Author: Griffin-Smith Ben
Date: June 2007
"As far as this case is concerned I have now had time to think it over and I can strongly recommend a course of leeches." This quotation is taken from the British comedy series Blackadder, but those with an interest in medieval medicine are well aware that the use of maggots, leeches and other creepy-crawlers to cure just about anything goes back a long way. In fact such practices date as far back as ancient Egypt, where leeches were first used for blood-letting. For most of the time that it was used, there was little or no understanding of what the creatures actually did, and the treatments do seem to fit a more barbarous time than ours. Many of you may be surprised, therefore, to learn that such creatures are still being used today, and with a few new discoveries and clever innovations, are likely to find a new niche in modern treatment.
"leave them, they will clean it, wait and see", maggots cleaning Maximus' wound in the film Gladiator'
Maggot miracle?
Maggots have historically been used to clean open wounds both of infections and necrotic (dead) tissue. Modern medicine has many ways of achieving the same thing without the need for insect larvae, but new research suggests that they may have a new use.
Research led by Prof. Andrew Boulton at the University of Manchester, conducted a study early this year that tested the use of maggots (insect larvae) to treat diabetic patients with foot ulcers infected with methicillin resistant Staphylococcus aureus (MRSA). Infections of this superbug' have been spreading in hospitals due to an absence of effective antibiotics against the bacterium.
Boulton's team of researchers treated the infected ulcers with sterile larvae of the green bottle fly Lucilia Sericata, applied between 2 and 8 times. 12 of 13 patients studied were cleared of MRSA with no adverse side effects after being treated with green bottle fly maggots in pressure-relieving dressings. In a majority of cases, unlike some other treatments for the condition, there were no adverse side effects. The larvae are sterile, as they are specially farmed instead of taking them from a fly. They are also put in special pressure-relieving dressings before application, so that the larvae can work away without being crushed underfoot.
In the study, not only were most of the infections cleared, but in a majority of cases dead tissue was removed and there was an increased amount of healthy, growing flesh on the last removal of the bandage; the maggots are able to effectively heal the wound as clear it of infection. Boulton is certainly hopeful that the treatment will prove useful, half-joking that "Maggots are the world's smallest surgeons. In fact they are better than surgeons - they are much cheaper and work 24 hours a day." He hopes that the treatment will find a more general application in treating MRSA in infected wounds, proposing that "There is no reason this cannot be applied to many other areas of the body, except perhaps a large abdominal wound".
Maggots help healing by eating dead tissue Image Courtesy: BBC News
The use of maggots to treat wounds is in fact not as novel as you might expect. Boulton and his team came across the MRSA application because they have been treating (non-MRSA infected) foot ulcers of diabetic patients with maggots for ten years. The increasing incidence of MRSA in some of his patients led him to carry out a study to see if his treatment consistently worked in killing off the bacterium. In not abandoning the use of maggots to history books, he and his team may have found a novel way of tackling a serious medical issue.
Living with leeches
Maggots aren't the only seemingly outdated type of treatment that have been able to reassert itself in the present day. Leeches have been used in surgeries since the early 1980s, in reattaching severed extremities and in reconstructive surgery after treatment of breast cancers, to name two of the most common applications. Leeches naturally secrete anticoagulants as they suck your skin, keeping blood flowing and preventing clotting. However, leeches often carry harmful bacteria that can infect the wound. Antibiotics are often used after treatment with leeches, in treating infections caused by certain bacteria commonly found in the creatures. This problem was admirably tackled by researchers at the University of Wisconsin in 2001. They developed a synthetic leech,' a small glass instrument that could carry out the same job as live leeches, resolving not only problems of bacterial infection but also of patient squeamishness.
Leeches have also proven to be beneficial when treating osteoarthritis. In 2001, at team of researchers in Germany were able to use leeches to treat osteoarthritis, specifically in the knee. It was believed that the blood-suckers produce a natural anesthetic that was reducing the pain, whilst a small loss of blood from the area helped reduce swelling. A similar study at the Essen-Mitte Clinic, again in Germany, showed that a high proportion of osteoarthritis patients benefited and further studies by various other groups have shown that even when pain relief isn't as long-lived as the initial study suggested, patients often report less stiffness and improved mobility. The use of leeches in this way is now carried out in a few places, including the Beth Israel Medical Center in New York City, which adopted the treatment in 2005 after more research provided evidence for the existence of an anti-inflammatory effect.
A novel approach
Whether you find using maggots and leeches in therapy intriguing or nauseating, they certainly provide a unique and fruitful avenue of research. You only need to dip into modern science to see that nature still provides us with some of our greatest inspiration. Even if the direct use of maggots and leeches never catches on as it once did, the development of the synthetic leech shows that such treatments can be adapted and studied. Secrets are evidently yet to be gleaned even from some of our smallest, and least fashionable, neighbors on this planet.
References:
"Larval Therapy: A Novel Treatment in Eliminating Methicillin-Resistant Staphylococcus aureus From Diabetic Foot Ulcers." Diabetes Care, 30(2) (2007).
- Written By Ben-Griffin Smith.
- Reviewed By Nira Datta.