Gangrene is a nasty way to go. There being lots of nasty ways to go but given much of the photographic evidence, gangrene is particularly nasty. Gangrene itself is a type of necrosis; a form of cell injury which results in the premature death of cells in living tissue. This can be caused by toxins, infection, or in the case of poor old McKinley, as a result of lead shot in the gut courtesy of a unhinged anarchist. Indeed necrosis can come about as a result of any chronic health issue that affects blood circulation. Diabetes, as you might imagine – so too smoking – is a dark hand behind many of modern day gangrene statistics, much to the chagrin of the aforementioned health czars. The good news for those who neither smoke nor guzzle high fructose corn syrup is that you can’t catch gangrene. It doesn’t spread from bod to bod.
Now the treatment of gangrene, if the antibiotics have let it get out of hand involves the removal of all the affected tissue in order to stop it spreading. This can be done via surgery which, as it may infer, is often most effectively done by the lopping off of limbs. In the US, there are about forty thousand amputations each year, a number – given the trajectory of Type-2 diabetes – that is expected to double by 2050, according to some ashen faced health group. Good news for surgeons, not so good for Nike. There is though, another option, one which needs a bit of chutzpah. Maggots. Otherwise known as maggot therapy.
A maggot is the lava of a fly. A fly such as the house fly, cheese fly or blow fly. Be careful though, the term maggot is not a technical one, and does not appear in many standard textbooks of entomology. That said, they are tough. They are difficult to kill. Boiling? No good. A pish-pish of some fly spray? Pathetic. If you want to get rid of maggots, you need to squash them, stand one them, jump up and down; or if that fails, put them in the freezer next to the lamb chops. They do though, despite their unsightly appearance and rugged disposition, do a lot of good across ecology and medicine. When it comes to gangrene then, a big bag of maggots is often, just what the Doctor ordered. Quite literally. In 2004 the U.S Food and Drug Administration, the FDA, gave the big thump-thump of an official stamp to the production and marketing of live maggots for use in humans, much to the disappointment to the weekend angler, who had previously sewed up the demand side of the market for a bag of live maggots.
History, though, is alive with descriptions of the use of maggots in wound treatment.
Amidst the blood and mud, and cold and shrapnel and all the other ghastly aspects of World War 1, Dr William S. Baer – an orthopedic surgeon – had the remarkable nous to recognize the effectiveness of maggot colonization in healing wounds. One day, struggling to keep the front line alive, in on a stretcher came a soldier who had been left for dead on no man’s land. Despite a couple of nights out in the mud and guts, he was still alive. On examination, despite having a compound fracture of the femur – an injury that came with an 80% death rate – in addition to some nasty flesh wounds to the abdomen and the, umm, scrotum, the soldier had no trace of a fever. None whatsoever. His interest piqued, Dr. Baer asked the nurse to cut off his clothes which she duly did. When the soldier’s clothes were removed those close enough gulped, for his body was covered in maggots. Thousands and thousands of maggots. To Dr. Baer’s surprise, when the maggots were removed – and I quote his diary – “the surrounding parts were covered with the most beautiful pink tissue one could imagine”. But then, given Dr Baer was on the front line of the Great War, perhaps it was a relative call. It is not recorded what the nurse said.
Dr. Baer should have read his history books though. Back in the American civil war, medical officers had long since encouraged the therapeutic use of maggots; they being the most effective agents they had at cleaning out a wound. That the other agents at hand were oily rags and whisky perhaps made it an easy contest for the maggots. They did though save many lives. Go back further still, and the use of maggots can be traced to antiquity, in many of the etchings of North American and Aborginal tribes. Maggots have been good news for a very long time.
Why maggots are good news is that they basically love a bit of dead flesh. Or any sort of dead tissue. What they do, is nibble it. And nibble it in a manner that is way, way more effective a method of removal that can be achieved by conventional surgery. They can clean up a wound in just a couple of days. You do though have to get your maggots right. Some maggots feed on dead tissue, but some too like bit of the live stuff. For maggot therapy, you want a blow fly, or if you really want to get into the knitting, the lucilla sericata, which is the most well-known – perhaps in certain circles – of the numerous green bottle fly species. Slightly bigger than your irritating house fly, it has a brilliant, metallic, blue-green or golden colour, so looks good too. As much as flies can look good.
And that’s maggots for you. Good for catching a bit of perch, good for staving off a run of gangrene.
“Things are not always as they seem; the first appearance deceives many” –Phaedrus. Although presumably not with maggots in mind.