‘Maggot Therapy’ Crawls Ahead
The dictionaries say that a maggot is either a legless grub or a whim. In this story it is both.
Even Dr. Ronald A. Sherman recognizes the whimsical side of his research into the medical uses of larvae propagated by the green blowfly, known to scientists as Phaenicia sericata.
Medicinal maggots?
“I laugh all the time when I’m talking to patients, doing their treatments,” said Sherman, a world authority in this curious corner of medicine. Humor, the UC Irvine researcher knows, can be the best antidote for the nervous tensions of nurses, patients and hospital visitors whose first reaction to maggots crawling under the dressing of a wound is “Yecch!”
But patients also accept what Sherman’s research is showing: Maggots are efficient, precise surgeons, devouring dead tissue from open wounds and wiping out bacteria by excreting a solution similar to ammonia.
Often, Sherman says, what he calls “maggot therapy” can prove an effective alternative to conventional antibiotic or surgical treatments for certain kinds of gangrenous infections.
A small but growing number of doctors apparently agree. Maggots are now being used in a handful of hospitals in the United States, and dozens in Great Britain, to treat bedsores, leg ulcers, diabetic foot wounds and stubborn post-surgical infections.
Doctors since the Napoleonic wars have found to their surprise that injured soldiers fared better when their battlefield wounds were overrun by the repulsive parasites. Maggot therapy was reportedly popular as late as the 1930s. But maggots fell out of favor after World War II with the rise of antibiotics and modern surgery.
Dr. Edward Pechter, a plastic surgeon on the faculty of the UCLA Medical Center, who published an article with Sherman on the history of maggot therapy in 1982, said he used maggots recently on a patient with a bedsore who was a poor risk for surgery.
“It’s not a generally accepted treatment,” Pechter said. But he added that the patient responded well. Sherman, he said, is “as far away from being a crackpot as you could be.”
In the last two years, Sherman has supplied maggots from his laboratory to 22 medical institutions or doctors and three scientific research teams in the United States. He now fills as many as four orders a week. In February, he won a $340,000 grant from the National Institutes of Health for a five-year study.
From 1990 to 1996, Sherman used maggots to treat about 200 patients at the Veterans Affairs Medical Center in Long Beach. One of them, Vitus Smieja, said he owes his legs to the maggot doctor.
The 76-year-old resident of Sun City in Riverside County was hospitalized in 1995 with leg ulcers, an infection common among older people with poor circulation. He said doctors counseled amputation after antibiotic treatment failed.
But Smieja signed up for a study of maggot therapy Sherman was conducting at the center. Steady application of maggot dressings wiped out the infections over several weeks. Every three days, Smieja recalled, the dressings were changed as newly hatched maggots replaced engorged ones.
None of that fazed a man who was facing life in a wheelchair.
“You couldn’t hardly see them,” Smieja said. “On the last of the three days you could feel them crawling. But it doesn’t hurt at all. After I got through with them, I never had more sores.”
Sherman cautions that the therapy he champions is neither a miracle cure nor a replacement for conventional treatments. But he is evidently a doctor of both medicine and spin.
“We normally think of insects and medicine together in a negative context, with insects considered as vectors [carrying disease] or pests,” Sherman said. “Maggot therapy offers a more positive light on the intersection of bugs and medicine.”
The centerpiece of his laboratory is an old Kelvinator refrigerator-turned-incubator. Inside are maggots crawling on rotting chicken and beef liver, their preferred food; four cages holding about 8,000 adult blowflies; jars of sawdust with burrowed pupae in the post-larval stage of the fly’s life cycle; and one fly swatter, to keep out aliens.
For Sherman’s flies are thoroughbreds. Sherman has maintained the colony continuously since catching a female green blowfly in Long Beach in 1990. (Green blowflies, Sherman said, have a proven medical record and are common on the West Coast.) Part of the adults’ diet is a protein supplement called Gainers Fuel 1000. Its bottle label advertises the powder as “designed for the serious bodybuilder or competitive athlete.”
Although bacteria naturally flock to a laboratory that cultivates rotting meat, Sherman takes pains to ensure that maggots bound for hospitals are clean. He washes the maggot eggs in a disinfectant solution of diluted bleach before they hatch and feeds them sterilized meat afterward.
Sherman himself is a vegetarian who confesses that he jumps at the sight of spiders.
Sherman, a 40-year-old Los Angeles native who was an entomologist before entering medical school, has become something of a maggot missionary. He plans to travel to Israel next April for a conference on “biotherapy,” a term coined for the growing medical uses of maggots and other creatures. Leeches, for instance, are increasingly used to help stimulate blood circulation in surgically reattached body parts.
British doctors have followed Sherman’s work closely. In the past year and a half, a laboratory in Wales has shipped maggots to 145 hospitals and clinics in the United Kingdom, according to Dr. John Church, an orthopedic surgeon who is a research associate at Oxford University. Many patients, he said, are enthusiastic converts to what the British more discreetly call “larval therapy.”
But Church acknowledged that the procedure faces certain public relations obstacles. “We call it the ‘yuck factor,’ ” Church said, “by which we mean that people regard this with some degree of apprehension, or indeed frank horror, when first introduced to the idea.”
