but a whole host of
Speaker 1: anti microbial compounds that in studies have been shown to
Speaker 1: be active against things like staff and strep, which are
Speaker 1: really common skin flora, and interestingly, they're less effective perhaps
Speaker 1: against other types of bacteria which might be less common
Speaker 1: to be found on decaying carcasses. But on top of that,
Speaker 1: they're also eating a whole bunch of these microbes that
Speaker 1: could potentially be infecting a wound, so they're disinfecting the wound.
Speaker 1: They're controlling the infection of chronic wounds, and their little
Speaker 1: mouth hooks help to disrupt biofilm formation and biofilms win
Speaker 1: bacteria are able to like latch on and form a
Speaker 1: biofilm on top of a chronic wound. That is very
Speaker 1: difficult to deal with. And maggots are great at it.
Speaker 1: And if that wasn't enough, you're not yet convinced, listeners,
Speaker 1: because Aaron, I know you are. I'm sure that maggots
Speaker 1: are just like the bee's knees when it comes to
Speaker 1: wound healing. They literally help promote the healing of wounds.
Speaker 1: How So, wounds in many studies that have been treated
Speaker 1: with maggot therapy heal faster than wounds not treated with
Speaker 1: maggot therapy. So let's talk a little bit about what
Speaker 1: that means, Like, how do wounds actually heal. There's three
Speaker 1: major phases of wound healing. There's inflammation, proliferation like of
Speaker 1: the tissue, and then maturation. Chronic wounds, the type that
Speaker 1: are really like good for maggot therapy, are usually stuck
Speaker 1: in an inflammatory state, like they're stuck there and they
Speaker 1: just can't progress because of the necrotic tissue, because of bacteria,
Speaker 1: because of a whole bunch of stuff. Some of the
Speaker 1: secretions from magots act to inhibit this inflammation and that
Speaker 1: helps the wound to actually progress further through the stages
Speaker 1: of healing. And some of these compounds also seem to
Speaker 1: help to stimulate angiogenesis. Angiogenesis is the process of which
Speaker 1: we make new blood vessels so that you can get
Speaker 1: more oxygen to a wound, which, by the way, is
Speaker 1: how hyperbaric oxygen therapy works to help here wounds. And
Speaker 1: so this combination of things also helps to actually speed
Speaker 1: along the process of wound healing. So it's just amazing
Speaker 1: that maggots can do all of this.
Speaker 3: Yeah, why why do those things help wound? Like not why?
Speaker 3: But do you know what I mean, why, yeah, why not?
Speaker 2: Why? But also why that's all.
Speaker 1: I had the same thought, especially the idea that like,
Speaker 1: why would they be anti inflammatory?
Speaker 2: Because if a lot of what they are.
Speaker 1: Feeding on is like dead necrotic tissue in my brain,
Speaker 1: I wouldn't expect for there to necessarily be a lot
Speaker 1: of inflammation. But it seems like a lot of it
Speaker 1: is that they reduce some of the pro inflammatory cytokinds
Speaker 1: that we have circulating and reactive oxygen species. And reactive
Speaker 1: oxygen is something that definitely is present in the environment
Speaker 1: when cells start to lice, which is what's going to
Speaker 1: happen during necrosis and as something is decaying. So in
Speaker 1: that way, it kind of makes sense that it's to
Speaker 1: protect themselves, they're reducing reactive oxygen species. That's my best
Speaker 1: I didn't read that directly, but that's my best way
Speaker 1: of understanding it.
Speaker 3: Okay, can I ask some questions?
Speaker 1: Absolutely, Aaron, please, I have like two more pages of
Speaker 1: info I thought you might ask me questions about.
Speaker 3: Okay, let's stay if we can get through it now,
Speaker 3: I'm going to hit all those paragraphs. Yeah, okay, So
Speaker 3: when is maggot therapy indicated and when is it not.
Speaker 1: So that's a really good question. Chronic wounds is a
Speaker 1: very broad category. There's lots of different things that cause
Speaker 1: chronic wounds. There's lots of different types of chronic wounds.
Speaker 1: There isn't necessarily like one wound that is like, oh,
Speaker 1: definitely use maggots for this, and other wounds that you're like, ooh,
Speaker 1: never use maggots for this. In general, maggots are really
Speaker 1: safe to use for most all types of wounds, but
Speaker 1: any wounds that have a lot of necrotic tissue, like
Speaker 1: that dead tissue, anything that looks black on top is necrotic,
Speaker 1: that is going to be an especially good wound for
Speaker 1: maggots to be able.
Speaker 2: To be helpful for.
Speaker 1: They can be helpful in things like burns which need
Speaker 1: to breeding right away and in a pretty like gentle
Speaker 1: kind of way. And they're very helpful for any anything
Speaker 1: that's like difficult to reach or difficult to visualize, because
Speaker 1: they are going to crawl their way into nooks and
Speaker 1: crannies but then always come back up to the surface,
Speaker 1: either because they run out of food or because they
Speaker 1: need air, or because they're done growing and they need
Speaker 1: to mold. So really, like any type of skin and
Speaker 1: soft tissue wound could be amenable to maggot therapy, less
Speaker 1: so for things like bone and tendons and ligaments, just
Speaker 1: because all of these things that are so great about
Speaker 1: maggots don't work as well on those types of tissues.
Speaker 3: Interesting, okay, but.
Speaker 1: They're still not used as much as you would think.
Speaker 2: Given all of the benefits that I just mentioned.
Speaker 3: Yeah, So, like how many hospitals have a maggot colony.
Speaker 2: It's a great question. I have no idea.
Speaker 1: Okay, I think most hospitals probably have access to them
Speaker 1: in some capacity. I know when I have rotated through
Speaker 1: wound care they do use them sometimes, but in general
Speaker 1: they use them very often as kind of like a
Speaker 1: last resort rather than like a first line therapy, which I.
Speaker 2: Find really interesting.
Speaker 3: Is that just the ick factor.
Speaker 1: I think that's a big part of it. There's definitely
Speaker 1: a lot of research on like what is preventing people
Speaker 1: from using maggot therapy, and a lot of it comes
Speaker 1: back to either education, not knowing how great they can be,
Speaker 1: not knowing that they're effective, and like, yeah, the yuck factory,
Speaker 1: interestingly more for practitioners than patients, which I think is very.
Speaker 3: Interesting that is really interesting. Yeah, yeah, okay. Let's say
Speaker 3: that you go in, you have a wound, and your
Speaker 3: physicians like, we think that maggot therapy is the right
Speaker 3: call here, and you say, yes, I consent to this
Speaker 3: because I assume there's like consent involved in magot therapy
Speaker 3: and like sort of this is so, then what happens next?
Speaker 3: What can you expect to happen?
Speaker 2: So this is such a good question.
Speaker 1: So generally with they'll do is they'll take five to
Speaker 1: ten maggots per square centimeter of area that you need
Speaker 1: wound a breadment on.
Speaker 3: Oh, that's so many maggots, okay, is it?
Speaker 2: They're quite small.
Speaker 3: I know, I just just jam packing them in there.
Speaker 1: Just yeah, you want them to be efficient, and then
Speaker 1: you basically put them on the wound. There's two different
Speaker 1: ways to do this. Sometimes you just put them all
Speaker 1: in a little baggie that they can't escape from, and
Speaker 1: put that baggie on the wound and then kind of
Speaker 1: tape it on, and that way you know for sure
Speaker 1: they can't wander off, and when you're done, you literally
Speaker 1: just pick up the bag and toss them. The other option,
Speaker 1: and that's great, especially if you're like I don't want
Speaker 1: to touch the maggots, like you're not really ever coming
Speaker 1: in direct contact with individual maggots. But they're much less
Speaker 1: efficient that way because they're not going to be able
Speaker 1: to wander all the way to the edges. You have
Speaker 1: to make sure, you know. It's just a little less efficient.
Speaker 1: So the other way is taking individual maggots and usually
Speaker 1: putting them in like a gauze or something, but just
Speaker 1: not a closed system, putting them onto the wound, and
Speaker 1: then enclosing the edges of that wound, so making sure
Speaker 1: that they can't just escape from and go wherever wander off.
Speaker 1: And then you leave them on for a couple of
Speaker 1: days in both cases, usually forty eight to seventy two hours,
Speaker 1: maybe a little more depending on the area and things
Speaker 1: like that. And then you take them off and you
Speaker 1: see what it looks like, and if you need another
Speaker 1: round or a few other rounds, you may or you
Speaker 1: may not.
Speaker 2: And that's it.
Speaker 3: What happens to the maggots after they're full, their lives
Speaker 3: have been sacrificed.
Speaker 1: Yeah, they're done, Okay, okay, thank you for giving your
Speaker 1: lives and service of wound healing.
Speaker 3: Of wound healing.
Speaker 2: Yeah, and I.
Speaker 1: Should also mention that the maggots used for medicinal therapy
Speaker 1: are like grown in a lab, they're sterilized. They're like,
Speaker 1: this is a very rigorous it is an FDA regulated
Speaker 1: process in the US and in most of their countries
Speaker 1: it's regulated by some capacity.
Speaker 3: How does maggot therapy use very globally?
Speaker 2: Oh, great question.
Speaker 1: I don't know, and I don't think that we have
Speaker 1: a good sense of it in all honesty from what
Speaker 1: I read. It's not like I just failed to look
Speaker 1: for it. It's just that we don't really have a
Speaker 1: great sense of.
Speaker 2: Like it is a great option. It's not.
Speaker 1: It's not accessible everywhere necessarily. It's probably used in some
Speaker 1: places in different ways. So, yeah, we don't have a
Speaker 1: good sense of like numbers globally.
Speaker 3: Okay. So one of the things that I came across
Speaker 3: in the history of maggots and their use for medicinal
Speaker 3: purposes was that they began to realize pretty quickly in
Speaker 3: the twentieth century. After centuries and millennia of using maggots,
Speaker 3: they were like, oh, we need to have an entomologist
Speaker 3: on hand who can distinguish between the different types of flies,
Speaker 3: because not all flies create the type of maggots that
Speaker 3: will just eat necrotic tissue.
Speaker 1: Correct, Yes, so that that is very true. So the
Speaker 1: types of maggots used for wound care are a couple
Speaker 1: of very specific species. Maggots in wound care is not
Speaker 1: the same thing as maggots infesting open wounds or parasitizing
Speaker 1: healthy flesh. So the technical name for that process is myiasis,
Speaker 1: which is being parasitized by fly larva, either by healthy
Speaker 1: flesh or open wounds, and that can be a very
Speaker 1: serious health problem, both for animals and for humans. And
Speaker 1: that is could be from a few different reasons. It
Speaker 1: could be the right kind of like blowflies, but too
Speaker 1: many of them, because once they start replicating right like,
Speaker 1: they grow into adults and then they lay more eggs
Speaker 1: and then that infection can get out of control pretty quickly.
Speaker 1: Or it could be that it's the wrong type. There's
Speaker 1: so literally hundreds of thousands species of flies, many of
Speaker 1: which love to eat flesh. That's what they do, and
Speaker 1: so in those cases it is very dangerous to have
Speaker 1: a maggot that's infesting a wound. This is in a
Speaker 1: medical setting, very different. Okay, we also use blowflies for forensics,
Speaker 1: just tuk it out there. So Aaron, yeah, I know
Speaker 1: that historically this is not all the maggots were used for.
Speaker 2: So please, can you tell me about how we got
Speaker 2: to this point?
Speaker 3: Can't wait? Oh, let's just take a quick break and
Speaker 3: then I'll get into it. Ancient remedies are one of
Speaker 3: the staples of our podcast so much. We bring these
Speaker 3: up all the time, right, Like, I think Rabies featured
Speaker 3: a lot of these, and when we talk about these,
Speaker 3: when we bring up these examples, I think it's pretty
Speaker 3: easy to think, Oh, my gosh, how absurd. Can you
Speaker 3: believe people ever thought that the ashes of a shrew's
Speaker 3: tail applied to the bite of a rabid dog would
Speaker 3: do anything. We are so guilty of that too, Like, totally, totally,
Speaker 3: because from our perspective in the twenty first century, we
Speaker 3: know that rabies is caused by a virus and that
Speaker 3: there's no effective treatment, and we feel smugly superior to
Speaker 3: those foolish ideas of the past. But and this is
Speaker 3: something that I think that we've gained more of an
Speaker 3: appreciation for over the course of making this podcast. That attitude,
Speaker 3: that superior attitude, ignores two crucial things, the first one
Speaker 3: being that yes, many ancient remedies show little to no
Speaker 3: efficacy in what they were intended to treat, but many
Speaker 3: others do and have just been rebranded as modern medical advancements,
Speaker 3: like digitalis or aspirin, even without their long history and
Speaker 3: early use acknowledged. And the second thing that is ignored
Speaker 3: is that we're in the same boat with medicine today.
Speaker 3: We may have better methods of testing efficacy and safety,
Speaker 3: but it's really arrogant to think that we're at the
Speaker 3: pinnacle of medical knowledge and that our ideas and cures
Speaker 3: today won't face similar ridicule in the future. And so
Speaker 3: this is my call, maybe especially for myself but broadly too,
Speaker 3: to eat some humble pie and consider what these cures
Speaker 3: have to offer us today, whether that's an insight into
Speaker 3: the past or novel and effective treatments for today. Let's
Speaker 3: start with maggots.
Speaker 2: I love it.
Speaker 3: There is this unavoidable yuck factor that we've talked about
Speaker 3: when it comes to maggots, and it's for a good reason.
Speaker 3: The places that we're likely to encounter maggots are things
Speaker 3: like decomposing carcasses, rotting food, things that can make us
Speaker 3: sick if we get too close and maggots, along with
Speaker 3: the stench of rot, provide a pretty good signal to
Speaker 3: stay away.
Speaker 2: Peace out, yep.
Speaker 3: But these delightfully disgusting habitat preferences of flies and their
Speaker 3: larvae have been harnessed by humans for millennia. As you
Speaker 3: talked about Aaron, the larvae of some fly species are
Speaker 3: amazing at discerning healthy from dead tissue and just taking
Speaker 3: care of business to cob by eating that dead tissue.
Speaker 3: And it turns out that larval therapy or biosurgery as
Speaker 3: I saw it, rebranded biotherapy. Okay, uhh, It has been
Speaker 3: used for a really long time around the world. There's
Speaker 3: evidence that the Neampar people of New South Wales used
Speaker 3: larval therapy, as did certain ethnic groups in the hilly
Speaker 3: regions of Myanmar and Mayan healers in Central America. And
Speaker 3: I don't really think it's a huge stretch to imagine
Speaker 3: how people first came up with using larvae from flies
Speaker 3: to treat wounds. Like you have a wound, it begins
Speaker 3: to fester, the right flies lay eggs in that wound.
Speaker 3: Larvae hatch, they begin feeding on the disease tissue. Your
Speaker 3: wound heels the larvae leave and hey, you know what,
Speaker 3: that worked better than expected. Right, I did not expect this,
Speaker 3: but he love it.
Speaker 2: But it worked out.
Speaker 3: It worked out.
Speaker 2: Try it again.
Speaker 3: We know that maggots have infested wounds since ancient times
Speaker 3: because it's what they do. But if you want written proof,
Speaker 3: I've got some in the form of some old Testament goodness.
Speaker 3: So this is from the Book of Job. My body
Speaker 3: is clothed with worms and scabs. My skin is broken
Speaker 3: and festering. End quote. That's myiasis, right, it's not.
Speaker 2: Yeah, my isis sounds like it. Yeah, sounds like not the.
Speaker 3: Good worms, not the good worms. Yeah, my body is
Speaker 3: clothed with worms. It sounds really painful and miserable. Yeah.
Speaker 3: But in terms of ancient medical texts mentioning larval therapy,
Speaker 3: I didn't really come across any specifically interesting. And the
Speaker 3: first written mentions of using maggots to treat wounds comes
Speaker 3: from the fifteen hundreds, and again we know that it
Speaker 3: goes much further back across the globe. And so this
Speaker 3: is sort of like what I would say the first
Speaker 3: documented rediscovery of the practice, or like reclaiming as like,
Speaker 3: oh wow, I came up with this great idea. Amvois
Speaker 3: pare the famous French surgeon who I've definitely mentioned on
Speaker 3: the podcast before I have I have Aaron, I just
Speaker 3: don't know why. So he used maggots and treating wounds
Speaker 3: in the mid fifteen hundreds, especially on the battlefield. It
Speaker 3: seems like he came across it accidentally, kind of like
Speaker 3: in the first hand account, one of his patients had
Speaker 3: a really deep head wound where months later, months later,
Speaker 3: Aaron a quote, large number of maggots emerged from the wound,
Speaker 3: and Parey thought it could be the end for that
Speaker 3: patient because he had seen other times where maggots had
Speaker 3: just destroyed tissue. But apparently these were more discriminating maggots
Speaker 3: eating only dead tissue, and the person recovered. He lost
Speaker 3: a chunk of bone the size of a hand, but
Speaker 3: he recovered. Wow, Yeah, I don't know how, but he did.
Speaker 3: And so after this, Piret would occasionally use maggot therapy.
Speaker 3: Then fast forward a little over two hundred years and
Speaker 3: another French surgeon on another battlefield, this time Napoleon's army
Speaker 3: in Syria would also recognize the benefits of maggots. Baron
Speaker 3: Dominique Jean Laarat wrote about maggots of the quote unquote bluefly,
Speaker 3: removing dead tissue and helping to clean wounds. Quote. They
Speaker 3: are produced in a few hours and increase with such
Speaker 3: rapidity that in the course of a night they grow
Speaker 3: to the size of the barrel of a small quill.
Speaker 3: Although these insects were troublesome, they expedited the healing of
Speaker 3: the wounds by shortening the work of nature and causing
Speaker 3: the sloughs to fall off end quote.
Speaker 2: I love that. Wow.
Speaker 3: And an about sixty years after that, in the eighteen sixties,
Speaker 3: yet another war, this time the American Civil War, would
Speaker 3: provide yet another opportunity for someone to test out maggot therapy.
Speaker 3: Maryland surgeon John Forney Zacharias wrote, quote during my in
Speaker 3: the hospital at Danville, Virginia, I first used maggots to
Speaker 3: remove the decayed tissue in hospital Gangreen, and with eminent satisfaction.
Speaker 3: In a single day, they would clean a wound much
Speaker 3: better than any agents we had at our command. I
Speaker 3: used them afterwards at various places. I am sure I
Speaker 3: saved many lives by their use, escaped septocemia, and had
Speaker 3: rapid recoveries. End quote Wow, I mean ringing endorsement, and
Speaker 3: there was another Civil war doctor who also saw the
Speaker 3: benefits of maggots, but by and large, any pro maggot
Speaker 3: physician was absolutely in the minority during this time, and
Speaker 3: that minority would shrink to basically non existent once germ
Speaker 3: theory came about, because this concept made it very clear
Speaker 3: that wounds got infected from dirt or things that were dirty,
Speaker 3: and people definitely saw maggots as dirty and had for
Speaker 3: years forever. Maggots fell out of style from the mid
Speaker 3: eighteen hundreds until yet another war. Are you seeing a
Speaker 3: pattern here?
Speaker 2: Always always a war.
Speaker 3: World War One? And that's where our first hand account,
Speaker 3: of course, came from. That surgeon William Bhaer, was so
Speaker 3: impressed with those little friends that he went on to
Speaker 3: use them in non war conditions. But I just have
Speaker 3: to also add one little thing about the first hand account.
Speaker 3: So he pointed out that compound fractures of the femur
Speaker 3: at that time of that first hand account, which one
Speaker 3: of those people had led to death in about seventy
Speaker 3: five to eighty percent of cases, even with all of
Speaker 3: the care that could be provided, and that person lived.
Speaker 2: Wow.
Speaker 3: So again like pretty convincing. I would be convinced. I
Speaker 3: am convinced. And this is a quote from him once
Speaker 3: he began to use these maggots in non war times.
Speaker 3: Quote in September night, eighteen twenty eight, there were four
Speaker 3: cases of children that came into the hospital, each one
Speaker 3: of whom had been operated upon three or four times,
Speaker 3: and treatment had covered a period of from one to
Speaker 3: five years. Being baffled in their cure by the means
Speaker 3: usually employed, I thought it was time to put into
Speaker 3: active use the observation with a capital O, I might add,
Speaker 3: that I had made on the battlefield. We therefore obtained
Speaker 3: the maggots from the blowfly from our immediate neighborhood, and
Speaker 3: without sterilization of the fly or maggot, we loaded the
Speaker 3: wound up with these maggots and proceeded to watch the results.
Speaker 3: At the end of about six weeks, the wounds had
Speaker 3: entirely healed, not only in the deeper structures, but even
Speaker 3: as to the skin end.
Speaker 2: Quote wow, wow, six weeks. Yeah, yeah, that's incredible.
Speaker 3: It's incredible. And also, just to put this in context too,
Speaker 3: this is prebiotics still, so even in nineteen twenty eight,
Speaker 3: like peniciline was not going to be widely available. For another,
Speaker 3: I think this is only when it was first beginning
Speaker 3: to be discovered, and then it was only in the
Speaker 3: forties that it was available. So anyway, clearly Bear was
Speaker 3: onto something something, but his methods needed some refining. I
Speaker 3: don't know if the.
Speaker 2: Phrase starting collect blowfly larvae.
Speaker 3: Exactly without sterilization, I don't know if that stuck out
Speaker 3: to you, But yeah, that was a problem. So one
Speaker 3: issue though that he had was that the blowflies he
Speaker 3: used were seasonal, and so he couldn't just go to
Speaker 3: his backyard or his neighborhood and get them like all
Speaker 3: during the year. These treatments he could only do in
Speaker 3: certain times of year. And secondly was the lack of sterilization. Unfortunately,
Speaker 3: some of these maggots came with hitchhikers in the form
Speaker 3: of clustridium, perfringenes and tetany Oh no, yeah, he added
Speaker 3: quote this was a rather disconcerting observation.
Speaker 2: Yeah. Yeah, that's a little bit of an understatement, certainly.
Speaker 3: Certainly. Fortunately he was able to get anti toxin tetanus
Speaker 3: anti tooxin into his patients and most who were infected survived.
Speaker 3: But he saw he was like, okay, we need to
Speaker 3: find a way to raise these maggots in a sterile
Speaker 3: environment if we're going to keep doing this, and that
Speaker 3: would also eliminate the problem of the flies not being
Speaker 3: available year round, because he could just have this breeding
Speaker 3: ground for maggots. And so he listed the help of
Speaker 3: some entomologists and they came to a solution, and that
Speaker 3: really helped maggot therapy to become quite popular in the
Speaker 3: US in the nineteen thirties and forties, with more than
Speaker 3: three hundred hospitals in the US introducing a maggot therapy program,
Speaker 3: which is kind of a like I just had no
Speaker 3: idea that it was so popular even then, you know, Yeah,
Speaker 3: but then they fell back out of style. It's like
Speaker 3: this waxing and waning, like extreme peaks and popularity. I mean, I.
Speaker 1: Feel like it makes sense though in that like there's
Speaker 1: always going to be that yuck factor, like you said,
Speaker 1: And it's also like as new it probably correlates with
Speaker 1: like new therapies, like oh, well, we have this new
Speaker 1: dressing or we have this new debreder or whatever it is.
Speaker 1: So then it's like we don't need maggots anymore. So
Speaker 1: they fall out of favor and things like that.
Speaker 4: Yeah.
Speaker 3: So the new medical development or technology in the nineteen
Speaker 3: forties was, of course antibiotics, and you know, and there
Speaker 3: is something like would you rather take antibiotics and have
Speaker 3: antiseptics and go through wound debreadment try that first and
Speaker 3: then go to maggots or would you rather just like,
Speaker 3: let's hit with maggots straight up right right now.
Speaker 4: Yeah.
Speaker 3: Some of the description are like you can hear them,
Speaker 3: depending on where the wound is, like you can hear
Speaker 3: them feeding. It's incredibly itchy, and there's like, yeah, this
Speaker 3: this net bandage that keeps them all in, but they're
Speaker 3: all there.
Speaker 1: That's all still, that's all still the case. Yeah, so
Speaker 1: there are definitely downsides to it, and it's also can
Speaker 1: be quite painful as well.
Speaker 3: Oh that makes sense, Okay, yeah, once they get like
Speaker 3: closer to the living tissue.
Speaker 1: And I think too, just like because they're using their
Speaker 1: mouth hooks to kind of help break things up. I
Speaker 1: think that process it's usually not painful right away, but
Speaker 1: like after that first like twenty four hours or so,
Speaker 1: it can be. So yeah, okay, downsides, pros cons.
Speaker 3: It's a mixed bag, as most things in life are
Speaker 3: trade offs, right, but Yeah. So once once the nineteen
Speaker 3: forties came about and antibiotics were available, larval therapy fell
Speaker 3: out of favor. It still was you used here and there,
Speaker 3: but largely was forgotten. I found a paper by a
Speaker 3: researcher named Milton Wainwright that was published in nineteen eighty
Speaker 3: eight where he writes, quote, fortunately, maggot therapy is now
Speaker 3: relegated to a historical backwater of interest, more for its
Speaker 3: bizarre nature than its effect on the course of medical
Speaker 3: science end quote. But he spoke too soon.
Speaker 2: Yeah, didn't age well.
Speaker 3: It did not age well because as this paper was
Speaker 3: going to press with the first line stating, quote, the
Speaker 3: conquest of bacterial infection has been one of the major
Speaker 3: triumphs of modern medicine end quote. Yeah. As this paper
Speaker 3: was published, antibiotic resistance was on the rise, had been
Speaker 3: on the rise for a long time, and some physicians
Speaker 3: and surgeons were resorting back to the old ways to
Speaker 3: treat those stubborn infected wounds that just didn't seem to
Speaker 3: be able to heal. In the nineteen nineties, maggot therapy,
Speaker 3: rebranded in some cases as biotherapy, experienced yet another renaissance,
Speaker 3: this time backed by clinical trials and data that supported
Speaker 3: what amazing healing properties these little guys have. And I
Speaker 3: feel like there's just like this good lesson in maggot therapy.
Speaker 3: It reminds me a kind of like fecal transplants or
Speaker 3: a phage therapy. It's like, sometimes the solution is already there,
Speaker 3: but we need to challenge ourselves to think more outside
Speaker 3: the box. I don't know, but that's what I've got
Speaker 3: for maggots.
Speaker 2: I love it, Aaron, I love it so much too.
Speaker 2: So should we do sources?
Speaker 3: We should? Okay, let me pull up. I have a
Speaker 3: lot I'm going to shout out too. In particular, one
Speaker 3: is by Whittaker at All from two thousand and seven
Speaker 3: titled Larval Therapy from Antiquity to the present Day, Mechanisms
Speaker 3: of Action, clinical applications and Future Potential. And then there's
Speaker 3: a paper from two thousand by Sherman, Hall and Thomas
Speaker 3: titled Medicinal maggots An Ancient Remedy for some contemporary afflictions.
Speaker 2: Excellent.
Speaker 1: I had shockingly like essentially one which has never happened
Speaker 1: to me, but it really was so comprehensive. And that
Speaker 1: was the volume edited by Statler from twenty twenty two
Speaker 1: titled a Complete Guide to Maggot Therapy, Clinical Practice, therapeutic principles, production,
Speaker 1: distribution and ethics. Literally such a fun read. Had a
Speaker 1: couple of other papers. We'll post the list of all
Speaker 1: of the sources from this episode and every single one
Speaker 1: of our episodes on our website, this podcast with kill
Speaker 1: you dot Com under the episodes tab.
Speaker 3: We certainly will a big thank you to Bloodmobile for
Speaker 3: providing the music for this episode and all of our episodes.
Speaker 1: Thank you to Tom Bryfogel and Leona Scolacci for the
Speaker 1: incredible add you.
Speaker 3: Mixing, Thank you to exactly Right.
Speaker 1: And thank you so much to you listeners. We hope
Speaker 1: that you had as much fun as we did this week,
Speaker 1: and get ready because next week is going to be awesome.
Speaker 3: Oh my gosh, it is, and honestly like if you
Speaker 3: stuck with it the whole way, props. And also I
Speaker 3: hope that you gained a new appreciation for maggots right,
Speaker 3: They're kind of cool.
Speaker 2: They're very cool.
Speaker 3: And a big thank you, of course to our lovely, generous,
Speaker 3: wonderful patrons. Your support means the world to us.
Speaker 2: Thank you, thank you, thank you, thank you
Speaker 3: Well until next time wash your hands, you feel the
Speaker 3: animals u